Lebanon

Every pain yields a lesson, and every lesson transforms a person

Parisa's life was forever altered by HIV 25 years ago. The virus struck her family, snatching her husband's job and halting her child's education. Tragically, her husband passed away two years later, leaving Parisa to navigate the daunting landscape of loss and discrimination.

Undeterred by adversity, Parisa embarked on a relentless mission for human rights, determined to combat the pervasive stigma and discrimination surrounding HIV. Initially, she immersed herself in seminars and conferences, volunteering tirelessly at counselling centres, where she shared her own experiences to chip away at the stigma and discrimination.

Her unwavering dedication caught the attention of Dr Minoo Mohraz, the former director of the Iranian Research Centre for HIV/AIDS (IRCHA), who offered her a pivotal role in a Positive Club—a sanctuary for those grappling with similar challenges. Thus began Parisa's transformative journey, marked by a series of initiatives aimed at raising awareness, eradicating stigma and discrimination, and supporting her peers.
 

WHAT IS THE POSITIVE CLUB INITIATIVE? The Positive Club is a meeting place for people living with HIV, who run the club themselves, with supervision from Parisa and colleagues. At the club, people receive training in arts, and sports, and as peer educators.  The Positive Club initiative was one of the successful programmes aimed at promoting positive health, dignity, and HIV prevention; it has been running for over 12 years with support from UNAIDS in collaboration with national partners and civil society organizations. Through this initiative, over 10,000 people living with HIV have been supported across 25 Positive Clubs, empowering them through training classes, workshops on HIV prevention, care and treatment, counselling sessions, and psychosocial support.

Over the years, Parisa's efforts have been nothing short of extraordinary. From managing a Positive Club in Tehran to representing people living with HIV in various influential platforms, including Iran's Country Coordinating Mechanism, its Oversight Committee, and Global Fund, she has been a relentless advocate for change. 

Her initiatives have spanned diverse arenas, from radio shows and collaborations with filmmakers to training workshops for religious leaders and healthcare providers. Parisa's impact reverberates across borders, as she leverages regional platforms like MENA Rosa --the first regional network dedicated to women living with HIV in the Middle East and North Africa-- to exchange experiences and champion global efforts against HIV stigma and discrimination with a particular focus on Women living with and affected by HIV.

Amid the COVID-19 pandemic, Parisa's compassion for people living with and affected by HIV was once again evident. She mobilized support networks to provide essential supplies for Positive Club members and vulnerable families, ensuring that the crisis does not exacerbate the challenges faced by PLHIV.

Reflecting on the progress made over the last 25 years, Parisa acknowledged the remarkable strides in combating HIV-related stigma and discrimination. Efforts to eliminate HIV-related stigma and discrimination have been led by the UNAIDS Country Office for Iran, alongside national partners of the AIDS Control Programme. Notably, the first PLHIV Stigma Index study, conducted in 2010, laid the foundation for understanding the landscape of stigma in Iran. Subsequently, a second PLHIV Stigma Index study, was carried out by the network of PLHIV in collaboration with UNAIDS, Global Network of PLHIV (GNP+), International Community of Women Living with HIV (ICW), Johns Hopkins Medical University (JHMU), National AIDS Programme (NAP), and with financial support from Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) /UNDP. Parisa played an important role in implementing the Stigma Index 2.0 which provided updated insights.
 

COMPARING OF BOTH OF IRAN’S STIGMA INDEX STUDIES A comparison between the two Stigma Index studies conducted ten years apart, using updated methodologies, revealed promising changes. The prevalence of self-stigma among PLHIV decreased significantly from 80% to 40%. Similarly, the percentage of PLHIV refraining from seeking medical help has decreased from 80% to 19%, underscoring improved accessibility to healthcare services and increased health-seeking behaviour among affected individuals. Overall, reports of stigma and discrimination have decreased from 71% to 47%, reflecting tangible improvements in societal attitudes to HIV.

