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For all too many marginalized people, access to HIV care is elusive

Montreal Gazette | Dr. James Orbinski and Heather Johnston | July 20, 2016



This week, 18,000 delegates and 1,000 journalists are convening in Durban, South Africa for the 21st International AIDS Conference, one of the largest-ever gatherings of HIV/AIDS researchers, medical professionals, activists and policy-makers.

This year’s theme of Access Equity Rights Now sheds light on the historic opportunity we now have in the global response to the HIV/AIDS pandemic. The possibility of ending AIDS as a public health threat by 2030 is within our grasp. But we will need more commitment to helping those who are hardest to reach.

We are 35 years into the epidemic, and still more than 60 per cent of people living with HIV are without access to life-saving antiretroviral therapy. Women and girls, men who have sex with men, transgender people, sex workers, young people, prisoners, people who use drugs, and many other marginalized groups face the biggest barriers to life-saving care.

Equal access to HIV care means just that, whether you’re an intravenous drug user on Vancouver’s Downtown Eastside, or a pregnant woman in rural Africa. We know that the goal of ending AIDS will remain elusive as long as these hard-to-reach groups are not prioritized in our response. We need well-funded targeted programs to ensure access to those living on the margins. And we must commit to bold and ambitious action to end the widespread violations of human rights that undermine effective responses to the epidemic.

The Zomba Prison in Malawi is a good example of the obstacles marginalized individuals face in gaining equal access to HIV prevention and care. Since 2014, Dignitas International and the Malawi Prison Health Services have been implementing a screening and treatment program for HIV and other sexually transmitted infections at the maximum-security prison, which holds 2,000 inmates in a facility designed for 340.

The prevalence rate in the prison sits at a staggering 35 per cent, nearly four times higher than the national average. But it’s not all bad news. The authorities have shown a remarkable commitment to providing HIV treatment options through Dignitas. Because of this, and with stable funding from the U.S. government, close to 90 per cent of HIV-positive prisoners in Zomba Prison are on antiretroviral therapy.

So where’s the problem? It is one that is faced by many marginalized groups around the world. While prisoners are offered HIV care and treatment, they are denied the one simple strategy that would halt the rapid spread of HIV: condoms. The prisoners are almost entirely male, and homosexuality is illegal in Malawi. No condoms are allowed in the jail, which puts all prisoners at risk of infection unnecessarily.

In many countries, the criminalization of homosexuality, transgenderism, sex work and other vulnerable groups is a major barrier to providing comprehensive treatment, prevention and care. We witnessed this at the June UN High Level Meetings on AIDS in New York, where the world carved out its new political declaration to tackle HIV/AIDS. Many of these groups were denied a place at the table by their own governments. How will it be possible to meet their health needs if we refuse to acknowledge their voices?

In Durban this week, many important discussions are taking place, including, perhaps most notably, on financial commitments. Canada is already leading by example with its $785 million pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria and by agreeing to host the fund’s replenishment conference in September.

But investments are only part of the solution. Countries like Canada can be a strong voice in calling for an end to the human rights violations and criminalization that result in a lack of access to HIV prevention, care and treatment for people who need it most. We must also support the development of programs that promote equal access for marginalized groups.

Respecting fundamental human rights will be a critical factor in achieving the end of AIDS by 2030. Failure to do so will mean blundering what could have been the greatest public health achievement of our generation.

James Orbinski MD is co-founder of Dignitas International and a professor at Laurier University, in Waterloo, Ont. Heather Johnston is president and CEO of Dignitas International.

Dignitas InternationalFor all too many marginalized people, access to HIV care is elusive

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