Many people have been able to work from home during the COVID-19 pandemic and continue to be paid, but low-income workers often haven’t had that opportunity.

In Indonesia, the latest labour force survey results show that 29 million workers have been affected by the pandemic, with 24 million workers suffering from cuts in hours of work and income. Average wages were depressed by 5.2% between 2019 and 2020. Surveys conducted by the Indonesia AIDS Coalition show that the situation is similar for people living with HIV and key populations—more than 80% of 529 respondents had experienced a reduction or loss of income due to the pandemic.

To address the rising income inequality, the United Nations allocated a US$ 1.7 million funding package to bolster the economic empowerment of women and vulnerable populations in Indonesia and to help protect their livelihoods from the devastating socioeconomic fallout of the COVID-19 pandemic. In 2020, the UNAIDS Country Office for Indonesia worked with the International Labour Organization, the United Nations Development Programme and the Office of the United Nations High Commissioner for Refugees to mobilize the funding.

A joint project launched earlier this month will directly benefit and empower vulnerable groups, including women, people living with HIV, key populations, refugees, migrant workers and people in disadvantaged regions.

The one-year project offers support through training on entrepreneurship and business development and facilitates access to skills development and jobs. UNAIDS will work closely with civil society organizations to identify the beneficiaries and ensure that people living with HIV and transgender people and other key populations are among the approximately 3650 people to be supported by the project.

The Indonesia Positive Network is among the organizations that will be involved in the project. Meirinda Sebayang, the National Coordinator of the Indonesia Positive Network, appreciates the support of the project. “COVID-19 has amplified existing disparities, especially for the livelihoods of people living with HIV and key populations in Indonesia. In this difficult time, we learned that it is important to build trust and strong collaboration between communities, government, health services and United Nations partners, not only to ensure that essential services remain available but to ensure that our community is not left behind in the response and recovery from the socioeconomic impact of COVID-19,” she said.

The project also includes advocacy for policies that promote inclusion and respond to discrimination in the government, the private sector and trade unions. Through this sensitization and advocacy work, these sectors will be required to protect vulnerable groups from discrimination and exclusion from the job market, even beyond the COVID-19 recovery.

One year into the pandemic, it is crucial that United Nations agencies join forces to support vulnerable groups, which have been disproportionately impacted by COVID-19, in the recovery process.

“Many key populations affected by HIV work in informal settings and were seriously hit by the pandemic. While we may not be able to respond to every single need of the community, we aim to provide an example of how to support vulnerable communities in these stressful and critical times. We believe that through this project many people will receive the direct support and opportunities that are vital for the recovery of their livelihoods,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The transgender community has been severely affected by the COVID-19 pandemic in Asia and the Pacific. “My main worry is about survival and being able to support and cover the essential needs of the transgender community when job security is less and businesses are closing,” said Khartini Slamah, a transgender woman and activist from Sarawak, Malaysia, who is also known as Mama Tini in her community. “Many transgender people are unable to pay rent and utility bills, unable to do sex work, conduct their usual businesses. Some even lost their jobs,” she said.

Mama Tini’s testimony is featured in the COVID-19 Effect Series, a regular newsletter that profiles issues, challenges and solutions from the lesbian, gay, bisexual, transgender and intersex (LGBTI) communities, key populations and people living with HIV across Asia and the Pacific, created by APCOM, a regional network for LGBTI people based in Bangkok, Thailand. Since April 2020, with more than 19 issues, the newsletter has provided a platform to leverage the voices of people living with HIV and LGBTI people and to share stories, highlight challenges, showcase innovation and build strength within these communities.

The articles included in the newsletter show how civil society organizations are playing a critical role in providing essential safety nets for vulnerable communities during the pandemic. Since the first COVID-19 outbreak in Malaysia, Mama Tini has been working closely to provide support to transgender women, gay men and other men who have sex with men and female sex workers to encourage sexual health screening and testing and to raise awareness of HIV and other sexually transmitted infections.

