Forty years after the first cases of Aids were discovered, goals for its global elimination have yet to be achieved. In 2020, nearly 700,000 people died of Aids-related illnesses and 1.5 million people were newly infected with HIV.
This is despite scientific and medical advances in the testing, treatment and care of people living with HIV.
Part of the reason is something that those affected by HIV know all too well: discrimination. The history of the response to this virus has long been hampered by stigma and it continues to disproportionately affect key groups – men who have sex with men; sex workers; transgender people; people who inject drugs and prisoners. According to UNAIDS, the United Nations programme on Aids/HIV, these communities account for 93% of new HIV infections outside sub-Saharan Africa.
Social, state and symbolic discrimination and violence play a huge role in preventing people in these groups from accessing care and prevention services. It is difficult to protect yourself from HIV when, in some countries, having prevention tools in your pocket – whether it be sterile syringes or condoms – can lead to arrest.
It’s hard to talk to your doctor about sexual safety or access antiretroviral treatment when homophobia permeates your society. Discrimination is directly related to stigma and they are mutually reinforcing, acting as catalysts for transmission.
Punitive laws that infringe human rights also continue to hold back progress.
The criminalisation of certain behaviours and jobs – such as drug use, non-disclosure of HIV status, and sex work – infringes on the rights and freedoms of key populations and their ability to access justice and health services. Often, this is a result of prejudice among law enforcement.
Russia is one example of how pushing back on human rights, freedoms and personal autonomy also holds back the fight against HIV and Aids. In June, at the last UN high-level meeting on HIV and Aids, Russia submitted amendments to the final declaration to delete any reference to human rights, decriminalising sex work or harm reduction related to injecting drugs, claiming it was an affront to family values.
How can we not make the connection between these views and the worrying progression of the HIV epidemic in Russia? Russian government estimates suggest that new HIV infections increased annually by 10% to 15% a year between 2006 and 2015. It is a trajectory leading to enormous prevalence rates in key populations (including its estimated 1.8 million injection-drug users) and a general population prevalence of more than 1%. As in other countries where homosexuality is subject to social repression, there is reason to believe that these estimates are very conservative because the impact of homophobia reduces estimates of certain population sizes and incidence.
Alongside eliminating stigma, discrimination and criminalisation, nations need to consider how funding is directed. According to the Dutch organisation Aidsfonds, programmes targeting key, most at-risk groups in low- and middle-income countries receive only 2% of HIV funding.
Yet marginalised people have long proven their ability to implement innovative solutions to protect fellow human beings in the face of epidemics, whether it be Aids or Covid-19. Community-led responses that respect human rights in the local context are highly effective. Peer testing, for example, is extremely effective in reaching those furthest from the health system.
Cheick Hamala Sidibé, human rights officer at Arcad Santé Plus, has said that community-led initiatives during the Covid-19 pandemic by health workers in Mali – meeting people at home to offer HIV testing, distribute prevention kits and provide antiretroviral treatment – have pushed the government to improve its policy.
In Morocco, a third of those testing positive for HIV in 2019 were screened by community health workers from ACLS – a member of Coalition Plus, an international network to fight Aids and hepatitis – even though it uses only 10% of the kits available nationwide. In Ecuador, out of 40,000 tests, Kimirina, another Coalition Plus member, detected 900 HIV-positive people – nearly six times higher than the rate achieved by the public health system.
The new Global Fund strategy to fight Aids, TB and malaria places communities front and centre of the fight. Building on the fund’s proven impact, it’s vital that governments step up contributions next year in order to accelerate community-led responses.
Communities have always been best on the frontlines and sustainable funding of interventions designed and implemented by and for key population groups will go a long way to bringing the global HIV response on track.
Underpinning this must be a steadfast commitment to human rights; exerting political pressure to repeal punitive laws and enforcing laws to protect people from violence. Through this, we can, after 40 years, overcome discrimination and end Aids.
Hakima Himmich is the founder of ALCS in Morocco and has chaired the international network Coalition Plus since 2012.
Mike Podmore is director of StopAids, a UK-based network of 70 organisations, and a steering committee member at Action for Global Health UK and Global Fund Advocates Network.
Von der Leyen slammed for not revealing Pfizer CEO texts
The European Ombudsman has criticised the European Commission for its handling of a request for public access to text messages exchanged between president Ursula von der Leyen and Pfizer CEO Albert Bourla.
But, according to the ombudsman, inquiry commission staff never explicitly asked the president’s office to look for text messages, despite Fanta specifically requesting them.
Instead, the cabinet was asked to only look for “documents”, a term that does not include text messages by commission standards.
The EU watchdog has now asked the commission to do a more extensive search.
“The narrow way in which this public access request was treated meant that no attempt was made to identify if any text messages existed,” ombudsman Emily O’Reilly said in a statement.
“This falls short of reasonable expectations of transparency and administrative standards in the commission.”
