GENEVA, 16 May 2018—On the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), UNAIDS is calling for strengthened partnerships to support lesbian, gay, bisexual, transgender and intersex (LGBTI) people and their families living with or affected by HIV or facing discrimination.

“Stigma, discrimination and social and physical violence against sexual and gender minorities prevent them from accessing health services,” said Michel Sidibé, Executive Director of UNAIDS. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Gay men and other men who have sex with men and transgender women are among the populations most affected by HIV worldwide.

More than 40% of the 100 countries responding to UNAIDS criminalize same-sex relationships. Criminalizing people because of their gender or sexual orientation drives people underground and out of reach of essential health and social services, making them vulnerable to poor health and homelessness.

To end AIDS, it is essential to ensure that people can access HIV prevention technologies, including condoms and PrEP, and quality HIV treatment and care free from discrimination. UN Women, the United Nations Development Programme and UNAIDS are working with the Global Network of People Living with HIV to end all forms of HIV-related stigma and discrimination. The initiative will require rapid multisectoral support and civil society leadership and will contribute to achieving the time-bound commitments of United Nations Member States to end AIDS as a public health threat by 2030.

Increasing political commitment and investments for the health and well-being of some of the most vulnerable people in society will help to ensure that no one is left behind.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May. This year’s theme is alliances for solidarity to bring respect for LGBTI people and their families.

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.

Papua New Guinea has published the results of its first comprehensive survey on key populations in the country. The report is the conclusion of a study that collected estimates of the sizes of key population and biobehavioural data, which will be used to inform prevention and treatment services and policies for HIV and other sexually transmitted infections.

“Only when we ensure that Papua New Guinea’s HIV programming reaches the right people in the right way and place, and at the right time, will the increasing HIV infection rates amongst key populations be slowed,” said David Bridger, the UNAIDS Country Director for Papua New Guinea, at the report’s launch.

The study, Kauntim mi Tu (count us), was carried out in the three largest urban areas of the country—Port Moresby, Lae and Mount Hagen. It revealed that female sex workers, gay men and other men who have sex with men and transgender people often do not seek health care, get tested for HIV or other sexually transmitted infections or use condoms.

Members of key populations in the country face real and perceived stigma, discrimination and violence from police, clients and others in their communities on a daily basis, according to the report. High rates of stigma, discrimination and violence are deterring them from seeking or accessing health-care services.

A member of Friends Frangipani, an organization of sex workers, said, “Many of us live very difficult lives. We don’t all have access to clean water, healthy food or a safe space. We are struggling. Yet we are told to look after ourselves, protect ourselves from HIV and, if HIV-positive, stay healthy. That is very hard for many of us. People need to understand our lives better, and Kauntim mi Tu has done that.”

While adult female HIV prevalence is estimated at 1.1% nationally, the study found that prevalence was nearly 20% among female sex workers in Mount Hagen and almost 15% in the capital, Port Moresby. More than half of gay men and other men who have sex with men and transgender people were found to have never been tested for HIV. Three out of four men in the second largest city, Lae, reported having experienced violence related to their sexuality or sexual identity.

The study included biological testing, with participants offered point-of-care tests and, if needed, same-day treatment for syphilis, chlamydia and gonorrhoea. The research team included members of key populations.

The study’s principle investigator, Angela Kelly-Hanku, noted that much work remains to be done. “This work must be done in the context of safe, respectful and enabling environments that support adequate public health responses and invest in new and dynamic ways to increase HIV testing and ensure that treatment is continuously available, that viral load testing is standard HIV care and that prevention is paramount to everything. We cannot be complacent,” she said.

The report is available at http://www.aidsdatahub.org/sites/default/files/publication/PNG_Kauntim_mi_tu_Multi-Site_Summary_Report_from_the_Key_Population_IBBS_2018.pdf.

Kimi Avalos is a young transgender woman who lives in Buenos Aires, Argentina. Because of stigma and discrimination, she couldn’t continue with her studies and complete high school. She says that she experienced bullying and harassment; her classmates insulted and physically assaulted her, under the indifferent eye of her teachers. “I really wanted to learn, but I had to drop out of school. Now, thanks to the Transgender House, my dream of finishing high school will soon come true,” said Ms Avalos.