The newsletter is also a testament to how community-led organizations have used the structure and networks from the HIV response to ensure timely access to information about COVID-19 while preventing disruption to HIV services. Examples of these initiatives include how community-led HIV services provide antiretroviral therapy, HIV testing and pre-exposure prophylaxis (PrEP) to key populations and fundraising efforts for food packages.

CARMAH, a partner in Viet Nam, has been implementing the TestSGN initiative to encourage HIV testing in Ho Chi Minh City for several years. Since the beginning of the pandemic, CARMAH has provided PrEP to 450 gay men and other men who have sex with men and transgender people in Ho Chi Minh City. During the COVID-19 outbreak, the organization implemented more flexible working schedules to ensure that PrEP and HIV testing services were not disrupted.

“The COVID-19 Effect Series documents the important work carried by our community partners and individuals in the response to COVID-19. The series captures inspiring stories from the grass-roots level on overcoming challenges, sharing best practices and how we are all working tirelessly to ensure access to HIV prevention and treatment services and the protection of LGBTI rights,” said Midnight Poonkasetwattana, the Executive Director of APCOM

The COVID-19 Effect Series also captures the unique voices of outreach workers. One of them is Deepak Tripathi, a Senior Programme Officer at the Committed Communities Development Trust (CCDT), an organization based in Mumbai, India. He has a background in and passion for documentary movies, story-telling and news anchoring, but now works full time at CCDT. Throughout the pandemic, Mr Tripathi has been committed to helping the communities hit hard by the economic fall-out from COVID-19.

“Most nongovernment organizations in India, including CCDT, play a crucial role in continuing improving the health and well-being of their target population or beneficiaries, especially during natural crises or disasters, including the COVID-19 crisis,” said Mr Tripathi. CCDT held fundraising events to support migrant workers and daily-wage communities, donated medical equipment and 3000 personal protective equipment kits to hospitals in Mumbai and supplied nutrition kits or bags to 500 individuals and the families of people living with and affected by HIV.

APCOM has also used the COVID-19 Effect Series to promote fundraising initiatives, such as #CoronaAPCOMpassion, an emergency fund started by APCOM staff donating their salaries. APCOM collaborated with SWING, the Thai Sex Workers Organization, based in Bangkok and Pattaya, and mobilized 20 000 baht (US$ 650) to purchase basic food and supplies for sex workers. Also, APCOM donated 9000 baht (US$ 300) to the Bangkok Rainbow Organization to support the health and well-being of LGBTI people in Thailand. You can watch a video here and read about other communities that have benefited from this emergency funding, and how you can support it.

“The human-interest stories included in the COVID-19 Effect Series raise the visibility of human rights violations and the challenges faced by LGBTI people and people living with HIV in accessing health services. The series amplifies community voices that have often been unheard in COVID-19 narratives,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific, which has provided financial support to make the newsletter a reality.

To mark Zero Discrimination Day by making the voices of the communities heard, APCOM is launching a short report that compiles stories and articles published in the COVID-19 Effect Series.

Imagine using a health-care system that has no concept of you as a person, or of your unique needs. Nurses might not ask important questions. Doctors might overlook the solutions you really require. You might feel unwelcome.

That has always been the reality for transgender people in Jamaica. A new strategy seeks to change this.

With support from UNAIDS and the United Nations Population Fund (UNFPA), TransWave Jamaica has launched the Trans and Gender Non-Conforming National Health Strategy, the first of its kind in the English-speaking Caribbean. The five-year plan is a rights-based road map for how the health and well-being of transgender people can be advanced. It moves beyond recommendations for the health-care system to the structural and societal changes necessary to achieve equitable access to services and opportunities for the transgender community.

“Too many transgender people stay home and suffer or change who they are to access public health-care spaces,” explained TransWave Associate Director of Policy and Advocacy, Renae Green. “We need improvement to basic services, including psychosocial support. And we need transgender people to be able to access public health services as their authentic selves.”

