A/HRC/21/42 social and economic situation when living in poverty or being homeless may result in pervasive discrimination, stigmatization and negative stereotyping, which can lead to unequal access to services.18 People living in poverty face a range of barriers in accessing water and sanitation services, including a perception that they are to be blamed for their poverty and do not deserve adequate services. Homeless people and street children are frequently blamed for their homelessness, and labelled as ―mentally deficient‖, ―criminals‖ or ―addicts‖. Children living in dilapidated surroundings—without a social safety net, and without access to safe water and sanitation—may see those surroundings as a reflection of their own self-worth,19 hence growing up with low self-esteem and embarrassment. Slums and informal settlements are often not taken into account in urban planning. People living in slums are often simply absent from official records and urban plans; there is a perception that ―they do not count‖, once again highlighting the dehumanizing nature of stigma. C. Excluding people from facilities 36. Stigma often manifests itself in exclusion from social gatherings or everyday activities. Many people affected by stigma also experience the impact of stigma in their access to shared or common water and sanitation facilities. Reportedly, Dalits have been unable to collect water from shared wells or have been fined for drinking from a common water tap, and Dalit women have reportedly had to wait in a separate queue until non-Dalits have fetched water. Large-scale violence and physical attacks by members of the dominant caste have been reported where Dalits attempted to access facilities in areas inhabited by the dominant caste.20 Similarly, people living with HIV/AIDS have sometimes been locked out of communal latrines or water taps by their neighbours.21 37. Excluding people from water and sanitation facilities creates a vicious circle of further entrenching stigmatization. For instance, not providing homeless persons with the opportunity to use public facilities forces them to resort to urinating and defecating in public, without being afforded any privacy. In being so exposed, people are stigmatized even further. Ostracism within one’s own family D. 38. Stigmatization is not limited to the public sphere. For instance, many people living with HIV/AIDS face stigmatization within their families. Similarly, women with obstetric fistula are often stigmatized, due to the leaking of urine and sometimes faeces, resulting in a constant wetness and foul odour. The stigma associated with fistula demonstrates how closely the external and internalized dimensions of stigma are intertwined. Women suffering from fistula are often deserted by their family and friends while also feeling ashamed and disgraced; they often ―eat alone, sleep alone, and pray alone‖. 22 Lack of access to water and sanitation worsens the situation and reinforces the stigma against such women, who need to wash and bathe more frequently. 18 19 20 21 22 10 General comment No. 20, para. 35. Preliminary study of the Human Rights Council Advisory Committee on the promotion of human rights of the urban poor: strategies and best practices (A/HRC/AC/8/5), para. 9. See National Campaign on Dalit Human Rights, ―Stigmatization of Dalits in access to water and sanitation in India‖, submission to the Special Rapporteur. WaterAid Ethiopia and Progynist, ―Making the links: mapping the relationships between water, hygiene and sanitation and HIV/AIDS‖ (2004), p. 5. Maggie Bangser, ―Obstetric fistula and Stigma‖, The Lancet, vol. 367, No. 9509 (2006), p. 535.