Outspoken artist Edison Liburd, in St. John's, Antigua. Credit: Desmond Brown/IPS

By Desmond Brown
ST. JOHN'S, Antigua, Feb 10 2015 (IPS)

At 49 years old, Edison Liburd has established himself as one of Antigua and Barbuda’s most recognisable artists. But Liburd was not always in the spotlight. In fact, you could say he was a man in hiding.

“I have been infected with the HIV virus for about 24 years. I got my first HIV test done in February of 1993 at the Allen Pavilion Hospital in Manhattan New York,” Liburd told IPS."Equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one." -- Eleanor Frederick

“I can remember that day vividly. I felt like the earth had been removed from beneath me when I was handed the results of the test.”

HIV/AIDS first emerged in the 1980s, and now, more than three decades later, stigma associated with the disease has persisted. Liburd pointed to that sigma as the main reason why he concealed his HIV status for as long as he did.

“I hid my status for years from family. I told a few friends, but most people who I knew did not know anything about my health condition. It was fear of being ostracised that kept me from disclosing my status,” he said.

“In Antigua, HIV infected individuals still have to face job insecurity – first to be fired and last to be hired. Stigma and discrimination is still high because many still think themselves superior to individuals who are infected.

“Somehow they think themselves better than, but I believe that it is when infected individuals become empowered by taking hold of their health and indispensable to nation building that this will take a huge bite out of discrimination. People will begin to see you differently,” Liburd said.

The Caribbean is one of the most heavily affected regions in the world, with adult HIV prevalence about one percent higher than in any other region outside sub-Saharan Africa.

The HIV pandemic in the Caribbean is fuelled by a range of social and economic inequalities and is sustained by high levels of stigma, discrimination against the most at-risk and marginalised populations and persistent gender inequality, violence and homophobia.

HIV in the Caribbean is mostly concentrated in and around networks of men who have sex with men. Social stigma, however, has kept the epidemic among men who have sex with men hidden and unacknowledged. There is also a notable burden of infection among injecting drug users, sex workers and the clients of sex workers.

The main mode of transmission in the Caribbean is unprotected heterosexual intercourse – paid or otherwise. Sex between men is also thought to be a significant factor in several countries, although due to social stigma, this is mainly denied.

The level of stigma and discrimination suffered by those infected and affected by the virus in the Caribbean helps drive the epidemic underground. This makes it difficult to reach many groups.

After facing the worst of his fears, being hospitalised and getting close to death’s door, Liburd has “resolved to fight back against the discrimination by increasing my capacity to help others in every way through my gift of art and my voice on and in the media, in church and otherwise.

“This has really been a powerhouse for me. I have become more confident and bold when faced with opposition. It has and is still more than ever being a source of inspiration and encouragement for many who hear my story, both infected and non-infected alike.”

Executive director of the Antigua and Barbuda HIV/AIDS Network (ABHAN), Eleanor Frederick, said individuals living with HIV face many challenges such as unemployment, homelessness, and in some cases, they are abandoned by their families.

She said there are also other issues that are faced by some individuals “such as stigma, discrimination, resource shortage and social marginalisation” depending on the community with which they identify such as sexuality, gender, commercial sex workers, men who have sex with men, drug users and prisoners.

“Many individuals are reluctant to start treatment because of the myths and stories about HIV and AIDS,” Frederick told IPS. “Healthcare providers, peers and treatment navigators can help individuals to understand, the barriers and how to overcome them.”

ABHAN has a Peer/Buddy HIV Treatment Adherence Programmme which recruits, monitors and retains patients into treatment and care and ensures that they adhere to their treatment regimen. It also delivers a comprehensive package of services, including case management, leading to decreased risky sexual behaviour, improved immune system functioning, and general health improvement.

“The programme provides direct support services by specially trained ABHAN and American University of Antigua Medical School (AUA) student volunteers, in the form of social interaction, emotional support, monitoring of medication adherence, and facilitation of health care concerns to persons living with HIV and AIDS, and to members of their families,” Frederick told IPS.

At the country level, she said while there is legislation which specifically addresses the treatment of employees living with HIV/AIDS, it is not always followed.

“A pilot programme was undertaken in 2012. The intention was to encourage the implementation and observance of the standards set out in the International Labour Organisation (ILO) code of practice on HIV/AIDS and the world of work, the ILO Recommendation No. 200 as well as the National Tripartite Workplace Policy on HIV and AIDS in Antigua and Barbuda; based on the universal human rights standards applicable to HIV and the world of work,” Frederick explained.

