El Salvador

UNAIDS Regional Goodwill Ambassador for Latin America and the Caribbean and CNN Anchor Alejandra Oraa visited El Salvador from 9 to 11 August to raise awareness about strengthening HIV prevention efforts for adolescents and young people.

In El Salvador, there is a growing concern about the increase in new HIV infections reported since 2011 among adolescents aged between 15 and 19 years. Young people are not receiving the information they need to protect themselves from HIV: only 36.5% of young people aged 15–24 years know how to prevent HIV transmission.

During her visit, Ms Oraa met with youth leaders in order to analyse gaps in access by adolescents and young people to sexual and reproductive health and HIV-related services and comprehensive sexuality education. Young people stressed the need to urgently accelerate efforts to provide youth with the tools they need to make informed decisions to protect their health, rights and dignity.

Young people also talked about the initiatives in place to contribute to the HIV response from their perspective. For example, to improve access to information and education on HIV and sexual and reproductive health, the National Network of Positive Youth, in coordination with UNAIDS, the United Nations Population Fund and the National Youth Institute, organizes outreach awareness initiatives in public places and schools. Between Friends (Entre Amigos), a community-based organization, uses face-to-face approaches and offers combination prevention options for key populations, including young men who have sex with men and young transgender people.

In El Salvador, Ms Oraa leveraged her social media power to launch a new online survey to assess young people’s knowledge about HIV prevention and transmission. The findings of that United Nations Children’s Fund and UNAIDS joint initiative will be used to inform national public policies and strategies to prevent and reduce new HIV infections among young people. 

The Martin Ennals Foundation has announced the names of the three finalists for the prestigious global Martin Ennals Award for human rights defenders, which will be awarded in October 2017. One of the three finalists is Karla Avelar, a transgender woman living with HIV from El Salvador who, for more than 20 years, has been defending the human rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people and advocating for access to health care for people living with HIV.

In 1996, Ms Avelar was one of the founders of the first association of transgender people in El Salvador, and in 2008 she founded the first organization of transgender women living with HIV, COMCAVIS TRANS. The organization works to advance, defend and promote the human rights of LGBTI people, scale up HIV prevention and care and improve access to HIV services for people living with HIV and prisoners.

"On a daily basis, lesbian, gay, bisexual, transgender and intersex people are exposed to death threats, extortion, harassment, physical and verbal violence and discrimination because of our gender identity or sexual orientation,” said Ms Avelar. “This situation makes us vulnerable to HIV."

Ms Avelar, together with COMCAVIS TRANS peer educators, promotes HIV testing and HIV prevention and care among the LGBTI people through outreach activities, such as education and information dissemination in different parts of San Salvador.

Ms Avelar and her team also work on strengthening access to HIV prevention and treatment services for LGBTI prisoners in two penitentiary centres. “We are working on two fronts: with lesbian, gay, bisexual, transgender and intersex people, training them on sexual and reproductive health and HIV prevention, and raising awareness among administrative officials and custodial staff on human rights and zero discrimination,” explained Ms Avelar.

In 2013, the partnership between COMCAVIS TRANS and the penitentiary center of SENSUNTEPEQUE led to the adoption of an agreement, which allows prisoners to have access to condoms each month. COMCAVIS TRANS also supports LGBTI prisoners living with HIV to adhere to their treatment and monitors their access in order to ensure their psychosocial and emotional well-being. 

In El Salvador, LGBTI people continue facing a climate of discrimination and violence, exacerbated by high levels of impunity and limited access to justice. “El Salvador is a country with one of the highest rates of violence in Latin America and, as it is the case throughout the region, the life expectancy of a transgender woman does not exceed 35 years,” said Ms Avelar.

She supports LGBTI people who have suffered human rights violations and acts of violence. Together with her team and the group of volunteers, she advises them and accompanies them to file a complaint. Thanks to the collaboration of other organizations, she makes sure that people in need have open channels to legal and economic assistance. “There are still a lot of barriers,” she says. “However, we are promoting a dialogue with representatives of the national civil police and Office of the National Counsel for the Defense of Human Rights and other authorities to improve the mechanisms to denounce and investigate human rights violations and provide proper and sustained monitoring and evaluation.”

