World AIDS Day at 25: The Odds and Evens of a Quarter Century Fight against HIV/AIDS

HIV is not just a medical issue but also a social matter that requires a holistic, community-based response. (Photo by Peter Caton for India HIV/AIDS Alliance)

HIV is not just a medical issue but also a social matter that requires a holistic, community-based response. (Photo by Peter Caton for India HIV/AIDS Alliance)

It has been 25 years since the first observance of World AIDS Day on December 1, 1988. This quarter-century journey has been tumultuous. Denial of the epidemic and gross violations of the human rights led to the deaths of millions globally. People living with HIV spoke out and acted up. Others noticed, and slowly advocacy drove investment in HIV programmes by governments around the world.

In India, the first known case of HIV was diagnosed in 1986 in a female sex worker in Chennai. HIV remains concentrated in high-risk groups. While adult HIV prevalence stood at 0.27% in 2011, it continues to remain alarmingly high among men who have sex with men (MSM) at 4.43% and transgenders 8.82%. Pressed by community advocacy, the Government of India’s HIV response has prioritized prevention interventions for MSM. It has recently realized the necessity of developing a distinct HIV prevention strategy for transgender and hijra communities. By the end of 2012, 20 of the government’s targeted HIV prevention interventions were working exclusively with these populations.

Despite many years of work, HIV prevalence remains high in MSM, transgender and hijra (MTH) communities in India for complex reasons. Starting at the individual level, internalised homophobia and transphobia plagues many MTH community members. Often rejected by their families, there is lack of meaningful social support for them that adds to their vulnerability to HIV.

Society at large is still not comfortable with MTH communities. This is even more true for transgenders and hijras. They are more visible which often makes them targets. Lack of recognition of their gender identities by the government makes their lives difficult. Without proper identity documentation, they cannot access education, life insurance, bank loans and various social entitlement schemes.

Though the Delhi High Court read down Section 377 of Indian Penal Code in 2009, the ruling was appealed to the Supreme Court of India. The judgement is expected in December 2013. Activists in India and across the world are eagerly awaiting word from the Supreme Court. If the court upholds the Delhi High Court decision, it will be a landmark in the history of human rights.

We must be relentless in our pledge to make HIV history. In this, our governments and our communities are equal partners. HIV is not just a medical issue, and it never has been. It’s a social matter that requires a holistic response that puts affected communities at the centre. This World AIDS Day and every day, we need to strengthen community action on AIDS.

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The author of this post, Yadavendra Singh, is Advocacy Manager at India HIV/AIDS Alliance in New Delhi.

This blog was published on The Alternative on 1st December 2013.

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A Long Way to Zero… | World AIDS Day 2013

(Photo by Peter Caton for India HIV/AIDS Alliance)

(Photo by Peter Caton for India HIV/AIDS Alliance)

“Getting to zero” is the theme of this year’s World AIDS Day. It is an ambitious goal, to be sure. Three goals, in fact. Three zeros. Zero new HIV infections. Zero AIDS deaths. Zero stigma and discrimination. Are we now so close to declaring victory? Are we really on a path to an AIDS-free world? Is the end of AIDS on the horizon?

On one hand, we have never been better positioned to achieve such goals. We have good epidemiological data. We know where the epidemic thrives. We know who are most at risk, and we have the tools to reduce their vulnerability. For those infected, we have treatment.

Yet mastering this epidemic remains elusive. Why does there still seem to be zero chance that we will achieve any of UNAIDS’ zero targets anytime soon? Although it’s no longer popular to say so, AIDS remains exceptional. As a virus, it has proved remarkably resourceful, outwitting scientists and keeping a vaccine or cure out of reach.

But for all its microscopic muscularity, HIV is still winning because we’re letting it win. Those most at risk — sex workers, men who have sex with men, people who inject drugs, transgenders and hijras — remain on the margins, socially stigmatized and victimized by legal discrimination. People living with HIV bear a daily burden of society’s cruelty and inaction.

Don’t get me wrong. Things are better than they’ve ever been, but better isn’t good enough. Our tools and knowledge can only stifle this epidemic if they are marshaled to the task. Government coordination must be matched with community mobilization and sustained in collaboration with civil society. National treasuries, donor governments, corporate houses and private citizens alike need to pitch in to support these efforts.

This World AIDS Day, even as we appreciate progress in India and elsewhere, we should not lose our momentum or let crumble the foundation that has been built in the quarter century since the first World AIDS Day in 1988. The path to zero is still long, even if the destination is clear.

