New HIV infections are rising in around 50 countries, AIDS-related deaths are not falling fast enough and flat resources are threatening success. Half of all new HIV infections are among key populations and their partners, who are still not getting the services they need

PARIS/GENEVA, 18 July 2018—UNAIDS is issuing countries with a stark wake-up call. In a new report, launched today in Paris, France, at an event co-hosted with Coalition PLUS, UNAIDS warns that the global response to HIV is at a precarious point. At the halfway point to the 2020 targets, the report, Miles to go—closing gaps, breaking barriers, righting injustices, warns that the pace of progress is not matching global ambition. It calls for immediate action to put the world on course to reach critical 2020 targets.

“We are sounding the alarm,” said Michel Sidibé, Executive Director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”

HIV prevention crisis

Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. Although this is nearly half the number of new infections compared to the peak in 1996 (3.4 million), the decline is not quick enough to reach the target of fewer than 500 000 by 2020.

The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010. However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.

Treatment scale-up should not be taken for granted

Due to the impact of antiretroviral therapy roll-out, the number of AIDS-related deaths is the lowest this century (940 000), having dropped below 1 million for the first time in 2016. Yet, the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 AIDS-related deaths.

In just one year, an additional 2.3 million people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7 million. Almost 60% of the 36.9 million people living with HIV were on treatment in 2017, an important achievement, but to reach the 30 million target there needs to be an annual increase of 2.8 million people, and there are indications that the rate of scale-up is slowing down.

West and central Africa lagging behind

Just 26% of children and 41% of adults living with HIV had access to treatment in western and central Africa in 2017, compared to 59% of children and 66% of adults in eastern and southern Africa. Since 2010, AIDS-related deaths have fallen by 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half (51%) of the HIV burden in the region and there has been little progress in reducing new HIV infections in recent years. New HIV infections declined by only 5% (9000) in seven years (from 179 000 to 170 000) and only one in three people living with HIV is on treatment (33%), although HIV treatment coverage has increased from just 24% two years ago.

Progress for children has slowed

The report shows that the gains made for children are not being sustained. New HIV infections among children have declined by only 8% in the past two years, only half (52%) of all children living with HIV are getting treatment and 110 000 children died of AIDS-related illnesses in 2017. Although 80% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2017, an unacceptable 180 000 children acquired HIV during birth or breastfeeding—far away from the target of fewer than 40 000 by the end of 2018.

“One child becoming infected with HIV or one child dying of AIDS is one too many,” said Mr Sidibé. “Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”

Key populations account for almost half of all new HIV infections worldwide

The report also shows that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

“The right to health for all is non-negotiable,” said Mr Sidibé. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programmes. More investments are needed in reaching these key populations.”

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.

“Communities are echoing UNAIDS’ call,” said Vincent Pelletier, positive leader and Executive Director of Coalition PLUS. “We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”

Stigma and discrimination persists

Discrimination by health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing young people, people living with HIV and key populations from accessing HIV prevention, treatment and other sexual and reproductive health services.

Across 19 countries, one in five people living with HIV responding to surveys reported being denied health care and one in five people living with HIV avoided visiting a health facility for fear of stigma or discrimination related to their HIV status. In five of 13 countries with available data, more than 40% of people said they think that children living with HIV should not be able to attend school with children who are HIV-negative.

New agenda needed to stop violence against women

In 2017, around 58% of all new HIV infections among adults more than 15 years old were among women and 6600 young women between the ages of 15 and 24 years became infected with HIV every week. Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners.

“Inequality, a lack of empowerment and violence against women are human rights violations and are continuing to fuel new HIV infections,” said Mr Sidibé. “We must not let up in our efforts to address and root out harassment, abuse and violence, whether at home, in the community or in the workplace.”

90–90–90 can and must be achieved

There has been progress towards the 90–90–90 targets. Three quarters (75%) of all people living with HIV now know their HIV status; of the people who know their status, 79% were accessing treatment in 2017, and of the people accessing treatment, 81% had supressed viral loads.

