GENEVA, 30 March 2022—In the lead-up to the International Transgender Day of Visibility, on 31 March, UNAIDS has launched an initiative to raise awareness among parents, teachers and the wider community about gender identity during childhood.

The Unbox Me campaign advocates for the rights of transgender children. Most children love to have boxes or hidden places in which they can hide precious trinkets or prized possessions safely and securely. The hidden objects can reveal a lot about the child—who he or she is, what he or she likes and what his or her dreams are. For some transgender children, this act of hiding treasures in a box becomes a way of hiding their identity from disapproving eyes. Unbox Me is about giving transgender children visibility. It is a call for inclusion and acceptance.

In India, more than 90% of transgender people leave their homes or are thrown out by the age of 15 years. Inevitably, many live on the street with no money or education, often relying on sex work. Despite the campaign originating from India, its theme of acceptance and inclusion is universal.

Transgender people around the world are often marginalized and experience discrimination and violence. As a result, transgender people have a 34 times greater risk of acquiring HIV than other adults. Up to 24 countries in the world criminalize or prosecute transgender people. For example, early in the COVID-19 response, some governments instituted gender-specific mobility days during lockdowns, which resulted in arrests against transgender people out on the “wrong” day.

Stigma, discrimination and criminalization tend to make transgender and gender-diverse people invisible, with extreme forms of discrimination leading to even the denial of the existence of gender-diverse people.

This campaign is part of an ongoing UNAIDS collaboration with advertising agency FCB India. Last year, UNAIDS partnered with FCB and released a successful short film, The Mirror, as part of the #SeeMeAsIAm campaign about a young boy looking in the mirror and dressing up as a woman. The film served to raise awareness among parents, teachers and the wider community about gender identity during childhood. Building on the film, Unbox Me seeks to bring home the reality of the many transgender children who are denied their true identity. 

Swati Bhattacharya, FCB India’s Creative Chairperson, who conceptualized this campaign, said, “In India, children usually have a box which they use to store their most precious possessions, but in the case of transgender children they need to hide their box of treasures, since some of their most precious possessions don’t fit the gender norm that society expects them to conform to.”

UNAIDS works closely with the transgender community, civil society organizations and governments all around the world to decriminalize transgender people, secure their rights and ensure that they have access to health, education and social protection and that they are protected from abuse and exploitation.

“Many of us take our gender identity for granted, but for many children it is not so easy. It’s a matter of daily survival, a daily struggle,” said Mahesh Mahalingam, the UNAIDS Director of Communications and Global Advocacy. “Children all around the world must be supported in expressing their identity freely.”

In India, the Unbox Me campaign has garnered support among the education community. Teachers in many schools across India are using the boxes featured in the campaign as a conversation starter to raise awareness about gender identity.

Many prominent personalities and community leaders have also participated in the Unbox Me campaign, notably Indian film director Zoya Akhtar and television anchor Barkha Dutt.

UNAIDS is now extending the campaign to the global level.

If you would like to participate in the campaign or share your thoughts, contact UNAIDS at Communications@unaids.org.

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.

Una is a coastal city of just over 20 000 inhabitants in the Brazilian state of Bahia. Fourteen years ago, Rihanna Borges left her little piece of paradise behind, to arrive at a much larger metropolis: São Paulo. “I needed to be reborn as a person and have the freedom to be who I really was. I wanted to be Rihanna, this trans woman whose essence could not safely emerge in my home town.”

Her decision reflects the decisions made by many transgender people, who, at some point, need to move away from their families to live life fully. When she recognized herself as a transgender woman, she had her mother’s unspoken support and recognition, but got no support from her father, triggering conflict and rejection that brought her a lot of suffering.

“Imagine coming out in a small town, with deep conservative and sexist roots. I could suffer any kind of violence. When I left Una I knew I was not that person my father expected. I had to leave my roots and throw myself into the world, so that I could be entirely me,” said Ms Borges. She has now reconciled with her father and has, in her words, a “nice” relationship with her family.

“Stigma and discrimination steals our identity as human beings, destroying us, turning us into unimportant people, who can be abused, mistreated, violated. So, the support of our families is critical because the world outside is cruel and destructive,” she said.

Ms Borges is one of the residents of Casa Florescer, a pioneering transgender welcoming centre located in the city of São Paulo, which hosts them while providing housing and access to mental health and other health-care support. Owing to increased vulnerabilities, stigma and discrimination, inequalities and disrupted family ties, among other reasons, the transgender women served by Casa Florescer come from extremely vulnerable backgrounds, having a history of adopting, and being exposed to, higher risk behaviours, including unsafe sex and use of drugs.

