End social injustice if we want to end AIDS - IAC 2016
IAC Plenary – July 19th – End social injustice if we want to end AIDS.
The opening plenary of IAC 2016 Durban offered an exciting panel of speakers, from those working at the coal face of ARV research and treatment, who talked about practical issues and progress, to more personal experiences and advocacy issues.
Speaker after speaker highlighted the gender and justice disparities of the HIV epidemic and our progress and the need to attend to social injustice if we want to end AIDS by 2030.
Stephanie Strathdee spoke at length about both the achievements and the gaps – 17 million on treatment since Durban 2000 – but – no decrease in new infections; and of those new infections, 25% are in young woman in southern Africa – the ‘youth bulge’. Nonetheless, in vertical transmission, real progress has been made, with 85 countries having fully eliminated it.
Elizabeth Bakusi told us, ‘we must think gender or it will confront and confound us as we proceed’. Young women’s biological and social contexts increase their vulnerability to HIV, while stigma adds to the difficulty of testing and treatment; we also need to talk with them about contraception and provide empathetic, co-ordinated care within supportive communities; we must take collective responsibility for a powerful positive response to HIV.
Maurine Murenga cited her personal experiences and highlighted that HIV is not just a health condition; young women face stigma, discrimination, physical and emotional abuse and limited economic access; ‘we feel this; we live like this; but we can’t go on like this!” We need to make deliberate efforts to achieve gender equality for all and we need to watch the language we use – no more talking about mother-to-child transmission – instead use vertical transmission, so that we are not blaming women for transmission. Social and cultural norms also aggravate the situation for young women – the taboo about talking about sexuality means young women don’t know about PreP or contraception and they fear institutionalized stigma and discrimination from healthcare workers and others, including forced sterilisation.
Effective gender transformative programmes need to promote sexual and reproductive health and rights. Members of key populations are doubly stigmatised and this prevents universal health coverage. Next, Alex Coutinho spoke about our successes and failures in treatment and pointed out that in both the US and in South Africa we have still only achieved between 25% and 30% of those on treatment with viral suppression. He spoke of systems for health instead of health systems; systems that support health research and include community voices and activism. We need to fight stigma; strengthen our health systems; improve commodity supply chains and logistics; create partnerships between CSOs government and the private sector; with these, and with targets and monitoring we can get to 90-90-90.
But it needs to be funded. PEPFAR’s figures for the unit cost of ARVS are $100 but the actual unit cost is $700.
Patient-centred and youth focussed health programmes are critical. We need to close the gaps in prevention and turn off the tap of new infections. And stop expecting community health workers to be volunteers. We have a huge problem of unemployment.; pay them for the valuable work they do and create a proper continuum of care. Take services to where people live.
Justice Edwin Cameron, in the Janthan Mann Human Rights lecture, said, “AIDS exposes our terrible human vulnerability”. Laws that criminalise are misguided and evil; western countries are as guilty in this as African countries. ‘Gender diversity is a natural, joyful fact of being human’. We each have the right to be ourselves in dignity and equal with other human beings. Sex workers deserve our love and respect and support and the provision of PreP – not our contempt and condemnation; their criminalization is an evil and a distraction. Those who inject drugs should be recognised as victims of the US Government‘s war on drugs.
Young people must be empowered – especially girls. We must redouble our prevention and education efforts and we must test and test and test; it must be voluntary but not burdensome. And we must explore the epidemic of self stigma; the dread and prejudices that lurk within the minds of people living with HIV but whose source lies outside of us. We need to correct the social determinants of HIV by improving social justice and gender education.
Love us for who we are – not for what we have!
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