Guatemala

In the heart of the bustling Guatemala City, Juan used to face the daily grind of life with an unwavering spirit. He had been diagnosed with HIV several years ago and had learned to manage his health effectively. As a dedicated employee at a marketing firm, he poured creativity into every project he touched.

Life seemed to be on an upswing for him until an unexpected turn of events unfolded at the workplace. A colleague stumbled upon Juan's medical records and, in a breach of privacy, discovered his HIV status. Soon, whispers spread through the office, and Juan began to feel the cold stares and hushed conversations whenever he walked by. Ultimately, he was dismissed from his company for "restructuring reasons."

As the discrimination became more blatant, Juan decided it was time to take action. He sought advice from Líderes Profesionales, a network of lawyers specializing in discrimination cases for people living with HIV. With UNAIDS's support, this network is committed to fighting for justice and equality for marginalized communities.

Upon hearing Juan's story, the lawyers at Líderes Profesionales were appalled by the flagrant violation of privacy and the subsequent discrimination. They quickly assembled a legal team dedicated to ensuring justice for Juan. The lawyers explained the legal protections in place for individuals with HIV, emphasizing that workplace discrimination based on health status is a clear violation of the law.

Together with Juan, the legal team initiated a lawsuit against the firm. They filed a complaint citing violations of privacy, discrimination, and failure to provide a safe and inclusive work environment and asked for payment of benefits and compensation for unjustified dismissal.

Líderes Profesionales worked tirelessly to expose Juan's unjust treatment, seeking justice for him and advocating for broader change in workplace policies. They organized workshops to sensitize companies, urging them to implement comprehensive diversity and inclusion training and policy.

As of December 2023, the case is still ongoing. The legal team's goal is to seek compensation for Juan and foster an environment where such discrimination would not be tolerated in the future.

"Juan's experience and five other discrimination-related workplace cases this year inspire us to continue our advocacy work," says Julio Rodríguez, Director of Líderes Profesionales. "We redouble our efforts to support individuals facing discrimination, using each case as an opportunity to raise awareness and push for systemic change."

In Guatemala, 31,000 people are estimated to be living with HIV. HIV-related stigma and discrimination are still pervasive. According to the latest National Stigma Index (2017), 14% of people living with HIV reported losing their job or source of income due to their positive status for HIV, and 13% of people living with HIV reported being denied employment or opportunity to work because of HIV.

 "Having access to legal support really represented a turning point for Juan. Empowered by it, he is a more vocal advocate for HIV awareness and anti-discrimination efforts," says Marie Engel, UNAIDS Country Director for Guatemala, Honduras and Nicaragua. "Through his journey, Juan contributes to a more just and inclusive society for all." 

In the quiet corner of a community center in Guatemala City, 29-year-old Emma - fictitious name - sits among other women she does not know. In the faces and gestures of each of them, you can see that they all carry the weight of violence and injustice on their shoulders.

The first subtle rays of sunlight gradually fill the room; calm and comfort invite Emma and the others to feel more relaxed in their hearts and souls. With tired eyes, small hands, and a heart scarred by violence, she looks around, absorbs the energy of the place, and takes a deep breath as she awaits the start of a therapy session and an informative talk about HIV.

As the therapy session began, Emma shyly and cautiously shared her experiences with Wendi Polanco, who, since 2019, has become a helping hand for many women battered by gender-based violence. Through Latiendo Juntas, the organization she leads in Guatemala, Wendi clearly proves that sisterhood works and is transformative.  

With support from UNAIDS, Latiendo Juntas coordinates a project to improve access to comprehensive health services, including sexually transmitted infections (STI) and HIV testing and care for women survivors of violence. They also contribute to their resilience and empowerment by raising awareness of human rights, including their sexual and reproductive rights, through group therapy and HIV information talks, which provide facts and a platform for open dialogue, fostering a non-judgmental environment.

"The room becomes a sanctuary where the pain of women like Emma and so many others is recognized," says Wendi. "The community center is a refuge for them, and a network of support among the women is woven with the sun's warmth. I feel relieved when I see how the weight on their shoulders begins to lessen."

Throughout these therapy sessions, Emma and other women discover comfort and empowerment. The therapeutic journeys offered at Latiendo Juntas become a catalyst for their resilience, liberation, and self-care.

The link between HIV and violence against women is a widespread problem, as gender-based violence increases women's vulnerability to HIV infection. Women who experience violence may have difficulty negotiating safe sexual practices, including the use of condoms, which increases their risk of contracting HIV. In addition, fear of violence may deter women from seeking HIV testing, treatment, and support, perpetuating the cycle of violence and silence and limiting their access to critical and essential healthcare resources.

