Examples of Stigma and Discrimination
http://www.aidslaw.ca/
Employment
The workplace remains a potentially unsafe
environment for people with HIV/AIDS, whether they are currently at
work, returning to work, or looking for work for the first time. People
with HIV/AIDS in the workplace:
- have experienced breaches of confidentiality
regarding their HIV status;
- have often not had their needs accommodated with
respect to the duties they are able to perform, the schedule and side
effects of their drug regimen, the time required for medical
appointments, and the need for leave for temporary illnesses;
- have experienced cuts to their benefits or have
been laid off because of the cost to the employer of disability
insurance or drug insurance premiums;
- have sometimes not claimed their benefits – or
may not take antiretroviral therapy at all – for fear of disclosure,
harassment, and being fired; and
- have sometimes found themselves in an
environment in which they have been harassed, avoided, or ostracized.
While the new antiretroviral drug regimes have brought better health for
some, and the possibility of returning to work, they have also brought
new workplace hazards. People taking these drugs must adhere to strictly
regimented dosage schedules and they often suffer side effects. This can
lead to de facto disclosure of HIV status. In addition, employers or
co-workers may not accommodate the needs associated with these regimes.
As one person reported:
A person living with
HIV/AIDS was told to remove the pills from his desk – something he did
in order to remind himself to take them – because they made other
employees uncomfortable; a minor example, yet still telling: why were
the other employees not educated?
Health Care
In the first decade of the epidemic, there were flagrant and explicit
examples of discrimination against people with HIV/AIDS in health-care
settings. These included refusing to provide care, avoiding or
neglecting patients, and making prejudicial remarks. Such incidents have
decreased, but there are still many examples of inappropriate treatment:
- Some health-care workers continue to refuse to
treat people with HIV/AIDS.
- People with HIV/AIDS are sometimes refused
medical procedures not related to HIV/AIDS, such as cardiac care.
- Primary-care physicians often do not offer HIV
testing or fail to diagnose HIV-related symptoms among people who are
not readily identified with a “risk group”.
- In contrast to hospitals that specialize in
HIV/AIDS care (which appear, for the most part, to provide services in
a way that is knowledgeable, supportive, and non-discriminatory),
there are many difficulties in hospitals that see fewer HIV patients.
- Breaches of confidentiality remain frequent.
- Some physicians refuse to prescribe combination
therapies for certain groups of people – such as drug users and the
homeless – because they assume these people will not be able to
maintain the drug regimen.
Insurance
People with HIV/AIDS depend on public or private insurance for health
care, drugs, and income support. Thanks to Canada’s universal public
health-care insurance, coverage for physicians’ services and hospital
care is not among the larger problems that people with HIV/AIDS must
deal with. But income support and drug coverage is another matter.
Definition of disability
The definition used to determine eligibility for benefits under public
and private insurance plans has historically been based on a pattern of
long-term, permanent disability. Such definitions are not appropriate to
the cyclical and episodic nature of HIV disease. People with HIV may
experience periods of relatively good health that are interrupted by
periods of severe illness. Although combinations of drugs including
protease inhibitors have dramatically improved the health status of many
people with HIV, they have made problems of definition of disability
even more acute. There is an increasing trend toward out-and-out denial
for short- and long-term benefits: insurers fail to acknowledge that
some people cannot take protease inhibitors, that treatment is often
accompanied by debilitating side effects, that improved health status is
not immediate, and that indicators other than physical functioning must
be taken into account.
Exclusion criteria in private income insurance plans
Exclusion criteria affect people with HIV/AIDS in a number of ways.
They may not qualify for income insurance on account of a pre-existing
condition of HIV disease. If a person does qualify for coverage (or
qualified in the past before acquiring HIV), they may be forced to
remain with their present employer (even if they would prefer to change
employment), since it is unlikely that they will qualify for coverage
with a new employer. If they are receiving disability benefits but wish
to return to work, they may be discouraged from doing so if the terms of
their coverage limits their entitlement to further benefits should their
health deteriorate again.
Public income support programs
To obtain income in periods of short- or long-term disability, people
with HIV/AIDS turn to Employment Insurance, disability benefits under
the Canada Pension Plan, and, as a last resort, social assistance in the
form of welfare and family benefits. These programs present a variety of
problems for people with HIV/AIDS, largely because they are not designed
for people with cyclical or episodic illness.
Drug insurance
People with HIV/AIDS experience multiple problems in obtaining coverage
or benefits for HIV/AIDS drugs through their employment. For example:
(1) Insurers offer plans and employers adopt plans that limit claims to
a set amount, for example $2000 a year. This barely covers one month’s
worth of drugs for a person with HIV/AIDS; (2) While some provinces have
instituted catastrophic drug coverage for individuals who are employed
but cannot afford their medications, people are still required to pay
for the drugs initially, and must then apply to be reimbursed. (3)
People making claims for drug benefits through their employer have
suffered breaches of confidentiality and subsequent harassment or
dismissal.
Other Areas of Discrimination
These are not the only areas where discrimination
occurs. Other areas include housing, travel and immigration, family and
community, and community-based services (consult HIV/AIDS and
Discrimination: A Discussion Paper for examples).
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