Will fresh voices lead to better choices to help end AIDS?

10 July 2018

Ahead of the IDS Annual Lecture with Professor Peter Piot on 17 July entitled ‘Can we end the AIDS epidemic? The need for a development approach’, we hear from Christine Stegling, Executive Director of the International HIV/Aids Alliance on the need for honest discussions about what is and isn’t working to help end AIDS. 

Ntsiki, 22, a Community Adolescent Treatment Supporter in Swaziland. © Sydelle Willow Smith 

The question of whether or not we can end the AIDS epidemic will be asked aggressively in the days before and during the International AIDS Conference this month in Amsterdam. Three decades into the epidemic and with many years of heightened political, financial and intellectual support to address the complex issues that make up the response, it is no surprise that people are growing impatient when we tell them that it is not over yet.

But the truth is, it isn’t! In many countries in the world, HIV remains a serious issue despite all the rhetoric around ending AIDS. The figures speak for themselves: over one million people still died of AIDS-related illnesses in 2016 and over 1.8 million people got infected, which is not the sign of a diminishing epidemic.

According to UNAIDS, the risk of acquiring HIV for the most marginalized populations remain unacceptably high. Recent studies suggest that people who inject drugs are 24 times more likely to acquire HIV than adults in the general population, sex workers are 10 times more likely to acquire HIV and gay men and other men who have sex with men are 24 times more likely to acquire HIV. In addition, transgender people are 49 times more likely to be living with HIV.

I was confronted by this reality on my recent visit to Myanmar where the prevalence rate among drug users is 34%, as detailed in a new report from the Integrated Biological Behavioural Science.  This is a mind-boggling statistic and reminds us of the urgency of the situation. It is also heartbreaking to know that so many years into the response, globally AIDS remains a leading cause of death among adolescents aged 10-19 years and AIDS-related illnesses remain the leading cause of death among women of reproductive age (15–49 years) globally, and they are the second leading cause of death for young women aged 15–24 years in Africa. In 2016, 64,000 young people aged between 15-24 years died of AIDS related illnesses. This is hard to fathom for those of us who have spent our lives and careers looking for solutions, gathering political momentum and bringing services and medicines to those communities that are most affected.

But we can end AIDS – not by talking about it as if it was already over but by being honest in our assessments of what is and isn’t working. We must find new allies, address other health and development issues, and listen to fresh voices – especially young voices who are least heard because of their isolation as users of drugs or sexual and gender identity – and by finally accepting that there is no magic bullet to ending AIDS.

People make up communities and it is communities that have been the key to successful AIDS responses. Whether it was gay men organising themselves in Europe and the US to raise the alarm about a disease that was ravaging their communities in the early 1980s, or communities in Asia, Africa, Eastern Europe and Latin America and the Caribbean demanding access to life-saving treatment and quality services, or campaigning for changes in laws and policies. It is through community engagement that we have made the biggest gains. So the history of the AIDS movement is a history of people, politics, power and of bringing science and human rights together.

This is the time that we need to live up to our analysis which has told us over many years that a successful answer to this epidemic is multi-dimensional, multi-sectoral and combines structural, behavioural and biomedical interventions in a meaningful way. Above all, we need to be person-centred and focus on individual needs in everything we do. We will only end AIDS when each of us, especially adolescents and young people, has the power to make informed choices about our own health, can access high quality, evidence-based services, and live in communities that are free from discrimination, stigma and violence.

At the Alliance, we know that delivering person-centred, human-rights based and community-led HIV, health and rights programmes is the most effective way to end AIDS. But to actually achieve this we all need to take a hard look at ourselves, assess how effective we are being, and adjust where needed.

We know what community and civil society structures are effective in responding to HIV. Our choice is to strengthen these structures to promote innovation and remove the barriers to effective HIV prevention, treatment, care and support.

We choose to bring in fresh, young and divergent voices by forming powerful coalitions at the global and country level to strengthen our power and impact to end AIDS. We will continue to strengthen youth leadership and youth-owned programmes to meet the needs of those most affected. 

We choose to cut across politics of identity, power dynamics, race and gender to demand what is best for people affected by HIV. It is here that we can learn most from young people, especially those living with HIV, if we listen to them in their own words, rather than encouraging them to adopt our talk.

So yes we can end AIDS, but we need to articulate our demands differently and within a new global political context in which AIDS no longer occupies the privileged space it had for so many years. We need to link it meaningfully to other development and social justice priorities – with the knowledge that HIV affects disproportionately those who are most marginalised in society. And we need to be loud and angry in our demands for resources and political space because, as we all know: AIDS hasn’t ended yet. The choice to make this a reality is ours for the taking.

The IDS Annual Lecture on Tuesday 17 July will be followed by a drinks reception hosted in partnership with the International HIV/AIDS Alliance.  Register online to attend or to watch the lecture live via Facebook Live.

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