Latest UNAIDS numbers shows impacts of inequities — including in program norms

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globalaidsupdate2016In time for the United Nations High-Level Meeting that begins next week on the global HIV pandemic, UNAIDS has come out with its latest update of data, that show, the authors say, that “ending AIDS” can be done. They support that with numbers and charts showing steep and steady rises in global access to life-saving treatment for HIV, while also cautioning that “huge challenges” lie ahead in new infections. It calls for a “reinvigoration of HIV prevention needed to quicken the decline in adult infections.”

A look at the charts and graphs reveals a disquieting asymmetry, that, in turn, highlight the role that expanded treatment outreach and access, and strong and adequately equipped health systems will have to play in that prevention. It shows that Western and Central Africa, with close to three times as many people living with HIV than Western and central Europe and North America, have about half the rate of treatment coverage, four times the number of new infections and more than ten times as many deaths. Eastern and Southern Africa, with nearly ten times the number of people living with HIV than Western and central Europe and North America actually show similar rates of treatment coverage to those of Western and central Europe and North America — about half of those living with the virus in both cases — and similar new infection rates. But Eastern and Southern Africa also are home to a death rate from HIV more than four times that of Western and central Europe and North America.

Text on the next page gives one glimpse of why that might be, noting that the death rate drop for women since 2010 has been nearly double that of men, with more than 10 percent higher treatment rates leading, they point out, to the difference. This, they write, shows how “gender norms” keep men from accessing all the benefits of treatment. They do not say what those gender norms are, but appear to allude to what are often called “health-seeking behaviors.” With representatives of countries confronting HIV epidemics at home and abroad set to meet in a week, this could  a good time to look at “program norms” as well as “gender norms,” and ask what programs and their settings are doing to meet the testing, treatment, and healthcare needs of men.

Importantly, the latest report also points to a continuing imbalance between what might be called access to illness, and access to treatment, with laws, policies, and bias serving as health and treatment barriers to some of the hardest hit populations, including transgender women, men who have sex with men, sex workers, and people who inject drugs. This, of course, will be an important consideration for governments around the world that will need to concur on a commitment to unite in sustained, supportive and evidence-based efforts to stop HIV transmissions, illnesses, and deaths. A current draft of a declaration for countries to consider includes a call to end laws, policies and practices that stand between currently criminalized and otherwise marginalized populations and health services.

Rabita Aziz contributed to this post.

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