End Inequalities: End AIDS

“For every woman and girl violently attacked, we reduce our humanity. For every woman forced into unprotected sex because men demand this, we destroy dignity and pride. Every woman who has to sell her life for sex we condemn to a lifetime in prison. For every moment we remain silent, we conspire against our women. For every woman infected by HIV, we destroy a generation.”- Nelson Mandela. Every year, on 1 December, the international community commemorates World AIDS Day. The day is set aside to showcase unity and demonstrate support for people living with and affected by HIV and to remember those who lost their lives to AIDS. The global community is currently in its fourth decade of the HIV/AIDS pandemic. It is safe to say that we all know of at least one individual who is living with HIV or who have died from AIDS. HIV stands for human immunodeficiency virus. The human immunodeficiency virus (HIV) targets cells of the immune system, called CD4 cells, which help the body respond to infection. Within the CD4 cell, HIV replicates and in turn, damages and destroys the cell. Without effective treatment of a combination of antiretroviral (ARV) drugs, the immune system will become weakened to the point that it can no longer fight infection and disease. HIV remains a major public health issue that affects millions of people worldwide. According to the World Health Organization (WHO) an estimated 37,700,000 people are living with HIV in 2020. Ruben Pages of The Joint United Nations Programme on HIV/AIDS (UNAIDS Jamaica) in a recent presentation at the Optimist International Caribbean District Pre- World AIDS Day Inter-Island Webinar, stated that an estimated 330,000 people in the Caribbean are living with HIV; of that number 32,000 are Jamaicans. According to the WHO although the world has made significant progress in recent decades, important global targets for 2020 were not met. Various societal issues rooted in a culture of prejudice; such as division, disparity and disregard for human rights are among the failures that have allowed HIV to become and remain a global health crisis. It has become more challenging for those persons living with HIV in this ongoing COVID-19 pandemic. Globally, more than 5 million persons have died from COVID-19. Governments all over have had to make difficult decisions regarding where to spend the limited resources in the healthcare system. The COVID-19 pandemic has exacerbated inequities and disruptions to services, making the lives of many people living with HIV more demanding. The theme of World AIDS Day 2021 is “End inequalities. End AIDS”. With a special focus on reaching people left behind, WHO and its partners are highlighting the growing inequalities in access to essential HIV services. Stakeholders need to confront the inequalities that drive AIDS and to reach people who are currently not receiving essential HIV services. Economic, social, cultural and legal inequalities must be ended as a matter of urgency if we are to end AIDS by 2030. Governments need to ensure that treatments such as, Pre-exposure prophylaxis, or PrEP, are available to the specific target groups. PreP is a course of antiretroviral drugs that HIV-negative people can take to prevent HIV acquisition. When taken as recommended, it can practically eliminate the chance of acquiring HIV. PrEP is recommended for populations who are at higher risk of HIV. Gender and HIV/AIDS All the research which have been done have concluded that HIV disproportionately affects women and girls because of their unequal cultural, social and economic status in society. Women are less likely to negotiate condom use and safe sex practices in their relationships. According to Avert, a UK-based internationally focused charity, using digital communications to build health literacy on HIV and sexual health; women constitute more than half of all people living with HIV and AIDS-related illnesses remain the leading cause of death for women aged between 15 and 49. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections. In 2017, 7,000 adolescent girls and young women became HIV-positive. This is a far higher rate than new infections among young men, with young women twice as likely to acquire HIV as their male peers. Avert added that in sub-Saharan Africa, despite making up just 10% of the population, one out of every five new HIV infections happens among adolescent girls and young women. In the worse-affected countries, 80% of new HIV infections among adolescents are among girls, who are up to eight times more likely to be living with HIV than adolescent boys. The United Nations Children’s Fund (UNICEF) declares the main drivers of the HIV epidemic are influenced by a wide range of gender inequalities. According to UNICEF early and forced marriage, gender-based violence, unequal access to information, including sexual health knowledge, and a lack of negotiating power and economic autonomy are among the factors that place women and adolescent girls at increased risk of HIV infection as well as circumscribe their responses to being infected. At the same time, masculine norms that promote promiscuity and substance abuse increase the risk of infection among men and boys. The Path Towards 2030 The time has come for the wider society to dismantle the culture of stigma and discrimination which continue to suppress our progress regarding providing a holistic approach to treatment for those who are living with HIV/AIDS. There needs to be a broad- based approach to tackle HIV/AIDS. This approach must include the political directorate; especially as it relates to the legislative framework. Additionally, civil society, the church and other stakeholders must unite with a sense of purpose to address the numerous issues which are associated with HIV/AIDS. United Nations AIDS asserts that the international community faces an AIDS emergency. If the transformative measures needed on AIDS are not taken, the world will also stay trapped in the COVID-19 crisis and be dangerously unprepared for the pandemics to come. We can never underscore how important it is for us to treat those living with HIV/AIDS with dignity and respect. Persistent inequalities and the challenges posed by the COVID-19 pandemic require a renewed effort to end HIV as a public health threat by 2030. We must ensure that everyone everywhere has equal access to HIV prevention, testing, treatment and care, including COVID-19 vaccinations and services. WHO recommends a renewed focus on countries and populations that are still missing out in the global response to HIV and AIDS. These include the diverse groups of people being marginalized in each country, including “key” populations of people who are at high risk. We need to revisit how we teach sexual health and reproductive studies to our students. In most societies we operate on a false premise that if more information is provided to children regarding sex and sexuality then this inevitably will lead to more students engaging in sex. However, gone are those days when students solely depend on mainstream media for information. The proliferation of various social media platforms has added to the many sources of information widely available; unfortunately, some of this information is set in an atmosphere of falsehood. In order to end AIDS by 2030 we step up the game; an equitable programme of testing, treatment, access to medication and counselling for the targeted population is required. In the words of Margaret Chan, HIV AIDS is a disease with stigma. And we have learned with experience, not just with HIV AIDS but with other diseases, countries for many reasons are sometimes hesitant to admit they have a problem. 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 ©