In this context, UNAIDS launched in 2021 an innovative initiative, the FRESH Project, to engage transgender women in understanding combination HIV prevention, focusing on pre-exposure prophylaxis, post-exposure prophylaxis and harm reduction. Through the project, the participants are rewarded for positive behaviour change to reinforce positive behaviours and reduce their vulnerability and the impact of inequalities.  

The first initiative of the FRESH Project in Brazil saw the voluntary participation of 22 of the 30 transgender women residents of the Casa Florescer, including Ms Borges.

The participants were trained in photography in sessions promoted by the American photographer Sean Black, who specializes in portraying lesbian, gay, bisexual, transgender and intersex people, especially people living with HIV. During the sessions, the participants reflected on their daily lives through their photographs.

“It was incredible to realize, over the days, how many of the women had a very negative opinion of themselves, reflecting the stigma they suffer from society. They discovered themselves as the beautiful and unique people they are and understood how fundamental it is to take care of themselves,” said Mr Black. “The photographs that I took, and the ones that they also took, reveal the essence of each one of them and how they are people who dream and want to be happy, like everyone else,” he added.

Ariadne Ribeiro Ferreira, the UNAIDS Brazil Community, Gender and Human Rights Officer, who is a transgender woman, highlighted that one of the objectives of the FRESH Project was to show that transgender sisterhood also means strengthening the path of self-respect, self-love and self-care. “Stigma and discrimination, associated with society’s punitive logic, only increases the social abyss that the most vulnerable groups are forced to face. Therefore, positive reinforcement, in this case represented by photographic art, is transformative and a path to a process of personal and collective change.”

“When I saw my photos after the photography sessions, I realized how powerful is to show our essence, the beauty that each one of us has. I felt it strengthened in me the certainty of how important it is, first of all, that we take care of ourselves, love ourselves, in order to pass this love on to other people and face stigma and discrimination,” said Ms Borges.

GENEVA, 18 March 2022—UNAIDS congratulates Zimbabwe’s parliament for repealing section 79 of the Criminal Law Code, which criminalizes HIV transmission. A new marriage bill adopted by parliament that repeals the criminal code section is to be signed into law by the president. The criminalization of HIV transmission is ineffective, discriminatory and undermines efforts to reduce new HIV infections. Such laws actively discourage people from getting tested for HIV and from being referred to the appropriate treatment and prevention services.

“Public health goals are not served by denying people their individual rights and I commend Zimbabwe for taking this hugely important step,” said UNAIDS Executive Director, Winnie Byanyima. “This decision strengthens the HIV response in Zimbabwe by reducing the stigma and discrimination that too often prevents vulnerable groups of people from receiving HIV prevention, care and treatment services.”

UNAIDS has worked closely with Zimbabwe’s National AIDS Council, Zimbabwe Lawyers for Human Rights, parliamentarians, civil society activists and communities to advocate for the repeal of the law criminalizing HIV. Overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. More than 130 countries worldwide still criminalize HIV non-disclosure, exposure and transmission through either specific or general criminal legislation.

In 2019, Zimbabwe completed a legal environment assessment, which identified the criminalization of HIV transmission as a barrier to health care and a driver of stigma and discrimination for people living with HIV and other key populations. Since then, the United Nations Development Programme has worked with key populations and other stakeholders, convening meetings with parliamentarians and other partners to advance the recommendations of the legal environment assessment.

In 2018, UNAIDS, the International Association of Providers of AIDS Care and the International AIDS Society convened an expert group of scientists who developed an Expert Consensus Statement on the Science of HIV in the Context of Criminal Law. The statement calls on the criminal justice system to ensure that science informs the application of the law in criminal cases related to HIV. 

Zimbabwe has made great progress in the response to HIV over the past decade. It is estimated that 1.2 million of the 1.3 million people living with HIV in the country are now on life-saving medicines. AIDS-related deaths have decreased by 63% since 2010, with new HIV infections down by 66% over the same period.

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.

Michael James (not his real name) was shell-shocked when he was fired. He scanned the dismissal letter. It cited his performance and tardiness as reasons for the job loss. But years of performance appraisals told a different story. He’d consistently received positive evaluations and there were no memos about late-coming or substandard work on his file. The only reason he could discern was that colleagues recently learned that he was living with HIV.

HIV-related prejudice remains rife in Jamaica. One third of people living with HIV responding to the 2020 Jamaica People Living with HIV Stigma Index reported experiencing stigma and discrimination. Verbal harassment, gossip and discriminatory remarks were the most common violations. But one in 10 said they were refused employment or lost a source of income because of their HIV status. No legislation prohibits a Jamaican employer from discriminating on the basis of HIV status.

This has marked implications for the HIV response. Twenty-one per cent of respondents were worried about mistreatment or confidentiality breaches by health-care workers. Thirty-eight per cent delayed testing and 29% delayed starting treatment because of concerns about how they would be treated.

