Stigmatization<\/strong><\/p>\n In the UK, Wo In many contexts, the outlook for HIV prevention and reducing stigma is bleak and the \u201cpost-truth\u201d paradigm<\/a> seems to apply as much to AIDS policy as other spheres. In contrast to what decades of trials, epidemiology and social science research tell us could help to curb the HIV epidemic, the AIDS response in many countries remains deeply ideological. The Philippines has cut funding for contraception<\/a>. Russia continues to ban opioid substitution therapy<\/a> which could reduce HIV transmission among injecting drug users, and \u201cprefers to blame and criminalise drug users<\/a>\u201d for the rocketing incidence rates<\/a>. And 2017 will usher in a Vice President-Elect of the United States who in 2000 made sinister claims<\/a> about channelling HIV funding away from organisations which \u201ccelebrate behaviours that facilitate the spreading of the HIV virus\u201d to instead fund gay conversion therapy.<\/p>\n One challenge from a research point of view is unpacking how such stigmatising, dehumanising attitudes and policies affect HIV prevention, testing and treatment. Excitingly, a nested study in the PopART trial<\/a> is aiming to do just that, exploring the effects of stigma on the uptake of universal (i.e. community-wide) testing and treating for HIV. This will hopefully provide new insights into the extent to which prevention and treatment at the population level may reduce stigma. And it could also shine a light on a deeper issue in clinical HIV research, namely how far HIV-related stigma may undermine the real-world impact of interventions which have proven effective in controlled trial settings.<\/p>\n HIV among adolescent women<\/strong><\/p>\n One urgent issue for this World AIDS Day is the alarming burden of HIV among adolescent women, the emphasis of UNAIDS\u2019 Get on the Fast Track<\/em><\/a> report. Girls and young women, particularly in sub-Saharan Africa, face a range of social and structural vulnerabilities, such as poverty, lack of schooling and marginalisation, which put them at greater risk of violence, exploitation and HIV infection. For example, as shown in an HPP <\/em>study which sought to systematically quantify girls\u2019 vulnerability<\/a>, vulnerable girls in Botswana and Mozambique were less likely to insist on sex with a condom, thus increasing risk of HIV transmission.<\/p>\n The article therefore makes a powerful case that HIV programmes need to build in more flexibility, responding sensitively to the profound psychosocial complexities surrounding HIV at the household level experienced by women and girls. However this could prove challenging as funding for the AIDS response slows<\/a> and uncertainty prevails<\/a> around the US\u2019 role in global HIV financing (of which it currently provides two-thirds<\/a>). And as donors transform or transition their programmes and priorities in the face of scarce resources there will always be a human cost to consider. This is vividly illustrated in a cautionary tale from Lesotho<\/a>, where donors abruptly reduced funding in 2012 for HIV lay counsellors who play a key role in uptake of antiretrovirals in rural areas. The number of counsellors dropped from 487 in 2011 to 165 in 2012, and in the same period antiretroviral coverage dropped by 10%. While there may not be a precise cause\/effect relationship, the study makes a persuasive case for ensuring transitions in HIV funding and programming are effectively managed. As funding dries up, the kind of cost-effectiveness modelling deployed in another HPP <\/em>study<\/a> – on lifelong antiretroviral therapy to prevent mother to child HIV transmission \u2013 will be ever more crucial in shaping funding decisions to local political and economic realities.<\/p>\n Tools<\/strong> World AIDS Day is an important opportunity to commemorate the hard-won successes of people affected by HIV, advocates, activists, civil society and scientists across the world. There are more tools at our disposal to reach the hard-to-reach (for example HIV self-testing<\/a>), the Global Fund has thankfully been replenished<\/a> and our body of knowledge about HIV\/AIDS is growing all the time. It may sound trite, but behind every statistic about more antiretroviral enrolment or prevention of HIV transmission from mother to child are individuals with renewed hope for themselves and their families. This really struck home at a STOPAIDS event for World AIDS Day<\/a>, where Sanelisiwe, a Mothers2Mothers Peer Mentor<\/a> from South Africa, moved and inspired the audience with the story of her – ultimately successful – journey towards ensuring that her child was born HIV-negative.<\/p>\n Final note<\/strong><\/p>\n Nevertheless, all are agreed that there is no room for complacency<\/a> if we are going to achieve the global \u201c90-90-90\u201d targets<\/a>. UNAIDS has \u2018sounded the alarm\u2019 about new HIV infections<\/a>. Only 60% of people know their HIV status<\/a>. Key populations with high HIV risk like people who inject drugs<\/a> and LGBT people<\/a> remain marginalised and subject to punitive laws. And there is now widespread concern among the broader health community about the deteriorating geopolitical climate<\/a>. But at the micro-level of the AIDS response, among brave, proactive individuals, families and communities, there is a huge amount to celebrate this World AIDS Day. As the author Rebecca Solnit<\/a> reminds us in Hope in the Dark<\/em>, \u201cThe grounds for hope are in the shadows, in the people who are inventing the world while no one looks\u201d. HIV\/AIDS as a public health threat certainly isn\u2019t over, but momentum, solidarity and creative energy is still very much alive and must continue to be harnessed in the global response to the pandemic.<\/p>\n Oxford University Press are highlighting World AIDS Day with recently published relevant articles and a quote from our Director Peter Piot: http:\/\/blog.oup.com\/2016\/12\/fighting-stigma-hiv-aids\/<\/a>![\"capture3\"](\"http:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2016\/12\/Capture3.png\")
rld AIDS Day<\/a> is focussing on both the progress that\u2019s been made since the 1980s, and the continuing need to tackle stigma and myths around the disease which stubbornly persist. We\u2019ve seen Prince Harry take an HIV test live on TV<\/a> which is thought to have boosted HIV testing, perhaps the UK equivalent of the Charlie Sheen effect<\/a> on HIV awareness in the US. However, debates (settled<\/a> uneasily, for now) raged around whether the NHS or local authorities should fund PrEP, with headlines occasionally striking a distinctly 1980s tone<\/a>, and this in the UK where we like to think tolerance is relatively high and discrimination relatively low.<\/p>\n![\"capture\"](\"http:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2016\/12\/Capture-3.png\")
Once tested, young women are also more likely to face considerable barriers in accessing and adhering to antiretroviral treatment. An ethnographic study<\/a> in HPP of married women in Swaziland provides a powerful anthropological counterpoint to the epidemiological concept of being \u201clost to follow up\u201d and the programmatic notion of a \u201ctreatment cascade\u201d. Nkunku, a young Swazi woman, is described weighing up the pros and cons of accessing treatment for herself and her unborn baby while fearing the potentially ruinous consequences of disclosing HIV-positive status to her husband, and her and his families. Her linkage to treatment is fraught with obstacles imposed by rigid gender norms, patriarchy and delicate family dynamics. Nkunku, her husband and first child fortunately all enrolled on antiretrovirals by the end of the study period. However, another woman involved in the study, Sibongile, died because the lengthy process of negotiating permission and money from her husband meant she could not travel to the three adherence-counselling sessions that were a prerequisite to starting treatment.<\/p>\n![\"capture\"](\"http:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2016\/12\/Capture-4.png\")
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