World AIDS Day: Yes, communities could be our best hope for ending this plague

Carolyn Moynihan
December 2, 2019
Reproduced with Permission

The 31st World AIDS Day was observed on December 1st and probably most world leaders joined the UNAIDS Executive Director, Winnie Byanyima, in talking about the role of communities in fighting HIV.

After more than three decades, the virus that causes AIDS remains a serious global epidemic, with approximately 1.1 million people in the United States and 38 million around the world infected.

Rates of infection have been reduced by 40 percent since the peak in 1997, and 62 percent of all people living with HIV were accessing treatment last year. Around 82 percent of pregnant women with HIV had access to antiretroviral medicines to prevent transmission of the virus to their child. (These UNAIDS percentages are mid-range between the lowest and highest estimates).

In other words, there has been a lot of progress in the "fight" against HIV, and UNAIDS is pinning its hopes on the communities where it is most prevalent to carry the battle forward.

"Communities are the best hope for ending AIDS because communities have fought against HIV right from the beginning!" says Ms Byanyima.

"As the epidemic raged through our countries, cities, villages, women held communities together and bore the higher burden of care for their families.

For far too long we have taken their volunteerism for granted.

In the face of adversity, communities of gay men, sex workers and people who use drugs have organized themselves to claim their right to health as equal citizens.

So, we know that communities have proved their worth. There is no debate there.

Without communities, 24 million people would not be on treatment today. Without communities led by women living with and affected by HIV, we would not be close to ending new HIV infections among children, raising orphans and caring for the sick."

Yes, communities can achieve a lot. But people are still dying from AIDS – around 770,000 last year, which is a long way off the UNAIDS 2020 target of less than 500,000.

Only half of children (0-14) with HIV are accessing treatment and children are dying at the rate of 320 a day, although new infections among in this age group are down 41 percent since 2010 – to 160,000.

New infections overall were around 1.7 million [1.4-2.3 million] in 2018, down 16 percent overall on 2010. The risk of acquiring HIV is:

These "key populations" and their sexual partners account for upwards of 78 percent of new infections in the most or more developed countries, including Asia and the Pacific, but lower percentages in Latin America, Western and Central Africa, the Caribbean and eastern and southern Africa.

In fact, in the latter region only 25 percent of new infections are among key populations, but there is a burgeoning epidemic among young women. In sub-Saharan Africa more broadly, four out of five new infections among adolescents aged 15-19 in the region are in girls, and young women aged 15-24 are twice as likely to be living with HIV than men. Worldwide, 6000 young women (15-24 years) become infected every week.

In some regions around the world, UNAIDS points out, female infection is associated with experience of physical or sexual intimate partner violence.

I have written about this female epidemic recently in connection with the widespread use of the hormonal contraceptive injection in African (and other developing) countries. Despite recent research findings to the contrary, the two are likely connected. Ongoing concern in "reproductive health" quarters is driving research to produce a magic bullet pill that will stop babies and HIV at the same time.

The AIDS establishment for its part is focused on developing a vaccine against the disease, and better anti-retroviral drugs, which are used increasingly with at-risk populations before they start having risky sex.

The idea that people could be educated and persuaded not to become sexually active outside of a monogamous marriage – something achieved to a significant degree in Uganda in the 1990s – is regarded as so unrealistic as not to warrant even a mention in mainstream literature. Prevention means drugs.

Yet, while drugs are beneficial and necessary in dealing with the disease, reliance on them consumes billions of dollars that could otherwise go into development and eradicating poverty. UNAIDS estimates that US$ 26.2 billion (constant 2016 dollars) will be required for the AIDS response in 2020.

For Ms Byanyima, though, community activists play a key role. She has reminded governments that 30 percent of their AIDS funding is supposed to go to community-led HIV services, and 6 percent "to community mobilization, promoting human rights and changing harmful laws that act as barriers to ending AIDS." She believes that "challenging discrimination, criminalization and stigma" is necessary to end AIDS.

Of course, any unjust discrimination should go, and probably criminal laws against homosexual activity as well. But sodomy laws were thrown out in America, for example, in 2003 and same-sex marriage was legalised in 2015, and yet there were 38,500 new HIV infections in the US last year, and 6000 AIDS-related deaths.

If only some of that money earmarked for "communities" in the developing world could go to communities that really want to get rid of HIV-AIDS once and for all, natural communities where those wonderful women Ms Byanyima talks about could educate children in chastity and demand that their menfolk remain faithful to their wives.

Then we would see how AIDS could be ended, at least outside those key populations whose members need special kinds of help. And it would not cost a fortune.