December 1 is celebrated internationally as World AIDS Day. HIV/AIDS after many years of research has become a manageable chronic illness, much like Diabetes and Hypertension. However, HIV remains stigmatised preventing access to testing, care and treatment.
In an effort to end the AIDS epidemic, an ambitious goal was set for 2020 cleverly called 90-90-90. By 2020 90% of persons living with HIV should know their status, 90% of HIV positive persons should be on treatment and 90% of those on treatment should be virally suppressed. Why? because U=U… undetectable = untransmittable. That means, the more persons who know their status, and are on treatment and are virally suppressed, the less the virus will be transmitted and the less new cases of HIV will exist.
According to 2018 data, Jamaica’s 90-90-90 is more 84-47-62 and we are a month away from 2020… so we will not be meeting that target. The UNAIDS has a new target for 2030, this one is 95-95-95 which echos the same sentiments as the target for 2020.
Are these targets achievable? I think so.
On November 30, 2019 I went to the Jamaica Network of Seropositives(JN+)‘ World AIDS Day Breakfast Forum. JN+ is a non governmental organisation dedicated to advocating for the rights and concerns of persons living with HIV. I have attended this forum since I was a medical student, each year information is shared about what is being done locally to reduce the aids epidemic, how well our responses are and what shortfalls exist. I also get to hear the first hand experience of people living with HIV(PLHIV)) in an open and candid setting. This year’s theme was ‘Health for All: My Community… Our Stories to Tell.
Stigma and discrimination in Jamaica, remain one of the largest barriers to achieving our goals. Stigma is propagated in several social settings, and exists even after 40+ years of research, information and myth debunking. Stigma exists in homes, communities, health care facilities, workplaces, schools and within self. Treatment and prevention has to use the biopsychosocial model in order to become successful. As of 2019, we have methods for both successful prevention and treatment, that are easy and have less and less side effects. So why is it, with the invention of antiretrovirals, we are still doing subpar at preventing and treating HIV?
Take a moment to think about all the things you know about HIV. Take a moment to acknowledge your feelings about HIV. Almost reflexively people scorn and look down on the virus and, as such, persons living with the virus. However, we fail to realise the HIV does not know face, status or education level. HIV does not care who you are or what you do. Anyone can get HIV.
Certain key populations are more at risk of acquiring HIV, in the forum it was shared that transgender women and men who have sex with men make up the largest key populations affected. It was also shared, that while Jamaica is improving at diagnosing HIV, having persons start treatment or staying on treatment has become an issue.
Let us go back to the biopsychosocial model. This model looks at the complexities of biological, psychological and social aspects and how they interact to affect health, illness and health care delivery. We have the biological treatments and are constantly improving on same, now, we need to tackle aggressively the psychological and social aspects that act as barriers towards HIV treatment and prevention.
I have found that it is not only what we say, but how we say it that can have impact. Many times information about HIV prevention are presented in ways that support the incorrect view that HIV is a death sentence. Many of these tactics are scare tactics, and make HIV more than what it really is- a chronic illness that has risk factors- but ultimately anyone can get. Our language around HIV has to change.
For our language to change, we need the level of education around HIV to change too. This would mean talking more about sex, and having more sex positive conversations with our children and teenagers. There are still persons who don’t know how the virus is transmitted, or that it can be treated. Speaking about HIV has to become normalised, just like how we talk about hypertension and diabetes. Education empowers people, education breaks down barriers and changes the psychology of people. The more educated our population is on HIV, the more empowered they are to prevent new cases and appropriately treat current cases.
There needs to be social support, from families, schools, communities, non governmental organisations and government. Legislation around HIV has to improve so that persons aren’t criminalised and legally discriminated against for having the virus. Those who are most vulnerable need support and protection, especially from government. The social aspect of the virus, has become the biggest player. The impact of good social support can do wonders for anyone who is struggling. It is my personal view, that the social aspect of treatment and prevention is the most lacking, that with deliberate improvement of this there will be greater ease in ending the epidemic. JN+’s breakfast forum highlighted the positive impact of good social support the most for me.
When we look at the barriers to prevention and care, we see that young people, trans women and men who have sex with men are some of the most vulnerable, not just to acquiring HIV but in several other ways in Jamaica. The face of HIV, has to change from this scary image of death, disappointment and suffering to that of the HIV positive community who are thriving with HIV, despite it all. Who, as the keynote speaker said, are not “HIV positive”, but have HIV positively manifested through them.
It is time to end the epidemic through modern medical technology, education and most importantly, social support.
Samantha C. Johnson
Featured photo taken from Infectious Disease Advisors .