ASIA: After Medical Gains in HIV, Time to Tackle Stigma

By IPS Correspondents Reprint | | Print |

Johanna Son

BALI, Aug 11 2009 (IPS) - One can take anti-retroviral therapy to cope with HIV. But how does one remedy the deeply rooted social inequities that marginalises groups like men who have sex with men and drug users, as well as women, putting them out of the reach of efforts to address the pandemic?

This question, at the core of discussions at Tuesday’s plenary session at the 9th International Conference on AIDS in Asia and the Pacific (ICAAP) here, points to what many say is the next big step in the fight against HIV and AIDS.

This involves chipping away at society’s judgmental baggage — attitudes and prejudices that violate the rights of many groups with vulnerable behaviour to get information about HIV and AIDS prevention, and to be treated and cared for, if they do get ill.

“There is no magic pill to this,” said Geeta Rao Gupta, president of the Washington-based International Center for Research on Women (ICRW).

Nearly three decades after the earliest HIV cases were reported, the “technocratic, biomedical way” of addressing the pandemic has been the main approach the world over, she added. But after working on medical and scientific responses, “the only way the efforts against HIV and AIDS can succeed is if social and structural changes are undertaken,” Gupta argued.

No less than social change is needed to strengthen the potency of the medical gains made in coping with the pandemic, experts agree. “Human rights deficits and abuses fuel the epidemic,” U.N. Deputy High Commissioner for Human Rights Kyung-wha Kang said, even though the centrality of human rights in addressing HIV has become a “widely accepted premise” today.

Michael Tan, head of the University of the Philippines’ anthropology department and a reproductive health and sexuality advocate, likened the inequities that contribute to the pandemic to “underlying conditions” that medical experts use to describe which groups of people more likely to be affected by illnesses such as the H1N1 virus.

It is time to “fight the virus and the underlying conditions behind it” together, he explained, “but there are much more to ‘underlying conditions’ than physical ones”.

This is because social factors shape who gets access to treatment, attention, prevention and care, who gets sicker and who dies earlier, depending on which groups are shunned because of economic means, sexual orientation, social stigma, or neglect.

Social activist Jon Ungpakorn of Thailand, a former senator, pointed out that it was imperative to reach a wide range of those vulnerable to HIV and or those now being left out of education, prevention and treatment programmes. He listed prisoners, drug users, sex workers, men who have sex with men, transgenders, ethnic minorities, migrant workers, refugees and stateless people, homeless and street people.

“These groups matter because they are human beings all entitled to the same rights everybody else has, and because they are key to addressing the pandemic,” he explained.

Unless their needs are addressed and they are not left out because societies believe they are not worth the effort, “you’re not going to have long-term sustainability in addressing HIV and AIDS”, Ungpakorn stressed.

He added to his list of disadvantaged people “women who have sex with men”, coining a variation to the term ‘men who have sex with men’ to drive home the point that women who are married or in intimate relationships are getting infected with HIV from partners who engage in unsafe behaviour – such as drug use and unprotected sex with other partners.

Women now make up 35 percent of all new infections among adults in Asia, up from 17 percent in 1990, but critics say they are not addressed enough by HIV programmes.

“It is estimated that more than 90 percent of women living with HIV acquired the virus from their husbands or from their boyfriends while in long-term relationships,” said the report ‘HIV Transmission in Intimate Partner Relationships in Asia’, released by the Joint U.N. Programme on HIV/AIDS (UNAIDS) on Tuesday.

These male partners engage in unprotected paid sex, sharing of contaminated needles and syringes among drug users and unprotected sex among men who have sex with men, and pass HIV to their partners.

While “unprecedented attention” has been given to the role of gender equation in development issues, “we’re still not doing enough to uproot the role that gender plays in (fighting) the pandemic,” Rao pointed out.

HIV and AIDS schemes designed to address gender portray women are done piecemeal, and many “equate gender interchangeably with women” and leave out men. This, Rao explained, sends the wrong message that “male behaviour is inevitable and predetermined and only the women can do something (about their situation), which is a disservice to both women and men”.

Citing examples of how reproductive health programmes have not yet integrated enough into women’s different concerns and roles today, Tan said it is common to find HIV programmes that are targeted only toward sex workers for instance, but do not touch on issues like maternal health.

In the same way, maternal health programmes stay away HIV. It is almost like people forget that sex workers can also be mothers, Tan said.

Likewise, labour protection programmes for overseas Filipinos stay away from reproductive health and HIV. “We don’t want to see migrants as sexual beings,” Tan remarked.

Discussions at ICAAP have focused a lot on groups disadvantaged because of issues like sexual orientation, discriminatory laws that make it difficult for them to seek treatment and fight the stigma of HIV and AIDS, or society’s perceptions of them as problems or burdens.

“I used to think that sex workers were sinners, or that ‘why we should even talk about men who have sex with men?’ ” Maire Bopp Dupont, chief executive officer of the Pacific Islands AIDS Foundation, told the plenary.

But she said in the end, responses to HIV and AIDS must be grounded on the premise that all are entitled to the same basic rights.

There are an estimated 16 million men who have sex with men in Asia, says the Commission on AIDS in Asia. An online survey commissioned by the International HIV/AIDS Alliance showed that at least a third of respondents had experienced arrest, rape, blackmail and violence from police or authorities because they knew they had sex with other men.

*TerraViva at ICAAP ’09 (http://www.ipsterraviva.asia)