Zara Fauziah is a transgender woman from Indonesia. She learned she was living with HIV in 2017, but for four years coped with her diagnosis alone. The hospital where she could receive treatment wasn’t welcoming.  

Rere Agistya, another Indonesian transwoman, explains why: “If we come to get services or to get checked for HIV, we often get lectures with the purpose to ‘cure’ us.  Most of the time they blame our activities: ‘Well you know you are a man. Why do you want to be a woman?’” 

Many countries in the Asia Pacific region lack national guidelines on transgender care. As a result, healthcare workers often miss the mark on delivering non-discriminatory and medically appropriate services.

This is a critical gap for the AIDS response given the disproportionately high HIV rates among transgender people. HIV prevalence for the community is around four percent in India and the Philippines. In Cambodia, Indonesia, Malaysia and Thailand, roughly one in ten transgender women lives with HIV.

Samira Das lives in Chingrihata, India. She is a Hijra (Hijras include transgender and intersex people).  

“When my family members came to know I am HIV positive they separated my utensils and other things. They got me treated but they kept me in isolation. I stayed there, bearing everything,” she said. 

“People nowadays don’t die from HIV. They die from stigma and discrimination surrounding their physical and mental health and sometimes surrounding their sexuality as well as other sociodemographic factors,” Indonesian transgender physician and researcher, Dr. Alegra Wolter explained. “I’ve seen trans people who stop HIV medications because they don’t get the proper mental health services.”  

But Dr. Alegra emphasises that the issue goes beyond HIV. Transgender people have inadequate access to everything from primary healthcare to hormonal therapy. With support from the Robert Carr Fund, Youth LEAD partnered with the Asia Pacific Transgender Network (APTN) to conduct a situation analysis on trans youths’ access to healthcare in Indonesia, Thailand and the Philippines.  

“We conducted the study to raise the visibility of young trans people in the conversation around trans rights and healthcare, especially since they experience stigma and discrimination both as young people and as trans people,” explained Leo Villar, Youth LEAD’s Communications and Project Officer. “The study showed that young people seek knowledge from peers and undergo do-it-yourself treatments. This could lead to incorrect healthcare information and the misuse of hormones or HIV drugs.” 

Preliminary findings from the online study commissioned in December 2022 found that many transgender people between ages 18 and 30 endure systemic discrimination and abuse when accessing healthcare.  

“I experienced an incident where an officer asked for my identification and made fun of me. This made me feel uneasy as it occurred twice. As a result, I have been avoiding healthcare services,” one survey respondent said. 

Researcher, Dr. Benjamin Hegarty, noted that more than half (52%) the study participants strongly agreed that they worried about being negatively judged because of their gender identity or sexuality when accessing care. Around one-third thought this could negatively impact their evaluations and diagnoses. Asked about their top priorities for healthcare and funding, the majority of respondents pointed to the need for gender clinics, access to universal health coverage as well as counseling and mental health services. Also high on the list were trans-related health research and education about gender diversity. 

APTN has just launched the Towards Transformative Healthcare Module. This is a self-paced, interactive online training which is designed as an introductory resource on trans competent and gender-affirming healthcare for medical professionals and other healthcare workers in Asia and the Pacific. This includes those working in primary care and community-based health services.  

The module uses a rights-based approach that departs from “pathologising models” that treat transgender people as abnormal. Instead, it promotes transformative and culturally sensitive care. Twelve topics are covered including gender diversity, mental health, sexual and reproductive health and gender-affirming care. 

“Through this module, healthcare providers and trans clients can learn how to work together to create positive change and achieve HIV epidemic control,” said APTN Executive Director, Joe Wong. “We are emphasising core principles which can be applied by healthcare professionals even in areas with limited resources and training opportunities.” 

The Southeast Asia Stigma Reduction Quality Improvement (QIS+D) Network and Community of Practice are co-convened by the University of California, San Francisco, the Asia Pacific Network of People Living with HIV (APN+) and the UNAIDS Asia-Pacific Regional Support Team. As part of their shared aim to reduce stigma and discrimination in healthcare settings, these initiatives seek to improve the health experiences of trans people by forging partnerships among providers, policymakers and communities.

“Changes can be made at the facility and community levels that make a huge difference in the lives of transgender people,” said Quinten Lataire, UNAIDS’ Regional Human Rights and Law Adviser. “Collaborating with communities, peer navigation and building friendly clinic services are proven approaches. At the same time transgender clients need training about how to navigate care, along with counselling so they can process the issues around their gender identity.”

Online spaces can play a key role in this community support function. For example, using the UNAIDS COVID-19 Communications Grant, APTN developed a COVID-19 Trans Resilience Social Media Tool Kit that included content on mental health, financial security, social protection and human rights.  

