Rosma Karlina and Bambang Yulistyo Dwi live with their two young children in the rainy hillside town of Bogor, south of Jakarta.

“Sometimes we go to museums to introduce the children to history or feed the deer at the Presidential Palace. It’s simple entertainment but can teach the children to learn to love even animals,” Ms. Karlina said.

If their family life is traditional, their work life is anything but. Ms Karlina is the founder and Director of Suar Perempuan Lingkar Napza Nusantara (also called Womxn's Voice), an advocacy and care organisation serving women and transwomen who use drugs. Bambang, popularly known as Tedjo, founded the Indonesian Justice Action Foundation (AKSI). Since 2018 his team has provided legal aid and support to people who use drugs, and advocated for their rights.

Their workdays are a mix of community organizing, paralegal paperwork and responding to distress calls. A client reported her husband’s domestic violence. When the police arrived at the house, the husband informed the police of her drug use and the police arrested her instead.

The organisations successfully advocated for a man to be released from a compulsory rehabilitation centre so that he could access HIV treatment. Otherwise, he would have gone three months without his medicines.

The organisations have witnessed many examples of women living with HIV being faced with extreme scorn. A police officer once threw a pack of sanitary napkins into a woman’s cell instead of passing it to her, saying it was because he was afraid to be near her.

“Since 2018 I have seen many rights violations perpetrated by law enforcement officers—abuse physically, psychologically and even financially,” Ms Karlina said. “They extort families to pay to enable their loved ones to go home.”

The Rosma Karlina of today—nurturer and fierce advocate—evolved from almost two decades of drug abuse. She has been to rehabilitation centres 17 times. Rock bottom came during an 18-month incarceration for heroin possession.

“My family paid a lot of money to the prosecutors, but I was still imprisoned. I lost custody of my oldest child. The judge thought I did not deserve to be a mother because I was a drug user,” she recounted.

Tedjo also evolved from addiction to activism.

“I did drugs between 1989 and 2015. It has been a long journey,” he reflected. “When my life was a mess, I hurt many people. It was not easy to prove that I was better.”

The couple are leading voices on how harsh criminal laws for drug possession and use lead to rights violations against people who use drugs while also lowering access to health services.

A 38-country legal and policy analysis by UNAIDS and UNDP found that 14 countries in the region have corporal or capital punishment penalties for the use or possession of drugs. Some states have condoned extrajudicial killings for drug offences.  In 2021 an estimated 12% of new HIV infections in Asia and the Pacific were among people who inject drugs.

 “The war on drugs has created a lot of stigma, and a culture that views an entire community as criminals. When we access healthcare, we get treated as bad people,” Tedjo said.

Regional Coordinator of the Network of Asian People who Use Drugs (NAPUD), Francis Joseph, explained that in the absence of legally conducive environments people don’t have access to appropriate services.

“Healthcare providers and law enforcement agencies treat them with violence and abuse,” he said. “So they don’t want to come out the closet and say ‘I have shared needles and syringes and I need an HIV test’. Because drug users are not welcome in our health facilities that leads to them going into the shadows and staying there.”

Lord Lawrence Latonio, a Community Access to Redress and Empowerment (CARE) partner and law student noted that Philippines also criminalises the possession of what are seen as drug paraphernalia. This means that peer educators who disseminate clean needles and syringes have to be watchful so they are not apprehended.

Fortunately advocates successfully lobbied for the country’s HIV and AIDS Policy Act of 2018 to include protections for healthcare workers who provide HIV services. Part of CARE’s work is legal literacy training so communities understand their rights. CARE also has a network of peer officers working in different regions to support members of key population communities and people living with HIV with seeking redress in cases where there have been rights violations.

Twenty-one countries in the region operate either state-run compulsory detention and rehabilitation facilities for people who use drugs or similar facilities. These are a form of confinement where those accused of, or known to be using drugs, are involuntarily admitted for detoxification and “treatment”, often without due process. Conditions have been reported to involve forced labour, lack of adequate nutrition, and limited access to healthcare.

In 2012 and 2020 United Nations agencies called for the permanent closure of these compulsory facilities. But according to a 2022 report, progress on this issue in East and Southeast Asia has largely stalled.

“UNAIDS is working with the United Nations Office on Drugs and Crime (UNODC) to support countries to transition from compulsory facilities towards voluntary community-based treatment that provides evidence-informed and human-rights based services,” said UNAIDS Asia Pacific Human Rights and Law Adviser, Quinten Lataire.

UNAIDS Indonesia is working with Womx'n Voice to pilot a multi sector partnership shelter and education program for women and children in Bogor. Interventions include social protection, legal support, mental health support, HIV and health education and accompaniment to services.