Through the Unified Budget, Results and Accountability Framework Country Envelope for Jamaica, UNAIDS collaborated with UNFPA to support a robust year-long process of research, community engagement and strategy development, including a monitoring and evaluation framework. The strategy development process was informed by a multisectorial steering committee composed of civil society organizations, international cooperation partners and government authorities.

HIV is a major priority for the Jamaica transgender community. Around 50% of transgender women participants in two recent studies were living with HIV. But there are other pressing concerns. Two surveys found that around half of transgender respondents were unemployed. One third skip meals. One in ten sells sex to survive. Research conducted in 2020 by TransWave found that half of respondents had been physically assaulted in the past year, with 20% reporting sexual assault. More than 80% had been verbally abused.

“The needs go beyond HIV and health care. Other factors affect people’s ability to be safe, to be adherent or to remain HIV-negative. We should take into account the whole person, not just a part,” said Denise Chevannes-Vogel, HIV and AIDS Officer for the UNFPA Sub-Regional Office for the Caribbean.

“We value the fact that we were able to bring together the community to have a discussion about their needs beyond HIV,” said Ms Green.

The TransWave team led the community needs assessment. Some community requests, such as hormone replacement therapy or gender assignment surgery, are unique. But others are common to all people. They want access to health care and housing, education and employment. And they want to see themselves represented in the civil society spaces where many access care and support.

“We will not reach any AIDS-related targets if we do not prioritize transgender health as a whole. People are dying because of violence, living on the streets, lack of jobs and lack of opportunities. Even the HIV prevention knowledge that most people would acquire through formal education settings is not available to transgender people when they are bullied and forced to drop out. So this process was about reflecting on the impact indicators. What would it take for them to live longer, better lives?” said Ruben Pages, UNAIDS Jamaica’s Community Mobilization Adviser.

But what chance does this comprehensive and forward-thinking strategy have of succeeding in a country famed for its social conservatism? The partners are optimistic. On one hand, the approach calls for longer-term goals, including law reform around issues such as gender identity recognition and decriminalizing sex between same-sex partners. But the strategy is also a practical guide for transgender inclusion in systems and frameworks that are already in place. With targeted action there can be quick wins.

Manoela Manova, the UNAIDS Country Director for Jamaica, said the strategy will help the country accelerate progress to end AIDS.

“Going forward, there will be renewed focus on ensuring that excellent prevention, testing and treatment outcomes are achieved across all communities, especially key and vulnerable populations,” Ms Manova said. “This is an opportunity to make good on our commitment to leave no one behind.”

GENEVA, 10 December 2020—UNAIDS announces the launch of its Solidarity Fund, which will support social entrepreneurs and micro-business owned by key populations facing special hardship during the COVID-19 pandemic.

“Key populations are among those disproportionally impacted by COVID-19,” said Winnie Byanyima, UNAIDS Executive Director. “COVID-19 has highlighted and exacerbated the profound and widening economic and social inequalities. We must act to support and protect the people who are most impacted by the pandemic.”

Experience from the COVID-19 and HIV pandemics, and from other diseases, such as Ebola, has shown that key populations are more likely to be impacted by food insecurity, face barriers to health care and access to medicines, and suffer losses of livelihood, unemployment, homelessness and domestic violence.

Launched today, Human Rights Day, the new Solidarity Fund will support social entrepreneurs and small-scale businesses owned by people living with HIV, women or members of key populations, including sex workers, transgender people, people who use drugs and gay men and other men who have sex with men, the people who so often have their human rights violated.

“The fund will help bridge the gap between aspirations and opportunities of people from my community. It places trust and gives us a chance to show our innovation and entrepreneurship with no limitations,” said Maite Schneider, the cofounder and Chief Executive Officer of TransEmpregos.

To be piloted initially in five countries—Brazil, Ghana, India, Madagascar and Uganda—with a US$ 250 000 budget from UNAIDS, the initiative will scale up to additional countries over the coming months, with a goal of raising an additional US$ 3 million to US$ 5 million in 2021–2022.

