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By Wayne Campbell
“We can end AIDS if we end the inequalities which perpetuate it. This World AIDS Day we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities. To keep everyone safe, to protect everyone’s health, we need to Equalize.” – UNAIDS Executive Director, Winnie Byanyima.
Globally, 38.4 million are living with HIV/AIDS. UNAIDS reports that one person dies from AIDS every minute; 1.5 million people were newly infected with HIV in 2021.
The international community each year observes World AIDS Day on December 1. Since its inception in 1988, the day has served as a platform to show solidarity with those individuals who are living with and are impacted by HIV. The day is also set aside to remember those who have died as a result of complications from AIDS.
While great strides have been made over the four decades since the first known reported cases of AIDS, this disease remains a public health challenge. The day is also reserved as a day to bridge new and effective programmes and policies across different sectors around HIV/AIDS.
Every year, United Nations (UN) agencies, federal agencies, and societies from across the globe join together to campaign around specific themes related to HIV. The theme this year is Equalize, which is quite appropriate given the inequalities which perpetuate in many societies regarding the AIDS pandemic.
This World AIDS Day, UNAIDS is urging each of us to address the inequalities which are holding back progress in ending AIDS. The “Equalize” slogan is a call to action. It is a prompt for all of us to work for the proven practical actions needed to address inequalities and help end AIDS.
Data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result. World AIDS Day is also an opportunity for public and private partnerships to spread awareness concerning the status of the pandemic and encourage programmes in HIV/AIDS prevention, treatment and care.
One of the global partners in the fight against HIV/AIDS is the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The Centers for Disease Control and Prevention (CDC) states that new annual HIV infections in the USA have decreased by 54 per cent since their peak in 1996, and AIDS-related deaths have decreased by 68 per cent, from a peak of 2 million in 2004 to 650,000 in 2021. Data from CDC-supported population-based HIV impact surveys show many PEPFAR-supported countries in Africa have achieved or are on the cusp of achieving control of their HIV epidemics, including Botswana, which was recently recognized as the first country to surpass the ambitious UNAIDS 95-95-95 fast-track targets for ending their HIV epidemic, well ahead of the 2030 target.
Women and HIV/AIDS
The statistics emerging from UNAIDS are disturbing. In Sub-Saharan Africa, adolescent girls and young women are three times more likely to acquire HIV than adolescent boys and young men of the same age group.
Gender inequalities are a key driver of the AIDS epidemic. In many relationships, women are powerless to initiate and take control of a conversation regarding condom use. In many societies, the construction of masculinity is often rooted in a sense of promiscuity. The rather toxic view of masculinity and manhood renders the female helpless. This position of power and privilege for men exists in almost all societies as patriarchy is embedded across structural indicators from the political to the domestic spheres. Married women are also at an increased risk of contracting HIV, as in those specific types of relationships the wife is not on a level playing field regarding who wields the power in negotiating condom usage.
The Centers for Disease Control and Prevention (CDC) opines that many people are infected with HIV each year, and too many people living with HIV struggle to access life-saving treatment. We know that HIV does not affect everyone equally, and that social, economic, demographic, and geographic inequalities put some populations including adolescent girls and young women and key populations at disproportionate risk for HIV, impede their abilities to access HIV services, and hinder our progress towards ending the HIV epidemic. UNAIDS data states young women in Africa remain disproportionately affected by HIV. The report further added that in 19 African countries, dedicated combination prevention programmes for adolescent girls and young women are operating in only 40 per cent of those countries.
Jamaica
The Ministry of Health and Wellness mentions that HIV/AIDS became an issue in Jamaica in 1982 when its first case was reported. Currently, approximately 1.7 per cent of Jamaica’s adult population lives with HIV/AIDS. This represents about 27,000 people. The Pan American Health Organization (PAHO) adds that HIV prevalence among adults in Jamaica was 1.5 per cent in 2018. PAHO also gives a higher number of Jamaicans living with HIV at an estimated 32, 617 persons. Men having sex with men, sex workers, transgender are especially at risk.
