Lutte contre le VIH : Dr Safiatou Thiam redoute les effets pervers de la stigmatisation
The recent arrest of twelve people for acts described as "unnatural acts" and the deliberate transmission of HIV continues to spark widespread debate in Senegal. Beyond the emotion and legal controversies, several stakeholders in the national HIV response are calling for an assessment of the health, social, and legal consequences of such a sequence of events.
In a concept note from the National AIDS Control Council (CNLS), Dr. Safiatou Thiam, Executive Secretary dedicated to the fight against HIV, emphasizes the particularly sensitive context. “Senegal is facing a concentrated epidemic. Prevalence is low in the general population, around 0.3%, but it remains high in certain key groups. Any situation likely to undermine confidence in the health system could jeopardize the gains achieved through considerable effort,” she warns.
A risk to screening and continuity of care
According to national data, nearly 90% of people living with HIV now know their status and are on treatment, and 92% of them have a suppressed viral load, meaning they are no longer transmitting the virus. But the high media coverage of these arrests could, according to Dr. Thiam, have the opposite effect. “The fear of prosecution or public exposure may discourage some people from getting tested. However, early detection and rapid access to treatment are the cornerstones of prevention. Without them, we risk silent transmission of the virus,” she explains.
She is also concerned about potential treatment interruptions. "Fear of stigmatization can lead people living with HIV to stop their treatment. This exposes them to medical complications, treatment resistance, and an increased risk of transmission."
A complex legal question
Legally, the intentional transmission of HIV constitutes a crime under the 2010 law. However, Dr. Safiatou Thiam points out that its classification requires specific criteria. "There must be proven harm, a direct causal link, and above all, a deliberate intent to harm. Simply knowing someone's HIV status is not enough to constitute the offense," she emphasizes.
She also emphasizes the established scientific data: “A person living with HIV who is on effective treatment, with an undetectable viral load, does not transmit the virus. This is the U=U principle: undetectable equals untransmittable. It is essential that this scientific evidence be taken into account.” For her, imprecise or excessive criminalization could prove counterproductive. “If ignorance of one's status is perceived as legal protection, it discourages voluntary testing. This would be a major setback for public health.”
A social and national cohesion issue
Beyond the health and legal aspects, the social dimension is just as concerning. "The conflation of sexual orientation and serological status reinforces stigmatization and discrimination. This weakens already vulnerable groups and threatens social cohesion," says Dr. Thiam.
She calls for a balanced approach, reconciling the rule of law, public health, and respect for human rights. "We must reassure the public about the confidentiality of medical data, guarantee continuity of care for all those concerned, and strengthen communication on prevention, particularly among young people."
According to the expert, the HIV response has proven effective in Senegal. "We have made considerable progress. It would be regrettable if temporary tensions were to jeopardize years of effort. Public health must remain at the heart of our collective action."
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