You are viewing : Vol. 5, Issue 3 Oct - Dec, 2008

HIV Aadvocacy Mmovement: Friend or Foe?

Dr. Arthur Sekiziyivu

(Third part of our HIV chronology series)

No disease in the history of mankind has generated as huge an advocacy movement as HIV/AIDS. But this has not always been the case. In the early days it was seen as a purely medical/public health problem. So many of the interventions were focused on the diseased individual and their circumstances. As the numbers of infected persons and affected families grew into communities, and then to whole sections of society it was soon obvious that HIV/AIDS needed more than just drug therapies to the patient.Prominent personalities living with HIV came out to talk openly about the disease.

In Uganda, Philly Bongoley Lutaaya was the first prominent personality to come out openly about his status and appeal to the public not to stigmatize victims. Political, social and religious leaders followed. All this attention created a critical mass that turned HIV/AIDS prevention, treatment and care advocacy into a major feature of the fight against HIV/AIDS. The movement grew globally to include advocacy for prevention, treatment and care for vulnerable groups such as women, children, and displaced persons, among others.People living with HIV, as persons who understand how bad this condition is also started support groups such as The AIDS Support Organisation, commonly known as TASO.

Here patients engage in beneficial activities ranging from helping each other plan adherence, fight stigma and income generation. As time went on the search for a solution provoked research into new interventions such as new treatments and prevention strategies, a major part of which is the search for an HIV preventive vaccine. Many believe that this just might be the missing definitive blow this pandemic so rightly deserves. But of course not all are believers so the advocacy movement is playing a major part in ‘spreading the gospel’, so to speak. All the research into new drugs, interventions, clinical presentation and impact of HIV requires and consumes a lot of money.

We have the advocacy movement to thank for progress made so far as its members have lobbied massively and convinced not only governments but also private institutions and individuals to donate to this cause. This has especially been important in providing drugs to people in the third world who would ordinarily not afford them. We now have PEPFAR, a key provider of Antiretroviral drugs in Uganda; Bill and Melinda Gates foundation that sponsors a lot of research into HIV, Global fund, to mention but a few.But not everybody loves this movement. Some health care providers argue that HIV/AIDS advocacy has taken attention away from other diseases and public health problems of equal, if not greater importance in terms of social devastation, especially in the third world. Examples include malaria, respiratory tract infections, diarrhoeal diseases and maternal and infant mortality. It has taken away badly needed medical personnel from the mainstream into HIV/AIDS research. The donor pool for funds is also increasingly ‘monopolized’ by HIV, leaving other conditions lacking resources to research and pursue solutions to other diseases.Another issue is duplication and insufficient coordination of advocacy efforts. It is not uncommon to find a number of NGOs doing the same HIV work in one ‘easier to access’ district, and none in others. Wouldn’t it benefit the public more if these services were distributed evenly across the country? But do not imagine for even one minute that this movement has had smooth sailing.

They have had and still have to overcome some challenges like getting people to listen to prevention messages that go against accepted societal cultural norms and religious beliefs. A key example is medical male circumcision. Even though studies have shown that medical male circumcision reduces male-female transmission by over 50%, some communities and governments are yet to embrace the practice.There is the risk of giving confusing messages to the public as different arms of the anti-HIV movement publicize their work. For example some groups promote abstinence yet de-campaign condom use as a strategy for HIV prevention. There is also the question of how to handle socially unaccepted groups that some social workers argue play a major role in driving the epidemic. How do you help MSMs (men who have sex with men) in a largely homophobic society? What of sex workers? The benefits of the advocacy movement far outweigh the disadvantages. With proper regulation, advocacy would bring HIV/AIDS services to underprivileged communities especially in rural areas. It has helped focus the fight against HIV to those areas that are most critical. The beauty about it, anybody can be an advocate, including you, dear reader. All you need is to identify a worthy cause, find all the necessary information, adequately package it and accurately disseminate it to the target audience. Of course do not forget to get the relevant licenses from your local authority.