In 2019, 48 countries and territories impose some form of HIV-related restrictions and mandatory HIV testing that prevent people living with HIV from legally entering, transiting through or studying, working or residing in a country, solely based on their HIV status.

Mehdi Beji (not his real name) couldn’t wait to start his new job in a North Africa Middle East country. He had packed his belongings and said his goodbyes in Tunisia and filed all the paperwork requested by his new employer. Before his contract was approved, he had submitted the results of the blood tests he had been asked to take, but after he started work he was requested to get his blood tested again.

“After a month, I was contacted for an appointment to get my credit card, and when I arrived at the mall, I was arrested by the police,” Mr Beji said.  At the police station he was informed he was HIV-positive and that the country’s laws deny residency to people living with HIV.

"They deported me back to Tunisia without money and I was not able to recover my two months salary,” Mr Beji said. “When I contacted the bank, they informed me that the only way to access my account was through the bank card that they refused to grant me.”

Treated like a criminal

For 12 years Karim Haddad (not his real name) lived and worked in a North Africa Middle East country. As part of his medical check-up for his residency permit, his blood was tested for HIV without his consent. On the day he went to collect the test results, he said, police officers handcuffed him and locked him in a room.

Four days later, the authorities informed him that his deportation was imminent because of his HIV status. “I didn’t know anything about the virus, so I asked what HIV is and got no answer,” Mr Haddad said. He recalled feeling paralysed with fear.

When he asked about his wife and children, he was told that they would all board the same flight and would meet him at the airport. As for his financial rights or his belongings, he said they just kept repeating, “You have no rights.”

“I left the country as if I were a criminal,” Mr Haddad said, still in disbelief.

Nightmare

The above tales are experiences that Amina Zidane (not her real name) knows all too well. She left Algeria at the age of 19 for work. After a few years, her annual medical check-up did not go as usual.

“I could hear the nurses whispering to each other, “This is the one.”” She suspected something was wrong, so she asked her sister, who had accompanied her to the clinic, to get her results. “My sister told me that the police were downstairs saying that they had come “to arrest a woman with AIDS,”” she said.

She recalled being taken to jail and prayed that there had been a mistake or that it was just a bad dream. “They did not open the door, they just sent me food through a small window," Ms Zidane said.

A week later, the authorities deported her. “I was left at the border with my passport and my son,” she said. Her husband escaped because he didn’t want to be deported. “Fourteen years of my life disappeared just like that and I had done nothing wrong.”

Lost son

Sabrina Abdallah (not her real name) lived in a North Africa Middle East country most of her childhood. After passing a computer science degree, she married a fellow Sudanese. They rejoiced when they had a baby boy.

At barely three months old, their son’s cold would not clear up. Despite being in a hospital, his condition didn’t improve. “It's really hard to see one’s child suffering and feeling so helpless,” she said. At first, her doctor thought that her son might have cancer, but he was eventually tested and found to be living with HIV. “While I was in the midst of my anxiety and fear, news spread at the hospital about my son, and they placed him alone in a room, with no one looking after him,” she said.

Ms Abdallah tested for HIV and found out that she was also living with HIV. “They asked me to take my son and go home,” she said. “They wouldn’t let us leave him at the hospital and even assigned a police officer to escort us and make sure we would not leave the baby behind.”

Child in hand, she tried to get some answers. That’s when her husband told her he had known his HIV-positive status all along. She couldn’t understand why he would hide something like that from her. The police took her husband to jail and 10 days later they were all deported to the Sudan. She started treatment but unfortunately it was too late for her son.

She eventually divorced her husband because, she said, she could never forgive him for the death of their son. 

Student uprooted

For two years, Miriam Pepple (not her real name) studied at a university in central Europe. She paid her tuition fees and adapted to student life far from home. When she started having abdominal pains, she went to the student clinic. They advised her to have surgery. She had blood tests done, but thought nothing of it, since she had submitted her clinical tests to get a student permit while in her home country, Nigeria.

She said that the university asked her to take more blood tests and to bring her passport. After being told to visit various offices at the Ministry of Health, she was told to report to a police station. A day later, the authorities handed her an airline ticket to Abuja, Nigeria, along with a letter from the immigration office that claimed that she was an inadmissible immigrant.

