The Martin Ennals Foundation has announced the names of the three finalists for the prestigious global Martin Ennals Award for human rights defenders, which will be awarded in October 2017. One of the three finalists is Karla Avelar, a transgender woman living with HIV from El Salvador who, for more than 20 years, has been defending the human rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people and advocating for access to health care for people living with HIV.

In 1996, Ms Avelar was one of the founders of the first association of transgender people in El Salvador, and in 2008 she founded the first organization of transgender women living with HIV, COMCAVIS TRANS. The organization works to advance, defend and promote the human rights of LGBTI people, scale up HIV prevention and care and improve access to HIV services for people living with HIV and prisoners.

"On a daily basis, lesbian, gay, bisexual, transgender and intersex people are exposed to death threats, extortion, harassment, physical and verbal violence and discrimination because of our gender identity or sexual orientation,” said Ms Avelar. “This situation makes us vulnerable to HIV."

Ms Avelar, together with COMCAVIS TRANS peer educators, promotes HIV testing and HIV prevention and care among the LGBTI people through outreach activities, such as education and information dissemination in different parts of San Salvador.

Ms Avelar and her team also work on strengthening access to HIV prevention and treatment services for LGBTI prisoners in two penitentiary centres. “We are working on two fronts: with lesbian, gay, bisexual, transgender and intersex people, training them on sexual and reproductive health and HIV prevention, and raising awareness among administrative officials and custodial staff on human rights and zero discrimination,” explained Ms Avelar.

In 2013, the partnership between COMCAVIS TRANS and the penitentiary center of SENSUNTEPEQUE led to the adoption of an agreement, which allows prisoners to have access to condoms each month. COMCAVIS TRANS also supports LGBTI prisoners living with HIV to adhere to their treatment and monitors their access in order to ensure their psychosocial and emotional well-being. 

In El Salvador, LGBTI people continue facing a climate of discrimination and violence, exacerbated by high levels of impunity and limited access to justice. “El Salvador is a country with one of the highest rates of violence in Latin America and, as it is the case throughout the region, the life expectancy of a transgender woman does not exceed 35 years,” said Ms Avelar.

She supports LGBTI people who have suffered human rights violations and acts of violence. Together with her team and the group of volunteers, she advises them and accompanies them to file a complaint. Thanks to the collaboration of other organizations, she makes sure that people in need have open channels to legal and economic assistance. “There are still a lot of barriers,” she says. “However, we are promoting a dialogue with representatives of the national civil police and Office of the National Counsel for the Defense of Human Rights and other authorities to improve the mechanisms to denounce and investigate human rights violations and provide proper and sustained monitoring and evaluation.”

Ms Avelar has also played a significant role advocating for legislation reforms to protect and promote the rights of LGBTI people and address their needs. For example, together with UNAIDS and other national organizations, she participated in a review of an HIV law approved last January. Among other things, the law allows transgender people to receive a better health care free of stigma and discrimination, improve their quality of life and access to health services, education and work, ensuring the respect to their gender identity.

“For all those who know her, Karla Avelar is already the winner of the Martin Ennals Award,” said Celina Miranda, UNAIDS Country Director for El Salvador. “In the midst of all adversity, she is a tireless advocate for human rights, making a difference in the lives of lesbian, gay, bisexual, transgender and intersex people in El Salvador.”

About the Martin Ennals Award

The Martin Ennals Award is an annual prize for human rights defenders. Finalists and the laureate are selected by a jury of 10 of the world’s leading human rights nongovernmental organizations.

UNAIDS is working with partners to reaffirm that the full enjoyment of all human rights and fundamental freedoms for all supports the global response to the AIDS epidemic, including in the areas of prevention, treatment, care and support, and address stigma and discrimination against all people living with, presumed to be living with, at risk of and affected by HIV as a critical element in ending the AIDS epidemic and as outlined in the 2016 United Nations Political Declaration on ending AIDS.

In the lead-up to IDAHOT (the International Day against Homophobia, Transphobia and Biphobia) 2017, UNAIDS spoke with Kene Esom, the Executive Director of AMSHeR. AMSHeR promotes non-discrimination, particularly discrimination based on sexual orientation and gender identity, and advocates for access to quality health services for lesbian, gay, bisexual and transgender people in Africa.

