Criminalization

GENEVA | WASHINGTON, D.C., 29 May 2023— The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) are deeply concerned about the harmful impact of the Ugandan Anti-Homosexuality Act 2023 on the health of its citizens and its impact on the AIDS response that has been so successful up to now.

Uganda’s Leadership Towards Ending the AIDS Pandemic as a Public Health Threat

Uganda and President Yoweri Museveni have been leaders in the fight to end AIDS. Progress has been made thanks to the implementation of large-scale prevention, diagnosis, treatment and care programs, all provided on the principle of access to health care for all who need it, without stigma or discrimination. This approach has saved lives. The strong health systems built to support the AIDS response serve the entire population of Uganda. This was evident as community health workers and health systems developed for the AIDS response played a key role in tackling COVID-19 and other disease threats. Maintaining this is vital: Failures in the HIV public health response will have system-wide impacts that could negatively affect everyone.  

Success Is Possible

We know that we will be able to overcome this public health threat when we ensure that 95% of people living with HIV know their status, 95% of them are on treatment, and 95% of those on treatment have achieved viral suppression. Uganda can reach that. By 2021, 89% of people living with HIV in Uganda knew their status, more than 92% of people who knew their HIV status were receiving antiretroviral therapy, and 95% of those on treatment were virally suppressed.  Uganda is well on track to achieve the UNAIDS HIV treatment targets if progress can be maintained. 

Discrimination Threatens Progress in the AIDS Response

Uganda’s progress on its HIV response is now in grave jeopardy. The Anti-Homosexuality Act 2023 will obstruct health education and the outreach that can help end AIDS as a public health threat. The stigma and discrimination associated with the passage of the Act has already led to reduced access to prevention as well as treatment services. Trust, confidentiality, and stigma-free engagement are essential for anyone seeking health care. LGBTQI+ people in Uganda increasingly fear for their safety and security, and increasing numbers of people are being discouraged from seeking vital health services for fear of attack, punishment and further marginalization.

Uganda has repeatedly demonstrated leadership and commitment to ending AIDS – and has achieved great success – by leaving no one behind. Together as one, we call for the Act to be reconsidered so that Uganda may continue on its path to ensure equitable access to health services and end AIDS as a public health threat by 2030.  

Peter Sands, Executive Director, The Global Fund

Winnie Byanyima, Executive Director, UNAIDS, and Under-Secretary General of the United Nations

Ambassador John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, U.S. Department of State

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.

For many years Mami taught at a state school in Kanazawa, Japan. When she started transitioning and dressing in a less masculine way, her colleagues and supervisors frowned upon it. Finally, she was fired.

As a transgender woman in a small, conservative city, Mami struggled to find another job and felt very isolated. “When a friend invited me to work at the Kanazawa Rainbow Pride community centre, I was happy to have a place where I was accepted,” she said.

Founded in 2022, the Kanazawa LGBTQI+ centre is in a 150-year-old tea house in what was the city’s former Samurai marketplace. The sliding panels allow for a variety of configurations depending on gatherings. Mami and her friend, Kennosuke Okumara, Head of the Kanazawa centre’s secretariat, were serving tea and coffee in the open bar kitchen to visitors.

“Before I worked in Tokyo but I returned to my native city,” Mr Okumara explained. “The problem was that there were and are no options for gay people here,” he said.  Mr Okumara lives with HIV and laments the fact that HIV and LGBTQI+ issues are still taboo. “There is so little information, it is a shame and I am here to share my experience and share more awareness,” he said.

Mixing a green tea in a small cup with a bamboo whisk, Mr Okumara in his apron paused and looked at Mami. “This is a safe space for all here,” he said.

Diana Hoon, the centre’s co-President called the centre a beacon of hope. “We are like a lighthouse in a very conservative, patriarchal society,” she said. Showing off the many pamphlets and flyers varying from knowing one’s HIV status to the Pride parade in the city to books about coming out in the makeshift library, Ms Hoon said that the centre not only was attracting more people, they also had 10 volunteers helping out... many of whom are mothers.

"Our parent seminars about LGBTQI+ have had a lot of impact,” she said. “People share stories about their children and a connection is made.”

