What I learned from 30 years of tackling HIV around the world

It has been 27 years since the first World AIDS Day. This year I found out that the United Nations proclaimed the third Thursday of every November as World Philosophy Day. The fact these two days come so close together has significant meaning to me since I became an academic philosopher because of my years of HIV/AIDS work and activism. HIV/AIDS work showed me that protecting and improving health is about so much more than medicine: it is about the way we and the people around us think and act. We cannot take a pill to change these factors; instead we need to prescribe new ways of thinking.

Years of HIV prevention and advocacy work in the United States, India and other countries during the 1990s convinced me that people were suffering unnecessarily and dying prematurely because of the lack of clear thinking and bad ideas among those who are responsible for protecting people’s health. Discrimination, ignorance, fear, wilful neglect, short-sightedness, disrespect, misplaced priorities, arrogance and self-interest were causing millions of people to become infected with HIV, suffer physically and psychologically and die prematurely. This continues today.

There is an understandable belief that millions of people are still becoming infected with HIV and dying from AIDS or from many other diseases in developing countries because they lack ‘things’. Anthropologist and physician Paul Farmer recently stated regarding Ebola that what we need is more ‘stuff, staff, space, and systems.’ There is much truth in that: if these things had arrived quicker or had existed in the affected countries before, the number of deaths would have been significantly less.

However, what is critical to saving lives is something conceptually much bigger than clinical care. We should help people to be capable of being healthy. Prior to 1996 when drugs to manage HIV were announced, successful HIV prevention efforts had two components. Aside from HIV testing being easily available, during pre and post-test counselling, each individual was asked to reflect on the behaviours that made them vulnerable to infection and strategies to minimise their risk. There was also massive community mobilisation to change the social environment to support risk-reducing behaviours. For example, condom use became the social norm. Whether it was protecting sex workers in Calcutta or gay men in London, individual behaviour change and a supportive social environment had to happen together.

You might be surprised at how many powerful people are willing to cut public health funding or to keep focusing on treating disease or tolerate suffering and deaths because their concept of health policy does not include anything outside of clinical medicine. Such narrow thinking not only facilitates the spread of HIV/AIDS, it also denies people the ability to realise one of their fundamental human rights – the chance to be healthy.

Dr Sridhar Venkatapuram is Director of Global Health and Social Justice at The Department of Social Science, Health and Medicine, King’s College London