Ms Fauziah’s experience bears out the game-changing role communities can play. In 2021 she connected with the organization Sanggar Swara. They have not only supported her treatment adherence but provided emotional support. 

“It’s not your job to judge people. When your patient is someone with a different gender or sexual orientation, they only need your help. We need care and we also need space to be ourselves and not have to hide,” Ms Fauziah said. 

View APTN’s video “The cost of stigma: transgender individuals living with HIV struggling to access healthcare” (129) The Cost of Stigma: Transgender Individuals Living with HIV Struggling to Access Healthcare - YouTube 

GENEVA, 13 December 2022—UNAIDS warmly welcomes the appointment of Erika Castellanos as the new Executive Director of GATE (Global Action for Trans Equality). GATE works to ensure justice and equality for trans, gender diverse and intersex communities through strategic partnerships with diverse global entities, including UNAIDS and other United Nations bodies and mechanisms.

Born in Belize, Erica started her activism focusing on the rights of people living with HIV and sex workers. She brings to her work her lived experience as a transgender woman living with HIV and as a member of different communities of key populations.

“Erika Castellanos is an internationally recognized and highly respected HIV and human rights activist. UNAIDS appreciates our partnership with Erika as a civil society delegate to our Programme Coordinating Board" said Winnie Byanyima, UNAIDS Executive Director. “GATE’s work as a trans-led organization has been critical to foster the engagement of trans, gender diverse and intersex communities in the AIDS response. We look forward to continuing our work with Erika and GATE in addressing the inequalities affecting these communities”.

Erika Castellanos joined GATE in April 2017 as Director of Programs. In February 2022, she took the role of Interim Executive Director during which time she has continued to solidify GATE’s position as a global leader in trans, gender diverse and intersex advocacy.

Erika has served various positions at national, regional and global levels including as Executive Director of the Collaborative Network for Persons Living with HIV (C-NET+) – Belize, Vice-Chair of the Board of the Global Network of People Living with HIV (GNP+), board member of the HIV Justice Network and co-chair of the ViiV Positive Action program for men who have sex with men and transgender people. In 2018, Erika was the first openly transgender advocate to be appointed to the Board of the Global Fund, as part of the communities delegation.

Erika will begin her new role as GATE’s Executive Director on 1 January 2023.

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.

GENEVA, 29 October 2022—Responding to the statement by the Russian government that it intends to extend the so-called “LGBTQ propaganda” law, UNAIDS Executive Director Winnie Byanyima has joined with UN High Commissioner for Human Rights in expressing deep concern.

“Extension of this law,” said Ms Byanyima, “is a further violation of the rights of people to autonomy, dignity and equality. Not only will it harm the security and general wellbeing of LGBTQ individuals, it will have a serious negative impact on people’s health outcomes. The evidence is clear that punitive and restrictive laws, including those restricting free speech, increase the risk of acquiring HIV and decrease access to services. Such laws reduce the ability of service providers, including peer networks, to provide critical sexual and reproductive health information and services, and increase stigma related to sexual orientation, making it harder for people to protect their health and that of their communities. This will undermine Russia’s efforts to end AIDS by 2030. Our call to the Parliament and Government of Russia is to withdraw these harmful proposals and indeed to repeal the existing law. Stigmatising approaches damage public health, perpetuate pandemics and hurt everyone. Social solidarity, inclusion and protecting every person’s human rights are key to ending AIDS and ensuring health for all.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

It was a proud day for Stacy Velasquez the Executive Director of OTRANS Reinas de la Noche in June as she opened the doors to the community clinic that had just been officially approved as a health post by the Ministry of Public Health and Social Assistance. This meant that a full-time doctor was now in position.  

Around 40 transgender women and sex workers have come to the clinic since the doctor's arrival. The clinic has existed for several years, but with the approval by the Ministry of Health and financial support from the Global Fund and OXFAM, patients now have access to comprehensive care: HIV prevention and diagnosis; prevention, diagnosis and treatment of sexually transmitted infections; psychosocial counselling; medical consultations including hormone therapy; a laboratory service for sexual health testing and a pharmacy.

The clinic offers pre-exposure prophylaxis (PrEP), a biomedical intervention within the combination prevention approach, which refers to the use of antiretroviral drugs by HIV-negative individuals to reduce the risk of contracting the virus.

"In 2016, a comprehensive health strategy for trans people was approved with technical support from UNAIDS. It includes a manual of guidelines for the health care of trans people,” said Stacy. “The community clinic and this strategy are the fruit of the work of almost 18 years of advocacy by the trans community."

OTRANS contributes to the Centro de Documentación y Situación Trans de América Latina y el Caribe (CEDOSTALC), a community-based system for collecting information, monitoring and responding to human rights-related barriers faced by the transgender population in 26 countries in Latin American and the Caribbean.

