Will HIV Ever Be Safe Enough for You?

This post originally appeared on Mark S. King's Blog.

There is a classic episode of Oprah from 1987 that can still raise my blood pressure. That year, the tiny town of Williamson, West Virginia, became part of a national discussion about AIDS when Mike Sisco, who had returned to his home town to die of the disease, dared to step into a public pool.

The community freakout was immediate. Sisco was quickly labeled a psychopath (rumors emerged accusing him of spitting into food at the grocery store), and the town pool was closed the next day to begin a Silkwood-style pressurized cleaning.

Soon thereafter, Oprah Winfrey arrived with cameras for a town hall forum about the incident.  Fear was the order of the day. “If there’s just one chance in a million that somebody could catch that virus from a swimming pool,” the town’s mayor told Winfrey’s worldwide audience, “I think I did the right thing.”

Sure. Why not react in the most extreme way possible, if there is a chance in a million?

Williamson citizens were not swayed by health officials who calmly explained the established routes of HIV transmission and the impossibility of infection from a pool. “The doctors can say you can’t get it this way,” a woman countered, “but what if they come back someday and say, ‘We were wrong?’”

Indeed. What if? If there’s a chance in a million…?

That broadcast might have remained a sad footnote in HIV/AIDS history, an instructive example of people ignoring scientific fact to protect a satisfying fear, if history didn’t enjoy repeating itself so much. Today, though, the willful ignorance isn’t coming from uneducated residents of a southern town you can barely find on a map.

It’s coming from gay men. And they are just as threatened, frightened, and dismissive of science as the townsfolk of Williamson were thirty years ago.

Recently, research known as The PARTNER Study was presented at the prestigious Conference on Retroviruses and Opportunistic Infections (CROI). PARTNER proved something HIV advocates have long suspected: people with HIV with an undetectable viral load are not transmitting the virus to their partners. The study included nearly 800 couples, all involved in an HIV positive/negative relationship, gay and straight, with the positive partner maintaining an undetectable viral load. Over the course of two years, more than 30,000 sex acts were reported and documented (couples were chosen based on their tendency to have sex without condoms).

Not a single HIV transmission occurred during the study from someone with an undetectable viral load. If PARTNER had been researching a new medication, they would have stopped the trial and dispensed the drug immediately.

The PARTNER results bolster the prevention strategy known as “Treatment as Prevention” (TasP), meaning, a positive person on successful treatment prevents new infections. To date, there is not a single confirmed report of someone with an undetectable viral load infecting someone else, in studies or in real life.

Just don’t tell that to a sizable contingent of skeptical gay men, many of whom took to their keyboards to dismiss the PARTNER findings. Phrases like “false sense of security,” “positive guys lie,” “junk science,” and “if there’s even a small risk” appeared on Facebook postings and in web site comment sections. The people of Williamson must be slowly nodding their heads.

Resistance to the PARTNER study corresponds with stubborn doubts about PrEP (pre-exposure prophylaxis, or HIV negative people taking the drug Truvada to prevent infection). Although virtually every nervous argument against PrEP has been overruled by the facts, naysayers continue to either reject the evidence outright or make moral judgments about the sex lives of HIV negative gay men on PrEP.

Yes, there are unknowns. There always are when scientific studies meet the real world. And every strategy will not work for every person. But the vehement rejection of such profound breakthroughs suggests there is something more, something deeper, going on in the minds of gay men. What is it?

Our collective memories of AIDS horror are hard to shake, and that’s a good place to start. On a gut level, any study suggesting that HIV could be neutralized is met with a weary doubt. Good news is no match for the enduring grief that has shadowed us for 30 years.

The PARTNER study also threatens the view that positive men are nothing more than risks that must be managed. The study kills the HIV positive boogeyman. It means positive gay men who know their status might actually care enough about their health to seek out care, get on treatment, and become undetectable. And, once the positive partner is no longer a particular danger, both partners would bear responsibility for their actions. What an enormous psychic change that would require in our community.

It’s tough to do that when fear creeps in and “what if?” fantasy scenarios take hold. What if my partner missed a dose yesterday and, even though HIV meds stay in the bloodstream for extended periods, his viral load has inexplicably shot up? What if he isn’t being truthful about his viral load? What if he doesn’t know?

