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"Lip service is useless"
The
Star (www.thestar.com.my)
(30/11/05)
Byline: MARINA MAHATHIR
IT’S another World AIDS Day tomorrow and there is some good news to
announce. According to the latest UN AIDS report, sustained efforts “have
yielded decreases in HIV incidence among men who have sex with men in many
Western countries, among young people in Uganda, among sex workers and their
clients in Thailand and Cambodia, and among injecting drug users in Spain
and Brazil.” Also, prevention programmes that were begun some time ago are
finally bringing down HIV prevalence in Kenya, Zimbabwe and urban Haiti.
That’s it. For the rest of us, it’s still gloom and doom. Some 40.3 million
people are now living with HIV, 4.9 million of them newly added in the last
year. And 3.1 million adults and children died of AIDS last year.
What is going wrong? You would think that a global pandemic that has killed
more than 25 million people since it was first recognised in 1981 – making
it “one of the most destructive epidemics in recorded history” – would grab
more attention. Indeed it has: government leaders talk about it at major
gatherings, the rich ones pledge money, the less rich ones clasp their hands
in gratitude. But still, more people are getting infected and more and more
are dying, more than half a million of them children in the last year alone.
What is happening? National responses to HIV/AIDS in many countries can be
summed up in two words: lip service. In 2001, every single country in the
world, after much time-wasting wrangling, agreed to implement the
recommendations in the UN General Assembly Special Session’s Declaration of
Commitment. Yet, in 2005, most have not. One of the agreed-to
recommendations is that by this year, most young people would have access to
HIV education. Why then are we in Malaysia still talking about whether or
not to have HIV (and sex) education in schools?
Two years ago, the World Health Organisation rolled out its much-vaunted
three-by-five access to treatment programme. This means that by 2005, three
million people around the world would be on antiretroviral (ARV) therapy.
Has it happened?
More than one million people in low- and middle-income countries in the past
two years are living longer and more productive lives because they have had
access to ARVs and between 250,000 and 350,000 deaths were averted because
of it. But this is still far short of the target. In Malaysia, the
government announced that it would provide up to 4,000 Malaysians living
with HIV with ARVs, even though it is estimated that about 7,000 actually
need them. Yet only about 2,500 are actually getting the treatment. Has
anyone looked into why exactly the rest are not coming forward? (We cannot
assume that everybody will read the papers or watch TV the one time this was
announced.) Do they know where to go and will they get fair and professional
treatment when they do go?
Prevention is another thing. As long as we remain queasy about realistic
prevention programmes – and that means promoting condom use consistently to
ensure safer sex by everyone, and harm reduction programmes for injecting
drug users – we will never make a dent in the course of the epidemic.
Why aren’t we in Malaysia doing enough prevention? Firstly, because it means
having to deal with things we don’t want to deal with, such as drug use, and
sex outside marriage, among young people and between people of the same sex.
Secondly, when we do try and deal with them, we refuse to use programmes
that have been known to work, preferring to believe that we are so unique
that we need our own. We refuse to promote condoms because we think it
causes more people to have sex. Yet from the evidence from countries where
condom programmes have been comprehensive and long term, the results are
showing.
Thirdly, we need to do programmes at a scale that actually makes a
difference. Fourthly, we need to seriously deal with stigma and
discrimination.
The stigma of AIDS derives from its perceived associations with death, with
shame and with behaviour that we regard as anti-social. It also comes with
fear of infection. But with treatment, having HIV does not necessarily mean
one gets AIDS or dies anymore. Not everybody who has HIV is a drug user, sex
worker or gay, as the 17.5 million HIV-positive women, mostly married to
only one partner, will attest. Fear of infection can be reduced through
intense and accurate facts about how HIV is and is not transmitted. Dealing
with stigma and discrimination also means not tolerating cruel and inhuman
statements coming from people who may not know much about HIV, even though
they hold positions of authority.
When are we seriously going to walk the talk?
* For updates on the global AIDS pandemic, go to
www.unaids.org.
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