Communities are essential to the sustainability of the HIV response

GENEVA, 26 February 2025—On Zero Discrimination Day, 1 March, everyone’s right to live a full and productive life with dignity is celebrated. Zero Discrimination Day highlights how people can become informed and promote inclusion, compassion, peace and, above all, it is a movement for positive change.

This Zero Discrimination Day, UNAIDS is Standing Together with communities. Communities are essential to the sustainability of the HIV response and to broader global health efforts. They must be financed and supported in their steadfast commitment to ensuring that all people living with and affected by HIV have access to the services they need and are treated with dignity and respect.

"The only way to end AIDS is by working together with communities. They build trust and reach people which many traditional health facilities find hard to reach—the most marginalized, and people who face stigma and discrimination,” said Christine Stegling, UNAIDS Deputy Executive Director. “To end AIDS by 2030, sustained investment and support for community-led responses is crucial.”

Community healthcare and support providers are too often faced with challenges—stigma, discrimination, criminalization, funding cuts, and political backlash—despite their primary role in ensuring that health services reach everyone in need, including the most vulnerable.

Compounding this, the current crisis caused by the shift in U.S. government funding has resulted in deep anxiety and pain for many community organizations as the future of life-saving community-led HIV prevention, treatment, care, and support programmes are at risk, despite the clear evidence of the positive impact of community-led services.

Community led services are essential to the sustainability of the AIDS response up to and beyond 2030, yet community-led responses are too often unrecognized, under-resourced and in some places even under attack. Crackdowns on civil society and on the human rights of marginalized communities are obstructing communities from providing HIV prevention and treatment services. The underfunding of community-led initiatives is leaving them struggling to continue operating as well as holding them back from expanding. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS as a public health threat by 2030.

“No society can thrive where discrimination exists,” said Marc Angel, Vice President of the European Parliament and a long-time HIV activist. “Every right denied, every barrier imposed weakens us all. On Zero Discrimination Day, let’s make it clear: equality is not an option—it’s a necessity. We stand together.”

On this year’s Zero Discrimination Day, UNAIDS calls on countries, donors and partners to fulfill their commitments and Stand Together to support communities as they work to build sustainable HIV responses by ensuring that:

• Community-led organizations are able to deliver life-saving services and advocate without discrimination or harassment.
• Community-led organizations can legally be registered in the country they are working in and receive sustainable funding.
• Communities are supported in providing health services to vulnerable and marginalized groups.
• Communities are supported and funded in work to monitor respect for human rights including ending the criminalization of key populations, stigma and discrimination and gender inequalities.
• Government health services include community representatives within their structures as partners in the development, implementation and monitoring of health programmes to ensure they are accessible and acceptable to people living with HIV and marginalized populations.

The sustainability of the AIDS response now and into the future is critical with communities at the centre. Now is the time to reaffirm global commitment to their leadership.

GENEVA, 10 December 2024—The world can end AIDS—if the human rights of people living with or affected by HIV are respected, protected and fulfilled, to put communities in the lead and ensure equitable access to high-quality HIV services.

The HIV response has come a long way. The progress made to date on HIV prevention and treatment services has been made possible, in large part, thanks to the advocacy of people living with HIV, communities and civil society allies, demanding treatment, demanding services, demanding dignity, demanding action – demanding their rights.

Over 30 million people are now on treatment, and annual numbers of new HIV infections have declined by 39% since 2010. However we still have a long way to go. In 2023, 1.3 million people around the world newly acquired HIV—three times higher than the global target set for 2025 of no more than 370 000 new acquisitions.

“An approach grounded in human rights is vital to enable meaningful engagement of communities and access to HIV services for all without discrimination” said Christine Stegling, UNAIDS Deputy Executive Director. “HIV services will reach the people most in need only if their human rights are upheld; if communities are in the lead, discriminatory and harmful laws are removed; HIV-related stigma, discrimination and violence are effectively tackled and if access to life-saving medicines is assured.”

