BATTLING TABOOS: HIV treatment still undermined by stigma

WASHINGTON: An HIV diagnosis doesn’t carry the death sentence it once brought. Over the past 30 years, enormous improvements have been made in medicine’s ability to treat patients. For most people across the world, drugs are available for free. Now, people treated for HIV can live normal, productive and healthy lives — those who take medication can have sex without worrying about infecting their partner. Doctors who treat the virus told DW that the recent news about Johnson and Johnson’s failed vaccine trial was therefore disappointing, but not the end of the world.

The US pharmaceutical firm stopped phase 3 trials on a highly sought-after HIV vaccine in January after results found that the jab was ineffective at preventing infection.

Still, despite these improvements, HIV cases aren’t falling as quickly as desired and are actually increasing in some parts of the world. A UN report released last summer reported that more than 1.5 million people had become infected with HIV in 2021, around three times the global target. Of the 38 million people infected with the virus, around 73% were under treatment, and around 15% didn’t know they had it, the report said. It gave pandemic-related funding cuts to global HIV and AIDS prevention programs as one reason for the 2021 stagnation but that doesn’t tell the whole story.

Experts say that the first step in preventing the spread of HIV is knowing whether you have it. But sometimes people avoid testing out of fear of judgment. Certain homophobic, moralistic public health campaigns that emerged in the 1980s in response to the AIDS crisis are still deeply ingrained in people’s perceptions of the virus across the globe. “People don’t want to get tested and don’t want to go to the treatment center if they are going to be stigmatized and then afterwards, discriminated against,” said Josip Begovac, a physician who specializes in treating HIV in Croatia.

Begovac said this is why “integrated” clinics specializing in testing for all kinds of sexually transmitted diseases that are less stigmatized — such as syphilis, gonorrhoea and chlamydia — are generally more successful at reaching those at risk for HIV.

Treatment is available for free in Croatia for anyone who seeks it and has insurance. But it is not available to people who do not have insurance, such as undocumented migrants, Begovac said. And there is only one HIV treatment center in Croatia, so some have to travel long distances — for up to four or five hours — to access care.

Herbary Cheung, a social science professor in Hong Kong who has studied HIV stigma among single mothers in Thailand, also said HIV care required long travel for people living in rural remote areas. In some Thai provinces, it can take up to a day to get to a facility that treats the condition.

Once a woman arrives at a center that treats HIV, medication is cheap and available, Cheung said. But treatment is just one part of the struggle. If that woman comes from a tight-knit rural area, news of her positive status can spread fast among family and community members. Some of the women Cheung spoke with, who worked in restaurants or massage parlours, had been forced to leave their jobs after their bosses heard about their HIV status. Religion also impacts how HIV is perceived in Thailand — in the Buddhist tradition, the virus is often seen as bad karma, a sign of bad actions in a past life.

This stigmatization caused some of Cheung’s interview partners to uproot their lives in their small villages to larger metropolitan areas after receiving an HIV diagnosis. There, he said, the women were more anonymous and also had better access to care and employment.