In every region of the world, there are key populations who are particularly vulnerable to HIV infection. One of the key populations is transgender women, who are at 34 times greater risk of acquiring HIV than other adults.

Discrimination, abuse, harassment and violence are distressingly common experiences for transgender people. They often face, from a young age, stigma, discrimination and social rejection in their homes and communities for expressing their gender identity. Such discrimination, violence and criminalization prevent transgender people from getting the HIV services they need to stay healthy.

Transgender women who also are involved in sex work are even more likely to be subjected to such treatment, as shown in a study from the Dominican Republic.

Gender inequality and discrimination robs women and girls of their fundamental human rights, including the right to education, health and economic opportunities. The resulting disempowerment also denies women and girls sexual autonomy, decision-making power, dignity and safety.

These impacts are most pronounced in sub-Saharan Africa, where adolescent girls and young women (aged 15 to 24 years) accounted for 25% of HIV infections in 2020, despite representing just 10% of the population.

8 March 2022

Winnie Byanyima

Executive Director of UNAIDS

Under-Secretary-General of the United Nations

Congratulations on International Women’s Day to all whose determination and solidarity is the light of hope and the power for change.

Women are not waiting to be offered a seat at the table, they are bringing their own fold-up chair.

This year’s theme calls for “Gender equality today for a sustainable tomorrow”. As the women’s movements have brought to the fore, and as all the evidence demonstrates, every development goal depends on ensuring the rights of all women and girls.

Gender inequality is a threat to everyone. We cannot uphold patriarchy and defeat AIDS.

The COVID-19 crisis has exacerbated the intersecting inequalities women face. Surges have been reported in gender-based violence, forced child marriages and teenage pregnancies. Almost one in two women reported that they or a woman they know experienced violence since the COVID-19 pandemic started. Calls to helplines have increased fivefold in some countries during the pandemic. Violence against and harassment of lesbian, gay, bisexual, transgender and intersex people has increased, as has stigma and discrimination against marginalized communities. The trajectory to gender parity, which already had been 100 years away, is now 36 more years away.

The goal cannot only be to get back to normal, however: normal was the problem. Instead, leaders need to seize this moment of crisis and opportunity to secure transformation. They need to deliver now on the bold policy shifts and upscaled investments that will ensure equality.

We must end gender-based violence. Violence violates the dignity and freedom of women. Violence drives the AIDS pandemic. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV.

We must remove all barriers to access to sexual and reproductive health and rights. Only 55% of women and adolescent girls report being in control of decisions about their own sexual and reproductive health and rights. Maternal mortality is the leading cause of death for adolescent girls aged 15–19 years globally, and HIV is the third leading cause of death among women aged 15–49 years—both preventable when women control their own bodies.

We must ensure that every girl is educated and empowered. Research shows that completion of secondary education can reduce a girl’s risk of acquiring HIV by up to half, and by even more if this is complemented by a package of rights and services. We need all girls,  including those who dropped out during the COVID-19 pandemic and those who were out of school even before COVID-19, in school, safe and strong.

As countries struggle with the current fiscal challenges, services vital for gender equality are among sectors that are suffering the biggest budget cuts. If we do not find the money, we will all pay a much higher price as a consequence.

The only effective route map to ending AIDS, achieving the Sustainable Development Goals and ensuring health, rights and shared prosperity, is a feminist route map. Equality is the means of progress and is the right of every woman.

Women, in all your wonderful diversity, we the United Nations are on your side, and by your side. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Experiences of violence too often occur early in life. Violence in childhood has been linked to increased risks of: HIV and other sexually transmitted infections; mental health problems; delayed cognitive development; poor school performance and dropout; early pregnancy; reproductive health problems; communicable and noncommunicable diseases; and injury.

Among the 11 countries with available data between 2016 and 2020, violence (physical, sexual and/or emotional) experienced within the past 12 months by children (aged 13 to 17 years) ranged from 19.2% in the Republic of Moldova and Zimbabwe to 65.4% in Uganda among males, and from 17.7% in the Republic of Moldova to 57.5% in Uganda among females.

