In 1988, the year of the first World AIDS Day, an HIV diagnosis was considered a death sentence. All we had for treatment in those days was one single drug known as AZT. Our approach to prevention was to help people find approaches they could incorporate into their lives. We called it the menu approach, and that menu included condoms, dental dams, finger cots, “in me not on me,” bleach, sex with only one non-infected partner and, if it fit your lifestyle, abstinence.
As for those who were diagnosed, all we could do was help them to stay as healthy as possible, which meant eating well, exercising, quitting cigarettes, drugs and alcohol, and, above all, always using condoms when having sex. All of this required us to focus on people’s beliefs and behavior.
Twenty-eight years later, we have more options, increased possibilities, longer lives and hope. In addition to increased knowledge and more behavioral options, we now have many medically based options. This year’s World AIDS Day theme – Hands Up for #HIVprevention – expresses this well. We are doubling down and saying yes to the prevention of HIV!
Our menu includes many new options:
- Fighting to ensure that all men and women – including people who are gay, transgender or inject drugs – have equal rights and access to health care. Pact is working on this through the LINKAGES project, as well as through programming in Lesotho and Ukraine.
- Setting up community and facility-based systems to boost HIV testing. Pact does this in Zambia, Ethiopia, Tanzania, Ukraine, Swaziland, Lesotho and Indonesia.
- Coupling the tried and true condom with distribution of non-oil based lubricants.
- Providing opportunities for young men to get circumcised in clean, safe settings, like Pact is doing in Swaziland.
- Supporting people who cannot give up a particular lifestyle to at least reduce their risk through “harm reduction” approaches.
- Supporting the empowerment of young women and girls to stand up for themselves and say no, and helping men to respect them. Pact is working on this through DREAMS funding in Tanzania, Zambia and Swaziland.
- Providing pre-exposure prophylaxis for those who do not have HIV but are deemed to be most at risk to prevent HIV infection by taking a pill every day.
- Continuing the prevention of mother-to-child transmission services. In Nigeria, Pact has already helped more than 63,000 pregnant mothers get tested and, if positive, on treatment.
- Developing community, group and individual support systems to ensure that people living with HIV and AIDS get on treatment as early as possible and lower virus levels in their bodies by taking their HIV medicines every day.
The big lesson? We need the whole menu and an integrated approach to fight this disease. The lives of people affected and infected by HIV are complex. There is no magic bullet. We must make sure we are prepared to work from knowledge, through attitudes and behaviors, to medical offerings.
The end of HIV will only be found through a combination of raising awareness, addressing certain cultural beliefs, shifting community norms, changing behaviors, and ensuring that all people have access to all treatment and prevention options.
The struggle is not over yet. Let’s all put our hands up and say yes to ending discrimination and inequitable services and care.
Let’s all put our hands up and say yes to a world free of HIV.