As a Singaporean living with another woman who is originally from Kanazawa, Ms Hoon feels like she is doing her part to provide a lifeline for people and push for more acceptance.

“Among our many priorities we do HIV awareness as well as advocate for gender neutral toilets, gender neutral school uniforms and most importantly marriage for all, which does not yet exist in Japan,” she said. She also hopes that within five years they can add a shelter to house LGBTQI+ people.

In her mind there have been incremental steps. “Transgender people have been more outspoken of late and we have LGBTQI+ champions among the community,” she said.

Such a role model is Gon Matsunaka, Founder and former President of the Pride House Tokyo consortium and the Director of the Marriage for All movement in Japan. A former advertising executive for one of Japan’s top firms, Dentsu, Mr Matsunaka hid his sexuality for decades. “For me there was no future in my rural hometown, so I left for Tokyo,” he said. He then studied in Australia, worked in Tokyo as well as New York City and ultimately left his firm.

He came out as gay in 2010 and fixated on providing a community centre in Tokyo. The Olympic Games seemed like a golden opportunity.

The COVID pandemic struck, putting a lot of projects on hold but Mr Matsunaka and his team did not give up.

“In May 2020, survey after survey revealed that LGBTQI+ youth felt unsafe at home or they had lost touch with people, this really motivated me,” he said. He had secured 15 sponsors for a temporary LGBTQI+ safe space during the Olympic and Paralympic Games, called Tokyo Pride House. With the postponing of the Games however, the centre was cancelled.

The team persuaded the sponsors to shift their funding and create a permanent space. Years after the Olympics, Tokyo Pride House still stands proud within walking distance of the popular queer-friendly Shinjuku area in Tokyo.

In Kanazawa, Mr Matsunaka had linked up with Ms Hoon to start a Pride parade in 2021. Out of that success came the idea of a community centre.

Mr Matsunaka is particularly proud that the prefecture (city district) contributed half the funds to the Kanazawa Nijinoma centre. The rest was a result of crowdfunding.

Beaming in the Tokyo Pride House surrounded by rainbow flags, he said, “I never dreamed of this and never imagined it could be possible especially in a small city like Kanazawa.”

In his mind, women have been key. “Women have 2^nd rank to men especially in rural areas like Kanazawa, so they have been our greatest allies to change the patriarchal mentalities,” he said. “Mind you we have a lot more work ahead, but I only want to go forward not backwards."    

On International Day Against Homophobia, Biphopia and Transphobia (IDAHOT), UNAIDS stands in solidarity with the LGBTQI+ community. We must unite and celebrate diversity; a society where everyone, no matter where they live or whom they love, is able to live in peace and security; a society where everyone can contribute to the health and well-being of their community.

Released ahead of the International Day against Homophobia, Transphobia and Biphobia – 17 May 2023

GENEVA, 15 May 2023—Around the world, 67 countries still criminalise same sex relations, with 10 imposing the death penalty. 20 countries criminalise gender diversity. Such laws hurt the public health of everyone, costing lives. Public health and human rights go hand in hand.

“The importance of decriminalising homosexuality and gender diversity cannot be underestimated,” said Christine Stegling, Deputy Executive Director, Policy, Advocacy and Knowledge, UNAIDS. “Decriminalising will save lives and is a crucial step towards equality, dignity, and health for all.”

Across all cultures, sexual orientation, gender identity, and expression are diverse. LGBTQI+ people are part of every society in every country since time immemorial, yet LGBTQI+ people continue to be marginalised and excluded—be it legally, culturally, socially or a combination of all.

Criminalisation, along with pervasive discrimination and violence, obstructs LGBTQI+ people from accessing life-saving services. In a growing number of cases, health service providers are also experiencing being harassed by vigilantes or police for providing life-saving services to LGBTQI+ people.

UNAIDS reports that in countries where same sex relations are criminalised, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalised. Where there have been recent prosecutions, this increases to 12 times higher.

Recognizing that criminal laws have a detrimental impact on the HIV response, United Nations member states at the UN General Assembly committed to ambitious targets in the 2021 Political Declaration on HIV to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalisation as a critical element in the HIV response, countries made a commitment that by 2025, less than 10% of countries would have punitive legal and policy environments that affect the HIV response.