Shelly John (not her real name) recounts hopping from one treatment site to another before landing at Jamaica AIDS Support for Life. At other facilities she overheard nurses gossiping about patients’ medical histories.

“I felt uncomfortable. If I am hearing about other clients, other clients can come inside and hear about me as well,” she reasoned.

“The fear of stigma drives some persons underground and away from much needed health services. Owing to stigma and discrimination, some persons delay accessing needed services and, as a result, some are diagnosed with HIV at an advanced stage,” acknowledged State Minister in the Health and Wellness Ministry and Chair of the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination, Juliet Cuthbert Flynn.

Jamaica’s testing and treatment outcomes bear this out. While an estimated 86% of people living with HIV were aware of their status in 2020, just 40% of people living with HIV were on HIV treatment.

While the Jamaica Charter of Fundamental Rights and Freedom guarantees protection against discrimination, it is limited in scope. The protected grounds are race, sex, place of origin, social class, colour, religion and political opinions. There are piecemeal anti-discrimination provisions in different pieces of legislation, such as the 2014 Disabilities Act and the 1975 Employment Act. But neither the constitution nor ordinary legislation make discrimination on other grounds unlawful.

Since 2020, UNAIDS and the United Nations Development Programme have been providing technical and financial support to local nongovernmental organizations, including Jamaica AIDS Support for Life, to support the rollout of a national survey on the public’s perspectives and experiences with stigma and discrimination in Jamaica and on the need to have more adequate protections in the law. The results of the survey will be used to advocate for legislation to adequately deal with discrimination experienced by vulnerable and marginalized groups.

The proposed legislation should provide protection across areas including discrimination based on health status, pregnancy or childbirth, hiring or termination decisions and the denial of services to minority groups. It should also address discriminatory conduct based on assumptions about a person’s competence, capabilities, age, self-expression, income level, the neighbourhood in which they live or their educational background.

“Comprehensive anti-discrimination legislation will strengthen the legal framework for the protection of human rights towards achieving equality for all,” Manoela Manova, the UNAIDS Country Director for Jamaica, explained.

In real terms, this means that duty-bearers will have to consider how their policies, programmes and services will affect people with the protected characteristics. Critically, the focus on markers related to poverty would mean that for the first time public bodies will have a duty to consider socioeconomic disadvantage when making strategic decisions about how to exercise their functions and when proposing to use public funds.

“Our overarching finding has been that regardless of health status, sex, age or sexual orientation, the factor that fuels discrimination and makes people more vulnerable is poverty. Moving forward, it is critical that we don’t treat HIV as a stand-alone concern but address the full picture of what makes people marginalized and vulnerable in Jamaica,” said UNAIDS Community Support Adviser for Jamaica, Ruben Pages Ramos.

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform the way they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realized that transgender Guyanese exist and are part of our society. Some thought we should be treated equally and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitization that are needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of health-care providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected. Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalization of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritizing issues that it says go to the heart of transgender’s people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

Sexual activity often starts during adolescence. Many countries have age of consent laws in relation to sexual activity that are inconsistent with minimum age laws for accessing sexual and reproductive health information and services without parental permission. This means that adolescents may legally have sex before they can legally access any information or services relating to safer sex practices or contraception, leaving them at greater risk of HIV, other sexually transmitted infections (STIs) and unwanted pregnancy.

The removal of laws that require parental permission to access services for sexual and reproductive health and HIV prevention, testing and treatment has been shown to improve health-seeking behaviours. That effect is even stronger when schools can provide age-appropriate comprehensive sexuality education to young people so they can protect themselves from HIV, STIs, unwanted pregnancy and gender-based and sexual violence.

Forty countries reported to UNAIDS in 2021 that they have laws requiring parental/guardian consent for adolescents to access hormonal or long-lasting contraceptives, 108 reported that this consent is required for an HIV test, 43 for HIV self-testing, 92 for HIV treatment and 22 for PrEP. Among these countries, some provide exceptions based on demonstrated maturity: 10 for hormonal or long-lasting contraceptives, 15 for HIV testing, eight for self-testing and nine for HIV treatment. The age cut-off of parental consent laws varied by service. The majority of countries that reported having requirements for parental/guardian consent had an age cut-off of 18 years, with exceptions in a few countries where adolescents as young as 14 years could access a service without parental/guardian consent, which varied by service. 

GENEVA, 10 December 2021—On International Human Rights Day, UNAIDS is calling for concrete action to prevent and respond to systemic human rights violations that create and exacerbate inequalities.

“We live in one of the most unequal times in history,” said the UNAIDS Executive Director, Winnie Byanyima. “What the HIV pandemic had already revealed, COVID-19 has again confirmed: crises and disasters are felt most strongly along the fault lines of society. Those who experience systemic discrimination and inequality are pushed further and further behind.”