The greater threat, folks, isn’t positive guys who think they are undetectable but are not. It’s men who think they are HIV negative but are not. But we’d rather stay focused on the positive person being at fault, because, well, people with HIV lie a lot. We miss doses constantly because we have a death wish or we’re too busy finding our next victim.

I have some “what if?” questions of my own. What if these unrealistic fears were meant tostigmatize and isolate HIV positive people? What if I am undetectable and feel no responsibility to discuss my status with a sex partner because I don’t care to engage in a science lesson? What if everyone availed themselves to prevention options that worked best for them? What if my HIV status were none of your damn business?

These risks could be alleviated, of course, if everyone simply protected their own bodies when having sex with people they don’t know or trust. But that would place an equal burden on negative men, and what a bother that is.  Better to leave that discomfort to those with HIV, vectors of disease that we are. Just consider us criminals, lying to you about our viral loads and spitting in the food in Williamson, just waiting to infect you when we get the chance.

FACE OFF -- An HIV+ Man Faces His Accuser 

As long as we’re giving undue attention to fantasy scenarios we’re not focused on the real threats. The rates of STD’s are up. Young gay black men in the United States don’t have proper access to healthcare and have infection rates worse than any developed country. Our community is plagued by  alcoholism, addiction, and mental illness. Do we want to debate established science or should we devote that energy to other challenges to gay men’s health?

If you still have the arrogance to believe you could win the HIV Powerball Lottery and be the one person who gets infected in ways science has disproven, you’re perfectly entitled to that point of view.

Here are some helpful instructions, however. Carefully step away from your computer and don’t touch the cords because 50 people die of product related electrocutions each year. Walk slowly to your bedroom, being mindful of debris in your path because slip-and-falls kill 55 people every single day. Once there, refuse food or water because, well, you never know. Now slip into your bed of willful ignorance and try to make yourself comfortable.

The good people of Williamson are keeping a spot warm just for you.

Mark

p.s. In the time it took you to read this article, the number of people who were infected by someone with HIV who had no viral load was zero.

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Thank you to Mark for allowing us to share this post. If you would like to know more about his work, you can follow his twitter feed here.

For National Youth HIV/AIDS Awareness Day: A Timeline of HIV in American Children

Happy National Youth HIV/AIDS Awareness Day, #StigmaWarriors! Today our blog post will be about the history of HIV and HIV-related stigma and discrimination in children and young adults. As you’ll see, the United States has come a long way from the early days of the HIV epidemic, especially when it comes to the care and treatment of children and young adults who are living with HIV. So let’s get started with our history lesson!

1969

The first known case of AIDS in children/young adults in the United States wasn’t discovered to be AIDS until 1987. Robert Rayford, a sixteen year old from St. Louis, Missouri, died of a mysterious illness in 1969 [1], several months after checking himself into the hospital for treatment. When doctors performed an autopsy, they found several abnormalities, and were so baffled by Robert’s illness that they preserved samples of his tissue. In 1987, several years after the HIV epidemic was first identified in the United States, those same doctors tested Robert’s tissue samples, and they came back positive for HIV.

1982

On December 10th, the CDC reported a case of unexplained immunodeficiency [2] (later determined to be HIV) in an infant who had received a blood transfusion. Over the next several weeks, twenty-two more cases of infants [3] who were either living with or had died from unexplained immunodeficiency were reported. Most of the children were diagnosed with immunodeficiency after a blood transfusion or it was found that the condition was transmitted to them through their mother.

1985

Ryan White [4], a hemophiliac who contracted HIV from a blood transfusion, was kicked out of Western Middle School in Kokomo, Indiana, after it was disclosed to school officials that he was living with HIV. After a drawn out court battle, White was allowed to return to school, but his parents decided to withdraw him from Western and enrolled him in Hamilton Heights High School in Cicero, Indiana, where school officials and students welcomed him with open arms after being educated about HIV. This was the first nationally known case of the effects of HIV stigma.

In December, the US Public Health Service released the first recommendations for the prevention of mother-to-child transmission [5].

1987

A federal judge ordered the DeSoto County School Board in Arcadia, Florida, to allow the three HIV-positive Ray brothers (Ricky, Robert, and Randy) to attend school after they were kicked out because the parents of other children did not want children living with HIV to attend the school [6]. The brothers were hemophiliacs and most likely contracted HIV via blood transfusions. After the judge’s decision was handed down, other parents began withdrawing their children from school, and on August 28th the Ray’s home was burned down, prompting them to flee Arcadia [7].

