Yaounde — People living with HIV/AIDS in Cameroon, which has the highest prevalence of the disease in West and Central Africa, endure widespread stigma, with some facing difficulties obtaining bank loans or suffering mistreatment at hospitals, patients and observers say.

"Many HIV/AIDS carriers in Cameroon are victims of a common practice of discrimination in professional circles and in service institutions such as banks, insurance companies and in hospitals," said Isaac Bissala, the head of Cameroon Workers' Union.

"HIV is still considered a terminal disease despite the fact that many carriers in Cameroon are able to live normal lives today," Bissala told IRIN.

Around 600,000 Cameroonians are infected with HIV, the prevalence of which stands at 4.5 percent, according to UNAIDS statistics [ http://www.unaids.org/en/regionscountries/countries/cameroon/ ]. In 2007, the country made antiretroviral (ARV) treatment free, in part to fight a common belief that people with HIV were condemned to death, said David Kob of the National AIDS Control Committee.

Despite the government's efforts to make ARV treatment free, decentralize treatment centres and establish HIV/AIDS support programmes for patients, there are still widespread myths and discrimination associated with the disease, said Bissala. He noted that there are no laws protecting people living with HIV from discrimination.

The Cameroon labour code broadly forbids any form of discrimination at work, in education, businesses and in service provision.

"It is difficult to completely wipe out stigma and discrimination in Cameroon because much of the stigma and discrimination comes from the patients themselves, who don't step forward to report these cases to the authorities," said Kob.

Financial woes

Forty-seven-year-old Marshall Ngalle told IRIN that it has become increasingly difficult for him to get a loan from his bank since it started asking him for a medical report in 2010.

"Despite the fact that ARV treatment is very affordable in Cameroon, life is hard for me and many HIV/AIDS-infected people because it's difficult for an HIV carrier to acquire loans from a bank," said Ngalle.

In the absence of collateral, banks in Cameroon ask for life insurance before approving loans to individuals. Insurance companies request medical tests for diseases such as cancer and HIV/AIDS, explained Ngalle.

"I have been a customer of the bank for 15 years. They used to lend me more than three million francs [US$6,000], but since 2010, I cannot even get one million," he recounted.

However, Hugues Mbiakop, manager of a Yaoundé-based insurance company, said medical tests for the purposes of insurance coverage did not amount to discrimination. "This practice is not in any way a form of discrimination against a group of people, but is a general practice not only done in Cameroon... it is a measure that institutions take to protect their investments.

"Diseases like cancer and HIV are considered as terminal diseases, and no insurer is willing to insure a customer who will die in the very near future. There is no security system in the world for terminal diseases, and financial institutions are simply trying to follow procedures," Mbiakop said.

Bissala of the Cameroon Workers' Union said: "Common places where people diagnosed with HIV are defined as having a 'disability' are financial institutions and in some professions such as health and military [jobs]."

"That bad disease"

Discrimination against people living with HIV discourages them from seeking treatment and tests, said Odette Etamé, a rights defender with the No Limit for Women Project, a support group for women living with HIV/AIDS.

"HIV-positive women in Cameroon are the most discriminated against. In hospitals where these women are supposed to receive care and support, staff [mistreat] them," Etamé said.

She explained that they recorded cases of discrimination at a Yaoundé hospital where four pregnant and HIV-positive women were neglected during labour, with nurses coming to help only when the babies had been born to make sure they did not fall on the floor.

"Hospital staff make facial gestures to colleagues to indicate, 'Be careful with this one, she is carrying that bad disease'," Etamé said. "Many HIV-positive mothers end up not coming for post-pregnancy tests and the six weeks test that is recommended for babies born of HIV-positive patients."

A former teacher who gave her name only as Debora told IRIN she was dismissed from her job at a private college for revealing that she was HIV-positive.

"I was member of an infected people's support group, and from there I found the courage to speak out although this did not favour me in the long run. I felt that I had an opportunity to make others learn about AIDS and to stop the stigma and discrimination," she said.

"The school management fired me and told me that I did not like my job and that if I did, I would not have gone ahead and told others that I am a carrier," said Debora .

Another woman, Roseline Evina,* said that she was fired from her job as a hotel receptionist for disclosing to her employer that she was HIV-positive.

"I was forced by my boss to resign after I informed him of the reasons why I have become less friendly with hotel clients," said Evina. "I am HIV-positive and cannot risk the lives of others just because I want to please them during their stay in the hotel. I explained this to my boss." She said that her job required that she be open to sexual demands by clients.

"It is known that discrimination exist in the professional circles and mostly in the private sector. But the government has involved the private sector in the effort to support HIV patients in Cameroon," said Kob of the National AIDS Control Committee.

Strategies

In 2013, the government devised strategies to support ARV treatment. One involves partnering with the Association of Enterprises and Professional Syndicates in Cameroon (GICAM), a private sector group, to contribute to the national ARV treatment fund.

"We have planned to select delegates in each enterprise who will protect the plight of HIV-infected workers and sensitize the whole enterprise on its social responsibility on public health issues," said Nyam Ahola of GICAM.

"AIDS-related stigma is a big public health problem because it makes follow-up of patients and treatment difficult to manage, and patients might not show up for treatment or testing. When people are discriminated against in a particular place, they will not want to come back to that treatment centre," said Edwin Tchinda of the Chantal Biya International Reference Centre for HIVAIDS.

"Stigma leads to self-discrimination and trauma on carriers, and most people will die of stress- and trauma-related causes and not of HIV/AIDS," Tchinda said.

*Name changed