By Colin McGregor
At the 24th International AIDS Conference held in Montreal last summer, a lot of thought went into describing how inequality perpetuates AIDS. But the coronavirus and monkeypox were also on the agenda as scientists, activists and UN agency workers alike struggle to fight these plagues on our society.
And local Quebec organizations are also concenred about the same issues.
Winnie Byanyima is the executive director of UNAIDS. She says that her organization’s statistics show that infection rates for AIDS globally have been on the decrease for 20 years. But that this decrease has stalled, and global infections have held steady since 2018. More than 1.5 million people worldwide were infected in 2021, at a time when the world was fighting the COVID-19 pandemic.
And it’s largely because of laws that punish and marginalize those with the HIV virus, or those who have LGBTQ+ sex. When these marginalized people remain hidden, treatment and education is less likely to be obtained because people are scared to access them, and infection rates rise accordingly.
Roughly 650,000 people died of AIDS in 2021, about one person every minute, according to U.N.AIDS, the organization’s program on HIV and AIDS. Many of the new infections that year occurred in girls and women. One new infection in a teenage girl or young woman occurred every two minutes.
In sub-Saharan Africa, the southern part of the continent, young people accounted for 31% of new infections, and nearly four out of five of those were among girls and young women.
In El Salvador, HIV almost doubled among men who have sex with other men and rose about 8 times with transgender people.
Fully 93 countries have laws that criminalize HIV and 44% of all the nations on the planet criminalize same sex activity. In these countries, gay men have a 5 times greater HIV infection rate than in countries without these laws. That’s because criminalization drives people underground. They are too afraid to access health and safety measures, from condoms to the PrEP pill – Pre-exposure prophylaxis (or PrEP) is medicine taken to prevent getting HIV. PrEP is highly effective for preventing HIV when taken as prescribed. PrEP reduces the risk of getting HIV from sex by about 99%. PrEP reduces the risk of getting HIV from injection drug use by at least 74%.
“Criminalization affects treatment and the virus spreads,” says Byanyima. “When we react with police and prison rather than nurses and health care, the virus spreads.” In 11 countries, same sex activity is punishable by the death penalty.
And the situation is bound to get worse in some places. In the 52 countries where almost half the people living with HIV live, the World Bank projects that social spending will decrease in the years to come.
It would be better for countries to co-ordinate their response to AIDS and COVID, says Nobel Prize winning economist Joseph Stiglitz. “But that’s not the way the world is going. We are in the worst of all possible situations… Countries are going to be selfish in times of stress,” he observes.
The past two years have brought unrelenting hardship, especially in low and middle income countries, that has disrupted the prevention and diagnosis of HIV. And nations, says Stiglitz, have to make choices about paying down their debts to rich nations and big banks rather than spending the money on health care. In 2021, debt repayment for low-income countries comprised 171 per cent of spending on health care, education and social protection combined.
“These figures are about political will” says Byanyima, an aeronautical engineer from Uganda. “Do we care about empowering and protecting our girls? Do we want to stop AIDS deaths among children? Do we put saving lives ahead of criminalization? If we do, then we must get the AIDS response back on track.”
“Government choices have undermined treating pandemics,” Stiglitz says. “COVID 19 has exposed our inequalities. It’s very much a choice that was made to leave us in a poor state of preparedness.”
“COVID goes after people who are already in poor health,” he adds. “The way that the U.S. hasn’t recognized health care as a basic human right has raised the death rate.”
He adds: “It was a critical mistake to allow the drug companies to hoard their intellectual property – it intensified global inequality. There will be more mutations of the virus in poor countries now. And we will all suffer because of that.”
Both Stiglitz and Byanyima complain that multinational drug companies, in “hoarding COVID vaccines” and not letting them out into third world nations, will cost the world dearly. Says Stiglitz: “The drug companies know that the delay in bringing vaccines to the rest of the world, even though it costs humanity millions of deaths, they are willing to delay in order to make billions in profits.”
“Inequality is continuing to rise at an alarming rate,” says Byanyima. “When companies are being allowed to accumulate money in such large numbers, what do they do with that money? After all, you can only live in one house at a time, or swim in one pool at a time. They buy democracy. They capture the voice of the people.”
There is good news. Since 2010, AIDS deaths have been cut in half. But infections are growing in many countries. People in urban areas have higher rates than in rural areas; the urban poor have the highest HIV infection rates. And, as with COVID, these urban poor are not in great health to begin with, so their death rates are higher than the average population too. Moreover, infection rates among white men are falling, whereas rates among visible minority (Asian and black, for example) men are rising. Gay men have a 28 times greater risk of infection compared to heterosexual men.
AIDS and COVID death rates fall when steps are taken to close inequalities within a society.
Why has progress against HIV stalled? In 2021, 70% of all HIV infections came from:
– sex workers and their partners
– men who have sex with men,
– prisoners, and
– IV drug users.
All of these are marginalized people.
Groups that are oppressed in different parts of the world, or essentially lower on the social hierarchy, are not given the same access to HIV or COVID treatment.
In Canada, new HIV infections are higher among black people and indigenous communities compared with white people. Men who have sex with men, drug users and sex workers have about 30 times the risk of infection, compared with others in the population. Effective global policies should take these realities into account: it’s about more than handing people condoms and lube.
An estimated 40 million people are living with HIV worldwide. About 10 million of them, including about half of all infected children, do not have access to treatment.
In an ideal world, young women would have access to reproductive health services without stigma or judgment from their families and communities.
“We only support women with HIV,” says Veronica Pizzi, General Manager of the Centre d’Action SIDA Montréal (CASM). “An about 90% of the women we help that live with HIV in Montreal are black, from Africa or Haiti. Most of them learn that they have HIV through the immigration process.”
Most of these women are low income; about half live off social assistance. “The other half work with very low salaries.”
Pizzi confirms that taboo and ignorance propagate the spread of AIDS. “There’s a lot of taboo and stigma in Canada and in their home countries it’s even worse. If they are too afraid to get tested, they pass on the virus.”
She adds: “Even if they get tested and they’re HIV positive they keep it secret even within their families. It could be a reason for rejection – some who have told people they are HIV positive have been rejected from their families. They are afraid of things they shouldn’t be afraid of.”
She adds: “And when they don’t get tested, they pass on the virus. They are afraid of someone seeing them being tested.”
“It’s a lack of education,” says Pizzi of many of the women she treats at CASM. “They keep it a secret even from their daughters. Often a daughter doesn’t even know her mom has HIV. But a woman who is efficiently medicated can’t transmit the virus even during sexual intercourse. She can’t pass it on to her daughter even during childbirth.”
CASM provides free self-tests that take only a few minutes, for women who don’t want to go through the health care system. “The health care system can be complicated and intimidating,” Pizzi observes. “It can take weeks to get an appointment. Because of COVID, all the testing has been pushed back, it’s not instantaneous to get testing. The information may not be available. And in a clinic, the test could cost around $80.”
Pizza believes that Canada needs to do more to raise awareness and educate people. “We haven’t really concentrated our effort and our budget as a nation educating people about HIV. Because you don’t die from it any more, we’ve forgotten about it. If more awareness were created in schools, in companies, in the health care system, nobody would be afraid of people with HIV and they wouldn’t be stigmatized. It’s ignorance. Even in the health system it is very serious, and sometimes nurses and doctors don’t treat HIV people the way they should be treated.”