1988

Elizabeth Glaser, wife of Starsky and Hutch star Paul Michael Glaser and a mother living with HIV, founded the Pediatric AIDS Foundation (now the Elizabeth Glaser PediatricAIDS Foundation) [7] after their daughter Ariel died of AIDS. At this time there were no approved antiretroviral drugs for children living with HIV, and the Glasers' son Jake was dying of AIDS. Through lobbying, the EGPAF was able to get the FDA to approve antiretroviral treatments for children.

1989

Ryan White spoke before the President’s Commission about the HIV Epidemic about the HIV-related stigma he faced after his diagnosis [8], and emphasized how HIV education helped him be more accepted at his new school in Cicero. As a result, schools across the nation implemented education programs about HIV in health classes.

1990

HIV activist Ryan White died in April at the age of eighteen. Four months later, President George H. W. Bush signed the Ryan White CARE Act [9] into law, which provides government funding for HIV/AIDS research. It has been reauthorized four times, most recently in 2009.

1998

Five years after Ricky Ray’s death, Congress enacted the Ricky Ray Hemophilia Relief Fund Act [10], which authorizes payment to hemophiliacs and other people living with blood clotting disorders who were infected with HIV via contaminated blood transfusions between 1982 and 1987.

2002

Twenty years after HIV was confirmed in children, approximately thirteen million children and young people were living with HIV, mostly in Africa [11].

2006

The first National Women’s and Girl’s HIV/AIDS Awareness Day was commemorated on March 6th.

2013

In March, doctors at the CDC confirmed that a toddler in Mississippi [12] who had been diagnosed with HIV at birth had been “functionally cured” of HIV, leading to hope for a cure in children who were transmitted HIV in utero. One year later, the toddler was still free of HIV.

The first National Youth HIV/AIDS Awareness Day was commemorated on April 10th.

2014

In March, an infant in California was confirmed to be“functionally cured” of HIV [13] after receiving the same treatment as the Mississippi toddler who had been “functionally cured” of HIV one year earlier. The CDC is currently trying to work out clinical trials in order to find a cure for children prenatally exposed to HIV.

The Future

What an amazing timeline! It truly shows how the treatment of people living with HIV, especially children and young adults, has changed. Twenty years ago there were no treatments for children living with HIV, and now there are two toddlers who have been functionally cured of it! Isn’t modern medicine amazing? And now, children living with HIV don’t have to worry about being kicked out of school if their condition is diagnosed. Ryan White and the Ray brothers’ legacy is proof of that.

Who knows what the future holds? What we know it holds is a lot of hope for those living with HIV to potentially find preventative vaccines or even cures. It also holds hope for lives free of HIV-related stigma and discrimination.

Happy National Youth HIV/AIDS Awareness Day!

"Shuga" is Saving Lives in Nigeria - Mario Christodolou

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

MARIO CHRISTODOULOU

January 06, 2014

Sophie has just had unprotected sex with her “Sugar Daddy” (a person who exchanges large amounts of money or gifts for sexual favours). While he goes to freshen up in the bathroom, she innocently snoops around the bedside drawer to reveal a box of pills—little does she know that they are antiretrovirals. She has unknowingly put herself at risk of HIV infection.

The scenario described above is from the new series of the MTV show Shuga, which has now landed in Nigeria. Condensed into this 60-second scene are issues related to transactional sex, negotiation of safer sex, HIV treatment, and HIV disclosure. But this depiction is just the tip of a gargantuan, mass-media behavior-change iceberg.

A scene from Shuga showing Sophie and Solomon in bed. Photo © MTV Staying Alive Foundation

Produced by the MTV Staying Alive Foundation in partnership with the Bill & Melinda Gates Foundation, US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Nigerian National Agency for the Control of AIDS (NACA), the award-winning Shuga TV show has already had two hit seasons in Kenya. But Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation and Executive Producer of Shuga, has a vision for the Shuga campaign in Nigeria that far exceeds anything attempted previously in Kenya.

“Shuga is a ground-breaking TV show that portrays the lives and loves of a group of young people. Seamlessly interwoven into the storylines are vital messages related to HIV and a wide range of other sexual health messages,” explains Arnold. “Alongside the TV series is a substantial mass-media campaign, which reaches our audience at all the points where they interact, improving their access to vital sexual and reproductive health messaging and directing them to the health services they need.”