“Individuals have lost their jobs because of their HIV status and others have been asked to take an HIV test when it was suspected that they were possibly infected.”

The ABHAN executive director said HIV should be everyone’s concern, because “HIV does not discriminate, and knows no borders.”

She added that “equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one.

“Therefore, I would like to encourage everyone to help improve the quality of life for people with HIV and AIDS and increase compassion for them and their loved ones by providing vital human services for those in need of it based on a philosophy of non-judgmental support as practiced by ABHAN.”

Edited by Kitty Stapp

HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Dec 15 2014 (IPS)

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents.

Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally.

Drivers of HIV infection among adolescents include scarce information about sexual reproductive health and HIV, unprotected sex and sexual violence.

Between 2005 and 2012 the global AIDS death toll fell by 30 percent but increased by 50 percent among adolescents, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Late HIV diagnosis, fear of discrimination, low enrolment and adherence to antiretroviral treatment, and absence of specialized health services for HIV positive youths are some of the factors responsible for AIDS related deaths among adolescents in Africa.

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

At a time when HIV rates have stabilised or declined elsewhere, the epidemic is still advancing in the Arab world, exacerbated by factors such as political unrest, conflict, poverty and lack of awareness due to social taboos.

According to UNAIDS (the Joint United Nations Programme on HIV/AIDS), an estimated 270,000 people were living with human immunodeficiency virus (HIV) in the countries of the Middle East and North Africa (MENA) region in 2012.

“It is true that the Arab region has a low prevalence of infection, however it has the fastest growing epidemic in the world,“ warns Dr Khadija Moalla, an independent consultant on human rights/gender/civil society/HIV-AIDS.With the exception of Somalia and Djibouti, the [HIV] epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users

The United Nations estimates that there were 31,000 new cases and 16,500 new deaths in 2012 alone. “Infections grew by 74 percent between 2001 and 2012 while AIDS-related deaths almost tripled,” says Dr Matta Matta, an infection specialist based at the Bellevue Hospital in Lebanon.

However, both Moalla and Matta explain that figures can be often misleading in the region, due to under-reporting and the absence of consistent and accurate surveys.

With the exception of Somalia and Djibouti, the epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users.

In Libya, for example, 90 percent of those in the latter category also live with HIV, notes Matta. Furthermore, adds Moalla, most Arab countries do not have programmes allowing for exchange of syringes.

The legal framework criminalising such activities in most Arab countries means that it is difficult to reach out to specific groups.  With the exception of Tunisia, which recognises legalised sex work, female sex workers who work clandestinely in other countries are not safeguarded by law and thus cannot force their clients to use protection, which allows for the spread of disease.

Lack of awareness, the absence of voluntary testing and of sexual education, social taboos, as well as poverty, are among the factors driving HIV in the region. “Arab governments and societies deny the epidemic and the absence of voluntary testing means that for every infected person we have ten others that we do not know about,” stresses Moalla.

People living with HIV or those at risk face discrimination and stigma.  “More than half of the people living with HIV in Egypt have been denied treatment in healthcare facilities,” explains Matta.

This bleak scenario is compounded by the security challenges prevailing in the region which not only make it difficult to deliver prevention and other programmes, but also restrict access to services by those on treatment and cause displacement and loss of follow-up according to the UNAIDS report.

The war in Iraq that began in 2003, for example, led to the destruction of most of the country’s programmes and facilities under the National AIDS Programme and, according to Moalla, the national aids centre in Libya was recently burnt down.

In addition, in some countries, conflict has significantly increased the vulnerability of women. By 2012, for example, only eight percent of the estimated number of pregnant women living with HIV in the MENA region received appropriate treatment to prevent mother-to-child transmission according to the UNAIDS report.

Meanwhile, only a few governments have worked on effective programmes to fight the epidemic, although there are signs of the emergence of NGOs tackling the problem with people living with HIV and providing them with support.

“North African countries and Lebanon have generally done better than others, while Gulf countries are doing the least,” says Moalla, adding that less than one in five people living with HIV are receiving the medicines they need in the Arab region.

While some efforts have been made with the UNDP HIV Regional Programme pioneering legal reform in several countries, as well as drafting an Arab convention on protection of the rights of people living with HIV in partnership with the League of Arab States, these are not enough.

“The Arab world attitude taking the high moral ground on the issue of HIV is no barrier for the epidemic,” says Matta. “The region’s governments need to address a growing problem that is only worsened by the general upheaval.”

(Edited by Phil Harris)