GENEVA, 19 December 2023—During the 53rd meeting of UNAIDS’ Programme Coordinating Board (PCB) held in Geneva, Switzerland, the UNAIDS board adopted decisions on key populations with a focus to increase access to HIV prevention, testing, treatment and other social protection services for transgender people.

Member states and the Joint Programme recognized that each key population, including transgender people, is diverse, and experiences multiple and intersecting forms of stigma and discrimination, and therefore requires evidence-based, data-informed tailored programmes, services and resources that are responsive to their specific needs in the HIV response.

Exact follow-up actions they agreed upon include:

• Address gaps in population size estimates and expand disaggregated data on key populations focusing on existing gaps in transgender populations, in diverse situations and conditions, including through community-led data generation;
• Optimally resource and scale-up tailored and effective HIV prevention, testing and treatment programmes and services that address the diverse needs and circumstances of key populations, including transgender people;
• Increase the proportion of community-led services for HIV prevention, testing and treatment and for societal enablers to reach the 30-80-60 targets, as described in the Global AIDS Strategy 2021-2026, including through mechanisms to increase and facilitate funding and sustainable financing for community-led HIV organizations, including for those led by key populations;
• Address gender inequality, all forms of stigma, discrimination and marginalization, and review and reform harmful and punitive laws and policies that hinder access to HIV-related services for key populations;
• Reinforce an evidence-based public health approach to HIV, particularly in the context of gender equality and human rights;
• Integrate social protection with health and HIV responses by taking people-centered approaches, which addresses economic inequalities making education, welfare, and social protection systems more inclusive of key populations.

And finally, the board requested UNAIDS to reinforce and expand the meaningful engagement and leadership of all key populations, including transgender people, in the HIV response.

This is the first time a member state-led UN body has adopted a consensus decision (without a vote) that includes specific references and commitments to transgender people and actions to be taken by member states. Deputy Executive Director of UNAIDS Christine Stegling said, “We have broken through a barrier. UNAIDS is now fully focused on maximizing the programmatic impact of this decision in-country, for communities and with communities.”

The past two PCB meetings took place midway through the Global AIDS Strategy 2021-2026 so this decision will help UNAIDS focus on achieving the 2025 targets. The UNAIDS PCB is the premier UN and global forum on HIV, bringing together civil society, cosponsors and member states to help chart the future of the response to HIV, including the development of the next Global AIDS Strategy, the vision for 2030 and beyond. The PCB NGO delegates are comprised of people living with HIV and/or key populations including transgender people. They participate in all aspects of the board’s work and strongly advocate for people living with HIV and affected by HIV.

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.

A new report by UNAIDS demonstrates the critical role communities play, and how underfunding and harmful barriers are holding back their lifesaving work and obstructing the end of AIDS.

LONDON/GENEVA, 28 November 2023—As World AIDS Day (1 December) approaches, UNAIDS is urging governments across the world to unleash the power of grassroots communities across the world to lead the fight to end AIDS. A new report launched today by UNAIDS, Let Communities Lead, shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors.

“Communities across the world have shown that they are ready, willing and able to lead the way. But they need the barriers obstructing their work to be pulled down, and they need to be properly resourced,” said Winnie Byanyima, Executive Director of UNAIDS. “Too often, communities are treated by decision-makers as problems to be managed, instead of being recognised and supported as leaders. Communities are not in the way, they light the way to the end of AIDS.”

The report, launched in London during a World AIDS Day event organized by the civil society organization STOPAIDS, shows how communities have been the driving force for progress.

Community advocacy from the streets to the courtrooms to parliaments has secured groundbreaking changes in policy. Communities’ campaigning helped open up access to generic HIV medicines, leading to sharp, sustained reductions in the cost of treatment from US$ 25 000 per person per year in 1995 to less than US$ 70 in many countries most affected by HIV today.

Let Communities Lead shows that investing in community-led HIV programmes delivers transformational benefits. It sets out how programmes delivered by community-based organizations in Nigeria were associated with a 64% increase in access to HIV treatment, a doubling of the likelihood of HIV prevention service utilization, and a four-fold increase in consistent condom use among people at risk of HIV. It also notes how, among sex workers reached by a package of peer-based services in the United Republic of Tanzania, the HIV incidence rate was reduced to below half (5% vs 10.4%).