What shocked her even more, she said, is the letter she received from her university. “They said that I had terminated my studies on my own accord,” Ms Pepple recalls.

“I lost my self-esteem, dignity and respect,” she said. Her hope is that no one should ever go through such treatment because of the huge social and psychological affect it had on her.

Life crushed

Pradeep Agarwal (not his real name) was a successful businessman, working throughout the Middle East. He worked in three Gulf countries for more than 10 years until his life came crashing down around him.

“In a matter of hours, I lost my job, my dignity and my home,” Mr Agarwal said. “I was informed I was HIV-positive and had to leave the country.” He recounts being escorted by the police to a quarantine room. “After being treated for years with respect and dignity, I found myself with other people from all nationalities, among them doctors and engineers, treated in the same inhuman way,” he said.

“I was not even given a medical report that could enlighten me and I was spoken to in Arabic, which I do not understand,” he said. “I suddenly had become a criminal in their eyes.”

After his return to India, he became depressed and has been unable to find another job. He believes that deporting people who are living with HIV gives governments a false assurance that their societies are safe. “In fact, these travel restrictions and expulsions drive people underground, so it makes the situation worse,” Mr Agarwal said. “I want people to be more aware of these violations,” he added. “I want them to stop, so others do not suffer the same horrible fate I suffered.”

UNAIDS believes that these laws discriminate, impact on human rights and have no public health justification.

“For many of the millions of people living with HIV around the world, travel restrictions are a daily reminder that discrimination continues to be entrenched in harmful policies,” said Luisa Cabal, UNAIDS Director, a.i., of the Community Support, Social Justice and Inclusion Department. “They deny people’s freedom and, even worse, force people to abandon their workplace, school and home.”

At the 2nd European Games 2019 taking place in Minsk, Belarus, athletes and spectators are receiving information about HIV, free access to condoms and the possibility of taking a free rapid HIV test. 

Thanks to a partnership between UNAIDS, the directorate of the games, the ministry of health of Belarus, the parliament of Belarus, civil society organizations and the United Nations country team, Zero Discrimination zones offering HIV services have been established throughout the site hosting the games.

The main #zerodiscrimination pavilion was opened by the UNAIDS Ambassador for the European Games, Alexei Yagudin, the world champion figure skater and olympic gold medallist.

“The 2nd European Games are free from discrimination for everyone – regardless of your nationality, age, gender, sexual orientation or HIV status,” said Mr. Yagudin.  

The UNAIDS Zero Discrimination zones are placed around the official fan zone, the main sports stadium and in the athletes’ village. The zones are staffed by more than 90 dedicated volunteers, mostly doctors and nurses, who provide HIV information, HIV counselling and rapid testing and access to free condoms. Ahead of the games, UNAIDS had also provided extensive training on HIV and sexual and reproductive health to hundreds of volunteers.

In addition, the national TV Channel ONT, in close collaboration with UNAIDS, produced two public service announcements on zero discrimination and equal opportunity for all. They have been broadcast in more than 20 public venues in Minsk, on all national TV channels and during live broadcasts of the games.

Carrying the official torch of the games, the “Flame of Peace”, UNAIDS regional director Vinay Saldanha said “I am proud to carry this Flame of Peace on behalf of UNAIDS and on behalf of people who deserve to live free from discrimination, including people living with HIV that are competing in and visiting these games in Minsk.”

The 2nd European Games opened officially on 21 June and will continue until 30 June. More than 4000 athletes from 50 countries are participating in the Games, competing in 15 sports across 23 disciplines, 8 of which will also serve as qualifying events for the Olympics Games 2020 in Tokyo.

“The job has just begun. We have come a long way, but we still have a lot to do.” That was the message from Ajit Prakash Shah, who delivered the Delhi High Court judgement in 2009 that led the way to the eventual annulling in 2018 of Section 377 of the Indian Penal Code, which criminalized same-sex sexual relations.

The retired Chief Justice of Delhi High Court was speaking at a meeting hosted by UNAIDS and partners in New Delhi, India, on 15 and 16 May on the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people in India.

