Criminalization, stigma and discrimination continue to be the main barriers which are preventing people most in need from accessing lifesaving HIV services.

UNAIDS Deputy Executive Director Luiz Loures met with Dutch Aids ambassador Lambert Grijns and government funded community groups in the Netherlands for a two day meeting to reinforce efforts to enhance services for key populations and strengthen their human rights.

The country has been recognized for its pioneering role and willingness to take a high-profile stance on difficult issues related to people who use drugs, men who have sex with men and sex workers and have been a key and consistent player in the global efforts against AIDS.

In Amsterdam’s vibrant red light district, Dr Loures met with Dutch police to discuss law enforcement, sex work and HIV. The police explained that the decriminalization of sex work has had a positive impact on reducing new HIV infections with sex workers more at ease in accessing HIV prevention services, no longer fearing legal reprisals.

Dr Loures encouraged the Netherlands to continue its specialized work with key populations as a global champion for human rights and key populations. The Government and civil society groups will also continue to collaborate with UNAIDS at the country and global level to protect and promote human rights. 

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Men who have sex with men have been particularly affected by the AIDS epidemic.  Across the European Union a multi-country survey found that in 2010 around 8% of men who have sex with men were reported to be living with HIV. In 2012, France reported the highest HIV prevalence among men who have sex with men at around 18%, followed by Spain, Greece, Germany, Switzerland, Belgium and Portugal, all with rates well above 10%. The dual stigma and discrimination which continues to surround HIV and homosexuality is one of the barriers preventing people from accessing lifesaving HIV services.

On 6 November leading European policy makers, experts, lesbian, gay, bisexual, transgender and intersex (LGBTI) human rights activists and HIV organizations came together in Brussels to highlight the severe impact of HIV for LGBTI communities in Europe. At the European Parliament hearing “Achieving the right to health of LGBTI people – How can we reverse the crisis of HIV, health and human rights affecting LGBTI people in Europe” the participants discussed ways forward to strengthen rights of people affected by HIV in compliance with the EU Charter on Fundamental Rights.

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At the end of 2012, 9.7 million people worldwide had access to antiretroviral (ARV) therapy in low- and middle-income countries. Credit: UNAIDS

Experts call for increased access to life-saving HIV treatment. The call, made during a meeting held in New York on 4-5 September, follows the recommendations made last year by the independent Global Commission on HIV and the Law on improving access to HIV treatment.

The Global Commission’s landmark report recommended a new intellectual property framework for pharmaceuticals that would meet urgent public health needs while safeguarding the rights of inventors.

“While intellectual property protections are intended to provide an incentive for innovation, the evidence shows that excessive protection hinders access to affordable HIV treatment and other essential medicines,” Helen Clark, UN Development Programme (UNDP) Administrator told participants at the meeting convened by UNDP and UNAIDS. “Access to affordable, quality-assured pharmaceutical products remains an urgent priority for achieving the MDGs and improving health and development outcomes for poor and marginalized populations,” added Ms Clark.

At the end of 2012, 9.7 million people worldwide had access to antiretroviral (ARV) therapy in low- and middle-income countries, compared to just 300 000 people 10 years earlier. However, UNAIDS and the World Health Organisation estimate that another 16 million people are eligible to HIV treatment but lack access to it.

“We need solutions to increase access to life-saving HIV treatment and the recommendations of the Global Commission clearly outline how a people-centred approach can help ensure no one is left behind,” said Michel Sidibé, UNAIDS Executive Director. 

The World Trade Organization's (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights, known as TRIPS, requires countries to abide to high intellectual property standards, including patent criteria that grant pharmaceutical companies long-term monopolies on medicines. When the TRIPS treaty was signed in 1994, it included terms that allow poor countries to produce or import cheaper medicines under specific circumstances. However, external pressure from wealthier countries has often prevented the application of such special clauses.

“The real crux of the Commission’s Recommendations was for a new intellectual property regime for pharmaceutical products – it is not enough to tweak the existing system,” said J.V.R. Prasada Rao, former Commissioner.

Talks at the meeting focused on strategies, tactics, and timelines to confront the growing need for HIV treatment, including how to make intellectual property laws work better for low-and middle-income countries. Next steps are under discussion.