Last year, the EU commissioner for transparency and values, Věra Jourová, said that text messages do not fall under the scope of EU transparency rules on access to documents, as EUobserver reported.
“Due to their short-lived and ephemeral nature, text and instant messages are not meant to contain important information relating to policies, activities and decisions of the commission,” Jourová wrote in a statement.
But a New York Times article in April last year had shown that von der Leyen and Bourla had been exchanging texts and calls for months to seal a deal for 1.8 billion doses of the Pfizer/BioNTech Covid-19 vaccine.
“Not all text messages need to be recorded, but relevant text messages should be recorded. It is not credible to claim otherwise,” O’Reilly said, adding that “text messages clearly do fall under the EU transparency law.”
She has said in an official recommendation that the commission should ask von der Leyen for texts concerning EU policies and decisions.
“If text messages concern EU policies and decisions, they should be treated as EU documents,” she said, adding that the “EU administration needs to adapt its practice of recording documents.”
“What Ursula von der Leyen is typing into her phone is, frankly, not a private matter. We need public scrutiny of EU text messages when they are used to make billion-euro vaccine deals,” Fanta tweeted on Friday.
“It is unacceptable that the commission is refusing to be transparent on contacts between von der Leyen and Bourla,” tweeted MEP Kathleen Van Brempt from the Socialists & Democrats group on Friday and called for a dedicated Covid-19 parliamentary committee to further investigate the matter.
In response, a spokesperson has said that the commission will respond to the recommendation before the deadline of 26 April 2022.
‘We just sleep and hope we don’t perish’: 2m in Tigray in urgent need of food – UN | Hunger
At least 2 million people in the northern Ethiopian region of Tigray are suffering from an extreme lack of food, with the 15-month conflict between rebel and government forces pushing families to the brink, the UN’s emergency food agency has found.
In the first comprehensive assessment the World Food Programme (WFP) has carried out in Tigray since the start of the war, 37% of the population were found to be severely food insecure, meaning they had at times run out of food and gone a day or more without eating.
Families were found to be “exhausting all means to feed themselves”, with 13% of Tigrayan children under five and almost two-thirds of pregnant and breastfeeding women suffering from malnutrition.
“Before the conflict we were eating three times a day but now even once a day is difficult. I was borrowing food from my family but now they have run out. We just sleep and hope we do not perish,” Kiros, a single mother of six children living on the outskirts of the region’s capital, Mekelle, told researchers.
The assessment, which was based on face-to-face interviews with 980 households in accessible parts of Tigray, was carried out from mid-November until mid-December.
However, researchers were unable to travel to areas where fighting is impeding humanitarian access. Moreover, since the assessment was carried out, the needs of the region are thought to have become even more acute as no aid convoy has reached Tigray for about six weeks.
“This bleak assessment reconfirms that what the people of northern Ethiopia need is scaled up humanitarian assistance, and they need it now,” said Michael Dunford, WFP’s regional director for eastern Africa.
“WFP is doing all it can to ensure our convoys with food and medicines make it through the frontlines. But if hostilities persist, we need all the parties to the conflict to agree to a humanitarian pause and formally agreed transport corridors, so that supplies can reach the millions besieged by hunger.”
Across northern Ethiopia, where fighting has raged in the regions of Afar and Amhara as well as Tigray, WFP estimates that 9 million people are in need of humanitarian food assistance, the highest number yet.
In Amhara, hunger has more than doubled in five months, it says. In Afar, where fighting has intensified in recent days between the Tigray People’s Liberation Front and forces loyal to the prime minister, Abiy Ahmed, recent health screening data showed malnutrition rates for children under five were at 28%, far above the standard emergency threshold of 15%.
Since the conflict erupted in November 2020, it has been difficult for the UN and other humanitarian organisations to gauge the level of need in Tigray due to a lack of on-the-ground access and telecommunications. The UN has accused the federal government of preventing food and essential medical supplies from coming into the region in a de-facto blockade. The government denies this.
On Wednesday, the International Committee of the Red Cross (ICRC) said it had made its first delivery of medical supplies to Mekelle since last September. The drugs are understood to have included enough insulin supplies to last about a month, after medics at the Ayder referral hospital raised the alarm over severe shortages.
Dr Tedros Adhanom Ghebreyesus, director of the World Health Organization, recently accused Abiy’s government of imposing a “hell” on Tigray by denying entry to medical supplies.
“It is a huge relief that this first shipment is reaching hospitals,” said Apollo Barasa, health coordinator at the ICRC delegation in Ethiopia. “This assistance is a lifeline for thousands of people, and I can’t emphasise enough how crucial it is that these deliveries continue.”
Asylum applications on rise in EU
The EU Agency for Asylum on Friday said the number of asylum applications in November 2021 was the second-highest in five years, narrowly below the level in September. About 71,400 applications for international protection were lodged in the “EU+” (EU, plus Norway and Switzerland) in November 2021, up by nine percent from October. “This was the second-highest level since 2016,” it said.
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