Explained | World AIDS Day 2023: Human rights backlash threatens global AIDS response, says UN

The head of the United Nations AIDS programme recently warned that an unprecedented backlash against human rights which is leading to the stigmatisation of groups most at risk of HIV infection is putting the global response to the potentially life-threatening condition “under threat”.

Every year since 1998, December 1 has been observed as World AIDS Day. The international day is dedicated to raising awareness and showing support for those living with and affected by HIV and to remember those who lost their lives to AIDS. 

But before we delve into the long history and complexities surrounding HIV/AIDS epidemic it is important to understand the basics. 

Difference between HIV and AIDS

Human immunodeficiency virus, or HIV is a virus which attacks the immune system, specifically T cells that help the body fight infections. 

If left untreated, over time the virus destroys so many of these cells that a person is more vulnerable to other infections and diseases, eventually leading to the most severe form of an HIV infection – acquired immunodeficiency syndrome, or AIDS. 

The virus can spread through bodily fluids of a person with HIV but most commonly during unprotected sex and the sharing of needles for drug use, and also from parent to child. 

Why is the global response to AIDS under threat? 

Countries which have stringent laws against LGBTQ+ people or that criminalise sex work or personal drug use are largely the places witnessing a rise or plateau in new infections, Winnie Byanyima, executive director of UNAIDS told Reuters. 

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She also attributed this rise in infections to stigma, discrimination and a lack of comprehensive sex education. “This pushback - anti-human rights, anti-democratic, anti-gender equality - has put our work under threat,” said the UNAIDS chief. 

The US Centers for Disease Control and Prevention (CDC) defines ‘HIV stigma’ as “negative attitudes and beliefs” about people with HIV and labelling them as a part of a group which is believed to be “socially unacceptable.” 

This stigma has proven to be a hurdle in the testing and prevention of HIV. It has taken years of consistent awareness programmes and community-led initiatives to destigmatise HIV and encourage testing and treatment to contain the epidemic, but it still tends to be one of the biggest barriers to seeking HIV treatment. 

This stigma is also said to be rooted in the fear of HIV. Since the virus first emerged around the 1980s – before HIV was identified as the cause of AIDS – the infection was thought to only affect specific groups, such as gay men and people who use needles to inject drugs. 

In the US, though the virus reportedly first emerged around the 1970s, it was not until a decade later that it came to the public’s attention and subsequently turned into panic. Since the disease, at the time, appeared to affect mostly homosexual men, people began considering AIDS as a “gay disease” for many years. 

It was not until September 1982 that the CDC used the term AIDS to describe the disease for the first time, and by then HIV had spread to several European countries too. 

The virus was first isolated by Dr Françoise Barré-Sinoussi and Dr Luc Montagnier in 1983 at the Institut Pasteur in Paris. The pair received the Nobel Prize in Physiology or Medicine for their discovery in 2008. 

Decades-long epidemic

Over the years, scientists have managed to develop medicines for HIV treatment which reduce the amount of HIV in a person’s body and allow them to stay healthy. However, the decades-long epidemic is far from over. 

According to the WHO, HIV remains a major global public health issue which has claimed the lives of over 40 million people since the beginning of the epidemic. Even today, some report a rise in new infections. HIV also remains incurable.

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At the end of 2022, at least 39 million people were still living with HIV, out of which 1.3 million were newly infected, according to the figures released by the UN health agency in July. 

According to UNAIDS data, nearly 30 million of them are getting treatment, but there were still 630,000 deaths due to AIDS-related illnesses, in 2022. 

Let communities lead

The UN programme on HIV/AIDS aims to end the AIDS epidemic by 2030 and, as per a report published in July, has sought to achieve this by “95-95-95” targets, which include: 95 per cent people living with HIV knowing their HIV status, 95 per cent people who know they are living with HIV being on lifesaving antiretroviral treatment, and 95 per cent people who are on treatment being virally suppressed. 

But testing remains crucial. According to UNAIDS, an estimated 5.5 million were living with HIV but were unaware of their status in 2022. 

This delay or not receiving timely HIV treatment has been attributed to lack of access to healthcare; anticipated or encountered stigma and discrimination; logistical challenges of accessing care or collecting medication; and the possibility of inciting anger and mistrust in partners or family members, wrote a group of researchers in the journal Nature.

A report published by UNAIDS titled ‘Let Communities Lead,’ says “The world can end AIDS, with communities leading the way.” 

While the report in July highlighted “strong political leadership”, the new report calls for the upliftment of community organisations by recognising and funding them to help fight stigma and the wider backlash. 

Communities connect people and are more person-centred public health services, build trust, monitor the implementation of policies and services, and hold providers accountable, according to the UNAIDS report. 

However, they are often held back due to their leadership, it noted. This includes funding shortages, policy and regulatory hurdles, and crackdowns on civil society and the rights of marginalised communities, which are obstructing the progress of HIV prevention and treatment services.

“The end of AIDS is possible, it is within our grasp,” said Byanyima, in a statement. “To follow the path that ends AIDS, the world needs to let communities lead.”

(With inputs from agencies)