Our campaign focuses on access to treatment as an area of injustice where political action is urgently needed. However, we recognise a comprehensive approach is needed to effectively tackle AIDS.
Education
There’s still low awareness of HIV/AIDS and how to avoid contracting it in many places around the world. Local education is essential to teach communities not only that the virus exists but the truth about its effects, and how it is contracted. Open discussion of sexual practices in traditional cultures is often difficult. Sadly, lots of myths surround HIV, such as the idea that the virus itself does not exist or that you can be cured by having sex with a virgin. In South Africa, senior politicians — who should be tackling the epidemic — have instead caused much damage by undermining the connection between HIV and AIDS, and denying the effectiveness of ARVs. Villagers who start wasting away in Kenya sometimes conclude they have chira - an illness invited by flouting intricate social rules.
These kind of myths and misconceptions can only be dealt with through education, promoting safe sex and awareness of the effects of the virus.
Uganda and prevention
Uganda made real progress in fighting HIV/AIDS through their prevention efforts. They made public education the first priority. Local and NGO education programmes tried to widen understanding of the condition, and how it is contracted and prevented.
Although they promoted the principles of the ABC model - ‘abstaining’ from sexual activity, ‘being faithful’ and the ‘correct use of condoms’, ABC was not used alone. Messages were designed for different groups to ensure they were effective. Efforts were made to improve the status of women, and to provide better testing and treatment for sexually transmitted infections.
Open discussion and political leadership did much to challenge stigma. Dr Frances Omaswa, director of health services at Uganda’s Health Ministry, said: “The first step was acknowledging there was a problem by the political leadership. Uganda was the first country in Africa to declare that it had a problem with HIV.”
Figures published in 2002 showed 5% of the Ugandan population had HIV, down from 15% in the early 1990s. However, since then the situation has worsened, and the epidemic remains serious.
Stigma and testing
Many of the problems surrounding condom use and availability, and effective education, come from the stigma which still exists around HIV/AIDS. Many communities have high levels of ignorance, denial, fear and intolerance about the disease itself. In many cultures AIDS is associated with immoral behaviour. This can lead to isolation for people living with HIV/AIDS, and a general reluctance in the community to get tested, be open about their HIV status, or to change risky behaviour. The lack of simple and cheap testing facilities makes this worse, though there are many innovative programmes challenging discrimination.
Western Europe and the US similarly had high levels of stigma in the early years of the epidemic, but the problem has reduced as treatment has become available and support services for people living with HIV/AIDS have been expanded.
Gender inequalities
“The gender issue is the key driving force of the epidemic” Milly Katana, an HIV-positive Ugandan
Women are disproportionately, and increasingly, affected by the epidemic.
In male-dominated societies, it is often hard for women to insist on abstinence or using condoms, although they are biologically more vulnerable to the virus. In some societies it is acceptable for a man to have sexual partners outside marriage, while women are expected to remain faithful. Unfaithful husbands can infect their wives, and HIV is then frequently passed on to children in childbirth or through breast milk.
Although women are widely disadvantaged socially and economically, and may have little control over their sexual choices, they are often blamed for the spread of the disease. Women infected by their husbands can find themselves abandoned by their husbands, and rejected by their family and community.
Although it can be hard to get data on the ability of women to access treatment, there does not appear to be any systematic gender bias in access. However, even when treatment is available, where gender inequality and stigma exists women still face formidable challenges. A recent study in Zambia showed women are still reluctant to disclose their status for fear of discrimination, domestic violence, or untested husbands insisting on sharing their treatment.
Challenging gender discrimination, providing education, and empowering women and young people to protect themselves, through a combination of providing them with appropriate sexual and reproductive healthcare, and giving them the life-skills to become more confident to negotiate safe sex, are vital in reducing the impact of AIDS.
The Avert website has a range of information about HIV/AIDS and its spread around the world.
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