AIDS-prevention policies promote stigma - expert

Father Michael Kelly is not one to shy away from controversy. In his opening address to a conference on HIV-related stigma and discrimination this week in Pretoria, South Africa, he asked: "When was the last time you heard a minister at church say, 'let us celebrate good sex'?"

According to Kelly, HIV/AIDS was still associated with immoral sexual behaviour and divine punishment, fuelling stigma against HIV positive people. "But sex is good and wonderful," he said. "The real sins are stigma and discrimination."

Kelly is an Irish Jesuit priest who has lived in Zambia since 1955 and lectures in education at the University of Zambia. He is now a world-renowned AIDS expert.

The meeting of researchers and activists was organised by the Regional AIDS Initiative of Southern Africa (RAISA), an initiative of the UK-based development organisation, Voluntary Services Overseas (VSO). RAISA/VSO operates in Malawi, Mozambique, Namibia, South Africa, Zambia and Zimbabwe.

"With antiretrovirals we can cope with HIV, but there is no medicine against stigma," said Victoria Bam, a young Namibian woman who set up a support group for mothers living with HIV/AIDS when she was rejected by her family after losing her husband and baby daughter to AIDS.

Kelly warned that policies and principles applied by top aid agencies were actually contributing to stigma, and cited the cornerstone of the international AIDS response - behaviour change - which places the responsibility for HIV transmission on the individual.

This approach, said Kelly, institutionalised blame and stigma at the heart of the policy, turning HIV/AIDS into someone else's problem. He added that the limited "focus on behavioural change misses the point - HIV/AIDS is a broader problem of poverty, underdevelopment and inequality."

"International agencies pour condoms into poor countries and forget there is no clean water," he observed.

Michaela Clay, regional director of the AIDS and Rights Alliance for Southern Africa, agreed. "The focus on behaviour change ignores that many women are not in a position to choose safe sex, change power relations or transcend poverty, race and gender disparities," she pointed out.

With vast amounts of money flowing into antiretroviral treatment (ART) programmes, prevention efforts have been sidelined in terms of both resource allocation and public perception.

"Without prevention, we are creating an ART time bomb that the world will be unable to fund," Kelly cautioned.

Another policy inadvertently giving rise to stigma was aid agencies' targeting HIV-positive people, while ignoring equally needy people in the community. This raised resentment and prejudice against people living with HIV/AIDS, and could create an incentive for people to become infected with the virus to receive aid.

Aid agencies working with orphans had become aware of the problem and were now targeting all orphans and vulnerable children in a community, not only those affected by AIDS.

However, stigma would only be eradicated once gender inequalities in society had been tackled, the rights of people living with HIV/AIDS and all human rights were protected, and health services were made more widely available.

"Cutting the roots of stigma and discrimination will make the tree of AIDS wither and die," said Kelly.

Among the participants was leading AIDS activist Lynde Francis, founder of The Centre, an HIV/AIDS NGO, and the first white person in Zimbabwe to publicly disclose her HIV-positive status.

"It is comforting to see that the person least likely to experience discrimination - a white male in his seventies, a priest, a university lecturer and an intellectual - has such a good understanding of the stigma and discrimination that we suffer."