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Engage the Epidemic

By Linda-Gail Bekker, Anele Ngqokwe, Sibabale Silo, Akho Mpame, & Khanyiselo Silo

2017 has arrived, and I don’t know if you can feel it but we think it’s already looking up to be a much brighter year than the last. In the spirit of the New Year it’s always good to evaluate where we are at this new starting point and then look ahead to where we want to be in a year’s time.

The Starting Point:
January 2017: We stand at the tipping point of an HIV prevention revolution, with multiple new biomedical and structural interventions proving their value! Treatment using anti-retrovirals long ago changed an HIV-positive diagnosis from a death sentence to a chronic manageable disease, and allowed our focus to shift from solely coping with the infected to preventing the uninfected  from becoming exposed.

But! HIV/AIDS, the epidemic, arrived 36 years ago to wage war with the human race. Not only attacking our immune systems, the virus has exposed multiple weaknesses in our health care systems and in our societies. It drew back the curtain on unequal drug access in the global north and south, it provoked stigma and discrimination out of the closet, and most recently has exposed the destruction that gender inequality and gender-based violence can have on public health.

36.7 million people were still living with HIV globally at the end of 2015, and 2.1 million people become newly infected with HIV in 2015 alone (UNAIDS 2016). Some countries have managed to turn the tide and numbers of new infections are decreasing; South Africa has yet to reach that turning point

Where we could be:
UNAIDS has set global goals in an attempt to fast track the response to the epidemic and eradicate it by 2030: 90% of people must know their status, 90% of those diagnosed must be on antiretroviral treatment, 90% of those on treatment must be virally suppressed. In South Africa, where the most vulnerable population is our young women and adolescent girls, we also need to focus strongly on prevention.

How do we get there?
This context and these goals are not new. If you were born any time after the 90’s you have grown up hearing this, year in, year out. End AIDS, wear a condom, abstain. Either not enough of us are following this, or simply this is only part of the solution and we need to find the rest of it. What we really need this year is Engagement. We need to pick up this disease, turn it over, and just as a HIV scientist works with the virus to see how it infiltrates immune cells, we need to work out how it infiltrates our lives. We need to Engage this Epidemic.

To achieve this, we have set out a list of Engage the Epidemic “New Year’s Resolutions”. These resolutions are not arbitrary. They are based on what we as an organisation, and as a world, have learnt over 36 years of engagement with the virus. We have built this evidence base from the ground up. We know it works – we just need you to take part.

1. This year I will get tested for HIV, at a clinic or at home with an HIV self-testing kit (now available at all pharmacies in South Africa).
By doing this I will help normalise HIV testing and reduce the associated stigma. Anyone can become infected, even if they are not always at high-risk.
Action: gather your squad and go get tested as a group. Remember encouragement and support are key. An HIV-positive diagnosis is not a death sentence but a manageable condition. Knowing your status is power.

2. This year I will Normalize the Conversation
The conversation about HIV, the conversation about STIs and that Sex topic in general. By talking openly on difficult topics we can create open, safe spaces for others to ask questions and learn more. This spreads awareness and reduces stigma related to lack of understanding. This conversation is yours to start.
Action: commit to putting out an HIV-related post on your Twitter/Facebook/Instagram once a month to raise awareness and encourage a positive perspective (Example Tweet: “Progress: a virally suppressed #HIV positive person on ARVs can’t pass on the virus during #sex #EngageTheEpidemic #NormalizeTheConversation”).

3. This year I am going to be my own blesser. I am going to believe in myself and push for what I know I can achieve.
In South Africa, young women are most likely to contract HIV by having sex with older men. Blessers are men who provide young women with money or gifts, and expect sex in return. This interaction puts women at substantial risk. The empowerment and security in standing on your own two feet can never be under-emphasized. Young women worldwide have never been more powerful or important, and to the world’s benefit they must continue to rise.
Action: Be that queen and reach for your crown, whether that means pushing for another qualification, applying for a job, or simply having some more confidence in yourself. If you already wear that crown, work on being a mentor for others and show them the way!

4. This year I will not be afraid or ashamed to speak out against gender-based violence and report anything that happens. I will not take part in violent acts.
1 in 3 women continue to experience gender-based violence worldwide. Experiencing violence has shown to significantly increase a woman’s probability of contracting HIV. Read more here.
Action: reporting violent incidents, reaching out to hotlines, and being able to speak about past and recent experiences can help prevent and heal. Receiving HIV treatment immediately after a potential exposure can prevent a victim from becoming infected.

5. This year I am going to question my thoughts and beliefs, thinking through new and old ideas from all sides.
A person can contract HIV in many ways, of which sex is just one. Even when HIV is sexually-transmitted, in a country where the incidence is so high, a person does not have to engage in risky sexual behaviour to be put at risk. Consider these facts when approaching or thinking about people living with HIV. Additionally, populations high at risk such as the LGBT community and sex workers, are placed at further risk by stigma and discrimination. Engaging with and accepting these populations can actively decrease their risk.
Action: Treat people living with HIV and vulnerable communities with compassion and respect. This can be as simple as speaking out in that dinner/group conversation, not taking part in that joke, and choosing not to share or like that meme.

6. This year I will make education my priority: stay in school, go back to school, apply for university or actively help and encourage others to do the same.
Studies have shown that one additional year of secondary education reduces the chances of a woman contracting HIV by half. Education is a powerful social tool and protective force.
Action(s) for everyone: form a study group, tutor people who may be struggling, give them a lift to school, go collect that application form, and encourage people to keep going.

7. This year, I’m going to be bold and strong about safe sex: the conversation and the act.
Safe sex is something we often know about but find difficult to put into practice. In the heat of the moment or when you are unsure of your partner’s reaction, HIV and condoms is the last thing you want to mention. But while talking about condoms can be awkward, getting HIV or falling pregnant unexpectedly is much worse.
Despite huge advancements in the HIV prevention field, condoms remain one of the best ways of protecting yourself and your partner.
Action: find ways to open the conversation with your partner. This is not a one-day chat and should be continued throughout the relationship. Also, condoms expire, please check the expiry date.  

8. Can we be PrEPed? This year I will find out.
Not yet publically available in South Africa, PrEP is an HIV prevention pill for uninfected people at high-risk. Taking a PrEP pill once a day can prevent you from becoming infected, no matter what happens. As a drug, PrEP has been granted regulatory approval in South Africa, however, trials are still underway to determine whether national rollout is feasible and acceptable for those South African’s most at risk. Stay tuned for more information!

It starts with us. It starts with you.

Engage the Epidemic.