Events

We do not need to accept pandemics as fate, experts gathered at the International AIDS Conference concurred. By taking specific, well-evidenced, concrete actions to tackle the inequalities driving them, today’s health threats can all be overcome.

As the latest data reveals that progress in the HIV response is stalling, putting millions of lives in danger, as the COVID-19 crisis drags on, and as Monkeypox presents new risks,  all are being held back by inequalities, and all three viruses are in turn further exacerbating those inequalities. However, a focus on tackling underlying drivers of pandemic risk can enable a successful response, scientists, economists and heads of AIDS programmes concurred.

“There are Monkeypox vaccine doses in Europe but none in Africa. Most people at risk of dying from COVID-19 in lower-income countries have still not received a COVID-19 vaccine. New game changing prevention medicines for HIV will not be widely available in lower income counties for years unless there is a dramatic course correction,” said Winnie Byanyima, Executive Director, UNAIDS, and Under-Secretary-General of the United Nations. “An effective response to disease outbreaks and pandemics means tackling inequalities. That means empowering women and girls to shift power relations between men and women. It means tackling inequalities in access to health services between rich and poor. And it means removing punitive laws that push away from life-saving services LGBTQI+ people, people who use drugs, and sex workers.” 

The application of scientific advancements is currently being undermined by inequalities, delegates at the International AIDS Conference noted.  They recalled how, at the turn of the millennium, civil society and generic manufacturers teamed up to demand access to antiretrovirals  for people living with HIV and their victory against the odds helped save millions of lives. But whilst that battle was won, delegates highlighted that the overall process of research and development, innovation and how that translates into manufacturing, pricing and distribution has remained untransparent and heavily skewed to the interests of rich countries. This played out during the COVID-19 pandemic as tests, vaccines and now antivirals are widely available in rich countries while still scarce in lower-income countries. And now this is repeating again with Monkeypox. 

Inequality is not only about differential risks but is about cycles of power, the imbalance in how laws and policies are implemented, who is empowered by these policies, and who is disempowered. 

“The AIDS movement is one of the best examples of how groups of people experiencing intersecting inequalities can unite to overcome them, leading to millions of lives being saved,” said Professor Joseph Stiglitz, Nobel laureate in economics. “But those gains were not permanent. Now a heating world combined with systemic inequalities mean that new disease outbreaks are becoming more frequent and while technological advancement is important, if there’s not a serious move to tackle inequality, the pattern of prolonged pandemics will only continue.” Professor Stiglitz was speaking at the AIDS Conference’s flagship session entitled “How Inequalities Perpetuate Pandemics: Why We Need a New Approach to End AIDS.”

New HIV infections occurred disproportionately among young women and adolescent girls, with a new infection every two minutes in this population in 2021. The gendered HIV impact, particularly for young African women and girls, occurred amidst disruption of key HIV treatment and prevention services, millions of girls out of school due to pandemics, and spikes in teenage pregnancies and gender-based violence. In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men. 

Worldwide, only half (52%) of children living with HIV have access to life-saving medicine, and the inequality in HIV treatment coverage between children and adults is increasing rather than narrowing.​

Racial inequalities drive HIV too. In the United Kingdom and the United States, declines in new HIV diagnoses have been smaller among Black populations than among White. In Australia, Canada and the United States, HIV acquisition rates are higher in Indigenous communities than in non-Indigenous communities. 

Sbongile Nkosi, Co-Executive Director of the Global Network of PLHIV stated “Our experiences to date remind us that responding to pandemics such as HIV and COVID-19 is not just about dealing with a medical condition, it’s also about the environment in which we live and how my social status will determine the care I receive. It means centering interventions around the needs of people, listening to people. When we talk about key populations, we tend to group people. But then we misunderstand inequalities. People live intersecting lives and inequalities affect them differently.” During the disruptions of the last few years, key populations have been particularly affected in many communities – with rising prevalence in many locations. UNAIDS data have shown increasing risk of new infections faced by gay men and other men who have sex with men (MSM) globally. As of 2021, UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk.