“We are the vehicle for change that can end systematic injustices that continue to fuel HIV transmission. We have seen groundbreaking developments with U=U, improved access to medicines, and have made great strides in decriminalisation," said Robbie Lawlor, Co-Founder of Access to Medicines Ireland. “Yet, we are expected to move mountains without being financially supported. We are supposed to fight for a more equitable world and are tasked with dismantling stigma yet are side-lined in crucial discussions. We are at a tipping point. Communities can no longer be relegated to the periphery. The time for leadership is now.”

The report highlights how communities are at the forefront of innovation. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. In China, community organizations developed smartphone apps that link people to self-testing which contributed to a more than four-fold increase in HIV tests across the country from 2009 to 2020.

The report reveals how communities are also holding service providers to account. In South Africa five community networks of people living with HIV inspected 400 sites across 29 districts and conducted more than 33 000 interviews with people living with HIV. In the Free State province, these findings led provincial health officials to implement new appointment protocols to reduce clinic wait times and three- and six-month dispensing of antiretroviral medicines.

“I am extremely concerned about the exclusion from health services of key populations like the LGBT+ community,” said Andrew Mitchell, Minister of State for Development and Africa. “The UK champions the rights of such communities, and we will continue to protect them, working closely with our partners in civil society. I thank UNAIDS for keeping us focused on the inequities driving the pandemic and I look forward to working with our partners to champion the voice of people living with HIV and end AIDS as a public health threat by 2030.”

Despite the clear evidence of community-led impact, community-led responses are 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. Underfunding of community-led initiatives is leaving them struggling to continue operating and holding them back from expansion. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS.

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to people most at risk of HIV. However, whereas in 2012, when over 31% of HIV funding was channelled through civil society organizations, ten years later, in 2021, only 20% of funding for HIV was available—an unprecedented backsliding in commitments which has cost and is continuing to cost lives.

“At this time, community-led action is the most important countermeasure in the AIDS response,” said Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition. “Yet, shockingly, it isn’t a cornerstone of global plans, agendas, strategies, or financing mechanisms for improving pandemic preparedness and health for all. It is time to change that.”

Every minute, a life is lost to AIDS. Every week, 4000 girls and young women become infected with HIV, and out of the 39 million people living with HIV, 9.2 million do not have access to lifesaving treatment. There is a Path that Ends AIDS and AIDS can be ended by 2030, but only if communities lead.

UNAIDS is calling for: Communities’ leadership roles to be made core in all HIV plans and programmes; Communities’ leadership roles to be fully and reliably funded; And for barriers to communities’ leadership roles to be removed.

The report features nine guest essays from community leaders, in which they share their experience on the achievements they have secured, the barriers they face, and what the world needs to end AIDS as a public health threat.

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.

As millions of people around the world march in the streets of several big cities this month of June to celebrate and honor Pride Month, in Guatemala, over 200 LGBTIQ+ people in human mobility - applicants for refugee or asylum status or nationals and foreigners in transit – and in need of protection find every year in Asociación Lambda their reason to celebrate pride and life through psychosocial care, legal support, medical follow-up and the provision of a shelter or a safe space to be who they are.

Roberto Gonzales*, a Colombian migrant, is one of them. Like hundreds of thousands of other migrants, he overcame the exhausting experience of crossing the Darien Gap,  a journey in which the dangers include natural hazards and criminal gangs known for inflicting violence, including sexual abuse and robbery. According to statistics from the Government of Panama, from January to April 2023, a record number of 127,000 people crossed the Darien.

Unlike many people who go after the American dream, Gonzales wants to stay in Guatemala because the country has a lot to offer. "LAMBDA, for me, is a unique platform of empowerment. They listen to you; they invite you for training twice a month", he says. "Through Lambda, I have formed a network of friends and support. One should not forget the importance of mental health if we want to move forward."

Asociación Lambda works to improve the livelihoods of this marginalized group by providing technical assistance to community groups in management, governance, leadership, and entrepreneurship skills. Lambda's activities strengthen community organizations through education and training and build action and peer-to-peer learning networks.