Ms Avelar has also played a significant role advocating for legislation reforms to protect and promote the rights of LGBTI people and address their needs. For example, together with UNAIDS and other national organizations, she participated in a review of an HIV law approved last January. Among other things, the law allows transgender people to receive a better health care free of stigma and discrimination, improve their quality of life and access to health services, education and work, ensuring the respect to their gender identity.

“For all those who know her, Karla Avelar is already the winner of the Martin Ennals Award,” said Celina Miranda, UNAIDS Country Director for El Salvador. “In the midst of all adversity, she is a tireless advocate for human rights, making a difference in the lives of lesbian, gay, bisexual, transgender and intersex people in El Salvador.”

About the Martin Ennals Award

The Martin Ennals Award is an annual prize for human rights defenders. Finalists and the laureate are selected by a jury of 10 of the world’s leading human rights nongovernmental organizations.

UNAIDS is working with partners to reaffirm that the full enjoyment of all human rights and fundamental freedoms for all supports the global response to the AIDS epidemic, including in the areas of prevention, treatment, care and support, and address stigma and discrimination against all people living with, presumed to be living with, at risk of and affected by HIV as a critical element in ending the AIDS epidemic and as outlined in the 2016 United Nations Political Declaration on ending AIDS.

Female sex workers receiving HIV prevention information in Myanmar. Credit: UNAIDS/Seng Mai

The response to HIV, tuberculosis and malaria in three pilot countries has been dramatically enhanced with multimillion dollar grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. El Salvador, Myanmar and Zimbabwe will receive US$ 622 million from the recently created Global Fund’s new funding model.

The new model maximizes available resources and ensures that investments are strategically focused on programmes which have been proven to achieve the greatest possible impact.

Representing a shift in the Global Fund’s business model, it features new central elements such as a multi-partner country dialogue; followed by a focused concept note that summarizes the national context. The request for funding—an iterative application process— now includes increased engagement of technical partners such as UNAIDS.

Following the most recent Global Fund Board meeting in Sri Lanka (18-19 June) which approved the grants for the three early applicant nations, the Board’s chair Simon Bland said, “Countries have been able to act quickly to get this new funding model started, and that’s great news.” Mr Bland stressed that, “These first grants show how, by working with partners, we can reach more people facing these diseases.”

Technical guidance, partnerships and inclusion

Myanmar will receive more than US$ 315 million over the next four years, US$ 160 million of which is for the country’s AIDS response. A particular focus will be meeting an urgent need for antiretroviral treatment coverage with the goal of achieving universal access to HIV treatment by 2016, up from 43% in 2012. HIV services will also be expanded to reach more areas of the country and HIV prevention activities including harm reduction and methadone programming are to be increased.

UNAIDS and its Cosponsors collaborated in the Myanmar’s successful application through technical guidance and assistance. UNAIDS supported the Myanmar Technical Strategy Group on AIDS chaired by the government to facilitate a consultative process which identified programme priorities, with input from technical partners, key populations and programme implementers.

“As members of the Technical Strategy Group and the concept note drafting team, UNAIDS supported us through a transparent and inclusive consultation process,” said Soe Moe Kyaw, member of the Myanmar Positive Group. “Network members representing key populations of people who inject drugs, sex workers and men who have sex with men participated in meetings at which priorities and programmatic gaps were identified. They were also consulted directly to ensure that their priority needs were fully understood and incorporated in order to reflect and complete the country concept note,” added Mr Kyaw.

The grant to El Salvador, worth US$ 26.9 million, will improve access to HIV-related services and deliver treatment among key populations such as men who have sex with men, transgender people and sex workers. By 2016, it aims to reach more than 90% service coverage for these groups. UNAIDS helped national partners with the collection of evidence and epidemiological data and worked with civil society to support the country dialogue, which included key populations.

“The new funding approach allowed the country to identify gaps in the HIV response and to strengthen efforts to reach key populations, which have been engaged since the beginning of the process and will be key partners in the implementation of the grant,” said Dr Ana Isabel Nieto, Director of the National AIDS Programme. “We recognize the invaluable help which UNAIDS provided, especially in terms of collecting, analyzing and documenting strategic information to support the funding proposal.”

