What will it take to end HIV?

Meera Senthilingham , 2017;

This article maps out the global AIDS response from the moment that Nelson Mandela made a speech drawing attention to the scale of the AIDS crisis in Africa in 2000, at the 13th Annual AIDS conference. In Mandela's words, the AIDS crisis was “a tragedy of unprecedented proportions…claiming more lives than the sum total of all wars, famines and floods, and the ravages of deadly diseases such as Malaria.” This speech was a turning point in the epidemic, when it became clear that tackling HIV rates required a radical shift in thinking.

Written by Meera Senthilingham, the article is published on the new-look website of the London School of Hygiene & Tropical Medicine.

The rise of ART

Since 2000 there has been a dramatic change in the global AIDS response, with ART being made more available to those who needed it most. Numbers of people accessing antiretroviral treatment increased from 0.1 million in 2002 to more than 10 million people in 2014. This victory still represents only 41% of people in need of treatment, but the benefits have been huge.

Gender

Aside from biomedical intervention a focus has also shifted to vulnerable groups, which is reflected in the work of STRIVE.

Globally, women constitute more than half of the numbers infected with HIV, and in sub-Saharan Africa, women make up 58% of all people living with the infection, according to UNAIDS.

“Gender inequality is a central issue that shapes women’s vulnerability to HIV. ... Power imbalances between women and men, both social and economic, can severely limit women’s options to protect themselves from HIV. ... A woman might exchange sex for access to finances, a job or to acquire essential items such as sanitary wear or school fees, through to commodities such as air credit on their phone.”

Prof Charlotte Watts, ­­­­founder of the Gender Violence and Health Centre at the School, currently seconded to the Department for International Development (DFID) as Chief Scientific Adviser.

Relationships with older men are also not uncommon. “If these relationships are with men who are at higher risk of HIV, this puts adolescent girls at increased HIV risk."

Violence 

Researchers at the Gender Violence and Health Centre (GVHC) are currently trialling a range of interventions, including community studies that aim to

  • empower women to increase their economic and social independence
  • communicate openly and peacefully to solve any problems in their relationships
  • try new, more equitable and less violent behaviours

Findings show that beliefs and practices that seem set within a community can in fact be changed. The SASA! trial in Uganda worked with whole communities, including women and men, the police, religious and local leaders, to get them discussing the implications of gender inequality and violence, and to support them to resolve conflicts peacefully.

“Women’s experience of physical partner violence in those communities reduced by over a half. ... Men in intervention communities also reported less extramarital sexual relationships. ... It’s easy to think that issues are too ingrained, too difficult, too complex, but what our research is showing is that we can achieve quite a big impact over programmatic timeframes."

Prof Watts

In other studies, interventions such as Parivartan use sport to engage the adolescents and get both boys and girls talking about sex, equality and relationships. The hope is that by reaching them early and changing attitudes, this next generation will have new behaviours to pass on. 

Read the full article here.

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