There has been a positive wave of progress. In the past year Antigua & Barbuda, St Kitts & Nevis, Singapore, Barbados and the Cook Islands have repealed old colonial laws which had criminalised same-sex relations. Kuwait’s court overturned a law that had criminalised “imitating the opposite sex”.

Brazil is amongst the countries driving forward progress in advancing the human rights of LGBTQI+ people. The Minister of Health and the Minister of Human Rights will announce that the country will be joining the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination during an event on 17 May. The event will focus on access to care and justice for trans and gender-diverse communities.

However, running counter to the wave of progress is a renewed, well-funded, well-organised international drive to sow prejudice and push discriminatory and harmful new anti-homosexuality legislation and anti-trans legislation.

If enacted into law, this legislation will have extremely damaging consequences for public health, obstructing LGBTQI + people from accessing health services, and obstructing health workers from providing, life-saving services including services to prevent and treat HIV. It is vital for public health that this harmful push be stopped.

On International Day against Homophobia, Transphobia and Biphobia, UNAIDS is calling on all countries to remove punitive laws and tackle prejudices against lesbian, gay, bisexual, transgender and intersex people. A more just, equitable and kind world is a healthier one, for everyone.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

On April 14^th members of the Cook Islands rainbow community assembled at parliament with colourful flags and cautious optimism. It turned out to be the day they’d been working toward for the last twelve years. Parliament removed laws prohibiting consensual sex between men, striking out sections of the Crimes Act that had been on the books since the turn of the 20^th century.

“This decision by Cook Islands is part of a wave of global progress around abolishing harmful laws,” noted UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

“This was a huge historical moment,” said Valery Wichman, President of the Te Tiare Association, the nation’s oldest lesbian, gay, bisexual and transgender (LGBT) organisation. “It’s not just a win for the community, but also a shift in terms of our nation maturing and upholding the constitutional rights of all people.”

Ms Wichman, an attorney and public servant, is also an akava'ine—a Māori word meaning transgender woman. She attests that the anti-LGBT laws which made so-called “sodomy” and “indecent acts” punishable by imprisonment reinforced prejudices. This contributed to the LGBT community’s exclusion, harassment and bullying. She has herself experienced being mocked and assaulted.

“A lot of people chose not to live here. It was too hard for them to endure their family’s and society’s judgment. The idea that you are not worthy has carried down from parents to children and has affected how we have been treated by our peers. A lot of trans women have not gone to the doctor because they have been misgendered and have felt disrespected. There have been cases where they ended up dying,” she said.

The journey toward law reform started in 2011. The spark was the discriminatory response to the nation’s first HIV diagnosis. Te Tiare led the advocacy charge with support from organisations including the Cook Islands Family Welfare Association.

A Crimes Bill drafted around 2013 removed the discriminatory clauses. In 2017 parliament set up a Standing Committee to review its raft of proposed revisions. Support for civil society to prepare submissions outlining public health grounds for reforms was provided by the United Nations Development Programme (UNDP), the lead agency amongst the United Nations Joint Programme on HIV and AIDS working on effective democratic governance and issues affecting sexual and gender minorities.

But following a political change the next year, the committee’s Chair recommended retaining the ban on gay sex. What’s more, he proposed a new section criminalising sex between women. The bill remained in limbo for years. Reform efforts seemed to hit a wall.

A strategy of public dialogue and political engagement rooted in Cook Islands culture enabled a breakthrough. Pride Cook Islands (PCI) was formed as a sister organisation to Te Tiare, focusing on this public advocacy branch of work.

“Obviously we are in a unique situation as a small, conservative, religious population,” PCI President, Karla Eggelton began. “The work of advocacy becomes more delicate when you are living beside people making these decisions for you. We welcomed support from international allies, but we knew we had to do this our own way and have our own approach that is mindful of the situation and culture we live in.”

First TCI tackled messaging. There were deep deliberations around word choice. The mandate was to keep the conversation simple. Ultimately the cause was framed as an equality issue. The rallying cry became, ‘don’t make us criminals in our own country’.

The organisation stayed in communication with policymakers on both sides of aisle. They not only explained their position, but sought to understand politicians’ concerns.

