The Sunday Mail
Forward Nyanyiwa
Bill Clinton once said: “We live in a completely inter-dependent world, which simply means we cannot escape each other. How we respond to Aids depends, in part, on whether we understand this inter-dependence. It is not someone else’s problem. This is everybody’s problem.”
To stigmatise or not is the question. The heart-wrenching story of a male practitioner in the health fraternity makes sad reading. “They could hardly hear my footsteps because of their conversation. I was not interested in their discussion until I heard the mention of my name. I froze in my step, and still, they kept talking.
“Their discussion, which mainly bordered on my ill-health, was pregnant with mockery and had it not been that my lower extremities are malfunctioning, I would have caused a scene, but a forced croaked cough alerted them of my presence, sending them scurrying into hiding in cubicles at our work- place,” narrates one Tarwirei Chigayi (not his real name).
Chigayi is a qualified male nurse in Chitungwiza and has been on anti-retroviral treatment since the turn of the millennium. He, however, admits that he has been working under difficult conditions as his colleagues – fellow nurses, have subjected him to stigma and discrimination. Colleagues are unwilling to understand his predicament. “Sometimes it is so palpable that as I walk around the clinic doing my work, I feel that the talk is about me and I have now resorted to secluding myself in the dispensary where I do minimal errands,” he said as he frantically tries to hold back his tears.
He said he started to feel sick years ago, but could not go on treatment because of the fear of going public about it. “It is when I developed recurrent tuberculosis that whispers started to do rounds that I was HIV-positive.
“I finished the TB treatment course, but those whispers affected me so badly that I lost considerable weight. At one time, a patient I was helping asked me if I was also on ART, but I became evasive. Little did I know that my colleagues were picking my name as an example behind my back,” said Chigayi.
He also feels he did little to help his cause as he sometimes defaulted, giving himself false security that he was negative. “I could skip my drugs and it somehow gave me a sense of hope that I will wake up one day negative and that was not good at all. Some might feel that I stigmatised myself, but the truth is I never got support,” he went on.
But it is the negative attitude he is getting from those in the profession which he believes should understand better.
“Inasmuch as I am entitled to my privacy, I feel my ill-health has become an open public secret and I need support than mongering. As professionals we must support each other.
“I am in the know of some who are HIV-positive, but they go to the rural centres to collect their drugs. It is bad for the profession,” he added.
This story is not in isolation as there are many stories of this nature happening on a daily basis. Early this week, our sister paper The Herald which attracted a lot of interest from different HIV and Aids activists.
A nurse is alleged to have falsified information to her employer that she was not suffering from any “serious illness” when she was recruited for the job.
It is further alleged that she later suffered a stroke in 2012, which culminated in her employer ordering an investigation which revealed that she had omitted relevant information about her health. Questions, however, have arisen whether the nurse got a raw deal as she was exercising her right to privacy in line with Section 57(e) of the Constitution and also whether her rights to dignity and protection against inhuman and degrading treatment where trampled upon.
Prominent Harare lawyer Mr Jonathan Samkange said the Constitution protects both parties and if it was part of the contract for the nurse to reveal such information, she should have done that.
“The law does protect the employer and employee. If the contract required the nurse to divulge such information, then she must have done that. There was no point of her falsifying such information and by doing so, the employer is right to charge her for omitting relevant information,” he said.
Mr Samkange went on to say had it been that she was denied employment for revealing her HIV-positive status, then it would be a different issue.
“If the employer was going to deny her employment because of her HIV-positive status then she was free to approach the courts, citing stigma and discrimination. Then she would be today saying my disclosure cost me my job,” said Mr Samkange.
Dean of Law at Zimbabwe Ezekiel Guti University, labour lawyer and international legal author, Advocate Caleb Mucheche, said the nurse erred by not supplying the required information and that the employer was correct in laying the charges. “The employee was charged under the Collective Bargaining Agreement Code of Conduct which makes it a misconduct for an employee to falsify information to the employer.
“The employment relationship is voluntary in nature and an employee is free to take or leave the terms upon which the employer wants to employ him or her. In this case, if the employee did not want to reveal her HIV status, she was at liberty to forego the job offer,” said Advocate Mucheche.
He went on to say there was no violation of privacy nor was there any rights trampled upon. “The right to privacy in terms of Section 57(e) of the Constitution of Zimbabwe is not absolute but subject to limitations imposed by Section 86 of the same Constitution. Individual rights and liberties must be balanced with other people’s rights as well. Director of Aids and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi said that the Government policy does not require one to state his or her HIV status, but on this case, it looks like it is a labour issue.
“Our policy as a ministry is that no one is forced to reveal his or her HIV status, and there is no Statutory Instrument mandating that. Everyone is entitled to privacy but for this case, it looks like more of a labour case than anything else and it might need the Public Service to address, but unfortunately the said hospital is a private institution,” said Dr Mugurungi.
HIV and Aids commentator Dr Justin Dambaza said while it can be debatable to classify HIV as a “serious illness”, the issue here is not about stigma or discrimination, it is a labour issue.
“It is a tricky case in the sense that the employer is accusing the employee of not revealing her HIV status, thus it ceases to be a stigma issue. The challenge now is whether we can classify HIV under what is called serious illness.
“Remember HIV is not Aids and how can we say it can fall under the serious illness category. From my understanding, the issue of stigma could have come up if she could have missed the opportunity to get employment because of her HIV status,” said Dr Dambaza.
He, however, said the current medical examination form has got a column to fill one’s HIV status.
“The previous forms used back then were ‘silent’ on the HIV issue, but the current one has a column where you have to fill your status,” he said.
However, Advocate Mucheche said the issue of classifying HIV as a “serious illness” depends on the merits of a given case.
“According to the applicable employment code binding both the employer and employee, HIV is also classified as a serious illness. Each case must depend on its own facts and merits,” he added.
Stigma and discrimination has been one of the major stumbling blocks in the fight against HIV/Aids and the fact that it is now rampant within the health profession, the supposed preachers against it, has become disturbing.
That HIV is associated with high sexual activity and promiscuity is not helping matters as many people shun opening up in fear of being labelled “loose”. This is fuelling stigma and discrimination to alarming levels.
Dr Mugurungi said they haven’t actually assessed the levels and impact of stigma among the health professionals since such exercises require resources, but they train health workers on the need to support each other.
“Every time we carry out trainings on different new programmes and guidelines, we do train them to cope with issues like burn-out, psychological support and the need to fight stigma within the profession,” said Dr Mugurungi.
He said society needed to change its attitude first. “Nurses and doctors, by virtue of the nature of their work, are viewed as some other people by the society. That creates a problem when they are infected, they won’t open up, so the society must first accept that nurses are also humans,” he said.
