World AIDS Day: NUH doctor explains the challenges facing an African community | Latest news

The theme for this year’s World AIDS Day is “Let Communities Lead” - a call to action to enable and support communities as the frontline of progress in the HIV response.

An estimated 38 million people worldwide live with HIV, and more than 35 million people have died of HIV or AIDS-related illnesses over the past 40 years.

Medical advances mean people with HIV in the UK can expect a long and healthy life and that we have the tools to stop HIV transmissions. But in other countries, there’s still a long way to go.

Simon Deery is a sexual health doctor for Nottingham University Hospitals NHS Trust (NUH), and a former Chair of our LGBTQIA+ staff network. He is three months into a secondment in Lesotho, Africa, working on a project to upscale the delivery of PrEP (Pre-exposure Prophylaxis) -  a medication taken by someone who is HIV negative that can protect against HIV transmission.

Lesotho has the second highest prevalence of HIV in the world, with around 1 in 5 people living with HIV. But getting PrEP to the people that need it is a challenge due to stigma and discrimination.

“Evidence of how extreme these attitudes can be in Lesotho can found in population-based surveys such as LePHIA (Lesotho Population-based HIV Impact Assessment),” said Simon.

“They found that 17% of respondents would not buy vegetables from a shopkeeper who was living with HIV. They also believed that children living with HIV should not be able to attend school alongside children who are HIV negative.

“Deeply stigmatising beliefs such as these prevent people from coming forward to get PrEP, as they want to avoid all association with HIV.”

HIV/AIDS remain the number one cause of death in Lesotho. Data in 2020 showed that 45% of people aged 15-49 hadn’t heard of PrEP; maximising PrEP uptake and educating people about HIV prevention is crucial.

Simon said: “Some people in Lesotho wrongly believe that PrEP promotes promiscuity, or that it is only for sex workers. Others can have exaggerated concerns about side effects, despite PrEP’s proven safety record. Dispelling these myths through education is crucial in empowering individuals to make informed decisions about their sexual health, and making PrEP available to the people that most need it.

“I have had to reflect on the unjust privileges that I have been given simply by virtue of being a male born in a wealthy country of the world. In stark contrast, in Lesotho – like in several African nations - women are disproportionately burdened by HIV, with 3 out of 4 new HIV infections in sub-Saharan Africa in females (UN data).

“In Lesotho part of this is driven by sociocultural norms that often prevent women from being able to negotiate safe sex practices, or even access healthcare. A large part of society is still organised around a male-based chief culture. The fact that only men can inherit chieftainship is reflective of gender-based power disparities.

“Sadly, gender-based violence is also significant issue in Lesotho, with 86% of women experiencing it in their lifetime. A sobering experience was that the majority of the victims who passed through the clinic did not want to involve the authorities.

“The World Health Organization says that gender-based violence increases HIV risk both directly and indirectly. This is through limitation of a person’s power to maintain healthy sexual relationships, an inability to refuse sex or negotiate condom use, and through the negative impact of fear and trauma on help-seeking behaviours.”

Efforts are being made across Lesotho to address these challenges, with multiple programmes and initiatives that aim to empower women economically, educate them about HIV prevention and reduce gender-based violence.

Simon added: “The intersection of HIV and gender in Lesotho is a complex issue. Addressing gender disparities and promoting gender equality remains crucial in the ongoing fight against HIV in Lesotho.”

Lesotho has been making progress towards improving LGBT+ rights; it took a huge step in decriminalising same-sex activity in 2012. But there is no recognition of same-sex marriage and no legal protection from anti-discrimination laws, and attitudes towards the LGBT+ community remain very mixed. As a result, many members of the LGBT+ community face social exclusion, making it difficult to live openly and access essential services such as healthcare and education.

Simon said: “I had a stark reality check in my rural clinic, when I asked staff about high-risk HIV communities. When I tried to ask how many transgender people may be living in this region, they said that there weren’t any transgender people in the country. The fact the transgender community aren’t being seen or recognised is a sign of how far the country still has to go.”

Simon’s secondment was made possible thanks to the NHS Improving Global Health Programme

He continued: “I’ve been interested in Global Health ever since my work experience preparing for medical school, ­­which was in a Fijian leprosy hospital. This embedded my need to be cognisant of the inequalities that drive health disparities in the UK and abroad; the Covid pandemic shone a spotlight on these.

“I wasn’t prepared for the cultural shock of being displaced to rural sub-Saharan Africa. Top tips I’ve learnt to mitigate this are letting go of fixed expectations, learning the local language, and having a support network you can lean on.

“Working or volunteering abroad as a healthcare worker fosters a greater sense of global solidarity and empathy. The relationships you can form during these experiences can be enriching and transcend borders. Working as an NHS doctor in Africa for me has been a transformative journey with benefits both for me and the communities I’ve been working to serve.”

If you think you could benefit from PrEP you can discuss this with your local Sexual Health Clinic, in Nottingham we can be contacted via: 01159 627 627.