The group met with traditional leaders who are grassroots decision-makers. Village communities were invited to have conversations during public meetings.

“It offered an opportunity for us to understand the misperceptions. We were able to explain that all we are asking for is to not be made criminals. People said, ‘we don’t want to send you to jail, we love our neighbours and our family’,” Ms Eggelton remembered.

The organisation’s patron is Lady Tuaine Marsters whose husband, Sir Tom Marsters, is the British King’s Representative. Lady Marsters frequently attended consultations. Other spokespersons included parents and people with standing in the church. At times supporters were invited to simply stand in solidarity. But anyone who would speak was carefully prepared.

“We spent hours articulating what we would say. We reaffirmed our pledge to not become emotional. We had to keep each other in check to make sure we did not say anything we could regret,” Ms Eggelton outlined.

Then came an effort to increase visibility. The call for equality was largely coming from the LGBT community. They needed other people to demand the same. So PCI embarked on a campaign for people to show their support either by lending their voice to the public dialogue or flying the rainbow flag.  The group distributed free flags, urging people to fly one for their daughter, son or grandchild. From restaurants to bars, t-shirts to earrings, the display of support resonated.  

A first-of-its-kind pride ad on TV, newspapers and radio challenged Cook Islanders: “We are good enough to be your teachers, nurses, choreographers, dressmakers and orators… but not good enough in the eyes of the law. We are already part of your community, we are just asking you to recognise us as equals.”

This visibility and advocacy work was supported by UNDP through the Being LGBTI in Asia and the Pacific program. PCI developed a project to strengthen the digital capacities of community organisations. A critical outcome was the Pride Pledge Cook Islands initiative with the business community which provides visible safe spaces for LGBT people.

“The UNDP support was instrumental in promoting acceptance and awareness and utilising digital tools to share our message,” Ms Eggelton said.

TCI conducted frequent polls to gauge public sentiment. At the start of the process they lagged behind reform opponents. But by the time would-be Prime Minister, Mark Brown, made an election promise to change the law last year, public sentiment had tilted.

“Once we were able to establish that it was really about equality, then we saw a changing of the tide,” Ms Eggelton reflected.

Ultimately the entire government bench voted in favour of an Amendment Bill while opposition leader, Tina Brown, and two of her Members of Parliament also supported.

Renata Ram, UNAIDS Country Director for Fiji and the Pacific, noted that seven other countries in the Pacific region retain laws criminalising same-sex relations.

“The Cook Islands example proves that along with law reform we can have national dialogues about inclusion, justice and equity,” Ms Ram said.

At a national ceremony marking the end of the South Pacific cyclone season the rainbow community gathered once more, this time to give thanks.

“We want to make sure people understand our gratitude for everything that has transpired and for everyone who worked hard to achieve this,” Ms. Eggelton said. “Our community is now recognised through the eyes of the law as being equal. Now people can feel safe, not like second class citizens.”

BANGKOK, 15 April 2023—UNAIDS applauds today’s decision by Cook Islands lawmakers to remove laws prohibiting consensual sexual acts between men from the Crimes Act. By decriminalising sex between same-sex partners, the Pacific nation joins a global movement toward affirming the human rights to non-discrimination and privacy.

“Cook Islands’ latest move is part of a wave of global progress around removing laws that harm. It will inspire countries across the Pacific, Asia and the world to follow suit. Decriminalise, save lives," said UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

Criminalisation of same-sex relations undermines the human rights of lesbian, gay, bisexual and transgender (LGBT) people. Punitive laws reinforce stigma and discrimination against LGBT people, undermining their access to the rights, remedies and opportunities available to other people. Such laws also obstruct access to vital services, including sexual and reproductive healthcare.

"This decision by Cook Islands will save lives,” said Mr Murphy. “The abolition of punitive and discriminatory colonial laws across the world is essential for public health, including for ensuring the end of AIDS.”

Bi-partisan support for the Crimes (Sexual Offences) Amendment Bill demonstrates that policy-makers, civil society and communities can dialogue to develop laws that create more just and equitable societies. 

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 International Committee of Jurists (ICJ) along with UNAIDS and the Office of the High Commissioner for Human Rights (OHCHR) officially launched a new set of expert jurist legal principles to guide the application of international human rights law to criminal law. 