In Guatemala, transgender women still face exclusion, discrimination, stigma, verbal and physical violence, criminalization, marginalization and a lack of recognition of their rights, resulting in a life expectancy of only 35 to 40 years old. The average life expectancy in the country is 74 years old.

During a visit to the clinic, UNAIDS country director, Marie Engel praised the work of the site and paid tribute to Andrea Gonzalez, the OTRANS legal representative who was murdered in 2021.  

“In Guatemala, the HIV prevalence rate is 22.2% among the transgender population, compared to 0.2% for the general population,” said Ms Engel. “And although new HIV infections declined by 23% among all women between 2010 and 2019 globally, they have not declined among transgender women. And yet, transgender people have less access to HIV services than the rest of the population.”

Stigma and discrimination have a profound negative effect on the mental health of transgender people, which in turn can influence their vulnerability to HIV infection. Data reported to UNAIDS in recent years show that the percentage of transgender people who avoid seeking HIV testing due to stigma and discrimination ranges from 47% to 73%.

On 17 May, people around the world came together to celebrate the International Day against Homophobia, Transphobia and Biphobia (IDAHOBIT) to champion inclusion and build a better world for the lesbian, gay, bisexual, transgender and intersex (LGBTI) community. In many countries, lack of adequate legal protection against discrimination on grounds of sexual orientation and gender identity exposes many LGBTI people to violations of their human rights. This is even more the case within the context of war and humanitarian crisis, as currently experienced in Ukraine.

UNAIDS and ILGA-Europe co-hosted an event, moderated by Cianán B. Russell, Senior Policy Officer, ILGA-Europe, to mark IDAHOBIT. The event brought together LGBTI representatives and a wide range of thought leaders, policymakers and practitioners.

The panellists highlighted the multiple vulnerabilities and challenges facing LGBTI people in and fleeing from Ukraine during the war. These vulnerabilities and challenges were clearly articulated by two LGBTI representatives.

“Levels of discrimination, violation of rights and hate crimes have risen in Ukraine since the start of the war. Meanwhile, no regulations or specific measures have been put in place in shelters to protect key populations. LGBTI people have no safety net since the war started,” said Olena Shevchenko, from Insight. “Go to local organizations and ask them what they need if you are intent on helping Ukraine. Ensure the accountability of humanitarian missions to fulfil the needs of the local community,” she added.

Tymur Lysenko, a Ukraine crisis consultant working for Transgender Europe, spoke about the essence of leaving no one behind, saying ““Leave no one behind” should work, not just be empty words. Trans people in Ukraine should be provided with humanitarian support, safe evacuation and access to medical care, and functioning gender recognition regulation procedures. Foster direct connections that are strong and sustainable between local organizations and international humanitarian missions. Stick to organizations that have a track record in providing direct support to LGBTI people.”

Reflecting on their own work and experiences, the panellists also reviewed the actions taken to date to protect the human rights of LGBTI people in and fleeing from Ukraine and the existing gaps within the humanitarian response and concluded with recommendations and commitment to better protect the human rights of LGBTI people staying in Ukraine or who have left.

“Humanitarian agencies must ensure that civil society organizations with expertise are included in the planning and implementation of all humanitarian assistance and in recovery efforts,” said Victor Madrigal-Borloz, a United Nations Independent Expert on Sexual Orientation and Gender Identity.

This was echoed by Kate Thomson, Head of the Community, Rights and Gender Department at the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), who referred to the need for all partners to work collectively to build back resilient health and community systems. “All partners to work together to support access to HIV services in Ukraine, including those led by LGBTI communities, inside Ukraine and abroad. Let’s work collectively to help Ukraine build back better its health and community systems,” she said.

Matthew Kavanagh, UNAIDS Deputy Executive Director, a.i., spoke about the importance of maintaining and increasing the funding for the AIDS response. “We stand with the Ukrainians who are fighting so hard to make sure that their responses—the AIDS response, the community response, the rights response, the LGBTI response—are not destroyed by the moment that we are in now. There is an urgent need to move funding towards that, and an urgent need to fund the Global Fund at the same time. We cannot choose between these two things or we will end up in a less safe world—we have to do both,” he said.

Joanna Darmanin, Head of the Humanitarian Aid Thematic Policies Unit, European Union Directorate-General for European Civil Protection and Humanitarian Aid Operations, reiterated the European Union’s commitment for an inclusive humanitarian response. “Supporting Ukraine and neighbouring countries remains the priority for the European Union, and we remain committed to providing humanitarian support in an inclusive manner, taking into account the specific needs and vulnerabilities faced by the LGBTI community,” she said.

This commitment was re-echoed by Katalin Cseh, Member of the European Parliament Committee on Foreign Affairs, who pledged to fight for inclusiveness of the LGBTI community. “I pledge to fight with all my means to ensure better consultation with the LGBTI communities on the ground in Ukraine and also within the European reception area.”

