How machismo prevents ending AIDS

Machismo harms health. In its latest report, UNAIDS points to it as one of the major obstacles holding back the fight against HIV, in ways that are not always obvious. An example: the risk of infection increases by 50% in girls without schooling, which, in part, explains why young women and adolescents (15 to 24 years old) are three times more likely to contract it than boys of the same age in Sub-Saharan Africa, the region with the highest incidence on the planet.

“The world will not be able to defeat AIDS while reinforcing patriarchy,” emphasizes Winnie Byanyima, Executive Director of UNAIDS, in updating her annual report, which this year focuses on analyzing how inequities are a barrier to ending the pandemic. HIV. It happens all over the world and with different types of inequalities: wealth, age and gender. And it is especially pronounced among men and women in sub-Saharan Africa, where they recorded 63% of new infections in 2021.

“We need to address the intersecting inequalities that women face. In areas of high HIV incidence, those who experience intimate partner violence are up to 50% more likely to contract HIV. In 33 countries, between 2015 and 2021, only 41% of married women aged 15-24 could make their own sexual health decisions. The only effective roadmap to end AIDS, achieve the sustainable development goals and guarantee health, rights and prosperity is a feminist roadmap,” says Byanyima, who spoke with EL PAIS before the presentation. Of the report.

The world will not be able to defeat AIDS while reinforcing patriarchy

Winnie Byanyima

Byanyima returns to the example of schooling. Although the gap between boys and girls is narrowing in Africa, adolescent girls still lag behind boys when it comes to completing secondary school: 26% compared to 29%, according to Unesco data. “The problem is that when they are not in school they are exposed to situations where they have unwanted sex,” she says.

Behind this, she says, there are patriarchal structures that marginalize women and do not let them make their decisions in much of the world. And this does not only affect women, men are also affected. “Toxic masculinities discourage them from seeking attention. While 80% of women living with HIV access treatment, this percentage drops to 70% in men”, reads the report.

This reality represents a real obstacle to the achievement of the international objectives for the eradication of AIDS, which go through the so-called 90-90-90 strategy by 2030. It consists in the fact that 90% of those who suffer from HIV should be diagnosed that year; that 90% of them follow the treatment, and that 90% of these have an undetectable viral load, which means that they stop infecting other people.

According to the latest UNAIDS report, published in July, progress is not enough to reach the goal. Last year there were 1.5 million infections and 650,000 people died due to AIDS. Although the disease continues to recede, it is doing so at a slower rate than it had been: with a decrease of 3.6%, it is the smallest annual drop since 2016. At that rate, the number of new annual infections will exceed 1.2 million in 2025, the year in which the UN has set the goal of having fewer than 370,000 new cases.

Despite these figures, Byanyima assures that it is possible to reach the goals of 2030. “It is a question of political will,” he says. “We have the data on where infections occur and the resources to prevent them,” he adds. But in order to end AIDS as a public health threat, he continues, in eight years it would be necessary to put an end to the inequalities denounced in the latest UNAIDS report.

Last year there were 1.5 million infections and 650,000 people died due to AIDS

In addition to gender inequities, the document also notes large differences based on age. While more than three-quarters of adults living with HIV receive antiretroviral therapy, this share drops to just over half of children. “This has deadly consequences.” In 2021, children accounted for just 4% of all people living with HIV, but 15% of AIDS-related deaths globally.

“It’s a shame!” exclaims Byanyima. “It seems that because they can’t speak up and fight for their own rights, no one is doing it for them, so we want to put a lot of emphasis here.”

Although AIDS is a major problem in developing countries (70% of the 38.5 million people with HIV in the world live in Africa), it also plagues the rich, who are not exempt from the inequalities listed in the report. of UNAIDS. Its director explains that in countries like the United States, Canada or Australia, indigenous people are several times more at risk of infection than the rest of the population: “In the United States, if you are a black woman, your chances of contracting HIV are so high like those of a gay man in Uganda, a very poor country”.

AIDS and human rights

Stigma and discrimination have been attached to AIDS since before the virus was discovered. Although the worst is behind us in parts of the world, they are still creating havoc that makes it extremely difficult to end the pandemic. Some facts: the relative risk of contracting HIV is 35 times higher among people who inject drugs than in the general population, five times higher among people in prison, 30 times higher among sex workers, 14 times higher among women transgender, 28 times higher among men who have sex with men.

This is no coincidence and it happens, to a large extent, because in many countries these groups are persecuted or criminalized. “In states that stop criminalizing same-sex relationships, we see how infections among the gay population begin to decrease. The same thing happens with sex workers. It is a matter of human rights”, says Byanyima.

Sharon Lewin, president of the International AIDS Society, considers it a “moral imperative” to put people with HIV at the forefront of all aspects of the response. “Whether in clinical trial design, policy making or any other aspect of our efforts, people living with and affected by HIV must be not only beneficiaries, but also the actors driving our efforts forward in a world riddled with inequalities”, he maintains.

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