Getting to Zero

It’s not a gay thing.  It’s not a moral thing.  What it is is a public health thing.  It’s a human thing.  It’s about being pro-life in the real sense of that phrase.  It’s about planting the seeds now that will grow into trees that will shade future generations.  We can, we must, get to zero.  As the United Nations notes:


People living with HIV and affected by the AIDS epidemic must lead and own effective HIV responses to ensure a rights-based, sustainable response and to hold national and global partners accountable. The remarkable gains to date are largely the result of their activism, mobilization and building of alliances with other stakeholders.


Advancing human rights and gender equality for the HIV response means ending the HIV-related stigma, discrimination, gender inequality and violence against women and girls that drive the risk of, and vulnerability to, HIV infection by keeping people from accessing prevention, treatment, care and support services. It means putting laws, policies and programmes in place to create legal environments that protect people from infection and support access to justice. At the core of these efforts is protecting human rights in the context of HIV— including the rights of people living with HIV, women, young people, men who have sex with men, people who use drugs and sex workers and their clients.

"Getting to Zero” has three goals…

1. ZERO New HIV Infections

If you are already infected with the HIV virus, prevention of its spread to others is as important as the steps you take to preserve your own health.  In just this decade, there have been some exciting advances in this regard; just remember the acronyms TasP, U=U, and PrEP.

U=U or Undetectable = Untransmittable.  Maintaining an undetectable viral load on treatment is the best form of prevention.  We refer to this as TasP or Treatment as Prevention, and it is far more effective in halting the spread of the virus than condoms alone since we know today that condoms are only effective between 70-95% of the time, and that The US Centers for Disease Control (CDC) found that only 17% of men who have sex with men use a condom every single time.  This is not to suggest that condoms are not important, as they are an effective means of preventing other STIs (sexually transmitted infections) and are an important part of your sexual health quiver.

Another arrow in that quiver, for those NOT infected with HIV, is called pre-exposure prophylaxis or PrEP, which involves taking a medication called Truvada daily to prevent infection.

2. ZERO HIV Discrimination

There is a cyclical relationship between stigma and HIV — people who experience stigma and discrimination are marginalized and made more vulnerable to HIV, while those living with HIV are more vulnerable to experiencing stigma and discrimination.  Adopting a human rights approach to HIV and AIDS which sees the pandemic as a health crisis is key to eradicating stigma and discrimination.  Those most at risk of contracting HIV (known as "key affected populations") continue to face stigma and discrimination based on their actual or perceived health status, race, socioeconomic status, age, sexual orientation, gender, or gender identity.

don't be a stigmasaurus

Don’t be a stigmasaurus!

As of 2015, more than 70 countries were using the HIV Stigma Index, a project of the Global Network of People Living with HIV, which documents the experiences of people living with HIV collected by more than 1,400 people also living with HIV who interviewed over 70,000 people living with HIV.

Self-stigma, or internalized stigma, and/or fear of a negative family/community reaction hinders efforts to address the HIV pandemic by perpetuating the ignorance which leads to poor adherence to treatment and access to health services.  A country’s discriminatory laws, including the 35 countries which have laws that restrict the entry, stay, and residence of people living with HIV, and the 17 countries which will deport individuals once their HIV positive status is discovered, discourage people from getting tested and seeking treatment despite the fact that there is no scientific evidence that HIV-related travel restrictions protect public health or prevent HIV transmission (cf:  UNAIDS, September 2015).

At work, people living with HIV may suffer stigma from their coworkers — such as social isolation — or employers — such as termination or refusal of employment.  Evidence from the HIV Stigma Index suggests that HIV-related stigma and discrimination are as frequently or more frequently a cause of unemployment or a denial of work opportunity as ill health.

3. ZERO AIDS-related Deaths

HIV is no longer an automatic death sentence, especially if you’re diagnosed early, get started on medications right away, and take your medication daily; under these circumstances, the life expectancy of someone living with HIV can be the same as it would have been without HIV.

The key to a long and healthy life with HIV is getting good medical care and adhering to drug therapy; but, as noted above, social and economic factors inhibit access to both.  There aren’t many chronic diseases that can be treated so effectively with well-tolerated daily medication.

And since treatment is the only 100% reliable method of preventing both the spread of the disease and the life-threatening suppression of the immune system of those infected with HIV, access to treatment and medication is a 2 for 1 deal:  AIDS deaths will decrease as will new infections.

It seems almost too simple, doesn’t it thoughtful reader?  Adopting a human rights approach to HIV and AIDS is in the best interest of public health all around, meaning for those who are negative and those who are positive for the virus.

The promise of an AIDS-free generation is reachable.  But to achieve it, we must focus our efforts on convincing people to get tested for HIV and to come in for treatment.  To do that, we must challenge attitudes that keep people away from the health services they need.

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