“This is the first time I feel comfortable expressing my true identity," said Yogi one of the youth festival participants in Bali, Indonesia. "I am currently involved in this youth festival, and I feel safe being among new friends who are in a similar situation as me," Yogi added. "I also received new information about HIV as well as gaining access to counselling services that are a comfort.” 

In a conservative country like Indonesia, sex is considered a taboo subject. Whether with parents, teachers or other adults, discussing sex and sexual health with young people is strongly discouraged. Accessing comprehensive information on sex and sexual and reproductive health and rights (SRHR) is even more challenging for young key populations, who do not have many safe spaces for discussion and are not adequately empowered with knowledge due to marginalization and discrimination.

Data shows that the level of knowledge on HIV and the level of comprehensive sexuality education (CSE) among adolescents in Indonesia are still very low. According to the 2017 Demographic and Health Survey (IDHS), 82% of women and 83% of men have heard of HIV and AIDS. Unfortunately, only 14% of women and men aged 15-24 have comprehensive knowledge of HIV. The lack of comprehensive knowledge about HIV contributes to the low demand for and access to HIV prevention and testing services, making it more difficult to curb new HIV infections in Indonesia.

“I gained access to HIV-related services only after I had been diagnosed, so I was feeling quite hopeless then," said a youth participant in a focus group discussion held by Inti Muda, the national young key population network. "I used to think that once you are infected with HIV, you will certainly die, so I used to feel scared seeking help by going to HIV services,” the participant added.

With the intention of addressing the challenges experienced by young key populations in accessing health information and services, Inti Muda and UNAIDS Indonesia, with support from the Government of Australia’s Department of Foreign Affairs and Trade (DFAT), initiated a series of Youth Festivals in various cities in Indonesia.

These festivals provided young key populations with a safe and comfortable space for collective discussion, expression and learning about issues important to their sexual health and well-being. The event not only included education about HIV and SRHR, it also provided opportunities for young people the to show off their talents while raising the topic of HIV and sexual and reproductive health and rights. Moreover, youth participants were able to access free HIV testing on site, with youth-friendly counselling free from judgment and discrimination.

“The festivals allowed us to bring out our talents in public speaking, poetry reading, and storytelling towards HIV and SRHR issues. This showed that we can be empowered, creative and have talents to be leveraged,” expressed Febri, another participants in the youth festival in Jakarta.

Having activities tailored for young key populations and connecting young people with their peers to learn about HIV and SRHR contributes to the HIV response in Indonesia, as young people who are informed about their bodies are more empowered to protect themselves from HIV. This is especially crucial in Indonesia where young people (15-24) account for almost half of new HIV infections in the country.

“Educational methods or outreach activities that are too conservative sometimes can make youth reluctant to actively participate,” explained Sepi Maulana Ardiansyah, National Coordinator for Inti Muda Indonesia.

From February to April 2022, youth festivals were successfully held in 7 provinces in Indonesia, including Jakarta, South Sulawesi, Papua, Bali, North Sumatra, East Java, and West Java. Over 700 young people from key populations participated in these festivals and 140 participants accessed HIV testing services provided by Inti Muda in collaboration with local health provinces and Primary Health Centres.

"As we want to reach more young key populations as targeted beneficiaries, it is crucial for UNAIDS to be able to listen and believe in the approach that is used by Inti Muda Indonesia as a partner that is youth-led. This is done to ensure that youth empowerment, participation, leadership as well as activities and approaches are meeting the needs of young key populations,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

As part of the Education Plus initiative, young women advocates in Senegal have met with key female figures in the region to discuss the education of girls in sub-Saharan Africa and the challenges they face.

A social work student in her second year of professional training said young women like her who are living with HIV still face stigma and economic marginalization in most spheres of life “Sometimes, the medicines are not in stock, and young women living with HIV often have to share their medication with each other while waiting for a new supply.” According to her, education guarantees a better future for young people, as it did for her in helping her to overcome the challenges she faces because of her HIV status and her difficult upbringing.

Another participant, Maah Koudia Keita (known as Lady Maah Keita), a Senegalese woman with albinism, and a musician, said that women with albinism are victims of harassment and the majority of them have experienced rape and sexual violence.

