Destigmatization Needed to Cut HIV Infection Rates to Zero

Sandra Yin

June 10, 2011

June 10, 2011 — At the opening of the General Assembly 2011 High-Level Meeting on AIDS at the United Nations, held June 8 to 10 in New York City, UN Secretary-General Ban Ki-moon celebrated some of the achievements of the past decade as he looked ahead. The goal, he said, is to end AIDS within the decade, with zero new infections, zero stigma, and zero AIDS-related deaths.

"Thirty years ago, AIDS was terrifying, deadly, and spreading fast," he told world leaders and representatives of nongovernmental organizations, the private sector, and international agencies. "Today, we have a chance to end this epidemic once and for all."

Since 2001, new infections have declined by 20%, he said. Since 2006, when leaders set specific goals for the global AIDS response and pledged to get services and care to those who needed it, AIDS-related deaths have also dropped by 20%.

HIV is in decline in some of the most affected countries, like Ethiopia, South Africa, Zambia, and Zimbabwe, which have the largest epidemics in the world. Around the world, more than 6 million people now are getting treatment.

In later remarks, Michel Sidibé, executive director of UNAIDS, reminded the audience of earlier pessimism. Back in 2001, he said, people said they could not afford to treat those living with HIV in the developing world. That would never happen, they said. Some even told UNAIDS that their prevention strategies wouldn't work. But Mr. Sidibé pointed out that the number of countries that have managed to stabilize their epidemic, and even cut infections significantly, has risen to 56, up from 3 in 2001.

"We cannot stop our investments now," said Mr. Sidibé. "With an effective, up-front investment, we can make the down payment to alter the cost trajectory and end this epidemic."

Not everyone is as optimistic about reaching the triple-zero goal. At a panel on prevention and what can be done to get to zero new infections, speakers were less self-congratulatory. Instead, they focused on what still needs to be done to stop the spread of HIV, and had a frank discussion about the devastating impact that stigma, discrimination, and harmful social attitudes have had on efforts to stop the spread of HIV.

"How can we take HIV out of the shadows if we don't have the confidence to talk openly about all aspects of the disease, especially with groups affected by it?" said Marie-Josée Jacobs, Luxembourg's minister of cooperation and humanitarian affairs, who chaired the panel.

Although she acknowledged the progress made over the past 3 decades, Ms. Jacobs said that the HIV/AIDS epidemic is still eclipsing efforts to stifle it. Some 7000 new infections surface each day.

Jaevion Nelson, from the Jamaica Youth Action Network, contended that the only way to cut new infections to zero is to stop discrimination against marginalized groups. The big obstacle to zero infections, he said, is too many laws.

Mr. Nelson called for an end to laws and policies that punish drug users, criminalize behavior between consenting same-sex couples, and criminalize people because of their HIV status. Far too many people are dying because interventions fail to answer their needs. One critical factor, he said, is that affected groups do not participate in these interventions.

Laws in Jamaica, Mr. Nelson's home country, are counterproductive because they often aim to punish HIV-infected women and girls or gays and lesbians with criminal action. Mr. Nelson called on governments to adopt legal and policy frameworks to protect populations that suffer the greatest burden. He also demanded that governments endorse universal access to prevention, treatment, and care.

Reaching zero HIV infections will be a "tough, tough challenge," said Jarbas Barbosa, MD, Brazil's vice-minister of health.

A speaker from Indonesia called on the panel to target a largely ignored group, which she called the "4-M group" — millions of mobile men with money who live in a macho environment. Besides being ignored, those men blatantly ignore calls for action against HIV. But is it their human right to have sex with anybody, anywhere, anytime without concern for the consequences? These men, she said, refuse to use condoms, although they know they are putting the lives of their partners at risk. She urged the group to explore the issue and try to ensure that men become more responsible, which could cut the infection rate to zero among women, girls, and children.

A representative from the Office of the United Nations High Commissioner for Human Rights cautioned that reaching zero infections continues to be difficult, because several vulnerable groups — including men who have sex with men, sex workers, prisoners, and intravenous drug users — are not inside the social protection net, owing to a mix of neglect, intimidation, and social stigma.

"We can no longer afford to turn a blind eye to these populations," he said, calling for the most vulnerable to be given access to services and for discrimination against stigmatized groups to end.

Webcasts are available of Ban Ki-moon's opening remarks, Mr. Sidibé's remarks, and the panel discussion chaired by Ms. Jacobs.

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