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

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

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

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

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

A one stop shop for sexual health services

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

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

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

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

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

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

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

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

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

A redress mechanism for rights violations

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

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

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

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

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

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

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

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

User fees and other out-of-pocket expenses―defined as direct payments made by people to health-care providers at the time of service use―are a major barrier to people getting tested for HIV, to people living with HIV being treated and to people living with HIV being retained in treatment and care.

Even if antiretroviral medicines are available free of charge, fees for diagnostic tests, consultations and medicines for opportunistic infections have a huge impact on people living on a lower income. User fees have also been shown to reduce access to health services more broadly among the more vulnerable within society. Out-of-pocket payments make up substantial proportions of total health expenditure in all regions, and in some low- and middle-income countries private out-of-pocket spending is estimated to account for more than 60% of total health expenditure.

According to the World Bank, around 3.4 billion people globally who earn US$ 5.50 a day or less are just one medical bill away from sinking into poverty.

Results from a large-scale European study among serodiscordant gay couples show that adherence to effective treatment prevents transmission of HIV

GENEVA, 3 May 2019—UNAIDS warmly welcomes the PARTNER2 study results that show that HIV transmission does not occur when a person living with HIV is on effective antiretroviral therapy. The study, which enrolled nearly 1000 gay couples in which one partner was living with HIV and the other was not, showed that where the person living with HIV was taking effective antiretroviral therapy and had a suppressed viral load, there was no HIV transmission within the couple.  

“This is excellent news. People living with HIV now have confirmation that provided they take treatment regularly and are virally suppressed, they are not infectious,” said Michel Sidibé, Executive Director of UNAIDS. “This gives a strong, positive message that will help to reduce the stigma around HIV and improve the self-esteem and self-confidence of people living with HIV.”

By the end of the eight-year study, 15 people did become infected with HIV. Virus screening showed that none of the new infections were linked to the HIV-positive partners in the study, but came from a sexual partner outside of the couple. The researchers estimate that within the study, which took place across 14 European countries, around 472 HIV transmissions were averted over the eight years.

UNAIDS hopes that the results will encourage more people to get tested early and take effective treatment. In recent years there has been a huge scale-up in the roll-out and uptake of antiretroviral therapy. In 2017, of the 36.9 million people living with HIV, 59% (21.7 million) had access to treatment and 47% were virally suppressed. Concerted efforts are needed to ensure that all people living with HIV have access to and adhere to effective antiretroviral therapy.

A large proportion of HIV transmission still occurs before people know their HIV status. The risk of HIV transmission is highest in the weeks and months immediately after infection, when the viral load is high and the person who has contracted the virus is unlikely to know their status, is not on treatment and is not virally suppressed. This demonstrates the critical importance of continuing HIV prevention efforts, including condom use and pre-exposure prophylaxis—medicine taken by an HIV-negative person to prevent HIV.

UNAIDS

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

The Executive Director of UNAIDS, Michel Sidibé, emphasized the importance of cities in ending the AIDS epidemic by 2030 during a speech to the Council of Paris on 4 July, highlighting that cities can use their HIV responses as a transformative force for society.

In his address, Mr Sidibé also spoke of the challenges faced in western and central Africa, where three out of four people living with HIV do not have access to HIV treatment. The African Union has endorsed an emergency catch-up for western and central Africa that sets a target of an additional 1.2 million people on treatment over the next 18 months. The emergency plan places a focus on cities and challenges mayors to take the lead. Mr Sidibé noted that support from Paris can assist western and central African countries to bridge the gaps and reach their goals.

Mr Sidibé finished his address with a call for unity across city borders and country boundaries. “Let us tackle inequalities together. We must not lose focus. Rather, let us continue to fully fund the response in Paris, but also support partners in Africa to tackle inequalities and fragilities.”

Following his address, the Mayor of Paris, Anne Hidalgo, invited Mr Sidibé to join the Let’s Make Paris the City of Love without AIDS! (#FaisonslAmour) campaign. #FaisonslAmour channels the spirit of Paris, uniting Parisians around the target of ending AIDS while raising awareness around the HIV treatment and prevention options available. #FaisonslAmour aims to inform people about the need to know their HIV status and seek treatment early, and to raise awareness about the availability of pre-exposure prophylaxis.

Six Parisians are profiled in the campaign, who reflect the reality of the epidemic within an inclusive city, proud of its diversity. One of the profiles highlights the efficacy of treatment as prevention. The campaign is the first in France to state that a person living with HIV adhering to an effective antiretroviral regime will not pass on the virus. Speaking about the radical campaign, Ms Hidalgo said, “Together, we must mobilize and be vigilant, but, above all, we must act to prevent new infections by delivering just and appropriate messages.”

The #FaisonslAmour campaign is a significant step towards ending AIDS in Paris and demonstrates that Paris is providing leadership in the response to HIV. The campaign is co-chaired by the City of Paris and the Vers Paris sans SIDA association, with the support of the MAC AIDS Fund, and produced by Agence Australie. The posters will be displayed across Paris from 28 June to 25 July.