She is one of three professional female bass players in Africa and the only one in Senegal. She said, “People like me who were lucky to get an education now have to do the work of dispelling myths around women with albinism that drive the violence.” According to Ms Keita, the more educated and aware the community is, the better women and people with albinism can defend themselves.

Adama Pouye, a feminist activist and member of the Senegalese feminist collective that led the Buul Ma Risu (Don’t Mess with Me) movement, spoke at length during the meeting about raising awareness on sexual assault on public transport.

“Every day, you hear violent words and women come to believe that’s what they deserve,” she said. “You are told how far you can go by standards put in place by a patriarchal society, by men, and by religious standards, but our religious interpretations cannot be about oppressing women,” Ms Pouye said.

Young women are key advocates who the Education Plus initiative is working with to rally political leadership, development partners and communities in order to fulfil every adolescent girl’s right to education and health by enabling all girls to complete a quality secondary education in a violence-free environment.

As UNAIDS Executive Director Winnie Byanyima stressed at the meeting, “In this region of western and central Africa, the vulnerability of girls is high.”

She also said that four out of 10 young women are married before the age of 18 years, saying that children becoming brides is a gross violation and a failure to harness the full potential of girls.

“Keeping girls in a classroom, if she stays and completes secondary school, has a protective effect for girls from HIV. What we fought and won for primary school is what is needed for secondary education,” Ms Byanyima said.

Fatou Nar Mbaye Diouf, the Deputy Executive Secretary of the National AIDS Council, Senegal, could not agree more. “We know that allowing girls to complete secondary education protects them from HIV and improves many other health and development factors,” she said.

Sharing key data from Senegal, Ms Nar said the level of comprehensive knowledge about HIV increases with the level of education. “Among young women, it is 10% among those with no education and 41% among those with secondary education or higher, while among young men knowledge of HIV varies from 9% among those with no education to 51% with education,” she said. “Education is key.”

The Regional Director for West and Central Africa for UN Women, Oulimata Sarr, concluded the intergenerational dialogue by saying that girls’ education is not a threat, nor should it be seen as that. “We want to move the needle and move it together with young women,” she said.

Ms Sarr wants the next generation to be supported as they seek more space in decision-making. “We need to pass the baton to young people, who organize differently from us, create an intergenerational legacy with young people holding us to account.”

Angola faces a considerable challenge of new HIV infections among young people. In 2020, there were 7000 new HIV infections among young people aged 15–24 years. One of the barriers to reducing new HIV infections among young people and ensuring treatment are restrictions on their ability to get tested to learn whether they have HIV.

As in several countries, young people under the age of 18 years cannot be tested for HIV without first asking their parents to consent to it. As young people often fear discussing HIV testing with parents, many decide instead to not seek testing, and so remain unaware of their HIV status, putting them at grave risk and negatively impacting public health efforts.

As part of efforts to remove these barriers, Angola received support from the Technical Support Mechanism, a UNAIDS managed, country-driven mechanism, funded by USAID, which supports countries to overcome HIV policy and programmatic challenges.

A review carried out by the Technical Support Mechanism assessed the alignment of Angolan laws, regulations and policies regarding age of consent to HIV testing and counselling with public health and human rights norms and standards and the extent to which they create barriers to access to services.

The review produced evidence that informed a recommendation for Angola to remove the legal barriers preventing young people, including young members of key populations, from accessing HIV and tuberculosis testing services. This would allow young people aged 14 years, and those below 14 years if they are sufficiently mature, to seek and access HIV testing and counselling without requiring them to ask their parents first. This will help to establish an enabling legal environment for early diagnosis of HIV. In turn, access to information and HIV services would reduce the likelihood of HIV transmission and contribute to a decrease in new HIV infections and AIDS-related deaths.

By enabling more young people to access HIV testing services, Angola will also be able to leverage resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria to reach young members of key populations—a priority for achieving national HIV targets. Strategic learning from this experience could also provide valuable insight for similar technical support in eastern and southern Africa and in other regions.