Parisa reflects on these notable shifts in HIV-related Stigma observed between the two studies. In the initial Stigma Index conducted a decade ago, internal stigma was predominant among PLHIV, followed by societal and healthcare provider stigma. However, in the subsequent study, internal stigma was significantly reduced, while stigma and discrimination from healthcare providers emerged as the most prevalent issue. The improvement observed in internal stigma among PLHIV could be partly attributed to the work of the empowering Positive Clubs. Additionally, this improvement highlights the importance of ongoing efforts to address stigma and discrimination comprehensively, with a particular focus on healthcare settings. By acknowledging these shifts and persisting in their efforts, UNAIDS Iran, Parisa and her colleagues remain committed to building a future free from the burdens of HIV-related stigma and discrimination.

Through her nearly two decades of hotline counselling experience, Parisa has witnessed a shift in attitudes, with increased awareness and openness surrounding HIV discourse. 

She credits grassroots campaigns and community-led initiatives for driving this transformation, paving the way for a more inclusive society.

In 2019, Iran joined the Global Partnership to Eliminate all forms of HIV-related stigma and discrimination, prioritizing a strong emphasis on interventions within communities, emergency/humanitarian settings, and healthcare facilities. With support from UNAIDS, protocols and training packages were developed to address stigma and discrimination in these critical areas. These efforts were carried out in close collaboration with national partners and civil society organizations, with training workshops being a key component of the initiative.
 

OVERVIEW OF GLOBAL PARTNERSHIP The Global Partnership for action to eliminate all forms of HIV-related stigma and discrimination is a critical vehicle for action to mobilise all countries to reach the political declaration and Global AIDS Strategy targets. It leverages partnerships to enhance coordination of interventions and funding; it provides knowledge and evidence-guided technical support; and increases accountability mechanisms and community leadership.

Parisa was actively involved in the implementation phase of these projects. Her contributions have been instrumental in advancing the work to eradicate HIV-related stigma and discrimination across humanitarian, healthcare, and community settings.

However, Parisa acknowledges the persistent challenges faced by PLHIV, from sporadic bouts of self-doubt to occasional rejections and the lingering shadows of depression and fear. Despite these hurdles, she remains steadfast in her belief that we can achieve a future free from stigma and discrimination.

As Parisa continues her tireless advocacy, her journey stands as a testament to the resilience of the human spirit and the power of collective action in fostering a world where every individual, regardless of their HIV status, is embraced with dignity and compassion. 

UNAIDS has played a pivotal role in the establishment and sustained operation of Positive Clubs for over a decade, catalyzing transformative changes in the lives of people living with HIV such as Parisa and in the fight against stigma and discrimination. Nonetheless, the journey towards eliminating stigma and discrimination remains unfinished, albeit considerably smoother and more steadfast with the collaborative efforts and political commitment of initiatives such as the Global Partnership.

“For five years I have been subjected to harassment and threats—rape threats, murder threats, vilification, character assassination, phone calls to my family, to my mom,” said Lebanese television anchor Dima Sadek.

To raise public awareness about sexual harassment and bullying in Lebanon, particularly against female journalists during the recent protests, the Arab Foundation for Freedoms and Equality—UNAIDS’ regional partner on rights and health—has produced a video that sheds light on this human rights abuse committed against many women in the country.

Made in partnership with the HIVOS Women Empowered for Leadership (WE4L) programme, with funding from the Dutch Ministry of Foreign Affairs, the video highlights cases of harassment and assault—reporters whose bodily autonomy has been violated, whose personal telephone numbers have been leaked and who subsequently received rape threats and pornography and who have been verbally and physically attacked while live on television.

“You don’t expect that someone could be this hurtful or that they could say such things. You don’t know them and they don’t know you, but because you differ on politics, they feel they are allowed to talk to you in this way,” said Layal Saad, a reporter.

