YouTubers, influencers and virtual activists took part in inspirational conversations about HIV and discrimination in São Paulo, Brazil, on 30 May.

“No one in my group of friends and very few of my generation know anyone who died because of AIDS. Because past generations lived and witnessed so many AIDS-related deaths, there was this culture of fear, which is no longer present among us. However, we have not replaced this culture of fear with anything more positive,” said young Brazilian YouTuber Murilo Araújo, who describes himself in his channel, Muro Pequeno, as, “Proud to be gay, black, catholic, proud to be resistance in a society that tells me all the time that I cannot be any of that.”

Taboos, stigma both within and against the gay community, discrimination against people living with HIV and communicating to a highly connected generation were some of the topics debated. The event was moderated by renowned journalist and UNAIDS Goodwill Ambassador for Brazil Glória Maria, who asked, “Why do you think the HIV epidemic seems to be rebounding among young people, especially among gay men?” to trigger the first conversation.

“We saw all this in our biology classes, we saw it in campaigns. But it’s really hard to associate what they teach us with our real life, with relationships, with affection and with sexual experiences. I think this is the missing link we are trying to connect with our work on YouTube,” said actor and YouTuber Gabriel Estrela, from the Projeto Boa Sorte channel. “It seemed like something very distant from my reality, something that only happens in the movies.”

New HIV infections have grown substantially among young men, especially young men who have sex with men, in Brazil in the past decade. According to data from the Ministry of Health, they almost tripled among youth aged 15 to 19, and more than doubled among those aged between 20 and 24.

Nathan Fernandes, the Editor of Galileu Magazine, one of Brazil’s most influential monthly magazines among young people, said that, “The press played a very important role at the beginning of the epidemic. The first cases were reported even before civil society was able to organize itself for a common response. The problem is that the same press also reinforced stigma and discrimination by describing AIDS as the “gay plague” or “gay cancer”, among other things. We are now very aware that we have to be very careful with what and how we report,” he added.

As gay social networks become popular, discussions about HIV and prevention tend to gain the spotlight, said André Fischer, Director of Hornet Brazil. “We can’t run away from the fact that AIDS is still an important issue for the gay community. It is still a strong taboo subject. But we see more and more people being able to come out and reveal their HIV-positive status.”

Digital activist Matheus Emilio said it is possible to include HIV in the discussions of social networks and help break stigma and discrimination around the subject. Mr Emilio runs the Facebook page Menino Gay, with a focus on the lesbian, gay, bisexual, transgender and intersex community, whose posts reach more than 600 000 followers. “Besides talking about culture, music and lesbian, gay, bisexual, transgender and intersex rights, I also include information on HIV, health and prevention”, said Mr Emilio, who was diagnosed HIV-positive two years ago.

“Our goal is to promote connections among people and to promote a debate on HIV, with a focus on young gay men and other men who have sex with men, going beyond the point of view of science, health and public management. We want to create a debate involving young people, society, digital culture and human rights within the universe of young gay people,” said Georgiana Braga-Orillard, UNAIDS Country Director for Brazil.

The series of debates, #EseFosseComVocê? (What if it happened to you?), was organized by UNAIDS in partnership with the British Embassy in Brazil, Ogilvy Brazil, Hornet and Cultura Inglesa. The event, which was live-streamed on several accounts on Facebook, reached more than 300 000 online viewers. 

The Martin Ennals Foundation has announced the names of the three finalists for the prestigious global Martin Ennals Award for human rights defenders, which will be awarded in October 2017. One of the three finalists is Karla Avelar, a transgender woman living with HIV from El Salvador who, for more than 20 years, has been defending the human rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people and advocating for access to health care for people living with HIV.

In 1996, Ms Avelar was one of the founders of the first association of transgender people in El Salvador, and in 2008 she founded the first organization of transgender women living with HIV, COMCAVIS TRANS. The organization works to advance, defend and promote the human rights of LGBTI people, scale up HIV prevention and care and improve access to HIV services for people living with HIV and prisoners.

"On a daily basis, lesbian, gay, bisexual, transgender and intersex people are exposed to death threats, extortion, harassment, physical and verbal violence and discrimination because of our gender identity or sexual orientation,” said Ms Avelar. “This situation makes us vulnerable to HIV."

