On HIV: Those slipping through the cracks
BANGKOK, Thailand – It was a conference where the number zero was the hero – or at least, the target. At the recently concluded 11th International Conference on AIDS in Asia and the Pacific (ICAAP11), experts, advocates, and country leaders rallied for the achievement of a triple zero goal in terms of zero new HIV infections, zero discrimination, and zero AIDS-related deaths.
The main theme of the conference called for “investing in innovation.” To achieve this triple zero goal, countries were called on to adopt innovative preventive approaches and to scale up and scale out treatment care and support.
It also urged countries to advance human rights while capitalizing on gender equality to mitigate discrimination and stigma.
But others called for a more basic strategy: investing in studying the groups that are falling through the cracks. These are the groups that are overlooked in the HIV response or made vulnerable to infection because punitive laws and policies prevent them from accessing HIV healthcare services.
Gays bullied and stigmatized
According to new figures released by UNICEF, there were some 350,000 people newly infected with HIV in Asia and the Pacific in 2012, over 6% of whom are children under 14 years old. Adolescents in the 10 to 19 age bracket accounted for 17% of new infection. In the region, about 240,000 teenagers currently live with HIV.
Unprotected sex and injecting drug use were identified as key risk factors among young gay and bisexual men, injecting drug users, and sex workers. However, young advocates said that stigma and isolation is often a bigger factor to contend with.
“A problem among young MSM is homophobic bullying—or even bullying in itself. Young MSMs are seen as different and they have no models to see how they grow up to accept their sexuality,” said Jeffrey Acaba, project officer of Action for Health Initiatives (ACHIEVE). As a result, Acaba said, “young MSM tend to be depressed and are vulnerable to suicidal tendencies and engaging in risky sexual behavior.”
In some countries including the Philippines, there are laws that prohibit a minor (those under the age of 18) from getting an HIV anti-body test without parental consent.
“The existing AIDS law is inconsistent with laws we already have like laws on sexual consent which states that age of consent is 12 years old,” said Acaba.
Women at risk
Women are at risk for HIV infection because of the sexual behavior of their partner. A 2009 UNAIDS study estimated that 50 million women in Asia are at risk of becoming infected with HIV from their intimate partners. Many of these women are either married or in long-term relationships with men who engage in risky sexual behavior such as unprotected sex or have multiple sex partners.
UNAIDS estimated that more than 90% of the 1.7 million women living with HIV in Asia became infected from their husbands or partners.
A health officer from Myanmar said that in their country, the Ministry of Health came out with public service announcements calling for a couple to get tested for HIV before getting married.
“I have interviewed women who have had only one sexual partner and yet, have become infected with HIV,” he said.
In Myanmar, after injecting drug use, sexual transmission from sex workers has the highest rate of transmission.
At the ICAAP, sex workers called for the repeal of laws that criminalize sex work and promote the possession of condoms as evidence of a being in sex work.
What you do not know, you cannot treat or address. That seems to appropriately describe the state of transgender women in the scope of HIV response.
Dr Chris Beyrer of the Johns Hopkins Center for Global Health said transgender women had been neglected in the past.
“For transgender women, data is available in only 15 countries so it’s still very under-studied as a population, but they are 48 times more likely as other reproductive-aged adults to be living with HIV globally," Beyrer said.
“So it’s an enormously disproportionately burdened population and one for which there is still tremendous stigma and discrimination and access to healthcare issues,” he added.
“There is a basic lack of understanding about who transgenders are. We are lumped together with MSM when the needs and vulnerabilities of transgender women are different from MSM,” said Abhina Aher, program manager for the HIV/AIDS Alliance in India.
Prison: bound and forgotten
Closed settings like prisons are high-risk settings for HIV transmission. The UN Office on Drugs and Crime (UNODC) estimates that 30 million men and women spend time in prison every year. HIV prevalence in prisons can be 2 to 10 times higher than in the community.
Risky sexual behavior in prison includes unsafe sex, injecting drug use, and tattooing and body piercing.
Unsafe sex practices among inmates remains to be a taboo topic that is not openly discussed even in the context of HIV prevention.
“Some countries have an anti-sodomy law, example. So sex among men is not even supposed to be allowed; and when it’s not allowed, it is [thought of as] not happening,” said one officer in an international aid agency.
These factors hinder condom distribution programs and information dissemination intiatives. Needle-syringe programs (NSP) as an intervention for HIV transmission is also not widely accepted.
Among the countries in Asia, there are no NSP in place in the prison setting.
“We cannot get to zero new infections if we don’t look at [addressing] HIV transmission in prison settings,” said Anne Bergenstorm, Regional Adviser for HIV/AIDS at UNODC.
Bergenstorm added that some counties do not include HIV infection among prisoners in the numbers reported to their national AIDS registries. – Rappler.com