The AIDS epidemic has been characterized by the stigma and discrimination of people who are all too often already on the margins of society.
This marginalization has made it more difficult for millions of people on every continent to access much-needed HIV prevention, treatment, care and support services. As we recognize International Human Rights Day on Dec. 10, we cannot lose sight of the inextricable link between HIV and human rights, which should be the cornerstone of our response to and understanding of this epidemic.
And there is, perhaps, reason for cautious optimism.
Despite some policy gains and increased global attention, HIV continues to disproportionately affect “key populations” — men who have sex with men, sex workers, people who inject drugs and transgender people. UNAIDS estimates that 40 to 50 percent of new adult HIV infections worldwide occur among key populations and their partners.
HIV travels the path of vulnerability, occurring in communities where health care and social services are hardest to access due to stigma and discrimination. Many countries have criminalized the behaviors of key populations, making access to services and lifesaving treatment even more difficult. Yet, even in the absence of criminalization, stigma and poor conduct from health care providers discourage members of key populations from attending clinics at all or disclosing their behaviors if they do, which leads to gaps in services that violate key populations’ right to access quality health care.
According to the World Health Organization, female sex workers are 14 times more likely to have HIV than other women, transgender women are almost 50 times more likely to contract the disease than other adults, and men who have sex with men are 19 times more likely to become infected than the general population. For people who inject drugs, the risk of HIV contagion can be 50 times higher than that of the general population.
In its landmark 2012 report, the Global Commission on HIV and the Law called for donors, civil society and the United Nations to hold governments accountable to their human rights commitments. Addressing HIV requires that we address human rights issues, including strengthening the agency of key populations and their access to health and social justice. The Greater Involvement of People Living with HIV principle acts as a galvanizing call to address stigma and discrimination and to proactively support the empowerment of people living with HIV. To put the GIPA principle into practice and manage the epidemic among key populations, we must meaningfully engage them in policies and programs that affect their lives.
Political commitment has been a well-established ingredient for ensuring that the AIDS rhetoric is met with concrete and tangible action. The indicators of this commitment have, over time, spurred much-needed AIDS action. Still, in many countries around the world, a unique combination of factors is needed to ensure that we can realistically talk about ending this epidemic: courageous policy action to address the structural drivers of the epidemic, such as addressing gender and stigma; sustained and predictable investment targeted to those most at risk; and developing innovative partnerships between community, the private and public sectors.
While the increased global conversation about the end of AIDS is aspirational and motivates action, an AIDS-free generation will not be achieved without a sizable investment in tailored programs and responses that address the HIV epidemic among men who have sex with men, sex workers, people who inject drugs and transgender people. And this is beginning to happen.
At the 20th International AIDS Conference earlier this year in Melbourne, meeting the needs of key populations emerged as a main message. Private foundations and donors are increasingly refocusing their strategies on these groups. Earlier this year, the U.S. President’s Emergency Plan for AIDS Relief and the U.S. Agency for International Development created LINKAGES, the first-ever global project dedicated to key populations across the continuum of HIV services for key populations affected by HIV. The timing could not be more opportune. The proof of success will lie in the increased availability of, access to and retention in HIV services by key populations — especially among those living in policy and social environments that are not supportive.
Human rights icon and Nobel Peace Prize laureate Archbishop Desmond Tutu recently said: “AIDS is not over while one person still needs ARV medicines. It is not over until the last new HIV infection. It is not over until the evils that drive HIV … are defeated.” Ending the epidemic is within reach, but only if recent scientific advances in HIV treatment and biomedical and social HIV interventions are available to everyone who needs them.
There is reason for optimism.
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Kevin Osborne is FHI 360's project director for LINKAGES. Osborne's 20-year career in public health includes extensive expertise in HIV as well as sexual and reproductive health and rights, with a particular focus on key affected populations.
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