Fifteen years ago, MIT professor John Essigmann and colleagues from the University of Washington had a novel idea for an HIV drug. They thought if they could induce the virus to mutate uncontrollably, they could force it to weaken and eventually die out — a strategy that our immune system uses against many viruses.
As homophobic discrimination continues to sweep across the African continent, we should be acutely mindful of the diverse ways it harms societies. While we are most aware of the direct effect of homophobic physical violence on sexual minority groups, it is also crucial that we are cognisant of the other insidious and multifaceted ways in which stigma and discrimination impact not just on sexual minorities but also on society at large.
One of the most important ways we need to appreciate this is in relation to health. As the Nobel Laureate and co-discoverer of the HI virus, Francoise Barre-Sinoussi, pointed out this week during her inaugural address to the 2014 International AIDS Society conference in Melbourne, Australia, homophobia is the perfect breeding ground for AIDS. In societies that discriminate, sexual minorities are less likely to have access to the information and methods necessary to protect themselves from HIV. Simultaneously, a failure to offer comprehensive HIV prevention and treatment services to sexual minorities can lead to an increase in national HIV prevalence. Not offering health services and programmes to one stigmatised group in society can negatively impact on all members of society.
As a result the 12,000 delegates currently attending the Melbourne conference are being urged to sign a declaration that insists that all sexual minorities are entitled to the same access to HIV prevention, treatment and care as the general population. This is clearly an important step it is also essential that we figure out how best to translate a declaration into actionable and accountable change on the ground. Sustained lowering of HIV prevalence requires more than good will; it requires persistent engagement with the hearts and minds of societies across the continent.
A key method to do this exists right here, in South Africa. Since 2010, Health4Men, a project of the Anova Health Institute and funded by PEPFAR/USAID and The Global Fund to Fight HIV, TB and Malaria, has developed a holistic approach towards the sexual health needs of sexual minorities, and in particular men who have sex with men (MSM). For four years now, Health4Men has developed ground-breaking ways of challenging misconceptions about, and forms of discrimination against, sexual minority groups. This was initiated to make it easier for sexual minority groups to protect their own health and also to be able to access competent clinical care when needed. As Glenn de Swardt, Health4Men’s programme manager stated: “To put it simply, Health4Men came to understand that homophobia has the potential not only to limit competent medical care, but also to increase the likelihood of needing that medical care to begin with. Challenging homophobia within the community and among medical professionals is key.”
This work within South Africa, which has recently been highlighted and publically acknowledged by the World Health Organisation at the Melbourne Conference, has led to the project offering its expertise across the continent. In particular, its clinical training and mentoring programme, which so far has trained over 3,000 clinical workers in South Africa, is now being offered to healthcare workers in Kenya, Uganda and Tanzania, supported by the International HIV/Aids Alliance. This comes after a successful piloting phase in Zimbabwe.
This work is not easy. Training of clinical staff, for example, is not a simple quick fix to sometimes-longstanding misconceptions and lack of understanding about sexual diversity. It also requires more than a change in attitudes. To make a sustained and institutionalised change in healthcare provision requires long term mentoring of clinical staff, drawing on the medical knowledge base created, for example, at Health4Men’s two centres of excellence in MSM care, located in Cape Town and Johannesburg.
Beyond the importance of the recent Melbourne declaration, such work is crucial if we are to make a permanent shift in HIV prevalence figures across Africa. As a result of work closer to home we have a tried and tested road map to continue this work across the continent.
For more information please contact:
Tanja Bencun, Communications Manager at Anova Health Institute.
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