“Ensuring that young people know their HIV status is vital. Rules that effectively bar many young people from accessing HIV testing by requiring parental consent delays them from knowing their HIV status and holds them back from accessing life-saving HIV services. The laws imposing an age of consent for HIV testing need to be removed in the interests of everyone’s health. This will save lives and help Angola end AIDS,” said Michel Kouakou, the UNAIDS Country Director for Angola.

The 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030 reaffirmed the importance of leadership by young people in the HIV response.

The Global Network of Young People Living with HIV (Y+ Global) and The PACT are two innovative networks led by young people that have consistently proved the innovation and resourcefulness of young people in the HIV response. With support from UNAIDS, they are currently rolling out the #UPROOT Scorecard 2.0, a monitoring tool led by young people, in seven countries: Burundi, Ghana, Kyrgyzstan, the Philippines, Uganda, Viet Nam and Zimbabwe.

This is the second phase of monitoring work led by young people, which started in 2017 with the #UPROOT Agenda. The scorecard process engages young people, bringing them together to assess how their country’s HIV response is working for them and if they are meeting the commitments on young people that are required to reach the 2025 HIV targets and achieve Sustainable Development Goal 3.

Tinashe Grateful Rufurwadzo, the Director of Programmes, Management and Governance at Y+ Global, has been working closely with UNAIDS on the roll-out. “Equity, inclusion and solidarity are core principles in ensuring that we end the AIDS epidemic by 2030. The #Uproot Scorecards 2.0 will continue to strengthen youth-led monitoring at the country level, further harvesting evidence for advocacy and holding our governments accountable. There is a continued need to improve the quality of care that young people living with and affected by HIV in our diversity receive and to ensure that we are all leading happy, healthy and fulfilling lives. #UPROOT Scorecard 2.0 is a platform to raise our voices and secure our future!” he said.

Ekanem Itoro, Chair of The PACT, reiterated the need for data on young people. “It is extremely crucial in the global HIV response to strengthen adolescent and youth engagement using real-time data systems and interpersonal platforms in order to positively influence knowledge, attitudes and social and behaviour change, as well as to enhance social accountability of service providers and decision-makers towards improving the quality of life of young people living with HIV and other sexual minorities.”

Young people make up 16% of the world’s population but accounted for 27% of new HIV infections in 2020. Despite the disproportionate HIV burden on young people, they continue to face age-based discrimination and exclusion from sexual and reproductive health and rights, harm reduction and HIV services. Through the completion of the scorecards, The PACT and Y+ Global aim to generate accurate qualitative data for national and grass-roots organizations led by young people to hold their governments and service providers accountable for commitments made on the health and well-being of young people. This will help catalyse advocacy on identified national priorities to achieve the targets set out in the Political Declaration on AIDS and the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS.

“Leadership by young people has been recognized as key to achieving the global targets that have been set, and the generation of that data will be central to scaling up the already pivotal work of networks of young people around the world,” said Suki Beavers, Director of the UNAIDS Department for Gender Equality, Human Rights and Community Engagement.

UNAIDS will continue to partner with organizations led by young people to promote youth leadership in the HIV response.

“Young people here don’t regularly access HIV services. I really want to invite my friends to get tested, but they are all so afraid. They don’t have enough information or support from their families and are scared about finding out their status,” said Andika Bayu Aji, a young person from West Papua, Indonesia.

The HIV epidemic among young people in Asia and the Pacific has largely been overlooked, even though about a quarter of new HIV infections in the region are among people aged 15–24 years. The vast majority of young people affected by HIV in the region are members of vulnerable populations—people living with HIV, gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs.

Like many countries in the region, Indonesia’s HIV infections among young people, which make up almost half of new infections, are attributed to stigma and discrimination, poor educational awareness of HIV, lack of youth-friendly services and social taboos.

“Young people far too often experience stigma and discrimination in health-care settings. Health-care workers are first-line responders. If the services are bad, young people won’t use them and they will tell other young people not to use them. We are limited by which clinics we can access because many, if not most, are not youth-friendly,” said Sepi Maulana Ardiansyah, who is known as Davi and is the National Coordinator for Inti Muda, the national network of young key populations in Indonesia.

