On World AIDS Day, it is certainly a poignant time to reflect on our progress and to reinvigorate our determination to halt this epidemic. We have encouraging news. The rates of HIV have fallen to the lowest levels since the peak of the epidemic, new HIV infections were reduced by 21% since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005 (UNAIDS, 2011).
While these are encouraging statistics, there are still parts of the world including our own country in which the epidemic rages on. The number of new HIV infections continues to rise in Eastern Europe, Central Asia, Oceania, the Middle-East, and North Africa. Here in the US - we still see rises in certain urban centers (particularly among African Americans and men who have sex with men) and, overall, we see an increase in HIV infections in the South-east (particularly in poorest areas).
Poverty is still a major predictor of risk of HIV infection. The poor, disenfranchised, stigmatized, and marginalized bear the overall burden of disease and HIV remains a serious threat. Thus racial and sexual minorities are still very much at risk. Youth in these groups are particularly vulnerable.
While we need to address the serious issues of poverty, discrimination, prejudice, and the lack of basic sexual rights, we know that even the disenfranchised can be empowered through comprehensive sexuality education and access to preventative services. We need to put HIV prevention in the context of a comprehensive sexuality approach.
We can be encouraged by the fact that when youth are educated with comprehensive sexuality education, they are more likely to delay the onset of sexual intercourse and use condoms. We know that condoms are highly effective in preventing the spread of HIV and other sexually transmitted infections. While the effects of stigma and discrimination are still a powerful force, comprehensive sexuality education can lead to empowerment.
We need an HIV-prevention approach that is sex-positive recognizing that people have a basic instinct and drive to be sexual and that beyond the reproductive utility of sexual activity, people are motivated to experience pleasure and that sex is a fundamental form of communication and expressing intimacy. We have spent too much time on de-sexualizing HIV prevention, now it is time to promote what I have termed "sexualized HIV prevention." Let's bring positive sexuality back into HIV prevention - and let's focus on the marginalized populations and empower them to enjoy a fulfilling and pleasurable sexual life.
Eli Coleman, PhD
Director and Professor
Chair in Sexual Health
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