HIV and AIDS can play a role in exacerbating or even creating social exclusion for a range of different people. Although HIV has not traditionally been considered as a factor contributing to social exclusion, this report by the Terence Higgins Trust, argues that there is a need to address HIV as a social exclusion issue. The UK government and civil society should actively collaborate to ensure that people with HIV become fully included within society.
Social exclusion occurs when people suffer from a combination of problems such as unemployment, low income, high crime environments, poor health, a low-skill base and family breakdown. Social exclusion affects society as a whole due to higher social security costs and increased levels of crime.
HIV is a serious threat to public and individual health and the rate of infection is steadily increasing in the UK. Social exclusion contributes to the spread of HIV and increases ill health in people with HIV. Equally, HIV itself may lead to the social exclusion of vulnerable groups, by contributing to:
- Tensions within families. The majority of people with HIV in the UK have not told some of their family members due to the fear of being rejected.
- Isolation within schools. The stigma attached to HIV – even by association – may lead to the exclusion of school children due to the fear of bullying, threats and public prejudice.
- Alienation from local communities. Pressure from neighbourhoods may force an individual or family to move because of threats of violence.
- Restrictions on access to health care. Some medical professionals are unwilling to treat people with HIV and where treatment is available, people with HIV are often forced to wait longer to receive medical assistance.
- Discrimination within the workplace. People with HIV are often reluctant to reveal a HIV diagnosis to employers or colleagues due to the fear of discrimination.
- Obstacles to employment. People with HIV may be refused a job if they disclose their illness or may be accused of having concealed their illness if they failed to disclose it when asked a health-related question during a job interview.
The UK government should take steps to prevent the exclusion of vulnerable groups within society and reintegrate those who have been excluded from mainstream services. A joined-up approach is vital to ensure coordination and collaboration within government and the voluntary sector to break the cycle of HIV and AIDS. This can be achieved by:
- Promoting coordination among the relevant government departments that have a distinct role to play in the social inclusion of people with HIV, including the Departments of Health, Work & Pensions, Education & Skills and the Home Office.
- Establishing a cross-departmental coordinating mechanism to oversee legislative reforms and other changes that are needed to combat social exclusion caused by HIV.
- Learning from best practice in the Social Exclusion Unit of the Cabinet Office in areas such as rough sleeping and teenage pregnancy, which illustrates that cross-cutting governmental action is essential for long-term change.
- Guaranteeing genuine collaboration within the HIV voluntary sector to ensure the best use of limited funding and to avoid the duplication of activities and rivalry among organisations.
- Providing adequate funding for a national public information campaign to reduce stigma and prejudice about HIV, which should involve people with HIV and those who support them.