Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

SFear, stigma and denial: a vicious circle
Warnings about the growing threat of HIV and AIDS date back to the early and mid1980s. But many people, from members of affected communities to leaders of
global organizations, have failed to take them seriously. In some cases, the denial
has been deliberate. People simply do not want to admit that a fatal disease spread
by behaviour branded as "immoral" could be rampaging through their community or
their country.
Other unique features of AIDS aid and abet denial. The behaviours that spread HIV
take place in private. There is a lag time of up to a decade and more between infection and any visible sign of illness. HIV does not cause a single, specific fatal disease; instead, individuals whose immune system has been weakened by the virus
fall prey to infections and ailments that may look familiar in their community. In
other words, people who do not want to accept the reality or gravity of AIDS can
find all sorts of ways of questioning whether it is as bad as the data from surveillance suggest.
A country in which denial flourishes is a country whose citizens are vulnerable to
the silent spread of HIV. Until political figures and respected community leaders
speak out and breach the wall of silence, there is little hope of mounting a vigorous, broad-based effort against the epidemic (see pages 108-109). Fortunately,
the past year has seen major progress at the highest level of political leadership
(see Box 6 below).
Box 6. Breaking the silence in Africa
Nearly a decade ago, a few bricks were chipped out of the wall of silence erected by
political leaders around the fearful subject of AIDS in Africa. That was when Ugandan
President Yoweri Museveni, faced with rising sickness and death in his country,
reversed his long-standing opposition to condoms and began talking openly about
AIDS. The subsequent national response helped bring about a significant fall in the
prevalence of HIV infection in the country, described on pages 9-10.
Public acknowledgement of the existence and danger of AIDS gathered momentum
with an event that electrified Mozambique last year: the announcement that Boaventura
Machel, the brother of Mozambique's independence hero and first president, had died
of AIDS. In Blantyre, Malawi's president Bakili Muluzi invited a cross-section of society,
including soldiers, schoolchildren, prostitutes and HIV-infected persons, to the launch
of a new five-year plan against AIDS.
A clarion call for greater openness had already been sounded by South African
President Thabo Mbeki. "For too long we have closed our eyes as a nation, hoping the
truth was not so real," the then Deputy President Mbeki told South Africans in 1998.

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