Fostering resilient societies where human rights are protected and communities are enabled to lead requires long-term structural and systemic changes. If we are to have a sustainable HIV response, we must have a sustainable, well-resourced, approach to human rights.

On World AIDS Day, 1 December, UNAIDS released a report ‘The Rights Path’ to show what can be done. It shares examples from around the world of proven policies and programmes that are succeeding in protecting health and HIV services by protecting rights.

The HIV response is at a crossroads. We can end AIDS, if we take the rights path. Let us walk it together.

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.

Christoforos Mallouris' journey from humble beginnings in Cyprus to becoming a prominent global HIV advocate is a powerful story of personal transformation.

In his youth, Mallouris struggled with accepting his sexuality. "I couldn’t admit to myself that I was gay," shares Mallouris. The burden of self-stigma made it difficult for him to value his life: "In a way, I was homophobic towards myself and others."   

At 29, while studying in Chicago, he was diagnosed with HIV. The diagnosis marked a pivotal moment in his life. "It changed how I understood myself, really forcing me to learn to value my life and accept who I am."

By the time he was diagnosed, he had already developed AIDS. Fortunately, Mallouris got support from his sister, who came to take care of him during his lowest moments.

Being HIV-positive in the United States as a foreign student presented its own set of challenges. "At the time, being HIV positive in the United States as a foreigner was illegal," Mallouris recalled, "so if the authorities found out, I would be deported." The fear of deportation hung over him as he was doing his PhD in astrophysics, but that fear also catalyzed his first act of activism.

Faced with health insurance that covered only two months of his costly HIV medication, Mallouris approached the Dean of Students at the University of Chicago. He boldly stated, "What are you going to do about it? I’m sure you don’t want this to go to the press." To his surprise, the Dean took immediate action, negotiating better health insurance coverage for all students with chronic illnesses.

As Mallouris’ health improved, he began to question his career path. Although he had completed his PhD in astrophysics, he no longer felt fulfilled enough by that field. He sought something that connected directly to being able to help people.

After securing a postdoctoral position at the Institute of Astrophysics in Paris, Mallouris found himself increasingly drawn to HIV work, so he started volunteering at a local NGO focused on HIV education and prevention for non-French speakers in Paris. It wasn’t long before he realized that this work was where his heart was.

He joined the Global Network of People Living with HIV, managing community empowerment programs in the HIV response. "I changed my career because of my HIV status," he said. "I wanted to do something that truly impacts lives."

Mallouris has had to overcome stigma and discrimination throughout his journey. Dating, for instance, was difficult. "There was a lot of rejection as soon as people found out I was HIV-positive," he shared. But despite the challenges, he found strength in the support of his friends, who have stood by him unconditionally. "I am lucky to have a strong network of support."

Mallouris joined UNAIDS in 2013, first as a Community Mobilization Advisor in Geneva and later as an Equality and Rights Advisor in Johannesburg. He describes UNAIDS as a supportive and inclusive workplace, where he feels valued for his skills and experience.

Mallouris highlights that the work to help secure treatment for people living with HIV is inseparable from the work to secure the recognition of people living with HIV as equal human beings. "Success in the HIV response depends on accepting all people, especially the most marginalized members of society.”

Mallouris is proud as he looks back, and hopeful as he looks ahead. He will always speak out for the rights of communities, even when—especially when—it isn’t popular.

HIV may have started as a burden in his life, but over time, it has become his strength, guiding him towards work that makes a profound difference, advancing a world where everyone is safe, has a place, and is welcome.

GENEVA, 1 December 2024 — This World AIDS Day (1 December), sixteen global celebrities, including Hollywood film star Luke Evans and singer-songwriter Sia of the Unstoppable hit song, are uniting behind UNAIDS’ call for world leaders to protect human rights, which they say is vital to ensuring the success of efforts to end AIDS.