Since similar attacks, including online bullying and harassment both online and offline, have also been reported by female protesters, the video also seeks to raise awareness about the everyday sexual harassment, bullying and violence that women in general are subjected to, emphasizing the need for policies that allow women to become leaders.

Diana Moukalled, a journalist, explained that legal protection against sexual harassment is needed, since at present there are no laws that criminalize sexual harassment in Lebanon. “Lebanese women are among the most politically marginalized in the world, not just in the region. We see women present on many levels, yet there is a sharp discrepancy between the role of Lebanese women and their representation,” she said.

The video’s title is We Carry On, echoing the sentiment of the many women who watched and reacted to it—a feeling of resilience in the face of adversity and a determination to achieve the social justice demanded by women in Lebanon.

Credit: UNAIDS/P.Virot

Men who have sex with men (MSM) and transgendered people are amongst the most stigmatized populations in the Middle East and North Africa (MENA). In spite of social tension and sensitivities, most countries in the region have recognized the importance of programming for, and working with, MSM to strengthen effective national AIDS responses. Nevertheless, existing prevention programmes have remained limited in scope and scale, highlighting limitations in coverage and quality.

In this context, UNAIDS brought together representatives from civil society, governments, national AIDS programmes and regional and international partners to a workshop in Lebanon to discuss ways to scale up interventions that focus on the needs of MSM in the region.

The workshop was organized in collaboration with Helem-Lebanese Protection for LGBT association, the International AIDS Alliance (AA) and the Regional Arab Network Against AIDS (RANAA). It focused on the outcomes of a policy research project entitled “Enabling Access to HIV Services for Men Who Have Sex with Men - Situational analysis and Partnership Development”. The main purpose of the research, conducted in Algeria, Lebanon, Morocco and Tunisia, was to identify ways to enable and facilitate this access to HIV services.

Existing repressive laws and policies deter MSM from seeking HIV prevention, treatment, care and support services.  Currently 18 of the 21 countries that form the MENA region criminalize male to male sex behaviour—and 4 enforce capital punishment.

Participants at the meeting highlighted the importance of creating enabling environments that allow unrestricted dissemination of prevention messages and services, appropriate provision of HIV treatment, care and support services, and the empowerment of MSM and transgender population in planning, implementing and evaluating programme strategies.

Participants also reviewed a handbook developed by UNAIDS, based on field experiences and lessons learnt, to inform effective, expanded and culturally sensitive programmatic interventions among MSM and transgender people.

“Most programmes in MENA are still at a pilot stage. We need to scale up current programs using the extensive experience over the last years. This handbook, adapted to the region’s context, will hopefully inform interventions among MSM and transgender people,” said Ms Nicole Massoud, Regional Monitoring and Evaluation Advisor for the UNAIDS regional support team.

There are no reliable estimates of the number of men who have sex with men in the region. However, there is documented evidence of increased HIV spread and risk among MSM and transgender people, which may result in concentrated HIV epidemics over the next decade.

A man receiving opioid substitution therapy as part of a harm reduction programme in the Islamic Republic of Iran. Credit: UNAIDS/P.Virot

Injecting drug use and the growing HIV epidemic in the Middle East and North Africa were the focus of the Harm Reduction 2011 conference that took place in Beirut, Lebanon from 3-7 April 2011

Some 1000 scientists, researchers, drug users, doctors and politicians from 80 countries participated in the first international drugs-related conference to be held in the Middle East and North African (MENA) region.

Discussions during the conference centred around the existence of legislation in the region that hinders the implementation of harm reduction programmes. Nearly one million people in the Middle East and North Africa (MENA) inject drugs. Injecting drug use is already the major mode of HIV transmission in Afghanistan, Pakistan, the Islamic Republic of Iran (more than 67% of registered cases) and Libya (up to 90% of cases). It is also significant in Oman and Bahrain and has growing incidence in Morocco and Egypt.