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The author of this blog, James Robertson, is Executive Director of India HIV/AIDS Alliance in New Delhi.

This blog was republished on One World South Asia on 2nd December 2013. 

AIDS Response at Crossroads: World AIDS Day 2013

prasadablog

This year’s World AIDS Day will not just be a string of events the world community observes every year on December 1st, reiterating our resolve to combat the pandemic. This year, it will occur at a defining moment in the global response when all stakeholders are standing at crossroads, looking to where we should head.

There is celebration, sometimes excessive, about the successes achieved since 2001 when the rules of engagement with HIV/AIDS changed from appeasement to aggressive combat, denial to ownership, and condemnation to meaningful participation by communities infected and affected by the epidemic. The resource base for AIDS programmes moved to billions, and affordable generic medicines have been made available, saving the lives of 10 million people. New infections have made an appreciable decline of 33% in the Ground Zero of the epidemic, sub-Saharan Africa. Most important, there has been an aggressive breakthrough in reducing the number of children born with HIV, and the target of zero new infections among children by 2015 appears feasible.

Encouraged by this impressive progress, world leaders have started talking about an AIDS-free society as an achievable goal in a finite time frame. Secretary-General United Nations has spoken on more than one occasion about the emergence of an AIDS-free world. The UN Joint Programme on AIDS (UNAIDS) has adopted the achievement of three zeroes as a global strategy. A new Commission established jointly by UNAIDS and Lancet has ‘what will it take to end AIDS’ as one of its three overarching objectives.

An outsider who is not familiar with the history of the epidemic can be led to believe that success is on hand and an AIDS-free world is just round the corner. This is the pitfall in crying victory too early when there are many challenges lying ahead, including sustainable financing and political support for AIDS programmes. While new infections are on decline in Africa and Asia-Pacific, they are still on rise in Eastern Europe, Middle East and Northern Africa. Another 5 million more people are in need of treatment, and this number will increase further with the new WHO guidelines on treatment. The biggest obstacle is however the adverse legal environment surrounding the people living with HIV and key affected populations. Progress on decriminalising these behaviours has been extremely slow and in some countries negative.

Resource availability for AIDS programmes has been impressive until now, but it is uncertain whether countries will commit matching domestic resources to cover the gap left by withdrawal of donors from AIDS financing. Evidence shows that external financing has funded prevention programmes focussing on vulnerable key populations. These communities are apprehensive about whether countries would continue with this prioritisation once the external funds are withdrawn. And for political leaders at country level, AIDS is no more a challenge. By providing treatment services to infected populations and preventing them from dying, they feel they have won the battle.

The added challenge on this World AIDS Day is the ongoing global dialogue on defining the post-2015 development agenda for the next 15 years. In the next year, world leaders will be actively negotiating various components of a new development regime where priority will be accorded to issues like environment and sustainable development. There is overall concern whether health and HIV will get the right priority in the post-2015 agenda. As this will evolve through an intergovernmental process in the UN General Assembly, much depends on what priority country leadership, especially non-health actors, will accord to AIDS and whether emergence of an AIDS-free society would be considered by them as an achievable goal.

On this World AIDS Day, we need to be vigilant and work closely with country leadership and UNAIDS to ensure that AIDS is not dropped just at a time when the battle is half won.

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The author of this post, J.V.R. Prasada Rao, is UN Secretary-General’s Special Envoy for AIDS in Asia and the Pacific and serves as chair on the board of India HIV/AIDS Alliance.

What Difference Does Discrimination Make? Reflections for World AIDS Day 2013

Lord Fowler during his visit to Lakshya Trust in Surat, Gujarat. (Photo: India HIV/AIDS Alliance)

Lord Fowler during his visit to Lakshya Trust in Surat, Gujarat. (Photo: India HIV/AIDS Alliance)

I have just returned from a visit to India to see what is being done in tackling HIV and AIDS. Back at the start of the epidemic in 1986 I was health minister in Britain. We carried out a very high profile public education campaign using television, radio, poster sites to get the message through. We sent leaflets to every home in the country. Remember at this time there was no treatment. If you contracted HIV it was so often a death sentence.

But of course we were a relatively small country. India has a massive population of well over a billion and a vast area to cover. It is enormous credit to those early public health activists and to their successors on what has been accomplished. The creation of the National AIDS Control Organisation in itself was a massive achievement. Unlike some countries I have visited over the last 18 months there has been close cooperation with civil society organisations like India HIV/AIDS Alliance and many others. India put prevention first and the figures tell the story.

