GENEVA, 22 May 2022—UNAIDS has expressed concern that some public reporting and commentary on Monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes and exacerbate stigma. Lessons from the AIDS response show that stigma and blame directed at certain groups of people can rapidly undermine outbreak response.

Since May 13, 2022, an outbreak of Monkeypox has been reported in multiple UN member states where cases are not usually reported. As of May 21, the World Health Organization received reports of 92 laboratory-confirmed cases and 28 suspected cases from 12 Member States not endemic for the disease. A significant portion of the cases have been identified among gay, bisexual, and other men who have sex with men, with some cases identified through sexual health clinics. Investigations are ongoing.  WHO notes that available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, and that risk is not limited to men who have sex with men.

UNAIDS urges media, governments, and communities to respond with a rights-based, evidence-based approach that avoids stigma.

“Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” said Matthew Kavanagh, UNAIDS Deputy Executive Director a.i. “Experience shows that stigmatizing rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures. We appreciate the LGBTI community for having led the way on raising awareness – and we reiterate that this disease can affect anyone.”

The Monkeypox outbreak illustrates that communities will continue to face threats from viruses, and that international coordination and solidarity is essential for public health as viruses can only be overcome globally.

“This outbreak highlights the urgent need for leaders to strengthen pandemic prevention, including building stronger community-led capacity and human rights infrastructure to support effective and non-stigmatizing responses to outbreaks,” noted Dr. Kavanagh. “Stigma hurts everyone. Shared science and social solidarity help everyone.”

UNAIDS urges all media covering Monkeypox to follow the regular updates being issued by WHO.

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.

The prevalence of discriminatory attitudes towards people living with HIV varies widely. Across nearly all regions, there are countries where large proportions of adults continue to hold discriminatory attitudes towards people living with HIV.

In 52 of 58 countries with recent population-based survey data, more than 25% of people aged 15 to 49 years reported holding discriminatory attitudes towards people living with HIV, and more than 50% held discriminatory attitudes in 36 of 58 countries.

The high level of stigma and discrimination against people living with HIV and various key populations continues to hamper the fight against aids. Around the world, people or groups deemed ‘different’ are targeted for many different and unjustified reasons. In the context of HIV, discrimination, which refers to the unfair or inequitable treatment of individuals based on their actual or perceived HIV status, hinders the identification of risk and the provision of care for those affected. HIV-related discrimination and stigma are rooted in pre-existing social inequalities and reinforce them, further excluding those affected by the virus and fuelling the epidemic.

On the occasion of the Zero Discrimination Day on 1 March 2022, UNAIDS, together with the National Network of Associations of People Living with HIV (RNP+) of Senegal and Trace Senegal, invited students from BEM Management School in Dakar to join in for a conversation about HIV. This is an opportunity to deepen the understanding of HIV and its response, and to share situations of HIV-related stigma and discrimination. It is also intended to foster commitment to overcoming these barriers within a community of students who could potentially hold leadership positions in the future. 

"We are very committed to raising awareness of HIV and other sexually transmitted infections to protect the health and well-being of our students," said Mr Diakhaté, Director of BEM Dakar. "We immediately seized the opportunity to host UNAIDS and its partners here, as we know that this interaction can play a key role in the development and engagement of our students as members of society and as professionals. We remain committed to the CEO's vision of seeing our students become activists and actors in a world of peace, tolerance and responsible progress.” The discussion took place in a friendly and open environment, which helped building trust between the speakers and the students and encouraged dialogue.

Knowledge of HIV among 15–24-year-olds in Senegal and West and Central Africa remains limited. Only 27.5% of young Senegalese can correctly identify the means of preventing sexual transmission of HIV and reject the main misconceptions about the spread of the virus. Educating students about HIV to combat discrimination is therefore a crucial intervention for HIV prevention.

To raise awareness among students, key actors in the fight against HIV-related discrimination and stigma were keen to share their experiences.

Soukeyna Ndiaye, an activist deeply committed to people living with HIV and President of RNP+, talks about her experience. She recounts how she was excluded by her family, who wanted to deprive her of "her responsibilities as a wife and mother" after learning of her HIV status. "People looked at me with pity, as if I was already dead.” Her children also suffered from discrimination at school, especially from teachers who organised school meetings to discuss their 'case'. Today, thanks to medication, Soukeyna is healthy and none of her seven children have HIV. In a world without discrimination, she would live a normal life.

Wassour Touré is the President of the Association Départementale And Juboo (ADAJ), an organisation of people living with HIV. In Wolof, And Juboo means “living together in peace and tolerance.” He shares a powerful testimony about the discriminatory treatment he witnessed in a hospital. "People living with HIV had to wait until all the other patients had been taken care of before they could be seen. They were put on a separate bench, waiting for a doctor to deal with them separately.” There was indignation and astonishment in the room, reflecting real empathy from the students, but also showing that discrimination and stigmatisation of people living with HIV is a subject that is not sufficiently raised. "I had no idea about this," explains one student, "it shocks me. We need to talk about it. Why have I never heard about this?”

