UNAIDS is a Joint United Nations Programme on HIV/AIDS in which agencies such as the World Health Organization (WHO), UNICEF, and the United Nations Development Program (UNDP) participate. In December 2010, UNAIDS formulated its UNAIDS strategy for the next few years, which “aims to advance global progress in achieving country set targets for universal access to HIV prevention, treatment, care and support and to halt and reverse the spread of HIV and contribute to the achievement of the Millennium Development goals by 2015.”
In the following contribution, Angeline Obutu and Helen O’Regan rscj, who both work for the Catholic Diocese of Eldoret, Kenya, in the AIDS Education and Prevention Programme, reflect on the 10 strategies of UNAIDS from the perspective of their experience in Kenya.
1. Sexual transmission of HIV reduced by half
This goal does not seem realistic unless the promotion of attitude/behavior change is embraced by all stakeholders.
2. Vertical transmission of HIV eliminated, and AIDS-related maternal mortality reduced by half
When the World Health Organization (WHO) had to make a decision in the early 1980’s whether HIV would be a public health issue or a human rights issue, it settled on human rights. Recently it is subtly shifting to considering it a public health issue, which infringes on human rights.
In order that this goal may be realistic, issues of culture, poverty and respect for human rights must be addressed. Our experience indicates increasing numbers of HIV positive children. Another area to be addressed is the role of traditional birth attendants, giving pregnant women additional instructions that can promote safe motherhood. A serious issue around breastfeeding by HIV positive mothers is poverty. Though advised to breastfeed exclusively for six months and then stop completely, on account of low income some continue, and the baby is therefore at higher risk for infection.
3. All new HIV infections prevented among people who use drugs
In the past few years there has been an increased abuse of hard drugs. The treatment centers are few for those who may wish to stop. In addition drug abusers are not frank about their use due to stigma attached to drug use. While it is doubtful that “all” prevention is realistic, working toward this creatively and with the realities of those involved is essential.
4. Universal access to antiretroviral therapy for people living with HIV who are eligible for treatment
This goal is not realistic unless practical and ethical issues are addressed as well as management of opportunistic infections. For example, because of the potency of the treatment drugs used, it is very difficult to take ARVs without having enough food to eat.
5. TB deaths among people living with HIV reduced by half
This is a realistic goal. It is crucial to support every health unit in the world with adequate teaching/education materials towards this goal. People are still ignorant about TB. The deadly resistant strain must not be allowed to spread; it is both difficult and expensive to treat.
6. People living with HIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support
Poverty is the biggest challenge to this goal. Neighbors still help neighbors, even among the poorest of people. In Africa if you are from the same village and live in town you help as if you are still in the village. In 1997 AIDS was declared a national disaster in Kenya. It is still a national disaster – moving in and out of the limelight.
In addition cultural issues need to be addressed. Examples include wife inheritance, land inheritance and polygamy. It is evident that, even if a practice is illegal, if it is culturally based, it will take time to eradicate it, e.g. female circumcision.
7. Countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half
It is incumbent upon religious groups to reduce the stigma around HIV. It is not a sin to be HIV positive. Legal issues around HIV need to be addressed in employment policies. For example, teachers must learn how to relate to HIV positive children, especially those who have too many secondary infections, and how to reduce stigma in a school. Changes in the law will result from changes in peoples’ minds and hearts towards those living with HIV.
8. HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions
This is realistic if efforts are made to educate all concerned.
9. HIV-specific needs of women and girls are addressed in at least half of all national HIV responses
This is more of a challenge culturally in some countries. It is hoped that this is a realistic goal. It must also include men in support groups – those married to women of child-bearing age.
10. Zero tolerance for gender-based violence
Again culture is a challenge, especially where secrecy surrounds domestic violence. The naming of rape as a war crime has been a great boost to the prevention of gender-based violence.
Angeline Obutu and Helen O’Regan rscj