Six countries, Botswana, Cambodia, Denmark, Eswatini, Namibia and the Netherlands, have already reached the 90–90–90 targets and seven more countries are on track. The largest gap is in the first 90; in western and central Africa, for example, only 48% of people living with HIV know their status.

A big year for the response to tuberculosis

There have been gains in treating and diagnosing HIV among people with tuberculosis (TB)—around nine out of 10 people with TB who are diagnosed with HIV are on treatment. However, TB is still the biggest killer of people living with HIV and three out of five people starting HIV treatment are not screened, tested or treated for TB. The United Nations High-Level Meeting on Tuberculosis in September 2018 is an opportunity to bolster momentum around reaching the TB/HIV targets.

The cost of inaction

Around US$ 20.6 billion was available for the AIDS response in 2017—a rise of 8% since 2016 and 80% of the 2020 target set by the United Nations General Assembly. However, there were no significant new commitments and as a result the one-year rise in resources is unlikely to continue. Achieving the 2020 targets will only be possible if investments from both donor and domestic sources increase.

Ways forward

From townships in southern Africa to remote villages in the Amazon to mega-cities in Asia, the dozens of innovations contained within the pages of the report show that collaboration between health systems and individual communities can successfully reduce stigma and discrimination and deliver services to the vast majority of the people who need them the most.

These innovative approaches continue to drive the solutions needed to achieve the 2020 targets. When combination HIV prevention—including condoms and voluntary medical male circumcision—is pursued at scale, population-level declines in new HIV infections are achieved. Oral pre-exposure prophylaxis (PrEP) is having an impact, particularly among key populations. Offering HIV testing and counselling to family members and the sexual partners of people diagnosed with HIV has significantly improved testing access.

Eastern and southern Africa has seen significant domestic and international investments coupled with strong political commitment and community engagement and is showing significant progress in achieving the 2020 targets.

“For every challenge there is a solution,” said Mr Sidibé. “It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”

In 2017, an estimated:

36.9 million [31.1 million–43.9 million] people globally were living with HIV

21.7 million [19.1 million–22.6 million] people were accessing treatment

1.8 million [1.4 million–2.4 million] people became newly infected with HIV

940 000 [670 000–1.3 million] people died from AIDS-related illnesses

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.

The China children’s summer camp kicked off it’s annual activities this year in Liangshan, an autonomous prefecture in the south of the Chinese province of Sichuan. Sichuan is one of the largest provinces in China, it is also one of the most affected by HIV which is why this camp is so important. The camp brings together children who are living with HIV and runs under the theme “love in the sunshine”. At the camp the children are encouraged to participate in a wide range of activities in an environment they feel safe in, where they won’t be judged and where they will be respected by the other children and staff.

The event was one of a series of activities the Executive Director of UNAIDS Michel Sidibé was invited to participate in by the First Lady of China as part of UNAIDS and China’s strengthened cooperation and joint commitment for a robust response to HIV both in China and around the world.

One such activity was a visit to the Xichang University. Universities are playing a key role in the response to HIV. Xichang University for example, is encouraging students to actively engage in HIV prevention efforts in the community. During the visit the group, which included the Chinese Vice Minister of Health, joined in Red Ribbon Youth activities and spoke to students about their experiences as HIV prevention volunteers going out into villages to raise awareness of HIV prevention. 

Mr. Sidibé also met with Governor of Sichuan Province Yin Li in Chengdu, who governs over the 80 million strong population who live in the Province. He said that in recent years, HIV prevention and control efforts in Sichuan have made positive progress, a significant step forwards for a province which is home to more people than France or the United Kingdom. He also said that he would like Sichuan to further strengthen its cooperation with UNAIDS to explore more effective ways of stopping HIV and ensuring access to treatment. 

