How do you fight the human skulls, bleeding syringes and coffins, finger pointing, sickly faces and fearful looks of HIV? How do you help someone suffering from the “extraordinary” virus? If you’re Thabo Mbeki, you make it ordinary; tell people HIV is caused by poverty, bad nourishment and general ill health, and that they shouldn’t take expensive Western medicine – no matter how life saving it has proved to be. Of course, Mbeki is accused of 330,000 “needless” deaths by a Harvard research team and a leading South African AIDS activist. Ignoring mainstream medicine isn’t going to win you any awards from the international community.
So what’s a world leader to do? Last week, The World Health Organisation (WHO) suggested that an annual, compulsory mass-testing scheme should be set up in the hardest hit areas, like the sub-Sahara. The WHO scientists who raised the proposition also suggested compulsory and immediate antiretroviral treatment for all people found to have HIV. They claim in Sub-Saharan Africa this scheme would mean “the proportion of people with HIV would run to under 1% in less than 50 years”. The Indonesian government is set to go a step further. Next month, an Indonesian parliament will vote on a scheme that proposes to tag, using microchips, “sexually aggressive” people with HIV. “The health situation is extraordinary, so we have to take extraordinary action”, one MP claimed.
The health situation regarding HIV is indeed extraordinary. Across the world over 30 million suffer from AIDS, the disease caused by HIV. Yet even more extraordinary is the stigma and ignorance that surrounds these 30 million people, a global under-class vulnerable to fear and prejudice. In 2005, a UN report found that in India nearly 20% of surveyed pregnant women suffering from HIV were effectively bullied into having an abortion. In Somalia, you risk your own life just by diagnosing HIV; ”If we tell someone that they are HIV positive, they might take revenge,” Josef Prior Tio, general coordinator for Doctors Without Borders, told The Boston Globe last year. Revenge is common, it is reported.
Even government intervention can lead to stigma, rather than eliminate it. The same UN report states “The legal framework of the English-speaking Caribbean actually perpetuates stigma and discrimination against some high risk groups”. In Vietnam, “human skulls, bleeding syringes, coffins…and sickly faces” is how HIV is portrayed by the government and the media. 58 countries worldwide have laws that criminalize HIV or use existing laws to prosecute people for transmitting the virus. Another 33 countries are considering similar legislation. In Benin, simply exposing others to HIV is a crime, even if transmission doesn’t occur.
There is no way of predicting how mandatory tests and treatment will diminish stigma. Even in Brazil, where antiretroviral therapy is universally available, many HIV-positive children and youths still face significant stigma. How would mandatory testing and treatment be enforced in some of the world’s poorest countries? How can the WHO temper fear and stigma when it resorts to methods that are “extremely radical”, according to Imperial College London? As for microchipping, “it will increase stigma and promote a feeling of complacency”, according to the associate director of The International HIV/Aids Alliance. The WHO could be seen as stern but fair nurse to AIDS sufferers, tying them to apron strings for their own good; it could also be seen as a mad doctor with a bloody syringe in one hand and a pair of shackles in the other. Totalitarianism or benign control, either way human rights are to be buried in a coffin branded with H – I – V.