2.2 Stigma and discrimination

Measures to reduce MTCT of HIV, especially the administration of antiretroviral drugs and avoidance of breastfeeding, make it virtually impossible for HIV-positive women to keep their infection a secret from their families and people in the wider community. It is therefore essential to the safety and acceptability of MTCT interventions that effective steps be taken to combat rejection of people with HIV/AIDS. Where women fear discrimination, violence, and perhaps even murder if they are identified as HIV-infected, they will be reluctant or completely unable to take advantage of opportunities offered to protect their infants from infection. Special attention should be paid, in particular, to developing positive and non-judgemental attitudes towards HIV/AIDS in health staff so that they can serve their clients with empathy. In places where stigmatization of HIV-infected people is a serious problem, it would be advisable to introduce the antiretroviral strategy for reducing MTCT in a pilot programme initially, so that the risks can be carefully monitored and ways of dealing with stigma and discrimination tested.

It is still common for women to be blamed for spreading STDs, including HIV, despite the fact that very often they are infected by the husband or partner to whom they are entirely faithful. To challenge this pervasive prejudice, as well as to encourage joint responsibility for childbearing and related decisions, it is a good idea to offer counselling and testing to pregnant women’s partners also, where this is feasible and desired.