Over the next week thousands of delegates will arrive in Washington DC for the XIX International AIDS conference. Barack Obama’s decision to lift the travel ban on HIV-positive people means that for some it will be their first time on US soil. It’s a good moment to take stock of where we have come from, where we are going, and what we might be looking out for this week.
Over the past few years, there has been a series of good-news stories and successes – attempts to address the asymmetries of the global epidemic, as others have termed them – in efforts to control and curb the AIDS epidemic.
- HIV prevalence is reducing in many parts of the world, especially amongst young people in high-burden countries (eg UNAIDS, 2011 Ghys et al 2010).
- Access to HIV-treatment, while still not sufficient, is improving with increasing numbers of people being able to access and continue to take anti-retroviral treatment (ART).
- Treatment as prevention (TASP) has been shown to reduce HIV transmission rate potentially by as much as 96 per cent.
- There is growing excitement about a potentially AIDS-free generation with the UNICEF-led global plan towards elimination of new infections among children.
- From a human-rights and inclusionary perspective, not only are key populations, or those who are considered to be most at risk of acquiring HIV (sex workers, men-who-have-sex-with-men (MSM), transgenders, injecting drug users (IDUs) ), who for many years have been ignored/neglected, becoming more acknowledged/recognised as an essential part of national responses, but the recent release of the HIV and law commission report also demonstrates the significant strides made in the past few years in this domain.
Despite the above achievements, however, challenges remain.
- Coverage of HIV treatment is still far from ideal in terms of reaching targets, with over 9 million people still living beyond the reach of treatment programmers.
- Stigma and discrimination remain rampant both towards people living with HIV (PLHIV) and key populations.
- Even though key populations are becoming more acknowledged, only those who are willing to be identified as such are coming forward; the vast majority remain hidden, reluctant to come forward because of issues of illegality and/or stigma related to their practices and behaviours.
- We still do not have answers to many critical issues including, importantly, the behavioural and social implications of these scientific advances and the lack of robust social-science contributions to these questions.
Going into the conference, the following are some questions I would like to see explored.
To what extent are we seeing reductions in funding for HIV and AIDS? What are the implications of scientific advances? Might this be the time and opportunity to move towards seeing HIV and AIDS from a more holistic perspective, as part of a broader development agenda, integrated into wider health issues including sexual and reproductive health – thus perhaps also showing that there is value for money and cost effectiveness in integrating and linking?
It is critical to build on existing learning and evidence. Much evidence already exists on issues such as how to engage communities in fighting stigma, and in supporting HIV prevention and treatment. However, ways to harness this learning to influence programming and policy is not sufficiently addressed. As such, not only would I want to see interesting and innovative approaches and findings coming from the field but also lessons on how to use this learning, how to adapt and replicate it for different contexts, how to scale it up and how to build in issues of sustainability and continuity.
Where is the social? While science is moving forward, the impacts of this science on individuals, families, communities, how it is understood and incorporated into people’s lives remains a largely neglected area in these debates. I’m involved with an association of social scientists – Association for Social Scientists and Humanities in HIV (ASSHH). A first conference was held in June 2011, a second conference will be held in July 2013, with the aim to bring rigorous social science to these debates, to try to influence and shape the largely medical-led agenda in HIV and AIDS, and to ensure that at such international conferences the social-science track goes beyond merely presenting findings from community and NGO studies, which clearly are also critical, to presenting both a rigorous counter-argument and proposed agenda to the level of that presented by the bio-medical community.
Hence in this conference I hope to see more, and more rigorous, social-science presentations providing real alternatives and ways forward to some of the challenges the bio-medical community are facing as they often discover that some of their technologies, against expectations, are in reality not being taken up.