World AIDS day: why community engagement is as important as scientific progress
Despite breakthroughs in the treatment of HIV-AIDS, the disease continues to affect millions of lives. This points to the need for engaging more with communities.
This year witnessed a major milestone in the treatment of HIV-AIDS when in March researchers announced that a man from London was completely cured of HIV virus after undergoing a bone marrow transplant.
In medical science history, the ‘London patient’ was the second person to be completely cured of the disease which affects 37.9 million across the world. The first, Timothy Ray Brown -- also called the ‘Berlin patient’ – was reportedly cured in 2008.
In the same month, scientists reported another major breakthrough in anti-retroviral therapy (ART) [ART refers to medical treatments that inhibit virus replication in the body]. A monthly injection of long-acting medicines was proved to be as effective as daily pills that HIV patients had to take to lead a normal life.
It meant more freedom for patients. With an injection of cabotegravir and rilpivirine — first of several long-acting antiretroviral HIV medicines in development – they no longer have to remember to take medicines every day.
Currently, 24.5 million people access to ART, advances in which has allowed HIV positive patients to live a life that's not far off from someone who isn’t positive.
Progress in numbers
HIV infections were at peak in the mid-90s. According to UNAIDS, 2.9 million people were affected by the virus in 1997. In 2018, the number was 1.7 million. The number of AIDS-related deaths were 1.7 million in 2004; now the figure is 770,000.
Despite a range of new HIV treatment and prevention technologies, including the oral Pre-exposure Prophylaxis (PrEP) and voluntary medical male circumcision, the rate of decline of HIV incidence has been less than 2% since 2010. A major reason -- these are not being fully utilized.
“Research shows that these new HIV prevention modalities – such as PrEP – are underutilised. In addition, 38.5% of those infected are not receiving treatment. Retention in care remains suboptimal,” says Hilton Humphries, a Behavioural Scientist at the Centre for the AIDS Program of Research in South Africa (CAPRISA).
This highlights the role of communities in fighting HIV-AIDS. Hence, this year’s World AIDS Day has the theme "communities make the difference".
“Preventing HIV transmission demands a deep engagement with the social, cultural, community and political factors that produce vulnerability and risk,” says Humphries.
There are several examples that highlight the role of communities. One of the most successful was the role of India’s sex workers in averting an AIDS epidemic in the country of over a billion people. They were key in expanding HIV prevention services to vulnerable sections, and bringing down the prevalence of the disease to 0.22% -- lower than that of even the United States.
“Without communities, 24 million people would not be on treatment today. Without communities led by women living with and affected by HIV, we would not be close to ending new HIV infections among children, raising orphans and caring for the sick,” says Winnie Byanyima, UNAIDS Executive Director.