Before arriving in Liangshan, the Executive Director of UNAIDS attended serval important meetings in Beijing including a meeting with the Chinese Vice Premier Sun Chunlan who commended UNAIDS on the robust response to HIV. She said that China stood ready to work together with UNAIDS on HIV prevention and treatment efforts to improve the health and well-being of people around the world.

Mr Sidibé also met with the Chinese National Drug Administration and congratulated the Chinese government for its achievements in drug regulatory reform. China has extensive pharmaceutical production capacity and an important drug regulatory system. He stressed that there are great opportunities for China and Africa cooperation in trade, technology transfer and local production of medicines.

Also in Beijing, Mr. Sidibé joined the community of people living with HIV for a meaningful discussion on the implementation of 90-90-90 in China. He called for more efforts to make HIV testing and immediate treatment become a reality everywhere and to ensure the availability and accessibility of simplified, high quality drug regimens.

The Joint UN team in China is working hand in hand with the Chinese government, partners and communities to achieve "zero new HIV infections, zero discrimination, and zero AIDS-related deaths."  On 20 June 2018 the Joint UN team launched its Joint Work Plan on AIDS in China further strengthen efforts to end AIDS in China.

GENEVA, 16 May 2018—On the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), UNAIDS is calling for strengthened partnerships to support lesbian, gay, bisexual, transgender and intersex (LGBTI) people and their families living with or affected by HIV or facing discrimination.

“Stigma, discrimination and social and physical violence against sexual and gender minorities prevent them from accessing health services,” said Michel Sidibé, Executive Director of UNAIDS. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Gay men and other men who have sex with men and transgender women are among the populations most affected by HIV worldwide.

More than 40% of the 100 countries responding to UNAIDS criminalize same-sex relationships. Criminalizing people because of their gender or sexual orientation drives people underground and out of reach of essential health and social services, making them vulnerable to poor health and homelessness.

To end AIDS, it is essential to ensure that people can access HIV prevention technologies, including condoms and PrEP, and quality HIV treatment and care free from discrimination. UN Women, the United Nations Development Programme and UNAIDS are working with the Global Network of People Living with HIV to end all forms of HIV-related stigma and discrimination. The initiative will require rapid multisectoral support and civil society leadership and will contribute to achieving the time-bound commitments of United Nations Member States to end AIDS as a public health threat by 2030.

Increasing political commitment and investments for the health and well-being of some of the most vulnerable people in society will help to ensure that no one is left behind.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May. This year’s theme is alliances for solidarity to bring respect for LGBTI people and their families.

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.

Around the world, many women, children and adolescents still have little or no access to quality health services and education, clean air and water, adequate sanitation and good nutrition. And far too many face violence and discrimination, unequal access to power and opportunity, and numerous barriers that harm their physical, mental and emotional health and well-being.

To accelerate change, the executive heads of the H6 partnership met on the sidelines of the United Nations System Chief Executives Board in London, United Kingdom, on 2 May and agreed a new results framework, H6 Results 2020. H6 Results 2020 aims to shape the H6 partnership into a trusted, valued source for technical support, strategic policy advice and best practices for the health and well-being of women, children and adolescents.

Developed under the chairpersonship of UNAIDS Executive Director Michel Sidibé, H6 Results 2020 is closely aligned with the Every Woman Every Child Every Adolescent Global Strategy and the 2020 Every Woman Every Child Partners’ Framework. H6 Results 2020 sets ambitious goals while committing to deliver on a number of concrete results for 2020.

“I am excited about our revitalized H6 partnership. As the technical arm of the Every Woman Every Child movement, we plan to further streamline and simplify the health architecture, coordinating with key partners to leverage political capital, technical expertise and advocacy for results for women, children and adolescents everywhere,” said Mr Sidibé.