Question: Tell us about the changes across the African continent since AMSHeR started nine years ago

AMSHeR was established to address discrimination and human rights violations based on sexual orientation and gender identity, the disproportionate vulnerability to HIV of men who have sex with men and the policy and social barriers that hinder access to services for lesbian, gay, bisexual and transgender (LGBT) people in Africa.

African LGBT people are bringing the issues of sexual orientation, gender identity and human rights into regional and global policy and legal spaces and are making the African LGBT experience the basis of policy, service delivery and funding decisions on Africa.

Never before has there been more visibility and interest in LGBT issues and understanding of the experience and needs of African LGBT people and effective representation of African LGBT communities in the global discourse. This is largely because of AMSHeR’s courageous mandate to make African LGBT people the faces and voices of inclusion in Africa and by so doing put LGBT inclusion on the agenda of African states and policy-makers as well as human rights and social justice movements.

Question: What made you focus your recent campaign on engaging with faith leaders?

It is widely accepted that religion and religious leaders have a great influence on political leaders and in African society. The widespread intolerance, discrimination and violence against people based on their real or perceived sexual orientation, gender identity and expression, and lack of access to health services, may be attributed to a highly religious environment that has normalized heterosexuality and patriarchy while demonizing sexual diversity.

Religion-inspired discrimination is very rife, particularly in Africa. The experiences of African LGBT people have been varied, from torture and inhumane treatment in the form of exorcism and conversion therapy, to mob violence incited by religious leaders from the pulpits, to the experiences of religious leaders sitting on national health agencies blocking attempts to provide health and rights services to LGBT people, to religious leaders actively sponsoring discriminatory legislation. 

Religious leaders, because of their respected positions in society, are critical in addressing issues of stigma and discrimination as well as upholding the rights of all people regardless of sexual orientation, and, even more importantly, have emerged as strategically placed in discourses on HIV, sexuality and spirituality.

AMSHeR appreciates the role that religious leaders play, but at times they perpetuate discrimination based on sexual orientation and gender identity, and that is why, since 2015, under our Integrating Spirituality and Sexuality project, we have been working with religious leaders and LGBT people of faith to address these issues.

We have partnered with leaders of faith-based communities to initiate dialogue between institutions and LGBT communities in order to find common ground to integrate spirituality and sexuality. This has been done following lessons learned on how faith-based organizations have been integral in advocating for non-discrimination and stigma against people living with HIV. Faith-based organizations have proved to be allies to many civil society organizations in pushing for non-discrimination and stigma against people living with HIV.

As part of its work, AMSHeR has released a documentary, Queer Voices of Faith, for IDAHOT 2017.

Question: You are a Nigerian working in South Africa for a pan-African organization. What motivates you?

Whether in Nigeria, South Africa, Mozambique or Morocco, I am amazed at the remarkable kindred spirit that connects African societies. I consider myself a pan-Africanist, I believe there is more that connects us than otherwise, despite our diversities, and I celebrate Africa’s diversity and the values that unite us.

AMSHeR has been a perfect vehicle to express my pan-African ideals and promote the quest for social justice across Africa.

Question: What do you see as the future on the continent for LGBT people?

The future of LGBT people in Africa is to strengthen the movement that is now under way in which LGBT people, their leaders and other advocates are steadily seeking to realize their fundamental human rights, including the rights to equality and non‐discrimination, the highest attainable standard of health, freedom of expression, freedom of association and assembly, freedom from unlawful arrest and detention and equal access to justice.

I see a future and it is a bright one. A lot has changed since 2009, when AMSHeR came into operation. We have taken and continue to take incremental steps towards achieving the full inclusion of African LGBT people as equal citizens of Africa. The tide is flowing in one direction and it is in the right direction.

Question: This year’s theme for IDAHOT is family. What does family mean to you?

Family is a bond of love as opposed to biology and all families, in whatever shape or form, should be afforded the same protection and recognition from a legal and ideological perspective. Africa is replete with different expressions of family and we celebrate the role that families play in shaping society. It is also imperative to acknowledge that it is through families that we can reframe respect for diversity and unlearn the prejudice that is at the root of the discrimination that LGBT people face today.