Maria Arena, Chair of the European Parliament Subcommittee on Human Rights, highlighted the need to position the humanitarian response to the needs of LGBTI people, saying, “The conflict zones are putting at risk people with these vulnerabilities, so we have to be really aware of the situation and to adapt our answers for the needs of these people, including with traceability of these funds.”

Marc Angel, Co-President of the European Parliament LGBTI Intergroup, emphasized the importance of ensuring that promises made correspond with funding. “Action and money must follow words and promises,” he said.

Valeriia Rachynska, from the Global Partnership against All Forms of HIV-Related Stigma and Discrimination, spoke about the Global Partnership’s commitment to fight for and save all lives, saying, “Our main target is to save and fight for life; we will do everything in our power to save the lives of LGBTI people in Ukraine.”

Indeed, to champion and build a better world for the LGBTI community, and to end inequalities for an effective AIDS response, especially in a humanitarian crisis context, institutional actors with differing responsibilities must ensure that no one is left behind. This among others, includes directed action to: combat discrimination targeting LGBTI people and people living with HIV, rebuild or reinforce the HIV response system, meaningfully engage LGBTI civil society both in crisis planning and in crisis response systems, ensure that LGBTI-led humanitarian efforts are adequately resourced and ensure that human rights violations faced by LGBTI people are documented, investigated and result in access to justice. 

Sasha wishes to have two children. Deusa wants to go to business school. Rihanna's dream is to be respected and be who she wants to be. And all Alicia wants is to fulfill her dreams. In the lead-up to the May 17 celebrations of the International Day against Homophobia, Transphobia and Biphobia (IDAHOBIT), UNAIDS echoes the voices and dreams of four transgender women. They, like many others, are in search of a dignified life, full of opportunities able to love who they wish to love, and not endure violence, stigma and discrimination.

Inspired by the Unbox Me campaign, launched by UNAIDS on the International Transgender Day of Visibility, 31 March, UNAIDS gave four Brazilian transgender women a small box with their portraits from a photo shoot session in 2021 with Sean Black, a photographer from the United States who specializes in LGBTQI+ subjects. As the portraits were revealed to the transgender women, they reflected on the importance of their bodies, of self-care, and of their right to live healthy and empowered lives.

"This insecurity comes from our experiences, and from our past. But with each passing day I had the opportunity to strengthen myself, to discover the beauty that I sometimes thought I didn't have, so I felt more confident," recalled Alicia Kalloch, when unboxing her self-portraits.

“There are so many bad things that we go through,” said another participant, Sasha Santos. “My portraits from the photo sessions gave me the certainty that I'm capable of many things like going to college, owning a house and having children,” she added.

Alicia, Sasha, Rihanna and Deusa were chosen to represent the 24 women from the transgender shelter, Casa Florescer, in São Paulo, who participated in the FRESH Project. Developed by UNAIDS in partnership with Black and Casa Florescer, the initiative included photo sessions as part of a therapeutic approach to provide positive reinforcement and stimulate behavior change. All the photos are being released virtually today in cooperation with the United Nations Educational, Scientific and Cultural Organization (UNESCO) office in Brazil, marking the IDAHOBIT celebrations.

"When I saw my picture, I saw an empowered woman,” said Rihanna Borges, who currently works with other transgender women to provide counseling and peer support. “I think the role I play today is incredible, working with other sisters, talking to them about the importance of self-care and HIV combination prevention." Their plea is to have society see transgender people for who they are. “I want us to feel empowered and say, ‘Today I am somebody’ and leave this invisibility behind,” she added.   

Inequalities, stigma, and discrimination disproportionately affect populations in situations of greater vulnerability, such as transgender women. A report by the Brazilian National Association of Transsexuals and Transgender People (ANTRA) shows that 140 transgender people were murdered in 2021 in the country, 99% of whom were transgender women. HIV prevalence among transgender women in Brazil is above 30%, whereas for the general population prevalence is at 0.4%.

Most of the transgender women at Casa Florescer were forced to leave their homes against their will and many ended up using drugs or suffering various types of violence.

"At the shelter we seek to work with people in a cycle of self-discovery and empowerment so that they can overcome past vulnerabilities,” explained Beto Silva, Coordinator of Casa Florescer. “Photographic art, which was an important part of the FRESH Project, was an efficient way to mobilize and engage them.”

"Participating in the photo shoot not only served to show the internal and external beauty of this group of transgender women, it was also an important step to help them gain control over their bodies and their lives," said Claudia Velasquez, Director and Representative of UNAIDS in Brazil. Deusa de Souza could not agree more.  As a participant in the photography workshop, she said, she felt recognized as a beautiful transgender woman. “It was important for me to see myself in these photos and how they reflect my empowerment and my own personality and beauty.”

