1 March is Zero Discrimination Day, a day to celebrate diversity and strengthen our resolve for inclusive societies free from discrimination and inequality. The impact of stigma and discrimination has been catastrophic in the fight against HIV/AIDS. When discrimination occurs in healthcare facilities or at the hands of healthcare workers, the provision of quality care is compromised. The experience in consequence undermines access to sustained care, adherence to HIV treatment, and the adoption of HIV-preventative behaviours for those most vulnerable to HIV.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has stated that "over thirty years into the [HIV] epidemic, stigma remains high ... and access to justice in the context of HIV is very low." In order to combat stigma and discrimination in healthcare facilities, research indicates that interventions need to focus on individual, environmental and policy levels. A lack of clear policies and guidance relating to HIV-positive patients and other vulnerable groups reinforces discriminatory behaviours amongst healthcare workers. To be effective, such policies need to be routinely monitored and implemented. Access to justice and redress for patients who experience discrimination in healthcare is therefore an important component of reducing stigma and discrimination and in the fight against HIV and AIDS.
In an effort to advance access to justice for persons experiencing discrimination in healthcare, the Southern Africa Litigation Centre (SALC) is currently undertaking research on "Strengthening Redress and Accountability for Discrimination in Healthcare in Botswana, Malawi and Zambia." Working with partners in the three countries, the research seeks to understand the experiences of select key populations and vulnerable groups of discrimination in healthcare and their related experiences and needs in referring complaints of that conduct through both formal and informal complaints mechanisms. The study focuses on sex workers, women living with HIV, LGBT persons, men who have sex with men, and persons living with disabilities and will include focus group discussions and key informant interviews with persons and organisations based in both rural and urban contexts.
Initial indications are that accessing healthcare freely and safely and in full respect of patients' human dignity remains constrained for these persons in Botswana, Malawi and Zambia. The ability to pursue appropriate recourse when denied care, mistreated, given inadequate care or neglected, for example, is similarly inadequate and subject to systems that generally lack transparency and independence, or are inaccessible for a variety of reasons.
As we celebrate diversity and inclusion today, SALC acknowledges the importance of ensuring healthcare institutions, systems and professionals remain accountable to legal and ethical standards of care that demand quality treatment without discrimination. We are hopeful that the research, anticipated to be published in mid-2016, will advance and inform strategies to ensure that the highest attainable standard of health is achievable for all.
 Nyblade L et al "Combatting HIV stigma in health care settings: What works?" J Int AIDS Soc, 2009; 12:15.