GENEVA, 17 May 2017—UNAIDS’ vision of zero discrimination and ending AIDS by 2030 will only become a reality if the response to HIV reaches everyone, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

The International Day against Homophobia, Transphobia and Biphobia (IDAHOT), a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May. This year’s theme is families, focusing on the role of families in the well-being of LGBTI people and respect of the rights of LGBTI families.

“Many young gay and transgender people are rejected by their families, living on the streets, facing all types of discrimination and violence,” said the Executive Director of UNAIDS, Michel Sidibé. “This is not the path to healthy and productive societies. We must encourage inclusion and compassion and ensure that networks of support are in place, including access to essential health and social services.”

Gay men and other men who have sex with men are 24 times more likely to acquire HIV than other men and transgender people are 49 times more likely. However, in many health-care settings, LGBTI people find it difficult to access quality health services free from discrimination, making them more vulnerable to HIV and less likely to access treatment and care.

Under international human rights law, countries have a legal obligation to address discrimination in health and in the workplace. In 2016, UNAIDS launched an Agenda for Zero Discrimination in Health-Care Settings, which brings together all stakeholders for joint efforts towards a world where everyone, everywhere, is able to receive the health care they need with no discrimination.

UNAIDS is calling for respect for diversity and zero discrimination. To end AIDS it is essential to end the stigma and discrimination faced by LGBTI people.

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.

UNAIDS has received the LGBTI Citizenship Allies Award in recognition of its human rights-based approach to responding to the AIDS epidemic among gay men and other men who have sex with men. Created by Grupo Dignidade (Dignity Group), one of Brazil’s most respected nongovernmental organizations working on issues related to lesbian, gay, bisexual, transgender and intersex (LGBTI) people and on HIV prevention among gay men and other men who have sex with men, the award is given to people and organizations in recognition of their contribution to advancing the rights of LGBTI people in Brazil.

The award highlights some of the efforts made by UNAIDS in this area, including the development of campaigns and initiatives such as the zero discrimination campaign, the production of a wide variety of publications and its advocacy efforts to specifically mention LGBTI people and other key populations in the 2016 United Nations Political Declaration on Ending AIDS.

Georgiana Braga-Orillard, UNAIDS Country Director in Brazil, highlighted the importance of the award. “We are investing time and effort in human rights and zero discrimination in the country and globally. The award shows us that we are going in the right direction and that our efforts are having an impact for the communities we want to support,” she said.

The award ceremony marked the 25th anniversary of Grupo Dignidade. Grupo Dignidade works with partners—including the municipal, state and federal departments of the Public Ministry, public human rights authorities and Brazil’s Supreme Court—on key areas related to human rights and the rights of LGBTI people.

“Much of what I have learned in terms of respect for diversity and the importance of the social movements for the response to the AIDS epidemic came from my constant interaction with Grupo Dignidade,” said Mariângela Simão, UNAIDS Director of Rights, Gender, Prevention and Community Mobilization, in a video message to the award ceremony. “Receiving this award from Grupo Dignidade is very important to us and I would like to thank you, in the name of Michel Sidibé, the UNAIDS Executive Director,” she added.

The ceremony also hosted the Educating on Respect for Sexual Diversity Award, given to 11 selected individual and institutional initiatives that recognized, valued and encouraged the promotion of respect for sexual diversity in the educational environment in Brazil.

UNAIDS is working to support countries to reach the targets set out in the 2016 Political Declaration, which include the review and reform of legislation that may create barriers or reinforce stigma and discrimination, and to promote access to non-discriminatory health-care services, including for populations at higher risk of HIV, specifically sex workers, men who have sex with men, people who inject drugs, transgender people and prisoners.

Since 2010, the annual global number of new HIV infections among adults (15 years and older) has remained static, at an estimated 1.9 million. Members of key populations, including sex workers, people who inject drugs, transgender people, prisoners and gay men and other men who have sex with men, and their sexual partners accounted for 45% of all new HIV infections in 2015.

In some countries and regions, infection rates among key populations are extremely high—HIV prevalence among sex workers varies between 50% and 70% in several countries in southern Africa. One study from Zimbabwe found HIV prevalence rates of 27% for male inmates, 39% for female inmates and 60% for sex workers, with 9.6% of these getting newly infected between 2009-2014. New infections among gay men and other men who have sex with men have been increasing in all regions in recent years. Across countries, key populations are between 10 and 50 times in greater risk of HIV infection compared to other adults.  