A recent study conducted by Inti Muda and the University of Padjajaran found that the willingness of young people to access services in provinces like West Papua was very low, mainly due to the lack of youth-friendly services and the poor understanding of key population issues by health-care workers. Young people often face difficulty accessing services because of the remoteness of clinics and hospitals and encounter barriers such as the age of consent for testing.

Stigma and discrimination, and especially discrimination from health-care providers, discourages many young key populations from accessing HIV services. Concerns about privacy and confidentiality are some of the main challenges. Additional obstacles include that the opening hours of public clinics are often ill-suited to people’s daily routines, and the assumptions and attitudes of health-care workers can be judgemental, especially on issues around sexual orientation, gender identity and mental health.

Between 14 and 18 March, Inti Muda, with technical support from Youth LEAD and UNAIDS, organized a sensitization training of health-care workers in two cities, Sentani and Jayapura, in the West Papua region. More than 50 health-care workers participated. A few days before the training, Inti Muda organized a festival for more than 80 young people, joining in an effort to engage young people in the HIV response and generate demand for access to HIV services.

“Prior to this training, I didn’t know about the different needs of key populations, which hinders our ability to reach them. We learned about important techniques for reaching young people, such as providing youth-friendly counselling, digital interventions and encouraging them to get tested,” said Kristanti, from the District Health Office of Jayapura.

“I learned that the needs of young people are diverse. The training will allow us to improve our services to become youth-friendly, which is now our main priority,” added Hilda Rumboy, a midwife in charge of the HIV Services Department at the Waibhu Primary Health Centre.

The training and festival were supported by the Australian Department of Foreign Affairs and Trade (DFAT). The recent investment of AU$ 9.65 million set aside by the Australian Government from the sixth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), including DFAT funding of AU$ 2 million previously committed to UNAIDS, is aimed at reducing the annual number of new HIV infections among key populations in Cambodia, Indonesia, Papua New Guinea and the Philippines.

“Ensuring young people and vulnerable groups have access to accurate, digestible information about how to prevent HIV, and that testing facilities are cheap and accessible, is crucial to ending the AIDS epidemic. We are proud to work with local communities and UNAIDS to increase availability of information on HIV, improve the reach and quality of medical services and encourage young people and vulnerable groups to get tested,” said Simon Ernst, Acting Minister Counsellor for Governance and Human Development at the Australian Embassy in Indonesia.

The training is based on the manual developed by Youth LEAD in 2021, which was financially supported by the Global Fund’s Sustainability of HIV Services for Key Populations in Asia Programme and the UNAIDS Regional Support Team for Asia and the Pacific. Under the DFAT grant for the next two years, Youth LEAD will expand the training to two more countries, Cambodia and the Philippines, supporting networks led by young people in the respective countries to roll out the training.

“Young people still encounter many challenges that prevent them from accessing the life-saving health care they need. The UNAIDS Country Office for Indonesia is working closely with the UNAIDS regional support team and DFAT to ensure that networks led by young people have the capacity and leadership capabilities to take control of the HIV response and to have direct involvement in creating safe spaces where young people can access HIV services free from stigma and discrimination,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The high level of stigma and discrimination against people living with HIV and various key populations continues to hamper the fight against aids. Around the world, people or groups deemed ‘different’ are targeted for many different and unjustified reasons. In the context of HIV, discrimination, which refers to the unfair or inequitable treatment of individuals based on their actual or perceived HIV status, hinders the identification of risk and the provision of care for those affected. HIV-related discrimination and stigma are rooted in pre-existing social inequalities and reinforce them, further excluding those affected by the virus and fuelling the epidemic.

On the occasion of the Zero Discrimination Day on 1 March 2022, UNAIDS, together with the National Network of Associations of People Living with HIV (RNP+) of Senegal and Trace Senegal, invited students from BEM Management School in Dakar to join in for a conversation about HIV. This is an opportunity to deepen the understanding of HIV and its response, and to share situations of HIV-related stigma and discrimination. It is also intended to foster commitment to overcoming these barriers within a community of students who could potentially hold leadership positions in the future. 

