Can you imagine having your family disown you? What if doctors refused to treat you, even with basic care? What would it feel like if you were not allowed to pursue any form of education? How about if you had no possibility of a future with a romantic partner?
We will never make strides in preventing HIV transmission until we confront the taboos that surround it.
This is reality for millions of men, women, and children in sub-Saharan Africa who have been diagnosed with HIV/AIDS. As of 2013, that number was 24.7 million, which accounts for the vast majority of the world’s total reported cases, which by 2014 approached 37 million people, 2.6 million of whom were children. In 2013 alone, 1.5 million sub-Saharan Africans were newly infected. Since the first case was reported in 1981, a certain stigma has always lingered around the disease. Many in the United States refer to it as the “gay disease” or accuse those infected of bestiality. They may say that someone who has been diagnosed should avoid intimacy, believing that a person with HIV is incapable of functional relationships without infecting their partner. In Africa, the implications are even more harsh. Often believed to be a “curse from God,” many regions exile an infected person from their community.
Worse, the stigma does not stop with individuals. It bleeds into the legal, political, and economic arenas as well. This is true worldwide. Some places have prosecuted women for transmitting the virus to their child, or have prosecuted individuals for not disclosing their positive status even if they have reached an undetectable viral load through antiretroviral therapy (ART). The discrimination surrounding a positive diagnosis is cited as the primary hurdle in addressing prevention and care.
Considering HIV/AIDS ranks among the deadliest infectious diseases in the world, having taken 39 million lives since the first reported case (1.5 million in 2013 alone), it makes sense for the first line of defense to be dissolving the stigma that fuels its spread. The stakes of someone learning of the diagnosis are high for many of these individuals, thus they live in secret. If we create an environment where they feel comfortable getting tested, seeking treatment, and communicating openly with their partners and medical professionals, we will decrease the spread. Fortunately, groups that otherwise disagree on a lot of keystone issues agree on this point. This epidemic needs to be curtailed.
As of current day, there is no cure for HIV. It is a virus that progressively causes the immune system to fail, thus allowing life-threatening infections to thrive. AIDS is a condition that develops when HIV has caused serious damage to the immune system. There is, however, treatment that allows someone infected to lead more of a normal life, and even reduces the transmission risk.
Since it is tragically common for a mother to transmit the disease to her child during pregnancy, childbirth, or breastfeeding, in July 2011, UNAIDS identified 21 “priority countries” in sub-Saharan Africa and developed a global plan to eliminate new HIV infections in children and keep their mothers alive by promoting ART. Though declines vary by area, an approximate 43 percent decline has been reported in new child infections in sub-Saharan Africa. In 2013, 67 percent of pregnant women living with HIV in low- and middle-income countries received ART to avoid transmission to their children, up from 47 percent in 2010.
Sadly, accessing ART treatment has proven to be incredibly difficult for individuals in sub-Saharan Africa. Roughly 50 percent of those who test positive are lost between testing and ART eligibility screening, and 32 percent that qualify for treatment do not pursue it. Aside from the aforementioned stigma, there are many other barriers ranging from poverty, limited education on HIV, limited staffing and accessibility at centers, religious beliefs, and gender dynamics.
As with most health-related issues, prevention is the best method.
Studies have shown that the key affected populations in sub-Saharan Africa are children, sex workers, men who have sex with men, IV drug users, and young women under the age of 25. There are targeted efforts underway to address the AIDS crisis for each of these groups.
This is one of the few issues for which I believe all approaches are important. Yes, condoms are effective. Yes, abstinence and fidelity are effective. Yes, harm reduction programs are effective. Yes, voluntary male circumcision is effective. Yes, providing women with feminine hygiene is effective. Why? Because they are all compassionate and empowering choices.
When you talk to men about circumcision, you are giving them a powerful choice, one that reduces HIV transmission risk from females to males by 60 percent. According to a 2012 World Health Organization fact sheet, if 80 percent of men in target areas complied, an estimated 3.4 million new infections could be averted by 2025. When you provide an addict with needle-exchange programs, opioid substitution therapy, and supervised injection sites, you are preventing the spread of HIV while increasing their odds of being reached by drug-dependence treatment. When you discuss sexuality with individuals, you are gifting them with options and information to make informed decisions to reduce their risks through condom usage and partner reduction or abstinence, thus breaking the thought cycle that categorizes women as sex objects. When you hand a woman a reusable cloth menstrual pad, you are telling her that her body is nothing to be ashamed of.
Drug use. Sex. Menstruation. HIV. All such taboo subjects, but we will never make strides if they stay that way. We must encourage open dialogue and accept that there are different avenues to combat this, all of which are equally valid, if we are to move forward in our fight against this disease.