The region is slowly increasing availability of harm reduction programmes although countries are at different stages of introducing the different components of the harm reduction package. The Islamic Republic of Iran is a model—with a rapidly scaled-up plan to make available needles and syringes, opioid substitution therapy (OST), HIV testing and counseling, and sexually transmitted infection services. Morocco also has integrated harm reduction policies into its national AIDS strategic plan. Pilot drop-in centres with needle and syringe exchange are in place, and preparations for introducing OST are underway.

The Lebanese Minister of Health announced during the conference the launch of a pilot programme consisting of the first ever legal sale of Buprenorphine in government hospitals for people who inject drugs. “The government’s support for harm reduction measures such as the provision of Buprenorphine is based on our belief that the evidence for such a public health measure is irrefutable—its implementation has helped to contain HIV and Hepatitis infections amongst injecting drug use communities in every country it has been introduced,” said Dr Walid Ammar, Director General of the Lebanese Ministry of Public Health.

Despite positive changes occurring in some countries, repressive measures and criminalization of drug users are still predominant in the region. This discourages people at higher risk of transmission from accessing HIV services.

Funding harm reduction

The uptake of harm reduction in most of the region has been slow mainly due to governments and civil society organizations lack of awareness as well as capacity to implement effective harm reduction activities.

To try reverse this situation, the Global Fund to fight AIDS, Tuberculosis and Malaria has granted $US 8.3 million to a multi-country project. Its aim is to raise awareness, advocate and build capacity of civil society organizations to scale up the provision of harm reduction services in 12 countries over the next three years. The 12 countries included in the project are Iran, Pakistan, Libya, Lebanon, Syria, Jordan, Bahrain, Morocco, Egypt, Afghanistan, Oman and West Bank and Gaza.

The project will begin in July 2011 and will be coordinated by the Middle East and North Africa Harm Reduction Association (MENAHRA), based in Beirut.  

With arts and culture being pillars of the Jeux de la Francophonie, the Y-PEER network performed a dance and song written by its members about AIDS. Beirut, 28 September 2009. Credit: UNAIDS/Nabil

The UNFPA-supported Y-PEER initiative is a groundbreaking youth programme that raises HIV prevention awareness through street art, music and dance. UNAIDS Executive Director Michel Sidibé had the opportunity this week to attend a dance performance by the Youth Peer Education Network during the Jeux de la Francophonie.

With arts and culture being one of the two pillars of the Jeux de la Francophonie, the Y-PEER network performed a dance and song written specifically by its members for these games. The lyrics include HIV prevention messages in Arabic, French and English, with the dancers forming a large red ribbon of red fabric at the end of the routine.

“UNAIDS and our Cosponsors are committed to including young people’s leadership as an integral part of national responses including empowering young people to prevent sexual and other transmission of HIV infection among their peers,” said Mr Sidibé.

“This evening’s performance was inspiring, putting these goals into action with young people creatively participating in the AIDS response in their own terms,” said Mr Sidibé after the show. “Culture and creative expression are powerful tools for mobilizing people of all ages and I applaud the Y-PEER.”

UNAIDS Executive Director Michel Sidibé writes a message at the UNAIDS booth at Y-PEER event, Beirut, 28 September 2009. Credit: UNAIDS/Nabil

Y-PEER is a groundbreaking and comprehensive youth-to-youth initiative pioneered by UNFPA. The international network includes over 7000 young peer educators in Europe, Central Asia, Latin America, North Africa and the Middle East. The network has adopted an approach of “edutainment”—combining education and entertainment— to communicating HIV facts. Young people work together to raise awareness on sexual and reproductive health including the facts about sexually transmitted infection and HIV prevention.

The Lebanese Y-PEER network was launched in 2008 with the support of UNFPA and through 35 peer educators, the network has reached 1000 young people all over country in just three months.

With 7,400 new HIV infections daily worldwide and young people aged 15-24 accounting for 45% of these. 

The Jeux de la Francophonie brings together sport and culture to foster dialogue and understanding among French speaking nations. It will run in Beirut until 6 October, bringing together 70 countries from all over the world.