Just as tackling inequalities has been key to progress in tackling HIV,  so it is in tackling COVID-19. But too many COVID-19 responses have ignored this. “We have failed to learn a lot of the lessons from HIV/AIDS in the way we responded to COVID-19. And we need to be honest about that and reflect on where we go from here,” noted Executive Director of the Global Fund, Peter Sands.

“It's time not only to know your gaps but to close those gaps,” said Ambassador John Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy. 

Today’s inequalities are bleak. But the most important message is a hopeful one.  We know how to end AIDS by 2030 and also how to overcome Monkeypox, COVID-19 and other current and future health threats: when we tackle the inequalities which drive health risks, we can keep everyone safe.

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 1 March, Marc Angel, a Member of the European Parliament and former champion for the 90–90–90 HIV targets, hosted a virtual Zero Discrimination Day parliamentary event. The event, co-organized by the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination (Global Partnership), brought together high-level speakers who are passionate about ending discrimination in the European Union (EU) and beyond.

The speakers addressed HIV-related rights violations, societal barriers, including laws and policies, and the underlying stigma and discrimination that fuels the AIDS pandemic. Reflecting on their own work and experiences, they discussed how the EU and its member states could advance the work of the Global Partnership in ending discriminatory laws, policies and practices within the EU region and partner countries.

“Stigma and discrimination hurt the fight against HIV/AIDS, as they constitute a major obstacle to seeking testing and accessing or staying on treatment,” said Helena Dalli, the EU Commissioner for Equality. “We can, and must, combat HIV stigma and discrimination, speak up, collect evidence and share facts and knowledge.”

Evidence gathered by community networks and civil society organizations reveals significant levels of stigma and discrimination and other human rights violations that impact people living with and affected by HIV in the EU, which has been exacerbated by the COVID-19 pandemic.

“When it comes to the EU, there are still growing inequalities, which are major barriers in the HIV response,” said Ferenc Bagyinszky, the Executive Coordinator of AIDS Action Europe. “The global AIDS strategy gives an excellent opportunity for the EU and its member states, together with the communities, to work towards ending these inequalities in the EU, especially in relation to the 10–10–10 targets.”

“The EU can make a critical contribution to address HIV-related stigma and discrimination by establishing linkages with its various human rights and gender equality projects,” said Mandeep Dhaliwal, Director of the HIV, Health and Development Group of the United Nations Development Programme.

“By leveraging its expertise, resources and political leadership to support communities and partner countries in ending HIV-related stigma and discrimination wherever it exists, the EU can make a huge contribution to getting the HIV response back on track,” said Matthew Kavanagh, UNAIDS Deputy Executive Director, a.i., Policy, Advocacy and Knowledge.

To date, 29 countries, none of which are EU member states, have joined the Global Partnership.

Luxembourg’s Minister for Development and Humanitarian Affairs, Franz Fayot, announced Luxembourg’s support for the Global Partnership, the first EU member state to do so. “We support the work of the Global Partnership and can only applaud its role in assisting countries in achieving the 10–10–10 targets by removing laws that harm and creating laws that empower. The Global Partnership’s strategic approach and inclusive platform to manage the diverse human rights violations faced by people living with HIV and marginalized populations will be key to addressing counterproductive discriminatory practices,” Mr Fayot said.

“The Global Partnership is a unique opportunity for the EU and its member states to end intersecting inequalities and injustices for a pandemic-resilient Europe and the world,” said Mr Angel.

Catharina Rinzema, a Member of the European Parliament, spoke about the importance of talking about HIV openly, to correct misconceptions and help the public to educate themselves. She also alluded to the stigma and discrimination that lesbian, gay, bisexual, transgender and intersex people face in the EU. “We should have a blood donation policy where it doesn’t matter with whom you have sex, but whether the sex was safe,” she said.

