Fiji: Leading transformative change in the Pacific through the AIDS response
There is much to celebrate on this World AIDS Day.
Almost 16 million people are on life-changing HIV treatment worldwide and in 2014 new HIV infections had fallen by 35 percent since the peak in 2000.However, in many countries HIV continues to deprive too many people of healthy lives, narrowing educational l and professional options and exposing people to abuse, violence, stigma and discrimination.
Fiji is an example of how engaged leadership and strong partnerships have led not only to a successful HIV response, but social reforms with impact far beyond the response itself.
It has been more than a quarter of a century, since the first reported HIV case in this country.
From the beginning, government, communities, health and education sectors have come together in a meaningful partnership. This collaboration has led to smart strategies: promoting sustained HIV prevention campaigns, high condom use by sex workers, the scaling up of HIV treatment with peer counselors which has encouraged adherence to antiretroviral treatment.
Thanks to these actions, Fiji has managed to contain HIV and prevent exponential growth of the disease.
There were less than 1000 people living with HIV and fewer than 100 new infections in 2014.
Fiji’s successful response to HIV has never been just about improving health, but has always touched many facets of society with its integrated approach and inclusive vision.
In Fiji, as in many countries across the world, key populations, including sex workers, men who have sex with men, transgender people, prisoners and migrants are at higher risk of HIV and have little access to health services.
Stigma and discrimination are a major impediment to the provision of effective HIV prevention, treatment and care. They deter people from accessing life-saving programmes and stubbornly sustain a culture of silence around HIV.
Fiji recognized an urgent need to shift the collective mindset and put equity and human rights at the center of the HIV response and address the challenges faced by key populations.
The country saw that the constant threat of arrest, conviction and incarceration faced by men who have sex with men increased their vulnerability to HIV.
Fiji became the first Pacific island country with colonial-era laws to formally decriminalize sex between men in 2010. Then in 2011, the government enacted the Fiji HIV/AIDS decree which addressed human rights violations that acted as barriers to the HIV response. The decree removed HIV-related travel restrictions and HIV-specific criminal offences for HIV transmission or exposure. The benefits of these legal changes have been enormous. We have not only seen improved access to HIV services by key populations, but the laws have echoed beyond health.
Encouraged by these transformations, lesbian, gay, bisexual, transgender and intersex (LGBTI) people are demanding recognition of their equal rights to jobs, education, housing and healthcare not only in Fiji but throughout the Pacific islands.
On World AIDS Day, let us celebrate these milestones and achievements, which have improved the lives of all Fijians, who benefit from a social tapestry rich in diversity, understanding and solidarity. But, let us remember that our work on HIV is not yet over.
As Nobel Laureate Nelson Mandela said, “After climbing a great hill, one only finds that there are many more hills to climb.”
Gender-based violence is a significant challenge in many countries and Fiji is no exception.
A study published by the Fiji Women’s Crisis Centre in 2013 finds that the rates of violence against women and girls are among the very highest in the world. 64% of women who have ever been in an intimate relationship have experienced physical and/or sexual violence by a husband or intimate partner in their lifetime.
Another study published in 2014 found that 13% of sex workers and 20% of transgender sex workers reported being raped by a client in the previous 12-months, while just under a third of sex workers said they would not feel comfortable telling anyone they were raped.
This is not acceptable. Violence or the fear of violence can prevent women from negotiating safer sex or if they are HIV-positive from disclosing their status and seeking treatment. Women and girls must be free to make decisions about their health, lives and futures.
In Fiji over 50% of new infections in 2014 were among people aged 20-29 years old.
Young people often lack the awareness to practice safe sex or negotiate safe sex, including condom use.
Young people need to be empowered, educated and have access to comprehensive sexual and reproductive health and rights services.This is why we consider it important that top leaders visit schools and engage with students, so that they can become messengers of hope to their peers, families and communities.
In September, Fiji was one of 193 United Nations member states to adopt the Sustainable Development Goals (SDGs) including the target to end the AIDS epidemic as a public health threat by 2030. While this is certainly ambitious, it is achievable.
UNAIDS is encouraging countries to Fast Track their response to HIV by accelerating action and frontloading investments over the next five years, as a critical step towards ending AIDS by 2030.
This will also enable impact across sustainable development issues more broadly. In Fiji, action is already well advanced. The country’s new HIV and AIDS National Strategic Plan (2016-2020) soon to be launched is aligned with the SDG framework and the UNAIDS Fast Track approach.
Fiji is an example of an HIV response that has been successful because of commitment at the very highest levels of government, strong partnerships with civil society and a multisectoral approach which took AIDS out of isolation. Fiji may be small geographically but it thinks big and is proud to be contributing to social change not only at home but throughout the Pacific and even beyond.
Ratu Epeli Nailatikau is the former President of Fiji and UNAIDS Regional Goodwill Ambassador for the Pacific
Jan Beagle is the UNAIDS Deputy Executive Director and Assistant Secretary-General of the United Nations