This Opinion Piece has been jointly authored by myself and Matthias Schmale, Under-Secretary General of the International Federation of Red Cross and Red Crescent Societies.
If the test of a humane society is the way in which it treats the most vulnerable and marginalised members of a community then we are failing that test.
Every day, violence, stigma and discrimination are driving the very people who need to access HIV prevention, care and treatment away from it. Sex workers, men who have sex with men and people who use drugs are regularly marginalised and are especially vulnerable to acquiring HIV.
The international community met this month to review progress and agree how to continue to tackle the global AIDS response. It’s still a huge challenge. 33.3 million people globally are living with HIV and 1.8 million people died of AIDS related causes in 2009.
People who live with HIV face unacceptable levels of prejudice and hostility which means that even earning a living can be impossible. For those in poorer countries accessing treatment is a huge challenge when there are limited supplies of antiretroviral therapy and getting to healthcare facilities takes hours of walking.
We need to be doing all that we can to protect communities that are marginalised, vulnerable and at higher risk of HIV, making them an active part of our health responses not persecuting or leaving them to die.
Despite the great progress over the last 30 years that mean millions can now access treatment and live healthy HIV positive lives, our next big test is how we address the continuing consequences of HIV on the most vulnerable in our societies.
What we see however is the funding available to tackle HIV barely reaches these communities. Instead, it is often directed to more politically palatable groups, despite the fact it makes little impact on the epidemic.
In Eastern Europe and Central Asia where epidemics are primarily concentrated among people who use drugs, 89 per cent of prevention funding fails to prioritize the people at highest risk.
In African countries that have high prevalence rates among the general population the communities that have higher risk of infection see less than 1 per cent of spending on prevention activities.
This is neither a rational nor a cost effective use of available funds. Why are the communities most affected by AIDS still not able to access funds when they know what works best for their community?
Recently we have seen a number of punitive laws being used to address HIV. Many countries have introduced new laws criminalising HIV transmission. Increased penalties for sex work and sodomy offences have been proposed or enacted and media attention given to prosecution and draconian bills is feeding stigma. All this makes it much harder for HIV programmes to reach those at higher risk of HIV infection. The law must support fair health¬care services yet in too many countries the law undermines our ability to tackle HIV effectively.
Many lives are at stake
What is urgently required is the same level of leadership we have seen to date in the AIDS response applied to providing supportive legal environments. Protecting public health and promoting human rights are mutually reinforcing strategies.
To undo the progress we have made to date in the AIDS response would be a major mistake. We should rightly acknowledge the huge strides that have been made. Let’s not forget that just 30 years ago the majority of people died from AIDS. Now, thanks to treatment people can live full, active and healthy lives. Just this year we have clear confirmation that AIDS anti-retroviral treatment can now be used as a method of prevention.
However, these gains could easily have been reversed at the recent UN High Level meeting on AIDS. The onus is on our law makers to guarantee that any new AIDS declaration contains a clear commitment for countries to provide a safe environment and ensure that those most at risk of HIV are fully protected and cared for so they get the HIV prevention, treatment and support to which they are entitled.