Gender based violence

A national forum of women living with HIV and women’s leaders was convened in Nairobi, Kenya, on 28 and 29 June to discuss sexual and gender-based violence, especially against women living with HIV.

Participants at the national forum, supported by the United Nations Development Programme and the national network of people living with HIV, in partnership with the National AIDS Control Council and UNAIDS, recognized the slow progress in realizing gender equality and women’s empowerment in Kenya.

The forum called for greater protection from, and response to, sexual and gender-based violence, including access to justice. The HIV and AIDS Tribunal of Kenya—the only HIV-specific statutory body in the world—was cited as a model that could be used to accelerate access to justice. It aims to protect and promote the rights of people living with and affected by HIV in Kenya by increasing access to justice. The forum participants agreed to engage with the tribunal to seek redress and information on preventing violence, especially against women living with HIV.

The forum stressed the importance of holding the government accountable for the implementation of policies and guidelines to protect women from violence, a significant driver of new infections among women and adolescent girls.

Gender-based violence is a global health challenge—women who experience violence are more likely to acquire HIV and women living with HIV are more likely to be subjected to violence. 

Human rights experts have called for concerted efforts to end human rights violations based on sexual orientation and gender identity.

A report launched today during the 58th Ordinary Session of the African Commission on Human and Peoples’ Rights, being held in Banjul, Gambia, summarizes a historic dialogue that took place in November 2015 between United Nations human rights experts and representatives of the African Commission on Human and Peoples’ Rights and the Inter-American Commission on Human Rights.

The report, Ending violence and other human rights violations based on sexual orientation and gender identity, highlights grave violations that take place in all regions of the world against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

The report notes the impact of these abuses on the health of LGBTI people and their access to HIV prevention and care, but also emphasizes positive developments made around the world in protecting the rights of LGBTI people.

In 2014, the African Commission on Human and Peoples’ Rights adopted a resolution calling for the protection of people against violence and other violations on the basis of their real or perceived sexual orientation or gender identity. Commenting on the launch of the report, Pansy Tlakula, Chairperson of the African Commission on Human and Peoples’ Rights, said, “Violence and other human rights violations based on sexual orientation and gender identity constitute universal challenges that require concerted responses by national, regional and United Nations human rights institutions.”

The Inter-American Commission on Human Rights has established a rapporteurship on the rights of LGBTI people. James Cavallaro, President of the Inter-American Commission on Human Rights, highlighted a fundamental element of the work of the Commission. “Bringing the voices of lesbian, gay, bisexual, transgender and intersex people into our work is to challenge the invisibility of the serious human rights violations that they continue to face throughout the Americas and hold States accountable for these violations,” he said.

The United Nations Human Rights Council has passed two resolutions condemning violence and discrimination based on sexual orientation and gender identity. “The dialogue allowed us to share good practices to guide our common struggle to combat impunity and to ensure the protection and realization of the human rights of all individuals, including lesbian, gay, bisexual, transgender and intersex people,” said Christof Heyns, United Nations Special Rapporteur on extrajudicial, summary or arbitrary executions.

The UNAIDS Executive Director, Michel Sidibé, and the United Nations High Commissioner for Human Rights, Zeid Ra’ad Al Hussein, said on the launch of the report, “Ending violence, criminalization, discrimination and other human rights violations against lesbian, gay, bisexual, transgender and intersex people are priorities for our organizations and for the entire United Nations system.”

Civil society organizations have also welcomed the report. “Ongoing collaboration and openness to experience-sharing between regional and international human rights systems reinforces the idea of the universality of human rights, and can only help advance the protection of human rights for everyone, including for LGBTI people,” said Sibongile Ndashe, Executive Director of the Initiative for Strategic Litigation in Africa.

As part of the global effort to achieve the Millennium Development Goals (MDGs), countries around the world reported major gains in the health and wellbeing of women and children between 1990 and 2015. The global rate of maternal mortality fell by 47 per cent and child mortality declined by 49 per cent. However, any celebration of progress is tempered by the reality that millions of women, children, newborns, and adolescents continue to die every year; mostly from preventable causes. As the world transitions from the MDGs to the Sustainable Development Goals (SDGs), we must uphold our commitment to keep reproductive, maternal, newborn, child, and adolescent health (RMNCAH) at the heart of the global agenda. Fulfilling this promise is both a practical imperative and a moral obligation.