The percentage of young people (aged 18 to 24 years) who experienced one or more types of violence during childhood (before the age of 18) is high across all 11 countries with available data between 2016 and 2020, ranging from 26.3% in Zimbabwe to 75.6% in Uganda among males, and from 26.5% in Zimbabwe to 75.3% in Uganda among females.

“Ending gender-based violence requires a whole-of-government, whole-of-society approach. But I am convinced that if decision-makers, at a minimum, push on these key actions, we will have a win–win for everyone: less violence against women and girls and fewer women and girls acquiring HIV or falling through the cracks in accessing and staying on antiretroviral therapy. We must revolutionize the ways of doing business in the AIDS response. Gender equality and women’s rights must be at the centre. There is no room for complacency or acceptance of gender-based violence if we are to end AIDS as a public health emergency by the 2030 deadline for achieving the Sustainable Development Goals,” said Winnie Byanyima, Executive Director of UNAIDS.

One in three women and adolescent girls around the world endure physical and/or sexual violence from their husbands, male partners or strangers. This violence takes place in their homes and neighbourhoods, where they should be safest. And this staggering statistic doesn’t count the millions more women and girls facing a myriad of other forms of gender-based violence and harmful practices. Under COVID-19, reports of intimate partner violence, child and forced marriage, female genital mutilation and sexual violence have only increased.

For women and girls living with HIV, the risks of violence multiply, including from their intimate partners, families and communities or when they seek services. Among its many consequences and costs, gender-based violence undermines hard-won gains in preventing HIV and ending AIDS as a public health emergency.

In countries with high HIV prevalence, intimate partner violence can increase the chances of women acquiring HIV by up to 50%. Violence or the fear of it blocks women’s access to services and their ability to negotiate condom use with perpetrators, disclose their HIV status or stay on HIV treatment.  

Many women living with HIV also experience discrimination and sexual and reproductive rights violations in health facilities. Female sex workers, women who use drugs and bisexual and transgender people face exceptionally high risks of both HIV and gender-based violence and sexual assault, fuelled by HIV-related stigma, discrimination and criminalization.

Five key actions

In line with the United Nations General Assembly Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030, Ms Byanyima urges governments, United Nations agencies, donors, service providers and all stakeholders in the HIV response to immediately and systematically address the interlinkages of HIV and violence against women and girls, in all their diversity, including by:

1. Getting with the basics: at a minimum, countries should comply with international standards for health-service provision for women and girls living with or at higher risk of HIV, integrating prevention and response measures to gender-based violence across HIV services, including for women from key populations, and ensuring protection of sexual and reproductive health and rights.
2. Starting early on HIV and gender-based violence prevention: work with adolescent girls and boys to tackle harmful gender norms by investing in gender-transformative education and interventions, including comprehensive sexuality education, instilling values of respect for bodily autonomy, sexual consent, safe dating and use of condoms as the norm, and ensuring zero tolerance for gender-based violence and HIV stigma and discrimination in schools.
3. Going beyond engaging men to seek HIV services: leverage HIV programmes engaging men and boys to incorporate gender-transformative approaches that challenge harmful masculinities fuelling both HIV and violence against women and girls. Men and boys should be engaged in HIV testing and treatment uptake alongside efforts to ensure respect of women’s sexual and reproductive health and rights and their rights to be free of gender-based violence.
4. Ending impunity for violence against women and girls living with HIV: fast-track legal reforms and enforcement to uphold the human rights of all women to live free from violence, regardless of their HIV status or any other grounds, and end the overuse of criminal laws that target or disproportionately impact on women because of their sexuality, sexual activity, HIV status, gender or drug use. Expand legal and human rights literacy among women and girls living with or at risk of HIV so they know their rights and where to seek legal aid and access justice, and ensure that complaint and redress mechanisms for gender-based violence and reproductive rights violations are accessible across health and other services.
5. Investing in women’s leadership to turn the tide on both HIV and gender-based violence: institute mechanisms for the meaningful participation and leadership of women and girls living with and at risk of HIV, in all their diversity, in decision-making for responding to the twin pandemics of AIDS and violence against women and girls. Invest in feminist leadership and women-led HIV community-based interventions, and value their experiences and expertise as central to an effective HIV response.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Larisa Aleksandrova is a legal expert at the Center for Human Rights and has been protecting the rights of women living with HIV in Tajikistan since 2011.