Andres Martinez*, from Nicaragua, is thankful to Lambda for their support in successfully processing his refugee claim. In his country, he was persecuted for being a journalist and suffered violence in his community because of his sexual orientation. "It is difficult to reinvent oneself in another country, but my favorite color is green, the color of hope, because I hope one day to return to my country," says Martinez. "Here, at Lambda, I felt supported by a brother. One feels very safe with the staff. The shelter is my second home."

As in many parts of the world, LGBTQI+ people in Central America face a complex reality that exposes them to different forms of violence and discrimination and puts their physical integrity at risk, limits their life options, often forces them to flee their homes, and, in some cases, to escape their own countries. The National LGBTIQ+ Human Rights Observatory, which Lambda coordinates, documented at least 29 violent deaths of LGBTIQ+ people in 2022 in the region, killed for reasons allegedly related to their sexual orientation, gender identity, and gender expression.

As part of the LGBTIQ+ Pride Month activities, Lambda opened the doors of its shelter to a United Nations delegation in Guatemala led by the Resident Coordinator Miguel Barreto for an exchange with migrants hosted and receiving care in their safe space. "I came away from the dialogue more human and supportive, and convinced of the centrality of the United Nations commitment to end discrimination and exclusion, reduce vulnerabilities, and promote the human rights of every human being," said Barreto after the visit and the dialogues.

Along with UNAIDS, several UN agencies, funds, and programmes, like the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM), and the Office of the High Commissioner for Human Rights (OHCHR), have joined forces to support Lambda in different fronts hosting, sheltering and supporting LGBTIQ+ migrants and those in transit or in need of protection.

"Before coming to Lambda, very few of our clients had had sufficient access to information about HIV risks and prevention, many of them are victims of sexual crimes, and it is only when they arrive at Lambda that they are offered information and testing free of charge," explains Carlos Valdés, Director of Lambda. "Some people were already aware of their HIV diagnosis but did not know how to access care services."

Globally in 2021 gay men and other men who have sex with men have a 28 times higher risk of acquiring HIV than the rest of the adult (15-49) male population, and among transgender women, the risk is 14 times higher than adult women (15-49) in the general population

Among over 200 people who came to Lambda in 2022, 19% of the men and 17% of the women lived with HIV.

"The vast majority of these people were trans women and gay men, mainly from Guatemala, Honduras, Venezuela, and Nicaragua," explains Marie Engel, UNAIDS Representative for Guatemala, Nicaragua, and Honduras. "We know that these situations of stigma, discrimination, and violence create barriers to accessing health services, including HIV. We must recognize the greater vulnerability of the LGBTQI+ community to HIV and support their right to health and dignity."

*All names of Lambda beneficiaries in this report have been changed for people’s safety.

At his previous factory job, Tom Wang (not his real name) says coworkers gossiped about his sexuality and made fun of him. When he visited a public health facility for an HIV test, the nurse peppered him with questions like “Why do you need it? Have you been sleeping with many partners?”

Thailand is a country famed for its tolerance. It is among the world’s top locations for gender affirming care. Same-sex sexual activity hasn’t been criminalised since 1956. And the policy tide is turning on other key population issues. A 2021 Drug Law allows for harm reduction as opposed to automatic imprisonment, while a bill is in the pipeline to affirm the rights of sex workers. Yet stigma and discrimination persist. In homes, communities, schools, workplaces and—critically—healthcare settings, discriminatory attitudes can take their toll.

“Microaggressions—intentional or unconscious verbal or behavioural slights toward stigmatised groups—can drive people away from HIV prevention and treatment,” noted UNAIDS Regional Human Rights and Law Adviser, Quinten Lataire. “There are evidence-based approaches for measuring and lowering both overt and subtle stigma and discrimination in healthcare settings.”

It was this need for stigma-free services that led to the establishment of the Rainbow Sky Association of Thailand (RSAT). RSAT offers sexual healthcare for men who have sex with men, migrants, people who use drugs, sex workers and transgender people. It also advocates for the full rights and equity of lesbian, gay, bisexual and transgender (LGBT) communities. Tom Wang is amongst the clients who have benefited from their support.

This work is critical if HIV programmes are to reach and retain key population communities. In Thailand, as in the rest of Asia, these groups carry the heaviest HIV burden. Nationally HIV prevalence is 1% for sex workers, 8% for people who use drugs, 11% for transgender women and 12% for men who have sex with men.