“Our aim is to mobilize and organize the community so they can together help each other,” said Bilali Camara, UNAIDS Country Director for India.

The speakers noted that despite recent legal judgements―including the annulling of Section 377 and the decision by the Supreme Court of India in 2014 on the rights of transgender people―the situation for LGBTI people in India had not changed drastically. However, it was noted that there is a perception that there is an increasing understanding of the issues of transgender people among the general public.

“The reason for the spike in crimes against lesbian, gay, bisexual, transgender and intersex people is partly due to a lot of cases now being reported, while earlier they were not being reported. The National AIDS Control Organisation has worked with communities that at one time in history fell onto the other side of the law. It has built models that have worked and are being replicated around India,” said Shree Alok Saxena, the Joint Secretary of the National AIDS Control Organisation.

Marietou Satin, Deputy Director of USAID, India, said, “Excluding any section of society is not only a moral evil, but it also impacts a country as a whole. You are denying a large population from being productive members of society. By including them, you are also investing in your economy. They have a right to contribute. For that, people need access to jobs and safety in the workplace.”

The meeting also saw the establishment of an LGBTI taskforce to provide strategic advice to UNAIDS and the United Nations Development Programme in India on current and emerging LGBTI issues in India, and on policy, programmes and services to address those issues.

The participants noted the need end discrimination, sensitize political leaders and policy-makers and ensure that the LGBTI community has access to all services, including health and education, and employment.

“If I want to see the change, I need to be the change,” said Aniz Mitha, the Executive Director of Community Health Rights Advocacy (CHeRA), an organization that works with male sex workers in Malawi. When Mr Mitha speaks of change, he does so with the quiet and unwavering authority of someone who knows what he is talking about.

From a conservative Muslim family in Malawi, Mr Mitha was thrown out of the house at a young age when his parents found out that he was gay. With nowhere to go and no means to support himself, he fled to Johannesburg, South Africa, where he spent many years as a sex worker. “For me, I was looking to survive; I wasn’t thinking about my health,” he said.

When he became ill, he took an HIV test, and he learned that he was living with HIV. Being an illegal immigrant, he couldn’t access health-care services in South Africa. He returned to Malawi, where he began HIV treatment and started CHeRA. “I thought: how can I help others not go through the same experience that I did?” he said.

CHeRA raises awareness and builds the capacity of male sex workers on HIV prevention and treatment, sexual and reproductive health and rights, economic empowerment, psychosocial support and access to justice. Through a UNAIDS funding arrangement, it recently reached more than 250 male sex workers in three priority districts in Malawi, distributed more than 30 000 condoms and lubricant and linked six male sex workers living with HIV to care and treatment. In another programme funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the organization has trained 50 peer educators and distributed more than 6000 condoms and condom-compatible lubricant.

Mr Mitha is keenly aware of the many challenges that face male sex workers, having faced them himself. “In Malawi, sex work is not recognized as work, so there are no laws to protect sex workers. Also, most of our male sex workers are gay men or men who have sex with men, so they live in fear of arrest because homosexuality is illegal in Malawi,” he said.

Stigma and discrimination is institutional, he said. “Male sex workers are not recognized as a key population in the HIV response in Malawi, so we are not prioritized in government plans. And negative attitudes from health-care workers push us away from care.”

“Say I am being abused or beaten and I go to a police station,” continues Mr Mitha, “I will get questions like “Why you are dressed like this or why do you speak like this?” The abuse is institutionalized. It pushes us away, so even in terms of health care, we go to private hospitals where we pay money even if we don’t have money.”

CHeRA is now registered as a nongovernmental organization. Although started in 2016, it was only registered in 2017 after UNAIDS played a pivotal role in amending provisions in the Malawi HIV and AIDS Management Control Act of 2018 that criminalized or discriminated against certain groups, such as sex workers. This paved the way for organizations of lesbian, gay, bisexual, transgender and intersex people and sex workers to be registered.

Like many people who serve others, his work has spilled over into his private life. Knowing what it feels like to be disowned by one’s family, Mr Mitha gives shelter to people who have nowhere else to go, who stay as long as it takes until they can look after themselves.

