While some countries in East and Southern Africa are cautiously hopeful about achieving ‘epidemic control,’ the AIDS response in Mozambique is drastically off track. Unsurprisingly, this crisis extends to some of the most vulnerable people: men who have sex with men, sex workers, transgender people and people who use drugs, who have a higher prevalence of HIV infection than the general population.
Stigma and discrimination in health facilities push men who have sex with men, transgender people, people who use drugs, and sex workers into the shadows, when they urgently need access to HIV treatment and prevention services delivered with dignity and solidarity. Even when a health clinic is truly welcoming to all, they are too often closed during the times that people are able to access services–despite commitments on paper by the government to deliver services that are designed to be ‘friendly’ to the most vulnerable, in practice, this rarely happens.
For the population overall, the picture is also bleak: Mozambique is a country suffering with the second highest number of AIDS deaths and new HIV infections in the region. In 2017, HIV treatment coverage was only 47%, while the regional average is 66%. After one year on treatment, one in three people is ‘lost to follow up’—a polite way of saying they have either died, stopped treatment, or have disappeared. Retaining people in care is vital in order to save lives and prevent new HIV infections. Viral load testing is virtually unavailable in Mozambique. The rate of HIV transmission during pregnancy, labor, and breastfeeding is estimated to be 14%—while neighboring countries are approaching elimination of perinatal HIV infection.
It’s 2018 and the world has a powerful set of tools for addressing HIV in its toolbox. Why is this happening? The answers have to do with political will, years of flat funding from the U.S. government, chronic lack of prioritization of the needs of Mozambicans with HIV by the government, a daunting health worker shortage, and the real barriers to access to quality care in one of the poorest countries on the planet: 90 percent of the population lives at least an hour’s walk from a primary health care center.
The one effective antidote to a lack of political will that we know for sure works, is powerful, informed activism.
The one effective antidote to a lack of political will that we know for sure works, is powerful, informed activism. Strong activism led by people with HIV and marginalized communities heavily impacted by the epidemic is vital to turn this crisis around.
That’s why at Health GAP, we have been working with a team of civil society allies in Mozambique to build and implement bold new strategies to fight back. Last week, I worked with our partners at Lambda, to organize a press conference to focus attention on the faltering response to HIV. This event was strategically timed—coming just after World AIDS Day, on the eve of national PEPFAR meeting on the status of the HIV response, and as the UN Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, Victor Madrigal-Borloz, concluded his mission to Mozambique, heralding the indispensable leadership of Lambda in the fight for LGBT rights.
Against daunting odds, civil society was creating new opportunities to send a strong message: bold new action by their government, PEPFAR, and the Global Fund to Fight AIDS, Tuberculosis and Malaria is needed to correct this ongoing crisis. These activists are a bright spark against what sometimes feels like a bleak landscape. They have a bold vision: they are calling for expanded access to peer-led HIV treatment and prevention programs free of the kind of discrimination and judgment they experience when they visit health care centers right now. And, they want increased access to PrEP and self-testing to stem the burgeoning epidemic among men who have sex with men, sex workers, and other marginalized communities. And they want enough trained and paid community-based health workers to ensure access to quality care for all who need it.
Mozambique faces an incredibly steep climb ahead in its HIV response but these powerful activists that I have the privilege of working should give us all reason to hope.