Ms Avalos is one of 30 transgender students who recently started a new educational programme through which they can study for primary and secondary school diplomas by attending a combination of face-to-face and virtual classes. This innovative project is implemented in the Transgender House, a community centre for training and empowerment of transgender people founded in Buenos Aires in June 2017 by Marcela Romero, Coordinator of ATTTA (Association of Argentinian Transvestites, Transsexuals and Transgender) in collaboration with the City Council of Buenos Aires.

“To have this house has meant that as transgender people, we can come out from the darkness. The centre is in a visible space, on one of the main streets of Buenos Aires, in the San Cristóbal neighbourhood. This is our achievement; it shows that we exist as a community and that we have the right to a space like any other organization,” explains Ms Romero.

In Argentina, as well as in the rest of Latin America and the Caribbean, stigma and discrimination undermine learning opportunities and educational achievement of transgender people, thus affecting their future employment prospects. Discrimination and stigmatization also prevent transgender people from accessing appropriate health care, including HIV prevention, social protection and justice services.

In the region, transgender people experience frequent physical and sexual violence and hate crimes. According to data from ATTTA, 20 transgender people have been killed in Argentina since the beginning of 2018 and gender-based violence is increasing. Discrimination, gender-based violence and exclusion also contribute to increasing the vulnerability of transgender people to HIV. Transgender women continue to be heavily affected by HIV.

The Transgender House was created with the aim of providing a safe space where transgender people can be empowered and acquire knowledge and skills without the fear of being discriminated against, rejected or attacked. It works in partnership with governmental agencies, civil society and the private sector to provide a wide range of services and programmes based on the specific needs of transgender people.

MORE ON TRANSGENDER DAY OF VISIBILITY

Voices of activists for transgender rights

Among other initiatives, the Transgender House has established integrated counselling services and professional guidance for job searching, as well as legal advice from lawyers, who are available 24 hours a day. In collaboration with the Ministry of Education, Transgender House has recently begun educational projects that range from the implementation of primary and secondary education programmes to professional training, such as on providing care services to the elderly.

Other important activities include the promotion of prevention of HIV and other sexually transmitted infections, HIV testing and vaccination campaigns. The Transgender House also provides continuous psychological assistance and, through a partnership with Fernández Hospital, counselling services on hormone therapy. In addition, the house engages in outreach work with a team of community health promoters that visit sex workers at their places of work at night, distributing condoms and informative material on HIV prevention.

While the Transgender House is currently a successful project, a point of reference for transgender people in Buenos Aires and has multiple partnerships in the city, it hasn’t been an easy process to get to this point. Ms Romero says that she first approached the Buenos Aires City Council eight years ago, advocating for a space where transgender people could meet. Finally, two years ago, the council approved the remodelling and refitting of one of their buildings, and with the help of an architect and the vision of the ATTTA Coordinator, the Transgender House became a reality.

“The Transgender House is a best practice of community service delivery that is contributing to the achievement of the Fast-Track Targets, leaving no one behind,” said Carlos Passarelli, the UNAIDS Country Director for Argentina, Chile, Uruguay and Paraguay.

Around 400 people visit the Transgender House each month to receive counselling and information and approximately 600 people regularly participate in workshops, group meetings and courses there. “I couldn’t be happier and more grateful for the opportunity that I am given at the Transgender House. I hope that this model of respect and promotion of human rights serves as an example to transform and change society so that all of us can live with dignity,” said Ms Avalos.

Young sex workers, transgender people, lesbian women, gay men and other men who have sex with men, people who inject drugs and people living with HIV from across Africa came together on 2 and 3 December for a preconference meeting ahead of the 19th International Conference on AIDS and STIs in Africa (ICASA), being held in Abidjan, Côte d’Ivoire, from 4 to 9 December.

The meeting, entitled Onto the African Map: Youth Key Populations and HIV, was a way for young people to express the challenges that they face, from a lack of opportunities to discrimination and social and legal injustices.

Those barriers make young members of key populations particularly vulnerable to HIV, violence, harassment and a lack of hope. Despite these challenges, attention to the protection of human rights and to the health needs of key populations remains limited in national HIV responses.

