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.
Protests flare across Poland after death of young mother denied an abortion | Abortion
Protests are under way across Poland after the death of a 37-year-old woman this week who was refused an abortion, a year since the country introduced one of the most restrictive abortion laws in Europe.
On the streets of Warsaw on Tuesday night, protesters laid wreaths and lanterns in memory of Agnieszka T, who died earlier that day. She was pregnant with twins when one of the foetus’ heartbeat stopped and doctors refused to carry out an abortion. In a statement, her family accused the government of having “blood on its hands”. Further protests are planned in Częstochowa, the city in southern Poland where the mother-of-three was from.
“We continue to protest so that no one else will die,” Marta Lempart, organiser of the protests, told Polish media. “The Polish abortion ban kills. Another person has died because the necessary medical procedure was not carried out on time.” All-Poland Women’s Strike has called on people across the country to picket the offices of the ruling Law and Justice party (PiS) and organise road blockades in the coming days.
Agnieszka was first admitted to the Blessed Virgin Mary hospital in Częstochowa with abdominal pain on 21 December. She is said to have been in the first trimester of a twin pregnancy when she arrived and was in “a good physical and mental shape”, according to her family, who said her condition then deteriorated.
On 21 December the heartbeat of one of the twins stopped and, according to Agnieszka’s family, the doctors refused to remove it, quoting the current abortion legislation. They waited several days until the second foetus also died. A further two days passed before the pregnancy was terminated on 31 December, according to the family.
A priest was then summoned by hospital staff to perform a funeral for the twins, the family said.
The family say that the doctors refused to terminate the pregnancy earlier, citing Poland’s abortion legislation. “Her husband begged the doctors to save his wife, even at the cost of the pregnancy,” Agnieszka’s twin sister, Wioletta Paciepnik, said on Tuesday.
After the termination, Agnieszka was moved from the gynaecological ward and her health continued to deteriorate. Her family suspect that she died of sepsis but the cause of death was not identified in a statement released by the hospital.
Shortly after her death, a statement by her family accusing the hospital of neglect was published on Facebook, alongside a distressing video of Agnieszka’s last days.
Agnieszka’s death marks the first anniversary of the 2021 ruling that declared abortion due to foetal abnormalities illegal. Abortion can now only be carried out in cases of rape, incest or if the mother’s life and health are in danger.
Her death comes after that of a woman known as Izabela last September, who died after being denied medical intervention when her waters broke in the 22nd week of her pregnancy. Her family claim the 30-year-old was refused an abortion or caesarean section and that the hospital cited the country’s abortion laws. An investigation found that “medical malpractice” led to Izabela’s death and the hospital was fined. Soon after, an anonymous man from Świdnica in south-west Poland came forward to share that his wife, Ania, died in similar circumstances in June last year.
While “selective abortion” is possible in the case of a twin pregnancy, it is unclear whether aborting an unviable foetus to save its healthy twin is permitted by the new abortion legislation. The Polish court has not referenced the questions raised by this situation, presented by opposition senators last year, in the new legislation.
“We want to honour the memory of my beloved sister and save other women in Poland from a similar fate,” Paciepnik said in a video appeal. The case is now being investigated by the regional prosecutors in Katowice, who also investigated the case of Izabela.
The family are represented by Kamila Ferenc, from the Federation for Women and Family Planning, who confirmed that an autopsy of Agnieszka’s body has been ordered by the court.
According to a statement from the hospital, Agnieszka tested positive for Covid before her death, although she tested negative twice when first admitted. “We stress that the hospital staff did all the necessary actions to save the patient,” the statement read. The hospital did not respond to the Guardian for a request for comment.
Italy welcoming back EU tourists from February
Italy will remove all Covid-linked restrictions on international visitors from the EU from 1 February, except the requirement to carry a “Green Pass” – a certificate of vaccination, negative test result, or immunity through having had the virus. Roberto Speranza, the health minister, also gave Italians the go-ahead to travel once again to Cuba, Singapore, Turkey, Thailand (the island of Phuket), Oman, and French Polynesia, Reuters reports.
Polish state has ‘blood on its hands’ after death of woman refused an abortion | Abortion
The family of a Polish woman who died on Tuesday after doctors refused to perform an abortion when the foetus’s heart stopped beating have accused the government of having “blood on their hands”.
The woman, identified only as Agnieszka T, was said to have been in the first trimester of a twin pregnancy when she was admitted to the Blessed Virgin Mary hospital in Częstochowa on 21 December. Her death comes a year after Poland introduced one of the most restrictive abortion laws in Europe.
According to a statement released by relatives, the 37-year-old was experiencing pain when she arrived at the hospital but was “fully conscious and in good physical shape”.
The first foetus died in the womb on 23 December, but doctors refused to remove it, quoting the current abortion legislation, and Agnieszka’s family claim “her state quickly deteriorated”. The hospital waited until the heartbeat of the second twin also stopped a week later, and then waited a further two days before terminating the pregnancy on 31 December.
Agnieszka died on 25 January after weeks of deteriorating health. Her family suspect that she died as a result of septic shock, but the hospital did not identify the cause of her death in statement issued on Wednesday.
“This is proof of the fact that the current government has blood on their hands,” the woman’s family said in a statement on Facebook. The family also uploaded distressing footage of Agnieszka in poor health shortly before she died.
After the termination of the pregnancy a priest was summoned by the hospital staff to perform a funeral for the twins, Agnieszka’s family said.
Her death follows that of a woman known as Izabela last September, who died after being denied medical intervention when her waters broke in the 22nd week of her pregnancy. Her family claim the 30-year-old was denied an abortion or caesarean section and that the hospital cited the country’s abortion laws. An investigation found “medical malpractice” led to Izabela’s death and the hospital was fined.
Agnieszka’s family claim that contact with the hospital was very poor and that the hospital refused to share the results of Agnieszka’s medical tests citing confidentiality guidelines. They say the doctors “insinuated” that Agnieszka’s rapidly deteriorating state could be caused by BSE, commonly known as “mad cow disease”, or Creutzfeldt–Jakob disease (CJD) and suggested she ate raw meat. The hospital did not reference this claim in their statement.
According to the statement from the hospital, Agnieszka tested positive for Covid before her death, although she tested negative twice when first admitted. “We stress that the hospital staff did all the necessary actions to save the patient,” the statement read. It is not clear whether an autopsy has been ordered.
Agnieszka is survived by her husband and three children.
The Guardian has contacted the Blessed Virgin Mary hospital for comment.
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