bAccording to the Joint United Nations Programme on AIDS (UNAIDS), HIV/AIDS continues to be a major global public health issue. Since the beginning of the global HIV/AIDS epidemic, over 78 million people have become infected with HIV and more than 35 million people have died of AIDS-related illnesses.
Just last year, nearly 1 million people died from HIV-related causes globally. While HIV/AIDS is a truly global issue, Sub-Saharan Africa (SSA) remains the region most heavily affected by the HIV/ AIDS epidemic. Specifically, of the estimated 35 million people living with HIV, over 25 million are living in SSA, and the region accounts for approximately 75% of all the people dying from AIDS-related causes (UNAIDS 2018).
Although HIV/AIDS is one of the most significant and pressing public health challenges in the world, significant progress has been made. For example, between 2000 and 2017, new HIV infections fell by 36%, and HIV-related deaths fell by 38%, with 11.4 million lives saved through antiretroviral therapy (ART) in the same period. In general, these achievements were largely the result of great efforts by national HIV programmes supported by civil society and a range of development partners around the world.
Notably, Eritrea, a young, low-income, developing country located within the Horn of Africa, has made considerable progress in combating HIV/AIDS. HIV prevalence in the country is approximately 0.59% among 15-45 year olds, and is steadily declining every year – a figure that is amongst the lowest within the region or the continent. Generally, Eritrea’s considerable progress and success in combating HIV/AIDS can be attributed to a multidimensional approach that also involves the targeting of harmful societal behaviours and traditions. Inter alia, the country has: expanded prevention and treatment services; targeted traditional and patriarchal stereotypes and practices, including banning child marriage and FGM/ FGC; focused on improving gender equality and decreasing the burden of poverty borne by women; and sought to reduce stigma and discrimination. Furthermore, community awareness programs have been vigorous and effective in the social marketing of condoms, communicating safe practices, offering educational programs, and providing youth or peer counselling.
An important dimension of the country’s multifaceted efforts against HIV/AIDS has been BIDHO, which is a national association of people living with HIV/AIDS. BIDHO – which means “challenge” in Tigrigna, thus expressing the association’s focus on challenging the spread and growth of HIV/AIDS – was established on 10 January 2002 through the sponsorship of the Ministry of Health.
Today, the association, which is guided by an executive board and receives considerable technical and other assistance from the Ministry of Health, has over 6000 members – male and female, young and old, and from Eritrea’s various ethno-linguistic groups – with greater than 25000 affected dependents nationwide. More than 100 staff members work for the association in locations and branches located across Eritrea’s six zobas. BIDHO broadly describes itself as wanting to “bring Eritreans living with HIV/ AIDS together and support them, play a vital role in the community response to HIV/AIDS, and work for the existence of an HIV/AIDS-free generation.”
Of note, the association’s members are able to access a variety of important skills training and self-help programmes, which help empower and encourage self-dependency among affected and poor households. For example, many members receive significant support with micro-finance programmes and other small income-generating activities, such as weaving and poultry farming. As well, BIDHO members perform a range of important roles, including serving as counsellors to individuals that enter Voluntary Counselling and Testing centers (VCT) or use ART, providing home-based support and care, working as life-skills trainers, and generally promoting positive living.
Since its establishment, BIDHO has also advocated for increased access to treatments (such as ART, which helps avert HIV/AIDS-related deaths and is a critical factor in driving down the rate of new infections), helped raise public awareness of HIV/AIDS through its “Giving Face” programs, moving personal testimonies, and the organization of countless informative public workshops and seminars, extended important nutritional support to people living with HIV/AIDS and severely ill children, helped significantly improve the quality of life of those infected or affected by HIV/AIDS through capacity-building, as well as closely worked with religious institutions and other societal organizations to offer social, psychological, and spiritual support to individuals and families impacted by HIV/AIDS.
One of BIDHO’s main areas of focus is combating, reducing, and eliminating stigma and discrimination. Stigma, described as a dynamic process of devaluation that significantly discredits an individual in the eyes of others (Goffman 1963), and discrimination, which refers to any form of arbitrary distinction, exclusion, or restriction affecting a person, usually but not only by virtue of an inherent personal characteristic or perceived belonging to a particular group, have fuelled the transmission of HIV and have greatly increased the negative impact associated with the epidemic (UNAIDS 2000).
Around the world (as well as within Eritrea), stigma and discrimination associated with HIV/ AIDS is underpinned by a number of different factors, including a lack of understanding of the illness, misconceptions about how HIV is transmitted, lack of access to treatment, irresponsible media reporting on the epidemic, the incurability of AIDS, and prejudice and fears relating to a number of socially sensitive issues, such as sexuality, disease and death, and drug use. Of particular note, HIV-related stigma and discrimination continue to be manifest in every country and region of the world, creating major barriers to preventing further infection, alleviating impact, and providing adequate care, support, and treatment. In Eritrea, while stigma and discrimination have been reduced, undeniably influenced by the important work conducted by BIDHO in “breaking the silence” and creating spaces for open dialogue, they remain apparent.
Although BIDHO has made numerous and significant contributions across the country, positively impacting numerous lives, it is also confronted by several challenges. Preventing new infections among the general population and at-risk groups and improving the quality of life for those infected or affected, require unrelenting vigilance and continued attention. BIDHO is also faced with a shortage of resources (including material, personnel, and transport), while medication and provisions of high quality nutrition are expensive. Despite these challenges, however, BIDHO remains strongly committed to combating HIV/AIDS and helping to secure the fundamental rights and basic dignity of people living with or affected by HIV/AIDS.