“We should be encouraged that this meeting comes at a pivotal time when we are discussing the post-2015 development agenda, which presents us with significant opportunities,” said Michael Kirby, former Commissioner.

UNAIDS Deputy Executive Director, Programme, Luiz Loures met and dialogued with civil society and community members during his country visit to Sri Lanka. Credit: UNAIDS/Jayalal

Communities at higher risk of HIV infections should be placed at the centre of the AIDS programme design and implementation in Sri Lanka. This was the central message highlighted through discussions between representatives of civil society and the UNAIDS Deputy Executive Director, Programme, Luiz Loures, during an official visit to the country from 16-18 June.

While in Sri Lanka, Mr Loures visited several community-led programmes and met with representatives of key populations such as men who have sex with men, sex workers and women living with HIV. Through in-depth conversations, he listened to examples of focused programming in the country which have helped facilitate greater access to a number of HIV services for key populations, as well as significant network building.

National HIV prevalence remains relatively low in Sri Lanka, estimated at 0.1%, but the country is one of four in the Asia Pacific region that has shown up to a 25% increase in new HIV infections in the period 2001-2011. Higher levels of HIV are often concentrated around certain geographical sites and within communities at higher risk of HIV infection. According to national studies, in the city of Kandy for example, HIV prevalence among men who have sex with men is estimated to be at 4%—more than 40 times the general population average.

“In Sri Lanka—as more broadly in Asia Pacific and across the globe—we see that where communities are front and centre of the AIDS response, the greatest impact is achieved,” said Dr Loures, commending the programmes showcased during his visit. He highlighted how successful programmes have been initiated with key populations in Sri Lanka despite challenging legal and policy environments which criminalize sex work and same sex relations.

Speaking about the urgency needed to further scale such programmes across the country to stem rising HIV infection rates Dr Loures noted that, “Even in countries with low prevalence, we must maintain a sense of urgency to ensure responses and financing are focused to where they are most needed and that they are developed for communities by communities.”

Across countries that reported on AIDS progress in 2012, only 19% of HIV prevention spending was estimated to be for key affected populations. Despite that 25% of all new HIV infections in the region are estimated to be occurring among men who have sex with men, only around 1% of investments are directed towards programming among this community.

In Sri Lanka, community representatives are urging for much greater attention and resources to be given to ensure coverage and services are increased for people most in need.

“We have built a very successful network and we know what needs to be done, but we need the commitment and the resources to be able to increase programmes in size and scale so we can really make sure people are not being left behind,” said Lalith Dharmawardena, Executive Director of the Heart to Heart Organization, a network visited by Dr Loures set up to promote the sexual health and other human rights of Sri Lankan men who have sex with men.

UNAIDS Executive Director Luiz Loures met and dialogued with community members during his country visit to Sri Lanka.
Credit: UNAIDS/P.Wijayananda

Punitive legal and policy environments and subsequent high levels of stigma and discrimination towards people living with HIV and key communities were also highlighted as presenting a major barrier to Sri Lanka’s AIDS response. Both sex work and sexual relations between men are prohibited by national laws, codes and/or policies. National surveys suggest that many people at higher risk of infection delay testing for HIV and coming forward for treatment because they are concerned by the implications of their identification and testing HIV-positive, and the confidentiality of their HIV status.

Princey Mangalika, President of the Sri Lankan Positive Women’s Network, underlined how normalization of HIV and key communities can have a positive impact on reducing stigma and discrimination. She also urged government and authority officials present at the community interactions to ensure greater participation of people living with HIV and from key communities in decision-making bodies and the national response. Ms Mangalika also thanked the government and the Global Fund for making antiretroviral treatment freely available to those who need it in Sri Lanka.

“We are seeing some really positive signs in Sri Lanka and we now need permanent spaces for women living with HIV and other communities,” said Ms Mangalika, whose efforts—both personal and those of her organization—won a Red Ribbon Award in 2012 for outstanding community based care and support programmes. “We need the authorities to listen more closely to particular community needs—women, men, transgender—and let us help lead. We know how to best reach people,” she said.