Ms Karlina called for increased investments in mental health care, poverty alleviation and education. “We need proper assessments to better look at each situation and come up with an effective solution. Prison is not the answer. If you see us as humans, you will take care of us as humans,” she insisted. 

On Zero Discrimination Day 2023, commemorated on March 1, UNAIDS highlights the need to remove laws that criminalize people living with HIV and key populations.* The 2023 theme, “Save lives: Decriminalize”, points to the positive impact on health and life outcomes when discriminatory and punitive laws are removed.

In 2021, the world set ambitious law reform targets to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalization as a critical element in the 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.

Winnie Byanyima, Executive Director of UNAIDS, said:

"Criminalizing laws chase people away from life-saving treatment. Those need to be removed. The only reason people are still dying of AIDS is the inequalities in society, from social norms, from the lack of opportunities in school, etc. and all these come together to make them more at risk."

"At the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.”

These targets are ambitious but they are necessary

Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalize same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions.

Criminalization of sex work increases both the risk of sex workers acquiring HIV and their vulnerability to violence perpetrated by clients, police and other third parties. The criminalization of the clients of sex workers has also been repeatedly shown to negatively affect sex workers’ safety and health, including reducing condom access and use, and increasing the rates of violence.

Decriminalization of drug use and possession for personal use is associated with significant decreases in HIV incidence among people who inject drugs, including through greater access to harm reduction services, reductions in violence and arrest or harassment by law enforcement agencies.

Winnie Byanyima said:

"We have the evidence that when you repeal criminal laws on same-sex relations that the risk of contracting HIV falls, the risk of new infections amongst gay men, MSM, drops significantly.

"To me HIV is a disease but it's more a social injustice. It's driven by inequalities in society. These are not things that can happen without a consensus in the society, so we need everybody on board."

Law reform is therefore critical if we are to end AIDS as a public health threat by 2030.

The targets are ambitious but not impossible

Indeed, recent experience is proving just how possible they are.  In 2022 alone Belgium and Australia have removed laws criminalizing sex work; Zimbabwe decriminalized HIV exposure, non-disclosure, and transmission and the Central Africa Republic reduced the scope of its HIV criminal laws; Antigua & Barbuda, St Kitts & Nevis, Singapore and Barbados have repealed old colonial laws criminalizing same-sex sexual activity. Kuwait repealed a law criminalizing the imitation of the opposite sex, a law used to target transgender persons while New Zealand removed travel restrictions relating to HIV.

However, despite such encouraging reforms, the world is not on track to ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services. In 2021, 134 reporting countries explicitly criminalized or otherwise prosecuted HIV exposure, non-disclosure or transmission; 20 reporting countries criminalized and/or prosecuted transgender persons; 153 reporting countries criminalized at least one aspect of sex work; and 67 countries now criminalize consensual same-sex sexual activity, according to UNAIDS. In addition, 48 countries still place restrictions on entry into their territory for people living with HIV, while 53 countries report that they require mandatory HIV testing, for example for marriage certificates or for performing certain professions. 106 countries report requiring parental consent for adolescents to access HIV testing.

Such laws and sanctions violate international human rights norms and stigmatize and discriminate against already marginalized populations.

Decriminalisation saves lives and helps advance the end of the AIDS pandemic.

* Key populations are communities at higher risk of HIV infection including gay men and other men who have sex with men, people who use drugs, sex workers, transgender people and people in prisons and other closed settings.

As a girl Ikka dreamed of becoming an accountant. She knew her parents could not afford to send her to university, so she resolved to pay for university herself by moving into a brothel. For almost three years she lived and worked there while studying.

Davi’s parents divorced when he was a baby and he was raised by caring grandparents. In high school he led lots of extracurricular activities. He was also gay. Just three months before his final exams Davi was raped by a teacher who threatened to “out” him. He ran away to the city. After a desperate search for work, he landed a job in a massage parlour.

From the Bangkok offices of Youth LEAD and the Asia Pacific Network of People Living With HIV and AIDS (APN+), the pair reflects on those chaotic adolescent years with halting candour. They unpack layers of vulnerability and abuse—the way poverty and trauma can propel young people toward sexual exploitation, higher HIV risk and a cascade of rights violations. And they say that the criminalisation of sex work only made their situations worse.    

“No one tells you anything other than that you need to please your client. Just be submissive and quiet. There’s no protection, no information, no nothing,” Ikka remembers.

The brothel would occasionally force the women to undergo HIV and STI testing. Saying ‘no’ wasn’t an option. But when Ikka went to a clinic on her own to get condoms or contraceptives, she was turned away.