The Director General in the Ministry of Public Health, Lebanon, Dr Walid Ammar (right) met UNAIDS Executive Director Michel Sidibé. Beirut, 28 September 2009. Credit: UNAIDS/Nabil

UNAIDS Executive Director Michel Sidibé concluded an official visit to Lebanon on 29 September. Mr Sidibé recognized and supported the country’s achievements in the HIV response and efforts to target key populations at risk of HIV. He also welcomed the Government of Lebanon’s strong commitment to introduce oral substitution therapy into the country’s public health system.

Mr Sidibé met with the Director General in the Ministry of Public Health, Lebanon, Dr Walid Ammar, and commended the government’s initiative to scale up its harm reduction programme. He stressed the need to expand prevention and treatment efforts among key populations affected with HIV in order to achieve universal access goals.

Mr Sidibé also met with the Executive Secretary of the Economic and Social Commission for Western Asia, Mr Bader Al-Dafa, to discuss approaches to prevent escalation of the HIV epidemic in the countries of the Middle East and North Africa, focusing on gender, socio-economic, marginalization and other factors which increase vulnerability.

Mr Sidibé emphasized the priority of keeping HIV prevalence low in the region, “for low prevalence to continue, I encourage more openness in communicating about AIDS issues. Let us all work together without judgment or discrimination for people living with or at risk of HIV,” said Mr Sidibé.

Mr Sidibé met with civil society groups while in Lebanon. Credit: UNAIDS/Nabil

Recognizing the pivotal role of civil society in the HIV effort, he also met with representatives from non-governmental organizations (NGOs) in the country. These included Helem Association, the first organization working with men who have sex with men (MSM) in the region as well as Soins Infirmiers et Developpement Communautaire (SIDC) which has implemented outreach and HIV prevention for MSM. He also met with Vivre Positif, which works towards ending discrimination and stigmatization towards people living with HIV.

Lebanon’s national AIDS programme has recently introduced 19 voluntary counselling and treatment centres that target key populations and are managed through NGOs. The country also recently launched a centre for antiretroviral distribution along with the provision of psycho-social support for people living with HIV.

According to UNAIDS 2007 estimates, Lebanon is a low HIV prevalence country with a total of 2900 people living with HIV. High mobility and migration levels are important drivers of the epidemic, with 45% of notified HIV cases up to 2004 being linked to travel abroad. Lebanon is among the few countries in the region that has accounted for specific strategies to target each of the key population groups.

Mr Sidibé's visit to Lebanon also included his participation in the Jeux de la Francophonie, of which UNAIDS is an official partner this year.

Jeux de la Francophonie opened in Beirut. Credit: UNAIDS/Nabil

The Jeux de la Francophonie (the Francophone Games) have been opened in Beirut by His Excellency Michel Suleiman, the President of Lebanon. The Jeux de la Francophonie is an event where sport and culture combine to foster dialogue and understanding among French speaking nations. The games are organized by a national organizing committee and the l’Organisation Internationale de la Francophonie (OIF).

“Through partnership change can happen,” said Mr Michel Sidibé, Executive Director of UNAIDS. “I am delighted that this year for the first time, UNAIDS is an official partner to the Jeux de la Francophonie. The OIF has shown leadership and a strong commitment to placing AIDS on the games’ agenda.”

Abdou Diouf, Secretary-General of La Francophonie addresses the opening ceremony
Credit: UNAIDS/Nabil

Observing the opening ceremony, Mr Sidibé noted the ability of the event to unify people all over the world. “The games, with their unique approach of merging sport and culture, have created a space for the open and respectful dialogue needed to challenge the taboos often surrounding issues pertaining to AIDS,” said Mr Sidibé.

Empowering young people to protect themselves from HIV is one of UNAIDS nine priority areas in the Outcome Framework 2009-2011.

