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3 December, 2018 10:32:04 AM
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The 30th anniversary of World AIDS Day

Bangladesh continues to be a low prevalence country, albeit one with very high vulnerability
Mohammed Abul Kalam, PhD
The 30th anniversary of World AIDS Day

This year’s theme for World AIDS Day, which marked its 30th anniversary on 1 December, 2018 was be “Know your status”. Significant progress has been made in the AIDS response since 1988, and today three in four people living with HIV know their status. But we still have miles to go, as the latest UNAIDS report shows, and that includes reaching people living with HIV who do not know their status and ensuring that they are linked to quality care and prevention services. HIV testing is essential for expanding treatment and ensuring that all people living with HIV can lead healthy and productive lives. It is also crucial to achieving the 90–90–90 targets and empowering people to make choices about HIV prevention so they can protect themselves and their loved ones. Unfortunately, many barriers to HIV testing remain. Stigma and discrimination still deters people from taking an HIV test. Access to confidential HIV testing is still an issue of concern. Many people still only get tested after becoming ill and symptomatic.
The good news is that there are many new ways of expanding access to HIV testing. Self-testing, community-based testing and multidisease testing are all helping people to know their HIV status. HIV testing programmes must be expanded. For this, we need political will and investment, as well as novel and innovative approaches to HIV testing that are fully leveraged and taken to scale. Join us this World AIDS Day in raising awareness about the importance of knowing one’s status and calling for the removal of all barriers to accessing HIV testing (UNAIDS 2018).

World AIDS Day originated at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention. Since then, every year United Nations agencies, governments and civil society join together to campaign around specific themes related to AIDS.

Bangladesh continues to be a low prevalence country, albeit one with very high vulnerability. Levels of risk behavior, in terms of high levels of unprotected sex with commercial partners, and unsafe injecting practices, make the country very vulnerable. Condom use is in Bangladesh is reportedly lowest in Asia, although the figures have been rising, due to NGO interventions. The porous borders with India and Myanmar, which are experiencing concentrated epidemics and high migration both within the country and across the borders, increase the vulnerability.

Cross-cutting issues:  Human rights: At its core, the response to AIDS is and has always been more than a fight against a disease – it is a fight for human rights. Violence, discrimination, stigmatization and persecution continue to mark the daily lives of many of the world’s most vulnerable people, increasing their risk of HIV acquisition and obstructing their access to essential health services. In some places, laws still criminalize HIV transmission, exposure and non-disclosure and being part of a key population. And health facilities, rather than acting as sanctuaries of care, are often where stigma and discrimination is most frequently experienced. With fewer than half of all people in need of treatment receiving ART, the right to health itself continues to be aspirational for most people living with HIV. I firmly believe that it is not enough to simply advocate for a human rights-based AIDS response. The protection and safe-guarding of human rights must be incorporated into every aspect of that response – from research to implementation, from policy to programming.

Prioritizing gender transformation and inclusivity in every aspect of the response: Gender: The role of gender in defining the course of the AIDS epidemic and the world’s response to it is widely acknowledged, but insufficiently addressed in many aspects of research, policy and programme design and implementation. Women and girls continue to bear a disproportionate share of the HIV burden in some of the most highly affected regions, and transgender women are among those at risk of HIV exposure. Despite this, trans and intersex people continue to be largely excluded from most HIV research and programming. Lack of gender-transformative programming, high rates of intimate partner and gender-based violence, discriminatory laws and limited opportunities for women, as well as narrow conceptualizations of gender, gender norms and sexuality, have all contributed to the making of an epidemic that cannot be successfully fought without placing gender at the centre of our efforts. The Government should be committed to integrating gender across its programmes and initiatives by ensuring that a “gender lens” is incorporated into our work. This includes advancing a response that fully accounts for gender priority interventions that are inclusive of individuals across the full gender spectrum, including men and boys whose engagement is key to challenging entrenched gender norms and inequities that fuel the epidemic.

Amplifying youth voices and empowering youth leaders: Youth: Recent progress in expanding access to ART for adults and significantly reducing the number of children born with HIV has obscured stagnation in the response for children and adolescents –adolescents are the only age group for whom AIDS-related deaths are increasing. Falling through the cracks between paediatric and adult services, young people must contend with a lack of services tailored to their specific needs. The impact of the epidemic is felt particularly acutely by young key populations and young women. Of all new HIV infections among adolescents in Asia, an estimated 95% occur among men who have sex with men, sex workers, and people who inject drug. In sub-Saharan Africa, adolescent girls account for 75% of new HIV infections among adolescents.  The voices of youth are frequently stifled, and young people are not as meaningfully involved as they should be in the policy discussions that directly affect them. To improve the AIDS response for youth, their voices must be heard and listened to every step of the way – from research, to policy, to programme implementation.

The right to health is the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, as enshrined in the 1966 International Covenant on Economic, Social and Cultural Rights.

This includes the right of everyone including people living with and affected by HIV, to the prevention and treatment of ill health, to make decisions about one’s own health and to be treated with respect and dignity and without discrimination. Everyone, regardless of who they are or where they live, has a right to health, which is also dependent on adequate sanitation and housing, nutritious food, healthy working conditions and access to justice. The right to health is supported by, and linked to, a wider set of rights. Without the conditions to ensure access to justice, the right to a clean environment, the right to be free from violence or the right to education, for example, we cannot fulfill our right to health. Ending AIDS as a public health threat can only happen if these rights are placed at the centre of global health, so that quality health care is available and accessible for everyone and leaves no one behind.

The 2030 Agenda for Sustainable Development reflects the interdependence and complexity of a changing world and the imperative for global collective action. In shifting from so-called development for the poorest countries to sustainable development for all, the global agenda has expanded in scope and complexity. As a set of indivisible goals, the SDGs give all stakeholders a mandate for integration of efforts. The AIDS response is no exception: the epidemic cannot be ended without addressing the determinants of health and vulnerability, and the holistic needs of people at risk of and living with HIV. People living with HIV often live in fragile communities, and are most affected by discrimination, inequality and instability. Their concerns must be at the forefront of sustainable development efforts.  

By extension, lessons learned from the multisectoral, multi-stakeholder AIDS response are key to progress across the SDGs. The AIDS response has advanced such issues as the right to health, gender equality, health information systems, service delivery platforms, commodity access and security and social protection. The response has garnered substantial experience in addressing entrenched social norms, social exclusion and legal barriers that undermine health and development outcomes, and its investment approach is increasingly being adopted to accelerate gains across global health and development. The AIDS response can be a leader in leveraging strategic intersections with the Sustainable Development Goals (SDGs), while disseminating lessons learned from three decades of unprecedented progress.

-Civil society activists, working closely with researchers and national regulatory authorities, promoted unprecedented investment in AIDS research and accelerated access to new medicines. This enabled new medicines and combinations to get to patients faster than ever before. Pressure from the global AIDS movement also ensured that the prices of new medicines were rapidly brought down to make them affordable to almost every country in the world.

States should adhere to the following basic human rights obligations: (1) Respect: refrain from interfering with a person’s ability to fulfill their right to health (2) Protect: act to prevent third parties from interfering with a person’s ability to fulfill their right to health (3) Fulfill: adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures to enable everyone to fully realize their right to health and put measures in place to actively inform and promote the fulfillment of the right to health (4) Almost all of the Sustainable Development Goals are linked some way to health(5) Achieving the Sustainable Development Goals, including ending AIDS as a public health threat, will depend heavily on ensuring the right to health for all; and (6) Only by placing rights at the centre of global health can quality health care be available and accessible for everyone, leaving no one behind.

The writer is former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR), Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com

SHK

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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