NAPWA at IAC 2012
August 12, 2012
Thursday was the day of "key populations" -- men who have sex with men (MSM), sex workers, and transgender people: the excluded, marginalized groups that have borne the heaviest burden of HIV and AIDS.
Uganda's Paul Semugoma led off the morning Plenary, telling the Conference that we can end HIV and AIDS, but not until we have real equality for MSM. "These [new prevention technologies] are interesting," he said, "but how are we going to apply them, especially to these harassed communities?" Infection rates are high, especially in Africa and the African diaspora. Prevention and treatment resources should be targeted to where the epidemic is most concentrated, but governmental homophobia leads to underallocation of resources, reinforced by by anti-homosexuality laws and HIV criminalization laws that ensure the MSM epidemic will stay underground where it spreads most easily. MSM's own internalized homophobia drives up infection rates, Semugoma said, so he closed by celebrating his own identity as a gay man and calling out to his partner in the audience, "Brian, I love you!"
Australian sex work researcher Cheryl Overs said, Protect sex workers from laws meant to "protect" them! Laws and public policy meant to regulate sex work make it impossible for sex workers to find places to work safely. Carrying condoms can expose them to prosecution. If they seek testing and treatment, they may be forced to disclose their partners. When they are "rescued" from sex work, they risk being sent to "rehabilitation" that is imprisonment in all but name. So long as sex work is criminalized and sex workers are driven underground, Overs told us, new prevention technologies like PrEP may actually decrease sex workers' safety, making it easier for clients to insist on sex without condoms. Sex workers need to be on the boards of ASOs -- they know realities the rest of us can't imagine. And PEPFAR's anti-prostitution pledge needs to be overturned.
District of Columbia transwoman Debbie McMillan told us about what it's like for transgender people, especially those who transition from male to female. They face a perfect storm of stigmas, homophobia when they are looked at as men, disempowerment of women when they are looked at as women, exclusion from employment and simple acceptance except on the street, extremely vulnerable to drugs to dull the pain when they hit the street and start working. Every assault on self-respect that can happen to MSM, sex workers, and disempowered women happens to them. The result is a lack of care resources and diminished ability to seek what care is available. But those who survive bring unique experience to the table and need to be part of mainstream HIV leadership. "For 20 years," Debbie said, "I lived a life that guaranteed I would become HIV-positive. I was not irrelevant then, and I am not irrelevant now!"
The message for all three "key populations" was the same: real equality and respect for these groups are not just human rights, they are indispensible necessities of public health. We can end the epidemic -- but not while "key populations" are underground.
The WHO's Gottfied Hirnschall closed the morning Plenary by laying out the practicalities of extending treatment to "key populations," even in countries where they are able to seek care. New WHO guidelines call for all poeple living with HIV to start ART treatment when their T cell counts go below 350/mL. By 2015, the target year for achieving worldwide treatment at or below 350/mL, that will mean providing AIDS drugs to 15 million people. If Treatment-as-Prevention populations -- the HIV-positive members of serodiscordant couples and all members of our "key populations," regardless of T cell counts -- are added to the target, 23 million will need to be served by 2015. That's expensive, Hirnschall said, but cost-effective, because getting ahead of the epidemic, bringing more people into treatment every year than are newly infected, will bring treatment costs down.
A cure, alas, will not be enought to end the epidemic, if the number of new infections is greater than the number of cures. Nevertheless, a late-afternoon session evaluated progress towards a cure and reported that either a functional cure or eradication cure may be in sight. Outside the Conference, researchers at the University of North Carolina reported the lymphoma drug voronistat shows efficacy in "flushing" dormant HIV into its active stage, where the HIV drugs we already have can destroy it.
This article was provided by National Association of People With AIDS.
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