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Negative attitudes resulting in stigma and discrimination have been connected with HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) since the illness was first recognized in the early 1980s. While many groups are adversely affected by stigma and discrimination, few are affected to the magnitude of those who are HIV positive. Negative attitudes associated with the disease can be a death sentence for a person who is HIV positive, since the stigma and discrimination associated with HIV results in many individuals not seeking the medical treatment needed to prevent the illness from being life threatening. In fact, attitudes toward individuals who have been marginalized, such as individuals who are HIV positive, can be far more damaging than the illness or disability itself.

In 2008, the World Health Organization launched an assault on stigma and discrimination related to mental health problems in an effort to protect human rights and ensure equality and full participation in society. It recognized the necessity of working with other groups that face discrimination, such as those living in poverty and those from ethnic minority backgrounds, because it believed that allowing the devaluation of any group of individuals is unacceptable. It hoped to promote the innate value and worth of every individual regardless of disability, sexual preference, ethnicity, or any other negative label attributed by society. Accordingly, this entry also touches on mental illness, physical disabilities, and other characteristics that result in discrimination.

HIV as a Disability

According to the Americans with Disability Act (ADA) of 1990 and reaffirmed by the ADA Amendments Act of 2008, if an individual has a physical or mental impairment substantially limiting one or more major activities, he or she is considered to have a disability. Also, an individual who has a record of such impairment or whom others believe to have such impairment can be protected by the ADA. In 1998, in Abbott v. Bragdon, the U.S. Supreme Court ruled that people who are HIV positive have physical impairments that qualify them as individuals with disabilities who are protected by the ADA. This was upheld again in 2005 when John Couture, an individual who was HIV positive, alleged that he was wrongfully terminated from his job at Bonfils Memorial Blood Center in Colorado.

However, not everyone views HIV as a disability, especially in its asymptomatic stage. Jesse Helms, a senator from North Carolina, fought to ensure that individuals who were transsexuals or transvestites or who had gender identity issues or any sexual behavior disorders were not protected by the ADA—never mind that psychologists and counselors do consider these “conditions” to be potential mental health disorders. While some individuals applauded this and hoped that it would ensure that people who were gay and HIV would be protected, others viewed it as a way of limiting the ADA to individuals who were deemed “worthy.”

World Health Organization and International Classification of Functioning Definitions of Disability

Discrimination against individuals with disabilities dates back as far as the ancient Romans, where children born with a visible disability were taken out into the countryside by their fathers to die. According to the World Health Organization, disability is a human rights issue, with policy shifting from one of segregation to one of participation and inclusion. Disability is a complex concept that involves the interaction between the person and environment—people are disabled by the environment rather than their physical impairment. This is clearly applicable to individuals who are HIV positive. Current medical treatment helps mitigate much of the negative impact of the disease on one's health, yet the stigma and discrimination that the public bestows on someone with the illness limits him or her in many ways. The International Classification of Functioning adopted a “bio-psycho-social model” of disability that considers the interaction between health condition and the environment. It recognizes personal factors, but it is the interaction between attitudinal and environmental factors and the individual himself or herself that “handicaps” an individual, resulting in activity limitations and participation restrictions. While there are some physical and environmental barriers related to HIV, attitudinal barriers are by far the most debilitating.

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