Ahead of the International Day Against Homophobia, Biphobia, Interphobia and Transphobia (IDAHoBiT) held annually on 17 May, UNAIDS talks to Evelyne Paradis, Executive Director of ILGA-Europe, the Europe-based Lesbian, Gay, Bisexual, Trans and Intersex Association about protecting the rights of LGBTI people in humanitarian crises. 

How do humanitarian crises particularly affect LGBTI people?  

Humanitarian crises affect everybody, however, some communities sometimes need a targeted response because of pre-existing vulnerabilities. These particular vulnerabilities make people feel unsafe when dealing with humanitarian organisations providing safe shelter, basic necessities food and medical aid. Not knowing if they will be treated without discrimination, simply welcomed and be taken care of, is a barrier for people in accessing humanitarian support.

ILGA-Europe is heavily involved in the Ukraine crisis.  What are the main challenges facing LGBTI people affected by the war? 

In the Ukraine crisis, what we are seeing is that LGBTI people are not de facto integrated in first aid supply chains. Transition-related and intersex-specific medication, such as hormone replacement therapy, and to a certain extent medicines for people living with HIV, are not ensured in humanitarian packages at the moment. On top of this, a significant portion of the LGBTI community cannot meet their basic needs, due to pre-existing socioeconomic inequalities.

Trans women with a male gender marker on their documents can be obliged to join the army or cannot leave the country along with other women, which puts them in a potentially very harmful situation.

Having access to safe shelter is also an issue. In Ukraine, many LGBTI people don’t feel safe to be ‘out’ in regular shelter, while some who are displaced in the country are reporting facing discrimination when trying to rent an apartment. As a result many of the LGBTI groups have set up shelters to support their communities. Some of those who are staying and are visible have been physically attacked, as LGBTIphobia was already an issue in Ukraine before the war.

This is all happening while LGBTI people face the same struggles everyone else is facing; money, food, caring for loved ones, and so much more.

What are organizations like ILGA-Europe doing to help? 

We are sending direct financial support to groups who are staying in Ukraine and are providing direct support to their communities, as well as to LGBTI groups in hosting countries. We’re also actively working to mobilise resources for all the LGBTI groups working in support of LGBTI people in Ukraine and abroad. We’re working with large humanitarian groups and organisations like UNAIDS and connecting them to the needs on the ground, while advocating with European institutions and governments to take action both in support of LGBTI communities in Ukraine and for LGBTI people who have left the country.

What can be done to better address the unique needs of LGBTIQ+ people in humanitarian crises?  

What we are seeing is that an LGBTI perspective is really not integrated into humanitarian work and the development of protection measures, such as protection from gender-based violence or access to medicines. In many ways we have had to start from zero, including having to establish contacts with actors in the humanitarian sector.

While it is still early in this particular crisis to have specific recommendations, there will be no doubt be a lot of learning to be done from the work currently happening, so that we make sure that in future LGBTI perspectives and needs are integrated in the way humanitarian actors respond from the start.

Many civil society and community organizations are supporting LGBTI people affected by the war in Ukraine.  What challenges do they face in carrying out this important work?  

Most LGBTI organisations are not set up to be doing humanitarian work, and yet they are supporting basic needs in addition to the work they continue to do for their communities. But they cannot do it all. If they become the first point of support and assistance, there’s a lot of other work, like advocating for rights, that will not be done. This is true in Ukraine as well as in hosting countries.

Inequalities, stigma, discrimination and human rights violations against are continuing to prevent LGBTI people from being able to access the HIV and health services they need. How can we achieve positive political, legal and social change?  

The work that has started with the humanitarian sector shows there’s a need, but it’s also an opportunity. If the humanitarian sector incorporates an LGBTI perspective and LGBTI people in their work from the start, this can mean a positive change for these communities, especially in times of crisis.

Evelyne Paradis will be one of the speakers at an IDAHOBIT event held on the 17 May focusing on how to better protect the rights of LGBTIQ+ people, particularly in the context of the war in Ukraine, and how to ensure equal rights for all. More information

Andrii Chernyshev heads the advocacy work of the Ukrainian national lesbian, gay, bisexual, transgender and intersex (LGBTI) organization ALLIANCE.GLOBAL, which is one of the largest among about 30 LGBTI community organizations across the country. After the start of the war in Ukraine, he moved from Kyiv to the central part of Ukraine, a safer place to continue his work. His Facebook page has been full of announcements about where LGBTI people fleeing hostilities can find shelter and help, both inside and outside the country.

Before the war, the primary focus of ALLIANCE.GLOBAL was public health, HIV prevention, monitoring of violations of human rights and national LGBTI advocacy. But the war has brought about new urgent tasks.  

“The main challenge for all people during the war, including LGBTI people, is just to survive. Many have lost their homes and relatives. Just recently, we welcomed several people from Mariupol, which is now completely destroyed. Although they managed to leave the city, they are in a very bad psychological state,” said Mr Chernyshev.