The speakers certainly raised awareness and generated strong reactions among the students. "I was very moved by the story of all these people, and I would really like to help in the fight against all forms of discrimination," says one student.

UNAIDS is hoping to develop a long-term partnership with students. The creation of a focus group and a youth ambassador programme against discrimination and stigma would allow BEM’s and other students to be involved in advocacy activities alongside UNAIDS and its partners. "Students have a contagious energy and determination. This can be crucial in the fight against discrimination and stigma—an area where 'setting a good example' is particularly important," says Patrick Brenny, UNAIDS Regional Director for West and Central Africa. "Working with them can help reach an even greater audience in a personal and credible way. We are delighted with the students' enthusiasm for our project.”

The desire of BEM students to build a more inclusive environment, free of discrimination in all its forms, is particularly encouraging in a country where human rights issues are sometimes contentious, and where there are regular protests in favour of stricter legislation against homosexuality. Young people are the driving force behind Senegal's economic and social development, and it is essential to rely on them to prepare the country's future. Fostering dialogue about HIV and providing students with the necessary knowledge about the virus, prevention, testing, and treatment methods are key elements of this pathway, and a crucial step in empowering young people to fight HIV-related discrimination and stigma.

On 1 March, Marc Angel, a Member of the European Parliament and former champion for the 90–90–90 HIV targets, hosted a virtual Zero Discrimination Day parliamentary event. The event, co-organized by the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination (Global Partnership), brought together high-level speakers who are passionate about ending discrimination in the European Union (EU) and beyond.

The speakers addressed HIV-related rights violations, societal barriers, including laws and policies, and the underlying stigma and discrimination that fuels the AIDS pandemic. Reflecting on their own work and experiences, they discussed how the EU and its member states could advance the work of the Global Partnership in ending discriminatory laws, policies and practices within the EU region and partner countries.

“Stigma and discrimination hurt the fight against HIV/AIDS, as they constitute a major obstacle to seeking testing and accessing or staying on treatment,” said Helena Dalli, the EU Commissioner for Equality. “We can, and must, combat HIV stigma and discrimination, speak up, collect evidence and share facts and knowledge.”

Evidence gathered by community networks and civil society organizations reveals significant levels of stigma and discrimination and other human rights violations that impact people living with and affected by HIV in the EU, which has been exacerbated by the COVID-19 pandemic.

“When it comes to the EU, there are still growing inequalities, which are major barriers in the HIV response,” said Ferenc Bagyinszky, the Executive Coordinator of AIDS Action Europe. “The global AIDS strategy gives an excellent opportunity for the EU and its member states, together with the communities, to work towards ending these inequalities in the EU, especially in relation to the 10–10–10 targets.”

“The EU can make a critical contribution to address HIV-related stigma and discrimination by establishing linkages with its various human rights and gender equality projects,” said Mandeep Dhaliwal, Director of the HIV, Health and Development Group of the United Nations Development Programme.

“By leveraging its expertise, resources and political leadership to support communities and partner countries in ending HIV-related stigma and discrimination wherever it exists, the EU can make a huge contribution to getting the HIV response back on track,” said Matthew Kavanagh, UNAIDS Deputy Executive Director, a.i., Policy, Advocacy and Knowledge.

To date, 29 countries, none of which are EU member states, have joined the Global Partnership.

Luxembourg’s Minister for Development and Humanitarian Affairs, Franz Fayot, announced Luxembourg’s support for the Global Partnership, the first EU member state to do so. “We support the work of the Global Partnership and can only applaud its role in assisting countries in achieving the 10–10–10 targets by removing laws that harm and creating laws that empower. The Global Partnership’s strategic approach and inclusive platform to manage the diverse human rights violations faced by people living with HIV and marginalized populations will be key to addressing counterproductive discriminatory practices,” Mr Fayot said.

“The Global Partnership is a unique opportunity for the EU and its member states to end intersecting inequalities and injustices for a pandemic-resilient Europe and the world,” said Mr Angel.

Catharina Rinzema, a Member of the European Parliament, spoke about the importance of talking about HIV openly, to correct misconceptions and help the public to educate themselves. She also alluded to the stigma and discrimination that lesbian, gay, bisexual, transgender and intersex people face in the EU. “We should have a blood donation policy where it doesn’t matter with whom you have sex, but whether the sex was safe,” she said.

Maria Walsh, a Member of the European Parliament, referred to the effects that stigma and discrimination has on the mental health and well-being of people living with HIV and called for an inclusive and comprehensive EU mental health strategy. “In order to break the stigma and empower HIV-positive people, it is essential that we speak openly and honestly about their lived experience,” she said.