Criminalization and stigmatization of same-sex relationships, sex work and drug possession and use, and discrimination, including in the health sector, are preventing key populations from accessing HIV prevention services. Effective government support and community-based and implemented HIV prevention and treatment programmes that provide tailored services for each group are currently too few and too small to result in a significant reduction in new infections.

In order to achieve the target of reducing new HIV infections among key populations by 75% by 2020, a large-scale increase of programmes and the creation of an enabling social and legal environment are needed.

We must reduce new HIV infections among key populations

The global number of new HIV infections among adults has remained static, at an estimated 1.9 million, since 2010, threatening further progress towards the end of the AIDS epidemic.

New HIV infections among gay men and other men who have sex with men are rising globally, and there has been no apparent reductions of new infections among sex workers, transgender people, people who use drugs or prisoners. Studies conducted in southern Africa have found HIV prevalence 10–20 times higher among sex workers than among adults in the general population, with rates of HIV infection reaching 50% of all sex workers tested, and HIV prevalence reaching 86% in one study in Zimbabwe. A synthesis of studies including more than 11 000 transgender people worldwide estimates HIV prevalence to be 19.1%.

Key populations remain among the most vulnerable to HIV. Analysis of the data available to UNAIDS suggests that more than 90% of new HIV infections in central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, who accounted for 45% of new HIV infections worldwide in 2015.

Reinvigorating HIV prevention among key populations requires domestic and international investments to provide key populations with tools, such as condoms and lubricants, pre-exposure prophylaxis and sterile needles and syringes, and testing and treatment. However, the design and delivery of such HIV combination prevention services is often limited by a reluctance to invest in the health of key populations and to reach out to them.

In many countries, key populations are pushed to the fringes of society by stigma and the criminalization of same-sex relationships, drug use and sex work. Marginalization, including discrimination in the health sector, limits access to effective HIV services. There is an urgent need to ensure that key populations are fully included in AIDS responses and that services are made available to them.

Guidelines and tools have been developed for and with the participation of key populations in order to strengthen community empowerment and improve the delivery of combination prevention services by community-led civil society organizations, governments and development partners.

The available evidence shows that when services are made available within an environment free of stigma and discrimination and involving key population communities, new HIV infections have declined significantly. For example, street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements.

The replication of such successes and the scale-up of combination prevention programmes in all cities and sites where key populations live and work, implemented by countries and community organization networks, will help prevention efforts get back on track to achieving the target of reducing new HIV infections by 75% by 2020.

Quotes

GENEVA, 17 May 2016—UNAIDS stands with people and organizations around the world in commemorating the International Day against Homophobia, Transphobia and Biphobia (IDAHOT) on 17 May, the day 26 years ago when the World Health Organization declassified homosexuality as a mental disorder. The IDAHOT theme for 2016 is mental health and well-being.

Although there is still much progress to be made to achieve UNAIDS’ vision of zero discrimination, there have been encouraging steps in the right direction. In June 2015, Mozambique decriminalized homosexuality in its new penal code. In September 2015, some 12 United Nations agencies issued a powerful joint call to action on ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people. In May 2016, the Government of the United States of America released guidance “to help provide educators the information they need to ensure that all students, including transgender students, can attend school in an environment free from discrimination based on sex.”

“It is unacceptable that lesbian, gay, bisexual, transgender and intersex (LGBTI) people face violence and discrimination just because of who they are and who they love,” said UNAIDS Executive Director Michel Sidibé. “They are our sons and daughters, our brothers and sisters, our friends and colleagues. LGBTI rights are human rights. We must challenge prejudice wherever we are.”

Many LGBTI people continue to face enormous daily challenges, sometimes living in fear, in isolation and out of reach of life-saving health services. Fear of abuse or discrimination by health-care workers prevents people from accessing HIV testing and treatment services. In addition, a large percentage of LGBTI people face isolation and discrimination in their immediate social environment, negatively affecting their mental health.

Reaching the Sustainable Development Goals, which include ending AIDS by 2030, requires the end of discrimination in all its forms.

UNAIDS calls for full and complete access to quality health care for LGBTI people, including access to mental health services, which are often less well supported in health systems. “Act with compassion. Embrace diversity. Leave no one behind,” added Mr Sidibé.