As well as the TV show, the points of interaction that Arnold alludes to include a radio series, a mobile service (SMS), a comic book (focused on the domestic violence story line in the TV drama, aimed specifically at girls with low literacy levels), digital and social media, and a Skype service through which users can “call a character” from the show and share their thoughts.

Nii and Malaika in Shuga. Photo © MTV Staying Alive Foundation.

“The particular nature of stories and dramas not only deliver informational content but create emotional connections to characters and role models, which promote a better context for learning and behavior change than do factual presentations,” observes Victor Orozco, an economist at the World Bank and coordinator of their Africa HIV/AIDS Impact Evaluation Program. “TV could play an important role in introducing ideas to large segments of a society, especially segments where literacy is low and social norms discourage discussion of stigmatized issues such as HIV/AIDS and teen pregnancy.”

 Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of a half billion people.By keeping messages from the TV show at the forefront of people’s minds, the introduction of multimedia elements may have the potential to reinforce and promote positive behavior change. For example, sending weekly text messages can significantly increase adherence to antiretroviral treatment for people living with HIV. The Shuga campaign in Nigeria will aim to reinforce the messages of the Shuga TV show with a 360-degree campaign, including several social media and mobile components, such as text messaging and interactive voice recordings. Orozco is working with MTV to evaluate the behavior-change effects of the show and the additional impact of mobile messages through a randomized study.  

A character on the show is tested for HIV. Photo © MTV Staying Alive Foundation.

Shuga has made the journey from Kenya to Nigeria for several reasons. While some might argue that on the basis of prevalence, the need for a campaign like Shuga is greater in Kenya than in Nigeria—HIV prevalence in Kenya (6 percent) is double that of Nigeria (3 percent). However, Nigeria has the second highest number of people living with the disease, and while maternal mortality has significantly fallen since 1990 in the country, one in 13 women still die during childbirth. Additionally, of Nigeria’s burgeoning population of over 150 million, nearly a third are young people aged 10 to 24 years—a population that falls neatly into the MTV demographic and who will relate more closely with stories portrayed in Shuga.

These public health concerns are compounded by a severe lack of knowledge about HIV among young men and young women. “Comprehensive knowledge about HIV is defined as knowing that condom use and having just one HIV negative and faithful partner can reduce the chances of contracting HIV; knowing that a healthy-looking person can have HIV; rejecting the two most common misconceptions about HIV transmission—that HIV can be transmitted by mosquito bites and that HIV can be transmitted by supernatural means," explains Dr Emmanuel Alhassan, Director, Resource Mobilization at NACA. “However, only 22 percent of young women and 33 percent of young men [in Nigeria] have comprehensive knowledge about HIV.”

Shuga has the potential to displace the silence that has engulfed serious issues like HIV in Nigeria and beyond, and to fill the knowledge vacuum that such silence has created. Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of half billion people. With this kind of reach, the ability for this so-called entertainment education to inform, change attitudes, and even change behavior is undeniable.

However, Orozco notes that policy makers and funders might be seriously under-investing in such mass-media approaches due to lack of rigorous evidence. But with the support of the Gates Foundation and MTV Staying Alive, he and other researchers are remedying this by evaluating Shuga and creating a knowledge base of what methods works and what is worth scaling up in Nigeria and elsewhere.

“Our vision for Shuga is to see a transformation in attitudes about the way the world talks about sex, not as a dirty topic, or something that should be hidden, but something that is openly discussed: parent to child, peer to peer,” envisions Arnold. “Only by doing this will we see a real change in people’s attitudes about HIV and their knowledge about it. Only through open and honest dialogue can we can hope to save lives.”

Find links to the episodes that have aired so far here. 

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

An Interview with "James" by Brian Fuss

The following is from an interview with James (not his real name) an HIV+, gay male, sex worker, pro-Dom, and former drug user.  Thank you for sharing your story, James.

James grew up in a Midwest town Pentecostal family where religion and family were constantly reinforced by their twice a week church attendance. James remarked, “All of my friends were from that church; in fact, I did not know anyone other than church members.” At the age of 16, after struggling with his sexuality “forever,” James shared with his older sister about being gay. James stated, “My sister betrayed me and told my parents and this ensued a shit storm in my life.” His parents demanded he “repent of his homosexual, evil ways and go back to loving the Lord.” However, James knew he could not deny who he was, and told his parents as much. His parents threw him out of the house until “he properly repented and served the Lord.” Alone, hungry, scared with his last $100.00, James went to LA hoping a friend would help.