The UN Secretary-General's Global Strategy for Women's, Children's, and Adolescents' Health sets out a plan to give every woman, child, and adolescent the opportunity to not only survive, but to thrive and transform his or her community. Implementing the Global Strategy and achieving the SDG targets requires an unprecedented level of alignment and coordination amongst each and every one of us working in the field of RMNCAH.

On behalf of the six organizations responsible for promoting and implementing the global health agenda across the UN system, UNAIDS, UNFPA, UNICEF, UN Women, WHO, and the World Bank Group, we, the undersigned, stand united in our commitment to operationalize the Global Strategy.

Building on our tradition of working together to support countries in achieving the MDGs, we, as members of the H6 (previously known as the H4+), will provide coordinated technical support to country-led efforts to implement the Global Strategy and achieve the ambitious targets of the health-related SDGs. At the same time, we will continue to advocate for evidence-based RMNCAH programmes and policies at the global, regional, and national levels.

As the current H6 chair (2016-2018), UNAIDS will lead the partnership in fulfilling its mandate to leverage the strengths and capacities of each of the six member organizations in order to support high-burden countries in their efforts to improve the survival, health, and well-being of every woman, newborn, child, and adolescent.

As representatives of the H6, we renew our commitment to implement this mandate in support of the Global Strategy. We call on RMNCAH activists and advocates worldwide to join us in fulfilling this shared pledge to women, children, and adolescents everywhere.

Michel Sidibé, Executive Director, UNAIDS

Babatunde Osotimehin, Executive Director, UNFPA

Anthony Lake, Executive Director, UNICEF

Phumzile Mlambo-Ngcuka, Executive Director, UN Women

Margaret Chan, Director General, WHO

Tim Evans, Senior Director, Health, Nutrition and Population Global Practice, The World Bank Group

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.

Sexual violence is a global problem. An estimated one in three women has experienced physical and/or sexual violence, and 120 million girls worldwide experienced forced sexual intercourse before their 18th birthday. Moreover, in high HIV prevalence settings women who experience intimate partner violence are 50% more likely to acquire HIV than other women.

Access to post-exposure prophylaxis (PEP) in the event of sexual violence, rape or unprotected sexual intercourse within 72 hours can reduce the risk of HIV infection by more than 80%. However, PEP alone is not enough and needs to be part of a package that includes action to address sexually transmitted infections, pregnancy, physical injury, mental illness and access to justice and legal protection.

Supporting people throughout their recovery, including in adhering to the full 28-day course of antiretroviral medicines that needs to be taken for PEP to be effective, is critical. However, people still face many barriers to freely accessing quality services, including stigma and discrimination in health-care settings.

On 16 March, Together for Girls, the World Health Organization and UNAIDS hosted a side event on the margins of the sixtieth session of the Commission on the Status of Women to promote the Every Hour Matters campaign, which will increase awareness of the importance of rapid access to comprehensive post-rape care.

Health-care workers, uniformed services, peacekeepers and others involved in post-rape care must be trained in gender-sensitive methods of relating to people who have experienced sexual violence and to deliver care without judgement and free of discrimination.

Reducing gender-based violence to lessen the risk of acquiring HIV and its impact is at the core of the UNAIDS 2016–2021 Strategy. The United Nations General Assembly High-Level Meeting on Ending AIDS, to be held in June, and the accompanying Political Declaration on AIDS are a critical opportunity to ensure that the sexual and reproductive health and rights of women and girls are promoted and their right to live in a safe environment free from violence is assured.

Together for Girls is a global public–private partnership dedicated to ending violence against children, with a focus on sexual violence. To address this human rights violation and public health problem, Together for Girls brings together the expertise and resources of many organizations working in development, public health and children’s and women’s rights to collaborate with national governments and civil society.