The ‘8 March principles’ as they are called lay out a human rights-based approach to laws criminalising conduct in relation to sex, drug use, HIV, sexual and reproductive health, homelessness and poverty.

Ian Seiderman, Law and Policy Director at ICJ said, “Criminal law is among the harshest of tools at the disposal of the State to exert control over individuals...as such, it ought to be a measure of last resort however, globally, there has been a growing trend towards overcriminalization.” 

“We must acknowledge that these laws not only violate human rights, but the fundamental principles of criminal law themselves,” he said.

For Edwin Cameron, former South Africa Justice of the Constitutional Court and current Inspecting Judge for the South African Correctional Services, the principles are of immediate pertinence and use for judges, legislators, policymakers, civil society and academics. “The 8 March principles provide a clear, accessible and practical legal framework based on international criminal law and international human rights law,” he said.

The principles are the outcome of a 2018 workshop organized by UNAIDS and OHCHR along with the ICJ to discuss the role of jurists in addressing the harmful human rights impact of criminal laws. The meeting resulted in a call for a set of jurists’ principles to assist the courts, legislatures, advocates and prosecutors to address the detrimental human rights impact of such laws. 

The principles, developed over five years, are based on feedback and reviews from a range of experts and stakeholders. They were finalized in 2022. Initially, the principles focused on the impact of criminal laws proscribing sexual and reproductive health and rights, consensual sexual activity, gender identity, gender expression, HIV non-disclosure, exposure and transmission, drug use and the possession of drugs for personal use. Later, based on the inputs of civil society and other stakeholders, criminalization linked to homelessness and poverty were also included.

Continued overuse of criminal law by governments and in some cases arbitrary and discriminatory criminal laws have led to a number of human rights violations. They also perpetuate stigma, harmful gender stereotypes and discrimination based on such grounds as gender or sexual orientation.

In 2023, twenty countries criminalize or otherwise prosecute transgender people, 67 countries still criminalize same-sex sexual activity, 115 report criminalizing drug use, more than 130 criminalize HIV exposure, non-disclosure and transmission and over 150 countries criminalize some aspect of sex work.

In the world of HIV, the abuse and misuse of criminal laws not only affects the right to health, but a multitude of rights including: to be free from discrimination, to housing, security of the person, movement, family, privacy and bodily autonomy, and in extreme cases the very right to life. In countries where sex work is criminalized, for example, sex workers are seven times more likely to be living with HIV than where it is partially legalized. To be criminalized can also mean being deprived of the protection of the law and law enforcement. And yet, criminalized communities, particularly women, are often more likely to need the very protection they are denied.

UNAIDS Deputy Executive Director for the Policy, Advocacy and Knowledge Branch, Christine Stegling said, “I welcome the fact that these principles are being launched on International Women’s Day (IWD), in recognition of the detrimental effects criminal law can, and too often does have on women in all their diversity.”

“We will not end AIDS as a public health threat as long as these pernicious laws remain,” she added. “These principles will be of great use to us and our partners in our endeavors.”

Also remarking on the significance of IWD, Volker Türk, High Commissioner for Human Rights, said, “Today is an opportunity for all of us to think about power and male dominated systems.”

His remarks ended with, “I am glad that you have done this work, we need to use it and we need to use it also in a much more political context when it comes precisely to counter these power dynamics.”

“Frankly we need to ask these questions and make sure that they are part and parcel going forward as to what human rights means,” he said.

In conclusion, Phelister Abdalla, President of the Global Network of Sex Work Projects, based in Kenya noted: “When sex work is criminalized it sends the message that sex workers can be abused...We are human beings and sex workers are entitled to all human rights."

Rosma Karlina and Bambang Yulistyo Dwi live with their two young children in the rainy hillside town of Bogor, south of Jakarta.

“Sometimes we go to museums to introduce the children to history or feed the deer at the Presidential Palace. It’s simple entertainment but can teach the children to learn to love even animals,” Ms. Karlina said.