The visit of the UNAIDS Deputy Executive Director, Programme to Sri Lanka coincides with his attendance at the Twenty-Ninth Board Meeting Board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria which takes place in Colombo on 18-19 June 2013.

Participants at the judicial dialogue on HIV, human rights and the law. Bangkok, Thailand. 2-4 June 2013. Credit: UNAIDS

In Asia and the Pacific, almost all countries have some kind of punitive laws, policies and practices that hamper access to HIV services for people living with HIV and key populations at highest risk including people who use drugs, sex workers, men who have sex with men, and transgender people.

Faced with punitive legal environments, many people in need of HIV prevention and treatment services are not able to access them for fear of stigma, discrimination, legal reprisals and even violence.

Seeking to address these challenges, some 30 judges from the highest national courts of 16 countries in Asia and the Pacific joined to discuss the role of the judiciary in responding to HIV. They also debated about the specific actions that can be taken to create a more supportive legal and social environment for people living with and vulnerable to HIV in the region.

Convened by UNAIDS, UNDP and the International Commission of Jurists, the meeting was part of efforts to support judges become leaders in the HIV response. Participants stressed the critical role of Judges and courts in protecting people living with and affected by HIV and achieving the UNAIDS vision of ‘zero discrimination’.

30 years into the AIDS response, the need for legal environments to be aligned with the latest scientific developments on HIV and treatment was underlined. “Our authority is based on reason and evidence—this is the strongest ally we have in addressing the HIV epidemic and what we need for just and fair outcomes,” said Hon. Justice Edwin Cameron, Justice of the Constitutional Court of South Africa.

During the gathering, UNAIDS launched a new Judicial handbook on HIV, Human Rights and the Law, providing updated information on the latest scientific developments on HIV as well as key human rights and legal considerations to assist and guide judges’ HIV-related work.

Of the 38 United Nations Member States in the region, 11 impose some form of restriction on the entry, stay and residence of people living with HIV based on their HIV status; 37 criminalize some aspect of sex work; 18 criminalize same sex relations; 11 impose compulsory detention centres for people who use drugs; and 15 provide the death penalty for drug-related offences.

“The time has come for us to address all laws concerning people from marginalized sections of society. We need to re-look at legislation through the lens of the human rights guaranteed under the Constitution and ensure it is aligned to enable progress and to move with the necessary urgency,” said former Chief Justice of the Delhi High Court in India, Hon. Ajit Prakash Shah. Judge Shah was on the bench that handed down the July 2009 ruling that found India's 150-year-old statute (Section 377 of the Indian Penal Code) prohibiting homosexual acts as discriminatory and therefore a violation of fundamental rights.

Transformative jurisprudence

The striking down of Section 377 through the Delhi High Court was one of a number of protective jurisprudence examples that have had a transformative and beneficial impact on the national AIDS response and on public perception of HIV. Other examples are the progressive court decisions in Nepal, India and Bangladesh that have recognized the human rights of sex workers as defined under national Constitutions; decisions in Thailand and India that have ensured access to affordable generic medicines; and Pakistan’s inclusion of transgender people in population registration under the status of a third gender, among others.

Discussions at the Bangkok dialogue were supported by active involvement of representatives from groups of people living with HIV and key populations at highest risk, together with United Nations agencies and partners, who underlined the importance of the judiciary’s active support to the revision and removal of punitive laws in the region.

“If we don’t deal with these issues, we are not going to end AIDS,” said Mr Shiba Phurailatpam, Regional Coordinator of the Asia Pacific Network of People Living with HIV. “Judicial action can affect social views and have an impact on stigma and discrimination—it can save people’s lives,” he added.

“The law must be a shield that protects, not a sword that punishes and increases vulnerability to abuse, harassment and HIV infection,” said UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle who delivered the keynote address at the meeting. “Judges can help shape social and community attitudes by stance and attitude toward people living with HIV and members of key populations,” she added.

Director of the UNDP HIV Health and Development Practice, Dr Mandeep Dhaliwal stressed that judicial leadership is an essential component of addressing inequality. “Getting the legal environment right is essential for addressing the social and structural inequalities which fuel HIV and impede health and development progress,” she said.