Zimbabwe will use its US$ 311 grant to further strengthen impressive gains in challenging HIV. The funding is intended to increase the total number of people on antiretroviral therapy from 565 000 to just over 893 000 by 2016. UNAIDS and partners played a key role in the application process.

"UNAIDS co-led a highly participatory country dialogue involving communities and key populations and provided critical support in the development of the concept note,” said Dr Henry Madzorera, Minister of Health and Child Welfare.

Each of the early applicant grants include investments in improving data systems so that countries can really know their epidemic and in better monitoring and evaluation of programmes designed to reach most affected populations. The new funding model will be fully implemented in 2014 and six other countries are currently going through the application process.

Credit: Patricia Leiva/OAS

A new resolution adopted by the General Assembly of the Organization of American States (OAS), condemns discrimination against persons based on sexual orientation and gender identity. The same resolution urge states to adopt the necessary measures to prevent, punish and eradicate such discrimination.

Under the theme of “citizen security in the Americas,” the 41st General Assembly brought together Ministers of Foreign Affairs and delegates representing 34 countries to El Salvador from 5-7 June 2011.

“This is a success for us and our work,” said German Rincon-Prefetti, lawyer and human rights activist from Colombia and member of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations. The Coalition had been advocating over the past five years to strengthen the resolution to protect their human rights.

The General Assembly provided the opportunity, for the first time ever, to a transgender person to address the members present. Speaking on behalf of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations, Monica Hernandez shared the Coalition’s concerns about to the wave of violence and hate crime experienced by sexual minorities in the region. “Acts of violence, human rights violations and discrimination practiced against us because of our sexual orientation and gender identity is the reality of our every day life,” she said.

The HIV epidemic in Latin America remains concentrated among men who have sex with men and transgendered persons. The latter group has reported HIV prevalence rates of 27.6% in Argentina and of 29.6% in Peru. At the same time the region has experienced an alarming increase in violence and intimidation towards transgender and other sexual minorities. “All forms of discrimination and violence—including transphobia—block access to HIV prevention programmes and impact the quality of care for people living with HIV. Working for the respect of human rights is at the core of the HIV response in Latin America,” said Edgar Carrasco, UNAIDS Country Coordinator in Venezuela who represented the joint programme at the General Assembly.

UNAIDS has been working with the Inter American Commission on Human Rights (IACHR) since 2010 to support the development of a Hemispheric Report on Sexual Orientation and Gender Identity. The IACHR is a principal organ of the Organization of American States (OAS), mandated by the OAS Charter to promote the observance and protection of human rights in the region.

German Rincon- Prefetti is optimistic of the impact this resolution will make. “Now we have an instrument to document the human rights violations we are facing and to make changes for the better,” he said. “The new resolution requests IACHR to prepare the Hemispheric Report in time for the next General Assembly to take place in Bolivia in 2012, with the member states full participation and in collaboration with civil society.”

In follow-up to the new resolution, UNAIDS regional office in Latin America, in collaboration with the Pan American Health Organization (PAHO), supported the first of five expert meetings to establish the foundations for the Hemispheric Report on 17-18 June. 

The expert meeting developed a network of resource people linked to HIV and health issues for lesbians, gays, transgender, bisexual and intersex populations that will elaborate a roadmap for the Hemispheric report including the draft State and non-State questionnaire. This will provide the comprehensive and standardized information for the report to be implemented in the 35 countries.       

Organization of American States

The Organization of American States is a regional international organization whose members are the 35 independent states of the American Continent. It is headquartered in Washington, D.C., United States.

A recent visit from a UNAIDS Programme Coordinating Board (PCB) delegation to El Salvador stressed the importance of addressing stigma and discrimination in the response to HIV in the country and commended the government of El Salvador for its leadership on these issues.

"We congratulate the efforts by El Salvador in its national response to HIV under the leadership of the government with active participation by civil society," said Dr Marijke Wijnroks, AIDS Ambassador from the Netherlands, the current PCB Chair. “We are particularly impressed with the openness on sensitive issues such as comprehensive sexuality education for young people and stigma and discrimination of key populations like MSM, transgenders and sex workers”.

