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Every year on December 1st, the world observes World AIDS Day, and the statistics tell a different story from that of a medical marvel. We now have drugs that enable the infected to survive for a normal lifespan with HIV and have methods of prevention that are almost flawless. We can find the virus in a few weeks rather than in a few months. Almost by any measure of scientific progress, we’ve made a remarkable journey since the 1980s and 90s, when getting HIV was considered a death sentence.
The really complicated thing, however, is that the virus continues to spread. There are still new infections. People still put off getting tested. And still, some people choose to suffer silently instead of seeking help, not because medicine has failed them, but because society has.
These are not just promises—they are real breakthroughs. Modern antiretroviral therapy (ART) has changed HIV from a life-threatening disease to one that is a chronic, manageable illness. Patients taking the medications can even have a life expectancy of 80 or 90 years. Importantly, suppose someone’s viral load is undetectable. In that case, they are not able to transmit the virus to others, a phenomenon referred to as “undetectable equals untransmittable” (U=U), which ought to have revolutionised the way we talk about HIV. However, that hasn’t really been the case, at least not everywhere.
On top of that, there is prevention. Pre-exposure prophylaxis (PrEP) is a medication that can prevent HIV with more than 99% efficacy if the user is adherent to the regimen. Post-exposure prophylaxis (PEP) is the option that can prevent infection after exposure if the person intervenes without delay. We have rapid tests that give results in minutes. We have home testing kits. The technology exists to make new HIV infections optional in wealthy countries, essentially.
So, why do we continue to observe rising infection rates in certain populations? Why are people still getting diagnosed late, when their immune systems are already compromised? Why is it that so many people with HIV suffer silently and avoid medical care?
One single factor keeps coming back as an explanation: shame. Discrimination. Misinformation. Fear of judgment.
The stigma surrounding HIV is still a very significant factor, even where it shouldn’t be. Some people don’t get tested because they are scared of the truth, or of what others will think if they find out. A few are on treatment and skipping it for the very same reason. Others, however, may lose their jobs, housing or even the custody of their children if their status gets revealed. In a few countries, it is still considered illegal to have HIV, so obviously, it doesn’t facilitate the willingness to seek care.
The issue of misinformation is also there. Even after a long time of research and clear medical guidelines, some people still think that HIV can be caught by sharing a meal, a small hug, or simply being in one room. They also suppose that HIV-positive individuals on medication are not capable of working and can’t have relationships. These ideas are totally wrong, but they persist because no one is disputing them, or the corrections do not get to the people who need to hear them.
It also takes into account the factor of generation. Today’s young generation was not there when the AIDS crisis took place in in 1980s-90s. That time heavily contributed to stigmatisation, which is still carried, but younger people sometimes don’t have that background. They may not understand how dangerous HIV could be if not treated, or on the other hand, how easily it could be controlled with medicine. They may think that the disease is more common than it is or less common than it is. Misinformation is there to bridge the gaps.
Healthcare access adds another layer. Even in countries with good medical systems, getting on PrEP can be surprisingly difficult. Some doctors don’t know much about it. Insurance might not cover it. Waiting times at clinics can be very long. Moreover, if you happen to be in a community where healthcare providers are biased against sexual orientation or drug use, then accessing prevention and treatment without being judged might be something really difficult for you.
The real problem is that we’ve solved the technical part of this equation. We know how to prevent HIV. We know how to treat it. The remaining obstacles are almost entirely social and cultural. We’re waiting for society to catch up to what medicine already figured out.
That’s not intended as a criticism of progress. Science has made remarkable progress and saved the lives of millions. But it’s also a reminder that medical advancement and social change don’t automatically move together. You can have the best tools available and still not use them effectively if people are afraid to.
World AIDS Day is not merely the time to mourn those whom we have lost or to rejoice in the progress made. It is also the time to recognise the changes that are still necessary. We require improved education that genuinely impacts individuals. The elimination of stigma within healthcare settings is another necessity. Prevention and treatment should be made accessible and affordable to any person, not only those living in rich countries and having good insurance; that is what we need.
We need to stop linking AIDS to a moral disgrace and start to regard it as what it actually is: a virus.
The technology is ready. Society needs to be too.
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