Message from UNAIDS Executive Director Michel Sidibé

GENEVA, 17 May 2013—More than 30 years ago, gay men lit the first spark that kindled the world’s response to the AIDS epidemic. Thanks to the audacity and courage of lesbians, gays, bisexuals, and transgender people, we have now seen extraordinary progress against AIDS around the world.

However, stigma and discrimination based on sexual orientation or gender identity still drive new HIV infections and are an obstacle to treatment efforts in every part of the world.

We call on political and community leaders to cast aside discriminatory laws and social practices.

The right to health belongs to everyone. Everyone should have access to HIV prevention, care, treatment and support.

Today and every day, UNAIDS stands with our fellow LGBT brothers and sisters for a world without homophobia and transphobia.

Let us work together to realize our vision: a world with zero new HIV infections, zero discrimination, and zero AIDS-related deaths.

The countries of the South are shifting the global power balance with massive strides in economic growth, poverty reduction, education and health.

The world is changing rapidly with developing nations spearheading global economic growth, impressive poverty reduction and the rise of a healthier, better educated middle class, says the UN Development Programme’s (UNDP) Human Development Report 2013.

According to the publication, The Rise of the South: Human Progress in a Diverse World, this rise is “unprecedented in its speed and scale. Never in history have the living conditions and prospects of so many people changed so dramatically and so fast.” 

The momentum of such achievements in poverty reduction, education, income and tackling health issues like HIV, is increasing. It can be seen as an overdue “global rebalancing” with new actors “shaping the development landscape” and gaining in political and economic influence.  

There has been notably rapid progress in more than 40 countries of the South—traditionally referred to as developing nations—whose advancement has been markedly better than expected, the report notes. Coming from all continents and ranging widely in size, they include:  Bangladesh, Brazil, Chile, China, Ghana, India, Mexico, Rwanda, Uganda and Vietnam.  Uganda, for example, through a series of economic, health, education and social measures, has managed to halve extreme poverty before the Millennium Development Goal deadline of 2015. It fell from 56% in 1992-93 to 25% in 2009-10.

The report was launched in Mexico City on March 14 by the UNDP’s Administrator Helen Clark and Mexican President Enrique Peña Nieto.  As well as an extensive analysis of original research, it also contains an updated Human Development Index which measures the progress of nations in terms of health, education and income. In addition, the publication contains data on the critical gender aspect of development in its Gender Inequality Index which shows that despite serious inequities persisting, there has been progress in equality almost everywhere.

As with general development, the pace of success in the AIDS response is quickening in an unprecedented way. The 2012 UNAIDS global report showed that the rate of infection across 25 low- and middle-income countries has been cut by half.

The accelerated development of the South is critical to the success of the global AIDS response as the most heavily burdened countries are low-and middle income. UNAIDS maintains that getting to zero new infections, zero discrimination and zero AIDS-related deaths will need advances not only in the sphere of health and HIV but in terms of poverty reduction, education, gender equality and enhanced life opportunities

Co-chaires Hon Thokozani Khupe, Deputy Prime Minister of Zimbabwe (left) and Hon Julia Duncan-Cassell, Minister of Gender and Development of Liberia at the High Level Consultation Accelerating Zero-Tolerance to Gender based violence through the HIV response. New York City on March 9, 2013. Credit: UNAIDS/M. Taamallah

How much progress has the global AIDS response made in ensuring that women and girls live their lives free from violence? What are the next steps needed to strengthen the challenge to gender-based violence and its links to HIV? These critical questions dominated a high level consultation which took place in New York on 9 March during the 57^th session of the Commission on the Status of Women (CSW). 

Convened by UNAIDS and UN Women, and cosponsored by the Government of Ireland, the UN Development Programme and the UN Population Fund the consultation brought together key civil society activists, United Nations organizations and government representatives.

Co-chaired by Hon Thokozani Khupe, Deputy Prime Minister of Zimbabwe and Hon Julia Duncan-Cassell, Minister of Gender and Development of Liberia, the consultation took the priority theme of the CSW: elimination and prevention of all forms of violence against women and girls as a springboard to find ways to accelerate the attainment of Millennium Development Goals 3 (promoting gender equality) and 6 (halting HIV). Participants also discussed how to position HIV and gender-based violence on the post-2015 development agenda.

