By Noliwe Tlamane
Maseru, Nov.26 — Persistent inequalities, including infringements of human rights, continue to undermine progress towards ending AIDS by 2030 and ensuring access to services beyond 2030. As HIV continues to spread, worsening inequalities threaten to halt or even reverse what progress has been made, pushing people behind even as biomedical advances offer opportunities for improved HIV prevention and treatment.
The Global AIDS Strategy defines inequality as an imbalance or lack of equity, encompassing the many inequities, disparities and gaps in HIV vulnerability, service uptake and outcomes experienced in diverse settings and among the many populations living with or affected by HIV.
HIV-related inequalities are those social, economic, racial and gender inequalities, restrictive and discriminatory laws, policies and practices, stigma and multiple and intersecting forms of discrimination, including based on HIV status and human rights violations that perpetuate the HIV epidemic. HIV-related inequalities can result in increased vulnerability to infection for some populations and they can affect access to HIV-related services for other populations or increase the impact of HIV and the risk of poor HIV-related outcomes on some populations living with HIV.
Populations that are more likely to experience HIV-related inequalities will vary between and within countries and even within population groups, based on various factors, including intersecting and overlapping factors. Insufficient attention to inequalities can result in harmful gaps in understanding and addressing HIV risk and vulnerability factors, including those that prevent access to prevention and treatment.
Gender inequality remains one of the most pervasive forms of inequality globally, impacting the ability of women, girls and gender diverse people to prevent infection and mitigate the negative experience of living with HIV. Gender inequality and harmful gender norms can also impact on men and transgender people’s health seeking behaviour, making it harder for them to access HIV-related services.
However, it is important to recognize that a broad range of social and structural factors, health systems and services, as well as individual characteristics and actions, all shape individual experiences with HIV inequalities. All these factors need to be considered and addressed in trying to understand and respond to HIV inequalities.
Speaking in an interview with the Principal of Nkhaolise Primary school in Thaba-Tseka as one of the least privileged schools across the country, Mrs. ‘Manthethe Dingani said that the poor infrastructural developments in their school is one of the reasons that keeps children out of school especially girls exposing them to early school living that most of the time also exposed them to early marriages.
She indicated that enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50 percent as when this is reinforced with a package of empowerment support, girls’ risks are reduced even further.
She however mentioned that Leaders need to ensure all girls are in school, are protected from violence which is often normalized including through underage marriages, and have economic pathways that guarantee them a hopeful future.
On the other hand, a village health worker Mrs. ‘Malimakatso Motsumi indicated that hard to reach health facilities especially in the rural areas contributes intensively in the AIDS response and is being held back by inequalities of access to treatment between adults and children as well as men.
She therefore mentioned that it is important for the government to ensure services for children living with HIV reach them and meet their needs, closing the treatment gap so that AIDS in children is ended for good.
Amidst phenomenal progress that is being made in the global response to HIV, Lesotho’s efforts are being dragged behind by persistent inequalities and human rights violations perpetrated against the LGBTIQ+ community. The People’s Matrix Association’s latest report reveals the difficulties their marginalized population has been facing and how they stand in the way of their country’s efforts toward ending HIV.
According to the Executive Director of the association Tampose Mothopeng Challenges Faced by the LGBTIQ+ Community include discrimination and Stigma explained as Criminalization of same-sex relationships, along with entrenched levels of stigma in societies, places individuals under immense hostility. For many of them, there is great fear of approaches for judgment, outing, and rejection. This results in delayed diagnosis, treatment interruption, and increased health risk.
Mothopeng added that the other challenge is that of Limited Access to Healthcare Services saying Health services in Lesotho are barely tailored to respond to the specific needs of key populations, including Men having Sex with other Men and transgender people. Reports of discrimination in health facilities further alienate the LGBTIQ+ community and limit their access to essential HIV prevention and treatment services.
Additionally, Mothopeng indicated that Violence and Human Rights Violations to LGBTIQ+ individuals frequently experience violence, harassment, and exclusion, which harm their mental and physical well-being. These violations deter engagement with healthcare systems and advocacy platforms, exacerbating their vulnerability.
On issues related to Policy and Legal Barriers, Mothopeng stated that the absence of protective laws and policies perpetuates systemic inequities. The criminalization and legal ambiguity surrounding same-sex relationships obstruct the country’s ability to implement inclusive and effective HIV programming.
Furthermore, Mothopeng delineated that these challenges have a ripple effect in Lesotho’s response to combat HIV saying that on Prevention Efforts the impact is that of the fear of stigma and judgment in society that keeps people away from accessing HIV prevention tools like PrEP and condoms, putting them at great risk adding that on Treatment Gaps, many are afraid of being judged and withdraw from treatment programs dealing with HIV.
Data Gaps such as exclusion of LGBTIQ+ people in official data cannot make any special intervention tailored to meet their particular requirements.
In conclusion, Mothopeng said that it is sad that such poor progress towards ending HIV in Lesotho has been persistently undermined by inequalities and human rights violations. Civil society organizations, government institutions, and international partners must all commit to address these. People’s Matrix Association continues to stand firm for Justice, Equity, and Empowerment of LGBTIQ+ individuals as cornerstones of the national HIV response.
Sex workers on the other hand face multiple challenges accessing health care services and exercising their right to work. These are due to the attitudes and beliefs held in society about sex workers and/or lack of information about, and for, sex workers. They are viewed as people that are immoral, insatiable, promiscuous and not deserving of treatment in a resource strapped state.
This perception contributes to re-infections, misdiagnosis, and new infections of STIs among key populations, as well as the general population.
To address the challenges that sex workers face, a step of legally registering an organization named Key Affected Populations Alliance of Lesotho (KAPAL) was undertaken. KAPAL is an institution that represents constituencies that are most vulnerable to HIV infection and ill treatment.
While over three quarters of adults living with HIV are on antiretroviral therapy, just over half of children living with HIV are on the lifesaving medicine. This has had deadly consequences. In 2021, children accounted for only 4% of all people living with HIV but 15% of all AIDS-related deaths. Closing the treatment gap for children will save lives.
Discrimination against, stigmatization and criminalization of key populations are costing lives and preventing the world from achieving agreed AIDS targets.
There is a need to decriminalize people in same-sex relationships, sex workers, and people who use drugs, and invest in community-led services that enable their inclusion as this will help break down barriers to services and care for millions of people.
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