Ms Avelar, together with COMCAVIS TRANS peer educators, promotes HIV testing and HIV prevention and care among the LGBTI people through outreach activities, such as education and information dissemination in different parts of San Salvador.

Ms Avelar and her team also work on strengthening access to HIV prevention and treatment services for LGBTI prisoners in two penitentiary centres. “We are working on two fronts: with lesbian, gay, bisexual, transgender and intersex people, training them on sexual and reproductive health and HIV prevention, and raising awareness among administrative officials and custodial staff on human rights and zero discrimination,” explained Ms Avelar.

In 2013, the partnership between COMCAVIS TRANS and the penitentiary center of SENSUNTEPEQUE led to the adoption of an agreement, which allows prisoners to have access to condoms each month. COMCAVIS TRANS also supports LGBTI prisoners living with HIV to adhere to their treatment and monitors their access in order to ensure their psychosocial and emotional well-being. 

In El Salvador, LGBTI people continue facing a climate of discrimination and violence, exacerbated by high levels of impunity and limited access to justice. “El Salvador is a country with one of the highest rates of violence in Latin America and, as it is the case throughout the region, the life expectancy of a transgender woman does not exceed 35 years,” said Ms Avelar.

She supports LGBTI people who have suffered human rights violations and acts of violence. Together with her team and the group of volunteers, she advises them and accompanies them to file a complaint. Thanks to the collaboration of other organizations, she makes sure that people in need have open channels to legal and economic assistance. “There are still a lot of barriers,” she says. “However, we are promoting a dialogue with representatives of the national civil police and Office of the National Counsel for the Defense of Human Rights and other authorities to improve the mechanisms to denounce and investigate human rights violations and provide proper and sustained monitoring and evaluation.”

Ms Avelar has also played a significant role advocating for legislation reforms to protect and promote the rights of LGBTI people and address their needs. For example, together with UNAIDS and other national organizations, she participated in a review of an HIV law approved last January. Among other things, the law allows transgender people to receive a better health care free of stigma and discrimination, improve their quality of life and access to health services, education and work, ensuring the respect to their gender identity.

“For all those who know her, Karla Avelar is already the winner of the Martin Ennals Award,” said Celina Miranda, UNAIDS Country Director for El Salvador. “In the midst of all adversity, she is a tireless advocate for human rights, making a difference in the lives of lesbian, gay, bisexual, transgender and intersex people in El Salvador.”

About the Martin Ennals Award

The Martin Ennals Award is an annual prize for human rights defenders. Finalists and the laureate are selected by a jury of 10 of the world’s leading human rights nongovernmental organizations.

UNAIDS is working with partners to reaffirm that the full enjoyment of all human rights and fundamental freedoms for all supports the global response to the AIDS epidemic, including in the areas of prevention, treatment, care and support, and address stigma and discrimination against all people living with, presumed to be living with, at risk of and affected by HIV as a critical element in ending the AIDS epidemic and as outlined in the 2016 United Nations Political Declaration on ending AIDS.

Transgender people are continuing to face widespread stigma, discrimination and social rejection in Latin America and the Caribbean. In most countries in the region, there is no legal recognition of transgender people’s affirmed gender identity. Without official documents that recognize their gender identity, transgender people are often denied access to basic rights, including the right to health, education, justice and social welfare. Transgender people are also more susceptible to violence, including physical and sexual violence.

Transgender women are also particularly affected by HIV. Estimates show that HIV prevalence for transgender women in the region range from 8% to 31% and there are few support programmes that address their specific needs. Where programmes do exist, they rarely include access to sexual and reproductive health services or HIV prevention, testing and treatment services.

However, the transgender community is increasingly speaking out about the challenges they face. Marcela Romero, Coordinator of REDLACTRANS, the Latin American and Caribbean Network of Transgender People, said, “Countries must take urgent steps to enact robust laws for non-discrimination with respect to gender identity and pass gender identity laws to guarantee access to education, work, housing and health services. These laws give transgender people the right to health and to access all the benefits and opportunities that any other citizen has. Without this right, we cannot access HIV prevention, care and treatment services.”

In 2012 in Argentina, REDLACTRANS and ATTTA, the Argentine association for transvestites, transsexuals and transgender people, played a key role in the passing of a law that gives transgender people the right to request that their recorded sex, first name and image be amended to match their self-perceived gender identity.