Violence against women in Guatemala is endemic and can be described as a shadow pandemic. The country has one of the world's highest rates of femicide: the intentional murder of women because they are women.

"Addressing the intersection of HIV and violence against women requires comprehensive efforts that include education, empowerment, and dismantling gender-based power imbalances," says Irene Izquieta, UNAIDS Advisor on Rights and Gender for Guatemala, Honduras, and Nicaragua. 

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

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

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

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

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

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

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

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

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

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

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

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

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

The University of San Carlos de Guatemala (USAC) Faculty of Medical Sciences, in collaboration with UNAIDS, the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), launched an online course titled "Conceptos clave sobre VIH, Género y Derechos Humanos" (Key Concepts on HIV, Gender, and Human Rights). The four-module course is designed to provide teaching staff with detailed knowledge about key concepts related to HIV, its treatment and prevention, and the national and international legal framework guiding the response to HIV, as well as the gender and human rights dimensions of the epidemic.

With an estimated three new HIV infections each day in Guatemala and only 73% of the estimated 31,000 people living with HIV receiving antiretroviral treatment and persisting high level of stigma and discrimination towards people living with HIV, the course is a significant step towards addressing the country's HIV challenges. The course aims to provide teaching staff and students with the necessary resources to promote, protect, and fulfill the human rights of adults, adolescents, and children living with or at risk of acquiring HIV, in all their diversity.

The course consists of 140 hours of study, including 70 hours of theory and 70 hours of practice, and will be undertaken between May and August 2023. Course participants will join virtual classes and synchronous group workshops and will have to submit the required tasks according to a work schedule.

The course covers four modules: Module 1 - Update on HIV and AIDS; Module 2 - National and international legal framework for the response to HIV; Module 3 - Health sector Policy framework for HIV response; Module 4- Key concepts on gender and human Rights.

During the inauguration, Marie Engel, UNAIDS Country Director, expressed her hope that participants would enjoy taking the course as much as she and other partners had in developing it. She also emphasized that "the course will be enriched with participants' individual knowledge and experiences, their doubts and concerns. There is obviously a lot of knowledge and wisdom among course participants that the facilitators will strive to capture."

Dr. José María Gramajo, General Coordinator of the USAC Faculty of Medical Sciences' Area of Teachers and Postgraduate training, highlighted that "this refresher course will contribute to the professional development of faculty teachers, sharing with them the latest knowledge about innovations related to HIV prevention, detection, and care, and ensuring an in-depth understanding of cross-cutting issues relevant to HIV and other public health problems."

Teaching staff and students are catalysts with the power to change the national response to HIV. As stated by Dr. Mirna Herrarte, Coordinator of the national HIV, STI, and AIDS program, "I am glad to know that there are so many professionals who want to know more about HIV. In the country, HIV treatment schemes are constantly reviewed. As an anecdote, Guatemala had more than 200 antiretroviral schemes a year ago. Under my leadership, we have reduced those schemes by 75%."

Inequalities persist in the most basic health and HIV services, such as access to screening, treatment, and condoms. USAC's collaborative initiative is an important step towards ensuring that all sectors, including academia, are engaged in ending social, economic, and legal inequities. The University of San Carlos de Guatemala is the largest and oldest university in Guatemala, and the only national and public university in the Central American country. 

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%.

Preventing mother-to-child transmission of HIV remains one of the major challenges of the AIDS response in Guatemala. In 2015, testing coverage for HIV among pregnant women was 42%. Now, the International Labour Organization (ILO) has teamed up with the Coffee Foundation for Rural Development (Funcafé), the national coffee association, the national AIDS programme and other United Nations agencies, such as UNAIDS and the United Nations Children’s Fund, to promote access to HIV testing, treatment and prevention programmes among women who take up work on plantations during the coffee cutting season.

Seasonal workers employed on coffee plantations often have limited information about HIV and other health issues and restricted access to HIV care and support services. There is also the additional challenge of high levels of mobility and migration among plantation workers. The new programme leverages the network of 16 community health centres established by Funcafé in coffee producing areas of the country’s highlands to provide information related to the prevention of mother-to-child transmission of HIV and to promote the uptake of HIV testing and treatment services for pregnant women.

The project aims to diagnose pregnant women living with HIV and refer them to the official health system for further tests to confirm their status and to start antiretroviral treatment. ILO and its partners provide technical support to train community health workers on providing prevention of mother-to-child transmission of HIV services, bringing HIV treatment and prevention services closer to the people who need them and increasing testing and treatment coverage among pregnant women.

