“From Durban to Tomorrow” Shows the Fight Against HIV Is Far From Over
In July 2000, an HIV/AIDS conference changed the way the world viewed public health care. 12,000 people from around the world — medical professionals, health care activists, NGOs and people living with HIV — flocked to Durban, South Africa, to “break the silence” on preventing HIV in a way that ensured equal access to affordable treatment and prioritized human rights.
Thus started a worldwide initiative to combat the HIV epidemic, with governments across the globe introducing policies, with funding from international organizations, to put an end to a disease affecting millions of people. All the gains that were made in the decade that followed, however, have stalled in more recent years, which has led to disillusionment among health care activists — a global phenomenon tackled in “From Durban to Tomorrow,” a 40-minute documentary by Indian and Canadian filmmaker Dylan Mohan Gray.
“There has been a lot of hardening of sentiments, particularly vis-à-vis minority communities, vulnerable communities, marginalized communities, the poor in general,” Gray said. “That’s meant that people don’t see certain things to be important, which were seen to be important earlier — the idea of universal health care, equality, and also particularly giving help to communities that need extra help.”
In India, the initial government policies regarding HIV prevention specifically targeted sex workers, a group seen as having a high prevalence of HIV, said Meena Seshu, founder of Sangram, a health and human rights initiative operational in regions of northern Karnataka and southern Maharashtra. “The early policy brief was that you need to work with female sex workers to see that men who went to them as clients don’t get HIV,” she said. “You have to use these women to make sure the men don’t get it, which was a terrible thing to do.”
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The initiative distributed condoms to the women, almost “terrorizing” the sex workers into using them, Seshu said. But the condoms were also of bad quality, without lubrication, with the rubber easily coming off, she said. Ultimately, the effort lacked consideration for sex workers’ rights. This spurred NGOs to implement policies to develop a “collectivization model” of activism, Seshu added. “It caught on; we were [telling sex workers] that you’re not using the condom such that you are saving the client; you are using the condom such that you can be safe, that your life is safe.”
The model helped put the conversation about health care in the framework of the human rights of sex workers, and helped teach them language they could use to exercise their rights with medical professionals at government hospitals, Seshu said. It unofficially guided HIV prevention efforts for the next few years.
But while the model has been working at a grassroots level, the government has shifted to treatment-focused efforts — which are less effective at preventing the spread of HIV, and still fail to address human rights-related concerns such as: who has access to treatment?
As a result of a rollback on rights-centric health care initiatives, Seshu has witnessed increased police brutality against sex workers, and higher rates of STD transmission, she added.
Additionally, the current initiatives are only reaching 17% of the population that is at high risk of contracting HIV, such as sex workers, men who have sex with men and injecting drug users, according to UNICEF. “It is estimated that there are 200 million young people in high prevalence and highly vulnerable districts who need access to information, skills and services to reduce their vulnerability to HIV infection,” the agency adds.
While the Indian government has established institutions to combat the spread of HIV, such as the National AIDS Control Organisation (NACO) and the National AIDS Control Program, and even rolled out an anti-discrimination policy called “National HIV and AIDS Policy and the World of Work,” in 2009, activists like Seshu have seen few resulting reforms on the ground over the past decade. There is also no established organization dedicated to tackling discrimination against HIV-positive individuals and/or implementing these policies, rendering any intervention moot.
In 2016, India saw 80,000 new HIV infections and 62,000 AIDS-related deaths, according to UNAIDS. Only 49% of the population affected with HIV had access to the anti-retroviral therapy. For the rest of the population, cost and accessibility still remain an issue.
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“[HIV prevention] has now lost its color. It’s no longer the flavour of the month,” Seshu said. “It’s become very tokenistic. These programs used to look at community engagement, condom use, medication. Today, it is test, treat and forget. The discussion of rights of public health has disappeared from the programs of the government.”
It’s time political institutions stopped looking at the number of HIV-positive people on drugs, and start looking at those who are not, she added. It has taken 16 years to only save half of the population, she says, and “the race is not yet finished.”
“From Durban to Tomorrow” reinforces this sentiment, which is echoed by five health care activists in Guinea, Hungary, South Africa, Spain, and India. While each country has specific problems in their health care systems, there is a commonality across continents: “a disregard,” Gray says, of people existing on the lower end of the economic spectrum, for whom it is increasingly difficult to access and afford HIV treatments and drugs. A rising populist political sentiment across the world, which is characterized by an ‘us versus them’ mentality has also resulted in governments othering marginalized communities, which makes it difficult to provide quality care in an inclusive manner, Gray added.
“Out of pocket expenses for the rich can be an irritant, but for the poor, it’s poverty,” Seshu said. “It’s becoming increasingly apparent to us that we are able to keep the people who can afford health care healthier [for] longer, as compared to poor people. When you look at it from a human rights lens, the question is: why?”
The most worrying aspect of this decline is that the Indian government had already rolled out an effective response. “If they could do it then, why can’t they do it now?” Seshu asked. “Policies, and the politics that govern these policies, are changing rapidly; it’s becoming more anti-marginalized … which is driving this epidemic of abuse against poor people, and that is the crux of the matter.”
Seshu advocates for the inculcation of a “patients’ rights charter” in our health care system, which she says will empower patients with a “language of argument with the health care providers.”
“End of AIDS is not tomorrow,” she said. “We need to challenge the myth that AIDS is over. For whom is it over?”