A/HRC/21/42 27. Some older persons might also face stigma, in particular when suffering dementia or other mental illnesses and requiring care, including for their sanitation and hygiene needs. Incontinence is not uncommon, but usually not openly addressed. Again, stigma can contribute to making the particular needs of older persons invisible, preventing the care they require and isolating them. 28. The silencing effect of stigma is pronounced in relation to prisoners, who are often forgotten and neglected. Prison conditions, including concerning water and sanitation, are notoriously substandard in many parts of the world. The Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment has noted that in many countries ―authorities simply do not regard it as their responsibility to provide detainees with the most basic services necessary for survival, let alone for a dignified existence or ... an ‗adequate standard of living‘ ‖ (A/64/215 and Corr.1, para. 43). In one country he found that ―it is the task of [the detainees‘] families to bring them water in plastic bottles and food in plastic bags. Since there are no toilets, they must use the same bottles to urinate and the plastic bags to defecate‖ (ibid.). In another country he was confronted with ―detainees [using] the water in the toilets for drinking‖ (ibid., para. 44). There is often a perception that prisoners ―deserve‖ inadequate services and that scarce resources should not be used to improve prison conditions. The stigmatization of prisoners results in low priority given to their needs and a failure to meet basic human rights standards. B. Pushing people to the margins of society 29. Stigma is also manifest in the rejection, avoidance and marginalization of certain groups, quite literally pushing people to the margins of society. Racist and similar attitudes demean, degrade and dehumanize groups of people because of their racial, ethnic, religious, linguistic or caste identity. Many racial and ethnic groups or castes experience stigma, including indigenous peoples, pastoralists, (semi-)nomadic tribes such as the Bedouins, persons with albinism, Roma in Europe and Dalits in South Asia. They may suffer from pervasive negative stereotyping, social exclusion and denial of fundamental human rights. In some instances, people are forced to live at the outskirts of cities and villages, sometimes being relocated to more remote areas, subjected to an ―out of sight, out of mind‖ attitude. 30. In some situations, indigenous peoples may be stigmatized as ―primitive‖ and pursuing an ―uncivilized‖ lifestyle. In her missions to Costa Rica and to the United States of America, the Special Rapporteur observed that indigenous communities are disproportionately excluded from access to water and sanitation. 11 Similarly, pastoralist communities and (semi-)nomadic tribes are often neglected in terms of access to services.12 State policies may seek to ―civilize‖ indigenous, pastoralist or nomadic communities, pushing them to live on reserves or in urban slums, with substandard water and sanitation services even in these areas, highlighting how attitudes, stigmatization and public policies mutually reinforce each other to the detriment of these communities. 31. The situation is similar for many ethnic groups across the globe. Access to water and sanitation for Roma is notoriously precarious. It is not uncommon for Roma communities, including those living in countries where non-Roma communities have universal access to water and sanitation, to lack even rudimentary access, as found by the Special Rapporteur 11 12 8 Reports of the Special Rapporteur on her missions to Costa Rica (A/HRC/12/24/Add.1 and Corr.1), para. 48, and to the United States (A/HRC/18/33/Add.4), paras. 61-69. See, for example, Sharmila Murthy and Mark Williams, ―The complicated nature of stigma: realizing the human rights to water and sanitation for Bedouins in the Negev, Israel‖, submission to the Special Rapporteur.