In the Jeux de la Francophonie young athletes and artists of the French-speaking world are given an opportunity to meet through sporting and cultural events. The games have an ambition to foster dialogue and understanding among participants as well as spectators. It also aims to encourage young athletes and artist to contributing to international solidarity and gender equality, as well develop artistic exchanges between francophone countries.

"La Francophonie contre le sida - Francophone countries against AIDS"

Across the city of Beirut UNAIDS Goodwill Ambassadors Michael Ballack and Emmanuel Adebayor feature on 100 billboards with the powerful message “La Francophonie contre le sida” (Francophone countries against AIDS).
Credit: UNAIDS

In a joint campaign, across the city of Beirut UNAIDS Goodwill Ambassadors Michael Ballack and Emmanuel Adebayor feature on 100 billboards with the powerful message “La Francophonie contre le sida” (Francophone countries against AIDS). The UNAIDS logo along with other partners to the Games, is displayed by the organizing committee within the Chamoun stadium, visible to an expected 200, 000 spectators and 50 million people following the games via broadcasting. 

Through the partnership, UNAIDS aims to raise awareness on AIDS issues and to help inform young people how to protect themselves against HIV infection.

With 7,400 new HIV infections daily worldwide and young people aged 15-24 accounting for 45% of these, empowering young people and raising awareness of the epidemic is seen as a key to bring about change.

Running from the 27 September to 6 October, the Jeux de la Francophonie brings together 70 countries from all over the world.

The new study, Vulnerabilities of Migrant Women: from Asia to the Arab Statessays that Asian women migrating to Arab countries often face circumstances which leave them highly vulnerable to factors leading to HIV infection.

Asian women migrating to the Arab states often do so under unsafe conditions, are targets of sexual exploitation and violence and are highly vulnerable to factors that lead to HIV infection, according to a study launched today, produced in collaboration by UNDP, UNAIDS, CARAM Asia, IOM,UNIFEM, and Caritas Migrant Centre in Lebanon.

HIV Vulnerabilities of Migrant Women: from Asia to the Arab States examines the health, social and economic toll that migrant women often face, particularly those who are low-skilled. In the current global economic crisis, with rising unemployment, their situation can become precarious as they tend to be in a weak bargaining position and are more likely to accept poor conditions to secure or keep a job.

Migration itself is not a risk factor for HIV infection, but it is the conditions under which people migrate, and the working and living conditions they find themselves in that make them highly vulnerable to HIV.

Based on some 600 interviews in four Asian countries and three Arab states (Bahrain, Lebanon and United Arab Emirates), the study reveals that migrant women, many of whom become domestic workers, often lack legal coverage, suffer duress and sexual exploitation in the workplace, and have limited or no access to health and social services.

The Arab States are the primary destination for many migrant workers from Asia, including the four countries which are the focus of research; Bangladesh, Pakistan, the Philippines and Sri Lanka.

The movement of women and money between the countries studied is considerable. The report estimates that 70-80 percent of migrants from Sri Lanka and the Philippines to the Arab States are female. Between 1991 and 2007, 60 percent of women migrants from Bangladesh left to find employment in these countries and remittances from Filipinos working in the Arab States in 2007 amounted to US$ 2.17 billion. In Bangladesh, migrant workers sent back close to US$ 637 million from the UAE. Current remittances by migrant workers from Sri Lanka amount to US$ 3 billion.

HIV Vulnerabilities of Migrant Women: from Asia to the Arab States charts a way forward. According to the report, host countries and countries of origin share equal responsibility to provide protective policies and programmes for women who seek a better life away from home. Recommendations include:

• Migrants who have a medical condition that does not impair their ability to work, such as living with HIV, should not be denied the right to work
• Health insurance schemes for migrant workers should cover all aspects of health, including HIV
• Hiring agents and employer blacklists need to be created, monitored and shared
• Embassy and consular staff in host countries should be trained on the special needs and vulnerabilities of migrant women
• Existing labour laws should be changed/reformed to cover migrant workers in the domestic sector