"We are very committed to raising awareness of HIV and other sexually transmitted infections to protect the health and well-being of our students," said Mr Diakhaté, Director of BEM Dakar. "We immediately seized the opportunity to host UNAIDS and its partners here, as we know that this interaction can play a key role in the development and engagement of our students as members of society and as professionals. We remain committed to the CEO's vision of seeing our students become activists and actors in a world of peace, tolerance and responsible progress.” The discussion took place in a friendly and open environment, which helped building trust between the speakers and the students and encouraged dialogue.

Knowledge of HIV among 15–24-year-olds in Senegal and West and Central Africa remains limited. Only 27.5% of young Senegalese can correctly identify the means of preventing sexual transmission of HIV and reject the main misconceptions about the spread of the virus. Educating students about HIV to combat discrimination is therefore a crucial intervention for HIV prevention.

To raise awareness among students, key actors in the fight against HIV-related discrimination and stigma were keen to share their experiences.

Soukeyna Ndiaye, an activist deeply committed to people living with HIV and President of RNP+, talks about her experience. She recounts how she was excluded by her family, who wanted to deprive her of "her responsibilities as a wife and mother" after learning of her HIV status. "People looked at me with pity, as if I was already dead.” Her children also suffered from discrimination at school, especially from teachers who organised school meetings to discuss their 'case'. Today, thanks to medication, Soukeyna is healthy and none of her seven children have HIV. In a world without discrimination, she would live a normal life.

Wassour Touré is the President of the Association Départementale And Juboo (ADAJ), an organisation of people living with HIV. In Wolof, And Juboo means “living together in peace and tolerance.” He shares a powerful testimony about the discriminatory treatment he witnessed in a hospital. "People living with HIV had to wait until all the other patients had been taken care of before they could be seen. They were put on a separate bench, waiting for a doctor to deal with them separately.” There was indignation and astonishment in the room, reflecting real empathy from the students, but also showing that discrimination and stigmatisation of people living with HIV is a subject that is not sufficiently raised. "I had no idea about this," explains one student, "it shocks me. We need to talk about it. Why have I never heard about this?”

The speakers certainly raised awareness and generated strong reactions among the students. "I was very moved by the story of all these people, and I would really like to help in the fight against all forms of discrimination," says one student.

UNAIDS is hoping to develop a long-term partnership with students. The creation of a focus group and a youth ambassador programme against discrimination and stigma would allow BEM’s and other students to be involved in advocacy activities alongside UNAIDS and its partners. "Students have a contagious energy and determination. This can be crucial in the fight against discrimination and stigma—an area where 'setting a good example' is particularly important," says Patrick Brenny, UNAIDS Regional Director for West and Central Africa. "Working with them can help reach an even greater audience in a personal and credible way. We are delighted with the students' enthusiasm for our project.”

The desire of BEM students to build a more inclusive environment, free of discrimination in all its forms, is particularly encouraging in a country where human rights issues are sometimes contentious, and where there are regular protests in favour of stricter legislation against homosexuality. Young people are the driving force behind Senegal's economic and social development, and it is essential to rely on them to prepare the country's future. Fostering dialogue about HIV and providing students with the necessary knowledge about the virus, prevention, testing, and treatment methods are key elements of this pathway, and a crucial step in empowering young people to fight HIV-related discrimination and stigma.

Like any other regular day in Bangkok, Thailand, Pete went to work and was living a pretty normal life. He had a business that imported and exported fresh vegetables from neighbouring countries in South-East Asia, a family business that he shared with his sister. He was happy and in a serious long-term relationship with his boyfriend, and everything seemed perfect. That day, he and his partner went to get tested for HIV, and that’s when his life suddenly began to change.

“I found out about my HIV status in 2016 and soon after left my business because I didn’t know if I was going to live much longer. Without guidance and mental health support, I had many misconceptions about HIV, and I started to suffer from depression,” he said.

“I blamed myself for contracting HIV, and I couldn’t cope with this thought. I became a drug user, was engaging in chem sex, broke up with my partner and survived suicide attempts,” he continued. “But after receiving support from local organizations of people living with HIV, I decided to retake control of my life. I started to talk openly about HIV to help other young people live with a positive diagnosis. Even though this was never my plan, I knew I had to do it. That’s why I became an HIV activist,” he added.

