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Hatred is the real battle in HIV prevention

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Eliminating bigotry and intolerance to win the war on AIDS blog

Source: Paul Davey / Alamy

Those most at risk of HIV infection are often marginalised in society as this protest against laws against homosexuality demonstrates

It’s not enough to wear condoms to stop the spread of HIV. Men who have sex with men should take antiretrovirals as a method of preventing infection.

This is the startling suggestion from the World Health Organization (WHO) ahead of the International AIDS Conference on 20 July.

Of course, it is a broad-stroke, and largely unachievable, recommendation. It does not address, for example, the cost of implementing such a widespread scheme. Nor does it tackle patient compliance or educating people that this option is available.

But there is a far more potent hurdle to this blue-sky policy. Men who have sex with men are a hard-to-reach group often persecuted by society.

This is the true issue in HIV prevention. The key at-risk groups for HIV transmission – men who have sex with men, prisoners, those who misuse drugs, sex workers and the transgender community – are all often marginalised in society.

According to the WHO report, 83 countries in America, Asia, Africa and the Middle East have laws that make sex between men illegal. This does not include implicit discrimination, such as Russia’s homosexuality laws, or the occasional pockets of bigotry and intolerance encountered in even the most liberal countries such as the UK.

This creates a problem so intangible that, even if the WHO’s recommendations were enacted, they would fail almost immediately. We will never adequately reach communities who are forced to hide, either literally or figuratively, from healthcare interventions.

And the magnitude of the WHO’s recommendation cannot be understated. The WHO believes that, globally, the number of new HIV infections could be slashed by 20-25% if pre-exposure prophylaxis is adopted. This would prevent around one million new infections over 10 years.

Globally, we are reducing the number of AIDS-related deaths. The WHO estimates around 13 million people worldwide are taking antiretrovirals and HIV-related death rates dropped by 20% between 2009 and 2012.

But we won’t win the war on HIV/AIDS until we dramatically improve prevention.

And that means we must first win the war on intolerance.

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