Scientific solutions can only go so far if HIV stigma and discrimination remain

Rural villagers near the town of Wau in South Sudan learn about health and HIV through pictographs and facilitated discussion. In fragile contexts, the lack of health personnel is an acute gap and communities can play a critical role if duly supported. Photo by: Juozas Cernius / IFRC

The first thing you notice about the 2014 AIDS conference is just how personal HIV is to so many people from all walks of life and nations. From scientists to activists to epidemiologists to volunteers, the conference was not only a celebration of diversity but also a confirmation of our common determination to rid the world of HIV and AIDS once and for all.

For the International Federation of Red Cross and Red Crescent Societies and the participating Red Cross and Red Crescent from Jamaica, Uganda, Russia, Pakistan, Argentina, Vietnam, Guyana, the United States and Australia, the 20th International AIDS Conference provided a valuable opportunity to hear the latest news, discuss ongoing challenges in our HIV prevention and awareness work, and forge important connections and partnerships.

Indeed, I could only agree with former U.S. President Bill Clinton when he noted in his keynote address that AIDS 2014 is less of a conference but “more of a movement,” accurately describing a fluid, human mass of energy, emotion and determination.

Having attended a number of international AIDS conferences in the past, I was particularly struck by the optimism in Melbourne and inspired to hear, for the first time, open discussions about a realistic end to the global AIDS epidemic. Improvements in science, technology, access and affordable pricing of antiretroviral treatment have saved and bettered the lives of millions over the past 30 years and this should be celebrated. But at the same time, the conference also reminded us of the stubborn challenges and obstacles that still continue to slow us down in our fight to provide universal access to HIV testing and treatment.

Stigma, discrimination and fear of criminal punishment still prevent so many people, especially hard-to-reach communities such as men who have sex with men, transgender people and sex workers, from coming forward to get critical testing and the help they need to access services and start treatment. Scientific progress and the development of HIV prevention and treatment tools can only be effective, and save lives, if people come forward to benefit from them. Cultural prejudice, religious taboos and abominable laws that criminalize homosexuality are denying people their fundamental right to good health and it is imperative that our demands for these kinds of restrictions to be lifted are heard.

We should also not forget other hard-to-reach communities that lack access simply because they physically cannot reach testing and treatment facilities. The sick, disabled and the old must not be overlooked in our charge toward universal access for all.

I was immensely proud that IFRC Secretary-General Bekele Geleta, along with dignitaries such as Archbishop Desmond Tutu and Aung San Suu Kyi, signed the Melbourne Declaration, which calls for universal access to HIV testing and treatment and an end to discrimination and stigma. We as a movement need to “step up the pace” and support our local Red Cross and Red Crescent to engage in stronger advocacy and stand up for the rights of those hard-to-reach communities that often only they can access.

Seeing our Red Cross Red Crescent representatives actively engaging with their peers and colleagues from all over the world was immensely inspiring. These hardworking, courageous young men and women are operating on the front lines of HIV in their communities, often in challenging, hostile and dangerous environments. Their presence at the conference aptly symbolized the critical role of local people and volunteers in community efforts in HIV prevention, awareness and even testing.

Shifting basic HIV-related tasks to local trained teams of community health workers, including health volunteers from local organizations such as the Red Cross Red Crescent, can ensure higher rates of testing, treatment and adherence, thus containing the spread of the disease in communities that currently lack adequate HIV services. Moreover, in terms of economics, it is much more cost-effective to treat people living with HIV earlier rather than later. Therefore, scaling up community-led testing and treatment services could potentially generate returns up to three times the initial investment and relieve the burden on ailing national health services.

This is particularly true in fragile states and situations. State fragility can increase people’s vulnerability to HIV as well as disrupt care and treatment for people living with HIV. The negative impact of HIV can also increase the severity of fragile situations, leaving people less able to cope. Access to treatment in places like the Central African Republic or South Sudan is not guaranteed. People are being deprived of their access to both HIV-related drugs and children’s vaccines and medicines for tuberculosis. But this is not only a problem of supply and logistic. In those contexts, the lack of health personnel is an acute gap and communities can play a critical role if duly supported. There are community leaders in fragile states and we need to identify those leaders and engage them.

Finally, as stated by Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the best science won’t get us there unless we harness advances in humanity. The HIV response is about the people and promoting an inclusive society. Criminalization is driving people away from health services. If we want to harness an inclusive human family, local organizations have a key role to play.

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About the author

  • Stefan Seebacher

    Dr. Stefan Seebacher is head of the health department at the International Federation of Red Cross and Red Crescent Societies, responsible for development and emergency health programs. Active within the Red Cross and Red Crescent Movements since 1992, he has previously held the roles of international health adviser at the Austrian Red Cross, head of the Ankara and Minsk delegations and head of the regional health units, and regional technical coordinator for Southeast and East Asia. Dr. Seebacher has been a leading consultant in international health and development since 1992, having contributed to strategic planning and capacity building for many Red Cross and Red Crescent National Societies.