According to the Office of the United Nations High Commissioner for Refugees, there are now 7.7 million internally displaced people in Ukraine. This number includes members of key populations, including LGBTI people, and others who are especially vulnerable.

Sviatoslav Sheremet, the coordinator of policy and legislation work of the National MSM Consortium, said that there are several factors that make LGBTI people especially vulnerable. “Many LGBTI people are fleeing the areas occupied by Russian forces. People are afraid, and this fear has pushed them to actively move out to safer zones in Ukraine and outside the country.”

He noted that LGBTI people often cannot reveal their sexual orientation or gender identity, fearing violence, rejection and discrimination if they do. He underlined that all cases of homophobia are still being recorded and submitted to state bodies. “The proceedings on such cases are postponed until there is peace,” he added.

Both ALLIANCE.GLOBAL and the National MSM Consortium have significantly changed their work. Several additional shelters for LGBTI people have opened in Dnipro and Chernivtsi. Men and women, including transgender people, can stay there one night and move on, or stay longer, and can bring their relatives and friends. People also receive financial support to leave the war zones and reach shelter.

“The shelter in Chernivtsi, for example, was in a non-residential building,” said Mr Chernyshev. With a small grant from the UNAIDS Emergency Fund and other donors, we installed a shower and bought heaters. People have food, the Internet, a first aid kit, access to HIV counselling and antiretroviral therapy.”

LGBTI organizations outside the country have also provided support to people in need.

Stas Mishchenko, an LGBTI activist from Ukraine, now lives in Munich, Germany. At the beginning of the war, he joined the Contact Group of Munich Kyiv Queer, which is part of the Alliance for Assistance to Queer People of Ukraine, a group of more than 50 LGBTI organizations in Germany whose members volunteer to help people who have fled to Germany and those who remain in Ukraine.

“Sometimes there is homophobia and transphobia in refugee camps. And even if these are not systemic, there is always the human factor, combined with stress, fear and violence. That is why we accompany people on their way to us, provide psychological assistance, try to resettle them in private homes, help with humanitarian aid,” said Mr Mishchenko.

“The war exacerbated both good and bad in our society,” said Marina Novachuk, UNAIDS Community Adviser at the UNAIDS Country Office for Ukraine. It is essential for the state and all stakeholders engaged in protecting forcibly displaced people to recognize and respond to the unique needs of LGBTI and gender-diverse people.”

Over the past 20 years, Ukraine has made a real breakthrough in ensuring the rights of LGBTI people and in protecting their security. LGBTI rights are an integral part of the National Human Rights Strategy. Leaders of the LGBTI community sit on the National Council of HIV and TB, as well as on regional councils. The number of participants of the annual equality marches has risen from just a dozen to thousands of people. Ukraine plans to develop legislation on the registration of civil partnerships.

“Achieving civil equality has been the goal of my work for many years—I have seen huge improvements. The attitude towards LGBTI communities is a litmus test of civilization,” Mr Sheremet said.

In April 2022, Ukraine received a questionnaire from the European Commission on its readiness for candidate status for membership of the European Union. On 18 April, Ukraine completed and submitted the first part of the questionnaire, which includes several questions on the situation with regard to LGBTI people and legislation, specifically about the legislative and policy instruments in place to prevent and respond to discrimination and how hate crimes are addressed in the criminal code. ALLIANCE.GLOBAL and the National MSM Consortium team will follow the process closely.

“We have been working on changes in the legislation on LGBTI rights for many years now and we hope that now it will take not years but months to change. But first the war should end,” added Mr Chernyshev.

The economic impact of the COVID-19 pandemic on lesbian, gay, bisexual, transgender and intersex (LGBTI) people has been huge. A 2020 survey of more than 20 000 LGBTI people from 138 countries showed that many had lost their jobs because of the pandemic. In addition, members of the community experienced increased discrimination, hate crimes and arrests. Criminalization combined with stigma and discrimination of LGBTI people in some countries has hindered their ability to seek essential economic and health-care support.

Several of the 23 UNAIDS Solidarity Fund grantees across Brazil, Ghana, India, Madagascar and Uganda are supporting LGBTI organizations in building economic capacities and driving social impact for their respective communities through diverse social entrepreneurship projects.

Uganda is home to more than 1.5 million refugees. Same-sex sexual relations are illegal in the country, and being a refugee brings a host of other challenges, including social exclusion. Adding to this, the COVID-19 pandemic has destroyed the livelihoods of many of Uganda’s refugees who are members of key populations. Through a Solidarity Fund grant, the Simma Africa Creative Arts Foundation set up the Rainbow Drip Craft Shop Project, which markets creative and cultural goods, including fine beaded and brass jewellery, handmade leather-craft shoes and Ankara fusion clothing made by LGBTI people and adolescent girls and young women from refugee camps and host communities. “The shop has become a safe space and a creative outlet for the community to channel their skills and talents towards building self-sustaining livelihoods,” said Natasha Simma from Simma Africa.