A one stop shop for sexual health services

RSAT’s approach demonstrates how programmes can improve outcomes by implementing strategies to affirm and empower clients. They are jointly supported by PEPFAR, USAID, EpiC, the National Health Security Office (NHSO) and Thailand’s Institute of HIV Research and Innovation (IHRI).

There are no depressing charts or drab walls at their five key population clinics. At the Bangkok site the rainbow motif appears on the floors and walls. There are swarms of cut-out butterflies. Signs are either upbeat and multi-coloured or a soothing blue.

Most of the staff are themselves members of key population groups. All staff receive anti-stigma and discrimination training which even addresses the fine point of body language. Nothing about staff’s interactions should make a client feel judged or uncomfortable. The entire team is retrained annually. There is an internal complaint mechanism that allows clients to confidentially flag issues, as well quality assurance staff to ensure Standard Operating Procedures are followed. Every team member signs a confidentiality agreement.

RSAT’s service package includes on-site testing for HIV and other sexually transmitted infections, Hepatitis C, Tuberculosis and Covid-19. For transgender clients they offer hormone level monitoring. Mental health screenings which evaluate for depression, anxiety and stress have been integrated into the HIV service package. Where required, clients are referred for additional mental healthcare.

“Many of our clients engage in chem sex (recreational drug-use during intercourse). Some clients inject meth so we need to provide more than condoms. They also need clean syringes and needles which are part of our harm reduction package,” said Deputy Director, Kao Kierati Panpet.

Pre- and post-test counselling are critical. All counsellors are certified and accredited by the Ministry of Public Health according to Counsellor Supervisor, Sasiprapha Khamthi. Even before receiving HIV test results, clients know that treatment is available. Following a positive test, the counsellors reassure clients that with treatment they can live a normal life, explained Niphon Raina, Care and Counselling Supervisor.

“We also ask what their concerns are and give basic information about how HIV is and is not transmitted, using a picture book so they are clear on the facts,” Care and Counseling Officer, Bussarin Poonvisitkun added.

RSAT keeps a stock of antiretroviral therapy drugs onsite and can initiate new clients’ treatment on the day of diagnosis by giving them one month’s supply. Although HIV care is provided at the Ratchaphiphat Hospital, RSAT is able to dispense right away in accordance with instructions from a hospital doctor, delivered via telemedicine. Clients living with HIV receive help from the care and support team to navigate their next steps, including attending hospital visits.

RSAT also provides pre-exposure prophylaxis or PrEP services with hospital supervision. Mr. Tom Wang explains how this has protected his health: “I decided to get on PrEP because I am changing partners. To me PrEP is another means of protection in case you are intoxicated or the condom breaks. It’s a way to ensure I stay HIV-free.”

A redress mechanism for rights violations

The organisation advocates for structural changes to eliminate stigma and discrimination. For example, they are currently making recommendations for the Gender Recognition Draft Bill.

“But the reality is that policy and legal changes take a lot of time,” said RSAT Director, Tanachai Chaisalee.

While this longer-term work proceeds, a redress mechanism helps clients address current concerns. RSAT is tapped into the Crisis Response System (CRS) initiated by the Ministry of Public Health in collaboration with the Office of the Attorney General, Ministry of Justice. People with complaints about prejudice or rights violations in any sphere can scan a QR code and report their experience. Reports may also be sent via Facebook, email or LINE, Thailand’s answer to WhatsApp. A multi-disciplinary team conducts investigations and works with the client and other stakeholders to help.

The lion’s share of reports made via RSAT come from transwomen (78%) while gay men have lodged 17% of reports. The most common challenges relate to requirements for gender confirming attire, social exclusion (particularly during job application processes) and HIV status.

RSAT’s Human Rights Manger, Watcharawit Waraphattharanon, shares that they have been able to resolve some cases very quickly. For instance, if a person living with HIV is being forced to take an HIV test as a requirement for work, the Attorney General’s office does an emergency intervention.

“We can close these cases within one week,” he said.

“The work of key population-led, community-based organisations like RSAT is critical to reach those who most need HIV services,” UNAIDS Country Director, Patchara Benjarattanaporn stressed. “The Government’s progress in funding Community-led Health Services and building partnerships between these organisations and the public health system puts us on the path to end AIDS.”