Taking forward the vision endorsed by the executive heads in March 2018, H6 Results 2020 builds on the achievements of the H6 to date and reinforces existing mechanisms while strengthening United Nations mechanisms to support countries. It outlines how the H6 will harmonize efforts of the six H6 organizations and with key partners at the country, regional and global levels and will focus on the countries with the highest burdens of maternal, child and adolescent mortality and morbidity for intensified action.

“The H6 partnership plays a critical role in ensuring that countries focus on the health needs of women in an intersectional way, with laser-like focus on gender equality, human rights and other enablers, such as education,” said Phumzile Mlambo-Ngcuka, the Executive Director of UN Women.

By amplifying its added value, the H6 partnership seeks to serve as a living laboratory for United Nations reform—heeding the call of the United Nations Secretary-General for a more country-focused, coordinated, efficient and accountable development system better able to assist countries in implementing the 2030 Agenda for Sustainable Development.

“It is important that the United Nation comes together to focus its technical support on key priorities in a few high-burden countries, and what must drive our focus is results for people,” said Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization.

While committed to driving progress across a range of priorities for women, children and adolescent health, H6 Results 2020 puts clear emphasis on reaching adolescents. Adolescent girls and boys (aged 10–19 years) remain a particularly underserved population by the health and social programmes of many countries. Ensuring the health and well-being of adolescents is critical to delivering on the mandate of each of the H6 partners.

“The H6 partnership has proven that working in close collaboration and bringing different expertise and experience to the table is not only effective in enabling countries to deliver rights-based quality care for the women and girls left furthest behind, but also ensures strong country ownership,” said Natalia Kanem, the Executive Director of the United Nations Population Fund.

Ending the AIDS epidemic among children, adolescents and young women requires ambitious targets and a Super-Fast-Track approach. Building on the successes of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners* launched Start Free Stay Free AIDS Free in 2016 to provide a framework for the urgent work ahead.

Start Free Stay Free AIDS Free prioritizes action in 23 countries** that account for 87% of new HIV infections among children aged 0–14 years and approximately 87% of all children and adolescents living with HIV globally. In 2016, 2.1 million children were estimated to be living with HIV.

In its first progress report, Start Free Stay Free AIDS Free reflects on the achievements made during the first year of implementation and highlights areas where urgent action is needed.

“The world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy, but we need to do more to ensure that all children living with HIV have access to treatment immediately,” said Michel Sidibé, Executive Director of UNAIDS.

The report shows that globally in 2016, there were 160 000 new HIV infections among children and that 140 000 occurred in the 23 priority countries. Although there was an overall decline in new HIV infections, the decline was at a much slower rate than in previous years.

The report highlights concerns around new HIV infections among young women and girls. In 2016, around 200 000 adolescents between the ages of 15 and 19 years were newly infected with HIV in the 23 priority countries, 72% of whom were young women.

Most—more than 70%—of all new HIV infections among young people are in sub-Saharan Africa, which also has the fastest growing youth population in the world.

“A high number of new HIV infections among adolescents and a fast-growing population could make for an HIV explosion among young women in Africa,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “The United States Presidents Emergency Plan for AIDS Relief is driving harder and smarter to prevent HIV infections and ultimately help end AIDS among children, adolescents and young women. Every person deserves the chance to survive, thrive and pursue their dreams.”

Gains seen in access to treatment

The report shows that while important gains have been made in access to antiretroviral therapy for pregnant women living with HIV, much more needs to be done to reach children.

In 2016, around 78% of pregnant women living with HIV had access to antiretroviral therapy in the 23 priority countries.

Start Free targets

Reduce new HIV infections among children to 40 000 by 2018.

Reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018.

Stay Free targets

Reduce the number of new HIV infections among adolescents and young women to less than 100 000 by 2020.

Provide voluntary medical male circumcision for HIV prevention to 25 million additional men by 2020 globally, with a focus on young men aged 10–29 years.

AIDS Free targets

Ensure that 1.6 million children (0–14 years) and 1.2 million adolescents (15–19 years) living with HIV have access to antiretroviral therapy by 2018.

