More encouragingly, since 2000 the percentage of people living with HIV has stabilised. In several countries, the rate of new HIV infections has steadily declined, according to UNAIDS, a United Nations programme tasked with tracking the spread and prevention of HIV/AIDS globally.
Other encouraging trends are that more people have access to AIDS treatment and are better informed and equipped to prevent transmission, according to a report released earlier this year by UNAIDS.
However, the significance of this modest evidence of progress should not be taken for granted. Increased investment in treatment and prevention suggests that there is an increasing sense of urgency, and political will, to tackle the epidemic. Secondly, a global reduction in infection rates suggests that much needed behavioural changes among vulnerable groups might be taking place, and that there is reason to be optimistic that the trend may continue. Lastly, progress made thus far testifies to the increasing power and value of civil society globally, given that the drive to fight AIDS has been in large part fuelled by networks of hardy and persistent activists.
Nonetheless, while there has been progress globally, sub-Saharan Africa remains the epicentre of the disease, with 22 million of an estimated 33 million AIDS-infections worldwide. While the rest of the world makes progress, the region strains not only to combat the disease but also to contend with growing numbers of AIDS orphans (75 percent of children that have lost parents to the disease live in the region) and other knock-on effects, foremost among them decreased economic productivity and social disintegration.
The battle against the epidemic remains fierce and formidable in the region and will require a continuation of existing tactics as well as access to prevention and contraception, investment in treatment and other more generic strategies such as counselling and education.
A set of strategies aimed at tackling the psychological and cultural factors that fuel the spread of the disease in the region is necessary and equally important.
It remains permissible, and even commendable, for men to have multiple sexual partners, despite the tremendous risk that this presents. This and other similar perceptions shaped by cultural beliefs substantially increase the likelihood of men engaging in risky sexual behaviour by as much as three times, according to a UNAIDS study in Botswana among other countries in the region.
Cultural and religious perceptions have also contributed to the deafening silence on the uncomfortable social behaviour that contributes to the spread of the disease. The role of commercial sex workers and men who have sex with men in the spread of the disease remain little-acknowledged issues that should be candidly discussed and boldly tackled. More importantly, the lack of frank discussion, research and policy on these taboo issues stifles the prospect of developing comprehensive and relevant solutions to the epidemic.
Granted, changing entire cultures and deeply entrenched psychological beliefs is a formidable and difficult task. However, sub-Saharan Africa’s political leaders have a critical role to play in shaping the psychological beliefs that help sustain the epidemic. More pointedly, these leaders have the ability – and the imperative – to create policies that can forcefully re-shape those beliefs that sustain the epidemic.
In several African countries, policies to protect and promote the rights of groups vulnerable to the disease, including commercial sex workers, do not exist. Yet, if meaningful headway is to be made in the fight against AIDS, vulnerable groups need the full protection of the law and equal access rights to services and legal recourse should they face discrimination. This is particularly critical to helping boost the confidence of these ‘at-risk’ groups in seeking early testing and prompt treatment. Granting these groups the right to raise awareness of little-known aspects of the nature of AIDS without the fear of recrimination could also significantly alter how the epidemic is understood, and perhaps help shape better-informed sexual choices.
As the fight against AIDS shows signs of progress globally, it is critical for the sub-Saharan Africa – the region showing the least progress – to build on current successes in increasing awareness and access to treatment. And African leaders must face the crucial challenge of confronting a regional fear of questioning uncomfortable cultural beliefs. These leaders have the ultimate responsibility of making laws to counter these cultural prejudices that have hitherto helped sustain what has become an extremely formidable and costly epidemic.
