Ready to Do More for Access, Equity, and Rights Now
“Bringing the marginalized to the center of attention,” could have been the subtheme for this year’s International AIDS Conference held July 18-23, 2016 in Durban, South Africa. Access, Equity, and Rights Now was the conference’s official theme. It demanded that we focus on key populations affected by HIV that countries and communities often ignore, shun, criminalize, and stigmatize.
Sex workers; adolescent girls; men who have sex with men (MSM); people who inject drugs; women; and transgender people were addressed by speaker after speaker, demonstration after demonstration, and session after session. These populations exist on the margins and outskirts of power, but they were given prominent attention in Durban. And rightly so. These key populations require greater Access to prevention, treatment, and care. They need programs targeted to their unique issues to attain health Equity for all people affected by HIV. We need fair laws and policies to recognize and protect the Rights of all citizens affected by HIV.
The global population of people living with HIV grows by two million people a year, largely driven by increasing transmission in these key populations. While death rates decline when people obtain antiretroviral therapy (ART), only about 46% of the nearly 37 million people living with HIV are on treatment today. This dramatic and welcome increase in access has occurred in a short few years. But, the converse of that percentage is still a problem. More than half of the world’s people living with HIV live only on hope and do not have access to ART that can create a suppressed viral load to help them live a long life. We have a long way to go to on the path of Access, Equity and Rights to achieve our goals.
The UNAIDS goal for 2020 is ambitious—90-90-90. That means 90% of people living with HIV know their status, 90% are on treatment, and 90% are virally suppressed. We will never reach those goals if the key populations of marginalized people are not the focus of our attention as they were in Durban.
Unfortunately, sex workers and adolescent girls are often not thought of as having rights. MSM and same gender loving people face criminal laws in 77 countries, and along with people who inject drugs, face relentless stigma and discrimination. Women face power struggles in their own homes, families, and jobs, while transgender people struggle to be recognized and included in public health data and plans.
Americans attending the conference heard repeated reference to our HIV continuum and how far we have to go on Access, Equity and Rights. We are challenged at home to meet the goals of our National HIV/AIDS Strategy (NHAS) and reach its indicators updated for 2020. Those indicators focus on ending health disparities and on marginalized and stigmatized groups in the U.S. such as people who inject drugs and young Black gay men.
Doing more for marginalized populations is the key to achieving our national and global goals.
Doing more was my personal give and takeaway in Durban. I had the chance to speak on a plenary panel at a two-day pre-conference event for the faith community sponsored by UNAIDS. With the 2016 main conference theme of Access, Equity and Rights inspiring that event, I found myself quoting an ancient scripture passage, “Do justice and love mercy.” The HIV community has had many allies and supporters who do mercy and love justice, but I am concerned that the opposite is too often true. Loving justice while doing and delivering compassion may not be enough. Our love for doing acts of compassion has done wonders around the world, but the conference made clear that we have so much more to do for justice.
Stigma, discrimination, and criminalization target and demean people at the margins, making them more at risk of infection, less likely to know their status, and access treatment and care. At home, Medicaid expansion in southern states would bring greater justice to black and rural HIV populations. Around the world key populations affected by HIV are crying out for justice. Their voices and needs were heard loud and clear in Durban.
To achieve the goals of 90-90-90 and of our National HIV/AIDS Strategy, marginalized people must be the center of our attention and the focus of our advocacy. Prevention, treatment, and care should know no borders and no demographic bounds. We have much to do to create a just world where Access, Equity and Rights are true for everyone effected by HIV.
I came home from Durban ready to do more.
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