Communities can make an invaluable contribution in the fight against HIV and AIDS, as they can be important pillars of support. This is a key part of the theme of this year’s World Aids Day, which occurs on Sunday.
World AIDS Day has been commemorated on 1 December every year since it was first instituted in 1988. This year’s theme is ‘Communities make the difference’. This is intended to highlight what communities have done in the past and will be doing in the future in the fight against HIV and AIDS.
The theme is expected to encourage inactive communities to take up the various programmes and initiatives that are being implemented locally and internationally to eradicate the virus.
Communities all over the world contribute to HIV and AIDS awareness in many ways. Their leadership and advocacy ensure that their contributions remain relevant and well-grounded and keep people at the centre of the fight against AIDS without leaving anyone affected behind.
Among the people that make up our communities are peer educators, people living with or affected by HIV and AIDS, people who inject themselves with drugs, sex workers, young people, counsellors, community health workers, door-to-door service providers, civil society organisations and grassroots activists, all of whom play a major role in HIV and AIDS awareness campaigns.
World AIDS Day gives them and anyone else interested in the fight against HIV and AIDS, an important platform to highlight the role of communities at a time when reduced funding and a shrinking space for civil society are putting the sustainability of services and advocacy efforts at risk.
Ideas to mobilise more members of the community are urgently required to address the barriers that stop communities delivering services, including restrictions on registration and an absence of social contracting modalities.
The strong advocacy role played by communities is needed more than ever before to ensure that HIV and AIDS remain on the political agenda, that the human rights of those who have HIV or AIDS are respected and that decision-makers and implementers are held accountable.
HIV prevention programmes
HIV prevention programmes are interventions that aim to halt the transmission of HIV. They are implemented to either protect an individual and their community or are rolled out as public health policies.
Initially, HIV prevention programmes focused primarily on preventing the sexual transmission of HIV through behaviour change. For a number of years, the ABC approach of Abstinence, Being faithful, and use of condoms was used in response to the growing epidemic in Zimbabwe and sub-Saharan Africa.
However, by the mid-2000s, it became evident that effective HIV prevention needed to take into account underlying socio-cultural, economic, political, legal and other contextual factors.
This has resulted in the 'combination prevention' approach being used and has largely replaced the ABC-type approaches.
Combination prevention
Combination prevention is a holistic approach whereby HIV prevention is not a single intervention, such as condom distribution, but the simultaneous use of complementary behavioural, biomedicaland structuralprevention strategies.
Combination prevention programmes consider factors specific to each setting, such as levels of infrastructure, local culture and traditions as well as populations most affected by HIV. They can be implemented at the individual, community and population levels.
All combination prevention programmes require a strong community empowerment element and specific efforts to address legal and policy barriers, as well as the strengthening of health and social protection systems, plus actions to address gender inequality, stigma and discrimination.
For instance, young people in high prevalence countries need more than condoms and behaviour change communications. They also require comprehensive sex education and access to effective HIV and sexual and reproductive health services without economic barriers such as prohibitive costs or structural barriers such as parental consent laws.
A package for people who inject drugs should feature comprehensive harm reduction services, including needle and syringe programmes as well as opioid substitution therapy.
Behavioural interventions
Behavioural interventions seek to reduce the risk of HIV transmission by addressing risky behaviour. Therefore, behaviour change communication forms a basic component of combination prevention.
Behavioural intervention may aim to reduce the number of sexual partners individuals have, improve treatment adherence among people living with HIV, increase the use of clean needles among people who inject drugs or increase the consistent and correct use of condoms.
Examples of behavioural interventions include providing information on sex education, counselling and other forms of psycho-social support, information on safe infant feeding guidelines, stigma and discrimination reduction programmes.
Biomedical interventions
Biomedical interventions use a mix of clinical and medical approaches to reduce HIV transmission. Male circumcision is a good example of a biomedical intervention. This is a simple medical procedure that has been shown to reduce the risk of HIV transmission by up to 60 percent during unprotected sex.
In order to be effective, biomedical interventions are rarely implemented independently and are often used in conjunction with behavioural interventions. For example, when a man is circumcised, he will often be tested for HIV and receive counselling and education about condom use and safer sex.
Some examples of biomedical interventions include antiretroviral drugs for the prevention of mother-to-child transmission, pre-exposure prophylaxis, post-exposure prophylaxis and treatment, HIV testing and counselling, testing and treatment of sexually transmitted infections and needle and syringe programmes.
Structural interventions
Structural interventions seek to address underlying factors that make individuals or groups vulnerable to HIV infection. These can be social, economic, political or environmental.
Some HIV-related vulnerabilities are fuelled by inequalities and prejudices entrenched within the legal, social and economic structures of society.
For example, a woman’s subordinate status can affect her ability to negotiate condom use, while a lack of infrastructure such as transport prevents many people from accessing health clinics. By successfully addressing these structural barriers, individuals are empowered and able to access HIV prevention services.
Empowering women and girls, young people and people from groups most affected by HIV with the ability to claim their rights, receive a quality education, enjoy healthy lives and take measures to protect themselves from HIV is also a major part of combination HIV prevention.
However, structural interventions are more difficult to implement than other forms of intervention because they attempt to deal with deep-rooted socio-economic issues such as poverty, gender inequality and social marginalisation.
The information in this article is provided as a public service by the Cimas iGo wellness programme, which is designed to promote good health. It is provided for general information only and should not be construed as medical advice. Readers should consult their doctor or clinic on any matter related to their health or the treatment of any health problem. To contact the iGo team, email igo@cimas.co.zw or WhatsApp 0772 161 829 or phone 024-27730663.
