World AIDS Day 2018: Ending HIV/AIDS, together, with communities
The 1st December always bring forth a sense of consciousness and awareness that HIV and its wounds are still among us, fresh, unhealed. As we embark or different organising, commemorations, candlelight memorial and HIV-testing around the World AIDS Day this 1st December 2018, worldwide, some 36.9 million people are living with HIV worldwide, over 9 million people living with HIV need access to testing services, only some 59% of those living with HIV are accessing Antiretroviral Therapy (ART) and nearly 1 million people died due to AIDS related issues in 2017. Availability, accessibility and affordability of HIV-related services are amiss in a technology-fast moving world. Can we be insensitive to these figures?
In Mauritius, end June 2018, there has been some 7,203 people reported living with HIV of which only some 79% are accessing ART. People Who Inject Drugs (PWIDs), Gay and Bisexual men, Sex Workers, Prison Inmates and Transgender people are among those mostly infected; the epidemic being a concentrated one in Mauritius. These groups of people are what we would term as Key Affected Populations (KAPs). In addition, vulnerable populations such as young people, on street youths, disabled persons, people in rural areas, women and girls are more prone to being infected in HIV. Yet, programs are still failing KAPs and Vulnerable Populations.
Tackling the HIV epidemic would not have been possible without community efforts. In fact, studies have shown that when communities consisting of KAPs are empowered to provide HIV related services, there is a better reach to those mostly affected by HIV, better uptake of HIV services and KAPs are empowered in a holistic way. There is no doubt that Sex workers, PWIDs, Gay and Bisexual Men, Transgender people and Prison Inmates would feel more at ease in availing of services when their peers will offer and support them with same.
Empowerment of KAPs through KAPs-led organisations reinforces these mostly affected populations in not only tackling the HIV virus as a health issue, but in fact, strengthens the broader advocacy and general services to the communities they serve. Having a voice in the efforts against HIV means showing the disproportionate way HIV affects criminalised populations, highlighting and fighting the perpetual stigma and discrimination and being there at the discussion table to speak for what matters most to you as a KAPs.
While HIV programs were to strengthen KAPs-led organisations, in Mauritius, unfortunately, owing to failing and abysmal organisational politics and hook-or-crook funding agenda of big organisations, KAPs-led organisations are in a situation where funding are shrinking, lip service is the sole pre-requirement to continued programming, and Gay and Bisexual Men and Transgender people are the sole KAPs not leading their struggles through their organisations.
Complementary national health services
Organisational efforts are however insufficient to curb the epidemic. Mauritius has enjoyed a governance system where State services, the Private Sector and NGOs work synergistically to complement and supplement each other’s efforts – the Private healthcare sector to a lesser extent, alas. Governmental infrastructure, budgeting and staffing are enabling greater than before reach to a range of HIV-related services; even if the advocacy and broader services to KAPs are abysmally missing.
Moving towards health options
Programming around HIV/AIDS has so far been so focused on the health aspect that despite a decade of sustained funding to curb the virus, KAPs are still criminalised. Drawing a leaf out of the recent Indian Ocean HIV/AIDS colloquium held in Mauritius, HIV-related services are to a large extent prescriptive, reaching KAPs with “core packages” are figures to be filled in end of year targets to be reported to funding, needs of KAPs are often left out of the table – simply put, policy actors have, through blatant amateurism, reduced the struggle against HIV to a seemingly one-size-fits all programme.
Yet, with the change in marketing and business practices; even among NGOs and service providers, people-centred interventions and solutions proposals are the core of business activities and service provision. Moving towards available, affordable and accessible health options is the way forward, taking the needs of beneficiaries at the centre of interventions. Health options would therefore be to propose tailor-made quality services to beneficiaries over quantity, together and through KAPs focused NGOs.
The philosophy of the incremental change in approach is at the basis of the fact that as individuals with different ways of life, different beliefs, different physical needs, different mental states and different social determinants, a one-size-misfits-all intervention is not attractive. Rather, understanding the needs of the beneficiaries and proposing people-centred-solutions will ensure effective and efficient reach, higher retention in services and meaningful advocacy to decriminalise KAPs. Let us speak about HIV and issues related, yes, and let us also speak freely about laws, taboos, and sexuality openly, YES!
Health option further means allowing beneficiaries choosing their service provider or range of service providers, from State owned, NGOs to the Private healthcare sector. What if insurances covered HIV-related issues? What if drug stores offered HIV-related materials such as condoms, lubricant, needles and pills? What if private medical practitioners offered anonymous HIV-testing services? What if private clinics took at their charge AIDS-patients with better technologies and therapies? Health options is about the choice of services as well as the choice of service providers!
The 90-90-90 target by 2020, that 90% of people living with HIV are detected, 90% of those detected are on treatment, and 90% of those on treatment are virally suppressed is not at hand’s reach for KAPs nor for Mauritius. Gay and Bisexual men are stigmatised, pushed underground and unaccounted for in many parts of the world. New HIV options such as PrEP are being introduced but violence against Sex Workers are not being tackled thus, reducing intake of HIV-related services including PrEP. The wars on drugs are ever so pronounced with drug users treated like the worst of criminals. The voices and efforts of young people as vulnerable groups are undervalued and undernarrated in the struggle. Interest of big-pharma and private healthcare in HIV, if any, is money-related.
Despite some improper decisions, let us be reminded that the 1st December still is because of love; the love we have in reminiscing of our dear ones losing themselves to AIDS; the love that despite being Queer in some countries is criminal, equality in love is gaining inch-by-inch around the world; the love that despite being HIV-positive, one can still be in a safe and loving relationship; and, that one’s love for life triumphs on the World AIDS Day.