There has not been the explosion we have seen in Sub Saharan Africa where in one country almost a quarter of the population are infected. There may be two million people in India with HIV but compared with the population, prevalence is remarkably low. If you take injecting drug users then India has followed the sensible policy of providing clean needles. This should eliminate the spread of the infection by dirty needles being shared.

Does this mean then that all the problems in India have been solved? Of course not. No country can claim that. We still have a major problem of discrimination and stigma when it comes to  sexual minorities. Drug users are often treated with contempt as are transgender people who face particular prejudice. Sex workers continue to be exploited – although HIV transmission has fallen due to the vastly increased use of condoms. Men who have sex with men are still widely condemned.

And what difference does such discrimination make? It means that many men and women are unwilling to come forward for testing. They fear what the impact may be on their lives if it is known that they are positive. They fear the reaction in their families, in their communities and at work. And the effect is this: They are undiagnosed and continue to spread the virus. HIV and AIDS continue to increase. Deaths mount.

Of course this is not just a problem in India. It is a problem in every country in the world that I have visited. On this World AIDS Day we should vow to fight the discrimination and the stigma – and make a new effort to get people to test and get on treatment as it becomes more and more available. HIV is no longer a death sentence but the earlier a man or woman goes into treatment the longer life will be.

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The author of this blog, Lord Norman Fowler, was a member of Margaret Thatcher’s Cabinet and served as chairman of the Conservative Party under John Major between 1992 and 1994. He was instrumental in drawing public attention to the dangers of AIDS in Britain. He is the author of A Political Suicide: The Conservatives’ Voyage into the Wilderness and is currently writing a book on the global AIDS epidemic. Hosted by Alliance India, Lord Fowler recently visited New Delhi and Surat, Gujarat, to learn more about how this country has risen to the challenge of HIV.

Press Clippings: World AIDS Day All-India Run & Cultural Event Media Coverage (December 2012)

run

Motivated to raise awareness about HIV, more than a thousand people participated in India HIV/AIDS Alliance‘s World AIDS Day All-India Run & Cultural Event on Sunday, December 2, 2012. The run was followed by music and drama performances celebrating life and diversity in the face of the epidemic. The event was enthusiastically received by participants and attracted considerable interest from the media. The following is a selection of the coverage.

In English:

English-language newspapers that covered the World AIDS Day All-India Run & Cultural Event include: The Hindustan Times, Deccan Herald, Millennium Post, The Hindu, The Pioneer, Business Line, The Indian Express, Political and Business Daily , The Tribune, The Asian Age, The English Daily, and The Sikh Times. (Click on images of the clippings to enlarge.)

In Hindi:

Hindi newspapers that covered the World AIDS Day All-India Run & Cultural Event include: Dainik Bhaskar, Amar Ujjala, Rashtriya Sahara, Aaj Samaj, Mahamedha, Voice of Politics, Dainik Bharati, Dainik Nav Jyoti, Qaumipatrika, Amrit India and Adhikar. (Click on images of the clippings to enlarge.)

For more photos, please click here to see our album on Facebook.

World AIDS Day Op-Ed: New Optimism, Old Challenges: Prioritizing High-Risk Groups at the Frontline of AIDS

In a new opinion piece published on OneWorld South Asia, Alliance India’s James Robertson argues that while India’s admirable progress in achieving a greater than 50 percent reduction in new HIV infections deserves accolades and emulation, it should not be mistaken for victory over the epidemic. Click here to read more.

World AIDS Day Op-Ed: Cross Out HIV Stigma

In her column in the Asian Age newspaper, Patralekha Chatterjee admires India’s progress and wonders about the future of the AIDS response in the country. Alliance India’s James Robertson is quoted. Click here to read more. The column was also picked up by the Deccan Chronicle.

Thanks to everyone who took part and helped make our World AIDS Day activities such a success. Many thanks again to our co-sponsors: Population Council; CitibankUNDPCentre for Advocacy & Research (CFAR)Delhi Frontrunners; and Blind Relief Association. Special appreciation also to National AIDS Control Organisation, Delhi State AIDS Control Society and the Delhi Police for their support in mounting this event. 

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India HIV/AIDS Alliance (Alliance India) is a diverse partnership that brings together committed organisations and communities to support a sustained response to HIV in India. Complementing the national programme in India, it works through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, Alliance India supports the delivery of effective, innovative, communitybased HIV programmes to key groups affected by the epidemic.