Mr Angel concluded by encouraging EU member states to join the Global Partnership and highlighted the need for global and concerted action to meaningfully advance towards ending HIV-related stigma, discrimination, inequalities and AIDS by 2030. 

Michael James (not his real name) was shell-shocked when he was fired. He scanned the dismissal letter. It cited his performance and tardiness as reasons for the job loss. But years of performance appraisals told a different story. He’d consistently received positive evaluations and there were no memos about late-coming or substandard work on his file. The only reason he could discern was that colleagues recently learned that he was living with HIV.

HIV-related prejudice remains rife in Jamaica. One third of people living with HIV responding to the 2020 Jamaica People Living with HIV Stigma Index reported experiencing stigma and discrimination. Verbal harassment, gossip and discriminatory remarks were the most common violations. But one in 10 said they were refused employment or lost a source of income because of their HIV status. No legislation prohibits a Jamaican employer from discriminating on the basis of HIV status.

This has marked implications for the HIV response. Twenty-one per cent of respondents were worried about mistreatment or confidentiality breaches by health-care workers. Thirty-eight per cent delayed testing and 29% delayed starting treatment because of concerns about how they would be treated.

Shelly John (not her real name) recounts hopping from one treatment site to another before landing at Jamaica AIDS Support for Life. At other facilities she overheard nurses gossiping about patients’ medical histories.

“I felt uncomfortable. If I am hearing about other clients, other clients can come inside and hear about me as well,” she reasoned.

“The fear of stigma drives some persons underground and away from much needed health services. Owing to stigma and discrimination, some persons delay accessing needed services and, as a result, some are diagnosed with HIV at an advanced stage,” acknowledged State Minister in the Health and Wellness Ministry and Chair of the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination, Juliet Cuthbert Flynn.

Jamaica’s testing and treatment outcomes bear this out. While an estimated 86% of people living with HIV were aware of their status in 2020, just 40% of people living with HIV were on HIV treatment.

While the Jamaica Charter of Fundamental Rights and Freedom guarantees protection against discrimination, it is limited in scope. The protected grounds are race, sex, place of origin, social class, colour, religion and political opinions. There are piecemeal anti-discrimination provisions in different pieces of legislation, such as the 2014 Disabilities Act and the 1975 Employment Act. But neither the constitution nor ordinary legislation make discrimination on other grounds unlawful.

Since 2020, UNAIDS and the United Nations Development Programme have been providing technical and financial support to local nongovernmental organizations, including Jamaica AIDS Support for Life, to support the rollout of a national survey on the public’s perspectives and experiences with stigma and discrimination in Jamaica and on the need to have more adequate protections in the law. The results of the survey will be used to advocate for legislation to adequately deal with discrimination experienced by vulnerable and marginalized groups.

The proposed legislation should provide protection across areas including discrimination based on health status, pregnancy or childbirth, hiring or termination decisions and the denial of services to minority groups. It should also address discriminatory conduct based on assumptions about a person’s competence, capabilities, age, self-expression, income level, the neighbourhood in which they live or their educational background.

“Comprehensive anti-discrimination legislation will strengthen the legal framework for the protection of human rights towards achieving equality for all,” Manoela Manova, the UNAIDS Country Director for Jamaica, explained.

In real terms, this means that duty-bearers will have to consider how their policies, programmes and services will affect people with the protected characteristics. Critically, the focus on markers related to poverty would mean that for the first time public bodies will have a duty to consider socioeconomic disadvantage when making strategic decisions about how to exercise their functions and when proposing to use public funds.

“Our overarching finding has been that regardless of health status, sex, age or sexual orientation, the factor that fuels discrimination and makes people more vulnerable is poverty. Moving forward, it is critical that we don’t treat HIV as a stand-alone concern but address the full picture of what makes people marginalized and vulnerable in Jamaica,” said UNAIDS Community Support Adviser for Jamaica, Ruben Pages Ramos.

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform the way they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realized that transgender Guyanese exist and are part of our society. Some thought we should be treated equally and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitization that are needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of health-care providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected. Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalization of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritizing issues that it says go to the heart of transgender’s people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

Humanity is behind in eradicating AIDS by 2030. This delay is not due to a lack of knowledge, capacity or means, but to structural inequalities such as stigma and discrimination which are obstacles to access health services.

Viruses such as HIV or COVID-19 do not differentiate between people, but societies do. They stigmatize and discriminate against people living with HIV, mostly out of ignorance, because they are afraid of the disease.

Discrimination remains one of the biggest battlefields in the Central African Republic and this is why the country was the first in the world to join the Global Partnership to fight against all forms of HIV-related discrimination and stigma.