Ending discrimination will be one of the central themes discussed at the upcoming United Nations General Assembly High-Level Meeting on Ending AIDS, taking place at the United Nations in New York, United States of America, from 8 to 10 June 2016. For more information, go to www.hlm2016aids.unaids.org. 

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.

Human rights experts have called for concerted efforts to end human rights violations based on sexual orientation and gender identity.

A report launched today during the 58th Ordinary Session of the African Commission on Human and Peoples’ Rights, being held in Banjul, Gambia, summarizes a historic dialogue that took place in November 2015 between United Nations human rights experts and representatives of the African Commission on Human and Peoples’ Rights and the Inter-American Commission on Human Rights.

The report, Ending violence and other human rights violations based on sexual orientation and gender identity, highlights grave violations that take place in all regions of the world against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

The report notes the impact of these abuses on the health of LGBTI people and their access to HIV prevention and care, but also emphasizes positive developments made around the world in protecting the rights of LGBTI people.

In 2014, the African Commission on Human and Peoples’ Rights adopted a resolution calling for the protection of people against violence and other violations on the basis of their real or perceived sexual orientation or gender identity. Commenting on the launch of the report, Pansy Tlakula, Chairperson of the African Commission on Human and Peoples’ Rights, said, “Violence and other human rights violations based on sexual orientation and gender identity constitute universal challenges that require concerted responses by national, regional and United Nations human rights institutions.”

The Inter-American Commission on Human Rights has established a rapporteurship on the rights of LGBTI people. James Cavallaro, President of the Inter-American Commission on Human Rights, highlighted a fundamental element of the work of the Commission. “Bringing the voices of lesbian, gay, bisexual, transgender and intersex people into our work is to challenge the invisibility of the serious human rights violations that they continue to face throughout the Americas and hold States accountable for these violations,” he said.

The United Nations Human Rights Council has passed two resolutions condemning violence and discrimination based on sexual orientation and gender identity. “The dialogue allowed us to share good practices to guide our common struggle to combat impunity and to ensure the protection and realization of the human rights of all individuals, including lesbian, gay, bisexual, transgender and intersex people,” said Christof Heyns, United Nations Special Rapporteur on extrajudicial, summary or arbitrary executions.

The UNAIDS Executive Director, Michel Sidibé, and the United Nations High Commissioner for Human Rights, Zeid Ra’ad Al Hussein, said on the launch of the report, “Ending violence, criminalization, discrimination and other human rights violations against lesbian, gay, bisexual, transgender and intersex people are priorities for our organizations and for the entire United Nations system.”

Civil society organizations have also welcomed the report. “Ongoing collaboration and openness to experience-sharing between regional and international human rights systems reinforces the idea of the universality of human rights, and can only help advance the protection of human rights for everyone, including for LGBTI people,” said Sibongile Ndashe, Executive Director of the Initiative for Strategic Litigation in Africa.

In collaboration with UNAIDS and other partners, the United Nations Development Programme (UNDP) and IRTG, a Global Network of Trans Women and HIV, have released a new publication today entitled Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions. The publication presents concrete steps that public health officials, health workers and nongovernmental organizations can adopt to implement HIV and sexually transmitted infection (STI) programmes with transgender people.

Topics covered in the publication include community empowerment and human rights, addressing violence, stigma and discrimination, and delivering transgender-competent services, especially for HIV and STI prevention, diagnosis, treatment and care. The publication also covers community-led outreach, safe spaces and the use of information and communications technology in service delivery. It describes how to manage programmes and build the capacity of organizations led by transgender people and shows how services can be designed and implemented to be acceptable and accessible to transgender women. Wherever possible, it gives particular attention to programmes run by transgender organizations.

The publication was developed in collaboration with transgender people and advocates, service providers, researchers, government officials and representatives of nongovernmental organizations from all over the world. UNDP and IRTG coordinated its production, with the support of the United Nations Population Fund, the University of California, San Francisco, Center of Excellence for Transgender Health, the Johns Hopkins Bloomberg School of Public Health, the World Health Organization, the United States Agency for International Development, the United States President’s Emergency Plan for AIDS Relief and UNAIDS.

The document is based on recommendations included in the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, published in 2014 by the World Health Organization.

Transgender women continue to be heavily affected by HIV, being 49 times more likely to become infected with HIV than non-transgender adults.

Quotes