It’s been 30 years since HIV was identified as the cause of AIDS, and since then we’ve made significant progress in fighting the epidemic.
The massive rollout of antiretroviral drugs worldwide has dramatically reduced AIDS-related deaths and prolonged the lives of millions of people. Innovative biomedical interventions — such as microbicides, male circumcision, universal testing and ARV prophylaxis for preventing transmission from mother to child — have greatly expanded our collective prevention toolbox. Great strides have also been made in understanding how to deliver services and motivate uptake and adherence, from home-based HIV testing to education entertainment programs like Soul City. And perhaps most importantly, the tremendous advocacy efforts of people living with HIV in countries like South Africa and the United States have ensured widespread access to affordable, lifesaving treatment.
Although we have a lot to celebrate, we must remember that we’re not even close to ending this epidemic.
This week, the 20th International AIDS Conference is taking place in Melbourne, Australia, under the theme “Nobody left behind,” which underlines the need to use a human rights-based approach to ensure that everyone — especially those who are most at risk and affected by HIV and AIDS — receives treatment. We cannot accomplish this without overcoming one of the most devastating barriers to prevention and treatment: stigma and discrimination.
The problem
Stigma and discrimination prevent millions of people, especially vulnerable populations like women and youth, from accessing the prevention and treatment they need.
According to the 2014 Gap Report recently published by UNAIDS, more than half of those living with HIV globally do not know they have the virus because they have yet to get tested. Equally troubling, UNAIDS also notes that while more than 28 million individuals around the world need treatment, only 34 percent of these individuals had access to treatment. How does this happen? In many countries, the culprit is pervasive social stigma and discrimination in clinics and at both the local and national levels.
For example, a whopping 60 percent of countries around the world have laws, regulations or policies that prevent populations most at risk of HIV infection — like pregnant women, men who have sex with men, and people who inject drugs — from accessing these services. HIV transmission or the failure to disclose one’s HIV status to a sexual partner is criminalized in more than 60 countries. Additionally, 40 countries impose some form of restriction on entry, stay and residence of people living with HIV; 18 deport individuals whose HIV positive status is made public; and five countries have a complete ban on the entry and stay of individuals living with HIV.
Efforts to stigmatize and discriminate against populations living with HIV do nothing to reduce the rates of transmission. Instead, they keep people from getting tested for HIV and prevent people living with HIV from disclosing their status to partners, accessing care and adhering to treatment.
Small wins make a huge difference
Despite these worrying developments, organizations working to reduce stigma and discrimination have made significant progress over the past couple of years. For example, the 2014 Global AIDS Response Progress Report, which details the landscape of the epidemic around the world, now includes a section on measuring how many people hold discriminatory attitudes toward those living with HIV. Additionally, the U.S. State Department just released instructions on how embassies can work to track levels of HIV-related stigma and discrimination in countries as part of the department’s annual Human Rights report.
While these may seem like small wins, they’ll make a huge difference in measuring where stigma and discriminatory attitudes exist so that countries can better target their efforts to reduce these harmful social norms.
For far too long, gaps in data have prevented countries from truly understanding how stigma and discrimination prevent vulnerable populations from using needed health care services, and these efforts will help fill those gaps. The International Center for Research on Women is helping in this effort, undertaking important research on how HIV stigma and discrimination among health workers and communities in South Africa and Zambia influence the success of biomedical approaches to HIV prevention. This research will help inform how best to scale up new biomedical prevention strategies to ensure that the general population is open to accepting and adhering to them.
As the world’s attention turns to HIV and AIDS this week, we must redouble our efforts to ensure that sufficient attention is focused on how to reduce and overcome the stigma and discrimination that are impeding efforts to end AIDS. When we work together to end stigma and discrimination, we will be able to ensure that all people — regardless of their sexual orientation, race, age, gender or class — have access to vital HIV prevention, care and treatment services.
For more information on sessions and events at AIDS 2014 focused on stigma and discrimination, check out the Stigma Action Network's "stigma road map."
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