The increase in the roll-out and uptake of antiretroviral therapy during pregnancy and throughout breastfeeding is estimated to have averted around 270 000 new HIV infections among children in 2016 alone.

The numbers of children on treatment has also increased, but not on a big enough scale. In 2010, only 17% of children aged 0–14 years had access to treatment. By 2016, that had risen to around 43%, with around 920 000 children accessing antiretroviral therapy. Although this is a marked improvement, access to treatment for children still falls far behind access for adults. In 2016, around 54% of adults living with HIV had access to treatment.

The report cites multiple reasons for the slow growth of access to treatment for children, including poor testing rates. Only nine of the 23 priority countries managed to test and diagnose 50% or more of children who were exposed to HIV in 2016. There are particularly low rates of early infant diagnosis in the first two months of life, when it is most important to test, as HIV-related mortality is at its highest. Without access to testing and treatment, half of all children living with HIV will die before their second birthday.

Ways forward

The report offers a set of important actions countries can take to eliminate new HIV infections among children, to test and diagnose children and young people who may have been exposed to HIV and to ensure that children and young people access HIV prevention, quality medicines and age-appropriate sexual and reproductive education and care and support throughout their lives, free from stigma and discrimination.

Other important actions include accelerating new medicines and diagnostics, promoting community engagement and services, voluntary medical male circumcision, access to information on sexual and reproductive health and access to pre-exposure prophylaxis for young people at a higher risk of HIV.

“The future for children and adolescents depends on actions we take collectively today,” said Mr Sidibé.

The latest estimates, for the end of 2017, will be released in July 2018 and will provide further insight into the progress of Start Free Stay Free AIDS Free.

* United Nations Children’s Fund, World Health Organization and the Elizabeth Glaser Pediatric AIDS Foundation.

**Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

The H6 combines the strengths of six international organizations to help countries to realize the United Nations Secretary-General’s Every Woman Every Child strategy. The partnership mobilizes political commitment and resources to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being.

High-level representatives of the six organizations met in New York, United States of America, to shape a shared vision for the H6. During the meeting, which took place on 21 March, health leaders committed to jointly deliver more and faster results in countries.

The Chair of the H6, Michel Sidibé, shared his vision for the partnership, including how it can evolve to meet the demands of the Sustainable Development Goals, including in humanitarian settings, and be a leading platform to advance United Nations reform.

“As a transformative platform, I see the H6 as an outstanding opportunity to rapidly bring United Nations reform to life and deliver results for every woman, child and adolescent on the ground,” said Michel Sidibé, Executive Director of UNAIDS.

The participants were united in their ambition to make the H6 a one-stop shop for countries for strategic policy advice, technical assistance and strategic information. Adolescent health, particularly for 10–18-year-olds, was discussed as a key focus area.

“I see an effective H6 partnership as an important way to drive health impact at the country level for all children, including by better addressing gaps in services for the age group from 10 to18 years old, and by planting the seeds of development in humanitarian contexts,” said Henrietta Fore, the Executive Director of the United Nations Children’s Fund.

The participants also committed to ensure policy-making in which communities have a voice and decided to build innovative partnerships with stakeholders beyond the United Nations.

Enhanced transparency and accountability of the H6 and reducing fragmentation and duplication in the United Nations system, as well as between the United Nations and the World Bank, will be key to success, as will a strong focus on joint reporting of results. The H6 will also work in close collaboration with the Global Financing Facility and the Partnership for Maternal, Newborn & Child Health.

“The United Nations Population Fund is strongly committed to the H6 partnership, which has proven that working in close collaboration and bringing different expertise and experience to the table is not only effective in enabling countries to deliver quality care for the women and girls left furthest behind, but also ensures strong country ownership,” said Natalia Kanem, the Executive Director of the United Nations Population Fund.

The H6 principals will now develop a results framework and reconvene in May to review and endorse it. They are aiming to adopt a road map to roll out new ways of working by mid-year.