Speakers urge partners to move forward together to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals  

GENEVA/NEW YORK, 30 November 2016—On the eve of World AIDS Day, UNAIDS has hosted a special event at the United Nations Headquarters in New York, United States of America, to commemorate World AIDS Day. The event, Moving Forward Together: Leaving No One Behind, was also held to honour the leadership of the United Nations Secretary-General, Ban Ki-moon, and his remarkable contribution to the response to HIV in advance of his handover to the new Secretary-General, António Guterres, at the beginning of 2017.

Following a moment’s silence to remember the 35 million people who have lost their lives to AIDS, Michel Sidibé, Executive Director of UNAIDS, presented Mr Ban with the UNAIDS Award for Leadership for speaking out on behalf of, and his commitment to, the people most affected by HIV. 

Accepting the award, Mr Ban said that he was proud to be an activist for the rights of lesbian, gay, bisexual, transgender and intersex people and spoke of his motivation. “We are motivated to fight AIDS because we know that every child deserves care, every person deserves treatment and all vulnerable groups deserve protection from stigma and abuse. Tolerance and awareness help stop AIDS. Speaking out protects life,” he said.

Mr Sidibé paid tribute to the Secretary-General and the exceptional achievements made in the AIDS response during his tenure. “Secretary-General Ban Ki-moon, you have been a true champion for people living with HIV. When you arrived only three million people were on HIV treatment. Our World AIDS Day report shows that more than 18 million are now on treatment. This isn’t just about numbers, but the very lives of people. You have shown through these years that people’s dignity is central to your agenda,” he said.

Since Mr Ban assumed office as United Nations Secretary-General in January 2007, the number of people living with HIV accessing life-saving antiretroviral therapy has increased from 2.9 million at the end of 2006, to 18.2 million [16.1 million–19.0 million] in June 2016. The number of people who died from AIDS-related illnesses has halved, from 2 million in 2006 to 1.1 million in 2015, and the number of new HIV infections among children has been reduced by two thirds, from 430 000 in 2006 to 150 000 in 2015.

During the event, Mr Ban was reacquainted with Rebecca Awiti, a woman living with HIV who met the Secretary-General in 2011 during an official visit to Kenya, where he launched The Global Plan towards the elimination of new HIV infections among children and keeping their mothers alive. Ms Awiti is the mother of triplets, born free from HIV thanks to antiretroviral medicines. “You brought hope to me, my children and my children’s children that an AIDS-free generation is possible in our lifetime,” she said.

One of the founders of the global HIV treatment access movement, Eric Sawyer, praised the Secretary-General for his commitment to zero discrimination. “Mr Secretary-General, I thank you as a long-term survivor of HIV and as a long-time member of UN Plus and UN Cares, and a member of the Free and Equal campaign, for your leadership, for your compassion and for your commitment to the AIDS response, and for your commitment to equality and human rights for all,” he said.

As a special guest at the event, the First Lady of Panama, Lorena Castillo de Varela, who is also UNAIDS Special Ambassador for AIDS in Latin America, stressed the importance of breaking down the stigma still surrounding HIV and standing firm on zero discrimination. “We must all carry the torch for the Secretary-General and, as leaders, fight discrimination every day of our lives,” she said. “We must celebrate the diversity that unites us, and promote solidarity, respect, inclusion and peace.”

Kenneth Cole, amfAR Chair and a leading fashion designer, warned of a growing population that is disengaged and desensitized to the virus and said it was a critical time to coordinate and Fast-Track the effort to end AIDS. “We can contain and reverse the AIDS epidemic through a coordinated response. I strongly believe we can and must and will make AIDS history,” he said.

The President of the United Nations General Assembly, Peter Thomson, called on the world to do more and reach the clear time-bound targets set by Member States in the 2016 Political Declaration on Ending AIDS. “On this World AIDS Day, we honour those who have passed away by committing to end the AIDS epidemic, achieve the Sustainable Development Goals and build a healthy, safe, peaceful and sustainable future for us all,” he said.

Model, actress and philanthropist Naomi Campbell spoke of the triple threat facing young women and girls of not knowing their HIV status, not accessing life-saving treatment and not being empowered to protect themselves from HIV. “Today, I stand in solidarity with the millions of young women and adolescent girls growing up in a world where they are at risk of HIV,” she said. “I want to make a difference—you can count on me to do what I can to help end AIDS.”

Deputy Executive Director of the United Nations Population Fund, Laura Londén, underscored the importance of working as one to Fast-Track the response to HIV. “We can only reach the goal of ending the AIDS epidemic by 2030 if we are serious about HIV prevention. We need to end the isolation and fear that key populations face every day,” she said.

The event culminated with an inspirational and uplifting performance by the United Nations Choir, which performed Mae, a Japanese song about moving forward.

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.