Stigma and discrimination

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.

GENEVA, 21 JUNE 2024—UNAIDS applauds the judgment by the High Court of Namibia, striking out as unconstitutional the law which had criminalised same-sex relationships.  The court found the law incompatible with the constitutional rights of Namibian citizens. This decision, which is in line with a series of judgments by courts in Southern Africa in recent years, marks a significant victory for equality and human rights for all Namibians and will help protect the health of everyone.

"This decision by the High Court of Namibia is a powerful step towards a more inclusive Namibia," said Anne Githuku-Shongwe, UNAIDS Regional Director for East and Southern Africa. "The colonial-era common law that criminalized same-sex sexual relations perpetuated an environment of discrimination and fear, often hindering access to essential healthcare services for LGBTQ+ individuals. To protect everyone’s health, we need to protect everyone’s human rights.”

Originally introduced during colonial rule in Apartheid South Africa and maintained in Namibian law when the country gained independence in 1990, this law had been used to rationalize discrimination against LGBTQ+ people in Namibia. It not only violated the constitutional rights of Namibian citizens but also posed a challenge to public health. The climate created by the law discouraged LGBTQ+ individuals from seeking HIV testing and treatment, undermining efforts to control the epidemic.

"By decriminalizing same-sex relationships, Namibia creates a safer environment for LGBTQ+ communities," said Ms. Githuku-Shongwe. "This allows them to access vital healthcare services, contributing to the global goal of ending AIDS as a public health threat by 2030."

UNAIDS urges all countries to follow Namibia's lead, remove punitive laws, and tackle prejudices against lesbian, gay, bisexual, transgender, and intersex people. Since 2019, Botswana, Gabon, Angola, Bhutan, Antigua and Barbuda, Barbados, Singapore, Saint Kitts and Nevis, the Cook Islands, Mauritius, and Dominica have all repealed laws that criminalized LGBTQ+ people.

A more just, equitable and kind world is a healthier one for everyone.

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, 15 May 2024—Ahead of IDAHOBIT, commemorated worldwide on 17 May, UNAIDS is calling on governments everywhere to protect the human rights of LGBTQ+ people. Protecting the human rights of every person, UNAIDS research shows, is essential for protecting public health, because it enables inclusive and equitable access to health services without discrimination.

The movement for human rights for all has made important progress. For example, whereas, at the start of the AIDS pandemic, most countries criminalized LGBTQ+ people, now two thirds of countries do not.

However, more than 60 countries still do while another 20 countries criminalize gender expression and identity.

“Stigma, discrimination and criminalization can be lethal,” said Winnie Byanyima, Executive Director of UNAIDS. “In the response to HIV, we have learned that a human rights-based approach is critical in responding to a health crisis and leaving no-one behind. Countries must remove these discriminatory criminal laws and introduce legislation which protects rights if we are to end AIDS as a public health threat for everyone.”

Discrimination, violence and criminalization force many LGBTQ+ people underground and away from health services; as a result, gay men and other men who have sex with men, and transgender people, are more affected by HIV. Globally, in 2022, men who have sex with men were 23 times more likely to acquire HIV, and transgender women 20 times more likely to acquire HIV than other adults aged 15–49.

Criminalization of LGBTQ+ people in particular causes significant harm to health. In sub-Saharan Africa, men who have sex with men in countries where they are criminalized, are five times more likely to be living with HIV than in countries that do not criminalize same-sex sexual behavior.

As a recent IAS - Lancet report demonstrated, violations of human rights have multiple damaging impacts on public health. Treating people as criminals drives people away from vital services for fear of arrest and discrimination, resulting in them not accessing HIV prevention, treatment and care.  In addition, strict anti-LGBTQ+ laws have been associated with a lack of knowledge about HIV testing and HIV status.

“For far too many people in our LGBTQ+ communities and beyond, the most basic things are still too far from reach, because of the discrimination, stigma, and violence they face every day,” said the international lesbian, gay, bisexual, trans and intersex association, ILGA World, co-Secretaries General Luz Elena Aranda and Tuisina Ymania Brown.  “This is why they are rallying behind an urgent cry: ‘No one left behind: equality, freedom and justice for all,’ reminding us of the importance of rejecting discriminatory laws, policies, and attitudes.”  

Criminal laws that discriminate on the basis of sexual orientation and gender identity are a breach of the right to privacy and non-discrimination and impede the HIV response. UNAIDS calls on all states to repeal such laws and to introduce legal protections against discrimination on the basis of sexual orientation.

UNAIDS, the World Health Organization, the United Nations Development Programme, and the Global Commission on HIV and the Law have made the same recommendations, as have the Office of the United Nations High Commissioner for Human Rights and several other United Nations agencies.

UNAIDS stands with LGBTQ+ people everywhere who are facing hate, discrimination and marginalization, and calls for an end to their criminalization.

