Fighting the stigma of HIV and AIDS

World AIDS Day is held on the 1 December each year, uniting people in the fight against HIV and promoting the prevention and treatment of HIV. This year’s theme is ‘HIV Stigma: Not Retro, Just Wrong’ which is focused around ending the stigma surrounding HIV which makes the lives of those living with this disease extremely difficult.

To mark World AIDS Day 2016 we asked people working and researching in the field how they think views on HIV and AIDS have change over the past ten years, focusing in particular on outdated stereotypes, challenging myths, and the developing positivity towards finding a cure. In addition, we have provided a series of articles from a selection of journals on the topic of HIV – freely available to read until 1 March 2017.

“Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance” by Ragna S. Boerma, Cissy Kityo, T. Sonia Boender, et al. in the Journal of Tropical Pediatrics

“Exclusive Breast-feeding Protects against Mother-to-Child Transmission of HIV-1 through 12 Months of Age in Tanzania” by Karim P. Manji, Christopher Duggan, Enju Liu, et al. in the Journal of Tropical Pediatrics

Over ten years ago, it was thought that the HIV/AIDS epidemic could never be controlled without a vaccine. Since then, enormous progress has been achieved in increasing access to antiretroviral therapy, pre exposure prophylaxis, and reducing mother to child transmission of HIV. Although a vaccine would still be the most effective way to tackle the HIV/AIDS epidemic, the absence of a vaccine is no longer an insurmountable obstacle to controlling HIV.

In 2015, UNAIDS set the ultimate goal of eliminating HIV transmission by 2030 using existing tools and evidence-based interventions. The UNAIDS 90-90-90 initiative calling for 90% diagnosed, 90% treated, and 90% virally suppressed by 2020 was a turning point in how we approach HIV prevention. Although we do need a vaccine against HIV, working towards the 90-90-90 targets will bring us closer to eliminating HIV transmission.

– Quique Bassat, Editor-in-Chief of the Journal of Tropical Pediatrics

“Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study” by Krishna P. Reddy, Robert A. Parker, Elena Losina, et al. in The Journal of Infectious Diseases

“Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010” by Kate Buchacz, Bryan Lau, Yuezhou Jing, et al. in The Journal of Infectious Diseases

Over the past decade, our emphasis regarding HIV infections has changed enormously. We now attempt to treat all persons with HIV, not just a select few. As a result, life spans of individuals treated with antiretroviral combination regimens approach those who are not infected, and outdated stereotypes about persons with HIV are disappearing. We are also becoming more concerned with other non-infectious factors that may be problematic for HIV-infected individuals, such as excessive smoking. Greater efforts are being directed to preventing HIV infections with approaches such as pre-exposure prophylaxis. Finally, investment in cure research is also considerable, so that the goal of reducing and possibly eliminating HIV infection may become a reality in the decades ahead.

– Martin Hirsch, Editor-in-Chief of The Journal of Infectious Diseases

“CD4+ T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa” by Elvin H Geng, Torsten B Neilands, Rondolphe T Thièbaut, et al. in the International Journal of Epidemiology

“Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)” by George Reniers, Marylene Wamukoya, Mark Urassa, et al. in the International Journal of Epidemiology

One of the massive shifts over the last ten years has been in viewing HIV/AIDS as a unique, unprecedented epidemic – which it once was in many respects – to a condition that can be successfully managed for decades with effective antiretroviral therapy. This realisation has been driven by state-of-the-art epidemiologic research. This includes sophisticated observational analyses that allow researchers to approximate complex treatment strategies (Cain, et al), comparisons of treatment responses showing comparable treatment outcomes across the globe (Geng, et al,) and research platforms for population-based HIV research from across sub-Saharan Africa (Reniers, et al). These examples from the last 12 months are just a few examples of the epidemiological research that has helped to propel our understandings of HIV/AIDS forward at a remarkable rate.

– Landon Myer, International Journal of Epidemiology

“HIV-related stigma and universal testing and treatment for HIV prevention and care: design of an implementation science evaluation nested in the HPTN 071 (PopART) cluster-randomized trial in Zambia and South Africa” by James R Hargreaves, Anne Stangl, Virginia Bond, et al. in Health, Policy and Planning

“Resource needs and gap analysis in achieving universal access to HIV/AIDS services: a data envelopment analysis of 45 countries” by Wu Zeng, Donald S Shephard, Carlos Avila-Figueroa, and Haksoon Ahn in Health, Policy and Planning

“Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level” by Samuel Abimerech Luboga, Bert Stover, Travis W Lim, et al. in Health, Policy and Planning

Over the last decade, we’ve seen more people with HIV living as long, healthy lives as their HIV-negative peers. Though HIV is thankfully no longer an automatic death sentence, myths, stereotypes, and gaps in the public’s understanding of HIV/AIDS persist, even in the United Kingdom. Meanwhile in other parts of the world where human rights and social protection for populations at risk are virtually non-existent, stigma and discrimination are much more deeply rooted, hindering prevention and treatment efforts. In Russia for example, new HIV infections continue to increase especially rapidly among injecting drug users, but the government still prohibits opioid substitution therapy, and prefers to blame and criminalise drug users. So despite real progress in recent decades, it’s crucial to push governments further to fight stigma, heed scientific evidence, and respond to the epidemic by respecting, not violating, human rights.

– Professor Peter Piot, London School of Tropical Medicine and Hygiene

“HIV-associated lymphoma in the era of combination antiretroviral therapy: shifting the immunological landscape” by Virginia Carroll, Alfredo Garzino-Demo, and Patrik Bavoil in Pathogens and Disease

The response to the global HIV epidemic has been unprecedented. It has changed much of the way in which the world approaches health financing. Over the last 10–15 years, high-income countries have transferred large sums of money so that lower-income countries are provided with emergency HIV prevention and treatment programmes. Through highly successful programmes such as the Global Fund and PEPFAR, over $8 billion is made available each year to over 100 countries. The volume and rapid scale-up of this investment has undoubtedly resulted in tremendous health and economic savings around the world. So much so that the WHO and United Nations now seemingly see the end of AIDS in sight over the next 15 years. However, it is important to realize that whilst great gains have been achieved and the present is much better than the past, the future of HIV is still troubling. There is no vaccine or a cure. Furthermore, the cycle of HIV infection has not been broken: recent data from Southern Africa shows that young women are acquiring HIV from adult men, while men acquire HIV later in life, and continue the cycle of new infections; in Eastern Europe and Central Asia HIV prevalence is still increasing overall; and generally in other regions of the world there is no clear decline in HIV epidemics among men who have sex with men. Paradoxically, the lack of progress in some instance might be due to the success of therapeutic programs, which has decreased the sense of emergency once associated with HIV infection, and generated some degree of complacency and a false sense of security. The large international funding for HIV is not sustainable in the medium term and lower income countries are unlikely to be able to cover shortfalls and cover needed increases in resources. Therefore, without the needed research, medical technologies, political commitment to human rights and people-centered actions, and financial gaps mean that unfortunately HIV will be with us for decades to come.

– David Wilson, Pathogens and Disease

Featured image credit: Support For International AIDS Memorial Day by Sham Hardy. CC BY-SA 2.0 via Flickr.