“The friend was a total asshole and basically had sex with me for a few days and then told me to beat it.” Now, completely alone, in a strange city, and frustrated, James had no idea what to do. Then, a kindly man offered him a warm bed and food. “He was a nice guy…at first he said I could just hang out until I got on my feet. Then he started to flash around a lot of money. When I asked him what he did, he said he worked in the porn and sex industry. This was more money than I saw in my whole entire life.” He became James’s mentor, telling him what porn shoots to go on and what places to stay away from. “The way to make more money was to do it (sex) raw (bareback), so of course I became that type of actor. I was making a lot of money between this and my lucrative escort business. With that came the partying, more sex, and HIV.”

“HIV completely changed my life. First, it [HIV positive status] got me into recovery.” James explained he left partying and entered (drug and alcohol) recovery and has been sober for 5 years. “Being an escort brings its own stigma, but it, honestly, is something I do not have to self-disclose, unless I want to date you…there is the rub…most guys are completely intrigued by my sex work, but hesitate to get involved with me because of it. I have heard numerous times…you are a great guy but I can’t be with (date) a hooker…I ain’t no hooker!” James further explained that HIV is the second hurdle that creates a lot of stigma in his life, both professionally and personally. “I have an obligation to tell clients, if they ask, about my HIV status (James explained he is 80% safe with clients and is undetectable) if they want to fuck raw.” James stated he has been single because no one wants a “HIV positive sex worker for a boyfriend, and that just hurts.”

I asked James two question, which I believe are important and pertinent to the discussion of stigma and I offer James’s answers in their entirety.

Many profiles on gay dating sites have the terms clean and dirty to describe someone who is HIV- verses someone HIV+. What are your thoughts? “I’m not dirty! When I see that shit, I just get pissed and usually say someone. Gay men can be so pathetic when it comes to HIV status. Think about the terms…because I am HIV+ I am somehow defective and should be ignored or worse cleaned up…it reminds me of what my parents said when they threw me out of the house…maybe I am just dirty.”

What is your advice to other young men in a similar situation? “You are more than your status, the drugs you take or the work you do! Don’t let anyone take your humanity away from you!”

In conclusion, James tells a story of stigma and shame from growing up gay in a Midwestern town to being a sex worker to being in recovery to being HIV+. It is estimated that more people delay treatment or refuse to get tested out of shame and stigma, especially if they are involved in the sex industry.

_ _ _ _ _ _ _

This interview was conducted by Brian Fuss of the Harm Reduction Coalition 

International Day of the Girl

International Day of the Girl encourages us to draw our attention to the inequalities facing young girls across the world. We are called to take a critical look at whether or not girls are given the same opportunities as boys in terms of access to education, financial stability, and sexual empowerment. Here at the Stigma Action Network, we are most concerned with how girls are affected by the HIV epidemic. After examining the data related to this topic, we ultimately found that:

• In sub-Saharan Africa, young women aged 15 to 24 are up to 8 times more likely than young men to be living with HIV.[1]
• Worldwide, young women account for 66% of young people living with HIV.[2]
•  Women living with HIV are more likely to experience violence as result of their status, than men living with HIV.[3]
• Prevalence of first forced sex among adolescent girls is as high as 48% in some countries, which further maintains the HIV epidemic.[4]

While these facts are indeed surprising, the factors that perpetuate them are even more alarming. Three of these most significant factors are outlined below.

• Girls’ Lack of Empowerment: According to global statistics, girls are significantly poorer, less educated, and as a result less financially and socially empowered than their male counterparts. This power imbalance reduces young women’s choices as they negotiate their sexual health and relationships, often giving them little choice in determining if and when to have sex, and in cases of consensual sex, whether that sex is safe. Furthermore, poverty prevents underprivileged girls from receiving adequate health care and education, and as such resources are essential in fighting the HIV epidemic, breaches in these areas may lead to HIV infection.

• Biology: The risk of becoming infected during unprotected sex is two to four times greater for women than for men, and for young girls, the risk can be even higher.[5] This biological disparity gives further evidence as to the importance of educating girls about their sexual health and rights, specifically as they relate to HIV.