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, 30 April 2024—The Joint United Nations Programme on HIV/AIDS (UNAIDS) is deeply concerned about the impact of the harmful new legislation in Iraq amending the 1988 anti-sex work law to criminalize LGBTQ+ people. The legislation imposes a prison sentence of between 10 and 15 years for same-sex sexual relations. Transgender people face up to three years imprisonment for expressing their gender or receiving gender affirmation care.   Individuals also face up to seven years for promoting homosexuality. And up to three years for providing gender affirmation care.

Criminalizing consensual same-sex relationships and gender expression not only violates fundamental human rights but also undermines efforts to end AIDS by driving marginalized populations underground and away from essential health services, including life-saving HIV prevention, treatment and care services.

Globally, the movement for human rights has made progress in the past 40 years. At the start of the AIDS pandemic in the early 1980s, most countries criminalized same-sex sexual activity between men, now two thirds do not. An increasing number of countries have also recognized the rights of trans and other gender diverse people. However, this new legislation in Iraq represents a significant setback and is part of a wave of punitive and restrictive laws being passed that undermine the rights of LGBTQ+ people.  

The legislation passed in parliament is an amendment to an existing 1988 anti-sex work law which continues to criminalize both the selling and buying of sexual services. The amendments passed on Saturday 27 April 2024 increase the penalties in relation to sex work. These laws, which countries committed to removing under the 2021 United Nations General Assembly Political Declaration on HIV and AIDS, likewise undermine the human rights and public health of sex workers.

UNAIDS calls upon the authorities of Iraq to overturn this discriminatory legislation and fulfill its obligations under international human rights law to protect the rights of all people, regardless of sexual orientation or gender identity. UNAIDS stands in solidarity with LGBTQ+ people and communities and reaffirms its commitment to work with partners to promote equality, end stigma and discrimination, uphold human rights—including the right to health, and ensure access to comprehensive HIV services for everyone, everywhere.

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/JOHANNESBURG, 3 April 2024—The Constitutional Court of Uganda has today struck down certain sections of the Anti-Homosexuality Act, 2023.

“The Constitutional Court of Uganda made a judgment today to strike down certain sections of the Anti-Homosexuality Act, 2023. Evidence shows that criminalizing populations most at risk of HIV, such as the LGBTQ+ communities, obstructs access to life-saving health and HIV services, which undermines public health and the overall HIV response in the country,” said Anne Githuku-Shongwe, UNAIDS Regional Director for Eastern and Southern Africa. “To achieve the goal of ending the AIDS pandemic by 2030, it is vital to ensure that everyone has equal access to health services without fear."

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, 27 February 2024—Zero Discrimination Day was established by UNAIDS ten years ago to advance equality and fairness for everyone regardless of gender, age, sexuality, ethnicity or HIV status. However, progress is in peril.

Attacks on the rights of women and girls, of LGBTQ+ people, and of other marginalized communities are on the rise. And when laws, policies, practices or norms enshrine punishment, discrimination or stigma for people because they are women, or are LGBTQ+, or are migrants, or sex workers, or use drugs, the results lead to failing public health as these communities are pushed away from vital health and social services.

“The attacks on rights are a threat to freedom and democracy and are harmful to health. Stigma and discrimination obstruct HIV prevention, testing, treatment and care, and hold back progress towards ending AIDS by 2030,” said Winnie Byanyima, Executive Director of UNAIDS. “It is only by protecting everyone’s rights that we can protect everyone’s health.”

There has been progress. At the start of the AIDS pandemic 40 years ago, two thirds of countries in the world criminalized LGBTQ+ people, today two-thirds of countries do not.

38 countries around the world have pledged to end HIV-related stigma and discrimination and today 50 million more girls are in school than in 2015.

To continue this progress UNAIDS urges support for women’s movements and movements for the rights of LGBTQ+ people, for racial justice, for economic justice, for climate justice, and for peace. As communities across the world stand up for rights, the United Nations is not only on their side but by their side.

On this Zero Discrimination Day (1 March), and across the whole month of March, events and activities will remind the world of this vital lesson and call to action: by protecting everyone’s rights, we can protect everyone’s health.

“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals, and to secure a safer, fairer, kinder, and happier world – for everyone,” added Ms Byanyima.

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.

UNAIDS is concerned about the impact on peoples’ health and rights following the decision of the High Court of St. Vincent and the Grenadines regarding sections 146 and 148 of the Criminal Code, which upholds discriminatory and harmful laws against LGBTQ people.

On Friday, February 16, 2024, the High Court, in an oral delivery, denied the claim by two Vincentian nationals, who reside outside of the country, that sections 146 and 148 of the Criminal Code criminalising buggery between any two persons with a penalty of up to 10 years imprisonment, violate the fundamental rights to privacy, personal liberty, freedom of conscience, freedom of expression and protection from discrimination. The Court dismissed in their entirety all claims by the two Claimants and awarded the sum of EC$7,500 prescribed costs to the Attorney General to be paid by each of the Claimants. 