The meeting reviewed those challenges and identified key areas of action and recommendations that were compiled in the joint declaration adopted at the meeting. The declaration calls, among other things, for urgent action to stop violence, harassment and other human rights violations towards young people and key populations. It further calls for the participation of young key populations in health, policy and other decision that affect them and stresses the need to increase programmes and investments for services that address the needs of young key populations.

Quotes

From 14 to 21 October, almost 25 000 young people from 188 countries gathered in Sochi, Russian Federation, for the XIX World Festival of Youth and Students. The festival provided a space for young people to unite in addressing global challenges, with a special focus on the Sustainable Development Goals (SDGs).

Through the leadership of the PACT youth coalition against HIV and with support from UNAIDS and participation of UNFPA and UNESCO, the issues of ending AIDS and sexual and reproductive health and rights were high on the agenda.

Three sessions focused on comprehensive sexuality education, modern epidemics and the role of young people in ending AIDS by 2030. The overarching theme of the discussions was that although much progress has been achieved in the response to HIV, there are still persistent challenges that put young people at risk, including discrimination, exclusion, violence and lack of access to services such as comprehensive sexuality education.

Speakers at the comprehensive sexuality education session highlighted that the absence of quality comprehensive sexuality education remains one of the largest gaps in ensuring that young people know how to protect themselves from HIV. Speakers also presented key new products and platforms, including a comprehensive sexuality education hub, teensLIVE.info, a video lesson developed for schoolchildren in eastern Europe and central Asia featuring UNAIDS Goodwill Ambassador Vera Brezhneva and a series of videos by the NauchPok channel.

The PACT youth coalition met with the United Nations Secretary-General’s Envoy on Youth, Jayathma Wickramanayake, who said, “I am looking forward to working with all of you through UNAIDS and other partners. My goal is to ensure that young people have a voice in all United Nations processes and to help them address issues that are relevant to them and their communities, including those issues that may be perceived as sensitive or challenging.”

Lack of access to information on HIV leads to new HIV infections and sustains the root causes that put young people at risk, including inequality, discrimination, violence and exclusion. Dilyara Vagapova, from the Russian rock group Murakami, said, “Without open conversations with young people about HIV, sex and the harm done by drugs, we will not succeed in ending the HIV epidemic in eastern Europe and central Asia.”

To ensure that the targets in the 2016 United Nations Political Declaration on Ending AIDS are met, accountability is key. Young leaders from Bulgaria, India, South Africa, Tajikistan, Ukraine and the United Kingdom of Great Britain and Northern Ireland shared best practices in peer education and youth-led accountability for the SDGs and the HIV response. Yana Mladenova from Bulgaria, said, “A policy on paper is not the same as a policy in practice. Successful advocacy results in action in practice.” Yana Valchuk, from the Teenergizer adolescent network, said, “To end the epidemic, we need to end discrimination, so adolescents stop living in fear.”

Vinay P. Saldanha, the UNAIDS Regional Director for Eastern Europe and Central Asia, spoke at several sessions. “Achieving the Sustainable Development Goals, including ending AIDS by 2030, does not depend on those that negotiated them. It depends on the personal commitment of each young person at this festival. This is your world—these are your goals!,” he said.

While running a legal clinic for refugees 10 years ago, Kene Esom, former Director of African Men for Sexual Health and Rights (AMSHeR), saw how difficult it was for marginalized or vulnerable people to access health-care services. “That is where I realized that as a lawyer and a human rights defender, I could play a role in increasing access to health-care services and defending human rights.” In his more recent role as Strategic Initiatives Adviser to the AMSHeR Board, he is still at the forefront against discrimination, especially discrimination against gay men and other men who have sex with men in Africa.

Mr Esom makes it clear that when he is talking about human rights in the context of HIV, it is not just the right to health that matters. “There is a pattern of human rights violations towards gay men in many countries, owing particularly to the criminalization of consensual same-sex conduct,” said Mr Esom. “For example, when a newspaper decided to publish a sensational story about gay men having a party, the men were arrested. detained and forcibly tested for HIV. All their due process rights were violated and their right to privacy breached to the extent that their names, addresses and pictures were published in the newspaper.”

Mr Esom said that incidents such as this can roll back years of progress in providing HIV services for key populations. “You cannot provide health services without taking into consideration the human rights context of the populations you are providing the services for. You can build the best health-care facility, but gay men will not come to that facility if they are worried that police will arrest them or that doctors will report their sexual behavior.”

