A/HRC/44/46/Add.2 information through accessible channels and language, thus effectively changing mindsets with regard to Hansen’s disease. 41. During one of the Special Rapporteur’s meetings in Rio de Janeiro with national civil society organizations and international NGOs, some of the key issues to emerge were the social invisibility of, and institutional gaps on, the sexual and reproductive rights and the right to the highest attainable standard of mental health of persons affected by Hansen’s disease. 42. In the course of her visit, at several meetings, persons affected by Hansen’s disease, their family members, scholars, health workers and members of civil society organizations and NGOs reported discrimination against persons affected by Hansen’s disease and their family members. This included discrimination and violence within their families, including gender-based violence, job losses and impediments to work, and barriers to rehabilitation. Moreover, anticipated stigma seems to act as a barrier for the full participation of persons affected by Hansen’s disease in community life and society at large, leading to selfisolation, loss of self-esteem and deterioration of mental health. As the Special Rapporteur indicated in a previous report (A/HRC/41/47), the internalization of stigma is an extreme form of dehumanization. Self-care groups promoted by health services and NGOs were reported as an effective measure for overcoming trauma, as was participation in public affairs through membership of social movements. 43. The intersection of Hansen’s disease with poverty also hinders access to justice as a critical means of combating discrimination, as was pointed out to the Special Rapporteur in her meetings with the federal and state public defenders. She wholeheartedly welcomed the Federal Public Defender’s engagement on the issues discussed during the meeting. While acknowledging the structural invisibility of persons affected by Hansen’s disease, the Federal Public Defender committed his office to supporting this marginalized and vulnerable group in the enforcement of their rights. One of his commitments – to launch an educational campaign on the rights of persons affected by Hansen’s disease and their family members – has already been fulfilled. The Special Rapporteur also welcomes the commitment made by the public defenders she met at the state level and hopes that this will help lift the veil of invisibility surrounding Hansen’s disease and enable the individual and collective protection of persons affected by Hansen’s disease and their family members.23 44. The core problem of both institutionalized and interpersonal discrimination seems to be that formal equality, mentioned above as de jure equality, which is ensured by the Brazilian legal system, is not sufficient to ensure de facto equality of a group that has historically been discriminated against in what the Committee on Economic, Social and Cultural Rights referred to as systemic discrimination, given its entrenchment in social behaviour and organization.24 45. Notably, discrimination against persons affected by Hansen’s disease in Brazil is a clear example of what the Committee on Economic, Social and Cultural Rights points out about substantive discrimination in its general comment No. 20. Moreover, as detailed by the Special Rapporteur on extreme poverty and human rights (A/72/502), equality of opportunity does not ensure anything like equal outcomes, since available opportunities will often be effectively inaccessible to those living in poverty. Hence, in order to understand discrimination on the grounds of Hansen’s disease in Brazil and to tackle it, it is critical to take into consideration the observation of the Committee on the Elimination of Racial Discrimination in its general recommendation No. 32, that to treat in an equal manner persons or groups whose situations are objectively different will constitute discrimination in effect. Discrimination rooted in a history of systemic violations requires application of what the Committee on the Rights of Persons with Disabilities refers to in its general comment No. 6 (2018) on equality and non-discrimination as a substantive model of equality based on a redistributive dimension, aimed at simultaneously addressing socioeconomic disadvantages and fighting stigmatization. 23 24 10 Committee on the Elimination of Discrimination against Women, general recommendation No. 33 (2015) on women’s access to justice, para. 32. See Committee on Economic, Social and Cultural Rights, general comment No. 20.