A group of journalists visited the Ozone Foundation as part of the UNAIDS, UNDP, APN Plus and USAID/PEPFAR Southeast Asia Regional Workshop on HIV-related Stigma and Discrimination in Bangkok, Thailand on June 8, 2023. Learn more about this novel training

For many years Mami taught at a state school in Kanazawa, Japan. When she started transitioning and dressing in a less masculine way, her colleagues and supervisors frowned upon it. Finally, she was fired.

As a transgender woman in a small, conservative city, Mami struggled to find another job and felt very isolated. “When a friend invited me to work at the Kanazawa Rainbow Pride community centre, I was happy to have a place where I was accepted,” she said.

Founded in 2022, the Kanazawa LGBTQI+ centre is in a 150-year-old tea house in what was the city’s former Samurai marketplace. The sliding panels allow for a variety of configurations depending on gatherings. Mami and her friend, Kennosuke Okumara, Head of the Kanazawa centre’s secretariat, were serving tea and coffee in the open bar kitchen to visitors.

“Before I worked in Tokyo but I returned to my native city,” Mr Okumara explained. “The problem was that there were and are no options for gay people here,” he said.  Mr Okumara lives with HIV and laments the fact that HIV and LGBTQI+ issues are still taboo. “There is so little information, it is a shame and I am here to share my experience and share more awareness,” he said.

Mixing a green tea in a small cup with a bamboo whisk, Mr Okumara in his apron paused and looked at Mami. “This is a safe space for all here,” he said.

Diana Hoon, the centre’s co-President called the centre a beacon of hope. “We are like a lighthouse in a very conservative, patriarchal society,” she said. Showing off the many pamphlets and flyers varying from knowing one’s HIV status to the Pride parade in the city to books about coming out in the makeshift library, Ms Hoon said that the centre not only was attracting more people, they also had 10 volunteers helping out... many of whom are mothers.

"Our parent seminars about LGBTQI+ have had a lot of impact,” she said. “People share stories about their children and a connection is made.”

As a Singaporean living with another woman who is originally from Kanazawa, Ms Hoon feels like she is doing her part to provide a lifeline for people and push for more acceptance.

“Among our many priorities we do HIV awareness as well as advocate for gender neutral toilets, gender neutral school uniforms and most importantly marriage for all, which does not yet exist in Japan,” she said. She also hopes that within five years they can add a shelter to house LGBTQI+ people.

In her mind there have been incremental steps. “Transgender people have been more outspoken of late and we have LGBTQI+ champions among the community,” she said.

Such a role model is Gon Matsunaka, Founder and former President of the Pride House Tokyo consortium and the Director of the Marriage for All movement in Japan. A former advertising executive for one of Japan’s top firms, Dentsu, Mr Matsunaka hid his sexuality for decades. “For me there was no future in my rural hometown, so I left for Tokyo,” he said. He then studied in Australia, worked in Tokyo as well as New York City and ultimately left his firm.

He came out as gay in 2010 and fixated on providing a community centre in Tokyo. The Olympic Games seemed like a golden opportunity.

The COVID pandemic struck, putting a lot of projects on hold but Mr Matsunaka and his team did not give up.

“In May 2020, survey after survey revealed that LGBTQI+ youth felt unsafe at home or they had lost touch with people, this really motivated me,” he said. He had secured 15 sponsors for a temporary LGBTQI+ safe space during the Olympic and Paralympic Games, called Tokyo Pride House. With the postponing of the Games however, the centre was cancelled.

The team persuaded the sponsors to shift their funding and create a permanent space. Years after the Olympics, Tokyo Pride House still stands proud within walking distance of the popular queer-friendly Shinjuku area in Tokyo.

In Kanazawa, Mr Matsunaka had linked up with Ms Hoon to start a Pride parade in 2021. Out of that success came the idea of a community centre.

Mr Matsunaka is particularly proud that the prefecture (city district) contributed half the funds to the Kanazawa Nijinoma centre. The rest was a result of crowdfunding.

Beaming in the Tokyo Pride House surrounded by rainbow flags, he said, “I never dreamed of this and never imagined it could be possible especially in a small city like Kanazawa.”

