We have made huge progress in the fight against HIV/Aids in the last few decades, but there are still significant challenges. Communities most affected by the virus – sex workers, transgender people, men who have sex with men (MSM), and gay men – still face stigma and discrimination. Global infection rates have not fallen as much for these people as they have for the general population.
In fact, MSM and gay men are 19 times more likely to be infected with HIV than the general population. HIV infection between MSM and gay men ranges from 21% in Senegal, to 13.5% in Nigeria and 16% in Kenya.
Transgender women (people who are born as men but identify as women) carry the biggest burden of the virus, being 49 times more likely to contract HIV. UNAids understands this and has been encouraging the increased involvement of trans people in the fight against HIV.
Many will argue that risky behaviour is the main cause of the high rates of infection among the MSM, gay, trans and sex worker communities. While it is a factor, these people face so much stigma and discrimination that it can be challenging for them to access the healthcare they need.
When I was diagnosed with HIV in 2004, I was afraid to start treatment despite working in the field for more than three years. I was afraid because of the shame, the stigma and the discrimination. Even when I moved to the UK, I could feel the pressure of the stigma I carried with me from Nigeria.
In 2000, the International Aids Conference in Durban provided a turning point in the fight against HIV/Aids. Jeffrey Sachs, a world-renowned professor of economics and senior UN adviser, gave a moving call for the creation of a global fund for Aids. The following year, funding and political connections were secured and The Global Fund to Fight Aids, Tuberculosis and Malaria was formed. This single act of putting money in the mouth of the political dragon changed the landscape of the global HIV epidemic.
At that time, 28.6 million people were estimated to be living with HIV, yet just 690,000 (2%) of them were receiving treatment through anti-retroviral therapy (ART). By 2014, the number of people living with HIV had risen to almost 37 million, but nearly 15 million people (40%) had access to treatment. By mid-2015, 15.8 million people were receiving ART, meeting and exceeding the millennium development goal.
Now we know that we can treat and manage HIV, our biggest challenge in the fight against the virus is people’s reaction to those living with it. This must be addressed as the International Aids Conference returns to Durban in July.
The increasing criminalisation of LGBT people – especially in African countries – puts people’s lives at risk as they pursue sexual pleasure. Of the 52 countries in Africa, 35 criminalise same-sex relationships, with penalties ranging from five to 14 years’ imprisonment. Efforts to decriminalise LGBT people’s relationships and lives must be at the forefront of discussions in Durban. We do ourselves a disservice if we think the battle against HIV will be won without a global call for decriminalisation.
The continuous global criminalisation of sex work also needs to stop. Sex work is work is not just a slogan, it is the reality for men and women who sell sex, and they too need a safe work environment.
There must also be an increased focus on sensitive and humane care and support for people living with HIV in Africa – this is the only way we will drive the epidemic down further.
Aids 2016 should also be the place where discussion around pre-exposure prophylaxis (PrEP) for the most affected populations moves away from talking shop to action. We must not leave Durban without a proactive policy and a process of implementation for PrEP for the sex worker, trans, MSM and gay communities. It has been shown that if taken correctly, PrEP will work. Now is the time to take a bold step and provide access to those who need it, and follow in the footsteps of organisations such as Amsher and MSMGF, which work hard to make access to treatment a universal right.
As we prepare to return to Durban to discuss “Access equity rights now”, we need to commit to ending stigma and discrimination, including eliminating legalised discrimination. Until we do, HIV prevention and treatment will not be accessible or equitable for all.
Bisi Alimi is an HIV/Aids and LGBT advocate, and founder of the Bisi Alimi Foundation.
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