“HIV Prevention – What Really Works?”

November 16, 2008

Millennium Development Goal Number 6:
Halt and Begin to Reverse the Spread of HIV


“HIV Prevention – What Really Works?”

by Kelly N Patterson


Grim answer:  Nothing. 






Nothing sustainable will effectively work to halt and reverse the spread of HIV until the stigma and discrimination around HIV is eradicated on all levels of society:  individual, community, private and civil society sectors, the medical establishment, and all government systems.  Period.  All current HIV prevention issues are side-effects of the stigma and discrimination of being diagnosed with HIV.  Furthermore, fear of just being associated with HIV, in any way, is the chief obstacle to people getting tested, seeking and adhering to treatments, and protecting themselves and others from HIV exposure.


According to UNAIDS, AIDS Epidemic Update, December 2005, fifty percent of new HIV infections are the result of people unknowingly living with HIV/AIDS (not knowing they are HIV+), exposing HIV to others (unknowingly) through the usual suspects of bodily fluids and sharing needles.    People do not know they are HIV+ because they do not get tested, or they get tested and do not bother to return for the results. 


People do not want to be tested because the mere association with HIV, in most of the world, means death (lack of universal treatment), personal harassment as well as community isolation of their families and loved ones, job insecurity (discrimination), poverty (cannot afford quality healthcare and good nutrition), discrimination among the medical community, lack of legal protection, lack of government services, un-enforced policies (such as confidentiality agreements), and most damaging, loss of self-esteem.  Why would anyone want to know this could be his or her fate?  This fear continues to deter people from getting tested and impels people, who know they are HIV+, to hide their HIV status from even their own partners, children and family members—thus putting their partners and children at risk.


The stigma of HIV stems from the assumption, not the facts of transmission, one has done something “bad”, “immoral”, or unlawful, in order to “catch” HIV.  It has been 25 years now, and still the population in general associates HIV with drug-addicts, prostitutes, homosexuals, and promiscuous behavior, despite the overwhelming statistics that HIV is most rampant in heterosexual families of all races, creeds, education levels, and socio-economic backgrounds on every continent.  The world needs to see their celebrities, peers, neighbors, and colleagues living well with HIV, so they know most of the people living with HIV are not “bad”, or “immoral” but a lot like your cousin, Susan, who lives with diabetes, or some other chronic disease.


In some places, just asking for an HIV test at a local health clinic is suspect.  People assume you must have done something “bad” in order to request an HIV test and they assume you are HIV+ (regardless of the test results.)  In rural areas, chances are you know, or are even related to, someone working at the clinic or hospital and your chances of confidentiality are shot as soon as you request an HIV test. 


Everyone in your local pharmacy knows which drugs are for AIDS-related illnesses and the treatments for HIV, so now everyone at the pharmacy knows you are HIV.  Pregnant HIV+ women have to pretend to breastfeed in public so as not to expose their HIV status.  HIV+ women have to hide baby formula in concealed containers, in order to hide the fact that they cannot breastfeed with HIV, for fear of transmitting HIV to their infants.  Few people will boldly walk into a known “AIDS clinic” or AIDS service organization at all, much less without checking if someone is watching.  Most AIDS service organizations and clinics go to great lengths to conceal the location of their offices or clinics in order to prevent unwanted attention to their clients as they enter.


People do not realize that, in most of the world, the spouses, children, family and loved ones, even colleagues, of people living with HIV, also suffer from this associative stigma and discrimination.  Children with HIV+ parents, who are not even HIV+ themselves, are harassed in their schools.  All of these factors contribute to the spread of HIV and deter HIV prevention methods.


Studies have proven public health and safe sex campaigns are impotent; they have failed to significantly encourage sexual behavioral change.  Ignorance is confirmed by political leaders, such as South African President Thabo Mbeki, who stated, “Poverty causes AIDS”, in a speech during the 2000 International AIDS Conference in Durban, South Africa.  Medical researchers and international development workers have blamed poor education, poor quality primary healthcare, poor public infrastructures, and socio-economic factors as the common denominator in the escalating transmission of HIV throughout Africa, and most recently, new infection rates are soaring in India, the Caribbean and Central America, and Eastern Europe.  And we are yet to get reasonable statistics from our friends in China.  All of these regions are our neighbors and colleagues, and more and more, part of our families.


So if we do the math, we can see that it is inevitable that HIV will eventually reach every household on this planet, if we do not halt and reverse the spread of HIV.  This is not the place to describe what kind of destructive impact HIV has on community, business and political spheres.  But no HIV prevention campaign is going to work until the stigma and discrimination of HIV is eradicated.  Not until people can disclose their HIV safely, confidently, to loved ones, neighbors and employers, and get the concern, care and practical support they need, will people openly get tested, adhere to their treatments, and openly protect themselves and others from HIV transmission.







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