Human rights

Women living with HIV including women from key populations continue to suffer widespread reproductive coercion, mistreatment, and neglect when seeking reproductive health services and rights around the world, a new report by the International Community of Women Living with HIV (ICW) has revealed today. The report was launched at a joint ICW/UNAIDS event at the 25^th International AIDS Conference taking place in Munich, Germany.

The report, Confronting Coercion: A global scan of coercion, mistreatment and abuse experienced by women living with HIV in reproductive and sexual health services, shows that women living with HIV face practices that undermine their bodily autonomy. Reproductive choices are monitored, and women are subjected to various coercive practices.

The report documents experiences of sexual and reproductive health and rights (SRHR) violations and violence faced by women living with HIV and women from key populations from more than 60 countries across 3 regions and offers concrete actions for the reduction of coercive practices.

“This report offers a chilling reality of what women living with HIV experience every day in their struggle to realize their full sexual and reproductive health rights,” said Charity T. Mkona, Global Coercion Scan Committee, ICW ISC Global Chairperson. "For women living with HIV who have been subjected to coercive practices, mistreatment or abuse, the ability to heal and realize their full sexual and reproductive health and rights, demands accountability and justice."

The report reveals that reproductive coercion and mistreatment of women and gender diverse people living with HIV in SRHR services are a common, persistent, and widespread issues that require urgent action. Women living with HIV who reported engagement in sex work, drug use, or had disabilities reported experiencing coercive practices at higher rates than other women living with HIV.

Younger women living with HIV and women living with HIV who were migrants were also more likely to have experienced coercive practices than older women and women who were not migrants. Women have reported experiencing a lack of confidentiality and consensual care, as well as inappropriate medical interventions, such as unnecessary caesarean sections and forced or coerced abortions. Denial of care, stigmatizing comments or insults, and various forms of abuse - verbal, emotional, physical and sexual - were also documented.

While information about sexual and reproductive health and rights of women may be supplied to them, it is not always accurate, comprehensive, or up-to-date to empower them to claim their rights and often does not reflect the realities of women's lives.

"To end coercive practices experienced by women living with HIV, we must recognize the systemic and entrenched nature of these violations and understands that reform requires a systemic sea change and culture shift that respects women's bodily autonomy.” Sophie Brion, Director of Global Programmes at ICW.

“In a world where significant scientific advancements have been made in the treatment of HIV—including breakthroughs that allow women living with HIV whose viral load is undetectable to give birth to HIV negative babies—it’s shocking that some health care workers are not informed that women living with HIV can give birth without transmitting the virus,” said Christine Stegling, UNAIDS Deputy Executive Director for Policy, Advocacy and Knowledge. “This lack of education and coercive practices, including the forced sterilization of women living with HIV, must stop immediately.”

ICW is calling on governments worldwide, including donors and ministries of health, to eliminate these harmful practices. The organization is also calling on governments to ensure that health systems support women living with HIV to realize their full right to health, including sexual and reproductive health and rights, bodily autonomy and rights to informed consent.

"This report issues a powerful call to action to put the autonomy, desires and needs of women living with HIV at the centre of their sexual and reproductive health care programmes." said Immaculate Owomugisha Bazare, Global Coercion Scan Committee,  ICW Global Steering Committee Member.

Background

The Confronting Coercion report was developed through a blend of qualitative and quantitative research, incorporating insights from a gendered analysis of recent Stigma Index 2.0 data, a desk review of literature, and a qualitative study involving women, trans and gender non-binary people living with HIV who shared experiences of reproductive coercion over the past 3 years. The qualitative part of the study looked at coercion, mistreatment and neglect related to the SRHR of women and gender diverse people living with HIV in HIV, SRH and maternity care settings.

UNAIDS has supported the development of the report to address systematic gender inequalities, in particular gender-based discrimination and violence against women living with HIV, which fuels the HIV epidemic.

Joint Statement by UN High Commissioner for Human Rights Volker Türk and UNAIDS Executive Director Winnie Byanyima

GENEVA, 19 July 2024 — As courts and parliaments in a number of countries are in the midst of considering the legal framework around the rights of LGBTQ+ people, we highlight that punitive laws against lesbian, gay, bisexual, transgender and queer people violate human rights and undermine public health.

Such laws cost lives.

Laws criminalizing LGBTQ+ people must be consigned to history – and a growing number of countries are doing just that. 

The big – and very welcome – global shift is away from criminalization. Over two-thirds of countries now do not criminalize LGBTQ+ people.

In the last 10 years alone, Angola, Antigua and Barbuda, Barbados, Belize, Bhutan, Botswana, Cook Islands, Dominica, Gabon, India, Mauritius, Mozambique, Namibia, Nauru, Palau, Saint Kitts and Nevis, Seychelles, Singapore, and Trinidad and Tobago have all repealed laws that had criminalized LGBTQ+ people. 

There is a whole host of reasons why such laws must be scrapped.

Such laws are based on prejudice.

As Namibia's High Court recently noted, "the enforcement of the private moral views of a section of the community (even if they form the majority of that community), which are based to a large extent on nothing more than prejudice, cannot qualify as such a legitimate governmental purpose."

Such laws infringe upon human rights. 

The Eastern Caribbean Supreme Court put it clearly: “The criminalization of same-sex sexual expression between consenting adults is intrusive by its very nature and thereby offends the right to liberty and personal privacy.”

Many such laws are actually legacies of colonialism, imposed by colonial powers themselves. 