Kimi Avalos is a young transgender woman who lives in Buenos Aires, Argentina. Because of stigma and discrimination, she couldn’t continue with her studies and complete high school. She says that she experienced bullying and harassment; her classmates insulted and physically assaulted her, under the indifferent eye of her teachers. “I really wanted to learn, but I had to drop out of school. Now, thanks to the Transgender House, my dream of finishing high school will soon come true,” said Ms Avalos.

Ms Avalos is one of 30 transgender students who recently started a new educational programme through which they can study for primary and secondary school diplomas by attending a combination of face-to-face and virtual classes. This innovative project is implemented in the Transgender House, a community centre for training and empowerment of transgender people founded in Buenos Aires in June 2017 by Marcela Romero, Coordinator of ATTTA (Association of Argentinian Transvestites, Transsexuals and Transgender) in collaboration with the City Council of Buenos Aires.

“To have this house has meant that as transgender people, we can come out from the darkness. The centre is in a visible space, on one of the main streets of Buenos Aires, in the San Cristóbal neighbourhood. This is our achievement; it shows that we exist as a community and that we have the right to a space like any other organization,” explains Ms Romero.

In Argentina, as well as in the rest of Latin America and the Caribbean, stigma and discrimination undermine learning opportunities and educational achievement of transgender people, thus affecting their future employment prospects. Discrimination and stigmatization also prevent transgender people from accessing appropriate health care, including HIV prevention, social protection and justice services.

In the region, transgender people experience frequent physical and sexual violence and hate crimes. According to data from ATTTA, 20 transgender people have been killed in Argentina since the beginning of 2018 and gender-based violence is increasing. Discrimination, gender-based violence and exclusion also contribute to increasing the vulnerability of transgender people to HIV. Transgender women continue to be heavily affected by HIV.

The Transgender House was created with the aim of providing a safe space where transgender people can be empowered and acquire knowledge and skills without the fear of being discriminated against, rejected or attacked. It works in partnership with governmental agencies, civil society and the private sector to provide a wide range of services and programmes based on the specific needs of transgender people.

MORE ON TRANSGENDER DAY OF VISIBILITY

Voices of activists for transgender rights

Among other initiatives, the Transgender House has established integrated counselling services and professional guidance for job searching, as well as legal advice from lawyers, who are available 24 hours a day. In collaboration with the Ministry of Education, Transgender House has recently begun educational projects that range from the implementation of primary and secondary education programmes to professional training, such as on providing care services to the elderly.

Other important activities include the promotion of prevention of HIV and other sexually transmitted infections, HIV testing and vaccination campaigns. The Transgender House also provides continuous psychological assistance and, through a partnership with Fernández Hospital, counselling services on hormone therapy. In addition, the house engages in outreach work with a team of community health promoters that visit sex workers at their places of work at night, distributing condoms and informative material on HIV prevention.

While the Transgender House is currently a successful project, a point of reference for transgender people in Buenos Aires and has multiple partnerships in the city, it hasn’t been an easy process to get to this point. Ms Romero says that she first approached the Buenos Aires City Council eight years ago, advocating for a space where transgender people could meet. Finally, two years ago, the council approved the remodelling and refitting of one of their buildings, and with the help of an architect and the vision of the ATTTA Coordinator, the Transgender House became a reality.

“The Transgender House is a best practice of community service delivery that is contributing to the achievement of the Fast-Track Targets, leaving no one behind,” said Carlos Passarelli, the UNAIDS Country Director for Argentina, Chile, Uruguay and Paraguay.

Around 400 people visit the Transgender House each month to receive counselling and information and approximately 600 people regularly participate in workshops, group meetings and courses there. “I couldn’t be happier and more grateful for the opportunity that I am given at the Transgender House. I hope that this model of respect and promotion of human rights serves as an example to transform and change society so that all of us can live with dignity,” said Ms Avalos.