• Culture: And lastly, cultural mores may encourage men to have many sexual partners.[6] This is particularly problematic surrounding the issue of child marriage, as such customs can facilitate the spread of HIV to girls in high-risk areas. And given that one-third of the world’s girls are married before they reach the age of 18, such practices can have quite widespread and devastating effects.[7]

As you can see, there are a multitude of socio-economic and biological factors that put girls at a higher risk of HIV. But what is the solution to this problem? And how can we curb these inequalities and give girls the power to take control of their sexual health?

Carol Bellamy, Executive Director of UNICEF offers up her thoughts:

“Education is crucial to success against the pandemic. 

In fact, UNICEF remains convinced that until an effective remedy is found,

 education is one of the most effective tools for curbing HIV/AIDS”

Luckily, the following organizations are contributing to the fight against HIV by educating girls about the importance of and how to protect themselves by engaging in safe sex! Here are a few #StigmaWarriors who are doing great work with girls on HIV education:

Girls Learn International, Inc

Girls Learn International, Inc. takes a unique approach to girls’ education by partnering American schools with schools in foreign countries where girls do not enjoy the same educational opportunities as boys. This organization functions as an after school program that offers service oriented learning to young girls. Participants in the US chapters learn of the challenges facing girls in their partner schools including child marriage, trafficking, poverty, sexual health, and educational disparities. Money that is raised domestically goes towards purchasing textbooks, teachers' salaries, meals, and transportation in partner schools. Girls Learn International, Inc. has 47 partnerships in the following countries where HIV rates are notably high: Afghanistan, Bangladesh, Cambodia, Ghana, India, Kenya, Nepal, Pakistan, Tanzania, Uganda, and Vietnam. Learn more about this organization and how you can help support the education of girls across the world. 

Maasai Girls Education Fund

On the Top 10 list of countries most affected by HIV/AIDS, Kenya comes in at #4. Girls living in poverty have less control over their sexual health, both because of lack of education and because of sexual abuse. "A large, national survey of secondary school girls in Kenya found that 40 per cent of those reporting sexual activity indicated that their first sexual experience was forced or that they were 'cheated into having sex.'"[8] The Maasai are nomadic pastoralists originating from the lower Nile valley with a strong traditional culture that often prevents females from receiving an adequate education. Only 48% of Maasai girls in Kenya enroll in school, and only 5% of those who enroll reach the secondary school level.[9] Such educational disparity can further facilitate the spread of HIV, as girls who remain uneducated are not only unable to make sexually sound decisions, but are also unable decisions that may secure a promising future. The Maasai Girls Education Fund works to combat this, however, by providing a safe environment where girls can receive a quality education. Donations to the Maasai Girls Education Fund go towards buying uniforms, books, and helping to pay tuition. What makes this organization stand out are their community workshops that attempt to reverse cultural beliefs and norms that discourage young girls from enrolling in and committing to school. And as enrollment in school is the best HIV prevention method available to girls (as noted by the World Bank), this organization’s work can surely make a difference.

Commit 2 Change

Young women are the victims of heavy abuse in India as well, in part because they are viewed as the less desirable of the two genders: over 25,000 of adolescent girls are malnourished and suffer from illness and medical neglect [10]. Commit 2 Change is dedicated to supporting female orphans in India by providing them with secondary education, with a particular emphasis on sexual health and HIV/AIDS prevention. Millions of children across the world have become orphaned after losing their parents to HIV/AIDS. Orphaned children are more likely to become impoverished and less likely to be enrolled in school as a result. A study done by UNICEF reveals that "the irony is that orphans are frequently deprived of quality education, which is the very thing they need to help protect themselves from HIV" [11]. India ranks #3 on the Top 10 countries most affected by HIV/AIDS.

The SAN congratulates the above-mentioned organizations (and others around the world!) who are doing great work to educate girls about safe sex and to prevent the spread of HIV among this particularly vulnerable population. However, The Girls Insights report conducted by the International Center for Research on Women found that "girls said they still lack even the most basic knowledge, autonomy and other assets critical for their health and empowerment." This demonstrates that even more must be done if we are to stop the spread of HIV and related stigma!

We hope that more organizations accept the challenge of incorporating sexual education, including education around HIV, into curriculum for young girls and adolescents. Programs must also be developed in a way that empowers girls to use this education to make sound decisions about their own sexual health. Together, with this sort of integrated approach, we can help girls gain control over their lives and futures, and help make a future without HIV a reality.

(Visit UNICEF for more details.)