In his mind, women have been key. “Women have 2^nd rank to men especially in rural areas like Kanazawa, so they have been our greatest allies to change the patriarchal mentalities,” he said. “Mind you we have a lot more work ahead, but I only want to go forward not backwards."    

On International Day Against Homophobia, Biphopia and Transphobia (IDAHOT), UNAIDS stands in solidarity with the LGBTQI+ community. We must unite and celebrate diversity; a society where everyone, no matter where they live or whom they love, is able to live in peace and security; a society where everyone can contribute to the health and well-being of their community.

Released ahead of the International Day against Homophobia, Transphobia and Biphobia – 17 May 2023

GENEVA, 15 May 2023—Around the world, 67 countries still criminalise same sex relations, with 10 imposing the death penalty. 20 countries criminalise gender diversity. Such laws hurt the public health of everyone, costing lives. Public health and human rights go hand in hand.

“The importance of decriminalising homosexuality and gender diversity cannot be underestimated,” said Christine Stegling, Deputy Executive Director, Policy, Advocacy and Knowledge, UNAIDS. “Decriminalising will save lives and is a crucial step towards equality, dignity, and health for all.”

Across all cultures, sexual orientation, gender identity, and expression are diverse. LGBTQI+ people are part of every society in every country since time immemorial, yet LGBTQI+ people continue to be marginalised and excluded—be it legally, culturally, socially or a combination of all.

Criminalisation, along with pervasive discrimination and violence, obstructs LGBTQI+ people from accessing life-saving services. In a growing number of cases, health service providers are also experiencing being harassed by vigilantes or police for providing life-saving services to LGBTQI+ people.

UNAIDS reports that in countries where same sex relations are criminalised, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalised. Where there have been recent prosecutions, this increases to 12 times higher.

Recognizing that criminal laws have a detrimental impact on the HIV response, United Nations member states at the UN General Assembly committed to ambitious targets in the 2021 Political Declaration on HIV to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalisation as a critical element in the HIV response, countries made a commitment that by 2025, less than 10% of countries would have punitive legal and policy environments that affect the HIV response.

There has been a positive wave of progress. In the past year Antigua & Barbuda, St Kitts & Nevis, Singapore, Barbados and the Cook Islands have repealed old colonial laws which had criminalised same-sex relations. Kuwait’s court overturned a law that had criminalised “imitating the opposite sex”.

Brazil is amongst the countries driving forward progress in advancing the human rights of LGBTQI+ people. The Minister of Health and the Minister of Human Rights will announce that the country will be joining the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination during an event on 17 May. The event will focus on access to care and justice for trans and gender-diverse communities.

However, running counter to the wave of progress is a renewed, well-funded, well-organised international drive to sow prejudice and push discriminatory and harmful new anti-homosexuality legislation and anti-trans legislation.

If enacted into law, this legislation will have extremely damaging consequences for public health, obstructing LGBTQI + people from accessing health services, and obstructing health workers from providing, life-saving services including services to prevent and treat HIV. It is vital for public health that this harmful push be stopped.

On International Day against Homophobia, Transphobia and Biphobia, UNAIDS is calling on all countries to remove punitive laws and tackle prejudices against lesbian, gay, bisexual, transgender and intersex people. A more just, equitable and kind world is a healthier one, for everyone.

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.

On April 14^th members of the Cook Islands rainbow community assembled at parliament with colourful flags and cautious optimism. It turned out to be the day they’d been working toward for the last twelve years. Parliament removed laws prohibiting consensual sex between men, striking out sections of the Crimes Act that had been on the books since the turn of the 20^th century.

“This decision by Cook Islands is part of a wave of global progress around abolishing harmful laws,” noted UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

“This was a huge historical moment,” said Valery Wichman, President of the Te Tiare Association, the nation’s oldest lesbian, gay, bisexual and transgender (LGBT) organisation. “It’s not just a win for the community, but also a shift in terms of our nation maturing and upholding the constitutional rights of all people.”

Ms Wichman, an attorney and public servant, is also an akava'ine—a Māori word meaning transgender woman. She attests that the anti-LGBT laws which made so-called “sodomy” and “indecent acts” punishable by imprisonment reinforced prejudices. This contributed to the LGBT community’s exclusion, harassment and bullying. She has herself experienced being mocked and assaulted.