Maria Walsh, a Member of the European Parliament, referred to the effects that stigma and discrimination has on the mental health and well-being of people living with HIV and called for an inclusive and comprehensive EU mental health strategy. “In order to break the stigma and empower HIV-positive people, it is essential that we speak openly and honestly about their lived experience,” she said.

Mr Angel concluded by encouraging EU member states to join the Global Partnership and highlighted the need for global and concerted action to meaningfully advance towards ending HIV-related stigma, discrimination, inequalities and AIDS by 2030. 

Michael James (not his real name) was shell-shocked when he was fired. He scanned the dismissal letter. It cited his performance and tardiness as reasons for the job loss. But years of performance appraisals told a different story. He’d consistently received positive evaluations and there were no memos about late-coming or substandard work on his file. The only reason he could discern was that colleagues recently learned that he was living with HIV.

HIV-related prejudice remains rife in Jamaica. One third of people living with HIV responding to the 2020 Jamaica People Living with HIV Stigma Index reported experiencing stigma and discrimination. Verbal harassment, gossip and discriminatory remarks were the most common violations. But one in 10 said they were refused employment or lost a source of income because of their HIV status. No legislation prohibits a Jamaican employer from discriminating on the basis of HIV status.

This has marked implications for the HIV response. Twenty-one per cent of respondents were worried about mistreatment or confidentiality breaches by health-care workers. Thirty-eight per cent delayed testing and 29% delayed starting treatment because of concerns about how they would be treated.

Shelly John (not her real name) recounts hopping from one treatment site to another before landing at Jamaica AIDS Support for Life. At other facilities she overheard nurses gossiping about patients’ medical histories.

“I felt uncomfortable. If I am hearing about other clients, other clients can come inside and hear about me as well,” she reasoned.

“The fear of stigma drives some persons underground and away from much needed health services. Owing to stigma and discrimination, some persons delay accessing needed services and, as a result, some are diagnosed with HIV at an advanced stage,” acknowledged State Minister in the Health and Wellness Ministry and Chair of the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination, Juliet Cuthbert Flynn.

Jamaica’s testing and treatment outcomes bear this out. While an estimated 86% of people living with HIV were aware of their status in 2020, just 40% of people living with HIV were on HIV treatment.

While the Jamaica Charter of Fundamental Rights and Freedom guarantees protection against discrimination, it is limited in scope. The protected grounds are race, sex, place of origin, social class, colour, religion and political opinions. There are piecemeal anti-discrimination provisions in different pieces of legislation, such as the 2014 Disabilities Act and the 1975 Employment Act. But neither the constitution nor ordinary legislation make discrimination on other grounds unlawful.

Since 2020, UNAIDS and the United Nations Development Programme have been providing technical and financial support to local nongovernmental organizations, including Jamaica AIDS Support for Life, to support the rollout of a national survey on the public’s perspectives and experiences with stigma and discrimination in Jamaica and on the need to have more adequate protections in the law. The results of the survey will be used to advocate for legislation to adequately deal with discrimination experienced by vulnerable and marginalized groups.

The proposed legislation should provide protection across areas including discrimination based on health status, pregnancy or childbirth, hiring or termination decisions and the denial of services to minority groups. It should also address discriminatory conduct based on assumptions about a person’s competence, capabilities, age, self-expression, income level, the neighbourhood in which they live or their educational background.

“Comprehensive anti-discrimination legislation will strengthen the legal framework for the protection of human rights towards achieving equality for all,” Manoela Manova, the UNAIDS Country Director for Jamaica, explained.

In real terms, this means that duty-bearers will have to consider how their policies, programmes and services will affect people with the protected characteristics. Critically, the focus on markers related to poverty would mean that for the first time public bodies will have a duty to consider socioeconomic disadvantage when making strategic decisions about how to exercise their functions and when proposing to use public funds.