The field visit, that took place from 10-14 May 2010, coincided with the launch of a Presidential Decree that prohibits any discrimination based on sexual orientation and gender identity in the public sector. The Secretary of Social Inclusion, Dr Vanda Pignato, who is also the First Lady of El Salvador, officially opened the National Directorate for Sexual Diversity during the visit, and stressed that “this Presidential Decree represents the obligation of the State in addressing the issue of discrimination."

The PCB field visit provided an opportunity for Board members to be exposed to the realities of the epidemic and the work undertaken by UNAIDS, together with its national and international partners, on the ground. Dr Menna Ould Tolba, Delegate of the PCB and Coordinator of the AIDS Response in Mauritania said "After participating in this field visit, I am now convinced of the importance of working with and supporting populations at higher risk of HIV infections."

During their visit, PCB delegates met with the Minister of Foreign Affairs, Mr Hugo Martínez; Minister of Health, Dr. Maria Isabel Rodriguez; the Chief of HIV/AIDS Department, Ana Isabel Nieto; and Chief of the Tuberculosis Department, Dr. Julio Garay. They also met the Vice President of the Republic of El Salvador and Minister of Education, Salvador Sanchez Ceren and discussed with Ombudsman Oscar Luna various human rights issues in the context of the country’s HIV response. The delegates also met with representatives of civil society, including people living with HIV, MSM, sex workers and transgender communities.

Participants in the field visit took the opportunity to explain the ten priority areas under the UNAIDS Outcome Framework (2009–2011), highlighting the tenth area related to men who have sex with men (MSM), sex workers and transgender populations. According to UNAIDS, El Salvador has the highest HIV prevalence rate amongst men who have sex with men (MSM) in Central America at 17.8%

Minister of Health Dr. Rodriguez said, “HIV in our country is an important cross-sectional issue and we must explore every option in order to produce tangible results.”

PCB delegates also stressed the importance of linking sexual and reproductive health with the HIV response in meetings with the Ministers of Health and Education. Cases of HIV positive adolescent mothers with babies born with HIV were particularly highlighted during their visit to the Maternity Hospital of San Salvador. They also watched how an HIV prevention training guide is being implemented at the Canton Milingo School. Some key HIV prevention issues such as sex education in schools and stigma and discrimination have traditionally encountered resistance in the Salvadorian society. Delegates witnessed country efforts to implement programmes that address such issues while respecting the sensibilities of communities and individuals based on their religious views. "Education is the vaccine we already have against HIV,” said Delegate Dr Ibra Ndoye, Executive Secretary of the National AIDS Council, Senegal.

Whilst overall impressed with the quality of the programmes, delegates expressed concerns about the sustainability of HIV prevention programmes targeting key populations. Most of these programmes are implemented by NGOs and are heavily reliant upon external financing. With donors increasingly moving away from the region, sustainability could be at risk.

The delegates asked the government to ensure follow-up and implementation of the Ministerial Declaration that was adopted at the first meeting of Ministers of Health and Education to Stop HIV and STIs in Latin America and the Caribbean in July 2008 in Mexico City during the XVII International AIDS Conference. "We encourage El Salvador to share its experiences widely and hope to see the country play an even stronger leadership role in the regional response to HIV" said Dr César Antonio Núñez, UNAIDS Regional Director for Latin America.

UNAIDS is guided by a Programme Coordinating Board which serves as its governing body. The PCB has representatives from the five regions of the world, the UNAIDS Cosponsors, and nongovernmental organizations, including associations of people living with HIV.

El Salvador, which is currently the Vice Chair of the PCB, will assume the Chair for the year 2011. This move comes at a vital time for the AIDS response when stakeholders will come together to assess progress made towards achieving universal access to HIV prevention, treatment, care and support.

Dr. Guillermo Maza, Minister of Health of El Salvador signing the ministerial decree on 5th March 2009.

The Ministry of Public Health and Social Assistance of El Salvador approved, as part of its National Plan on HIV prevention, a set of actions to reduce homophobia and any type of discrimination based on sexual orientation in the health services.

