Patriarchy, Stigma And Inequality Are Slowing Down AIDS Response – Health Policy Watch

Winnie Byanyima (UNAIDS), George Simbachawene (Prime Minister’s Office for policy coordination and parliamentary affairs, Tanzania) and Dr Godwin O Mollel (Deputy minister of health, Tanzania).

The world is not on track to end AIDS by 2030 due to patriarchy, stigma against vulnerable communities and inequality, according to UNAIDS in its 2022 World AIDS Report. 

The report, titled “Dangerous Inequalities”, points out that unequal power dynamics between men and women and norms that prevent girls and women from exercising their bodily autonomy are major reasons behind the slowdown in HIV response.

The criminalisation of gay relationships and discrimination against key populations like gay men, men who have sex with men and transgender persons are also major stumbling blocks in the global HIV response. 

“The world will not be able to defeat AIDS while reinforcing patriarchy. The only effective route map to ending AIDS and achieving the sustainable development goals is a feminist route map. We can take action now to tackle gender inequalities and promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone,” Winnie Byanyima, the executive director of UNAIDS wrote in the foreword. 

Launching the report in Tanzania on Tuesday, Byanyima added that AIDS can end only if there is equality in the world. “The reason why we call it “dangerous” is because, currently, we are not on track, globally, to end AIDS by 2030 as was agreed by all the governments of the world. We are not on track. And the reason is inequality…But we can end AIDS by equalising.”

The gender lens

While 49% of new HIV infections across the world were among women and girls in 2021, in high-incidence regions like sub-Saharan Africa, women and girls accounted for nearly 63% of the new HIV infections. 

Women experiencing intimate partner violence in the past year are also three times more likely to have contracted HIV recently. This finding, coupled with the recent report by UN Women and UN Office on Drugs and Crimes (UNODC), which stated that more than five women are killed every hour by intimate partners or their own families, highlights women’s vulnerability. 

Distribution of new HIV infection by age and sex in sub-Saharan Africa, 2021.

Patriarchal norms also prevent men and adolescent boys from seeking the healthcare services they need, according to the report.

“Transforming harmful gender and masculinity norms among men and boys will help reduce their HIV risks, but it will also reduce risks and vulnerabilities to HIV among women and adolescent girls, including by respecting their sexual and reproductive health and rights and upholding zero tolerance for any violence against them,” the report added.  

Calling for an inclusive and comprehensive curriculum at schools that includes sexuality education, Byanyima said that pushing girls to complete secondary education would reduce their vulnerability to HIV infection by up to 50%. 

“We must combine services for sexual and reproductive health together with services for preventing and responding to gender-based violence and services for preventing and responding to HIV. These three must come together.. We must design it in such a way that they are tailored to meet the needs of girls and women in all their diversity.” 

Decriminalisation of queer relationships

While there is a significant decline in the incidence of HIV in western, southern, eastern and central Africa since 2010, the decrease is not significant among gay men and other men who have sex with men in these regions. 

“Key populations” – groups particularly vulnerable to HIV including men who have sex with men, people injecting drugs and sex workers – accounted for about 5% of the global population in 2021 but they and their sexual partners accounted for about 70% of new HIV infections. 

While several countries have decriminalised queer relationships, many countries still consider it a criminal act. Byanyima called for the decriminalisation of queer relationships to improve access to healthcare.  

“When you decriminalise, people will come forward and get services. Decriminalising saves lives…I suggest let’s confine these colonial and harmful laws to history. We don’t need them. God can judge them if they’re wrong. We don’t need the laws. They take people away from services. But we don’t only need to decriminalise, we need to fight stigma. Stigma is a sentence passed by society on people for who they are. Stigma kills. We need to end the stigma for people living with HIV.” 

Similarly, people who engage in sex work and those who inject drugs are at a higher risk of contracting HIV, which can only be addressed by involving community-led organisations in an effective manner to reach these key populations with prevention and treatment services.

“While efforts to expand services for key populations are critical to reducing the epidemic’s burden in these groups, the mere availability of services will not have the needed impact without concerted efforts to address societal enablers.”

Children left out of the equation

The UNAIDS report stated that children are disproportionately affected by HIV. While they make up 4% of the total HIV burden in 2021, they account for 15% of all AIDS-related deaths. The report also flagged that the gap between HIV treatment coverage for adults and children has widened since 2010. 

Antiretroviral treatment coverage comparison between children and adults at the global level, 2010-21.

It is estimated that globally, 800,000 children living with HIV are not receiving treatment. The report also stated that in Africa, the decrease in the number of new HIV infections among children has stagnated in the past five years. 

“Late diagnosis is an important contributor to the treatment inequalities that children experience. Globally, only 62% of HIV-exposed infants are tested within the first two months of life, but in western and central Africa, only one in four HIV-exposed infants receive early infant diagnostic services,” the report highlighted.

“The treatment gap for children can be closed if more pregnant and breastfeeding women and their infants are supported to confirm the child’s HIV status at birth and at the end of breastfeeding.” 

Allocation to key populations must increase

In 2021, low and middle-income countries channelled only 3% of their total HIV spending towards prevention and societal enabler programmes for key populations. UNAIDS said that this share has to increase to 21% by 2025 for the HIV response to be on the right track. 

Pointing out that increases in bilateral investment in HIV response in low and middle-income countries are usually met with similar increases in domestic investments in HIV response, UNAIDS said that donor and development partner investments into this cause must expand. 

Comparison of expenditure of external and domestic funding towards HIV response, 2018-20.

Similarly, the agency also called for focussed investments towards programmes that benefit young women and girls. 

Image Credits: UNAIDS.

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