For the past few months, she has been helping a lawyer to open a criminal case against a man who attacked his wife, Amina Khaidyrova (not her real name), and repeatedly threatened to rape her daughter from her first marriage. The prosecutor's office has so far refused to open the case, considering it a private family matter. According to the prosecutor’s office, if there are only minor injuries, the victim must seek to open a criminal case against the attacker by filing an application to the court by herself. The man is now in hiding and the prosecutor's office continues to refuse to open the case, now claiming that he cannot be found.

Ms Khaidyrova, who is living with HIV, will stop at nothing to get justice. She says that she has nothing to lose and fears for her life and the life of her daughter.

Ms Aleksandrova says that women who have been victims of violence often either do not report the assault to the police or withdraw the allegation, fearing the consequences. She says that women don’t report violence for a variety of reasons—some want to keep their family together, no matter what, others do not want publicity, but the majority are afraid of finding themselves without economic support, since women in Tajikistan are often economically dependent on their husbands.

“In general, women are ready to endure. And women living with HIV are even more willing to endure,” said Ms Aleksandrova.

She emphasized that there were rare cases when women living with HIV have sought help, but fear of disclosure of HIV status, stigma and discrimination, lack of support from family and friends, the vulnerability of people living with HIV because of the criminalization of HIV transmission, legal illiteracy and insecurity prevent women from asserting their rights in court.

Speaking at a training jointly organized by UNAIDS, the United Nations Development Programme and the United Nations Office on Drugs and Crime for 35 representatives of nongovernmental organizations working on human rights and gender-based violence prevention, Ms Aleksandrova presented the legal norms governing the legal status of people living with HIV. She also discussed the criminal legislation of the country on HIV, international and national standards for the protection of women’s rights and sexual and gender-based violence and mechanisms for the protection of women living with HIV who are victims of violence.

The participants analysed cases related to sexual and gender-based violence against women, reviewed and worked out strategies for prosecuting such cases and gave practical advice on strategies for dealing with gender-based violence. According to the participants, such training for nongovernmental organizations in Tajikistan is crucial if they are to reach more women, particularly women living with HIV.

“Community-based monitoring of violations of the rights of people living with HIV and their ability to access confidential HIV services is an important component of community empowerment to speak up and raise questions about the root causes that drive the spread of various forms of violence. These problems can only be resolved if communities are literate in the field of civil and international human rights and are ready to stand up for their rights and seek the proper implementation of the law against domestic violence,” said Nisso Kasymova, the UNAIDS Country Manager for Tajikistan.

Ms Aleksandrova believes that legal literacy is critical, but it is insufficient to solve the problem. She said that if a woman is economically dependent, she will not use her legal knowledge. “I always say that women need to be given confidence in the future, the confidence that they will not be thrown out into the street, that they will be able to protect themselves, they will be supported and they will be able to live on and realize themselves in life.” But you need to start small, she added, “Do not be silent, talk about the problem, demand and defend your right to life, health and economic independence.”

Alida Nguimale is a survivor. She has been living with HIV for 21 years in the Central African Republic. Some 10 years ago, she lost two of her children to AIDS-related illnesses. At the time, she was unaware that she was living with HIV, and life-saving antiretroviral therapy and medicine to prevent mother-to-child transmission of HIV were rare in the Central African Republic.

Speaking at the opening ceremony of a national workshop on HIV and gender, co-organized by the Ministry of Gender, the Ministry of Health, the National AIDS Council and UNAIDS, in Bangui, Central African Republic, on 30 and 31 August, Ms Nguimale explained how she was expelled from her home by her abusive partner, who accused her of bringing HIV into the household. She also recounted her helplessness in the face of denial and violence by her partner, who had refused to accept his own HIV-positive diagnosis.

Ms Nguimale’s story illustrates the vulnerability to HIV of women in the Central African Republic and the barriers that they face in accessing health services. More than 56% of all new HIV infections in the country in 2019 were among women and girls, and 60% of all people living with HIV in the country are women. According to data from the MICS-6 survey published in 2021 by the government, with the support of the United Nations, 23.6% of women and girls between the ages of 15 and 49 years were married or entered into a marital union before the age of 15 years. More than 21% of central African women had undergone female genital mutilation. In January 2021 alone, 340 cases of gender-based violence, including 72 rapes, were collected by the gender-based violence information management system in the Central African Republic.