The celebrities, including actress and comedian Margaret Cho; comedian and poet Alok Vaid-Menon; fashion designer and television personality Tan France; actor Alan Cumming; actor, broadcaster and comedian Stephen Fry; actress Uzo Aduba; Moroccan artist OUM; South African actress Thuso Mbedu; Chinese actor and singer Huang Xiaoming; professional football player Racheal Kundananji; Pakistani-British actor and comedian Mawaan Rizwan; Filipino model and actress Pia Wurtzbach; Ukrainian singer and TV show host Vera Brezhneva; and popular television presenter Erkin Ryzkullbekov have come together in support of UNAIDS call to “Take the rights path to end AIDS.”

“The choice is clear if we want to end AIDS as a public health threat. World leaders must take the rights path to protect people’s right to health and life. When human rights are respected and guaranteed, their lives are greatly improved because they can freely seek healthcare, including HIV prevention and treatment.” said Stephen Fry, broadcaster and comedian.

“In far too many countries, people are still criminalized for being who they are or for who they love. When LGBTQ+ people are criminalized, they are driven underground and out of reach of health services, including services to prevent and treat HIV.” said Alok Vaid-Menon, American comedian and poet.

The report highlights gaps in the realization of human rights and shows how violations of human rights are obstructing the end of the AIDS pandemic.

63 countries still criminalize LGBTQ+ people.

Discrimination against girls and women, from denial of education to denial of protection from gender-based violence, is also undermining progress in the global HIV response. In 2023, women and girls accounted for 62% of new HIV infections in sub-Saharan Africa.

“We all win the fight against AIDS when human rights and the right to health are secured for everyone everywhere. We can end AIDS as a public health threat by promoting rights, respect and dignity for all." said, Margaret Cho, actress and comedian.

“When girls cannot get access to education and information, when young women cannot access HIV prevention and testing, they are put at much greater risk of acquiring HIV,” said Winnie Byanyima, Executive Director of UNAIDS.

In 2023 alone, 1.3 million people around the world were newly infected with HIV—three times higher than the global target set for 2025 of no more than 370 000 new infections.

“To protect everyone’s health, we need to protect everyone’s rights,”

UNAIDS World AIDS Day report, “Take the rights path to end AIDS”, shows that the world can end AIDS—if the human rights of people living with or affected by HIV are respected, protected and fulfilled, to ensure equitable, accessible and high-quality HIV services.

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.

After Evelyn Siula’s husband died, she knew she had to get tested for HIV. The result came back as positive.

"I had prepared myself mentally for either outcome, but it was still a shock."

She was jobless and with three children to care for.

The stigma and discrimination surrounding the virus meant that many people were scared to disclose their status. "I had three friends whose families rejected them because their HIV status became known,” Evelyn shares.

But Evelyn chose to break the silence early, starting by telling her young daughter. Family support played a crucial role in Evelyn’s journey. Her family stood by her, offering constant encouragement and strength, vital for getting through the many challenges.

Stigma followed Evelyn. She recalls a particularly painful moment: “At a community gathering, someone pointed at me and asked, ‘Can you believe she’s HIV-positive?’ It was one of the worst experiences being talked about like that.”

Evelyn became a strong advocate for people living with HIV, standing up to stigma everywhere, including in her church. At a gathering in a church, when a speaker criticized people living with HIV, she shared her own status as HIV-positive and as a church elder. Her openness has helped challenge stigma and gain support. Through her work she  learned that many fellow church members were struggling in silence, and so helped create the Livingstonia Synod Positive Christians group, known as LISAP+.

Despite her bold advocacy, Evelyn acknowledges how mental health challenges, particularly fear and anxiety, have affected her. “I have thoughts like: ‘What if something happens to me? What if I die?’ I worry about my children and how they would manage without me. These are the fears that raise my blood pressure.”