“The post-2015 agenda must be seen as finishing the last mile,” said Thokozani Khupe, Deputy Prime Minister of Zimbabwe. “We must see the things that are unfinished and try to tackle them differently,” she added.

Gender based violence is a global epidemic, and it is the most brutal manifestation of gender inequality. According to UNAIDS, at least one in three women is beaten, coerced into sex or otherwise abused by an intimate partner in the course of her lifetime. In some countries, up to 45% of girls under the age of 15 report their first sexual experience as forced.

“Violence is not inevitable,” said Charlotte Watts from the London School of Hygiene and Tropical Medicine. “Even if figures are shocking, we should be inspired by them to work and address them.”

Tackling violence against women and girls is key if their vulnerability to the HIV is to be reduced. Women can be forced to have unwanted and unprotected sex and they can face violence if they reveal that they are living with HIV.  Research in South Africa has shown that young women subjected to intimate partner violence are 12% more likely to become infected with HIV.  Married women in India who experience both physical and sexual violence from their partners are three times more likely to be living with HIV than women not subjected to attacks at all. Cases of coerced sterilizations and abortions undertaken on women living with HIV without their informed consent are widespread and documented in many countries.

Representatives of civil society shared community perspectives of how HIV and gender-based violence are intimately linked. Jennifer Gatsi, from the Namibia Women’s Health Coalition, stressed the negative consequences suffered by women living with HIV.

Group photo of the participants at the High Level Consultation Accelerating Zero-Tolerance to Gender based violence through the HIV response. New York City on March 9, 2013.
Credit: UNAIDS/M. Taamallah

“The birth of a child is commonly the happiest day in a woman’s life,” said Ms Gatsi. “But in certain countries, the day a child is born from a mother with HIV, is the day when she dies or she starts to face discrimination.”

The consultation discussed the fact that, despite the extent and consequences of gender- based violence and its role in fuelling the HIV epidemic, it too often goes unaddressed and unpunished. It was noted that nothing less than working for social transformation of gender relations, including economic and legal empowerment of women, can bring about the changes needed to help them to stay safe.

According to the UNAIDS Director, Rights, Gender and Community Mobilization, Mariangela Simao, making real strides against gender-based violence is a core goal for effective HIV responses, as reflected in the UNAIDS Strategy 2011-1015.

Lynn Collins, a UNFPA HIV advisor who moderated a panel at the event said, "We at UNFPA have welcomed this opportunity to bring together a range of voices, united in the call to end violence in all its heinous forms through education and other means of empowerment, legal reform and redress, and rights-based sexual and reproductive health and HIV services."

The Commission on the Status of Women, which meets annually, is one of the main global policy-making bodies committed to gender equality and the advancement of women. This year’s meeting is taking place from March 4-15.

Failure to extend the transition period for least-developed countries to become fully compliant with the TRIPS Agreement could put millions of lives at risk

GENEVA, 26 February 2013—The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Development Programme (UNDP) today launched a new Issue Brief TRIPS transition period extensions for least-developed countries. The Issue Brief outlines that failure to extend the transition period for least-developed countries to become fully compliant with the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) could seriously impede access to lifesaving antiretroviral treatment and other essential medicines for people most in need.

Least-developed countries (LDCs) are home to some of the world’s most vulnerable people and bear considerable health burdens. In 2011, some 9.7 million of the 34 million people living with HIV worldwide, lived in LDCs. Of the people living with HIV in LDCs, 4.6 million were eligible for antiretroviral treatment in accordance with the 2010 World Health Organization HIV treatment guidelines, however only 2.5 million were receiving it.

In the 49 countries which are considered LDCs by the United Nations, non-communicable disease burdens are also rising much faster than in higher income countries. Data from low-income countries for instance suggests that cancer incidence is expected to rise by 82% from 2008 to 2030, whereas in high-income countries incidence is expected to rise at the much lower rate of 40%, in part due to widespread access to vaccines and medicines.

