Recently South Africa has been lauded by the international community and the United Nations for the great strides achieved in addressing HIV/AIDS, and certainly this calls for a celebration. These milestones have been reached through a collective effort by the government’s commitment, the involvement of the civil society and other key stakeholders. Yet, we cannot afford to be complacent because the country is still considered as the epicentre of HIV, and because the epidemic is generalized in the country’s context, often most-at-risk-populations (MARPs) remains hidden and overlooked in prevention efforts.
The need to engage the MARPs and people living with HIV to play a key role in advocating for biomedical research, in partnership with structural and social advocacy, for effective prevention strategies as part of national responses is vital if we are to succeed to end the AIDS epidemic. It is in the view that the HIV pandemic can only be conquered if all the key populations become part of the solution. Studies have shown that key populations in South Africa, like in many other countries, are vulnerable to infection.
The hate and marginalization of gay men, and other men having sex with men (MSM) even with an advanced constitution in place and the criminalized sex work in South Africa, for example, hinders the progress towards preventing new infections and achieving an HIV free generation, as they continue to act as barriers to fully engage these populations in service delivery and prevention research - whether biomedical, behavioural or structural - to progress towards access to effective prevention strategies. There is still limited and a minimum political will to document studies and prevention research that focuses on these populations. As a result the abatement of the virus remains an elusive ideal and an unattainable goal.
This is an exciting time to direct resources in building the capacity of the MARPs and positive individuals to play leading roles in advocating for effective prevention measures and to collaborate with the biomedical, behavioural and structural research institutions, civil society, community leaders and other stakeholders to curb the scourge of HIV/AIDS.
To date, much progress and impact has been achieved in lowering the prevalence of the epidemic in many parts of the world through tested methods such as prevention of vertical transmission through PMTCT (prevention of mother to child transmission), VMMC (voluntary medical male circumcision), ART (antiretroviral therapy), PrEP (Pre-exposure Prophylaxis) and many others. Scientists have made remarkable and innovative discoveries that are drawing us closer to the end of the epidemic.
Yet much can be done and much must be done. As we progress towards exciting times of “treatment as prevention”, “test and treat” and many other prevention combination approaches; collaboration with most vulnerable populations and those who are already infected becomes even more vital in realizing the deterrence of new infections. The reality is; these populations are contributing to the prevalence of the general population and they cannot be excluded in efforts to reaching more milestones in defeating the AIDS epidemic. We cannot afford to be complacent nor be despondent. Not at this time. The time has come to engage, implement and scale-up to “turn the tide” against HIV. Indeed, greater investment in the efficacy of biomedical measures continues to prove to be as equally important as addressing the social and structural determinants of the epidemic to achieve our goal collectively.
It is our moral obligation to reach out to the communities that have always been hidden and isolated due to stigma and discrimination as a result of social, cultural and religious norms, and to empower and work together with people living with HIV to prevent new infections in the realization of an HIV free generation. With our limited resources we have proven that we can. Now, more than ever, with more investment, and vigorous collaborative and innovative approaches we can do more not only to end infections but also to lift the burden that lies on our stretched resources.
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