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HIV – these three letters meant a death sentence 35 years ago when the virus was first linked with AIDS, in a time when Star Wars was only a trilogy, and when the first personal computer was starting to revolutionise society as we knew it.
 
On January 23, 1983, Dr Luc Montagnier, of the Pasteur Institute in Paris first identified the Human Immunodeficiency Virus (HIV) as the causes of AIDS, a rare disease among homosexual men that was to become one of the worst epidemics in human history.
 
Yet these three letters have come to mean something very different over the past 35 years. Now, people can live with HIV, the knowledge of the disease has dramatically improved and a child may be born free of the virus from a mother that is HIV positive. 
 
By 2020, the aspiration is that the world will have achieved UNAIDS’s so-called 90-90-90 target - 90 percent of people infected by HIV/AIDS should know their status, 90 per cent of these people should be on antiretroviral treatment, and 90 per cent of people on treatment should have undetectable levels of the virus. 

Since the universal access to antiretrovirals, the prevention focus was lost, and the focus is only on care,

Felipe Varela Ojeda

However, in the regions where most HIV-positive people live – African and Latin America and the Caribbean – there is a long way to go to meet these goals, according to UNAIDS in its 2017 status report Ending AIDS: progress towards the 90-90-90 targets.

Combined pic of new infections 2016 ii

Only one African country, Botswana, is among the seven worldwide that had already achieved the 90-90-90 goal, joining Cambodia, Denmark, Iceland, Singapore, Sweden and the United Kingdom.
 
In Latin America and the Caribbean, four countries have achieves at least one of the goals - Ecuador, Haiti, Brazil and Chile. That’s after some countries in the region made giant strides with the disease, including Cuba becoming in 2015 the first country to eliminate mother-to-child transmission of HIV.
 
The problem is that, despite the progress, stigma and ignorance are still hampering efforts to fight the disease in parts of Africa and Latin America, where most of the people living with HIV are located. Many states must still work to reverse the stigmatization of certain segments of the population such as homosexuals and drug users.

In Togo, for example, a survey by the Centre National de Lutte contre le Sida (CNLS) shows that infection rates are almost one in five among gay men, compared with 2.4 per cent nationally.

Combined pic of ART trtmnt 3
 
In Rwanda, prevalence among sex workers is estimated at 45 per cent nationwide, and 51 per cent in the capital Kigali, according to a 2015 government-led demographic and health survey.
 
"The discrimination that these groups often suffer prevents them from accessing screening and antiretroviral treatment," Claver Dagnra, the coordinator of CNLS in Togo, told SciDev.Net.
 
Most serious problem
But it is not only in Africa that this stigma is devastating. Gracia Violeta Ross, president of the National Network of People Living with HIV and AIDS in Bolivia, believes, for example, that "Stigma is the most serious problem. In Bolivia, there is very little information about HIV. The existing one indicates that it is a situation that should only concern risk groups, such as men who have sex with men, transgender women."
 
In recent years, the focus of in managing HIV/AIDs has shifted towards treatment with antiretroviral drugs as awareness levels rose across the world. However, as a result of these stigmatised communities, many observers continue to say that prevention must be placed once again at the heart of the campaign against HIV/AIDS to stop its progress.


Selected countries: % of people living with HIV recieving ART in 2015 (Source: UNAIDS)

In Colombia, for example, it is estimated that the use of condoms in the Colombian general population varies between 9 per cent in young people in certain medium-sized cities and 20 or 30 per cent in uninfected men and women, and up to 96 per cent in HIV-positive sex workers.
 
The situation is almost the same in Brazil, which has been a leader in fighting the disease and was the first country to defy patent laws covering the antiretroviral drug AZT. The main challenge there is still to fight the spread of the disease in remote areas. There, the population is more vulnerable, with limited access to health services, lower income, less education, less access to information and less ability of women to demand condom use, in addition to child prostitution.
 
"Since the universal access to retrovirals, the prevention focus was lost, and the focus is only on care,” said Felipe Varela Ojeda, investigator at Fundar Center for Analysis and Research in Mexico.
 
And in fact on this aspect of awareness, Marcelo Vila, sub-regional consultant on HIV, tuberculosis and hepatitis in Argentina says that, "the biggest challenge is diagnosis".

"Many people still do not know that they are infected.”
 
Additional reporting by Martin De Ambrosio, Paula Leighton, Aleida Rueda, Claudia Mazzeo, Rodrigo De Oliveira, María Paula Rubiano, Ana Laura Arbesú, Virgile Ahissou, Raphaël Djamessi,  Aimable Twahirwa, Richard Douala.

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