Also working with the Ugandan LGBTI and sex worker communities, Vijana Na Children’s Foundation (VINACEF Uganda) has set up a community-run salon offering diverse beauty treatment services. About 80 community members have been connected to social services and trained in social enterprise and financial management. “The social entrepreneurship project has enhanced community involvement and strengthened the capacity of LGBTI and sex worker communities while allowing them to gain and practice new skills to earn a sustainable income,” said Benard Ssembatya, the Executive Director of VINACEF Uganda. Inspired by this initiative, VINACEF Uganda is forming a network of salons to improve access to information on HIV, sexual and reproductive rights, tuberculosis, cancer and noncommunicable diseases for community members.

Similarly in Brazil, tapping into the talents of members from the LGBTI and sex worker communities in beauty treatment, Associação Social Anglicana de Solidariedade do Cerrado (Casa A+) implemented the Empodera Mais Project. “We motivated members from vulnerable backgrounds to participate in the social entrepreneurship project through the provision of the Empodera Mais Kit, with basic equipment and supplies for entering the hairdressing and beauty treatment profession,” said Anglican Bishop Maurício Andrade, the founder of Casa A+. The technical skills provided and encouraged members to start businesses in beauty treatment and survive the hardships of the COVID-19 pandemic. Technical partnerships with professionals, a beauty studio and institutions such as Palmas’ Municipal Department of Human Development provided the participants with on-site experience before launching their own businesses and generated a professional network to exchange experiences and get new business.

In Ghana, the Hope Alliance Foundation and the OHF Initiative launched the Community Economic Empowerment Program to set up social enterprises led by people living with HIV and LGBTI people to support them economically to confront complex political and COVID-19-related challenges. The initiative provided vocational skills training for the production of food and hygiene products to 30 young people, supported the creation of social enterprises in fashion design and supported the refurbishment and revamping of 10 selected small-scale businesses adversely impacted by COVID-19.

In India, Nachbaja.com’s online artist platform was set up to overcome the challenges of discrimination, unfair remuneration and the safety of artists from the LGBTI community. Meanwhile, Gaurav Trust opened its doors for members to be a part of a community-led salon, La Beauté and Style, and mobilized additional funding for sustainability and scalability.

Stories of growth continue with Let’s Walk Uganda, whose Jump Start project was established to host small-scale enterprises in fashion, design and the production of liquid soap led by gay men and other men who have sex with men. Community members have proven their ingenuity to grow, scale up and diversify their enterprises by successfully reinvesting the revenue from the first batch of products in new entrepreneurial ventures. This led to the development and launch of the UNAIDS-supported Stall App, an online social marketing app that could help to boost the sale of products developed by several key population-led enterprises, including other Solidarity Fund grantees.

“We must recognize that while the rest of the world recovers from the economic impact of the COVID-19 pandemic, its effects will last longer for marginalized communities. Hence, it is of the utmost importance to continue to support innovative community-led social enterprises designed to support livelihoods and overcome special challenges,” said Pradeep Kakkattil, the UNAIDS Director of Innovation.

Restoring the self-reliance and dignity of LGBTI communities must be grounded in initiatives led by themselves, with a focus on addressing inequalities. A common thread that connects these diverse enterprises is the ingenuity of LGBTI people in the face of hardship. The grantees demonstrated the potential of empowerment through art, creativity and professional skills supported by the Solidarity Fund seed funding.  Acknowledging and embracing diversity in sexual orientation and gender identity in all areas is crucial to making the community visible, protecting them from stigma, discrimination and violence, and engaging them in the response to pandemics.

Anastasiia Yeva Domani is the Director of Cohort, an expert on the Working Group of Trans People on HIV and Health in Eastern Europe and Central Asia and a representative of the transgender community on the Ukrainian National Council on HIV/AIDS and Tuberculosis.

UNAIDS spoke to her to see how she and the wider transgender community are coping after the Russian attack on Ukraine.

Tell us a bit about yourself and the transgender community in Ukraine

I am the Director of Cohort, an organization for transgender people. Cohort has existed for about two years, although I have been an activist for more than six years. According to the Public Health Center of the Ministry of Health of Ukraine, before the war there were about 10 000 transgender people in the country, although that number is likely to be an underestimate since many transgender people are not open about their gender identity. Many only seek help during a crisis—this was the case during the COVID-19 pandemic, and is happening now, during the war. Today, we are receiving requests for help from people we have never heard from before, people who are in dire need of humanitarian, financial and medical assistance.