Globally, gay men and other men who have sex with men are 24 times more likely to acquire HIV than adults in the general population. Stigma, discrimination, violence and the criminalization of same-sex sexual practices make it more difficult for these men to access HIV prevention, testing and treatment services.

AMSHeR supports human rights organizations to undertake evidence-informed advocacy. “Human rights defenders play a key role in bringing these issues to light and showing the impact that human rights violations can have on HIV responses, especially on services targeting key populations,” said Mr Esom.

Although there is still a lot of silence around issues surrounding sexuality, sexual orientation and gender identity, there is hope. “When I started this work six years ago it was a completely different context. There were very few people who wanted to advocate on these issues. Now, we have a greater pool of people in countries all over Africa and the world, and the communities are standing up for their rights and demanding access to services and a rights-based approach to service delivery.”

In its work, AMSHeR emphasizes the role of communities in advocating for change and speaking directly to policy-makers. “They are the voices and faces of the issues that affect them.”

The right to come together is key. “Many gay men think they are alone. Isolation increases their vulnerability. Bringing people together to discuss their issues creates a community that is empowered to speak up. If that space is not there, engaging policy-makers and service providers becomes more challenging.”

Mr Esom will be speaking about the promotion and protection of human rights in the context of HIV and other communicable disease at the Human Rights Council Social Forum, which is being held from 2 to 4 October. To hear more from Mr Esom and other human rights activists, register to participate at the Human Rights Council Social Forum at https://reg.unog.ch/event/6958/.

Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.

Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people.

The code of conduct provides for health personnel from public health facilities to be trained in avoiding discriminatory expressions and attitudes and to respect the confidentiality of patients. Among various provisions, it clearly stipulates that so-called treatment to “cure homosexuality or transexuality” must be avoided. It establishes that health centres should maintain a policy of zero tolerance for discrimination and must investigate accusations of discrimination. Health centres should also promote ongoing sexual and reproductive health and HIV prevention campaigns focused on LGBTI people.

The code of conduct was developed through a broad participatory process that included the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals, the National Center for HIV Prevention and Control, Specialized Condesa Clinic of Mexico City, the National Council for Preventing Discrimination and representatives of civil society and LGBTI organizations.

The next steps include a training process on its practical application, with the involvement of civil society and community-based organizations. The implementation will have a pilot phase and will begin in the largest cities in the country.

Quotes

There is a quiet hum in the room from the mostly young men sitting in chairs, eyeing their smartphones and chatting. Suddenly, a cheerful figure bursts into the executive lounge of the high-rise building in Taguig City, Philippines.

“Thank you, thank you,” said Ronivin (Vinn) Garcia Pagtakhan, the Executive Director and Founder of LoveYourself, a community-based organization providing health and empowerment services to men who have sex with men and transgender people. The team were wrapping up after a major event promoting HIV testing.

Mr Pagtakhan, with his shock of brown hair, frosted with a light green tint, bounced from one group to the next, joking and repeating his thanks.

Almost everyone here is a volunteer,” explained Mr Pagtakhan. “I get really moved when I talk about my volunteers. I owe everything to them.”

LoveYourself provides HIV testing and treatment services, as well as oral pre-exposure prophylaxis (PrEP) and tuberculosis screening. It has 25 staff members, who are supported by around 800 volunteers. Mr Pagtakhan founded LoveYourself in 2011, modelling it on a lesbian, gay, bisexual and transgender youth centre he volunteered in while living in San Francisco, United States of America.

“At the time, I felt there was a real problem with the way we were handling HIV prevention among the gay community in the Philippines,” said Mr Pagtakhan. “It was all about fear. I wanted something more optimistic and encouraging. I wanted a place that was lively, where people would want to hang out.”

He was only 25 years old at the time. “As they say, I know my market, because I am part of the community.”

He graduated from nursing school in the Philippines when he was 18 and got the fourth highest score on the national nursing board examinations. “This meant that I was in high demand by other candidates as a teacher helping to prepare people for their licensing exams. I travelled around the Philippines giving classes and I used social media to reach out to students as well,” said Mr Pagtakhan.

