Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000Fear, stigma and denial: a vicious circleWarnings about the growing threat of HIV and AIDS date back to the early and mid-1980s. But many people, from members of affected communities to leaders ofglobal organizations, have failed to take them seriously. In some cases, the denialhas been deliberate. People simply do not want to admit that a fatal disease spreadby behaviour branded as “immoral” could be rampaging through their community ortheir country.Other unique features of AIDS aid and abet denial. The behaviours that spread HIVtake place in private. There is a lag time of up to a decade and more between infectionand any visible sign of illness. HIV does not cause a single, specific fatal disease;instead, individuals whose immune system has been weakened by the virusfall prey to infections and ailments that may look familiar in their community. Inother words, people who do not want to accept the reality or gravity of AIDS canfind all sorts of ways of questioning whether it is as bad as the data from surveillancesuggest.A country in which denial flourishes is a country whose citizens are vulnerable tothe silent spread of HIV. Until political figures and respected community leadersspeak out and breach the wall of silence, there is little hope of mounting a vigorous,broad-based effort against the epidemic (see pages 108-109). Fortunately,the past year has seen major progress at the highest level of political leadership(see Box 6 below).Box 6. Breaking the silence in AfricaNearly a decade ago, a few bricks were chipped out of the wall of silence erected bypolitical leaders around the fearful subject of AIDS in Africa. That was when UgandanPresident Yoweri Museveni, faced with rising sickness and death in his country,reversed his long-standing opposition to condoms and began talking openly aboutAIDS. The subsequent national response helped bring about a significant fall in theprevalence of HIV infection in the country, described on pages 9-10.Public acknowledgement of the existence and danger of AIDS gathered momentumwith an event that electrified Mozambique last year: the announcement that BoaventuraMachel, the brother of Mozambique’s independence hero and first president, had diedof AIDS. In Blantyre, Malawi’s president Bakili Muluzi invited a cross-section of society,including soldiers, schoolchildren, prostitutes and HIV-infected persons, to the launchof a new five-year plan against AIDS.A clarion call for greater openness had already been sounded by South AfricanPresident Thabo Mbeki. “For too long we have closed our eyes as a nation, hoping thetruth was not so real,” the then Deputy President Mbeki told South Africans in 1998.–––>38