Vulnerability, high incidence and prevalence of HIV messaging

Knowledge of the role of vulnerability, marginalization and the consequences of power this brings about can be translated by providers into advocacy messages. Whether one is talking about Peru, Mexico, India, Somalia, Somaliland, Rwanda or South Sudan vulnerability, marginalization and power roles play very important functions in how one fulfills optimal ARV adherence once diagnosed with HIV and they need medication. The Western world has the ability to trace, monitor and provide follow up services for people living with HIV. This contributes to viral suppression. But, when marginalization comes into play it affects adherence which in turn reverses or even disrupts objectives for viral suppression. At the mental health level marginalization fuels stress, trauma and depression. At the structural level marginalization can trigger an inability to access services, this may mean not accessing the services of trained qualified service providers. At the cultural level, rejection and dejection may trigger low self esteem which in turn makes one to fail to socialize with others fulfillingly. As far as HIV goes, this is ground for vulnerability to infection or re-infection. People engaged in sex work often live in the shadows, on the margins of society. They may face harassment, prosecution and violence, and may be unable to negotiate the use of condoms to prevent HIV. There is need to develop an alternative context that questions certain dangerous practices such as those that demotivate one not to disclose one’s HIV status before a sexual event. Anything that fuels prejudice and eventually social discrimination means there are those who are deliberately pushed out of the nexus of  HIV prevention and care. Younger people and women’s social and economic marginalization puts them at higher risk for HIV. It is harder in such circumstances for a bio-medical approach to HIV to be insufficient. The root causes of vulnerability must be addressed.Messaging to improve parity, security and access should be such that it promotes inclusion. It must seek out those who have historically not been reached.