He has built an unshakeable sense of self, family and community through his work and his life. “I am living openly with HIV and as a gay person; I am a role model to so many. They see that it is possible. I see a lot more people like me opening up and living openly as gay and with HIV,” he said.

Mr Mitha wants to grow CHeRA into an organization that is a strong advocate for equitable access to health care for male sex workers.

“We need more financial support to expand the work we do,” he said. “We provide access to HIV prevention information and services to a population that is being left behind. It is making a difference. When you are working as a community organization, it means what affects my community affects me too,” he said.

Discriminatory laws drive key populations out of reach of critical health and social services

GENEVA, 16 May 2019—Ahead of the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), on 17 May, UNAIDS is calling on all countries to remove discriminatory laws against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

Stigma towards key populations—gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people—is reinforced by criminal laws. These in turn fuel violence, exploitation and a climate of fear, hindering efforts to make HIV services available to the people who need them.

“We all have a moral and legal obligation to remove discriminatory laws and enact laws that protect people from discrimination,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “To end the AIDS epidemic, people need to be protected from harm. We need justice and equality for all.”

More than 65 countries criminalize same-sex sexual relations, including at least eight that impose the death penalty. Globally, gay men and other men who have sex with men are around 28 times more likely to acquire HIV than the general population and are much less likely to access HIV services. In 2017, gay men and other men who have sex with men accounted for 18% of new HIV infections worldwide.

“It is critically important that we create a world where all people can access the health and social services they need without the threat of violence and discrimination. Universal health coverage means reaching all people―sexual and gender minorities have the same right to health as everyone else,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

Transgender people, who account for an estimated 0.1–1.1% of the global population, often face stigma, discrimination and social rejection in their homes and communities. Discrimination, violence and criminalization prevent transgender people from accessing the HIV services they need to stay healthy. It is estimated that transgender women are 13 times more likely to acquire HIV than other adults of reproductive age and that 16.5% of transgender women are living with HIV.

“Justice and protection for all are central to driving progress on the 2030 Agenda for Sustainable Development and the Sustainable Development Goals. Enacting and enforcing non-discriminatory laws and policies, repealing punitive laws and ensuring access to justice for all are critical to delivering on the commitment to leave no one behind,” said Achim Steiner, Administrator of the United Nations Development Programme.

UNAIDS joins with the United Nations Secretary-General and the United Nations High Commissioner for Human Rights in calling for the decriminalization of LGBTI people and for LGBTI people to be protected from violence and discrimination and to have full access to health and other social services.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May.

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.

New global survey aims to fill the data gap on the mental well-being of lesbian, gay, bisexual, transgender and intersex (LGBTI) people to create better conditions and improve health

GENEVA, 14 May 2019—UNAIDS and the LGBT Foundation have launched an online survey to evaluate happiness, sex and quality of life for LGBTI people. The survey, the first of its kind, is part of a campaign to gain more information and insight into the challenges faced by LGBTI people. The data gathered will help to voice the concerns and advocate for improving the conditions and treatment of LGBTI people, including ensuring access to inclusive health and social services.

“Many lesbian, gay, bisexual, transgender and intersex (LGBTI) people face stigma and discrimination daily in education, work, health and social settings. We want to understand how this affects wellness, including mental well-being, and also their responses and resiliencies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “By examining in depth how economic, socioecological, homophobic and other variables impact the lives of LGBTI people, we will be able to advocate more strongly for meaningful change to improve their lives.”

LGBTI people have to contend with stigma and discrimination and are often faced with a lack of economic opportunities and a lack of access to health and social care. They are also at much higher risk of HIV infection. Estimates show that the risk of acquiring HIV is 27 times higher among gay men and other men who have sex with men and 13 times higher among transgender people, yet studies show that many gay men and other men who have sex with men and transgender people avoid seeking health services for fear of stigma and discrimination.

Although there are studies that evaluate the well-being of LGBTI people through measuring levels of violence, legal status and health―often HIV risk and status―few look at the mental well-being of LGBTI people, which is essential to ensuring their overall health and access to economic opportunities.