UNAIDS will closely work with community networks, national innovation ecosystems, the private sector and other partners to create tailored support, especially capacity development on social entrepreneurship and mentoring to enhance the sustainability of social ventures and impact for the wider community, with special attention given to young key populations.

Among the partners is the venture development and investment platform Social Alpha, which will provide mentoring and entrepreneur support to the chosen beneficiaries. “We look forward to partner with communities and UNAIDS on the Solidarity Fund and leverage our experience in working with social entrepreneurs for solving complex social, economic and environmental challenges,” said Manoj Kumar, the Chief Executive Officer and founder of Social Alpha.

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.

Rena Janamnuaysook steps off the Skytrain in Bangkok’s bustling Sukhumvit shopping district. She looks up, filled with a sense of joy as her eye catches an advert just beyond the platform. The advert is promoting the PrEP in the City campaign to raise awareness and increase the uptake of PrEP among Thai transgender women and shows glimpses of the lives of four transgender women as they juggle their busy work schedules, their role as a mother and their relationship with loved ones, all the while taking control of their health with their daily dose of pre-exposure prophylaxis (PrEP). For Ms Janamnuaysook, a transgender advocate and Program Manager for Transgender Health at the Institute of HIV Research and Innovation (IHRI), this first-ever PrEP campaign for transgender women in Thailand signals promise for the country’s HIV response.

“PrEP campaigns of the past were only targeting other key populations, especially men who have sex with men and gay men. Transgender women were left out from PrEP campaigns or public messages,” says Ms Janamnuaysook. 

HIV prevalence among transgender people in Thailand was estimated to be 11% in 2018, with no sign of a decline in the past few years, and the current uptake of PrEP among transgender women is only 7%, making the group a particularly at-risk population. Less than half (42%) of transgender people reported that they are aware of their HIV status, while services catering to their specific needs are limited.

Limited awareness and knowledge about PrEP contribute to the low uptake. The campaign strategy includes reframing the conversation on PrEP use and challenging negative perceptions of PrEP within the transgender population. “For transgender women who know about PrEP already, they still don't want to get it because it has been associated with risky behaviour or negative behaviour. In Thai society, if you use PrEP then you are perceived to have multiple partners, be a sex worker or must have unprotected sex,” says Ms Janamnuaysook.

Ms Note, a client at the Tangerine Clinic, South East Asia’s first transgender-specific sexual health clinic that offers gender-affirming integrated health care and PrEP, among many other health services, speaks of the perception of PrEP, saying, “I had to be cautious so that nobody sees me taking the pills because sometimes people are worried and think that I am sick.” A goal of the campaign is to normalize the use of PrEP and promote continued use, particularly important when evidence suggests that nearly half of transgender women (46%) in Thailand did not return for their one-month visit after starting PrEP.

“The campaign makes taking PrEP seem similar to taking vitamins or supplements for good health. It removes the image that PrEP is suitable for only certain groups, when in fact it can be taken by anybody,” said Ms Note.  

Adverts for the campaign are on billboards across Bangkok, illustrative of the collaboration with the Bangkok Metropolitan Administration and the commitment to achieve the city’s Fast-Track Targets. Online, IHRI has enlisted various social media influencers, bloggers and opinion leaders in the transgender community to share information about the campaign.

“I personally feel proud to have participated in this campaign, which makes people see the other sides of us, transgender women, and our potentials,” says Jiratchaya (Mo) Sirimongkolnavin, a model and beauty blogger featured in the campaign, who is a former winner of Miss International Queen, one of the world’s largest transgender beauty pageants. She goes on to explain, “It encourages people to have general conversations about sex and how to protect themselves from HIV infection.”

Promoting positive representations of Thai transgender women is an underlying focus of the campaign. “I think the story in the video will help wider audiences to see the diversity among transgender people that actually exists in today’s society,” said Ms Note. “The fact that transgenders have many occupations and abilities.”