Customers sometimes didn’t pay, became violent or refused to stop having sex after even two or three hours. Abusive clients routinely threatened to report them.

“If someone called the police, they would arrest the sex worker. The customer is king,” Davi says. “So silence is better.”

“The police wouldn’t take your report. They think they have more important cases than you,” Ikka adds.

UNAIDS Asia Pacific Human Rights and Law Adviser, Quinten Lataire, explained that criminal laws against sex workers make it very difficult for sex workers to demand basic rights, substantially increasing their risk for abuse and exploitation, such as from law enforcement officers.

“The criminalization of sex workers does not end sex work. It simply makes people go underground, putting them at higher risk of violence and HIV transmission. This has a devastating impact on the sex workers themselves, their clients and the society at large,” Mr Lataire said.  

Almost all (99%) new HIV cases in young people in Asia Pacific are amongst key populations and their sexual partners. In Cambodia, Indonesia, Lao PDR, the Philippines and Thailand, youth account for between 40% and 50% of new infections. Since 2010, HIV rates among young people have risen in Afghanistan, Fiji, Malaysia, Pakistan, Papua New Guinea, the Philippines and Timor-Leste.

At ages 18 and 19 respectively, both Ikka and Davi learned that they were HIV positive. In Ikka’s case she was tested as a VISA requirement for a student exchange programme. Her results were forwarded to her school even before she got them and she was kicked out. From breach of confidentiality to discrimination in both education and healthcare settings—one rights violation after another. Ikka had the agency to confirm her HIV status at a community-based sex worker clinic she’d looked up and immediately started treatment.

Davi voluntarily tested with a community organization that visited the massage parlour to conduct sensitization sessions and offer services. He kept his status a secret at work but began attending support meetings on the weekend. He sometimes told the pimp that he was going out to meet a client, handing over the stipend he got from the organization when he got back.

“For eight months after I knew I was positive, I felt like I didn’t want to do sex work, but I needed the money. I told clients to use condoms but some of them would give me more money not to,” Ikka remembers.

The events that finally prompted her to leave the brothel still evoke strong emotions. Her best friend there also contracted HIV.

“I told her, ‘let’s go together to get antiretroviral treatment’. I showed her my medication as evidence. But she didn’t want to go. She would not get support from her parents and if the pimp found out, he would kick her out. She felt it was better to die,” Ikka remembers. Her friend passed away just two months after her diagnosis.

In both cases these young people demonstrated incredible resilience and were supported by community-led organizations with tailored services for sex workers and people living with HIV. Ikka joined an organization addressing sex workers’ rights, health and social support needs. She quickly carved a niche representing the interests and perspectives of young sex workers. She would go on to lead national young key population organizations and sit on the Global Fund’s Youth Council. Today she is the Regional Coordinator of Youth LEAD.

“I told myself I needed to help my community,” Davi says. “I don’t want no more people in my situation; no more students becoming victims of sexual violence; no more 19-year-olds HIV positive. I just chose to leave (the parlour) and volunteer with the community organization instead.” Encouraged and supported by community, Davi would go on to graduate from high school and earn a sociology degree. He is now aiming for a Masters qualification while working as APN+’s Youth Officer.

The issues Ikka and Davi faced remain today.

“I still use a condom, but many clients refuse,” says Rara, a 22-year-old sex worker. “When we’re desperate for money, we have no choice but to agree. In addition to gonorrhea, I got syphilis and got treated for it. Thankfully I’m still HIV negative.”

UNAIDS and the Inter-agency Task Team on Young Key Populations are working to address the inequalities faced by young key populations in Asia Pacific. Learn more about their work.

GENEVA, 13 December 2022—UNAIDS welcomes the judgement by the High Court in Barbados to strike down the country’s colonial-era gross indecency and buggery laws that criminalised consensual same-sex relations.

“This historic decision is a significant step towards protecting the human rights and dignity of LGBT people in Barbados,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “It will also strengthen the country’s HIV response by helping to reduce stigma and discrimination faced by LGBT people and increasing the uptake of HIV testing, treatment and prevention services.”

Under section 9 of the Barbados Sexual Offences Act, punishment could lead to life imprisonment for men engaging in same-sex sexual activity. Under section 12, both men and women were criminalised and liable to up to 10 years imprisonment. Laws that punish consensual same sex relations, in addition to contravening the human rights of LGBT people, act as a barrier to improving health outcomes, including in the HIV response. Such laws sustain stigma and discrimination against LGBT people and stop LGBT people seeking and receiving healthcare for fear of being punished or detained. Decriminalisation saves and changes lives and builds stronger societies.