Data are also lacking on LGBTI people in Africa, Asia and Latin America, which the survey hopes to address. Available in more than 17 languages, the survey has been distributed through social media to more than 25 million people around the world and will run until the end of July 2019.

“We want progress in lesbian, gay, bisexual, transgender and intersex (LGBTI) health and well-being. We want it now and this survey will help in this direction. It is a great initiative, where LGBTI people can confidentially speak up and build the knowledge to empower, raise public awareness and advocate, with an ultimate goal of eliminating stigma and discrimination against LGBTI people. It will be extremely helpful to the community,” said Sean Howell, Chief Executive Officer of the LGBT Foundation.

The survey was developed in collaboration with Aix-Marseille University and the University of Minnesota and was designed in collaboration with representatives of the LGBTI community, including people living with HIV. To ensure the highest standards with respect to privacy and the protection of personal data, the survey complies with the General Data Protection Regulation.

To secure and safeguard anonymity, access is provided via a secured weblink, which establishes an encrypted link between a web server and a browser. The research protocol for the survey has been approved by the Research Board of Ethics of Aix-Marseille University and by the Research Ethics Review Committee of the World Health Organization.

The survey is open for participation until 31 July 2019 and takes about 12 minutes to complete.

To participate in this groundbreaking survey, click on the following link: https://www.research.net/r/LGBTHappinessResearch.

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.

According to the World Health Organization, about one third of women worldwide have experienced violence. In some regions, women who have experienced physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced such violence. Among marginalized populations, such as sex workers or transgender women, a high prevalence of violence is linked with higher rates of HIV infection.

In the Middle East and North Africa (MENA) region, UNAIDS estimates that around 220 000 people are living with HIV. New infections were up by 12% between 2010 and 2017 and AIDS-related deaths increased by 11% over the same period. The stigma and discrimination associated with HIV as well as high levels of gender-based violence are preventing several countries from making progress against the epidemic. Gender-based violence in the region is strongly associated with harmful gender norms and stereotypes.

In 2018, the LEARN MENA project was launched to provide women with a platform to share experiences and explore the linkages between gender-based violence and HIV in the region. Underpinning the project is the Action Linking Initiatives in Violence against Women and HIV Everywhere (ALIV(H)E) framework, a research project that collates evidence on what works to prevent violence and builds women’s awareness to understand and address linkages between violence against women and HIV.

Through community dialogues led by MENA-Rosa, a regional network of women living with or affected by HIV, women are strengthening their own understanding of the root causes of violence and the links with HIV. The dialogues have highlighted the fact that gender inequality is at the centre of violence against women and an increased risk of HIV infection. For example, through the dialogues it was revealed that some women had never been to school. Many had experienced early or forced marriage. Many women acquire HIV from sexual violence, including within their own marriage.

“Violence is everywhere. Over time, and as you get older, you get to see it as normal,” said an Algerian woman participating in one of the dialogues. 

The participants described multiple forms of violence across different settings, including in health-care settings, which impede their access to health care, including to HIV prevention and treatment services.

So far, the project has been implemented in seven countries―Algeria, Egypt, Jordan, Lebanon, Morocco, Sudan and Tunisia.

Findings from the project are helping women living with and affected by HIV to advocate for an improved response to the epidemic in the region and for measures to reduce the impact of violence against women. The dialogues have amplified the voices of marginalized women living with and affected by HIV, encouraging decision-makers and partners to build strengthened national community responses. UNAIDS is supporting countries to implement the recommendations and action plans developed from the project.

“MENA-Rosa leaders have learned through this painful process that violence against us should be denounced and not brushed under the carpet,” said Rita Wahab, Regional Coordinator of MENA-Rosa. “Empowerment will help women in all their diversity to know and understand their rights. Our advocates will move forward to expose the links between violence against women and HIV. Gender equality starts at home, grows in society and blossoms in the legal environment.”

LEARN MENA is implemented by UNAIDS, Frontline AIDS and MENA-Rosa, with funding support from USAID. Additional technical support is provided by the Salamander Trust, the lead author of the ALIV(H)E framework.