But over time, Evelyn’s diagnosis has become not just a challenge but also a source of strength.

Today, Evelyn works for UNAIDS and is the vice chair of the UN Plus Advisory Group. She is proud to show that people living with HIV are leading healthy and productive lives.

She has completed  Bachelor’s and Master’s degrees in business administration. “The day I graduated with my Master’s degree was extra special because I graduated alongside my eldest son. It’s rare for a mother and son to share such a moment.”

Evelyn encourages everyone to ensure they know their HIV status as the first step to taking control of their health: “Please get tested. It's just a status. If you're positive, follow the advice of your doctors. There is full life after testing HIV positive. Take your medication religiously, eat well, and live a healthy life.”

“Never stigmatize anyone,” says Eveyln, “because we are all one.”

Life became chaotic for Poon early. (Not his real name.)

As a gay teenager he was bullied at school by students and teachers. He moved in with his grandparents when his parents separated, but eventually left northern Thailand for Bangkok. There he survived through sex work.

Then Poon learned he was living with HIV. The weight of HIV prejudice merged with the stigma he already carried as a young gay man and sex worker. Some friends he made at a camp disclosed his HIV status online after an argument. He was diagnosed with major depressive disorder.

A partner introduced him to drug-use during sex. He went on to use multiple substances including methamphetamines and cocaine.

“Sex, drugs and alcohol are my escape,” he said.

This was one of the stories shared at the 6th Asia Pacific Chemsex Symposium (APCS). Held in Bangkok on November 6 and 7, the event brought together over 300 stakeholders from 27 countries. They shared their research and responses to a practice that remains largely hidden and not yet well understood. The event specifically explored pleasure as opposed to risk as an entry point for providing services.  

Chemsex—also called High Fun in several Asian countries—refers to the use of stimulant drugs during sexual activity. It lowers inhibitions and may increase risk-taking. There are several public health implications including higher rates of HIV and sexually transmitted infections (STIs), lower adherence to treatment, overdose and the fallout linked with intoxication.

In Asia Pacific four of every five new HIV infections are among people from key population communities including men who have sex with men or MSM, people who use drugs, people in prisons or other closed settings, sex workers and transgender people. Young people make up a quarter of all new HIV infections and in some countries around half of new infections are among youth ages 15 to 24.

Several countries in the region are facing an HIV prevention crisis with new infections among MSM either increasing or decreasing far too slowly. In 2023, 43% of new infections in Asia-Pacific were among MSM. At the same time, there is evidence that the practice of chemsex in this community ranges from 3% to 31% depending on the country. But although chemsex is most visible in the MSM community, it is practiced by people from all populations.   

“We are talking about sex and drugs—two topics that people call taboo,” said Brigitte Quenum, UNAIDS Regional Team Lead for Sciences, Systems and Services at the opening ceremony. “But as HIV has taught us, to reach people, we must confront the realities of their lives.”

Toolkit now available for Asia Pacific health workers

On day 2 of the symposium UNAIDS and UNODC launched the first-ever toolkit on chemsex for Asia Pacific clinical service providers. The toolkit was developed by the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). It is geared toward health workers in Asia and the Pacific working with men who have sex with men and transgender women.

"The increasing use of stimulant drugs in the region, including for ‘Chemsex’, poses significant health risks, including drug use disorders and various psychosocial challenges," said Masood Karimipour, Regional Representative of UNODC’s Office for Southeast Asia and the Pacific. "This UNAIDS-UNODC toolkit provides essential guidance for healthcare providers to address these challenges through evidence-based interventions. It emphasizes the importance of holistic, non-judgmental care that prioritizes the physical, psychological and social wellbeing of individuals, while ensuring access to harm reduction services and the prevention and treatment of drug use disorders within a comprehensive continuum of care."

The resource was created to support comprehensive clinical services in the region’s restrictive legal environments. Twenty-eight countries in Asia Pacific criminalise drug possession for personal use while 17 criminalise same-sex relations. Penalties for drug-related offences in the region are among the world’s harshest.

