AGAINST the GRAIN

mainstay of pre- and post-test counselling and support, and of fine-tuning prevention and anti-stigma messages so that they work locally.

“For instance, there are different reasons behind HIV stigma in different countries. I’ve been concentrating particularly on India and China, where I am alarmed at the resistance towards taking HIV seriously. In China, stigma is largely fuelled by social shame - the dishonour of not conforming to the norm.
“In India, it’s much more a matter of sexuality. There are no role-models, and India will have to change its attitudes towards things like same-sex relationships very fast.” With characteristic optimism, he cites the furore around the Indian parliament’s attempts to push through anti-gay legislation as potentially a good thing in its unintended effects: “it may spark constructive debate. And it’s the brave pioneers in Indian gay and Aids support groups who, even though they may be jailed, are doing just that.

“Combating Aids always means going against public opinion.”
And what about treatment? The loudest cheer you got at Barcelona was when you said that treatment for Aids was a ‘non-negotiable’ right. And Bill Clinton said that one of the most powerful weapons against stigma was survival.
“Well,” he says carefully, “we hope there will be a reduction in stigma if people do not die.” I mention African programmes where it has happened the other way round - where people’s fear of stigma is even greater than their fear of death, and there has been poor take-up of pilot HIV drug programmes.
This is news to Piot - “I hadn’t heard that. I’ll look into it.” (He clearly did, because there is now a review of HIV stigma in west

Africa on the UNAIDS website that specifically mentions this heartbreaking phenomenon.)
“But combating stigma should not be the only reason for offering treatment, anyway. In many ways there should be no reason not to provide treatment - the justice of it should be self-