Ukraine created the most favourable environment for transgender people in the post-Soviet countries with regard to changing documentation and the legal and medical aspects of gender transition. It is far from perfect, but we and other organizations have done our best to improve it. Since 2019, transgender people have been represented on the Ukrainian National Council on HIV/AIDS and Tuberculosis.

What was the situation like for transgender people at the beginning of the war?

In 2016, a new clinical protocol for medical care for gender dysphoria was adopted in Ukraine, which greatly facilitated the medical part of gender transition. Thanks to it, the next year people were able to receive certificates of gender change.

However, many transgender people have yet to change all their documentation. Some people didn’t change any, some only changed a few documents and only a few changed absolutely all of them, including driver’s licences, documents on education and those that relate to military registration and enlistment. We warned about this, and now there is a war. Many transgender people didn’t realize that they needed to be deregistered at the military registration and enlistment office.

Due to martial law, men aged 18–60 years cannot leave the territory of Ukraine if they do not have permission from the military registration and enlistment office. We have a lot of non-binary people with male documentation who cannot leave.

With the outbreak of the war, many transgender people moved to western Ukraine. But, if according to your documents you are a man, you cannot leave Ukraine.

What is the situation now and what is the focus of your work?

Because of the war, in some cities there is no one left at all. Kharkiv had the largest number of transgender activists after Kyiv, including many who moved there from the occupied Luhansk and Donetsk regions in 2014. And now they must move again. We have no information about the death of any transgender people, but I think that this is only because there is no connection with some cities, such as Mariupol. Many simply did not have time to leave the city, and then it became impossible. I’m afraid that the statistics will be terrible, it just will take time to understand what happened there.

There is a lot of work going on in Odesa now—we have two Yulias there, transgender women from whom the community receives tremendous support. They took on many issues of support and funding. In Odesa, the situation is better with hormones, with medicines. We also still have a coordinator in Dnipro—she also does a lot.

Our work is now focused on financial, medical and legal assistance to transgender people who are in Ukraine, no matter where, in western Ukraine in shelters or apartments, or staying in their cities where the bombings are. Everyone has fears, but you still need to have some kind of inner core and try to fight. I don’t think everyone should leave. I understand that many people have a grudge against society, the state. For many years, decades, they lived as a victim. There is nothing to keep many of them here—there is neither work nor housing.

Who is supporting you financially?

We had projects planned for 2022, and literally on the first or second day of the war representatives of our donors said that the money could be used not only for planned projects but also for humanitarian aid. This included RFSL, Sweden, which approached this issue in the most flexible way and allowed us not only to use the project money but also to send money directly to our coordinators, so that they themselves could pay for people’s housing, travel, etc.

Then GATE (Global Action for Trans Equality) also immediately said that their funds could be used for humanitarian aid, and promised additional funds. The Public Health Alliance, through the Global Fund to Fight AIDS, Tuberculosis and Malaria, allowed changes to be made to the budget and the nature of the planned activities.

Now we will do what we can do in the context of the war, and the mobilization of the community will continue in Dnipro, Odesa, Lviv and Chernivtsi. New partners appeared that immediately responded to our needs.

I use OutRight Action funds every day for the humanitarian needs of transgender people, and also funds from LGBT Europe. There are also private donations, not large, of course, but they are also there.

What does your average day look like?

My day is filled with communication with journalists from leading publications. I also go to supermarkets for groceries and distribute them to those who need them—I have Google forms where I can see requests for help.

I administer requests for consultations with a psychologist and an endocrinologist, who continue to work in Ukraine. I receive many questions related to crossing the border and I provide information on how to communicate with the military registration and enlistment office and on which documents they need for deregistration.

There are a lot of calls, so I charge the phone five times a day. I have two Instagram accounts, two Facebooks accounts, three mail addresses, Signal, WhatsApp, etc. You need to be constantly in touch. I also need time to stand in two-hour queues at the post office—it’s such a waste of time, but people need the medicines I send. I also need to leave time to monitor the news, I need to know what is happening at the front, in the cities.

What is giving you strength?

Until my family and child left the city, I could not work in peace.

I am currently in Kyiv. In the first 10 days of the war I felt shock and fear—we literally lived from one hour to the next. Now we have got used to the danger and I’m not afraid anymore. I decided for myself, if it is destined, then so it will be. I no longer go down to the shelter: so much work, so many requests for help, calls, consultations every minute.

I was born here, in Kyiv, this is my home town. I realized that when things are bad for your country, you have to stay. I can’t run away, my conscience just won’t let me. I can’t because I know my city needs to be protected. You don’t have to be in the military to help—there is military defence, but there is also volunteer work, humanitarian aid is a lot of work.

What gives me strength? Because this is my country, I understand that everyone who can do anything, on any front, is there. We can do it everywhere, everyone can contribute, do something useful, and that gives me a sense of being needed, a sense that we can all do so much together.