Such gender identity laws greatly improve the quality of life of transgender people. “In countries where legal recognition of affirmed gender identity has been achieved, transgender people are enjoying a higher life expectancy. Gender identity laws recognize transgender people as human beings—as citizens—put transgender people on the agendas of governments and reduce transphobia, stigma and discrimination,” Ms Romero explained.

The International Transgender Day of Visibility celebrates transgender people and raises awareness of the discrimination faced by transgender people worldwide on 31 March each year. To mark the day, Ms Romero has a simple but powerful message: “We do not ask for other rights—we ask for the same rights as any other citizen. A person who does not have an identity does not exist. We are part of society!”

UNAIDS is working to ensure that the target in the 2016 United Nations Political Declaration on Ending AIDS of ensuring access to combination prevention options to at least 90% of people by 2020—especially young women and adolescent girls in high-prevalence countries and key populations, including transgender people—is met.

UNAIDS has received the LGBTI Citizenship Allies Award in recognition of its human rights-based approach to responding to the AIDS epidemic among gay men and other men who have sex with men. Created by Grupo Dignidade (Dignity Group), one of Brazil’s most respected nongovernmental organizations working on issues related to lesbian, gay, bisexual, transgender and intersex (LGBTI) people and on HIV prevention among gay men and other men who have sex with men, the award is given to people and organizations in recognition of their contribution to advancing the rights of LGBTI people in Brazil.

The award highlights some of the efforts made by UNAIDS in this area, including the development of campaigns and initiatives such as the zero discrimination campaign, the production of a wide variety of publications and its advocacy efforts to specifically mention LGBTI people and other key populations in the 2016 United Nations Political Declaration on Ending AIDS.

Georgiana Braga-Orillard, UNAIDS Country Director in Brazil, highlighted the importance of the award. “We are investing time and effort in human rights and zero discrimination in the country and globally. The award shows us that we are going in the right direction and that our efforts are having an impact for the communities we want to support,” she said.

The award ceremony marked the 25th anniversary of Grupo Dignidade. Grupo Dignidade works with partners—including the municipal, state and federal departments of the Public Ministry, public human rights authorities and Brazil’s Supreme Court—on key areas related to human rights and the rights of LGBTI people.

“Much of what I have learned in terms of respect for diversity and the importance of the social movements for the response to the AIDS epidemic came from my constant interaction with Grupo Dignidade,” said Mariângela Simão, UNAIDS Director of Rights, Gender, Prevention and Community Mobilization, in a video message to the award ceremony. “Receiving this award from Grupo Dignidade is very important to us and I would like to thank you, in the name of Michel Sidibé, the UNAIDS Executive Director,” she added.

The ceremony also hosted the Educating on Respect for Sexual Diversity Award, given to 11 selected individual and institutional initiatives that recognized, valued and encouraged the promotion of respect for sexual diversity in the educational environment in Brazil.

UNAIDS is working to support countries to reach the targets set out in the 2016 Political Declaration, which include the review and reform of legislation that may create barriers or reinforce stigma and discrimination, and to promote access to non-discriminatory health-care services, including for populations at higher risk of HIV, specifically sex workers, men who have sex with men, people who inject drugs, transgender people and prisoners.

Child marriage is widespread across much of Latin America and the Caribbean, accounting for around 23% of marriages in the region, despite laws against it.

The impact of child marriage and early unions (where one of the members is aged below 18 years of age) on girls and their societies can be devastating. Evidence shows that there is a strong link between child marriage and early unions with child pregnancy, maternal and infant mortality, lower education levels for girls and lower ranking on the human development index. And child marriage and early unions make girls more vulnerable to contracting sexually transmitted infections, including HIV.

At a high-level side event co-hosted by the Permanent Missions of Panama and Guatemala to the United Nations in collaboration with UN Women, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and UNAIDS, lessons learned and programmatic and policy options to address child marriage in Latin America and the Caribbean were presented.

In the event, which took place on 17 March at the United Nations Headquarters in New York, United States of America, during the sixty-first session of the Commission on the Status of Women, the participants recognized that child marriage and early unions are a violation of human rights and are a grave threat to the lives, health and future development of girls.

The event focused on the importance of supporting legislative reforms to raise the legal age of marriage to 18 and promoting programmes to empower girls and young women.

