Stigma against LGBT communities remains a challenge for organizations that work with HIV/AIDS patients. But the biggest challenge of all might be keeping the disease in the spotlight.

“Perhaps the greatest challenge is keeping AIDS in the public eye and making sure a message of hope gets out there,” Anne Aslett, executive director of the Elton John AIDS Foundation (EJAF), told Humanosphere in an email. “Public perception veers between ‘AIDS is all over’ to ‘It’s a hopeless case.’ Neither are true.”

In recent years we have seen enormous reductions in transmission of HIV/AIDS globally. More people are living with HIV through increased access to antiretroviral therapy.

This progress has allowed the epidemic to slip out of the spotlight, but the disease remains a major threat. AIDS-related deaths have declined over the last five years, but the number of new infections has reached a plateau. And the number of new infections is actually increasing in 74 countries, according to a study published earlier this year.

“AIDS is far from over,” said Aslett, “and, as the most lethal infectious disease in human history, if we don’t get it under control there is much worse to come.”

EJAF also funds programs to improve health-care access for LGBT communities in regions that repress homosexuality. Stigma against HIV-positive patients is especially challenging in Sub-Saharan Africa, which accounts for nearly 70 percent of HIV cases worldwide. But stigma, discrimination and violence prevent men who have sex with men (MSM) –  who, along with female sex workers and injecting drug users, have a disproportionately high risk of contracting HIV – from accessing services.

Lessons learned

Groups working in regions where discrimination against the LGBT community is rampant have learned to work within those constraints.

“One thing that should be avoided is confrontation with government,” said Sylvia Adebajo, director of Population Council’s office in Nigeria and an associate in the HIV and AIDS program, in an interview with Humanosphere. “That’s one of the lessons we have learned. That working closely with the government … is better than being confrontational.”

Population Council is a nongovernmental, nonprofit organization that works to stop the spread of HIV and improve the lives of those with the disease. Adebajo joined the Council in 2008 to direct the Men’s Health Network Nigeria, a nationwide initiative that provided comprehensive, male-friendly HIV services free from stigma and discrimination.

Having advocated for these services in Nigeria, Adebajo is acutely aware of the challenges in providing services to gay men with HIV/AIDS. Nigerian federal law criminalizes homosexuality – a public display of a “same-sex amorous relationship” is punishable for up to 10 years in prison – and the country accounts for 9 percent of all people living with HIV globally.

Aside from working alongside government bodies, Adebajo stressed the importance of working closely with health-care providers and empowering communities, “because ultimately, working closely with the community is the only way that you can sustain this type of work, in any country,” she said.

Nigeria and the rest of Sub-Saharan Africa will be a critical target for health organizations in coming years. They must continue to keep the disease in the spotlight amid all of the mixed messages.

“This means that although what we are doing is having an impact,” Adebajo said, “we need to do much, much more to avoid ‘standing still’ in terms of beating the epidemic.”