HIV/AIDS The Fourth Decade

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Vol. XLVIII No. 1 2011

The first issue of 2011 focuses on the ongoing battle against HIV/AIDS, now entering its fourth decade. Coinciding with the UN General Assembly High Level Meeting on AIDS in June 2011, the issue looks back at lessons learned from the earliest advocates that fought bravely against the virus and the stigma that came with it. It celebrates the strides that have been made towards accomplishing Millennium Development Goal 6: halting and reversing the spread of HIV/AIDS by 2015. It also highlights new challenges, including the global inequality in access to treatment, persistent stigma, and the need for HIV prevention that women can use and control."

What is it with women and girls? Why are we always left behind? Why can't we choose the things we want to be a part of? Why must we always race to the front, rather than be left peacefully alone when we would rather not partake? Is it because, as women, we are strong, powerful, and the foundation of our society?
When we started hearing about HIV in Motherland Nigeria, it was about men dying at the mines or long-distance truck drivers going home to die. But before you could form the words to thank God that women weren't acquiring the nasty virus, common sense reminded you that whatever a man acquires -- good or bad -- will surely come home.

The world faith community has made some good progress against the spread of HIV/AIDS by using individually-focused, informed messages, such as the ABC strategies, Abstinence, Being Faithful, Condom Use, as well as policies, programmes and budgets that are simple, morally appealing, politically convenient, financially lenient and scientifically relevant. For greater and more sustainable success against HIV/AIDS, these messages and programmes must be expanded, and the epidemic tackled with a multi-sectoral, multi-level, and multi-dimensional ethic that simultaneously reduces the Stigma, Shame, Denial, Discrimination, Inaction and Mis-action (SSDDIM) still attached to HIV, while promoting the SAVE model: Safer practices, Available medicines, Voluntary testing and Empowerment through education, at the individual, family, local community, national, regional, and global level. This must be accomplished if we are to significantly halt, reverse, and eventually overcome new infections related to AIDS before the virus triumphantly and devastatingly celebrates its fiftieth anniversary in 2031.

My primary impulse to write an article on HIV/AIDS came from my fundamental desire to contribute and to collaborate. I realize that my behaviour is founded upon a deeply-rooted sense of duty, a strong commitment, and a profound necessity. Psychologists refer to attitude as the disposition of a person confronting the world (the psychological view), which, once transported to a social setting, becomes values (the sociological view).
In this respect, therefore, allow me to coin the term "individual global responsibility: " a concept which embodies the attitude of an individual who, as a global citizen, demonstrates a profound sense of respect for human rights and dignity. Indeed, acting with individual global responsibility implies feeling an intense ethical and moral obligation to take positive action, starting with the understanding that in the world there are fellow human beings who are suffering and who have a right to be helped and supported. To be a global citizen means being aware of this obligation and this right.

A group of South African activists founded the Treatment Action Campaign (TAC) on 10 December 1998, International Human Rights Day. It was no accident that TAC was formed exactly fifty years after the adoption of the Universal Declaration of Human Rights. The backbone of TAC is its use of advocacy to fight for the realisation of the right to health, which is enshrined both in international treaties and in the South African Constitution.

In the context of the HIV epidemic in Papua New Guinea, sex workers and males who have sex with males (MSM) engage in potentially risky sexual practices which remain under archaic criminal laws.1 Those at risk continue to face prejudice, moral condemnation, and violent abuse from some sectors of society, as well as harassment by police and blackmail, which are aimed especially at MSM. Their vulnerability and lack of security impacts on the national response, as it drives them underground and affects their access to treatment and services. However, ongoing educational projects by MSM groups and sex workers appear to be improving police attitudes.

2011 marks the thirtieth anniversary of the first report of HIV, which came from the United States, where cases of an unusual disease were seen among young gay men. Thirty years later, the location and pace of the epidemic has changed dramatically. Globally, an estimated 33.3 million people are infected or living with HIV, of which 22.5 million are in sub-Saharan Africa. In addition, of the 2.5 million children in the world estimated to be living with HIV, 2.3 million are in sub-Saharan Africa. Southern Africa, the most affected region, includes a number of middle- and lower-middle-income nations known as the hyperendemic countries. In South Africa alone, there are about 5.7 million people living with HIV/AIDS. In Swaziland, 42 per cent of women attending antenatal clinics are infected, with similar rates found elsewhere in the region. Many children are affected by the disease in a number of ways: they live with sick parents and relatives in households drained of resources due to the epidemic, and those who have lost parents are less likely to go to school or continue with their education.