“This is an innovative initiative aimed at strengthening women’s access to prevention of mother-to-child transmission of HIV services by linking the community health system and the national health system and by promoting a multisectoral partnership between the private sector, the Ministry of Health and international partners, with the active participation of communities,” says Ricardo Garcia, UNAIDS Country Director in Guatemala.

Among other aspects, the initiative seeks to train community midwives on HIV prevention and prevention of mother-to-child transmission of HIV on coffee plantations. Midwives play an important role in rural areas as an entry point for pregnant women into the health system. The joint project also aims to raise awareness about HIV prevention and gender equality among male coffee workers and men living in rural areas.  

“Workplace settings are an opportunity to provide access to information about HIV prevention tools as well as to promote health, not only among our employees and their families, but in the communities in which we operate, benefiting the entire population,” explains Mynor Maldonado, the Executive Director of Funcafé.

The initiative is part of a wider programme that ILO and UNAIDS have been implementing since 2013. ILO and its partners are exploring similar initiatives with other agribusiness sectors. 

See to understand promotes the use of red glasses to make visible the commitment to counter stigma and discrimination related to HIV.

In Guatemala, wearing a pair of red glasses has transcended from being a fashion statement to a symbol against stigma and discrimination faced by people living with HIV. UNAIDS, in partnership with the National Red Cross, launched “See to understand”, a campaign that challenges people to look at the world through red glasses for a new perspective on what it can mean to live with HIV.

Millions of people still do not know what HIV is, how it is transmitted or how to prevent it. Furthermore, a range of social prejudices result in people living with HIV being frequently subject to discrimination in the workplace and in wider society. UNAIDS Guatemala and the Guatemalan Red Cross felt it was necessary to speak about HIV in order to stop taboos and prejudices.

The new initiative aims to raise awareness about HIV, eliminate stigma and discrimination and contribute to achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths in Guatemala.

Ver para entender (See to understand) promotes the use of red glasses to make visible the commitment to counter stigma and discrimination related to HIV. According to the campaign, wearing the glasses means prioritizing health over social and cultural norms and supporting people living with and affected by HIV. "‘To see’ means to challenge fear, ignorance, silence and myths that contribute to fuel the stigma and discrimination that jeopardize the progress made in the response to AIDS,” said Enrique Zelaya, UNAIDS Country Coordinator for Guatemala and Mexico.

Participants can support the campaign by taking a picture of themselves wearing a pair of red glasses and encourage others to do the same. So far more than 800 people have joined this initiative including national authorities and people living with HIV. Among them, Luz Lainfiesta Minister of Social Development, Claudia Samayoa Director of the National STD, HIV and AIDS Program and Otoniel Ramirez REDCA + Regional Secretary.

“HIV affects us all and the response requires a comprehensive approach,” said Minister Lainfiesta. “From the Ministry of Social Development we will work to reach the goal of zero discrimination towards people living with HIV.”

The powerful message of the campaign has already expanded beyond Guatemala. During the 19th Session of the Human Rights Council held in Geneva February 2012, the United Nations High Commissioner for Human Rights, Ms Navi Pillay put on the red glasses and urged countries to protect human rights and work towards the elimination of the stigma and discrimination affecting people living with HIV.

The campaign will undertake additional activities to raise awareness about HIV-related stigma and discrimination including the broadcast of radio messages and the organization of social mobilization activities such as discussion forums, surveys and community arts competitions on HIV. 

Prevailing stigma and discrimination

An estimated 65 000 people are living with HIV in the Guatemala. There are more than 20 people becoming newly infected every day amounting around 7 500 new HIV infections each year. The HIV epidemic in the country remains concentrated among key populations at higher risk such as sex workers and their clients and men who have sex with men. Discrimination against these affected populations is also very high in the country making it more difficult for them to access HIV services.

According to the first national human rights report, between 2009 – 2010 there were 313 complaints to the national attorney and civil society organizations of which 46% related to violations of the right to health and 13% to the right to life and integrity. Such violations ranged from shortages of antiretroviral medicines to lack of adequate and friendly health facilities and personnel.

The transgender organization OTRANS stressed in the report that transgender people had limited access to employment because of stigma and discrimination. OTRANS also reported cases of physical aggressions, disappearances and deaths because of gender identity. According to the organization, 13 deaths and 3 disappearances were reported from 2007 to 2011.

"Since the beginning of the epidemic, stigma and discrimination have been identified as the main obstacle to an effective HIV response,” said Cesar Núñez, UNAIDS Regional Director for Latin America. “Discrimination related to HIV is itself a violation of human rights, and, in turn, implies the violation of other rights, including the right to health, education, dignity and equality before the law," he added.

