Several themes were emphasized repeatedly during the Community Forum ahead of the 10th International AIDS Society (IAS) Conference on HIV Science in Mexico City: overcoming silos and identity politics, the crisis in Venezuela, efforts of indigenous communities to be heard, women's rights, insufficient pay for HIV service workers, sex worker rights, universal health coverage, and the criminalization of substance use.
"Not only must we overcome divisions within the HIV movement, we also must join with other organizations to accomplish common goals," an audience member noted.
One example of cooperation within the HIV community is the effort of 27 Colombian community organizations that are jointly addressing the issue of Venezuelans living with HIV who are emigrating to Colombia in search of antiretrovirals, Miguel Ángel Barriga Talero of RED SOMOS noted.
The economic crisis in Venezuela has caused 8,000 to 10,000 people living with HIV to leave the country because of a lack of HIV medications there, Alberto Nieves of Acción Ciudadana Contra el SIDA (Citizen Action Against AIDS) in Caracas, Venezuela, said. He told of the lack of drugs against malaria and other diseases, which presents a risk to the entire region as these illnesses go untreated. Because of hyperinflation combined with unemployment, malnutrition is common, exacerbating HIV-related health issues.
An economic crisis is also facing indigenous communities, leading many to migrate to cities or other countries, Amaranta Gómez of the Secretariado Internacional de Pueblos Indígenas y Afrodescendientes Frente al VIH (International Secretariat of Indigenous and Afro-descendant Peoples Against HIV) said. Other issues include traditional gender inequality, which does not allow women to insist on condom use, and the belief that HIV is just a problem for white people. One strategy has been to increase visibility at global HIV conferences. To that end, indigenous activists from Mexico and the U.S. staged a protest at the opening plenary of this IAS conference demanding an equal voice at the table.
Gender inequality affects all women across the region. This includes struggling to be heard within community organizations, a Mexican woman activist in attendance noted. "The male colleagues do not represent us," she insisted. She also called for adequate salaries and pension rights for workers in HIV services. "We cannot struggle for the rights of others and forget our own rights."
The need for appropriate pay for community advocates was echoed by Millie Milton of Guyana Trans United, who noted that travel reimbursements are not enough to offset lost income and other expenses. In her community, the risk of HIV acquisition is just one of many challenges. The stigma and discrimination faced by transgender people extends to their organizations. For example, her own group initially was unable to legally register as an organization and had to do so under another organization's banner.
Women's rights also include the current struggle in Argentina to legalize abortion, an issue important to sex workers, explained Elena Reynaga of RedTraSex. People in this occupation not only need reproductive health and HIV prevention services but are also fighting for better working conditions. Their organizations demand to be heard.
"You don't discuss us without us," Reynaga said.
Sex workers are often thought to be "hard to reach," but "a sex worker who is hard to reach is an unemployed sex worker," Raoul Fransen of International Civil Society Support followed.
Fransen also called for free, equitable access to quality health care for all. Universal health care is the third U in the undetectable equals untransmittable (U=U; I=I in Spanish) campaign, Murray Penner of Prevention Access Campaign said. While U=U can change the lives of people living with HIV and their partners and needs to be widely publicized, V≠V -- viral load does not equal value -- is also important. This means ensuring that people who do not manage to achieve or maintain undetectable viral loads are not stigmatized, Penner explained.
Another stigmatized group is people who inject drugs, especially in Eastern Europe, Péter Sarósi of the Rights Reporter Foundation explained in a documentary screened at the forum, "From Durban to Tomorrow." His organization trains community activists in video production to help change public attitudes via social media. Stigma and discrimination compound the criminalization and incarceration of those with substance use issues. At the forum, Andriy Klepikov of the Alliance for Public Health cited the case of the Crimea, where methadone clinics were closed after Russia annexed that territory in 2014. Within six months of the invasion, 10% of the clinics' 800 clients had died.
Other issues raised were the transition from international donor to domestic funding in countries such as Mexico; pre-exposure prophylaxis (PrEP) access and awareness; the need for holistic care that deals with all problems a person is facing, not just HIV; the redirecting of resources from HIV to Ebola in Guinea; sexual violence against young women in South Africa; the spread of fundamentalism in Central and Latin America, which keeps many LGBTQ people in the closet; and the elusiveness of health coverage for many people, even in high-income countries with a public health care system.