The HIV epidemic, it has been said, is at a turning point. Recent evidence suggests that this is true: Globally, the rate of new infections and the number of AIDS-related deaths have both decreased. More people than ever are on treatment. And this was all achieved in the span of a few of decades—an astounding rate of progress given the scope of the epidemic.
However, in light of recent political developments, suggesting that we are at a “turning point” paints an incomplete, if not inaccurate picture of our progress. The law recently passed in Nigeria prohibiting gay and lesbian citizens from gathering and organizing sets us back from creating an AIDS-free future. That Uganda just passed a law that toughens penalties for homosexual behavior, already illegal in that country, sets us back even further. These laws are a blow to public health and human rights.
Men who have sex with men (MSM) have a significant risk of HIV infection and are a critical population for HIV interventions. Yet stigma, discrimination, and now criminalization are preventing them from accessing HIV prevention, care, and treatment services.
Consider Nigeria: It has the second highest number of people living with HIV in the world, second only to South Africa. Based on the numbers alone, it has an urgent public health need to address the HIV-related needs of all people, especially those at the highest risk. The new law has just made that harder.
In the face of that, the global health community has one option for implementing HIV interventions in places like Nigeria: Keep going.
Five years ago, the Population Council set out to establish the first nationwide network of health providers in Nigeria focused on the needs of high risk men. Locating populations of men who had gone into hiding for the sake of their own safety was one of the first tasks. We started with just a few respected, influential people from each target community. It was a “snowball” approach—work with a select few to encourage their peers to seek out the free services provided by the network.
Since then, the Men’s Health Network, Nigeria (MHNN) has been able to provide approximately 100,000 high risk men and their sex partners with comprehensive, tailored, stigma-free health services. Nearly 80 percent of those men received HIV testing and counseling, the gateway to care for those who were infected and enhanced prevention for those who were not. Nearly half a million condoms were distributed.
While it is too soon to measure what impact the MHNN had on infection rates in Nigeria, the MHNN has demonstrated that we can reach key populations with necessary HIV services, even in difficult environments. It may mean starting with just one champion, but when we keep going, it can have a greater impact. Action research that started with one champion in Senegal and Kenya prompted both countries to address the HIV-related needs of MSM in national HIV policies.
Creating an AIDS-free future is contingent on addressing the discrimination that has such a significant impact on public health. In the face of potentially devastating roadblocks like the laws in Nigeria and Uganda, we have an option: Keep going.