At a launch event for the campaign, Satit Pitutecha, Deputy Minister of Public Health, spoke about the government’s commitment to strengthening the HIV response, stating, “The Ministry of Public Health has committed to working in partnership with communities and civil society to promote access to HIV and other health services for transgender people.”

Ms Janamnuaysook is proud of the buzz that the campaign has catalysed, which has been shared widely in Thailand and in surrounding countries. She hopes that this campaign, with its tailored messaging for transgender women, won’t be the last and believes that it can serve as a model for future campaigns focusing on other key populations.

The PrEP in the City campaign was developed by IHRI and is supported by the United States President’s Emergency Plan for AIDS Relief through the United States Agency for International Development’s LINKAGES Thailand Project, managed by FHI 360 and the United States Centers for Disease Control and Prevention, the Bangkok Metropolitan Administration, the Division of AIDS and STIs of the Ministry of Public Health and the UNAIDS Asia–Pacific Office.

As COVID-19 pushes the AIDS response even further off track and the 2020 targets are missed, UNAIDS is urging countries to learn from the lessons of underinvesting in health and to step up global action to end AIDS and other pandemics

GENEVA, 26 November 2020—In a new report, Prevailing against pandemics by putting people at the centre, UNAIDS is calling on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.

The global AIDS response was off track before the COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks. Modelling of the pandemic’s long-term impact on the HIV response shows that there could be an estimated 123 000 to 293 000 additional new HIV infections and 69 000 to 148 000 additional AIDS-related deaths between 2020 and 2022.

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Winnie Byanyima, Executive Director of UNAIDS. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

New targets for getting back on track

Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have done remarkably well and have achieved or even exceeded the targets set for 2020, many more countries are falling way behind. The high-performing countries have created a path for others to follow. UNAIDS has worked with its partners to distil those lessons into a set of proposed targets for 2025 that take a people-centred approach.

The targets focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They put people at the centre, especially the people most at risk and the marginalized—young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.

New HIV service delivery targets aim at achieving a 95% coverage for each sub-population of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics.

The 2025 targets also require ensuring a conducive environment for an effective HIV response and include ambitious antidiscrimination targets so that less than 10% of countries have punitive laws and policies, less than 10% of people living with and affected by HIV experience stigma and discrimination and less than 10% experience gender inequality and violence.

Prevailing against pandemics

Insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.

“No country can defeat these pandemics on its own,” said Ms Byanyima. “A challenge of this magnitude can only be defeated by forging global solidarity, accepting a shared responsibility and mobilizing a response that leaves no one behind. We can do this by sharing the load and working together.”

There are bright spots: the leadership, infrastructure and lessons of the HIV response are being leveraged to fight COVID-19. The HIV response has helped to ensure the continuity of services in the face of extraordinary challenges. The response by communities against COVID-19 has shown what can be achieved by working together.

In addition, the world must learn from the mistakes of the HIV response, when millions in developing countries died waiting for treatment. Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services.

Everyone has a right to health, which is why UNAIDS has been a leading advocate for a People’s Vaccine against COVID-19. Promising COVID-19 vaccines are emerging, but we must ensure that they are not the privilege of the rich. Therefore, UNAIDS and partners are calling on pharmaceutical companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce successful vaccines at the huge scale and speed required to protect 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.

Haiti’s first safe house for transgender people opened last week. Kay Trans Ayiti launched with the snip of a red ribbon and cheers from a circle of activists and residents. The group took turns taking pictures between bobbing pink and blue balloons tied to the veranda.

The triumphant moment came during a tough time. Asked how transgender people have fared in Haiti during COVID-19, home founder Yaisah Val was emphatic. “When the rest of the population has a cold, the trans community has pneumonia. Just imagine that with the hunger, poverty and meagre resources in Haiti, we are always on the outside,” she says.

