December 1 marks World Aids Day — the 35th time that this date has been marked globally.
It remembers those we have lost to Aids and raises awareness of human immunodeficiency virus (HIV) and HIV-related stigma since the onset of this devastating and persistent pandemic more than four decades ago.
In fact, it is exactly 40 years since the first Aids-related deaths occurred in Ireland in 1982 with many more lost in the years that followed.
It is fitting then, that we take some time today, both within communities impacted by HIV and as a society, to remember and mourn those we have lost and to show solidarity with those who continue to live with or be affected by HIV.
For people currently living with HIV in Ireland, much has changed.
Treatments to suppress HIV, the virus that attacks and weakens the immune system which can lead to Aids-related illness, have become very sophisticated and effective.
One pill a day is all that is required to ensure someone living with HIV can suppress the virus to such a small amount in their bloodstream that the virus effectively becomes undetectable and, as a result, untransmittable.
Medication to treat HIV continues to advance, including new treatment options that reduce the burden of daily oral medications and replaces them with long-acting injectable therapies.
Many people living with HIV in Ireland will soon be able to attend a clinic a few times a year to receive an injection of antiretroviral medication to ensure that they maintain viral suppression, both eliminating the need for a daily pill and ensuring that they continue to live long and healthy lives, all other things being equal.
The scientific advances do not stop there. The widespread availability of drugs which can prevent someone who is HIV-negative from acquiring the virus from someone who is HIV-positive and not virally suppressed is having a positive impact on rates of transmission.
Taken before or after a sexual encounter, these medications, known as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly effective and have revolutionised HIV prevention.
The popularity of PrEP as a preventive option is evident in the recent roll-out of a national PrEP programme by the HSE. The programme has been oversubscribed and significant delays are being experienced by those wishing to access the programme and who meet the qualifying criteria, mostly gay, bisexual, and other men who have sex with men, a group disproportionately affected by HIV.
To meet Ireland’s global commitments towards ending new HIV transmissions by 2030, it is imperative that our health services ensure that anyone who wishes to access PrEP can do so in a timely and accessible manner.
This undoubtedly requires additional personnel, resources, and investment, at a time of economic uncertainty, but the payoff is that the rate of new HIV transmissions will likely fall and the corresponding overall cost of providing ongoing treatment for HIV through the public health system will reduce.
It is also important to remember that access to lifesaving treatment and prevention options are not universal.
Far more people across the globe live without access to these medications and the continuing impact of this inequality on individuals, communities, and societies is devasting.
To make meaningful progress in ending new HIV transmissions and protecting those living with the virus, these inequalities must be addressed.
UNAIDS, the international agency tasked with monitoring and combating the global HIV pandemic has adopted ‘Equalize’ as its theme for this year’s World Aids Day.
The slogan is a call to action against the inequalities which perpetuate the global Aids pandemic.
Action to ensure everyone has access to testing, treatment, and prevention.
Action to reform laws, policies, and practices which stigmatise and exclude people living with HIV.
Action to enable communities to highlight the inequalities that impact them in their struggle against HIV and related stigma.
Action to ensure advances in technologies and treatments are shared.
If the science underpinning the drive to eliminate HIV is winning, why then does so much stigma surrounding HIV persist?
There are no easy answers to this but a lack of public awareness of advances in treatment and prevention, misconceptions and misinformation perpetuating myths and fears about how HIV is transmitted, and outdated beliefs about who can and cannot be impacted by the virus all contribute to the stigmatisation of people living HIV.
In contrast, by talking openly and taking appropriate actions we can change the perception and reality of HIV from life-threatening illness to treatable and preventable medical condition.
This year, HIV Ireland is once again promoting its Glow Red for World Aids Day campaign. The initiative encourages organisations and public authorities to light up landmark buildings around Ireland in red.
Acknowledging the need to conserve energy at this difficult time for global energy security, more than 40 landmarks across Ireland, which would otherwise remain lit throughout the night, will do so this evening.
Members of the public are also encouraged to wear something red — a piece of clothing, an enamel pin, a simple red ribbon — to show solidarity with people living with or vulnerable to HIV.
HIV stigma is real and ending HIV stigma is a real possibility. As internationally renowned Irish HIV activist and face of this year’s Glow Red campaign, Rebecca Tallon de Havilland, has said: “We can end stigma by strengthening the voices of people living with HIV. Using my voice has empowered me to overcome self-stigma and live my best life.”
That doesn’t mean everyone living with HIV must speak up, but they shouldn’t feel silenced because of stigma, and when they speak, we should listen.