Since the beginning of the AIDS epidemic, people living with HIV have suffered not only the direct effects of the illness but also the added burden of stigma and discrimination.

Men and women around the world have lost their jobs, their homes and the support of their friends and families as a result of others learning they are HIVpositive. Many have been verbally and physically attacked, and a few have even lost their lives.

As a newly published study from the Pan American Health Organization (PAHO) reveals, people with HIV have also faced discrimination in the health sector from those who have the social responsibility to take care of them and ensure their well-being.

Such discrimination can take many forms. It can range from violations of confidentiality to verbal assaults and other forms of mistreatment. A patient in Bolivia learned that he had contracted the virus when a doctor shouted at him in the waiting room: "You've got AIDS. Now you're going to die." In some cases, health workers have revealed the results of an HIV test to others without the patient's permission, an unacceptable practice.

In other instances, people with HIV have faced delays in or withholding of treatment. Reports from several countries in the Americas and elsewhere have confirmed that people with HIV have often been refused counseling or denied even inexpensive treatment for opportunistic infections. One health worker was quoted as saying there was no point in offering treatment because the patient was "going to die soon."

Acts of discrimination, whether overt or subtle, can have a significant physiological or psychological effect on those at whom they are directed. Over the 20 years since the disease was first identified, the actions—or inaction—of health workers have seriously affected the lives of hundreds of thousands, and perhaps millions, of people across the globe.

There are many reasons why some health service workers react so negatively toward people with HIV. They may hold negative attitudes based on what they know or assume to be the client's sexual or drug-taking behavior. They may be poorly trained. They may be under severe stress from working in an environment with inadequate resources, where the most appropriate treatment is not available.

HIV/AIDS-related stigma feeds off and adds to other kinds of stigma. Women with the virus are often assumed to be "promiscuous." Gay men and transgender individuals are particularly affected. One man in Chile who began treatment when married and a father of two found that health workers' attitudes toward him deteriorated significantly when he became openly homosexual.

But to effectively combat discrimination, we need more and better information about it. There have been some studies of discrimination in the health services, but overall, research in this area is limited. We know that many people with HIV/AIDS have negative experiences in health care settings, but we do not know if they are the minority or the majority. We don't know what proportion of health workers hold discriminatory attitudes or how often such attitudes translate into discriminatory behavior. There are reports that discrimination is decreasing, but we do not have the evidence to confirm this. In other words, we know there is a problem, but we do not know how big it is or where it is most acute. For public health, these are key questions that must be addressed in formulating an effective response.

As a first step, we must restate our respect for the dignity and human rights of all individuals. We must ensure that all health workers have the appropriate knowledge and skills to deal with people with this disease. We must restate and adhere to the appropriate ethical guidelines—and modify those guidelines where circumstances demand it.

It is important to address the needs not only of people with HIV/AIDS but also of our fellow health workers, in particular those who face the daily stress of dealing with patients who are severely ill and who may die in the prime of their lives. We should establish partnerships with organizations of health workers and people with HIV/AIDS. We can offer training, and we can identify systematic weaknesses in clinics, hospitals and other medical settings that allow discrimination to occur.

Those of us working in the health sector, whatever our role, have a particular duty to support people suffering from any disease, especially one as traumatizing as HIV/AIDS. We cannot allow stigma and discrimination to prevent us from fulfilling this duty. If we can overcome HIV/AIDS-related discrimination in the health services, all of us—patients and health workers alike—will be changed for the better.

Carol Vlassoff is chief of the Pan American Health Organization's HIV/AIDS unit. Click here to read the PAHO report Understanding and Responding to HIV/AIDS-related Stigma and Discrimination in the Health Sector.

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