In its 2008 country progress report El Salvador identified human rights violations as a major barrier to an effective response to the AIDS epidemic. The ministerial decree signed on 5th March 2009 by the Minister of Health Dr. Guillermo Maza, guarantees access to health services and respect of human rights to men who have sex with men, transgender, transvestites and lesbians.

The ministerial order states that all public health services such as hospitals, health clinics, etc. and their staff must facilitate, promote and support actions to eradicate discrimination based on sexual orientation. The decree also calls for all health institutions in the country to report back on the actions taken to reduce homophobia and discrimination.

“This ministerial decree reflects the fundamental principle of respect for the human rights of all those who suffer from stigma and discrimination and it reaffirms the spirit of the universal access to HIV prevention, treatment, care and support under a human rights frame,” said César Antonio Nuñez UNAIDS Director Regional Support Team for Latin America.

The decree also encourages multilateral cooperation agencies and International financing institutions to provide funds and technical support directed to effectively respond against discrimination.

According to UNAIDS, El Salvador has an HIV prevalence rate of 17.8% amongst men who have sex with men (MSM).

Aside from the individual pain homophobic attitudes inflict, the continuing stigma attached to same-sex relations is complicating the task of slowing the spread of HIV in the Latin America region in general where sex between men is a leading mode of HIV transmission according to national reports. Stigma and homophobia increase the isolation of gays, bisexuals and transgender people making them more reluctant to come forward, get advice and access HIV services such as treatment, testing and counseling.

By signing the ministerial decree, El Salvador builds on the country’s commitment to seriously expand efforts to address stigma and discrimination in health settings which will facilitate the intake of HIV services by one of the key populations at higher risk of HIV infection

UNAIDS Executive DIrector Dr Peter Piot
(left) and President Elías Antonio Saca of
El Salvador (right) during the signing of
the Memorandum of Understanding
between the Republic of El Salvador and
UNAIDS.

President Elías Antonio Saca of El Salvador hosted a meeting with UNAIDS Executive Director Dr Peter Piot on 10 June at the United Nations HQ in New York. On this occasion, a regional Memorandum of Understanding between the Republic of El Salvador and UNAIDS was signed.

Under the terms of this agreement, UNAIDS will provide support for the establishment of a Technical Support Secretariat (TS Secretariat) of the Regional Coordination Mechanism on HIV (RCM) to be located in El Salvador. The aim of the TS Secretariat is to enhance coordination between donors, national AIDS programmes, national and regional institutions, and other public and private sectors parties. UNAIDS will also support the TS secretariat by providing them with key tools, technical resources and up to date information on AIDS.

The RCM is a regional body that supports the management and oversight of the AIDS response in Central America.  It was established by the Council of Ministers of Health of Central America (COMISCA) and has already made a significant difference.

This new Secretariat aims to enhance coordination of the AIDS response in Central America by identifying areas of regional collaboration including harmonization of procedures for procurement of AIDS related commodities and supplies and promote partnerships with civil society, private and public sector and donors in the region.

By working closely with the heads of the Central America National AIDS Programmes the TS Secretariat will coordinate the technical assistance needs in the region and widely share information resources, best practices and tools. It also aims to identify opportunities for collaboration with other regional partners such as the International Centre for Technical Cooperation on HIV/AIDS in Brazil.

Regional cooperation in health is recognized as being highly effective for coordination, harmonization and political dialogue.

The Memorandum of Understanding was signed on behalf of the Government of El Salvador by Minister of Foreign Affairs Marisol de Argueta, and by UNAIDS Deputy Executive Director Michel Sidibe on behalf of UNAIDS.

Regional Director of UNAIDS, César Núñez addressed the ceremony of the signing of the cooperation agreement
Credit: UNAIDS/Lions Club

UNAIDS and UNICEF Regional Support Teams (RST) for Latin America have signed a cooperation agreement with the Lions Club International (LCI) in Central America.

The cooperation agreement will allow the organizations to join forces in response to HIV with the goal of promoting universal access to HIV prevention, treatment and care as well as sexual health education and information initiatives in Central America.

The letter was signed by the Regional Director of UNICEF for Latin America  and Caribbean, Mr Nils Kastberg; Regional Director of UNAIDS for Latin America, Dr. César Antonio Núñez; and President of the Governor Council Lion’s Club Multiple District D Istmania, PDG Ricardo Domínguez Posada.

