Stigma and shame still shrouds HIV amongst key populations

By Ntsiki Mpulo

Key populations including sex workers, men who have sex with men and injecting drug users are still marginalised and suffer the “internal nightmare of shame and stigma” despite the strides that have been made in the response to the AIDS epidemic. This was the message delivered by Constitutional Court Judge Edwin Cameron when he delivered the Jonathan Mann Lecture at the International AIDS Conference today (Tuesday).

Justice Edwin Cameron
Justice Edwin Cameron

Cameron reminded delegates that it had been 35 years since the Western world was alerted to AIDS, and since this first report, 35 million people had died of AIDS-related illnesses. In 2015 alone, 1.1 million people.

“These last 35 years, since then, have been long.  For many of us, it has been an arduous and exhausting and often dismaying journey,” said Cameron, himself openly living with HIV. He referred to the AIDS denialism era in which South Africa saw a reported 300 000 people dying as a result of a tacit refusal by the Mbeki government to treat people living with HIV.

Following a protracted and sustained advocacy campaign and court action led by civil society, South Africa finally introduced anti-retroviral treatment in the public health system in 2004.

Cameron acknowledged that access to life saving treatment had saved the lives of millions globally and that this had been hard won through focused activism.   “We honour the part, in treatment availability and accessibility, of angry, principled and determined activists, in South Africa’s Treatment Action Campaign and elsewhere.  For millions of poor people, their anger brought the gift of life,” he said.

He cautioned the global community against declaring the fight to curb the epidemic won, and made particular reference to South Africa saying that too many people were still denied access to ARVs.

“In South Africa, despite our many successes, well over six million people are living with HIV and globally, of the 36.7 million people living with HIV at the end of 2015, fewer than half had access to ARVs,” he said.

“Most of those still in need of ARVs are poor, marginalised and stigmatised – stigmatised by poverty, sexual orientation, gender identity, by the work they do, by their drug-taking and by being in prison.”

Cameron believes that healthcare for men who have sex with men (MSMs) is insufficient
Cameron believes that healthcare for men who have sex with men (MSMs) is insufficient. photo: avert.org

Cameron paid tribute to Dr Jonathan Mann who pioneered work with HIV in prisons saying that Mann recognised HIV stigma was driven by laws that specifically criminalise transmission of HIV and exposure by another to it. Cameron labelled the laws “vicious” and “ill-considered and explained that by criminalising undefined “exposure”, these legislators ignored the science of AIDS which has demonstrated that HIV is easily transmitted.

Although the South African government has announced that from September 2016 it would roll out a programme which would see people all who test HIV positive receiving treatment regardless of CD4 count, Cameron believes that healthcare for men who have sex with men (MSMs) is insufficient.

“They lack programs in awareness, education, outreach, condom provision and access to ARVs,” he said.  He quoted a study by Professor Chris Beyrer which showed that the means to end HIV infections and AIDS deaths amongst men having sex with men is available however “the world is still failing”.

“For this, there is one reason only – ignorance, prejudice, hatred and fear,” said Cameron. “The world has not yet accepted diversity in gender identity and sexual orientation as a natural and joyful fact of being human.”

Cameron made an impassioned plea for sex workers to be treated with dignity and respect. He called for police protection for sex workers rather than “exploitation and assault and humiliation”.

He invited activists from across Africa and the Caribbean to rise from their seats and join him on stage in solidarity against the stigmatisation of these key populations and called for renewed vigour in tackling the issues that were a barrier to equal treatment.

Read the full speech here