The AIDS Epidemic Can Be Ended

Published: August 20, 2013

While the debate about gay rights in the West has shifted to the rights of same sex couples to marry, these recent events bring back to light the cruel reality that in many countries people who are openly homosexual or suspected of being homosexual are still being thrown in jail for years or even facing death sentences. It beggars belief that in sub-Saharan Africa homosexuality remains illegal in 38 countries. 

It is crucial that pressure be stepped up on governments that, through punitive laws, continue to make the daily lives of homosexuals a nightmare. But even greater pressure can be exerted if we acknowledge that this deprivation of human rights goes beyond mere civil liberties: It is bad public health. 
Three decades of experience in responding to the H.I.V./AIDS epidemic has provided indisputable evidence that depriving those groups most at risk of H.I.V. infection of their human rights drives them underground. The impact is twofold: Not only do sex workers, men who have sex with men, drug users and transgender people live in daily fear of reprisals, but precisely because of that they are considerably less likely to access basic health services such as condoms to protect themselves from infection. Education campaigns that reach the general population are unlikely to reach these populations, and it is no surprise that in many parts of the world H.I.V. prevalence among sex workers, men who have sex with men, transgender people and sex workers is much higher than in other populations. 
In the early days of the H.I.V./AIDS epidemic, it was soon evident that the virus did not discriminate but that governments and people sometimes did. Today stigma and discrimination still fuel the epidemic — and we need look no further than Russia to see how repression and inaction have worsened one of the fastest-growing H.I.V. epidemics in the world. 
A decade ago estimates of the number of people in Russia living with H.I.V. ranged from 100,000 to twice that, most of whom were sickened by intravenous drug use. Today the figure stands at an alarming one million. Much of the blame lies with the public authorities’ refusal to support the provision of opioid substitution therapy, like methadone, or of clean needles. 
Intravenous drug users are subject to widespread discrimination in Russian society, and the government’s notorious “treatment” centers have drawn harsh condemnation for their human rights abuses over the years. 
It comes as no surprise that, in a country as historically distrustful of homosexuality and “Western” campaigns to give homosexuals increased rights, the rate of H.I.V. prevalence among men who have sex with men, especially younger men, is considerably higher than the general population. 
The renewed hard-line approach by the government only adds to the climate of fear for L.G.B.T. organizations — and will do little to bring down the rate of new infections among gay men. 
Much the same can be said of many of those 38 sub-Saharan African countries where homosexuality is still illegal. Their rates of H.I.V. among men who have sex with men are sketchy because of the fears of many men to be identified as having sex with other men. 
The potential for H.I.V. transmission among gay men in Russia as well as sub-Saharan Africa is very clear. At the same time, we know what steps can be taken that work to stem this tide. 
In the 1980s the implementation of needle-exchange and methadone programs was instrumental in preventing a spiraling epidemic among people who inject drugs. Today Western Europe, the United States and many other countries have close to zero H.I.V. prevalence among intravenous drug users. 
In countries like Portugal and the Czech Republic, the decriminalization of small amounts of drugs for personal use during the 1990s was a major factor behind the drop in H.I.V. infection rates. Conferring on drug users the right to dignified medical services and referring them to treatment centers as opposed to locking them up have produced a revolution in public health policy in those countries. 

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