Barbados becomes the third Caribbean country this year to announce the repeal of such discriminatory legislation. The case was filed by two Barbadian LGBT advocates with local organisation Equals Barbados providing community support, and the regional LGBT umbrella organisation, the Eastern Caribbean Alliance for Diversity and Equality, convening the process.

Earlier this year, courts in Antigua and Barbuda and St Kitts and Nevis also struck down as unconstitutional laws that criminalised gay men and other men who have sex with men. There now remain six countries in the Caribbean that criminalize gay sex between consenting adults, all of them former British colonies. They are Dominica, Grenada, Guyana, Jamaica, St. Lucia, and St. Vincent and the Grenadines.

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.

Responding to the decision of South Africa's Cabinet to propose a Bill that will repeal criminalisation of sex work, UNAIDS Country Director Eva Kiwango said:

"The evidence is clear: Criminalisation has been proven to have increased the risks faced by South Africa's sex workers, hurt their health and safety, and obstructed South Africa's HIV response.

UNAIDS welcomes South Africa's Cabinet's proposal to repeal criminalisation and to protect sex workers against abuse and exploitation.

Criminalisation has impeded South African sex workers' access to vital health-care services, including effective HIV prevention, treatment, care and support services.

To end AIDS, we need to repeal the harmful punitive laws which are perpetuating the pandemic. To save lives, decriminalise."

Note: The statement by South Africa's Cabinet on their agreement to propose repeal of criminalisation is published at https://www.gov.za/speeches/statement-cabinet-meeting-30-november-2022-1-dec-2022-0000 under "Criminal Law (Sexual Offences and Related Matters) Amendment Bill of 2022". The Bill will now be published for public comment.

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.

Responding to the scrapping of the colonial era law which had criminalised gay men, UNAIDS Regional Director for Asia and the Pacific region Taoufik Bakkali said:

“Everyone benefits from decriminalisation. The end of the criminalisation will save lives.

In all countries which have criminalised gay men, it has had the consequence of obstructing access to vital services. Laws which punish consensual same sex relations, as well as contravening the human rights of LGBT people, are a major barrier to improving health outcomes, including in the HIV response. Punitive legislation embeds stigma and discrimination against LGBT people, and  deters LGBT people from seeking healthcare for fear of being denounced to the authorities and facing punishment and detention.

The international momentum to scrap colonial punitive laws will inspire other countries to follow. The evidence is clear: if we are to protect the health of everyone, such harmful laws have no future."

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.

GENEVA, 30 August 2022—UNAIDS welcomes a St. Kitts and Nevis High Court ruling that laws criminalizing gay sex are unconstitutional, meaning that they are immediately struck from the legal code. The Court upheld the plaintiffs’ claim that Sections 56 and 57 of the Offences Against the Person Act violated the right to privacy and freedom of expression.

“This landmark ruling is an important step forward in ensuring equality and dignity for the lesbian, gay, bisexual and transgender community in St. Kitts and Nevis and the whole Caribbean,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “Today, St. Kitts and Nevis joins a growing list of Caribbean nations that have overturned these colonial-era laws that deny people’s human rights and hold back the response to the HIV pandemic. Everyone benefits from decriminalisation.”

Laws that punish consensual same sex relations, in addition to contravening the human rights of LGBT people, are a significant obstacle to improving health outcomes, including in the HIV response. Such laws help to sustain stigma and discrimination against LGBT people and are barriers to LGBT people seeking and receiving healthcare for fear of being punished or detained. Decriminalisation saves and changes lives.

The claim against the government of St. Kitts and Nevis was brought by a citizen, Jamal Jeffers, and the St. Kitts and Nevis Alliance for Equality, with the support of the Eastern Caribbean Alliance for Diversity and Equality. The ruling by the High Court follows a similar High Court decision for Antigua and Barbuda in July. Courts in Belize and Trinidad and Tobago have also repealed sections of their legal codes that criminalized same-sex sexual relations.

There remain seven countries in the Caribbean that criminalize gay sex between consenting adults, all of them former British colonies. They are Barbados, Dominica, Grenada, Guyana, Jamaica, St. Lucia, and St. Vincent and the Grenadines.

“Caribbean civil society is determined, and Caribbean courts are clear. The clock is ticking on these damaging colonial laws,” said Luisa Cabal. “Countries that have still not taken these laws off the books need to do so as a matter of urgency, for the health and human rights of all their people.”

The Court ruling reduces to 68 the number of countries worldwide criminalizing same-sex sexual relations. Earlier this month, Singapore announced that it is repealing legislation that punished gay sex by a prison sentence of up to two years.

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.