HIV has been with us for more than 3 decades. Millions have died worldwide. South Africa has been “ground zero” in some ways, being the country with the highest number of people living with HIV. The game-changer was, and is, ant-retroviral treatment (ART). ART does not cure or eradicate HIV but it does control the chronic infection such that HIV-positive people can and do live normal lives for the most part.

BUT, we still see more than half a million people dying worldwide each year, and at least 50 000 of those are South Africans. There are still concerns around stigma, prejudice, and discrimination. As we have said in the past, battles have been won but the war remains. HIV has affected poorer nations more than richer nations (in general and with some exceptions noted), for a number of complex reasons relating to healthcare resources, political leadership, social and cultural factors, education levels, communication and other infrastructure, and more.

COVID-19 has changed the world. This pandemic has caused millions of deaths, huge suffering, as well as unprecedented economic and social changes. Once again we have seen richer nations coping better (e.g. earlier and better vaccine roll-outs, better healthcare resources) while poorer nations struggle more (there are exceptions as ever, but in general this has been the case). This “inequality” has been seen despite the words of many political leaders who have spoken about “…no nation, no people, will be left behind…”.

End Inequalities. End AIDS. Reaching those left behind.

The theme for World AIDS Day 2021 (01 December is World AIDS day each year) is “End inequalities. End AIDS.” With the stated focus on “reaching people left behind”. This seems especially relevant for 2021 since COVID-19 has highlighted issues around the gulf between richer and poorer nations with regard to healthcare and health outcomes.

But campaign themes and political speeches are of limited use without action and without real change. It is well beyond the scope of this article to consider global healthcare economics or politics but perhaps we can offer a few thoughts on what we might each do personally:

  • Do you know your own HIV status? When were you last tested?
  • Do you know anyone living with HIV? Can you help to ensure they have access to HIV treatment (it is free from any government clinic or hospital)?
  • Do you know anyone who does not know her or his HIV status? Can you encourage them to be tested so that they can get life-saving treatment if needed? [Hint: the best way to approach this is to note that everyone should know their status and so it is important regardless of lifestyle, sexual behaviour, etc. In this way a non-judgemental conversation can be had if you are careful and sensitive.]
  • Are you certain, really certain, that you do not discriminate in any way as regards HIV status? If you see any form of discrimination, do you call it out?
  • Knowing that sex is the main method of HIV transmission, do you encourage safer sex within your family and social circles? Do you make condoms available in your home? Do you discuss these issues openly with your young teenage children?

To be clear: please do not feel that you should invade anyone’s privacy around these issues. Healthcare is a personal matter and a private matter. All aspects of healthcare. Including HIV status and HIV treatment. Knowing this – and we know that you “get it” – some caution and sensitivity is needed. But there are ways to respect privacy and still convey powerful messages around non-discrimination, the value of knowledge of status, and the efficacy of ARV treatment. In addition and of-course, personal beliefs including cultural and religious beliefs must be respected at all times. Please do not get into personal arguments about these sort of things.

This year’s World AIDS Day looks to focus on inequalities and those left behind. That seems ambitious and it is. Laudable, honourable, appropriate. But also ambitious. It has a lot to do with global economics and global politics and that’s complex by definition is it not? But perhaps it can also be applied in our own lives…

Author: Dr Colin Burns, retired medical practitioner and wellness coach