HIV does discriminate: The worldwide fight against stigma and discrimination
By Linda Villarosa
In a reversal of a long-standing public health mantra, one of the key messages from AIDS 2014 is that HIV does discriminate. In the first of this three-part series, writer Linda Villarosa lays out the populations most at risk and spotlights sex workers’ fight for their rights. Next week, in “HIV Does Discriminate: The Worldwide Fight Against Stigma and Discrimination, Part 2,” learn about the issues facing sex workers.
The first time I attended an International HIV/AIDS Conference, 12 years ago, a media trainer advised our group of journalists reporting on the event not to interview activists. “Stick to the scientists and focus on the serious stuff,” she said.
I didn’t listen and later became a trainer myself. But that tension still exists: Scientists and policymakers deliver important presentations at front-and-center plenaries and press conferences, while activists are shuttled away to the Global Village, the conference side-show and host to edgy performances and community net-working zones.
But over the years, activists have shoved and screamed their way onto the podiums and into the forefront. At this summer’s AIDS 2014 event in Melbourne, Australia, they didn’t need to push so hard. For the first time, conference organizers married science and activism into every part of the proceedings. In other words, they acknowledged that the world will never reach the new 90-90-90 targets (by 2020, 90 percent of all PLWHA would know their status; 90 percent of those who know their status would be on treatment; and 90 percent of those on treatment would be virally suppressed) or ever get to zero new infections without the active engagement of the most affected communities and a collective fight against stigma and discrimination.
A lack of progress on the scientific front accounted for some of the shift in focus at this year’s conference. Although re-searchers in Melbourne did their best to put a positive spin on progress toward a cure, in reality, they didn’t have much to report. Unlike in 2008 in Vienna, when the results of the CAPRISA trial of a microbicide gel brought new hope for stemming HIV transmission in women; or in 2010 in Washington, D.C., when treatment as prevention became a public health priority, few promising results surfaced this time around.
In fact, the most buzzed-about finding was the not-so-good news that the so-called Mississippi baby, thought to have been cured of HIV, had rebounded with detectable levels of the virus in her blood. Quick as a heartbeat, cure was downgraded to remission. Though her case may eventually lead to a way forward, and this little Black girl could prove to be a scientific hero someday, that day hasn’t arrived yet.
Instead, Melbourne featured a shift away from focusing on generalized epidemics—defined as when more than 1 percent of the population in a geographic area or demographic group is living with HIV—to a more pronounced emphasis on drilling down to what are called “key affected populations.”
Why? Around the world, there is positive news: Although 35 million people are living with HIV, UNAIDS is reporting the lowest levels of new HIV infections this century. AIDS-related deaths are at their lowest since the peak in 2005, having declined by 35 percent. And even in hard-hit sub-Saharan Africa, 90 percent of people who know their HIV status are receiving lifesaving treatment.
Despite this flurry of good news about the epidemic, HIV has grabbed hold and taken root in several key groups. To put it simply, although the idea that HIV doesn’t discriminate has long been a public health mantra, it actually does.
Globally, HIV prevalence is:
· * 12 times higher among sex workers than among the rest of the adult population.
· * 19 times higher among gay men and other MSM. In the U.S., African American gay, bisexual and other MSM represent 72 percent of new infections among all African American men, and more new HIV infections occur among young Black gay and bisexual men than among any other sub-group of gay and bisexual men.
· * 28 times higher among people who inject drugs.
· * 49 times higher among transgender women than among the rest of the adult population. In the U.S., Black transgender women have the highest percentage of new HIV-positive test results among all transgender people. In New York City, approximately 90 percent of transgender women newly diagnosed with HIV are African American or Latino.
And these are the groups that are most often ignored, shamed and discriminated against, even by the laws and authorities that are supposed to protect them. In the words of Michel Sidibé, the executive director of UNAIDS, “There will be no ending AIDS without putting people first, without ensuring that people living with and affected by the epidemic are part of a new movement.” And the signage at the conference—”No Barriers,” “No Exceptions,” “Nobody Left Be-hind”—offered an explicit acknowledgment of the emphasis on key affected populations.
I came to understand the is-sues of three of the groups—sex workers, MSM and trans women—by ignoring what I was taught 12 years ago and talking and listening to real people. (Injection drug users and their advocates were not as widespread in Melbourne, partially because the tragedy of the plane shot down over Ukraine right before the conference kept many representatives from Eastern Europe at home. Injecting drugs drives the epidemic in that region, particularly in Russia and Ukraine.) It wasn’t difficult: MSM, transgender women and sex workers were front and center and eager to be heard.
Linda Villarosa has covered HIV/AIDS since the early days of the epidemic and has attended the Inter-national AIDS Conference six times. She traveled to Melbourne as a volunteer reporter for Black AIDS Daily with her daughter, Kali.