In the written decision published February 22, 2024, the Court in dismissing the consolidated claims of Javin Johnson and Sean MacLeish held that the Claimants had failed to establish on the evidence, a present or existing breach of any alleged rights due to lack of locus standi (the requisite standing to invoke a review by the Court) as the Claimants do not reside in the State and had not for years prior to the filing of the claims.

UNAIDS is particularly concerned that the judgment referred to protecting public health and tackling the HIV epidemic as justifying punitive anti-LGTBQ laws, because the evidence shows that such laws hinder efforts to protect public health and tackle the HIV epidemic. At paragraph 267 of the judgment the court asserted: 

“to my mind the thought of a public health crisis occasioned by an unstemmed deluge of new HIV cases is a real and serious concern which reasonably justifies a public health response of the kind embedded in the challenged provisions”.

In fact, studies show that these laws have negative health outcomes. A punitive legal environment, including criminalisation of same sex relationships, drives people underground and away from vital health services, including HIV prevention, testing, treatment, and care. To achieve the goal of ending AIDS as a public health threat by 2030, it is vital to ensure that everyone has equal access to essential services without fear, stigma or discrimination.

UNAIDS has estimated that not achieving decriminalization of key populations in all countries would result in about 750 000 cumulative new HIV infections from 2020 to 2030.

The decision made in the High Court of St. Vincent and the Grenadines stands in stark contrast to the rulings in Belize, Guyana, Trinidad and Tobago, Antigua and Barbuda, St. Kitts and Nevis and Barbados where the courts ruled that laws which criminalise persons based on sexual orientation and gender identity violate the protected rights to dignity, privacy, personal liberty, freedom of conscience, freedom of expression and protection from discrimination.

Regardless of the outcome of this court decision, UNAIDS holds hope that the courts will serve as a vital last resort for social justice, the protection of human rights and the advancement of public health for improved health and wellbeing for all. UNAIDS work to end AIDS and to leave no one behind will continue in partnership with communities and with all branches of government, including the courts.

Punitive laws obstruct the end of AIDS and ultimately hurt everyone’s health. As we prepare for observance of the tenth anniversary of Zero Discrimination Day on March 1^st, 2024, we pay tribute to the courage of communities, and call on all duty bearers to protect the health of all by protecting the human rights for all.

NOTE FOR THE EDITORS:

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.

ZERO DISCRIMINATION DAY

March 1^st this year is the tenth anniversary of Zero Discrimination Day. Upholding everyone’s rights is the responsibility of us all. Everyone can play a part in ending discrimination. On 1 March, and across the whole month of March, events, activities and messages will remind the world of this vital lesson and call to action: to protect everyone’s health, protect everyone’s rights. #ZeroDiscrimination

Countries from across the world who have taken practical steps forward towards eliminating discrimination are showing what is possible, UNAIDS has said.

The countries are members of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, which have prioritized and pledged to accelerate the removal of stigmatizing and discriminatory practices, policies and laws across six settings: community, health, justice, education, workplace, and emergency/humanitarian. Recent progress that was made by members of the Global Partnership included:

• In the Central African Republic, the law on the rights of people living with HIV/AIDS was revised with a focus on social protection, opening new opportunities for people living with HIV to access enhanced support.
• In Argentina, the National Law for Comprehensive Response to HIV, STIs and Tuberculosis committed that care and treatment be provided without discrimination. 
• In Kazakhstan, the government increased domestic funding to sustain a successful community-led programme for shelter and support for women living with HIV who had been subjected to violence.
• In Ghana, a strong partnership between the government and the community enabled mothers living with HIV and caregivers of HIV-exposed infants and children to  benefit from targeted interventions that foster their and their children’s well-being, leading to improved adherence to treatment and linkage to care.
• In Thailand, a national Code of Conduct on HIV prevention and management in the workplace was adopted, and both government and the private sector committed to review HIV policies in line with the new Code of Conduct.
• In Iran, the Ministry of Health issued a bylaw to tackle the stigma and discrimination faced by people living with and affected by HIV. As a result, a protocol on elimination of stigma and discrimination in health care settings was developed to advance access to HIV services without discrimination, including strengthening the referral system.

“The practical steps forward which have been taken by members of the Global Partnership provide hope through action,” said UNAIDS Executive Director Winnie Byanyima. “They show what is possible. They show how it is through protecting the rights of every person that we can protect the health of every person. Progress on rights can power progress towards the end of AIDS.”

38 countries have joined the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, and more have expressed interest in joining.  More information on the Global Partnership can be found here: https://www.unaids.org/en/topic/global-partnership-discrimination

On March 1st the world will mark the tenth anniversary of Zero Discrimination Day. More information on Zero Discrimination Day can be found here: https://www.unaids.org/en/2024-zero-discrimination-day