Going beyond the silver bullet approach

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

At the International AIDS Conference in Washington this summer, the excitement over recent biomedical advances fizzed and bubbled and it was wonderful to be part of the chatter – whether it was around the implications of home-based testing for communities in developing countries or what the introduction of Truvada might mean if used as part of a comprehensive HIV prevention strategy.

But we also need to go beyond the “silver bullet” approach and look at the legal and cultural barriers impeding an effective global HIV response. We know that when governments fail to protect those most vulnerable to HIV, new infection rates go up. Everybody has the right to equal access to prevention, treatment, care and support services, in particular marginalised groups like men who have sex with men, transgender people, sex workers and people who inject drugs. Only if legal obstacles to access are removed and human rights are respected will we make the headway that is needed to eliminate AIDS once and for all.

Until that time however, human rights abuses will continue to fuel the epidemic and human rights violations will exacerbate the impact of the disease.

“We know that when governments fail to protect those most vulnerable to HIV, new infection rates go up.”

It’s not all doom and gloom though and we’ve seen some glimmers of light this year when it comes to legal reform.  Take the case of Argentina which in May approved the Gender Identity Law, a bill giving transgender citizens the right to have their gender recognised in law. The bill allows hormone therapy and reassignment surgery, and promotes an individual’s right to decide without needing prior medical or judicial approval.

Such a law should ultimately lead to a knock-on effect in the public health system where transgender needs will finally be addressed, increasing their access to HIV services and prevention interventions. The passing of the Gender Identity Law was the result of a brave and intense advocacy campaign by transgender people and sets an important precedent in a region with high levels of murder, violence and hate crimes against the transgender community.

At the end of September, the Alliance was pleased to hear that the Commonwealth Ministers of Foreign Affairs agreed to approve Recommendation 60, which advocates repealing discriminatory laws that undermine the global response to HIV. Our campaigning efforts, together with those of our partners and other organizations around the world, had paid off and for the 25 million people living with HIV in the Commonwealth there is now a chink of hope that current legislation which criminalises people living with HIV, people who use drugs, men who have sex with men, transgender women and other at-risk groups will at least be reviewed.

Nevertheless, we can’t afford to rest on our laurels as this success will only be confirmed once such laws are effectively repealed once and for all in Commonwealth countries and we still have a very long way to go to see this happen.

Other changes are presently afoot that could have a significant impact on how communities, and in particular most at-risk groups, are able to respond to the epidemic. The Global Fund is in the middle of an important reform process and it’s vital that civil society organisations remain at the centre of the response if we are to bring HIV, together with malaria and TB, under control. The Investment Framework for HIV and AIDS has described community mobilisation and human rights-based approaches as ‘critical’ ingredients for effective health programming and we need to be sure that the Global Fund will continue its commitment to funding programmes that are effective, strategic, based on evidence and centred on human rights.

Without communities and human rights, there is no such thing as an effective HIV response. In order to attain universal access to treatment, prevention and care, their front-line position must universally be acknowledged.

Dr Alvaro Bermejo is Executive Director of the International HIV/AIDS Alliance which works to support communities to address HIV prevention, treatment and care to most effectively reduce the spread and impact of HIV and AIDS around the world. He is also a board member for the Developed Country NGO Delegation of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

For further information on Universal Access to Treatment, see AVERT's page.

Images copyright: International HIV/AIDS Alliance