If their family life is traditional, their work life is anything but. Ms Karlina is the founder and Director of Suar Perempuan Lingkar Napza Nusantara (also called Womxn's Voice), an advocacy and care organisation serving women and transwomen who use drugs. Bambang, popularly known as Tedjo, founded the Indonesian Justice Action Foundation (AKSI). Since 2018 his team has provided legal aid and support to people who use drugs, and advocated for their rights.

Their workdays are a mix of community organizing, paralegal paperwork and responding to distress calls. A client reported her husband’s domestic violence. When the police arrived at the house, the husband informed the police of her drug use and the police arrested her instead.

The organisations successfully advocated for a man to be released from a compulsory rehabilitation centre so that he could access HIV treatment. Otherwise, he would have gone three months without his medicines.

The organisations have witnessed many examples of women living with HIV being faced with extreme scorn. A police officer once threw a pack of sanitary napkins into a woman’s cell instead of passing it to her, saying it was because he was afraid to be near her.

“Since 2018 I have seen many rights violations perpetrated by law enforcement officers—abuse physically, psychologically and even financially,” Ms Karlina said. “They extort families to pay to enable their loved ones to go home.”

The Rosma Karlina of today—nurturer and fierce advocate—evolved from almost two decades of drug abuse. She has been to rehabilitation centres 17 times. Rock bottom came during an 18-month incarceration for heroin possession.

“My family paid a lot of money to the prosecutors, but I was still imprisoned. I lost custody of my oldest child. The judge thought I did not deserve to be a mother because I was a drug user,” she recounted.

Tedjo also evolved from addiction to activism.

“I did drugs between 1989 and 2015. It has been a long journey,” he reflected. “When my life was a mess, I hurt many people. It was not easy to prove that I was better.”

The couple are leading voices on how harsh criminal laws for drug possession and use lead to rights violations against people who use drugs while also lowering access to health services.

A 38-country legal and policy analysis by UNAIDS and UNDP found that 14 countries in the region have corporal or capital punishment penalties for the use or possession of drugs. Some states have condoned extrajudicial killings for drug offences.  In 2021 an estimated 12% of new HIV infections in Asia and the Pacific were among people who inject drugs.

 “The war on drugs has created a lot of stigma, and a culture that views an entire community as criminals. When we access healthcare, we get treated as bad people,” Tedjo said.

Regional Coordinator of the Network of Asian People who Use Drugs (NAPUD), Francis Joseph, explained that in the absence of legally conducive environments people don’t have access to appropriate services.

“Healthcare providers and law enforcement agencies treat them with violence and abuse,” he said. “So they don’t want to come out the closet and say ‘I have shared needles and syringes and I need an HIV test’. Because drug users are not welcome in our health facilities that leads to them going into the shadows and staying there.”

Lord Lawrence Latonio, a Community Access to Redress and Empowerment (CARE) partner and law student noted that Philippines also criminalises the possession of what are seen as drug paraphernalia. This means that peer educators who disseminate clean needles and syringes have to be watchful so they are not apprehended.

Fortunately advocates successfully lobbied for the country’s HIV and AIDS Policy Act of 2018 to include protections for healthcare workers who provide HIV services. Part of CARE’s work is legal literacy training so communities understand their rights. CARE also has a network of peer officers working in different regions to support members of key population communities and people living with HIV with seeking redress in cases where there have been rights violations.

Twenty-one countries in the region operate either state-run compulsory detention and rehabilitation facilities for people who use drugs or similar facilities. These are a form of confinement where those accused of, or known to be using drugs, are involuntarily admitted for detoxification and “treatment”, often without due process. Conditions have been reported to involve forced labour, lack of adequate nutrition, and limited access to healthcare.

In 2012 and 2020 United Nations agencies called for the permanent closure of these compulsory facilities. But according to a 2022 report, progress on this issue in East and Southeast Asia has largely stalled.

“UNAIDS is working with the United Nations Office on Drugs and Crime (UNODC) to support countries to transition from compulsory facilities towards voluntary community-based treatment that provides evidence-informed and human-rights based services,” said UNAIDS Asia Pacific Human Rights and Law Adviser, Quinten Lataire.

UNAIDS Indonesia is working with Womx'n Voice to pilot a multi sector partnership shelter and education program for women and children in Bogor. Interventions include social protection, legal support, mental health support, HIV and health education and accompaniment to services.