For more information on the campaign, see the Together for Girls website at http://www.togetherforgirls.org/every-hour-matters/.

If the Fast-Track approach to end the AIDS epidemic is to be successful, the rights, roles and responsibilities of men in the AIDS response need to be placed firmly on the global agenda.

It has long been noted that the Fast-Track Strategy cannot be achieved without action on gender equality and human rights. The vulnerability of young women and girls has been an important focus of many programmes and has been debated many times, but more recognition is needed that harmful norms also drive the epidemic among men. Health systems are falling short of addressing the needs of men, which is having a negative impact on the health of both men and women.

“Men play a critical role. When we engage men for their own health and to change harmful gender norms, we improve both men’s and women’s health. This is an essential element of the UNAIDS Fast-Track approach to ending the AIDS epidemic,” said Michel Sidibé, UNAIDS Executive Director.

Reaching men with HIV-related prevention, treatment, care and support services is vital. Men and adolescent boys make up nearly 49% of the global population of 34.3 million adults living with HIV and account for 52% of all new adult HIV infections. Around 60% of the 1.2 million people who died of AIDS-related illness in 2014 were male.

According to UNAIDS, there is a lack of services for men who are at higher risk of HIV infection. Diversity among men, including age, risk behaviour and sexual orientation, needs to be taken into account when planning programmes.

Women under the age of 25 are often vulnerable to HIV, and gender inequality and the structures of society often prevent them from accessing the HIV information and services that can protect them. Men, on the other hand, are affected later in life and are more empowered to access services, but, for many reasons, they don’t.

Men’s access to HIV services is important for their own health but it is also an important way to reduce vulnerability among women. Engaging men in health services for their own health can also provide an entry point for programmes that can also transform harmful gender norms.

UNAIDS calls for more work to be done to explore exactly how harmful gender norms and notions of masculinity may increase men’s vulnerability. For example, stereotypes of male “strength” and invincibility can lead to men not using condoms and avoiding health services, such as HIV testing. It has been shown by research in 12 low- and middle-income countries that men with less equitable attitudes to women are less likely to be tested for HIV.

In addition, studies have reported that men are more likely not to seek out—and stick to—antiretroviral therapy.

UNAIDS contends that health professionals themselves often assume that men do not need, or are not willing to use, HIV-related services. There is a need for such preconceptions to change, with the development of comprehensive policies and programmes that promote men’s access to programmes and address their specific needs. This means changing the perceptions of men in the response to HIV, as they are often referred to as “transmitters” or “vectors”, stereotypes that blame them for infection, stigmatize them and isolate them further from accessing services.

There is a call for a global shift in the discussion on HIV and gender—that it should become more inclusive of men and encourage their greater positive engagement in all aspects of the AIDS response and in advancing gender equality. Sexual and reproductive health is not the responsibility of women alone. Focused, integrated sexual and reproductive health services must be made available to men and adolescent boys. Although much more research needs to be done, there is already a body of data that lays the groundwork for developing and implementing more comprehensive policies and programmes.

To reflect the seriousness of this issue and the need to chart the way forward, a global high-level meeting on men, adolescent boys and AIDS is being held in Geneva on 10 and 11 December. It is co-convened by UNAIDS, Sonke Gender Justice and the International Planned Parenthood Federation. The main objectives are, broadly, to build consensus on what the evidence is saying about men and adolescent boys in the HIV response and what role they have to play in ending the AIDS epidemic. 

GENEVA, 25 November 2015—On the International Day for the Elimination of Violence against Women, UNAIDS is urging countries to put women and girls at the centre of efforts to end the AIDS epidemic by 2030.

AIDS is the leading cause of death of women of reproductive age (15–49 years) and adolescent girls and young women are most affected by HIV. Every year around 380 000 adolescent girls and young women become newly infected with HIV and in sub-Saharan Africa adolescent girls and young women aged 15–24 years account for one in every four new HIV infections.

