HIV/AIDS: Breaking The Silence And Stigma Barriers

By ALESSENDRA TISOT

Every day, 14,000 people between 15-24 years and 2,200 under 15 years are infected by HIV. Between now and 2020, 70 million people will have died prematurely because of AIDS. Countries all over the world are losing their most economically active and productive population.

The economies and societies of South Asia are poised to make great advances over the next decade. But the looming shadow of AIDS may destroy these prospects.

The HIV/AIDS epidemic in South Asia today is at what epidemiologists refer to as a 'tipping point'. It is still relatively small compared to the population size, but left unchecked it will grow rapidly and ruthlessly. Only immediate, comprehensive action will prevent at least 5 million new HIV infections in South Asia this decade, and begin successfully turning back the epidemic.

Delay will produce a larger, more damaging, and more intractable epidemic. The action that is taken, or not taken, by leaders at all levels of government and society in South Asia in the coming months and years will determine whether the future faced by the region's children is bright - or falls further under the shadow of HIV/AIDS.

Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact. HIV/AIDS-related stigma and discrimination are universal, occurring in every country and region of the world. They are triggered by many forces, including lack of understanding of the disease, myths about how HIV is transmitted, prejudice, lack of treatment, irresponsible media reporting on the epidemic, the fact that AIDS is incurable, social fears about sexuality, fears relating to illness and death, and fears about illicit drugs and injecting drug use.

All over the world, the shame and stigma associated with the epidemic have silenced open discussion about its causes and the appropriate responses. This has caused those infected with HIV and affected by the disease to feel guilty and ashamed, unable to express their views and fearful that they will not be taken seriously. And they have led politicians and policy-makers in numerous countries to deny that there is a problem, and that urgent action needs to be taken.

People with HIV/AIDS are often believed to have deserved what has happened for doing something wrong. Often these 'wrongdoings' are linked to sex or to illegal and socially frowned-upon activities, such as injecting drug use. Men who become infected may be seen as homosexual, bisexual or as having had sex with prostitutes. Women with HIV/AIDS are viewed as having been 'promiscuous' or as having been sex workers. The family and community often perpetuate stigma and discrimination, partly through fear, partly through ignorance, and partly because it is convenient to blame those who have been affected first.

But HIV/AIDS respects no border, region or class of people. It is a well-documented fact that the impact of HIV/AIDS at the household levels especially the poor households has devastating consequences for the family members, the consequences of which are passed on inter-generationally. Silence, denial, stigma and discrimination are still featuring in HIV/AIDS discourse in South Asia.

Highlighting the linkages between the epidemic and the larger challenge of human deprivation in South Asia, the main objectives of the United Nations Development Program's comprehensive regional report are to create an understanding of the causes and consequences of HIV/AIDS within a human development framework and thereby advocate for a shift in development priorities and approaches to HIV and, on this basis, identify key points for HIV/AIDS and development strategies in the region.

Compared to other countries in Asia and the world, available data suggest that Nepal has a low level of HIV among the general population. In Nepal, the first cases of AIDS were reported in 1988 and since then the number of people living with HIV/AIDS has increased considerably.

Data regarding HIV/AIDS is scarce in Nepal; however, available data indicate that around 0.5 percent of the general population is HIV positive. As of May 2003, the Ministry of Health has reported 644 cases of AIDS and 2,883 HIV infections with 159 deaths reported so far.

It is estimated that there are approximately 60,000 people living with HIV/AIDS. In Nepal HIV/AIDS is considered to be in a concentrated epidemic stage among the most vulnerable sub population groups of Injecting Drug Users, sex workers, and returning sex workers from India. However the risk of it spilling into the general population is a real one.

The dynamics of the epidemic are especially dramatic in the Kathmandu Valley where HIV/AIDS prevalence was 2 percent or below among female sex workers and Injecting Drug Users in 1992. It is now recorded at 68 percent among Injecting Drug Users in Kathmandu and is 17 percent among the sex workers.

It is commendable that His Majesty's Government has established the National AIDS Council chaired by the prime minister. The council, with representation from government, non-government organizations and civil society, will go a long way in advocating for active participation in the fight against this epidemic among all strata of society.

HIV/AIDS is already included as one of two cross-cutting issues in the 10th Development Plan, which will cover the period 2002-2006.

The National Center for AIDS and STD Control has developed the National Strategy on HIV/AIDS, 2002-2006 which takes into account the Millennium Development Goals and the Commitments made at the Special Session of the UN General Assembly on HIV/AIDS.

The national strategy emphasizes that an effective and efficient response will result from a shift from individually funded 'projects' to a 'program' approach; from capacity building of central structures to strengthening implementation capacity, and that the graduation from a health sector response to a multi-sector approach will require time and resources.

Also, work has been going-on to strengthen the role, function and structure of the National Center for AIDS and STD Control, as the main government agency tasked to oversee the implementation of the national strategy.

The Global Fund for AIDS is now supporting national initiatives on HIV/AIDS in Nepal. There are also several other bilateral and multilateral donors who are willing to support the governments both technically and financially and it is heartening to note that the civil society and the business sectors are actively participating in the response.

This report is expected to be a useful tool for all of us who are engaged in addressing HIV/AIDS and development to find pragmatic ways to fight the epidemic and minimize its negative impact on humanity.

(This article is based on the address delivered by Ms. Tisot, acting resident representative of the UN Development Program, to the program organized to launch the report last week.)