In many ways, Ms Val is not as shut out as the people she serves. Haiti’s first publicly open transgender woman introduces herself as a mother of two and a wife. She has a degree in education and clinical psychology. She was a teacher and school counsellor before becoming a full-time community mobilizer, activist and gender identity spokesperson. During what she calls her stealth years, she was easily accepted as a woman.

Born in the United States of America to Haitian parents, she has had the benefit of a stable home, supportive teachers and a wildly loving grandmother.

“If you are going to be a sissy you will be the best sissy there is because you are mine,” her granny told her when she was a boy named Junior.

This is an anomaly. According to the United Caribbean Trans Network, transgender people in the region are far less likely to be supported by family, complete their secondary education and be employed. They are more likely to be homeless, to sell sex to survive and to face extreme violence. All this sharply increases the community’s HIV risk. A recent study found that transgender women in Haiti had an HIV prevalence of 27.6%—14 times higher than the general population.

But notwithstanding her “privileged” life, Ms Val’s 47-year journey has been fraught.

From when she was two or three years old she knew she was a girl. The gender policing from relatives was immediate and incessant: “Straighten up that boy. You can’t let him grow up like that.” At seven she was admitted to Washington Children’s Hospital with self-inflicted wounds to her genitals. Puberty was, “hell … a lot of confusion and self-hate.”

About 20 years ago she became herself during the Haitian Carnival. She braided her hair, slipped into a dress and boarded a loud, colourful tap-tap bus with her friends. One man flirted. He called her pretty and opened doors. She felt like Cinderella.

“That boy eventually found out and beat me within an inch of my life,” Ms Val remembers. “Whether you are upper class or middle class or on the streets, as long as you are trans it does not matter. Once you disclose, all respect is gone … you are just this thing. That one word disarms you of all humanity in people’s eyes.”

Transitioning offered a sort of freedom, “I was living and being seen as who I am, who I had always been.” But the fear of being assaulted or excluded made her identity a stressful secret. Old boyfriends did not know she was transgender until she came out years later. She only disclosed to the man who would become her husband after they had lived together for a year and were on the brink of getting married.

“I don’t recommend people do that,” Ms Val says again and again, referring to transgender people hiding their gender identity from romantic partners. “It can be violent. It can be dangerous.”

In her case it worked out. Her partner decided that she was the same person he knew and loved. Three years ago, the story repeated when she disclosed to her children.

“I was just surprised,” her son, Cedrick said. “I was shocked in a good way. They’d slowly started educating me over the years, so I understood what it meant. Ever since then the whole mother/son bond went to a new level for both of us. It filled in all those gaps. Now everything made sense, like her childhood stories.”

Coming out to those closest to her has opened the floodgates to activism. In 2016, Ms Val became the first person in Haiti’s history to publicly identify as a transgender person. She has been a key partner for UNAIDS Haiti and the island’s lesbian, gay, bisexual, transgender and intersex (LGBTI) people organizations. Last year she participated in a national dialogue on LGBTI rights. Together with her husband she started taking in homeless transgender people. That paved the way for Kay Trans Ayiti, which now houses 10 transgender people. Fundraising is under way for a programme of psychosocial support, hormonal replacement legal advice and job training. One of their employment initiatives is a food cart. Some of their residents are living with HIV. They are supported to remain adherent to their antiretroviral treatment.

Ms Val knows first-hand how terrifying it is to access sexual and reproductive health care as a transgender woman. She recalls the experience of going to a gynaecologist in Haiti to get a check-up related to her vaginoplasty. The doctor did not understand what “transgender” meant. That visit ended with the gynaecologist calling other doctors to gawk.

“I was a YouTube channel, a Google page … anything but a human being. I was upset. I was crying. This is why transgender people do not access health care! We have a lot of transmen with gynaecological issues who make herbal treatments rather than go to the doctor,” Ms Val says.

Her group, Community Action for the Integration of Vulnerable Women in Haiti (Action Communautaire pour l’integration des Femmes Vulnerable en Haiti, or ACIFVH), is working with two HIV clinics to sensitize health-care providers. Combatting the ignorance and conservatism is a tall task. Even after educational sessions some doctors and nurses have tried pushing their religious views on the trainers.  