The now scrapped punitive anti-LGBTQ+ law in Mauritius, the Supreme Court of Mauritius recently noted, “was not the expression of domestic democratic will but was a course imposed on Mauritius and other colonies.”

Such laws harm public health.

Criminalization of LGBTQ+ people generates justified fear amongst people who need access to health services, and amongst the frontline workers who provide those services.

In criminalizing countries, there is decreased provision and uptake of HIV prevention services, and decreased uptake of HIV care and treatment services. A study in sub-Saharan Africa showed that HIV-prevalence among gay men and men who have sex with men was five times higher in countries that criminalized same-sex relationships than in non-criminalized settings.

Criminalizing countries have significantly lower rates of both knowledge of HIV status and HIV viral suppression among all people living with HIV.

Such punitive laws have no “law and order” justification.

In decriminalizing homosexuality in Singapore, there was clear recognition by the Government that there was no basis for making private sexual behaviour between consenting adults a crime.

Such laws lead to harassment.

As the Supreme Court of India has stated, punitive legislation has “become an odious weapon for the harassment of the LGBT community by subjecting them to discrimination and unequal treatment.”

There is extensive evidence that such discriminatory laws increase exposure of people to brutal hate crimes, police abuse, harassment, blackmail, torture, and denial of access to healthcare, education and housing. 

They also drive impunity and undermine the rule of law, harming LGBTQ+ people, their families, communities, and the whole of society. 

Stigma kills. Solidarity saves lives.

The progress that has been won around the world, in legislation and attitudes, needs to continue, as does the increasing recognition that people should not be criminalized for who they are and whom they love.

Anti-rights policies, proposals and propaganda need to be challenged head on.

Together, we call on all countries to remove all punitive laws against lesbian, gay, bisexual, transgender and queer people.

Decriminalization of LGBTQ+ people is vital for protecting everyone’s human rights and everyone’s health.

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, 12 July 2024— UNAIDS welcomes the adoption, by consensus, of a critical resolution on human rights in the context of HIV and AIDS at the 56^th session of the UN Human Rights Council.

The 2024 resolution 56/20 Human Rights in the Context of HIV and AIDS, recognizes the centrality of human rights to the HIV response. The resolution reaffirms that, “the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic and its sustainability.”

It also recognizes the importance of human rights and community leadership in the HIV response, ensuring access to available and affordable HIV prevention, testing and treatment services for all, without discrimination.  The resolution also calls on countries to tackle discriminatory attitudes and punitive laws and policies that prevent access to health services and to support community-led organizations as well as protect civic space.

This ground-breaking text includes the first unqualified recognition of sexual and reproductive health and rights in a UN resolution and calls on countries to scale up comprehensive education on sexual and reproductive health with information on, “sexuality and comprehensive HIV prevention, gender equality and women’s and girls’ empowerment, human rights, and physical, psychological and pubertal development, to enable them to build self-esteem and risk reduction skills and to empower them in their decision-making, communication and development of respectful relationships, in order to enable them to protect themselves from HIV infection.” .

Every week, 4000 adolescent girls and young women (aged 15–24 years) became infected with HIV worldwide. 3100 of these infections occurred in sub-Saharan Africa, also where 6 out of 7 new HIV infections in adolescents (aged 10–19 years) were among girls.

UNAIDS Executive Director, Winnie Byanyima said, “We would not be where we are today in the HIV response, with 29 million people on treatment and a 56% reduction in new HIV infections, without having human rights and communities at the center of the response. However, the status quo is not enough. All stakeholders need to scale up action to respect, protect and fulfil human rights in the HIV response if we are to end inequalities and end AIDS for everyone.”

Human Rights Council members expressed concern that key populations face multiple and intersecting forms of discrimination, stigma, violence and abuse. This affects their access to clinics and/or peer-led drop-in centers and called on member states to take action to ensure access to non-stigmatizing health services free from discrimination and legal barriers.

The resolution recognizes the importance of the Global AIDS Strategy’s societal enabler targets and calls on countries to take action to remove punitive legal and policy frameworks, and end stigma. This also includes   addressing gender-based violence and inequalities, as well as changing gender stereotypes and negative social norms.

The societal enabler targets, outlined in both the 2021 Political Declaration on HIV and AIDS and the Global AIDS Strategy, 2021-2026, commit countries to the following targets: that by 2025, less than 10% of people living with HIV and key populations experience stigma and discrimination, less than 10% experience gender-based inequalities and violence and less than 10% of countries have punitive laws and policies.

Progress towards the 2025 milestone has been mixed, with many countries failing to make significant progress required to be on track to meet these targets and other human rights goals.

This resolution is an important commitment by countries to re-double their efforts to ensure human rights are at the center of a sustainable HIV response.

Going forward the resolution calls on OHCHR and UNAIDS, in collaboration with other stakeholders to hold a panel at the 58^th session of the Human Rights Council in 2025 to discuss the realization of human rights in sustaining and increasing the gains made in the HIV response. The session will include recommendations to countries and will be followed by a report on sustainability and human rights to be presented at the 60^th HRC session.

In 2025, countries are set to develop a new Global AIDS Strategy that will take the world to the 2030 deadline to meet the Sustainable Development Goals, which includes ending AIDS as a global health threat by 2030.

UNAIDS commends the leadership of Brazil and the other members of the core group, Colombia, Portugal and Thailand, for continuing to lead the resolution on HIV at the Human Rights Council and their significant success in bringing consensus back to this relevant resolution.

More information here: OHCHR | 56th regular session of the Human Rights Council: Resolutions, decisions and President’s statements

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.