The President of the LCI, H.L. Mahendra Amarasurya´s, emphasized the important role that LCI can have to “combine efforts with the United Nations in order to improve the quality of life of the boys, girls, men and women living with HIV, as well as to increase efforts in order to limit the progress of this disease”.

According to Regional Director of UNAIDS, César Núñez, “joint initiatives like this one, with important allies of civil society like the Lions Club, are what is needed in our country in order to keep moving ahead towards the goal of universal access”.

Lions Club International has 1.4 million members in 202 countries around the world
Credit: Lions Club International

Núñez said that “Latin America has been able to develop good practices in relation to the HIV response which will be strengthened by committed parties such as civil society, Governments and international organizations working together.”

The next step will be to prepare a Letter of Agreement among the three organizations and a strategic plan in order to define priorities and concrete actions to be developed in the future months. The plan will elaborate on activities along with estimated budget, a division of labour agreement and the different responsibilities and resources of the signing organizations. 

The ceremony took place on 21 February 2008 during the XXXVII Lions Forum for Latin America and the Caribbean in El Salvador and was attended by six Lions Governors from Central American countries.

About Lions Club International

The Lions Club was started by business man Melvin Jones in Chicago in 1917. Jones believed that business should look than narrow professional interests to the progress of their communities and the world. Jones' personal code, "You can't get very far until you start doing something for somebody else," reminds many Lions of the importance of community service.

Today, LCI is the world's largest secular service organization with over 44,500 clubs and more than 1.4 million members in 202 countries around the world. It has been collaborating with the United Nations since 1945.

UNAIDS Executive Director Dr Peter Piot meets with the President of El Salvador Elías Antonio Saca González, host of the Presidential
Summit of Central American heads of state in San Salvador,
11 November 2005.
Photo credit: UNAIDS/Carlos H. Bruch

The III Latin America and the Caribbean Forum on HIV/AIDS/STDs (Foro 2005) and the IV Central American Congress on STD/HIV/AIDS (CONCASIDA) closed on Friday 11 November with a gathering of Presidents and other leaders from the Central America region.

UNAIDS Executive Director Dr Peter Piot attended the Presidential Summit and addressed the conference closing plenary.

At the summit, Dr Piot met with the President of El Salvador Elías Antonio Saca González, the host of the conference.

"There is momentum on leadership – made manifest in today's gathering of Presidents and other leaders from this region here today," said Dr Piot prior to the President's Summit. "Now is the time to act.  So that together we can stop the threat of AIDS in our countries."

The President of Guatamela Oscar José Rafael Berger and the President of Costa Rica Abel Pacheco also attended the gathering, as well as the health ministers from Honduras and Nicaragua.

Dr Piot underlined the significant strides that have been made in the region to increase access to treatment. But, he added, these gains in treatment access need to be sustained and extended to the whole region. With more people living with HIV than ever in some countries, Dr Piot emphasized the urgent need to simultaneously increase HIV prevention programmes that reach all people at risk of infection, particularly those most marginalized such as men who have sex with men and sex workers.

"The region must revitalize its strategies to reach people most at risk – and they must address the deeper-rooted factors that affect vulnerability, such as social exclusion and inequalities of all kinds," he said.

Dr Piot urged leaders in the region to renew and reinvigorate their commitments at the highest political level and to agree to specific measures that will translate into concrete actions to reinforce AIDS responses nationally and regionally.

"The history of AIDS has shown us that when we are united, people win. Success depends on each of us truly being committed to tackling this exceptional crisis," said Dr Piot.

As part of the Presidential Summit, a declaration of enhanced commitment to a coordinated regional AIDS response was signed.

Related links:
 

UNAIDS press release: Putting the spotlight back on AIDS in Latin America and the Caribbean

 Speech by UNAIDS Executive Director: The future of the HIV epidemics: leadership for action  

11 November 2005: Declaration of enhanced commitment to a coordinated regional AIDS response signed at CONCASIDA (Spanish only)  

Photos: View photos from CONCASIDA 2005

Foro y Concasida

UNAIDS Regional information: Caribbean

UNAIDS Regional information: Latin America