“The vulnerability of women and girls to HIV in the Central African Republic is the consequence of protracted insecurity, violence and humanitarian crises compounded with toxic masculinities and negative social norms. There can be no end of the AIDS pandemic without renewed action and accountability to end this plague of gender-based violence and the social marginalization of women,” said Denise Brown, the Deputy Special Representative of the United Nations Secretary-General in the Central African Republic, Humanitarian Coordinator and United Nations Resident Coordinator.

For the first time, the Government of the Central African Republic, with the support of UNAIDS, conducted a thorough assessment of the gender dimensions of the HIV epidemic and response in the country. The assessment report, which was discussed and adopted during the national workshop on gender and HIV, warned that women, girls and key populations are being left behind in the recent progress made against HIV in the country. HIV prevalence is highest among sex workers, at 15%, and among gay men and other men who have sex with men, at 6.4%, compared to 3.6% among the general population. Access to prevention of mother-to-child transmission of HIV services also remains worryingly low, with less than 25% of women accessing such services in three of the country’s seven health regions.

“The gender assessment report alerts us on a blind spot in our response. We must refocus our efforts on transformative interventions that work for women, girls and key populations,” said Pierre Somse, the Minister of Health of the Central African Republic.

Building on the recommendations of the gender assessment, the participants of the meeting developed and adopted an action plan to implement key interventions in 2021–2023. The action plan includes a combination of structural, biomedical and behavioural interventions to promote gender-transformative education and sensitization, to address the legal, social and cultural barriers to access to HIV services by women, girls and key populations, to implement differentiated models of care that promote access to health, social and psychosocial services for women, including for prevention of mother-to-child transmission of HIV, and to ensure accountability for progress on gender, HIV and tuberculosis. The Minister of Gender, Marguerite Ramadan, noted that the assessment report and the action-oriented operational plan that ensued are essential to implement the vision of equality in the 2021 United Nations Political Declaration on AIDS.

Expressing satisfaction after the adoption of the operational plan, Patrick Eba, the UNAIDS Country Director for the Central African Republic, said, “UNAIDS is at its best when it brings together government, civil society, development partners and other stakeholders to critically assess the national response to HIV and articulate a collective agenda for action. There is no better way to vindicate the rights of those millions of women like Ms Nguimale who demand dignity, justice and health.”

GENEVA, 7 July 2021—UNAIDS strongly condemns the attacks on lesbian, gay, bisexual, transgender and intersex (LGBTI) activists and journalists at Tbilisi Pride’s offices and surrounding areas, which have forced the cancellation of Gay Pride events in the city. UNAIDS expresses its solidarity with all LGBTI people in Georgia.

“The shocking violence suffered by LGBTI activists and journalists in Tbilisi is completely unacceptable,” said Winnie Byanyima, Executive Director of UNAIDS. “The authorities must take urgent measures to protect the human rights of the LGBTI community, including their right to freedom of expression and assembly, and to bring those responsible for the attacks to justice.”

On 1 December 2018, Tbilisi signed the Paris Declaration to end the AIDS epidemic by 2030, joining more than 300 municipalities in the Fast-Track cities initiative, which was initiated by the Mayor of Paris, UNAIDS, IAPAC and UN-HABITAT in 2014. The initiative commits Tbilisi to work closely with communities, including gay men and other men who have sex with men and transgender people, to foster social equality.

The new UNAIDS Global AIDS Strategy 2021–2026: End Inequalities, End AIDS is also clear that stigma and discrimination against LGBTI people violates human rights, deepens inequalities and acts as a critical barrier to ending AIDS as a public health threat by 2030. A crucial element of the strategy is to address the challenges faced by key populations (gay men and other men who have sex with men, sex workers, transgender people and people who use drugs) so that less than 10% experience stigma, discrimination and violence by 2025. The strategy calls on countries to take immediate action to reduce stigmatizing attitudes and discrimination on the basis of sexual orientation and gender identity as a critical element to ending AIDS by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.