For the Transgender Day of Visibility, UNAIDS talked to transgender activists about the challenges they face and the importance of improving the visibility of transgender people.

Erika Castellanos is a transgender woman from Belize who recently moved to the Netherlands to work at GATE (Global Action for Trans Equality) as the Director of Programmes. She has been engaged in transgender and HIV advocacy at the local, regional and international levels.

What are the challenges that transgender people face?

Transgender people are subjected to stigma, discrimination, hate and violence—the number of transgender deaths because of hate crimes is alarming. In many parts of the world, being transgender is criminalized, which makes transgender people invisible in those places and forces them underground.

Many people do not understand what transgender people are, which translates into fear, the cause of stigma and discrimination. From their childhood, transgender people frequently experience rejection by their families, friends and society, finding themselves ostracized.

Why do you think it is important to give visibility to transgender people?

Visibility is power. Only when given visibility can we raise our voices and advocate for the enjoyment of our human rights. Visibility gives us presence, visibility gives us a voice. Ultimately, visibility gives us hope for a better life. Transgender people are an integral part of society who can no longer be ignored.

What do you think of the representation of transgender people by the media?

Almost all media coverage of transgender people is negative, demeaning or focused on the high murder rates and violence that our communities experience. While it is necessary to highlight the violence, negative and demeaning media coverage that dehumanizes transgender people only serves to perpetuate that violence. By portraying transgender people as objects of ridicule, media coverage places our community in further danger of social isolation, rejection from friends and family and violence.

Rena Janamnuaysook is a Thai transgender advocate at the Thai Red Cross AIDS Research Centre. She has extensive local, national and international experience working with HIV organizations.

What are the challenges that transgender people face in your country?

Thai transgender people face multiple challenges. Our country has no gender recognition law. Stigma and discrimination remains a barrier and leads to inequality. A survey conducted in 2015 by the Thai Transgender Alliance and Transgender Europe reported that 50% of transgender people who participated in the survey had a negative experience with health-care providers. In addition, transgender people experienced physical violence and harassment from families and in school and the workplace.

Why do you think it is important to give visibility to transgender people?

It is important to give visibility to transgender people as transgender people are less visible in all aspects of life—family, education, employment, health and the law. The International Day of Transgender Visibility raises public awareness of the needs of transgender people.

How easy is for transgender people in your country to get tested for HIV and get treatment?

A survey conducted by the Thai Ministry of Public Health in 2014 showed that 15% of health-care workers believed that HIV-positive transgender women should be ashamed of their gender identity and HIV status. This resulted in stigma and discrimination in public health facilities and prevented transgender people accessing health-care services, including HIV testing, treatment and support.

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The Transgender House: a community centre for transgender people in Buenos Aires

Kirit Solanki is an Indian politician who represents the Ahmedabad West constituency of Gujarat.

Can you tell us about your work with transgender people in India?

I trained as a doctor and became a surgeon. A patient came in and said that she had difficulty going to the bathroom. I realized that she was a transgender person and her sex change operation had not been properly done, effectively blocking her urethra. After a successful insertion of a catheter, word got around that I had saved the woman’s life. I suddenly had queues of transgender women come to my clinic with similar conditions.

What did you observe regarding treatment and care for transgender people?

I saw that so many transgender people needed various operations, but I found out that many of them were avoiding clinics and hospitals. When I finally got them to the hospital, they settled in the female ward. Within a day, the other patients complained, so the hospital sent them to the men’s ward. They fared no better there. That’s when it really dawned on me how pervasive discrimination against transgender people is.

What are you and other members of parliament trying to do?

It took 10 years for the Indian parliament to pass the HIV/AIDS bill, which makes life-saving treatment a legal right and criminalizes anyone who discriminates against someone based on their HIV status. We also have reintroduced a transgender persons bill to ensure zero discrimination, legal recognition and access to social services for India’s transgender community. It’s time for people to change their attitude and respect transgender people