Rene Mauricio Valdes, UN Resident Coordinator in Guatemala, at the inaugural event of the "HIV Testing Campaign" for UN staff members.
Credit: UNAIDS Guatemala

An estimated 100 000 people took part in the Ministry of Health and Social Welfare of Guatemala’s National HIV Testing Week Campaign, now in its second year. In order to fulfill the right to health for all citizens, the Ministry, through the National AIDS Program, has established 295 HIV testing sites at national hospitals and health centers around the country.

Twenty-seven years after the first reported case of HIV in Guatemala, access to testing remains limited. According to data from the National Epidemiology Center two out of three people living with HIV were unaware of their status. Early detection of HIV infection is crucial as it enables timely access to treatment and, with it, a better quality of life for people living with HIV.  

Under the slogan "No matter who you are, get tested for HIV," an estimated 100 000 people took an HIV test the last week of July. Supported by Red Cross Guatemala, civil society organizations, and universities, the initiative promoted inclusiveness and an environment free of stigma and discrimination.

To meet the country's commitment to universal access to prevention, treatment, care and support to HIV, the Government institutionalized the annual National HIV Testing Week to offer all citizens – including key populations at higher risk – access to HIV tests over a one week period.

"This is an opportunity to stop HIV in Guatemala and get closer to UNAIDS’ vision of zero new infections, zero AIDS deaths and zero stigma and discrimination,” said Enrique Zelaya, UNAIDS Country Coordinator for Guatemala and Mexico.

Innovative proposal in the UN

The UN system in Guatemala also took part in the weeklong campaign. Under the guidance of the UN system-wide workplace programme on HIV, UN Cares, with both human and material resources from the Red Cross and the Guatemala National AIDS Program, HIV testing was made available at different offices of the UN System in Guatemala.

"It is a privilege, an opportunity and a right to have this national initiative and to take it closer to our workplaces," said the UN Resident Coordinator in Guatemala, Rene Mauricio Valdes.

The HIV epidemic in Guatemala

An estimated 65 701 people are living with HIV in Guatemala. Each year, there are an estimated 7 557 new infections, the equivalent of 21 people newly infected each day. The country’s epidemic is concentrated among key populations at higher risk, such as transgender people, people with tuberculosis, men who have sex with men, female sex workers, youth at risk, and prisoners.

Children and adolescents from rural communities of Guatemala participating in the 5th Rolling Fair called More information, less infection.

More than 1000 indigenous children and adolescents aged 9 to 15 years old from rural communities of Guatemala learned about HIV in the 5^th Rolling Fair called More information, less infection.  The initiative, which took place in San Pedro Yepocapa, was organized by the non-governmental organization (NGO) Comunicares, with support from local authorities, the ministry of education, the municipality, public schools, and the children’s parents.

"Before I came to the fair I knew nothing about HIV. Now I have learned that HIV and AIDS are not the same thing, and also that we are very young for sex," said a 10 year old student looking to her friend as she tried to recall more information, "Ah! And that our body is only ours and no one can touch it.”

The event was part of a broader project “HIV prevention for vulnerable populations: rural, indigenous and sexually diverse” supported by UNAIDS with financial grants from the Kingdom of the Netherlands.

UNAIDS Project Coordinator Ms Pilar Marín highlighted that the project is a great opportunity to reach people, especially children and youth in the rural areas of Guatemala who have not had access to HIV information. "In Guatemala and specifically among the rural and indigenous populations, HIV is often perceived as a taboo.  Through the project we are enhancing skills and knowledge to achieve a change in the behaviour of young people, to avoid risky practices," said Ms Marín.

From 8 am until 6 pm students travelled through an educational and creative journey to learn about HIV. The Rolling Fair is an innovative initiative that consists of a train with 11 illustrative wagons. Each wagon provides information, entertainment and fun games related to themes such as modes of HIV transmission and ways to prevent HIV infection, sexual education, understanding of stigma and discrimination, as well as prevention of violence towards children, especially girls.

"The aim is that children learn through teenagers living in their own community and speak their own language. This fair also includes training for teachers and parents," remarked Oneida Rodas, Director of Comunicares.

The Dutch Ambassador Jan-Jaap van de Velde and UNAIDS Country Coordinator Enrique Zelaya also participated in the fair. They then traveled to San Juan Comalapa to take part in another event organized by the Association of Community Health Services (ASECSA). This initiative brought together 200 young students between 15 and 18 years of age from public institutions to participate in dynamic workshops and HIV awareness-raising talks as well as a play.

These activities have provided young people in this municipality with information about HIV prevention which is complementing the sexual and reproductive education received at school. According to government data, in 2009 only 23% of young people age 15 – 24 years old knew how to correctly identify ways of preventing sexual transmission of HIV and reject major misconceptions about HIV transmission.