let communities lead: what needs to be done to end the hiv epidemic
while medical advancements have changed hiv from an acute, life-threatening infection to a chronic and manageable disease, there are still many challenges to overcome to end the hiv epidemic
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education can help to reduce the stigma attached to living with this disease and prevent it from spreading. shutterstock
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2023 marked the 35th anniversary of world aids day, a chance to raise awareness of hiv/aids and encourage the international community to come together to spur progress in prevention and treatment. while many may think of hiv and aids as crises of the ‘80s, the hiv epidemic isn’t entirely in the past – hiv continues to be a global problem, with close to 40 million people living with the disease worldwide. and while world aids day – observed on december 1 – presents an opportunity to raise awareness of the ongoing hiv epidemic and to mourn those who have lost their lives to aids, it’s also a time to look forward to what needs to be done to end the epidemic.
“research in hiv has been incredible over the last three and a half decades, and the disease itself has changed from an acute, life-threatening infection to a chronic and manageable disease,” says dr. sharon walmsley, professor of medicine at the university of toronto, senior scientist at the toronto general hospital research institute, and director of the hiv clinic at toronto general. “we now have effective therapies that allow people to live relatively normal lives.”
those living with hiv have several therapeutic options available to suppress their viral load. “research has never advanced so quickly,” says dr. walmsley. “if people living with hiv take their therapy, they’re not capable of passing the virus on to anyone else. their viral load becomes undetectable, making it untransmittable.”
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the life expectancy for people living with hiv is now approaching that for the general population. women living with hiv can now give birth to babies who don’t carry the infection, and new therapies can also prevent people from getting hiv. it’s all very promising.
despite these advances, there are still barriers to overcome, including lack of awareness about the risk of contracting hiv and available testing options; gaps in individuals seeking medical attention and adherence to treatment; and a general lack of health-care professionals in canada.
the joint united nations programme on hiv/aids (unaids) set the theme for world aids day 2023 as “let communities lead” – encouraging communities to be the driving force in connecting people with person-centred public health services, building trust, innovating, monitoring the implementation of policies and services, and holding providers accountable.
this theme of community leadership is essential to the global health sector strategy on hiv that unaids and the world health organization (who) have established to help eliminate hiv as a public health threat by 2030. known as the 95-95-95 strategy, there are three global targets identified for the year 2030: 95 per cent of people with hiv know their infection status, 95 per cent of people diagnosed with hiv receive treatment, and 95 per cent of people taking treatment have an undetectable viral load.
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one of the main challenges in the push to achieve the 95-95-95 strategy is an education gap, according to dr. walmsley. “people need to understand whether or not they’re at risk for hiv, and they need to be able to go out and get tested so that they can prevent onward transmission,” she says.
“people often look at this as a gay man’s disease and they don’t perceive themselves to be at risk, and therefore they don’t go and get tested. and it’s the untreated person who’s responsible for transmission. knowledge is important.”
despite common misconceptions, it’s not only men who have sex with men or people who inject drugs who are affected by hiv. “over half of the people living with hiv are women1,” says dr. walmsley.
young women and girls between the ages of 15 and 24 are particularly affected, with certain groups of women being disproportionately affected, including women in sub-saharan africa, sex workers, women who inject drugs, and women who experience intimate partner violence. education can help to reduce the stigma attached to living with this disease – which leads to moral judgment and unfounded fears of contagion through casual contact – and prevent it from spreading.
“stigma discourages people from getting tested,” says shiny mary varghese, executive director at aids program south saskatchewan. “this can be overcome by increased and consistent hiv education and testing campaigns to dispel myths about hiv transmission and the importance of regular testing to promote early diagnosis and treatment. addressing stigma should be a priority at multiple levels — healthcare providers and social workers should be trained to address stigma and challenge negative attitudes among peers.”
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once people are diagnosed, there’s also a gap in them engaging in care and following through on medical protocols, says dr. walmsley. “the treatment is only as good as the person who actually takes it,” she says.
“and finally, the other issue is the manpower at the other end – having enough people to be able to appropriately diagnose and treat people,” says dr. walmsley. “in northern canada and the prairies, in particular, there simply aren’t enough doctors and nurses to be able to care for the people who have become newly infected there.”
part of the issue with the higher hiv rates in northern canada and in the prairies has to do with the fact that certain populations in canada are disproportionately affected by the virus, including racialized and marginalized communities, such as indigenous peoples.
in canada, indigenous people are disproportionately affected by hiv due to risk factors from injection drug use, poverty and homelessness to racism and the multi-generational effects of colonialism2. indigenous people make up a large proportion of the total population in canada’s northern territories and also in the prairies3.
“getting to 95-95-95 will happen when the people and communities most impacted by hiv are actually able to access the treatment and prevention tools that we already have at our disposal,” says michael kwag, executive director at the community-based research centre. “it requires making the necessary investments in communities that canada still hasn’t made to ensure that whatever barriers that people may be facing in accessing hiv treatment or prevention —whether it be around cost, accessibility, or stigma — will be overcome.”
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to achieve the 95-95-95 targets, dr. walmsley stresses that we must continue to address these barriers. patient engagement in the form of advocacy has been critical in the fight against hiv and these advocates have been key partners in research decision-making processes, dr. walmsley notes.
the
“let communities lead” theme confirms one thing: it will take a concerted and coordinated effort from all stakeholders to bring about the long-awaited end of the hiv epidemic.
1. https://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures
2. https://www.canada.ca/en/public-health/services/hiv-aids/publications/epi-updates/chapter-8-hiv-aids-among-aboriginal-people-canada.html
3. https://www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm
2. https://www.canada.ca/en/public-health/services/hiv-aids/publications/epi-updates/chapter-8-hiv-aids-among-aboriginal-people-canada.html
3. https://www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm
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this story was created by content works, healthing.ca’s commercial content division, on behalf of viiv healthcare.
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