Equality and non-discrimination are cornerstones of human rights. The Sustainable Development Goals made them a central element of the global development commitments that call on countries to reduce inequalities, including by removing the drivers of inequalities, such as discriminatory laws and policies.

Multiple and intersecting inequalities that drive the HIV epidemic are a result of human rights violations. Although new HIV infections globally have declined by more than 30% since 2010, progress has not been shared equally. In some countries, access to combination prevention tools such as pre-exposure prophylaxis and harm reduction services has resulted in progress among the most vulnerable groups of people, but in many others criminalization, marginalization, stigma and discrimination are leading to increased HIV incidence. However, during the past five years, countries that took a criminalizing approach to key populations (gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people) made less progress in HIV testing and treatment. In 2020, 65% of new HIV infections were among these key populations, driven by harmful laws, policies and discriminatory social norms that punish, stigmatize and force underground key populations and fail to make available or accessible the prevention, treatment and harm reduction services that could so easily be used to stop HIV transmission and mortality. Six out of seven new HIV infections among adolescents aged 15–19 years in sub-Saharan Africa are among adolescent girls. This is in part because their right to education is not fulfilled on an equal basis with boys, their right to health is breached when comprehensive sexuality education is not provided and their right to bodily autonomy and security of the person is denied when states fail to address harmful gender norms.

In many contexts, international trade agreements conflict with human rights obligations by enforcing excessive intellectual property protections, creating artificial barriers for low- and middle-income countries to access affordable health products, impeding the production and distribution of generic medicines and hampering efforts to support the research and development of innovative health technologies that meet public health needs.  

This is a time of parallel and converging crises: multiple pandemics, climate change and continued economic shocks. In the past two years we have seen how profoundly systemic and structural inequalities deepen and widen during times of adversity. We cannot simply weather these crises—we must prevent them from happening. We will only succeed if we make the fundamental structural changes to create a more equal and stronger society, capable of meeting the challenges of today and tomorrow and leaving no one behind.  We must dismantle the structures that violate human rights and create and deepen inequalities.

We must strengthen access to health services by eliminating user fees and promoting policies to ensure that health technologies are considered global public goods, not commodities.

We must replace coercive and punitive approaches to emergencies, including to pandemics and to health and other pressing societal issues generally, with enabling, supportive and non-discriminatory solutions.

We must radically transform our concepts of gender to ensure substantive gender equality for all and enable people of all genders to flourish and participate in society on an equal basis.

And we must take action to ensure that the rights of women are girls in all their diversity are realized through concrete measures and investments, not just promises.

We can only succeed if we take as our foundation the fundamental principles of human rights, with communities leading from the front and at all stages of the process.

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.

Health is a right, but in Africa it is estimated that up to 38% of the population delay or forgo health care due to its high costs and out-of-pocket expenditures. Africa is the continent with the greatest proportion of the population not having access to social protection and adequate health care, and where human needs are the greatest.

Limited local production and dependence on external markets and financing are barriers to equitable access to medicines and other medical supplies in Africa. All African countries are net importers of medical and pharmaceutical products, with most of them importing between 70% and 90% of the medicines they consume. 

The advent of the COVID-19 pandemic and its devastating consequences in Africa demonstrate that there is still a long way to go in terms of implementation and domestication of the various international, continental, regional and national human rights instruments.

To address these shortcomings, the African Commission on Human and Peoples’ Rights (ACHPR) held the High-Level Regional Seminar on the Right to Health and Social Protection in Africa, in Dakar, Senegal, from 8 to 10 December. It aimed to raise awareness among member states, national human rights institutes, nongovernmental organizations and other partners on the issue of deficient health-care systems and insufficient social protection coverage, to share best practices regarding health-care systems and social protection and to formulate key recommendations for implementation.

“We should not have a handout, but solve our own health problems in Africa. Dependence on international financing makes progress vulnerable,” said Maria Teresa Manuela, an ACHPR Commissioner and a Special Rapporteur on the Rights of Women in Africa.

Financing the right to health is a strong area of collaboration between UNAIDS and ACHPR that will be crystallized in a report to be launched in 2022.

“Pandemics can be a catalyst for transformative financing reforms that uphold the right to health for those left behind. Lessons from the AIDS response and many other leadership examples in Africa need to be leveraged to further mobilize leadership and investments to end AIDS and other pandemics, end inequalities and accelerate realization of the right to health for all,” said Patrick Brenny, the Director of the UNAIDS Regional Support Team for Western and Central Africa. He encouraged stakeholders to generate evidence to demonstrate the impact on the right to health of financing strategies and proposed fiscal policies, to increase development assistance in more than 35 countries and to promote the greater participation of parliamentarians in the financing dialogue, bridging the gap with those who make fiscal decisions.