Ms Karlina called for increased investments in mental health care, poverty alleviation and education. “We need proper assessments to better look at each situation and come up with an effective solution. Prison is not the answer. If you see us as humans, you will take care of us as humans,” she insisted. 

On Zero Discrimination Day 2023, commemorated on March 1, UNAIDS highlights the need to remove laws that criminalize people living with HIV and key populations.* The 2023 theme, “Save lives: Decriminalize”, points to the positive impact on health and life outcomes when discriminatory and punitive laws are removed.

In 2021, the world set ambitious law reform targets to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalization as a critical element in the response, countries made a commitment that by 2025 less than 10% of countries would have punitive legal and policy environments that affect the HIV response.

Winnie Byanyima, Executive Director of UNAIDS, said:

"Criminalizing laws chase people away from life-saving treatment. Those need to be removed. The only reason people are still dying of AIDS is the inequalities in society, from social norms, from the lack of opportunities in school, etc. and all these come together to make them more at risk."

"At the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.”

These targets are ambitious but they are necessary

Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalize same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions.

Criminalization of sex work increases both the risk of sex workers acquiring HIV and their vulnerability to violence perpetrated by clients, police and other third parties. The criminalization of the clients of sex workers has also been repeatedly shown to negatively affect sex workers’ safety and health, including reducing condom access and use, and increasing the rates of violence.

Decriminalization of drug use and possession for personal use is associated with significant decreases in HIV incidence among people who inject drugs, including through greater access to harm reduction services, reductions in violence and arrest or harassment by law enforcement agencies.

Winnie Byanyima said:

"We have the evidence that when you repeal criminal laws on same-sex relations that the risk of contracting HIV falls, the risk of new infections amongst gay men, MSM, drops significantly.

"To me HIV is a disease but it's more a social injustice. It's driven by inequalities in society. These are not things that can happen without a consensus in the society, so we need everybody on board."

Law reform is therefore critical if we are to end AIDS as a public health threat by 2030.

The targets are ambitious but not impossible

Indeed, recent experience is proving just how possible they are.  In 2022 alone Belgium and Australia have removed laws criminalizing sex work; Zimbabwe decriminalized HIV exposure, non-disclosure, and transmission and the Central Africa Republic reduced the scope of its HIV criminal laws; Antigua & Barbuda, St Kitts & Nevis, Singapore and Barbados have repealed old colonial laws criminalizing same-sex sexual activity. Kuwait repealed a law criminalizing the imitation of the opposite sex, a law used to target transgender persons while New Zealand removed travel restrictions relating to HIV.

However, despite such encouraging reforms, the world is not on track to ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services. In 2021, 134 reporting countries explicitly criminalized or otherwise prosecuted HIV exposure, non-disclosure or transmission; 20 reporting countries criminalized and/or prosecuted transgender persons; 153 reporting countries criminalized at least one aspect of sex work; and 67 countries now criminalize consensual same-sex sexual activity, according to UNAIDS. In addition, 48 countries still place restrictions on entry into their territory for people living with HIV, while 53 countries report that they require mandatory HIV testing, for example for marriage certificates or for performing certain professions. 106 countries report requiring parental consent for adolescents to access HIV testing.

Such laws and sanctions violate international human rights norms and stigmatize and discriminate against already marginalized populations.

Decriminalisation saves lives and helps advance the end of the AIDS pandemic.

* Key populations are communities at higher risk of HIV infection including gay men and other men who have sex with men, people who use drugs, sex workers, transgender people and people in prisons and other closed settings.

As a girl Ikka dreamed of becoming an accountant. She knew her parents could not afford to send her to university, so she resolved to pay for university herself by moving into a brothel. For almost three years she lived and worked there while studying.

Davi’s parents divorced when he was a baby and he was raised by caring grandparents. In high school he led lots of extracurricular activities. He was also gay. Just three months before his final exams Davi was raped by a teacher who threatened to “out” him. He ran away to the city. After a desperate search for work, he landed a job in a massage parlour.