He became a celebrity on social media, with 600 000 followers on Twitter, and won the prestigious international Twitter Shorty Awards as the Nurse of the Year. The prize money helped start LoveYourself.

“The first three years, it was like sending your child off to college. I basically supported the organization on my earnings. We didn’t have any donors,” said Mr Pagtakhan. “I like to think out of the box and I had a particular vision. I didn’t want grants to dictate what we did or became. I wanted to create ripples of positive change in the community. LoveYourself isn’t just about HIV, but rather about increasing a person’s self-worth.

The organization has three community centres in the Manila, Philippines, area offering HIV testing and other services. Anyone can drop in, even on the weekends and in the evenings, for free health services.

LoveYourself tested about 20 000 people in 2016 and diagnosed around 1500 new HIV infcetions, which represent around 50% of the newly diagnosed HIV cases reported by the Department of Health in Manila. LoveYourself also works with companies and schools to help them develop HIV policies and to conduct on-site HIV tests.

In July, the organization began piloting PrEP and with support from UNAIDS and the World Health Organization plans to start a demonstration project offering self-testing before the end of the year.

In just six years, LoveYourself has grown to become an important HIV service provider in Manila. Mr Pagtakhan is proud of the organization’s achievements and has bigger ambitions. “We are still renting. I want LoveYourself to own a place, which is a community centre, where we can have health services but also original events and activities,” he said.

For more information on LoveYourself, go to http://www.loveyourself.ph.

Although new HIV infections and AIDS deaths among young people have decreased, in many places knowledge about how to prevent HIV remains worryingly low. Ahead of International Youth Day UNAIDS spoke to four young people about the challenges they face around HIV.

Pavel Gunaev is 16 years old and lives in St. Petersburg, where he is part of the youth-led network of adolescents and young people living with HIV Teenergizer! Pavel said that in his city young people are not aware about HIV.

“AIDS isn't talked about so young people don’t know about the risks or how to protect themselves from HIV,” he said. “As a result, so many uninformed young people are acting and making decisions based on rumors.” Pavel believes that if everyone does more to inform adolescents and young people and dispel the myths around HIV, ending AIDS will be possible.

Chinmay Modi was born with HIV twenty-three years ago. He is a member of the National Coalition of People Living with HIV in India and country focal point for the Youth LEAD Asia Pacific Network.

“The biggest problem is raising awareness and giving young people age-appropriate information,” he said. In his view, parents are not comfortable talking with their children about sex and society shies away from it too. As a result, he explained, young people are engaging in sex and experimenting new things but with little knowledge of the risks involved.

“Condoms need to be promoted and partners should support youth empowerment so that everyone is held accountable,” Chinmay said. He is also frustrated because in India people cannot access stigma-free HIV services at an early age.

In his view, self-stigma is hampering efforts to tackle discrimination, violence and inequalities related to HIV. That’s why, he explained, he wants more people to share their stories and be positive about being positive.

Moises Maciel couldn’t agree more with Chinmay. He is a 20-year-old LGBT and HIV activist. He became a  member of the National Network of Adolescents and Youth Living with HIV/AIDS in Brazil after discovering his positive HIV status two years ago. Since then, he has been on a journey against HIV-related stigma. He has also been motivating his peers to get tested.

“Young people are still at great risk of HIV infection due to a variety of factors such as social marginalization related to gender and racial inequalities,” he said. “In Brazil, young transgender and gay people are particularly targeted,” he explained.

He said that it baffles him to see how stigma and prejudice still dominate despite people living with HIV living healthy lives with the help of antiretroviral therapy. “We should start talking to young people in an open and responsible way about sexuality, sexually transmitted infections, teenage pregnancy and life responsibilities,” Moises said.

Lorraine Anyango, a Boston-based youth health and rights advocate, works to ensure that young people's voices, specifically around HIV, get heard.

“Young people continue to be left out of spaces and discussions on issues that impact their lives,” Lorraine said. “Their autonomy as individual human beings continues to go unacknowledged, leaving them susceptible to the risk of HIV infection.”

In her opinion, young people’s participation in decisions that affect their health can contribute to strengthen national-level accountability, by ensuring that programmes are effectively responding to their needs. Lorraine concluded by saying, “Recognizing youth sexual and reproductive health and rights, and continuing the conversation on HIV will get us closer to ending AIDS by 2030.”