Join us for the World AIDS Day All-India Run & Cultural Event! (Sunday, 2 December 2012 in New Delhi)

World AIDS Day 2012 All-India Run and Cultural Event
***8am-2pm (***PLEASE note EARLIER starting time!)
Sunday, 2 December 2012

New Delhi

Organized by: India HIV/AIDS Alliance

Co-sponsored by: Population Council; Citibank; UNDP; Centre for Advocacy & Research (CFAR); Delhi Frontrunners; and Blind Relief Association

RSVP: Please let us know if you’ll join us. Click here!

All-India Run: Participants will include people affected by the epidemic, their friends and families, community members, students and other stakeholders motivated to raise awareness of HIV in India, including the private sector. At least 500 participants are expected to participate in the run, and medals will be awarded to the top finishers in the men’s, women’s and transgender categories.

Members of affected communities have also been invited to speak and serve as judges for the run. Representatives from a range of stakeholders have also been invited, including NACO, UN agencies, international donors and NGOs, along with Alliance India implementing partners and beneficiary communities from all over India.

Activities will begin at 8am at Safdarjung Tomb. The run will start around 9am and will follow Lodhi Road, ending at the Blind Relief Association (aka Delhi Blind School), near the Oberoi Hotel. The Cultural Event will take place immediately following the race on the ground of Delhi Blind School and will last until 2pm. (For detailed route information, please see map below.)

Starting Line:
Safdarjang Tomb, Lodi Estate
(At the intersection of Safdarjang Road and Aurobindo Marg)

Metro Station: Jor Bagh

Finish Line:
Blind Relief Association (aka Delhi Blind School)
Lal Bahadur Shastri Marg
Lodhi Road H.O.

(Near Oberoi Hotel)

Cultural Event: Immediately following the run, the Cultural Event will take place at Delhi Blind School. Celebrating life and creativity in the face of the epidemic, the cultural event will consist of music and drama performances. The jazz and rock bands invited have members from communities affected by the epidemic. Co-sponsor Population Council will organize a skit presentation between music acts to highlight issues of at-risk populations. Lunch will be available. In addition, stalls will be set up by sponsors and other national and international organisations, including Population Council, Citibank, and UNDP, to present their work addressing HIV/AIDS and supporting communities.

This event is open to the public. There is no fee for participation. Participants are encouraged to wear red or white, but all will be welcomed. 

Jamia Millia Islamia, Indira Gandhi National Open University, Bhim Rao Ambedkar College, and Amity University are collaborating with Alliance India to provide volunteers for the event and organise student participation.

If you have any questions, please email us at: worldaidsday@allianceindia.org

Poster: Help get the word out about this event. Print out our poster and display it in your community. Thanks!

Map of World AIDS Day All-India Run Route and Cultural Event Location

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Alliance India’s World AIDS Day 2012 Objectives
  • To raise awareness on the need for continued support to address HIV among high-risk groups
  • To celebrate the diversity of affected communities with a focus on living lives free from stigma and discrimination
  • To acknowledge and encourage stakeholders, including government, civil society and the private sector, to intensify efforts to ensure a continuum of care services for affected communities
India HIV/AIDS Alliance

Based in New Delhi, Alliance India was founded in 1999 as a non-governmental organization operating partnership with civil society and communities to support sustained responses to HIV in India. Complementing the Indian national program, Alliance India works through capacity building, technical support and advocacy to strengthen delivery of effective, innovative, community- based interventions to key populations affected by the epidemic. The organization’s programs focus on those most vulnerable to HIV, with a particular emphasis on marginalized populations, such as men who have sex with men, people who use drugs, transgenders, and sex workers.

World AIDS Day Background

World AIDS Day has been observed since 1988. HIV/AIDS has become one of the defining health and development issues of our time. Low- and middle-income nations, even those with increasingly powerful economies like India, still face serious shortfalls in resources for AIDS. Stigma and discrimination toward those affected by the epidemic continue to create significant barriers to effective responses. Two-thirds of those who require antiretroviral treatment to live healthy lives still do not have access to these life-saving drugs. Investment in programming for high-risk populations such as men who have sex with men, sex workers, people who use drugs, and transgenders continue to be grossly insufficient. Worldwide HIV has infected an estimated 34 million people. In India, the National AIDS Control Organisation estimates overall adult HIV prevalence at 0.31%, which translates into roughly 2.4 million people living with HIV in India.

2012 Global Theme for World AIDS Day

The theme for World AIDS Day as chosen by UNAIDS and its partners is Getting to Zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS Related Deaths. World AIDS Day advocacy will focus on ensuring universal access to services including prevention, care, support and treatment and of fulfilling human rights.