“I was lucky not to be hindered by transphobia and discrimination,” Ms Val reflects. “Imagine if I did not have a supportive grandmother, an education and opportunities. I would not have been the person you see now.

“If you throw a seed on concrete it is not going to thrive. Being trans is not the problem. It is the reaction people have to it:  throwing them on the streets, not letting them work, not taking them into schools. We need to have a place in society. It is hard. It will take a while. But someone has to start.”

In 2019, the proportion of new adult HIV infections globally among key populations and their sexual partners was 62%. This shift to an HIV epidemic increasingly among key populations is a result of the strong progress in HIV prevention in settings with high HIV prevalence in eastern and southern Africa, combined with a mixture of progress and setbacks in lower-prevalence regions.

Key populations—which include sex workers, people who inject drugs, prisoners, transgender people, and gay men and other men who have sex with men—constitute small proportions of the general population, but they are at elevated risk of acquiring HIV infection, in part due to discrimination and social exclusion.

Rose Clark (not her real name) is a 21-year-old transgender woman living in Kingston, Jamaica. Through sex work she’d been able to afford the basics—food, clothes and a small apartment.

Another transgender woman, Carla John (not her real name), worked in a hotel bar on Jamaica’s north coast. It allowed her to live independently of an unsupportive family since she was 19 years old.

COVID-19 upturned their lives. A night-time curfew made it impossible for Ms Clark to work. She was evicted in May. Ms John’s employer shut down operations in April and sent staff home. Since then she’s been living with hostile relatives.

These two are not alone. The Equality Group—a coalition of civil society organizations serving lesbian, gay, bisexual and transgender (LGBT) people in Jamaica—conducted an online survey to gauge the impact of COVID-19 on the LGBT community. It found that a quarter of respondents had lost their job, while three in 10 were unable to pay for food, rent or utilities.

“There’s been a sharp increase in homelessness,” reported Renae Green, Associate Director of Policy and Advocacy at Transwave. “The community has experienced major loss of income and people are unable to pay for housing, food and other basic amenities.”

The transgender community as a whole has several layers of vulnerability—low access to education and employment, small or non-existent family safety nets and high vulnerability to gender-based violence. These are the underlying causes for a 2018 study finding that half (51%) of transgender women in Jamaica were living with HIV. 

Transwave has collaborated with WE-Change, JFLAG and Equality Youth to run a COVID-19 hotline. It also provided care packages, including non-perishable food items and toiletries, to people in need. Already more than 100 transgender people have benefitted.

Critically, a Trans Emergency Fund was established to raise money to cover or subsidize applicants’ rent for short periods. Both individuals and organizations have made donations. And Transwave manages a virtual support group, providing much needed emotional solidarity during this trying time.

If anything, COVID-19 has intensified Transwave’s ongoing efforts to shine a light on the hidden issues facing one of Jamaica’s most marginalized groups.

“We are not included in decision-making processes,” Ms Green said plainly. “Decision-makers barely talk about us. We keep having to say “remember trans people”.”

UNAIDS Jamaica provided financial support that was used to ensure that Transwave had personal protective equipment and to supplement care package supplies. The office has also made certain that transgender issues are included in the coordinated HIV civil society response to COVID-19.

This fresh pandemic response has unfolded alongside Transwave’s 2020 strategic planning work, which has been supported by UNAIDS and the United Nations Population Fund.

“There is an urgent advocacy agenda for transgender people that includes all the social determinants to health and human rights,” said Manoela Manova, the UNAIDS Country Director for Jamaica.

“COVID-19 has laid bare just how vulnerable people are when they do not have equitable access to opportunities, justice and health care,” added UNAIDS Jamaica’s Community Mobilization Adviser, Ruben Pages. “That’s why it’s so important and inspiring that Transwave has continued its core work through all this.”