06 December 2005

Wednesday November 30, 2005
Lip service is useless
It's another World AIDS Day tomorrow and there is some good news to announce. According to the latest UN AIDS report, sustained efforts “have yielded decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injecting drug users in Spain and Brazil.” Also, prevention programmes that were begun some time ago are finally bringing down HIV prevalence in Kenya, Zimbabwe and urban Haiti.
That’s it. For the rest of us, it’s still gloom and doom. Some 40.3 million people are now living with HIV, 4.9 million of them newly added in the last year. And 3.1 million adults and children died of AIDS last year.
What is going wrong? You would think that a global pandemic that has killed more than 25 million people since it was first recognised in 1981 – making it “one of the most destructive epidemics in recorded history” – would grab more attention. Indeed it has: government leaders talk about it at major gatherings, the rich ones pledge money, the less rich ones clasp their hands in gratitude. But still, more people are getting infected and more and more are dying, more than half a million of them children in the last year alone.
What is happening? National responses to HIV/AIDS in many countries can be summed up in two words: lip service. In 2001, every single country in the world, after much time-wasting wrangling, agreed to implement the recommendations in the UN General Assembly Special Session’s Declaration of Commitment. Yet, in 2005, most have not. One of the agreed-to recommendations is that by this year, most young people would have access to HIV education. Why then are we in Malaysia still talking about whether or not to have HIV (and sex) education in schools?
Two years ago, the World Health Organisation rolled out its much-vaunted three-by-five access to treatment programme. This means that by 2005, three million people around the world would be on antiretroviral (ARV) therapy. Has it happened?
More than one million people in low- and middle-income countries in the past two years are living longer and more productive lives because they have had access to ARVs and between 250,000 and 350,000 deaths were averted because of it. But this is still far short of the target. In Malaysia, the government announced that it would provide up to 4,000 Malaysians living with HIV with ARVs, even though it is estimated that about 7,000 actually need them. Yet only about 2,500 are actually getting the treatment. Has anyone looked into why exactly the rest are not coming forward? (We cannot assume that everybody will read the papers or watch TV the one time this was announced.) Do they know where to go and will they get fair and professional treatment when they do go?
Prevention is another thing. As long as we remain queasy about realistic prevention programmes – and that means promoting condom use consistently to ensure safer sex by everyone, and harm reduction programmes for injecting drug users – we will never make a dent in the course of the epidemic.
Why aren’t we in Malaysia doing enough prevention? Firstly, because it means having to deal with things we don’t want to deal with, such as drug use, and sex outside marriage, among young people and between people of the same sex.
Secondly, when we do try and deal with them, we refuse to use programmes that have been known to work, preferring to believe that we are so unique that we need our own. We refuse to promote condoms because we think it causes more people to have sex. Yet from the evidence from countries where condom programmes have been comprehensive and long term, the results are showing.
Thirdly, we need to do programmes at a scale that actually makes a difference. Fourthly, we need to seriously deal with stigma and discrimination.
The stigma of AIDS derives from its perceived associations with death, with shame and with behaviour that we regard as anti-social. It also comes with fear of infection. But with treatment, having HIV does not necessarily mean one gets AIDS or dies anymore. Not everybody who has HIV is a drug user, sex worker or gay, as the 17.5 million HIV-positive women, mostly married to only one partner, will attest. Fear of infection can be reduced through intense and accurate facts about how HIV is and is not transmitted. Dealing with stigma and discrimination also means not tolerating cruel and inhuman statements coming from people who may not know much about HIV, even though they hold positions of authority.
When are we seriously going to walk the talk?
For updates on the global AIDS pandemic, go to www.unaids.org