The international community has reached the first part of Millennium Development Goal 6: halting and reversing the spread of HIV. At least fifty-six countries have either stabilized or reduced new HIV infections by more than 25 per cent in the past ten years, and this is especially evident in sub-Saharan Africa, the region most affected by the epidemic. New HIV infections among children have dropped by 25 per cent, a significant step towards achieving the virtual elimination of mother-to-child transmission by 2015. In addition, today more than five million people are on antiretroviral treatment, which has reduced AIDS-related deaths by more than 20 per cent in the past five years. However, with more than 33 million people living with HIV today, 2.6 million new HIV infections, and nearly 2 million deaths in 2009, the gains made in the AIDS response are fragile.

The world has been living with the HIV/AIDS epidemic for some thirty years, and prevention methods have been scientifically proven and disseminated to the public for nearly as long. Yet, there are, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) High Level Commission on HIV Prevention, at least 7,000 new HIV infections every day -- an alarming number that indicates HIV/AIDS awareness is at an unacceptable level of neglect by governments, civil society, and the private sector. There was a strong worldwide effort towards HIV prevention when the disease began spreading rapidly throughout the developing world in the early 1990s but, more recently, a disproportionate amount of funding has been directed towards treatment, rather than prevention. Obviously, prevention is the most effective method in slowing down the spread of this terrible disease, but decision-makers still view HIV prevention as a health problem, not a societal one.

In the beginning, the AIDS epidemic struck like a thief in the night -- suddenly, terrifyingly, and deadly. At first, there were a few cases of a rare malignancy, Kaposi's sarcoma; then came the appearance of Pneumocystis pneumonia; and finally a plethora of opportunistic infections including systemic candidiasis, cryptococcal meningitis, and Mycobacterium avium-intracellulare -- all rare diseases associated with this new mysterious, unknown, and unnamed spectre.

The story of interfaith response to HIV/AIDS is one that moved from initial doubt, denial and moral hesitation -- even direct denunciation -- to one of global reach and scale. This is a story that demonstrates both the power and challenges that come from specific beliefs, morals, and theology. It also points to greater possibilities for bridging divides in faith and culture through the power of common action on so great an issue of shared concern.

Maria's world started collapsing around her when the clinic nurse told her she was pregnant and HIV positive. She had been faithful, so it meant that Josef, her husband, had given her the virus. She felt the fear rise within her as she recalled how others in the village were treated when their tests came back positive. She was furious at Josef -- not just for infecting her with HIV, but also because he would be fired when the trucking company he worked for learned of his HIV status. She, too, would lose her factory job in the export processing zone because being pregnant or HIV positive was enough to get you fired -- labour laws did not apply in this zone. Employers knew that firing people for having HIV was illegal, but with little enforcement, some always managed to find ways to do so, without repercussions. It seemed like only yesterday that Josef had mentioned to Maria that his union was trying to start an HIV prevention programme, but was struggling due to lack of funds.

World Health Day, observed on 7 April 2011, focused on antimicrobial resistance including drug resistance issues related to HIV/AIDS. Antiretroviral treatment has been rapidly scaled up in many developing countries in the past decade without major emergence of HIV drug resistance as initially feared. WHO recommends a minimum resource strategy for prevention and assessment of HIV drug resistance in resource limited countries, and works with a global network of individuals, institutions, and countries to implement the strategy.

HIV/AIDS is particularly severe in Africa, where women bear a disproportionate burden of the epidemic. One of the most crucial challenges in HIV prevention in Africa is to reduce the high infection rates among young women. Worldwide, just over half of all people living with HIV are women, and 70-90 per cent of all HIV infections among women are through heterosexual intercourse.1 In sub-Saharan Africa, women aged fifteen- to twenty-four years with HIV represent 76 per cent of the total cases in that age group, outnumbering their male peers by as much as eight to one.1 Although the majority of new HIV cases in the United States are through male-to-male sexual contact, heterosexual contact accounts for 84 per cent of new infections among women.

Knowledge is power: If we learned anything in the gay male community during the early days of the HIV/AIDS epidemic in the United States, it was that. No one knew what had hit us, and people were dying in huge numbers all around us. The community lost friends, colleagues, and intimate partners. Initially mislabeled "gay-related immune deficiency" (GRID), valuable time was lost in responding to the crisis because most felt safe in the belief that they were not at risk. Since early victims were predominantly gay men, the stigma attached to homosexuality in the medical, governing, law enforcement and ecclesiastical institutions became a barrier to understanding, prevention, and treatment.