“Our overarching finding has been that regardless of health status, sex, age or sexual orientation, the factor that fuels discrimination and makes people more vulnerable is poverty. Moving forward, it is critical that we don’t treat HIV as a stand-alone concern but address the full picture of what makes people marginalized and vulnerable in Jamaica,” said UNAIDS Community Support Adviser for Jamaica, Ruben Pages Ramos.

DUBLIN/GENEVA, 1 March 2022—Ireland has today announced that it is increasing its core funding for UNAIDS from €2.4 million in 2021 to €2.5 million in 2022. The announcement was made at a meeting in Dublin between Ireland’s Minister for Overseas Development Aid and Diaspora, Colm Brophy, and the Executive Director of UNAIDS, Winnie Byanyima.

Ireland has been a partner and supporter of UNAIDS for more than 20 years. It has supported programmes that reduce the impact of HIV among some of the most-at-risk groups, including gay men and other men who have sex with men and young women and girls. In addition to the €2.4 million contribution in 2021, Ireland provided €1 million in support of UNAIDS’ zero discrimination agenda.

“Ireland is a strong leader in the global AIDS response and continues to be a steadfast ally to UNAIDS,” said Ms Byanyima. “This additional financial contribution from Irish Aid is an important signal at a time when the world must step up its efforts to remove laws that harm and instead create laws that empower so that people can receive life-saving and life-changing HIV services.”  

This year on Zero Discrimination Day, which is being held under the theme “Remove laws that harm, create laws that empower”, UNAIDS is highlighting the urgent need to take action against discriminatory laws. In many countries, laws result in people being treated differently, excluded from essential services or being subject to undue restrictions on how they live their lives, simply because of who they are, what they do or who they love. Such laws are discriminatory—they deny human rights and fundamental freedoms.

On Zero Discrimination Day, 1 March, we celebrate the right of everyone to live a full and productive life—and live it with dignity and free from discrimination.

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.

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. 

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform the way they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realized that transgender Guyanese exist and are part of our society. Some thought we should be treated equally and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitization that are needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of health-care providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected. Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalization of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritizing issues that it says go to the heart of transgender’s people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

Nargis was born in Dushanbe, Tajikistan, into a large family. Life was not easy, and she was sent to a boarding school for low-income families. Her favourite subject at school was physical education, excelling at basketball and swimming. She hoped that after graduating from school in 1991 with a diploma in physical education she would continue her studies at a technical school.

However, because of unrest in the country, she couldn’t carry on with her schooling. “I cried for six months, I really wanted to continue my studies, but instead of going to a technical school, my parents married me off. I was not yet 16 years old then,” said Nargis. When she was 17 years old, she gave birth to a son; five years later, while pregnant with her second child, she learned that her husband was involved in drug trafficking, and he was sent to prison.

From that time on, Nargis had to provide for herself and her family on her own. She got a job in a casino. The earnings were good, but it was there that she started taking drugs. “I was a shy girl, so to make me feel relaxed, I used drugs. From there, I became a drug addict. I didn’t even notice how it happened,” she recalled.

She was eventually fired from her job because of her drug-taking and was forced to look for other ways to survive.

Nargis injected drugs for 14 years, but she started on opioid substitution therapy when it was made available in the country. “While I was on methadone, I was hired as a peer counsellor. I worked with drug users, with people living with HIV. I worked as a consultant in several HIV prevention projects,” said Nargis.

Nargis remained on methadone until May 2021. “Last year, I had to stop methadone because I was sent to prison and there was no methadone in prison. It was very hard, I was in the prison hospital for several months, but as a result I got off methadone and, so far, I am holding on.”

Nargis was imprisoned under Article 125 of the Criminal Code of Tajikistan, under which it is a criminal offence to infect someone with HIV or to put them at risk of HIV infection. Based on this article, law enforcement agencies initiate criminal cases against people living with HIV just on the basis of the potential threat of HIV transmission or simply just based on their HIV-positive status.

