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HIV stigma: the beginning of the end? | The World Weekly

Several decades after the outbreak of the HIV/AIDS epidemic, there is still a huge gulf between the lives of those living with it and the wider public. This gap may have narrowed in terms of quality of life, with enormous medical advances enabling many to function as they did before first being infected. But those diagnosed with HIV are forced to attune themselves to a completely different reality, one which they must endure well beyond any treatment. 

There are few better examples of this than when the US’ Centres for Disease Control and Prevention (CDC) made an announcement earlier this month. To the general public, it could easily have passed as a fairly obscure development in the American medical community - but to the HIV community, it means a lot more. 

The CDC’s statement acknowledged that those on antiretroviral therapy (ART) who maintain an undetectable viral load “have effectively no risk of sexually transmitting the HIV virus to an HIV-negative partner.” 

An ‘undetectable viral load’ occurs when medication in HIV-positive people lowers the virus’ presence in the body to the point where it cannot be picked up by clinical tests. The statement essentially affirmed the public health body’s view that using ART to stop the spread of HIV works.

It is something that many in the medical community have believed for some time. The CDC’s decision is thought to have been spurred by two major studies in the last few years. Between them, they found that, among thousands of couples studied, not a single person with HIV who had had an undetectable viral load for six months or more transmitted the virus to their partner.

But the decision could not have come any sooner for people living with HIV, many of whom suspected as much well before the mountain of evidence built up. The risk of transmission is widely seen as a driving factor in HIV-related stigma, which continues to blight the lives of the 37 million people worldwide with the virus. 

‘A tremendous step’

The statement has been welcomed by campaigners fighting to raise awareness of the medical consensus. Leading the way on this front has been the Prevention Access Campaign (PAC), a campaign group which has condensed a complex medical issue into a simply stated mission: Undetectable = Untransmittable, or ‘U=U’.

“The CDC’s update is a tremendous step forward toward dismantling decades of stigma,” says Bruce Richman, PAC’s executive director. 

“It’s critically important to educate policymakers about the prevention benefits of treatment,” Mr. Richman told The World Weekly, underlining how tackling stigma is central not just to improving the lives of those with HIV, but to stopping the virus’ rampage altogether. 

“If all people with HIV can get access to treatment and services to maintain undetectable viral loads, that will not only save lives but also prevent new transmissions and get us closer to ending the epidemic.”

There is still a considerable way to go in addressing the problem. Some might doubt how effectively the influence of a US health body could spread to the rest of the world, for example. 

“In some parts of the world, there is denial about the extent of HIV and tremendous abuse and neglect of the people most vulnerable to it,” Mr. Richman adds, though he is optimistic about his campaign’s global potential. U=U now counts over 400 organisations from 62 countries among its signatories, as well as global bodies like the International Aids Society and UNAIDS. 

Top officials from the CDC and Boston Medical Centre participate in a panel discussion at 'Making AIDS History' on June 14.

Breaking down stigma

The HIV community is all too aware of how tall the obstacles are in countries where treatment is not so readily available. “We need to do more to ensure that resource-limited areas have access to ART and viral load tests," says Florence Anam of the International Community of Women Living with HIV (ICW). 

“As long as people are unable to monitor themselves, it will be difficult to achieve the realities of U=U,” she told The World Weekly. Indeed, that mountain can only be scaled by those who know to seek out treatment. 

Globally, only 53% of people with HIV know their status.

There is a considerable gap between those with access to ART - estimated to be around 17 million people, just over half of all people with HIV - and those without. But activists hope that tackling stigma can bridge this gap. 

“Our research suggests that those who don’t know that they are HIV-positive are causing the majority of new infections,” says Julian Hows of GNP+ (the Global Network of People living with HIV), “yet many people are too frightened to get tested because of the stigma surrounding the process.” 

HIV-related stigma goes far beyond cultural and emotional issues. Many countries have enacted legislation to prosecute those who knowingly transmit HIV, but many activists see this as part of the problem.

The fact that those who do not know their status cannot be prosecuted discourages people who suspect they have been infected from getting tested, argues Mr. Hows. In many countries, he adds, those who are known to have HIV can be prosecuted if they do not disclose their status to their sexual partners even if they have fully protected sex.

“These laws were put in place as a kneejerk reaction to a situation that we didn’t understand,” he told The World Weekly. “They belong to the panic of the 1980s - not the science of the ‘90s, or the medical treatment of the 21st century.”

Research from bodies like the ICW and GNP+ suggest societies’ failure to keep up with medical reality is taking its toll.

Mr. Hows, who has been working with GNP+’s People living with HIV Stigma Index for the best part of a decade, says that countries which have participated in the index on more than one occasion have, on the whole, not shown much progress.

“But if there’s one thing the index does show throughout,” he adds, “it is that people living with HIV are starting to feel better about themselves.” 

“Internal stigma is wearing down: more and more people are able to live without guilt, shame and a constant fear of death, and are able to get on with their lives.”

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