From the Bangkok offices of Youth LEAD and the Asia Pacific Network of People Living With HIV and AIDS (APN+), the pair reflects on those chaotic adolescent years with halting candour. They unpack layers of vulnerability and abuse—the way poverty and trauma can propel young people toward sexual exploitation, higher HIV risk and a cascade of rights violations. And they say that the criminalisation of sex work only made their situations worse.    

“No one tells you anything other than that you need to please your client. Just be submissive and quiet. There’s no protection, no information, no nothing,” Ikka remembers.

The brothel would occasionally force the women to undergo HIV and STI testing. Saying ‘no’ wasn’t an option. But when Ikka went to a clinic on her own to get condoms or contraceptives, she was turned away.

Customers sometimes didn’t pay, became violent or refused to stop having sex after even two or three hours. Abusive clients routinely threatened to report them.

“If someone called the police, they would arrest the sex worker. The customer is king,” Davi says. “So silence is better.”

“The police wouldn’t take your report. They think they have more important cases than you,” Ikka adds.

UNAIDS Asia Pacific Human Rights and Law Adviser, Quinten Lataire, explained that criminal laws against sex workers make it very difficult for sex workers to demand basic rights, substantially increasing their risk for abuse and exploitation, such as from law enforcement officers.

“The criminalization of sex workers does not end sex work. It simply makes people go underground, putting them at higher risk of violence and HIV transmission. This has a devastating impact on the sex workers themselves, their clients and the society at large,” Mr Lataire said.  

Almost all (99%) new HIV cases in young people in Asia Pacific are amongst key populations and their sexual partners. In Cambodia, Indonesia, Lao PDR, the Philippines and Thailand, youth account for between 40% and 50% of new infections. Since 2010, HIV rates among young people have risen in Afghanistan, Fiji, Malaysia, Pakistan, Papua New Guinea, the Philippines and Timor-Leste.

At ages 18 and 19 respectively, both Ikka and Davi learned that they were HIV positive. In Ikka’s case she was tested as a VISA requirement for a student exchange programme. Her results were forwarded to her school even before she got them and she was kicked out. From breach of confidentiality to discrimination in both education and healthcare settings—one rights violation after another. Ikka had the agency to confirm her HIV status at a community-based sex worker clinic she’d looked up and immediately started treatment.

Davi voluntarily tested with a community organization that visited the massage parlour to conduct sensitization sessions and offer services. He kept his status a secret at work but began attending support meetings on the weekend. He sometimes told the pimp that he was going out to meet a client, handing over the stipend he got from the organization when he got back.

“For eight months after I knew I was positive, I felt like I didn’t want to do sex work, but I needed the money. I told clients to use condoms but some of them would give me more money not to,” Ikka remembers.

The events that finally prompted her to leave the brothel still evoke strong emotions. Her best friend there also contracted HIV.

“I told her, ‘let’s go together to get antiretroviral treatment’. I showed her my medication as evidence. But she didn’t want to go. She would not get support from her parents and if the pimp found out, he would kick her out. She felt it was better to die,” Ikka remembers. Her friend passed away just two months after her diagnosis.

In both cases these young people demonstrated incredible resilience and were supported by community-led organizations with tailored services for sex workers and people living with HIV. Ikka joined an organization addressing sex workers’ rights, health and social support needs. She quickly carved a niche representing the interests and perspectives of young sex workers. She would go on to lead national young key population organizations and sit on the Global Fund’s Youth Council. Today she is the Regional Coordinator of Youth LEAD.

“I told myself I needed to help my community,” Davi says. “I don’t want no more people in my situation; no more students becoming victims of sexual violence; no more 19-year-olds HIV positive. I just chose to leave (the parlour) and volunteer with the community organization instead.” Encouraged and supported by community, Davi would go on to graduate from high school and earn a sociology degree. He is now aiming for a Masters qualification while working as APN+’s Youth Officer.

The issues Ikka and Davi faced remain today.

“I still use a condom, but many clients refuse,” says Rara, a 22-year-old sex worker. “When we’re desperate for money, we have no choice but to agree. In addition to gonorrhea, I got syphilis and got treated for it. Thankfully I’m still HIV negative.”

UNAIDS and the Inter-agency Task Team on Young Key Populations are working to address the inequalities faced by young key populations in Asia Pacific. Learn more about their work.