By Daniel A. Townsend, International Council of AIDS Service Organizations (ICASO) Programme Officer
I have always been sensitive to euphemisms and narratives, especially those which, when used correctly, capture a moment that creates further momentum and progress in responding to an issue.
On the theme of this year’s International AIDS Conference, Turning the Tide Together, I will admit I am slightly indifferent. This is not to say that is not a bold and powerful statement. It strikes an authoritative tone and it could be exactly the kind of get-it-together-now message that we need. Over thirty years into the epidemic, we can now see tangible outcomes of all our hard work. We have had three decades of twiddling with declarations, designing programmes, identifying and naming groups of people. And we have had successes. We have better treatment options that make it possible to imagine a world without HIV. Many countries have brought in progressive laws that uphold the dignity of all persons regardless of their HIV status. More children are being born free of HIV than at any other time in the epidemic. We continue to see breakthroughs in HIV prevention.
But this is of course only one part of the story: in many parts of world HIV and its related stigma strikes a different beat. Those most affected by HIV often live without dignity: they have no access to the drugs they need to stay healthy; their behaviours are criminalized; and they are poor, hungry and die early. For these people, HIV is structural; it is part of the social and political determinants that shape their lives. For them, HIV is a death sentence, despite the many changes and advances you will hear about during this conference.
Perhaps the simplest truth we have learned over the last 30 years is that effective responses to HIV require enabling contexts and conditions. For example, getting condoms to those who need them most is not just about increasing the supply of condoms, but also about addressing the structural and social conditions that limit their distribution and their consistent and correct use. Conversely, maintaining laws that provoke and sustain HIV-related stigma and discrimination is one sure-fire way to boost HIV infection rates and HIV-related mortality.
For key affected populations, such as men who have sex with men, the situation remains as dire as it always has been. In most of the settings where research has been conducted, HIV prevalence rates have been much higher in men who have sex with men, drug users and sex workers than in the general population. Similarly, HIV prevalence remains high in other groups such as sex workers around the world and African and Caribbean diaspora communities in higher-income countries. Yet, although we know that there are structural, economic, political and legal factors that contribute to these high rates, the global response to AIDS has still done too little to address them fully.
This is where my slight indifference to this year’s conference theme lies. It falls short of recognizing that ‘the tide’ can’t be turned successfully until more is done to address the deficiencies of the present response. For the tide to be turned truly, we must do more for the people most affected by HIV, and we cannot continue to avoid tackling head-on the factors that undermine our efforts. When we tackle issues such as gender and human rights, we need to make sure we are dealing with related, pernicious factors such as racism, endemic poverty, homophobia and misogyny. To do this, we must work together to name the problems and strengthen our approaches to turn the tide together.