“A lot of people chose not to live here. It was too hard for them to endure their family’s and society’s judgment. The idea that you are not worthy has carried down from parents to children and has affected how we have been treated by our peers. A lot of trans women have not gone to the doctor because they have been misgendered and have felt disrespected. There have been cases where they ended up dying,” she said.

The journey toward law reform started in 2011. The spark was the discriminatory response to the nation’s first HIV diagnosis. Te Tiare led the advocacy charge with support from organisations including the Cook Islands Family Welfare Association.

A Crimes Bill drafted around 2013 removed the discriminatory clauses. In 2017 parliament set up a Standing Committee to review its raft of proposed revisions. Support for civil society to prepare submissions outlining public health grounds for reforms was provided by the United Nations Development Programme (UNDP), the lead agency amongst the United Nations Joint Programme on HIV and AIDS working on effective democratic governance and issues affecting sexual and gender minorities.

But following a political change the next year, the committee’s Chair recommended retaining the ban on gay sex. What’s more, he proposed a new section criminalising sex between women. The bill remained in limbo for years. Reform efforts seemed to hit a wall.

A strategy of public dialogue and political engagement rooted in Cook Islands culture enabled a breakthrough. Pride Cook Islands (PCI) was formed as a sister organisation to Te Tiare, focusing on this public advocacy branch of work.

“Obviously we are in a unique situation as a small, conservative, religious population,” PCI President, Karla Eggelton began. “The work of advocacy becomes more delicate when you are living beside people making these decisions for you. We welcomed support from international allies, but we knew we had to do this our own way and have our own approach that is mindful of the situation and culture we live in.”

First TCI tackled messaging. There were deep deliberations around word choice. The mandate was to keep the conversation simple. Ultimately the cause was framed as an equality issue. The rallying cry became, ‘don’t make us criminals in our own country’.

The organisation stayed in communication with policymakers on both sides of aisle. They not only explained their position, but sought to understand politicians’ concerns.

The group met with traditional leaders who are grassroots decision-makers. Village communities were invited to have conversations during public meetings.

“It offered an opportunity for us to understand the misperceptions. We were able to explain that all we are asking for is to not be made criminals. People said, ‘we don’t want to send you to jail, we love our neighbours and our family’,” Ms Eggelton remembered.

The organisation’s patron is Lady Tuaine Marsters whose husband, Sir Tom Marsters, is the British King’s Representative. Lady Marsters frequently attended consultations. Other spokespersons included parents and people with standing in the church. At times supporters were invited to simply stand in solidarity. But anyone who would speak was carefully prepared.

“We spent hours articulating what we would say. We reaffirmed our pledge to not become emotional. We had to keep each other in check to make sure we did not say anything we could regret,” Ms Eggelton outlined.

Then came an effort to increase visibility. The call for equality was largely coming from the LGBT community. They needed other people to demand the same. So PCI embarked on a campaign for people to show their support either by lending their voice to the public dialogue or flying the rainbow flag.  The group distributed free flags, urging people to fly one for their daughter, son or grandchild. From restaurants to bars, t-shirts to earrings, the display of support resonated.  

A first-of-its-kind pride ad on TV, newspapers and radio challenged Cook Islanders: “We are good enough to be your teachers, nurses, choreographers, dressmakers and orators… but not good enough in the eyes of the law. We are already part of your community, we are just asking you to recognise us as equals.”

This visibility and advocacy work was supported by UNDP through the Being LGBTI in Asia and the Pacific program. PCI developed a project to strengthen the digital capacities of community organisations. A critical outcome was the Pride Pledge Cook Islands initiative with the business community which provides visible safe spaces for LGBT people.

“The UNDP support was instrumental in promoting acceptance and awareness and utilising digital tools to share our message,” Ms Eggelton said.

TCI conducted frequent polls to gauge public sentiment. At the start of the process they lagged behind reform opponents. But by the time would-be Prime Minister, Mark Brown, made an election promise to change the law last year, public sentiment had tilted.

“Once we were able to establish that it was really about equality, then we saw a changing of the tide,” Ms Eggelton reflected.

Ultimately the entire government bench voted in favour of an Amendment Bill while opposition leader, Tina Brown, and two of her Members of Parliament also supported.