To make this Global Partnership a reality, a Zero Discrimination Platform was established. It is composed of about thirty partners representing ministries, the National AIDS Council, UN agencies, technical and financial partners, civil society, human rights organizations and other organizations. With UNAIDS support, the Platform called on Ozaguin, the "king of Central African rumba" to use music and art to convey its messages of tolerance and compassion.

At the launch ceremony for Ozaguin's new song against discrimination, which took place on 9 December 2021 at the 20,000-seat stadium in Bangui, he was also nominated as a spokesperson for the Platform.

On behalf of the First Lady of the Central African Republic, the Minister of Health and Population invited every one, and in particular all institutions and influential personalities, not only not to discriminate, but also to fight against discrimination and stigmatization. "We must collectively report discrimination and stigma as soon as we see it and set an example. Discrimination kills. It exacerbates emergencies and fuels pandemics," said Minister Pierre Somsé.

The leadership shown by communities that are victims of discrimination and stigmatization remains a source of inspiration. Their determination, courage and vision are a star in the firmament, as demonstrated by the moving testimony of Ms. Christine Wilikon, a member of the national network of people living with HIV (RECAPEV) during the ceremony. "The first reactions to knowing my positive HIV status were dismay, and a desire to end my life. Rejection by my family members amplified my mental and social disorientation. But the support and advice provided by my parish priest gradually led to my social reintegration through income-generating activities such as petty trade, agriculture and market gardening.”, Christine shared. Her brave words were received with a standing ovation. She urged all Central Africans to put an end to feelings of guilt and shame, and to get tested to know their HIV status and if necessary, take the treatment which is free. 

Members of parliament have reaffirmed their commitment to tackle all forms of HIV-related stigma and discrimination in Jamaica and to help enhance efforts to create an enabling environment for people living with and affected by HIV.

At a meeting co-hosted by UNAIDS and Juliet Cuthbert-Flynn, the Minister of State for Health and Wellness and Chair of the country’s Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, members of parliament, from both the ruling and opposition parties, came together to review evidence on stigma and discrimination in Jamaica and its impact on health outcomes and to craft a way forward in which their role as lawmakers can contribute to eliminating stigma, discrimination and violence.

Jamaica’s legal landscape poses substantial barriers for people living with and affected by HIV to access health services. For example, same-sex sexual relations are criminalized in Jamaica, which continues to represent a considerable deterrent for marginalized communities. Moreover, the country lacks general legislation against discrimination, a national human rights institute and a gender recognition law that could provide further protection for transgender and gender non-conforming people in Jamaica.

Harmful laws, policies and generalized stigma and discrimination against people living with and affected by HIV have a profound negative effect on people’s health outcomes and life prospects. The most recent Knowledge, Attitudes, Practices and Behaviour Survey and the People Living with HIV Stigma Index showed that only approximately 12% of the general population have accepting attitudes towards people living with HIV, while close to 60% of people living with HIV have feelings of self-stigma. A 2019 study about the economic survivability of transgender and gender non-conforming communities in Jamaica found  that experiences of workplace stigma and discrimination were widespread, with about 60% of survey respondents declaring such incidents. Furthermore, 71% of respondents felt that transgender and gender non-conforming people had a harder time getting jobs than cisgender people. Another study suggests that approximately 20% of lesbian, gay, bisexual and transgender people in Jamaica have been homeless at some point of their lives.

In view of these pending challenges in the country’s HIV and human rights response, members of parliament explored creating a working group tasked with performing periodic reviews of relevant data, supporting the enactment of protective legislation, challenging harmful laws and policies and hosting permanent dialogues with communities of people living with and affected by HIV.

“We have a lot of work to do to ensure that all Jamaicans enjoy the full respect, protection and promotion of their rights. This meeting and its outcomes are a small step to achieving that goal, but a step that certainly is pointing us to the right direction on the role that members of parliament should play to end discrimination,” said Ms Cuthbert-Flynn.

These efforts, which aim to tackle deeply rooted misconceptions in society, require strong partnerships. As stated by Morais Guy, the Opposition Spokesperson on Health, who co-chaired the meeting, “The enhancement of people’s rights and collective efforts to ensure that every Jamaican can live a life free from stigma, discrimination and violence is not an issue of only one person, one entity or one political party. It is the business of all of us, to work in partnership for the dignity of all Jamaicans.” 

Members of parliament also discussed some of the challenges that they face as legislators to perform their duties, and the contributions that UNAIDS can make in facilitating a more efficient, effective and transparent law-making process in parliament. Moreover, options to mobilize and engage citizens at the community level to challenge stigma were also discussed in response to the critical need of raising more awareness, tolerance and respect towards people living with and affected by HIV.

“We are proud to partner with members of parliament to tackle stigma and discrimination in Jamaica and to provide all of the evidence, instruments and support that we can mobilize to leverage their role as allies and critical influencers in the future of the country,” said Manoela Manova, the UNAIDS Country Director for Jamaica.