The event identified successful approaches and strategies for reducing the rates of child marriage. For example, Panama—where an estimated 26% of girls are married before the age of 18 and approximately 7% before the age of 15—has reformed its national legislation on the legal age of marriage. The minimum legal age for marriage in Panama is now 18 years, as is the age of consent. Previously, with parental permission girls aged as young as 14 years and boys aged 16 years could marry. In Guatemala, thanks to advocacy actions led by UN Women, civil society and international cooperation, reforms to the civil and penal codes have been approved to increase the minimum age for marriage to 18 years.

Since 2015, UNAIDS has partnered with UN Women, UNICEF, UNFPA and PAHO/World Health Organization in a joint initiative on eliminating child marriage and early unions that supports government actions to ensure that, throughout their life cycle, the multiple needs of girls and women are recognized and guaranteed.

UNAIDS is working with countries to eliminate gender inequalities and all form of violence and discrimination against women and girls by 2020, as outlined in the 2016 United Nations Political Declaration on Ending AIDS.

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As the sixty-first session of the Commission on the Status of Women gets underway at the United Nations Headquarters in New York from 13 to 24 March 2017, UNAIDS highlights the urgent need to respond to gender based violence and HIV.

Through her work as a journalist, Alejandra Oraa, CNN news anchor and UNAIDS Goodwill Ambassador for Latin America and the Caribbean, has reported on many stories about women and violence in the region. Shortly after thousands of people took to the streets in October 2016 to protest against widespread violence against women in the country, she undertook a joint UNAIDS and UN Women mission to Argentina to meet with not only survivors of violence but also the groups and organizations working with them.

“In the region we have made progress to respond to gender-based violence, but, unfortunately, there is still a long way to go. I hope that our voices and examples change a statistic that shames Latin America,” said Ms Oraa, who is also a spokesperson for UN Women’s Orange the World campaign to raise money to respond to violence against women.

Gender-based violence remains one of the key development challenges in the region. In 12 Latin American and Caribbean countries, between 17% and 53% of women interviewed reported having suffered physical or sexual violence by an intimate partner. In seven of the countries, more than one in four women reported such violence. Gender-based violence is not only a human rights violation, it also makes women and girls more vulnerable to HIV infection.

Ms Oraa’s first stop was in Merlo, in the greater Buenos Aires area, which has the highest HIV prevalence in Argentina. There, she learned about how UNAIDS and UN Women are supporting local projects that integrate programmes responding to violence against women, promote gender equality and expand access to HIV prevention services, all of which are inextricably linked.

Ms Oraa met with the local organization of people living with HIV, which helps to run a free and confidential HIV testing site during health fairs organized by the Municipality of Merlo in different parts of the town, making it easy for anyone to access an HIV test.

During the visit, Marcela Alsina, President of the network of people living with HIV (Red Bonaerense de Personas que Viven con VIH), together with other representatives of the organization, spoke to Ms Oraa about how stigma and discrimination are affecting the ability of women living with HIV to access employment and health services.

“Despite progress in the HIV response, there are still important gaps and inequalities that limit women living with HIV from having full access to employment, motherhood and comprehensive health services. When HIV becomes a priority, as it is happening in Merlo, we see that stigma and discrimination starts to decrease and the quality of life of people living with HIV starts to improve,” said Ms Alsina.

Ms Oraa visited the HIV testing centre of the Dr Pedro Chutro Maternal and Paediatric Hospital in Merlo. The centre, through a joint team with support from the Ministry of Social Development, civil society and the Women’s Commissioner Office, promotes the integration of HIV services with services to prevent violence against women. It also offers outreach activities and support groups for women and children affected by violence and HIV.

In Buenos Aires, Ms Oraa met with Fabiana Túñez, President of the National Council for Women, and Mabel Bianco, Director of FEIM, a nongovernmental organization supporting women’s and children’s rights. They talked to Ms Oraa about the importance of a joint and coordinated response to HIV and gender-based violence in Argentina to ensure that the country can end its AIDS epidemic by 2030.

Ms Oraa also spoke to internationally renowned Argentine singer Diego Torres, a spokesperson for the HeForShe campaign for gender equality, who talked passionately about the importance of involving men in stopping violence against women and gender equality in Argentina.

“We have to ensure that men and women enjoy equal opportunities in different aspects of life, for example in the labour market and in politics. This is what I believe in and stand for,” said Mr Torres. 

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. 