“I have been taking antiretroviral therapy since 2013. I have never interrupted it. I have an undetectable viral load. No one wrote a statement against me. I did not infect anyone. The accusation was made on the basis of a note from a man I knew, because we were dating,” Nargis said.

The legislation does not take into account the informed consent of the other sexual partner, regardless of whether there was a risk of HIV infection, or whether the person living with HIV takes precautions against HIV transmission. In addition, the legislation does not define how someone living with HIV should declare their HIV status. In effect, all people living with HIV who have sex can be held criminally liable.

Nargis explained her shame, “Law enforcement agencies called everyone, doctors, my colleagues, relatives, and told them about my HIV diagnosis, asked what kind of relationship we were in, dishonoured me.”

“Article 162 of the Health Code gives doctors the right to disclose the status of HIV-infected patients at the request of the investigating authorities, and does not contain any justification for this. Some criminal cases under part 1 of Article 125 were initiated after the HIV clinic disclosed information about HIV to law enforcement agencies. During the investigation and trial, the defendants’ right to confidentiality regarding their HIV status is not ensured, since investigators, officials, court clerks and judges can request medical information in accordance with the provisions of the Health Code without any specific conditions,” said Larisa Aleksandrova, a lawyer.

Nargis is now free, but she said that she was just lucky. “I was released under an amnesty in connection with the 30th anniversary of the republic.”

She is out of prison, but there are still dozens of other people convicted under Article 125. Now that everyone knows that she is living with HIV, Nargis is ready to fearlessly fight for the right to live, work and love, despite her HIV status.

Nargis continues to work as a volunteer peer consultant on HIV prevention. She has many plans, but the main goal that she is striving for is the revision of articles criminalizing HIV in Tajikistan.

“I always say that there should be more information about HIV, about people living with HIV, so that they don’t fear us the way they do now. Now everything has changed, there is treatment, there is prevention. An HIV diagnosis should not be a guilty verdict—it’s just a diagnosis.”

Most countries in the eastern Europe and central Asia region have criminal penalties and various types of punishment, including imprisonment, for concealing a source of HIV infection, for putting someone at risk of HIV or for transmitting HIV. HIV criminalization disproportionately affects marginalized populations, especially women. Women are more likely to find out their HIV status when accessing health care, such as for pregnancy, and are more likely to be criminalized and punished.

“We know for certain that laws that criminalize HIV are counterproductive, undermining rather than supporting efforts to prevent new HIV infections. We hope that by consolidating the efforts of governments and public organizations it will be possible to revise outdated laws in the near future, taking into account the latest data on HIV, which will allow people living with HIV, or those who are most at risk of infection, to be open in their relationships with medical organizations, to disclose their HIV status and use affordable medical services,” said Eleanora Hvazdziova, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Discriminatory experiences within health-care settings can be especially common and pernicious. Country data reported to UNAIDS show that the proportions of people belonging to key populations who avoid health-care services due to stigma and/or discrimination remain disconcertingly high. Across all key populations, at least one in three reporting countries stated that more than 10% of respondents avoided health care, including three in four countries for people who inject drugs.

Removing laws that harm, such as laws on sex work, same-sex sexual relations, the use or possession of drugs for personal use and the non-disclosure, exposure or transmission of HIV, is one way of overcoming stigma and discrimination and hence increasing the uptake of services by key populations.

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. 

Criminalization of same-sex sexual relations, sex work, drug possession and use, and HIV exposure, non-disclosure and transmission have been shown to block HIV service access and increase HIV risk.

Countries that criminalize key populations saw less progress towards HIV testing and treatment targets over the past five years—with significantly lower percentages of people living with HIV knowing their HIV status and achieving viral suppression than in countries that avoided criminalization. Even greater gains were achieved in countries where laws have advanced human rights protections, particularly those that protected rights to non-discrimination and responded to gender-based violence. Despite this compelling evidence, discriminatory and punitive laws remain alarmingly common.