Renata Ram, UNAIDS Country Director for Fiji and the Pacific, noted that seven other countries in the Pacific region retain laws criminalising same-sex relations.

“The Cook Islands example proves that along with law reform we can have national dialogues about inclusion, justice and equity,” Ms Ram said.

At a national ceremony marking the end of the South Pacific cyclone season the rainbow community gathered once more, this time to give thanks.

“We want to make sure people understand our gratitude for everything that has transpired and for everyone who worked hard to achieve this,” Ms. Eggelton said. “Our community is now recognised through the eyes of the law as being equal. Now people can feel safe, not like second class citizens.”

Ratrish Saha is a transgender woman from Kolkata, India. Even with seven years’ work experience, she was anxious about applying for a new job last year. 

“Finding a job is never easy being a transgender woman. I would get rejected with statements like ‘currently no LGBT hiring is going on’ or ‘we do not have facilities to accommodate a trans individual in our office’,” she recalled. But through the Transgender Welfare Equity and Empowerment Trust or TWEET Foundation, she was paired with suitable opportunities in corporations that have received sensitivity training. She soon landed the position of associate consultant for Siemens Technology in Bangalore. 

She said of the interview process: “I only talked about my skills and no gender explanations were included in those conversations.” An ecstatic Ms. Saha says she is “grabbing the opportunity… putting my all into it”.  

Transgender people in India now have a new pathway toward dignified work thanks to a collaborative effort between communities, government and development partners.

Ahead of the International Day of Transgender Visibility, the UNAIDS Country Office for India and United Nations Development Programme (UNDP) supported the Trans Employment Mela (Job Fair) in New Delhi. The initiative was jointly hosted by the National Institute of Social Defence, Ministry of Social Justice and Empowerment,  TWEET Foundation and In Harmony, a diversity consulting firm. 

The programme aims to accelerate the socio-economic inclusion of the trans community by bringing awareness about their issues to mainstream corporations and providing a platform to connect them with job roles in inclusive organisations.  

“Not only does this approach provide an opportunity for dialogue between government representatives, civil society organisations, and businesses, but it facilitates access to skills training, career counselling, entrepreneurship support and mentorship support,” Maya Awasthi, Co-Chair and Co-founder of TWEET Foundation explained. 

India’s 2019 Transgender Persons (Protection of Rights) Act prohibits employment discrimination against trans people in either the public or private sectors. While stakeholders point to aspects of the law that could be strengthened, they acknowledge that the wide-ranging anti-discrimination provision creates a pathway toward building a more inclusive culture and pursuing redress when rights are violated. 

Addressing employment access inequality is relevant to the HIV response. In 2021 HIV prevalence among transgender people in India was 3.8%, almost 20 times the national average. A study commissioned by India’s National Human Rights Commission found that in 2017 just six percent of transgender people were formally employed in either the private or non-governmental organisation (NGO) sector. About 5% engaged in sex work and domestic labour respectively. Thirteen percent sold food and other items while 11% reported begging.  

“There are many ways in which higher paying and consistent work can reduce HIV vulnerability,” explained UNAIDS Country Director for India, David Bridger. “By addressing the inequalities that have unfairly pushed trans people away from opportunities, we can help build a more empowered community in which people fulfil their potential, enjoying better health and wellbeing in the process.” 

The 2017 Human Rights Commission study found that around half the transgender population never attended school. Several development partners are supporting initiatives to provide the community with education opportunities in a stigma-free environment as well as skills training to promote self-reliance. 

Aarav Singh is a transman who had been out of work for six months. He was able to score a human resource internship at Roop Automotives through the Trans Employment Mela.  

“This is a sensitised, trans inclusive organisation where I've faced zero issues with documentation. Not only me but my friends have scored great opportunities with some of the leading trans inclusive companies,” he said. “I hope this continues.” 

But while the Trans Employment Mela beneficiaries acknowledge the community dimension of their challenge, in other respects they feel like any other hopeful young professional or recent graduate.  

Yumnam Thawalngamba Meetei completed an MBA in 2022 but found it difficult to get a management position “or even a small job”.  

“With the help of TWEET Foundation I got into Mahindra Logistics Limited as an Executive for Talent Management and Organisational Development in Mumbai. I am thankful for this job to pave a path for my success,” he said.