The toolkit was developed through consultation with clinicians, community representatives and government agencies. It covers chemsex basics as well as approaches to harm reduction, sexual health, and mental health services. It also covers different service delivery models including face-to-face, online and by communities. The toolkit offers guides and tools on topics such as initiating non-judgmental conversations and risk assessment.

“Stronger HIV prevention strategies tailored to chemsex are needed, along with expanded, inclusive services for sexual, physical and mental health,” said Suniya Taimour, UNAIDS’ Community-led Responses Advisor for Pakistan and Afghanistan.

Thia approach recognises that comprehensive health services can be lifesavers by using one point of contact to address multiple issues including physical, sexual and mental health as well as social issues. Poon is a living example. He has benefitted from a service package that has combined his HIV treatment with harm reduction interventions and psychiatric care. Today he is a 22-year-old university student with clear life goals who feels more empowered about his HIV status.

In 2020, a gay Thai man living with HIV sparked controversy with a Facebook post. He was on antiretroviral therapy and had gotten lab tests to check the level of virus in his blood. Since his viral load was undetectable, he wrote, he was going to stop using condoms.

The public responded with a mix of contempt and disbelief. How could he? So selfish! So reckless! The resulting debate spilled from social media onto national radio and TV.

“There was a huge backlash,” remembered Dr Nittaya Phanuphak, the Executive Director of the Institute of HIV Research and Innovation (IHRI). She was telling the story from IHRI’s sunlit offices to teams from Botswana, Ghana, Ivory Coast, Jamaica, Mozambique, South Africa and Zambia. They’d come to Bangkok as part of a learning exchange coordinated by the Global Partnership for Action to Eliminate all Forms of HIV-related Stigma and Discrimination.

Dr Nittaya said that she and her father, Professor Praphan Phanuphak, thought it was their duty to contribute to the public discourse. While the man’s approach might have been unconventional, the science behind his statement was sound.

They would know. Professor Praphan diagnosed Thailand’s first HIV case in 1985 and dedicated his life to HIV research, service delivery and advocacy. He co-founded the Thai Red Cross AIDS Research Centre which in 2014 conducted cutting-edge research as part of the Opposites Attract Study. Done in Australia, Brazil and Thailand, that study tracked couples in which one person was HIV-negative and the other was living with HIV but had achieved an undetectable viral load through successful HIV treatment.  It confirmed that after two years of unprotected sex, there were no cases of HIV transmission between more than 300 couples. 

“It’s a scientific fact,” Dr Nittaya said. “For me, I felt like we really needed to do something. We cannot just wait 50 years for this knowledge to gradually seep into Thai society.”

The “knowledge” to which she refers is the concept of undetectable = untransmittable, or U=U for short. Last year the World Health Organization further endorsed the principle, stressing that when a person’s viral load is undetectable there is zero chance of sexual transmission.

“Before, HIV treatment just meant longevity,” said Pan (not his real name), a person living with HIV. “But with U=U, now it is love without fear.”

Within three to six months a person who takes their HIV treatment as prescribed and receives viral load monitoring can confirm that they have achieved an undetectable viral load. This removes the self-stigma associated with having an “infectious” disease. For Thai HIV response stakeholders, this concept can also transform the public’s attitudes about people living with HIV, making it easier for them to live full, happy lives.

“If social perceptions can be brought in line with the reality of HIV treatment, we can remove the stigma around getting an HIV test or diagnosis,” said Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia. “The more supportive the society, the more people we successfully treat and the fewer new infections.”

But for the U=U strategy to be fully utilized, work must be done to dispel myths and bolster confidence in science.

According to UNAIDS Country Director for Thailand, Dr Patchara Benjarattanaporn, a key step in the national process was bringing decision-makers together with relevant stakeholders, including voices from communities.

