A/HRC/21/42 physical violence, among many others, but fundamentally all these manifestations relate back to the process of devaluing and dehumanizing individuals in certain groups and creating an ―us and them‖ divide. Different people experience stigma in different ways, and the extent to which certain manifestations apply differs. The examples mentioned are for illustrative purposes only. They are not meant to imply that particular groups experience stigma exclusively in one way or another, or that other manifestations would relate only to other groups. A. Rendering people and their needs invisible 24. Stigma has a perverse effect of silencing. It creates taboos and results in issues not being addressed. Stigma renders some people and their needs invisible in society. For instance, denying the practice of ―untouchability‖ and the resulting silence that surrounds it is part of the stigma. Similarly, millions of people suffer from neglected tropical diseases,8 particularly the poorest in isolated rural areas. For the most part they are invisible in public health planning, research and treatment. Several of these diseases are linked to poor water and sanitation conditions, and have traditionally been a source of stigma and isolation. The fact that stigma is often internalized further contributes to the silencing effect by preventing people from bringing up certain issues due to their acceptance of the stigma. This silence results in denial that human rights violations exist—they are not seen, thought about or addressed. 25. The silence and stigma surrounding menstruation makes finding solutions for menstrual hygiene management a low priority. Menstruating women and girls often lack a private place to change or wash the rags used. Menstruation has many negative cultural attitudes associated with it, including the idea that menstruating women and girls are ―contaminated‖, ―dirty‖, ―impure‖ or ―polluted‖. These manifest in practices such as the seclusion of women and girls, reduced mobility, dietary restrictions, and/or women and girls being required to use different water sources or prohibited from preparing food for others during menstruation—practices that are often deeply rooted in sociocultural and patriarchal interpretations of religious prescriptions. Even where such restrictions are not followed, women and girls may continue to harbour internalized stigma and are embarrassed to discuss menstruation. The lack of privacy for cleaning and washing, the fear of staining and smelling, and the lack of hygiene in school toilets are major reasons for being absent from school during menstruation, and have a negative impact on girls‘ right to education.9 26. The invisibility created by stigma also has negative impacts on the situation of some persons with disabilities. The World Health Organization estimates that over 1 billion people worldwide live with some kind of physical, mental, intellectual or sensory impairment. 10 However, due to the silence and shame created by stigma, persons with disabilities and their needs are often rendered invisible, making it impossible for them to enjoy a range of human rights, as most practices, services and facilities are biased against them. In some societies, persons with disabilities are perceived as ―problems to be fixed‖ or as a ―burden‖. According to information received by the Special Rapporteur, in extreme cases, children and adults with mental disabilities have literally been tied up inside the home—with no access to sanitation—to hide them from the community. 8 9 10 See WHO, Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases: A Road Map for Implementation (Geneva, 2012). See United Nations Children‘s Fund (UNICEF), Equity in School Water and Sanitation: Overcoming Exclusion and Discrimination in South Asia – A Regional Perspective. WHO, World Report on Disability (Geneva, 2011), p. 29. 7