Transgender women face significant barriers that limit their access to health services and/or increase their vulnerability to HIV: stigma and discrimination, gender-based violence and gender inequities. As a result, the percentage of transgender women reached with HIV prevention and treatment services is very low.

To address the HIV prevention gap for transgender people, the Peruvian Ministry of Health organized a national consultation on combination HIV prevention in 2014 in partnership with Cayetano Heredia University and UNAIDS. This consultation opened a dialogue between stakeholders and community leaders on the future of HIV prevention in Peru. During the consultation, the Ministry of Health expressed its commitment to improve HIV combination prevention programming for transgender women. In 2015, it launched a targeted strategic plan for prevention and comprehensive care for HIV and other sexually transmitted infections (STIs) for transgender women .

The plan addresses the leading causes of the HIV epidemic among transgender women in Peru, including their poor socioeconomic conditions, their difficult living and working environments and the low accessibility of health services. In the plan, consideration is given to identifying effective strategies to respond to specific legal and human rights challenges, stigma and violence. The development of the plan was the result of a decade-long process of evidence generation, policy dialogue and capacity-building with the transgender community.

The plan is being translated into practice. Activities already implemented include special trainings of health personnel at STI treatment centres and community peer educators in how to address the HIV needs of transgender people, the provision of prevention services, including condoms and lubricants, HIV testing and linkage to health services for antiretroviral therapy and awareness-raising of local law enforcement personnel on the respect of human rights and prevention of gender-based violence for the transgender community.

Mao, a transgender women activist and peer educator of the Ministry of Health, said, “The focused plan is bringing services closer to the community. Some transgender women who could not go to the sexually transmitted infection treatment centres are now asking for condoms and testing, for information and for comprehensive health services. We are proud of being part of this initiative.”

The next phase of the transgender health plan will include an increase in the number of decentralized prevention and treatment service sites and a demonstration study on pre-exposure prophylaxis. The plan will be incorporated into and aligned with the national HIV programme.

UNAIDS has announced that Lorena Castillo de Varela, First Lady of Panama, will continue her commitment to the response to HIV as UNAIDS Special Ambassador for AIDS in Latin America. Since her appointment in November 2015, Ms Castillo de Varela has contributed to accelerating the AIDS response in Panama and to raising awareness about zero discrimination, calling for fairer and more inclusive societies.

Ms Castillo de Varela is leading the national Be the Transformation You Want to See campaign, which brings together political and religious leaders, celebrities, government institutions, nongovernmental organizations, key populations, health workers and people living with HIV to stand up for human rights and dignity for all. The campaign aims to remove obstacles that block access to health-care services, including HIV testing, and to ensure that health-care settings are safe and caring environments.

Ms Castillo de Varela has also made important contributions to increasing access to HIV testing through the nationwide Tests Save Lives campaign and the Love on Wheels initiative. The latter provides access to health-care services, including HIV testing, for women living in rural and remote areas through mobile clinics.

In the past year Panama has shown progress towards ending AIDS as a public health threat by 2030 and has invested more than US$ 38 million in the AIDS response. The Ministry of Health has created 15 clinics to provide health care-services to members of key populations and has put in place a training programme for health-care workers to strengthen primary health care for people living with HIV.

The First Lady of Panama has advocated for investing more in the HIV response at the regional and global levels.

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The Tests that Save Lives campaign in Panama, launched within the framework of the Global ProTest HIV initiative, aims to reduce the number of new HIV infections and AIDS-related deaths by offering free HIV testing and counselling every June. When the campaign was rolled out in June 2015, more than 13 100 people were tested for free across the country. That number increased to more than 16 200 in 2016.

Health fairs are held and mobile clinics tour as part of the campaign, which is led by the Ministry of Health, the Social Security Fund, the Office of the First Lady, the Inter-Governmental Network for HIV Prevention, the private sector and civil society.

Owing to the campaign’s success, the government decided in 2015 to make HIV testing free for adolescents and members of key populations in all public health-care facilities. From 2018, HIV testing will be free for everyone in Panama. 

First Lady Lorena Castillo de Varela’s Love on Wheels is a complementary initiative offering HIV testing and integrated health care through mobile clinics to women living in marginalized and rural communities.

Panama adopted the Fast-Track Targets in 2015, which, if met by 2020, will allow the world to end the AIDS epidemic by 2030. 

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