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AIDS remains one of the most destructive epidemics in history, accounting for 690'000 deaths in 2019 alone [1]. Every single week, 5500 young women become infected with HIV, and in Sub-Saharan Africa, five in six new infections is among adolescents girls aged 15-19. The disease burden is huge, and within the Sustainable Development Goals, 10 separate indicators are geared towards ending AIDS [2]. COVID19 enforced lockdowns and boarder closures have impacted both the production and distribution of medicines, and a recent study by UNAIDS revealed that the cost of medicines in India was 10% to 25% higher than normal prices [1]. Amidst the destructive impact of COVID19, World AIDS Day is a reminder for the public and government, that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education [3].

This year's World AIDS theme is ‘Global solidarity, shared responsibility' [3]. At a time when global priorities have shifted, the need to mobilise communities has never been more urgent.  Actors such as peer educators, community health workers, networks of people affected by AIDS, as well as civil society organisations play a huge role in sharing responsibility for preventative efforts [4]. Their role in combatting AIDS may include, but is not limited to: advocacy, direct participation in service delivery, participatory community-based research and lastly, community financing [4]. Within these activities, communities also play a major role in tackling AIDS-related stigma.

AIDS-related stigma has been a major issue since the epidemic erupted, affecting not only physical health but also mental health. The types of stigma that exist can be broadly categorised into three sections, namely: external stigma, internal stigma and stigma of association [5]. External stigma is stigma that is received and enacted. Such stigma refers to negative behaviours, attitudes or discrimination experienced by people living with AIDS [5].  This may manifest as verbal abuse, social isolation, as well as workplace and household stigma. Internal stigma on the other hand, is often self-stigma as a result of a positive status HIV status, in which persons may have negative self-perception often accompanied by self-blaming and high levels of shame [5]. Lastly, stigma of association is the discrimination to families or health care providers of people living with AIDS; such stigma is often reflected in local gossip and local communities distancing themselves [5].

The ECCC approach is commonly used to dismantle the stigma associated with AIDS [5]. ECCC stands for the following:
• Education
• Community involvement
• Contact with affected and infected groups
• Continuous counselling

Whilst all of these play a significant role in reducing stigma, in line with World Aids Day 2020, focus will be shifted to community involvement, in line with demonstrating global solidarity and shared responsibility.  Community involvement aims to sensitize people about stigma, by creating awareness campaigns and addressing the misconceptions and myths surrounding AIDS [5]. Platforms for carrying out such activities may include after church services, schools and community gatherings.  An exemplary case in the ‘anti-AIDS' clubs in Zambia, where youth are trained on how to care for people living with AIDS. By engaging and empowering youths, more family members became involved in their relatives care [6]. Involving people living with AIDS in service delivery has also had a significant impact, not only empowering HIV-positive individuals, but also reducing stigma among community members.  Studies in Burkina Faso, India and Zambia have revealed that, when people living with AIDS receive training, involvement in activities also facilitates in reducing their isolation [6]. It is therefore clear that communities offer tremendous potential tackling AIDS-related stigma and being part of the solution. That being said:

‘Communities need support on #WorldAIDSDay and every day'.
-  UN Secretary-General, António Guterres

Nefti Bempong-Ahun, MPH
Assistant Editor & Communications Assistant 

References

[1] https://www.unaids.org/en/resources/fact-sheet

[2] https://www.unaids.org/en/AIDS_SDGs

[3] https://www.unaids.org/en/World_AIDS_Day

[4]https://www.unaids.org/sites/default/files/media_asset/UNAIDS_JC2725_CommunitiesDeliver_en.pdf

[5] https://www.researchgate.net/publication/299435425_Guidelines_for_Community-Based_HIVAIDS_Stigma_Reduction_Intervention_in_a_Rural_Community

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821857