Even after 40 years the response to Aids in many countries is still held back by stigma

Forty years after the first cases of Aids were discovered, goals for its global elimination have yet to be achieved. In 2020, nearly 700,000 people died of Aids-related illnesses and 1.5 million people were newly infected with HIV.

This is despite scientific and medical advances in the testing, treatment and care of people living with HIV.

Part of the reason is something that those affected by HIV know all too well: discrimination. The history of the response to this virus has long been hampered by stigma and it continues to disproportionately affect key groups – men who have sex with men; sex workers; transgender people; people who inject drugs and prisoners. According to UNAIDS, the United Nations programme on Aids/HIV, these communities account for 93% of new HIV infections outside sub-Saharan Africa.

Social, state and symbolic discrimination and violence play a huge role in preventing people in these groups from accessing care and prevention services. It is difficult to protect yourself from HIV when, in some countries, having prevention tools in your pocket – whether it be sterile syringes or condoms – can lead to arrest.

It’s hard to talk to your doctor about sexual safety or access antiretroviral treatment when homophobia permeates your society. Discrimination is directly related to stigma and they are mutually reinforcing, acting as catalysts for transmission.

Punitive laws that infringe human rights also continue to hold back progress.

The criminalisation of certain behaviours and jobs – such as drug use, non-disclosure of HIV status, and sex work – infringes on the rights and freedoms of key populations and their ability to access justice and health services. Often, this is a result of prejudice among law enforcement.

Russia is one example of how pushing back on human rights, freedoms and personal autonomy also holds back the fight against HIV and Aids. In June, at the last UN high-level meeting on HIV and Aids, Russia submitted amendments to the final declaration to delete any reference to human rights, decriminalising sex work or harm reduction related to injecting drugs, claiming it was an affront to family values.

How can we not make the connection between these views and the worrying progression of the HIV epidemic in Russia? Russian government estimates suggest that new HIV infections increased annually by 10% to 15% a year between 2006 and 2015. It is a trajectory leading to enormous prevalence rates in key populations (including its estimated 1.8 million injection-drug users) and a general population prevalence of more than 1%. As in other countries where homosexuality is subject to social repression, there is reason to believe that these estimates are very conservative because the impact of homophobia reduces estimates of certain population sizes and incidence.

Alongside eliminating stigma, discrimination and criminalisation, nations need to consider how funding is directed. According to the Dutch organisation Aidsfonds, programmes targeting key, most at-risk groups in low- and middle-income countries receive only 2% of HIV funding.

Yet marginalised people have long proven their ability to implement innovative solutions to protect fellow human beings in the face of epidemics, whether it be Aids or Covid-19. Community-led responses that respect human rights in the local context are highly effective. Peer testing, for example, is extremely effective in reaching those furthest from the health system.

Cheick Hamala Sidibé, human rights officer at Arcad Santé Plus, has said that community-led initiatives during the Covid-19 pandemic by health workers in Mali – meeting people at home to offer HIV testing, distribute prevention kits and provide antiretroviral treatment – have pushed the government to improve its policy.

In Morocco, a third of those testing positive for HIV in 2019 were screened by community health workers from ACLS – a member of Coalition Plus, an international network to fight Aids and hepatitis – even though it uses only 10% of the kits available nationwide. In Ecuador, out of 40,000 tests, Kimirina, another Coalition Plus member, detected 900 HIV-positive people – nearly six times higher than the rate achieved by the public health system.

The new Global Fund strategy to fight Aids, TB and malaria places communities front and centre of the fight. Building on the fund’s proven impact, it’s vital that governments step up contributions next year in order to accelerate community-led responses.

Communities have always been best on the frontlines and sustainable funding of interventions designed and implemented by and for key population groups will go a long way to bringing the global HIV response on track.

Underpinning this must be a steadfast commitment to human rights; exerting political pressure to repeal punitive laws and enforcing laws to protect people from violence. Through this, we can, after 40 years, overcome discrimination and end Aids.

Hakima Himmich is the founder of ALCS in Morocco and has chaired the international network Coalition Plus since 2012.

Mike Podmore is director of StopAids, a UK-based network of 70 organisations, and a steering committee member at Action for Global Health UK and Global Fund Advocates Network.

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