In 2020, there were 79 reports of HIV-related discrimination, Jumoke Patrick, executive director of the Jamaica Network of Seropositives, disclosed. “The majority of those are centred or anchored in communities, whether it is the inner-city communities, rural communities, urban, etc. We recognized that it is within these particular communities persons living with HIV feel stigmatised the most and not necessarily when they access healthcare or on their jobs,” Patrick said in response to queries from a newspaper. The most common forms of stigma and discrimination experienced were verbal harassment, gossip, and discriminatory remarks. However, anyone who engages in unprotected sex may in fact contract HIV. AIDS is not a gay disease.
Ground-breaking treatment
In an article published in The Conversation, nearly 70 per cent of infections occur in key groups: sex workers and their clients, men who have sex with men, people who inject drugs, and transgender people and their sexual partners. Adolescent girls and young women in sub-Saharan Africa are another important group, with nearly 5, 000 getting HIV every week.
For many years, options for HIV prevention were quite limited. Early campaigns consisted of the ABCs – abstinence, being faithful, and condoms. In the early 2000s, male circumcision was added, but multiple attempts at developing a vaccine have been disappointing. In 2012, however, much excitement surrounded the introduction of HIV pre-exposure prophylaxis, or PrEP. The initial form of PrEP was a combination oral pill consisting of two medications used to treat HIV – emtricitabine and tenofovir. When taken regularly, PrEP is highly effective in preventing HIV infection and very safe. PrEP was seen as a game-changer by enabling people to take charge of their sexual health, particularly for those who could not necessarily control when or how they had sex.
Oral PrEP has worked well for many, particularly for men who have sex with men in high income settings and for serodifferent couples (couples in which one person has HIV and the other does not). For others like young people, it’s hard to take a pill consistently during periods of risk for getting HIV. The interest is there, but lots of things get in the way. Some relate to the person, like forgetfulness, transport to a clinic, and alternative priorities. Other factors relate to stigma and lack of support. PrEP administered via a vaginal ring is another safe option that has been developed. However, it is yet to be seen how many people will want to use it as it becomes more widely available.
The inequalities regarding access to ground breaking HIV treatment are real and must be addressed by governments. Access to PrEP has been slow and mostly limited to high-income countries. Some countries, like Kenya, Uganda, South Africa, Zambia, and Nigeria, have been more proactive than others, but it is still hard for many to get PrEP. Now that PrEP is available as an injectable, it is estimated that this will make a huge difference in HIV prevention. Unfortunately, PrEP is not widely available in Jamaica and can be very expensive.
On this World AIDS Day, let us utilize our various social media communities and join in the advocacy in spreading the message concerning a zero tolerance policy towards stigma and discrimination. We must be mindful that once you are sexually active, you can contract HIV. Undoubtedly, there is a lot of work to be done in empowering our population, especially the most vulnerable in providing the necessary tools to equip them in the fight against HIV/AIDS. Let us re-double our efforts in working to end AIDS.
UNAIDS estimates that US$29 billion (in constant 2019 US dollars) will be required for the AIDS response in low- and middle-income countries, including countries formerly considered to be upper-income countries, in 2025 to get on track to end AIDS as a global public health threat.
In the words of the Under-Secretary-General and UN Women Executive Director, Sima Bahous, this World AIDS Day, “I call upon all stakeholders to accelerate their work towards meeting both Sustainable Development Goal (SDG) 5 on gender equality and SDG 3 on health and well-being. The current rates of HIV infections among young women demonstrate how closely these two goals are interlinked, and how pressing it is to achieve both. I call on all to EQUALIZE by listening, respecting, and responding to young women and girls. We need more young women steering us towards the end of inequalities and AIDS by 2030. Let us accelerate progress on inequalities together, for everyone in the societies that we serve, and with women and girls at the centre.”
Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues.
waykam@yahoo.com
@WayneCamo © #WorldAIDSDay #SDG3 #SDG5