Nowadays, Pete (famously known online as Pete Living with HIV) is a well-known HIV activist in Thailand and has come far since his diagnosis. He has spent the past few years building an online community for people living with HIV. In this safe space, people can connect and be comfortable enough to share their stories and experiences in an open environment free from stigma and discrimination. His Facebook group, which has strict membership requirements (for obvious reasons), has more than 1300 members.

“I created this space because I didn’t have a place to share my story. I wanted to create a platform where people living with HIV can be proud of themselves and be reminded they are not alone. No one deserves to be stigmatized, bullied, dehumanized or disrespected. Everyone deserves to be loved, respected and accepted,” he said.

In 2019, the country announced the Thailand Partnership for Zero Discrimination, which calls for intensified collaboration between the government and civil society to work on stigma and discrimination beyond health-care settings, including workplaces, the education system and the legal and justice system. UNAIDS has been involved since the outset of the initiative by providing technical assistance to formulate the zero discrimination strategy and the five-year action plan, develop a monitoring and evaluation plan and operationalize the strategy as a joint effort between the government and civil society.

Pete thinks this initiative is a cornerstone to ending the AIDS epidemic, as stigma and discrimination continues to be the main barrier to HIV services. “Although it has improved a lot over the years, I still experience stigma and discrimination when I go for regular sexually transmitted infection check-ups. I still receive judgement from nurses and doctors,” he said.

Pete has also become a passionate activist for, and speaks about the importance of, U = U (undetectable = untransmittable) at international forums and conferences. “U = U changed my life. I continue to fight for and promote U = U because its messages have the power to change the lives of people living with and affected by HIV. Still, more importantly, it can change social attitudes and tackle stigma and discrimination,” he said.

With U = U, HIV treatment has transformed the HIV prevention landscape. The message is clear and life-changing: by being on HIV treatment and having an undetectable viral load, people living with HIV cannot transmit HIV to their partners. The awareness that they can no longer transmit HIV sexually can provide people living with HIV with confidence and a strong sense of agency in their approach to new or existing relationships.

Pete launched a campaign in 2020 focusing on U = U and mental health advocacy. “Through my social media channels, I raise awareness about the importance of listening to people and their experiences and respecting them. U = U is key to helping people living with HIV overcome self-stigma and negative feelings like shame, which discourage them from accessing and/or remaining on treatment. U = U is encouraging; it can help remind people living with HIV to be proud of themselves,” he said.

Pete is now strengthening partnerships with national stakeholders and allies of the HIV response to ensure that messages related to U = U, HIV prevention and zero discrimination are amplified and reach different audiences. He is also a representative on a multisectoral task force to design and implement the People Living with HIV Stigma Index in Thailand, which will be conducted this year. He has supported the United Nations in Thailand on various campaigns, including the Everybody Deserves Love Valentine's Day campaign and the zero discrimination campaign, in which he is engaging young people from across Thailand. 

Sexual activity often starts during adolescence. Many countries have age of consent laws in relation to sexual activity that are inconsistent with minimum age laws for accessing sexual and reproductive health information and services without parental permission. This means that adolescents may legally have sex before they can legally access any information or services relating to safer sex practices or contraception, leaving them at greater risk of HIV, other sexually transmitted infections (STIs) and unwanted pregnancy.

The removal of laws that require parental permission to access services for sexual and reproductive health and HIV prevention, testing and treatment has been shown to improve health-seeking behaviours. That effect is even stronger when schools can provide age-appropriate comprehensive sexuality education to young people so they can protect themselves from HIV, STIs, unwanted pregnancy and gender-based and sexual violence.

Forty countries reported to UNAIDS in 2021 that they have laws requiring parental/guardian consent for adolescents to access hormonal or long-lasting contraceptives, 108 reported that this consent is required for an HIV test, 43 for HIV self-testing, 92 for HIV treatment and 22 for PrEP. Among these countries, some provide exceptions based on demonstrated maturity: 10 for hormonal or long-lasting contraceptives, 15 for HIV testing, eight for self-testing and nine for HIV treatment. The age cut-off of parental consent laws varied by service. The majority of countries that reported having requirements for parental/guardian consent had an age cut-off of 18 years, with exceptions in a few countries where adolescents as young as 14 years could access a service without parental/guardian consent, which varied by service.