World AIDS Day offers the global HIV community a timely opportunity to reflect upon our accomplishments, take stock of the challenges we face, and renew our commitment to ending the AIDS pandemic. This is especially important today given our challenge in meeting the ambitious UNAIDS 90-90-90 targets by 2020. These targets challenge the global community to ensure that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 90 percent of all people receiving ART will be virally suppressed.
To reach these targets, we must overcome stigma and discrimination that threaten the health and rights of populations most at risk of HIV infection – including gay men and other men who have sex with men (MSM), people who inject drugs, and sex workers. And while there are many barriers to reaching and engaging these key populations in testing, care, and treatment in high-burden countries, one of the most important yet least successfully addressed is stigma.
In the late 90s, Council researchers helped conceptualize stigma as it relates specifically to HIV. We asked ourselves, “Where does it come from and what can be done about it?” We realized that stigma is a very complex issue, both based on fear of transmission, and negative judgements about certain behaviors of whole groups of people, and often informed by cultural norms, customs, and religion.
Our research demonstrated that combatting stigma and discrimination is essential for improving access to quality of HIV services, reducing fear around HIV testing, increasing retention in treatment, and improving the quality of life for people living with HIV. This is particularly important for key populations who are some of the most marginalized members of society and disproportionately affected by various forms of stigma and rights-based violations, including laws that criminalize their behaviors.
Stigma, however, can be reduced. Progress is being made, albeit slowly. One of the Council’s major contributions to the HIV field has been to provide evidence to decision-makers on just how much stigma is being faced by men who have sex with men (MSM) and their need for non-stigmatizing, life-saving HIV services. More than 15 years ago the Council, with support from USAID, took a bold step by conducting the first research on MSM in Africa. Other research, including biological surveillance and operations research, followed. We made the invisible visible to policymakers in several countries and the findings were a game-changer, resulting in increased programming and resources directed at MSM and the stigma they face. The Men’s Health Network Nigeria, a nationwide initiative directed by the Council which offers comprehensive, male-friendly HIV services free from stigma and discrimination, emerged from this work.
Providing non-stigmatizing services to marginalized groups is possible. Recently, through the Link Up project funded by the Dutch Ministry of Foreign Affairs, we showed that participatory trainings can improve health provider attitudes toward young members of key populations in Bangladesh. This improves quality of care at health facilities and satisfaction of their clients. And in this era of Test and Start, the Council, under Project SOAR, is evaluating different approaches to provide de-stigmatizing care and treatment services to sex workers in Tanzania.
On this World AIDS Day let us commit to reducing stigma in communities and health facilities by integrating efforts in to global and country HIV care and treatment strategies for populations at high risk. Achieving the 90-90-90 goals depend on it.