“Access to affordable HIV treatment and other essential medicines is vital if least-developed countries are to achieve the health-related and other Millennium Development Goals”, said Helen Clark, UNDP Administrator.

In the Issue Brief, UNAIDS and UNDP urge WTO Members to give urgent consideration to the continued special needs and requirements of LDCs in respect of their social and economic development.

“An extension would allow the world’s poorest nations to ensure sustained access to medicines, build up viable technology bases and manufacture or import the medicines they need,” said Michel Sidibé, Executive Director of UNAIDS.

The TRIPS Agreement was introduced in 1995 as a means of protecting intellectual property rights on a global scale. Patent protection, however, has also proved to be one of the factors contributing to high costs of medicines, placing many essential treatments outside the reach of LDCs. In recognition of this, WTO Members retained important options and flexibilities in the TRIPS Agreement. One of the flexibilities was that LDCs were granted an initial ten year transition period to become TRIPS compliant. Two extensions to this time period were granted. The general exception is due to expire on 31 July 2013. A proposal currently before the TRIPS Council, submitted on behalf of LDCs, requests a further extension to the general exemption from full TRIPS compliance for as long as a country remains an LDC.

The proposal is due to be discussed at the 5-6 March meeting of the TRIPS Council in Geneva, Switzerland. In the lead-up to and during discussions, UNAIDS and UNDP encourage all WTO Members to consider the full range of possible public health, economic and development benefits of such an extension.

Minister of Health and Social Affairs of France, Marisol Touraine presents the Red Ribbon Award during the International AIDS conference in Washington, on July 25, 2012.
Credit: UNAIDS/ Yuri Gripas

When Thet Mon Phyo underwent a gender change operation in 2005, her parents told her not to bother returning home.

“They were ashamed and I had to go and live with my aunt,” 34-year-old Phyo recalled. “When I was young my father often scolded me for my feminine behaviour. Later, my lover left me because his parents persuaded him that same-sex love was unnatural,” she said.

In Myanmar, many transgender people and men who have sex with men (MSM) face widespread stigma and discrimination, complicating efforts to halt the spread of HIV.

According to UNAIDS, the HIV prevalence among MSM and transgender people in some places is much higher than that of the general population (9.4% versus 0.53%). Male-to-male sex is illegal in Myanmar and there are no laws to protect MSM and transgender people from discrimination.

“They are objects of ridicule for some people, even hated,” Phyo said.

“There is discrimination in the workplace and even within families….some MSM are disowned, disinherited and expelled from their homes,” she added.

Phyo is Programme Manager at The Help, Myanmar, a group which focuses on HIV prevention, care, support and advocacy for MSM and transgender people and works to ensure their voices are heard and their issues taken up at the national level. All members of The Help are MSM or transgender and almost half are living with HIV.

The Help Myanmar was awarded a prestigious Red Ribbon Award at the XIX International AIDs conference held in August for its work on the prevention of sexual transmission of HIV and other STDs. The Red Ribbon Award is the world’s leading award for innovative and outstanding community work in the response to the AIDS epidemic.

The Help, Myanmar is working to change attitudes, reduce discrimination and improve access to HIV services. It is a challenging task.

Phyo said MSM and HIV positive people are denied equal employment opportunities and access to proper medical treatment, which in turn discourages them from safe behaviour.

Police often act as barriers in seeking legal protection. Threats and extortion attempts by some police highlight the need for immediate measure to increase public awareness of people’s rights and for the government to enact rights that protect people from discrimination.

Phyo said the authorities have not interfered with The Help’s work to increase MSM and TGs capabilities and set up self-help groups to support them. In fact, The Help sees this as a sign of tacit cooperation. But there is a long way to go.

“We are greatly encouraged for being recognized for helping MSMs and others in the community. The Red Ribbon Award has strengthened our determination to continue our struggle for truth, rights and benefits,” said Phyo.

The Help Myanmar’s efforts may also receive a boost following the recent appointment of Daw Aung San Suu Kyi as UNAIDS Global Advocate for Zero Discrimination.

“She has many things to do, but we believe in her and we think she can make a difference,” said Phyo.