“They considered both global and local evidence,” she explained. “Now there is consensus about the science. U=U also conveys the message ‘you=you’, affirming that all individuals are equal and that people are more than their HIV status. It emphasizes the importance of ensuring people are fully informed about their options and respecting their right to make choices about their sexual health depending on their realities.”

At the opening ceremony of the eight-country learning exchange, Dr Niti Haetanurak, Department of Disease Control Deputy Director, noted that the U=U concept is a key element of Thailand’s “all of society” strategy to address the prejudice and rights violations people living with HIV face. Thailand has a National Costed Action Plan to Eliminate all forms of HIV-related Stigma and Discrimination. The Ministry of Public Health and Sub-National Committee on AIDS Rights Promotion and Protection under National AIDS Committee coordinate the effort. Community organizations play a leading role.

During the exchange the country teams visited the Service Workers in Group (SWING) Foundation which serves sex workers and IHRI’s Tangerine Clinic which primarily serves transgender people. Both have come up with innovative approaches to ensure groups that usually find it challenging to receive healthcare at state-run facilities can get HIV and sexually transmitted infection (STI) testing and treatment in a friendly environment.

A key strategy is training members of those very communities to provide certain services themselves. They can even start clients on treatment for HIV and some other conditions the same day they are diagnosed. This approach makes it less likely for people to disappear into the shadows after diagnosis, with a high chance of infecting others and eventually becoming ill.

“This community-led health model can be applied to any health condition or population. But this does not really address stigma and discrimination. It just bypasses it by opening up alternative service delivery outlets for people who want to avoid negative experiences elsewhere,” Dr. Nittaya said.  “We need to address the heart of the stigma as well. That is why we are working on using U=U as a tool to explore how we can shift attitudes.”

The Bangkok Metropolitan Administration (BMA) is integrating this concept into its work in healthcare settings and the workplace. A masterplan is in the works. One branch of the strategy will tackle employers requiring HIV testing in the pre-employment phase or targeting employees they find out are living with HIV. Another aspect of the approach is the integration U=U into all levels of HIV service delivery and ongoing healthcare worker sensitization. All staff in clinics and hospitals are trained, not just nurses and doctors.

The work doesn’t stop there, though. Describing the Bangkok society as “open”, Dr Tavida Kamolvej, Deputy Governor of Bangkok, said that the whole of society was ready for deeper conversations about inclusion and HIV. But how could these approaches be applied in other countries and cities that are not quite as tolerant or accepting, she was asked.

“If you are confronted with beliefs that might not allow open conversations about HIV, sexuality and sex, you can strategically make it about health literacy, dignity and care for all people. I think this is soft enough to make people aware about health and wellbeing,” Dr Tavida advised.

Click here to learn more about the recent eight-country learning exchange to eliminate all forms of HIV-related stigma and discrimination.  

GENEVA, 1 October 2024—UNAIDS expresses deep concern over the recently adopted anti-LGBTQ+ legislation in Georgia, which poses serious risks to public health and human rights.

UNAIDS supports the UN Office for the High Commissioner of Human Rights' statement that these laws will “impose discriminatory restrictions on education, public discussion, and gatherings related to sexual orientation and gender identity.”

These discriminatory laws violate fundamental rights to autonomy, dignity, and equality, exacerbating stigma and hindering LGBTQ+ people's access to essential health services. This undermines Georgia’s efforts to end AIDS and combat other infectious diseases.

UNAIDS reiterates that laws discriminating against LGBTQ+ individuals have no place in modern society. They lead to harassment, discrimination, violence and social exclusion, jeopardizing efforts to end the HIV epidemic. We call on Georgian authorities to repeal these harmful laws, as they will further isolate marginalized communities and worsen public health outcomes.

Stigma kills, but solidarity saves lives. Upholding the rights of LGBTQ+ people is crucial to advancing public health, social cohesion, and equality for all.

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.