Health-e News Service - January 26, 2012
People living with HIV have a critical role to play in preventing
new HIV infections. A new strategy aims to enlist the help of
HIV-infected people in preventing the spread of HIV.
Called "Positive Health, Dignity and Prevention", the strategy
aims to enable people living with HIV and AIDS to get more
involved in preventing new infections. In the past, such a
programme was called "positive prevention".
The difference between the two is that "prevention with positives
tends to see people living with HIV as vectors of the virus and
they are likely to pass it on. It excludes everything else. The
dignity is not there, the stigma issues can arise. This
all-encompassing term really sees them as part of the response...
responsible people who also require treatment and also require
support", explains Mirriam Chipimo, senior policy and programmes
advisor for the United Nations' Agency for HIV and AIDS (UNAIDS),
in South Africa.
Chipimo says the strategy is all-encompassing and is concerned
with the health and dignity of the individual and prevention,
which is not only about the individual, but about others.
"This is really looking at promoting their health and from a
human rights perspective as human beings they are entitled to
these... the dignity, the respect, and so on. They should not be
stigmatised by virtue of a positive status. And so, this term...
is hoping we'll go a long way in addressing places where stigma
is still quite high", she says.
But whether the initiative is called "positive prevention" or
"Positive Health, Dignity and Prevention" should not be the
issue, argues AIDS activist, Pholokgolo Ramothwala.
"Either way, we are talking about prevention of new HIV
infections by people living with HIV. That's the important
message that we should be taking... How do people living with HIV
play a role in preventing new infections? I understand the
argument that it might be stigmatising. But the fact of the
matter is that you cannot get HIV from somebody who does not have
HIV. My understanding of prevention with positives is that... let's
involve people who are living with HIV in preventing new HIV
infections", Ramothwala says.
But how can people living with HIV be involved in prevention
"At least, for those people who already know that they have HIV,
you create education amongst themselves... behaviour change for
people living with HIV, which looks at: When you have HIV don't
have another person get infected with HIV because of you. We can
talk about prevention of mother-to-child transmission...
HIV-positive mothers who are pregnant to make sure that they take
antiretrovirals in order to reduce the risk of their children
"We can also talk about the prevention of stigma and
discrimination by people living with HIV where we will talk about
people living with HIV speaking out against stigma and presenting
themselves as people living with HIV who are still normal. In
fact, I believe that people living with HIV can be the drivers of
HIV prevention in this country", says Ramothwala.
"As a person who is living with HIV and have had a partner who is
not living with HIV, I've always believed that it's my
responsibility to make sure that she does not get infected with
HIV from me. Obviously, she has to take her responsibility, but
because I know that I have HIV I had to take extra precautions to
make sure that she does not get infected with HIV. Positive
prevention is also about preventing AIDS death. When we start
treatment on time, we prevent new AIDS death. People don't have
to die from AIDS whereas there is treatment. So, as people living
with HIV we can be the leaders in encouraging those who are still
scared or who don't know about preventing new AIDS deaths or
preventing new HIV infections to come on board", he adds.
Chief Director of the HIV and AIDS and STIs unit in the national
Department of Health, Dr Thobile Mbengashe, also emphasises that
prevention of new HIV infections by people living with HIV is
about taking responsibility.
"We have a responsibility of protecting others. I don't think any
one of us with any love of a person would actually knowingly
infect. You probably will have it very difficult to live with
yourself knowing that you've transmitted an infection to your
partner when you did not have to and when you did not have to
stop having sex... but it just meant that you were to be consistent
in using protections. I think all of us will feel terribly about
that. So, we don't have to feel terrible because if we know our
status, our partners know our status, we take the necessary
precautions of using a condom consistently... And if you do go
outside that relationship you have to use a condom all the time"
says Dr Mbengashe.
The UNAIDS's Mirriam Chipimo says the Positive Health, Dignity
and Prevention programme requires the full participation of
people living with HIV and AIDS to ensure the decline of new HIV
infections and, eventually, to get to zero infections.
"In the new National Strategic Plan we have several strategic
objectives. One of them is prevention. And within that we're
saying people living with HIV in each and every pillar have a
role to play. So, we are trying to strengthen the prevention
agenda for people living with HIV", she says.