“AIDS-related deaths are increasing among adolescents and we are seeing increased violence against young women,” said UNAIDS Executive Director Michel Sidibé. “Our call is to address the root cause—gender inequality, which can result in violence, lack of esteem, growing vulnerability and difficulty for young women and girls to make empowered and informed decisions about their health and well-being.”

In some regions, women who have experienced physical or sexual partner violence are 1.5 times more likely to acquire HIV compared to women who have not. While the experiences of violence faced by women living with HIV mirror those of women generally, living with HIV exposes women and girls to other forms of violence, including forced and coerced sterilization, because of their HIV-positive status.

The heightened vulnerability of women and girls to HIV is intricately linked to the sociocultural, economic and political inequalities they experience. Ending the AIDS epidemic will depend on a social justice agenda that demands equity in education, employment, political representation and access to justice and health, free from violence.  

At the start of the annual 16 Days of Activism against Gender-Based Violence, which is being held under the 2015 theme of “From peace in the home to peace in the world: make education safe for all,” UNAIDS is urging all countries to ensure the engagement and empowerment of women as a top priority to enable women and girls to live in a world free of inequalities and violence.

The newly adopted Sustainable Development Goals, as well as the UNAIDS 2016–2021 Strategy, reflect a collective global commitment to achieve gender equality, eliminate gender-based violence and advance the rights of women and girls, including sexual and reproductive health and rights, and their empowerment. Significantly, they provide a bold blueprint for action. These goals and targets call for true collaboration across sectors and generations to scale up efforts to ensure the safety and empowerment of women and girls everywhere. 

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.

Women living with HIV in western and central Africa gathered in Abuja, Nigeria, from 2 to 5 November for a workshop to improve their leadership skills and ability to advocate for the ambitious 90–90–90 treatment target.

The target is that by 2020, 90% of people living with HIV will know their status, 90% of people who know their HIV-positive status will be accessing antiretroviral treatment and 90% of people on treatment will have suppressed viral loads. If the target is reached by 2020, ending the AIDS epidemic as a public health threat is possible by 2030.

Under the umbrella of the International Community of Women Living with HIV/AIDS, West Africa, the 47 participants from 16 countries enhanced their understanding of the ambitious treatment target and policies on elimination of mother-to-child transmission of HIV.

They agreed to champion the 90–90–90 treatment target in western and central Africa and to urge their governments to increase domestic funding for health, including the AIDS response, to 15% of national budgets, as recommended by the African Union in its 2001 Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. Participants also agreed to advocate for the full engagement and representation of women living with HIV in the national planning and decision-making processes.

UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Robert Carr Civil Society Networks Fund supported the training.

Twelve United Nations (UN) entities have released a joint statement calling for an end to violence and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people. The joint statement highlights the UN’s inter-agency commitment on working with Member States to protect, respect and fulfil the right of LGBTI people to live free from violence, persecution, discrimination and stigma. It also calls on countries to repeal discriminatory laws.

LGBTI people face a wide range of human rights violations. The UN and others have documented widespread physical and psychological violence against LGBTI people in all regions, including murder, assault, kidnapping, rape and sexual violence, as well as torture and ill-treatment in institutional and other settings.

In many countries, the response to these violations is inadequate; in others, human rights defenders challenging these violations are frequently persecuted and face restrictions on their activities. The legislative framework can exacerbate the situation, with 76 countries criminalizing consensual same-sex relationships between adults. These laws expose individuals to the risk of arbitrary arrest, prosecution, imprisonment and even the death penalty in at least five countries.

Punitive environments that marginalize LGBTI people also create significant challenges in responding to HIV. Gay men and other men who have sex with men are 19 times more likely to be living with HIV than the general population, and HIV prevalence among gay men and other men who have sex with men is rising in certain regions, including Asia and the Pacific and Latin America. Transgender women are 49 times more likely to be living with HIV.

In addition to violating the fundamental human rights of LGBTI people, punitive laws severely restrict the ability of LGBTI people to access critical HIV and other health services. Service providers are often forced to stop working, owing to harassment or fear of prosecution.

The UN Secretary-General, Ban Ki-moon, re-affirmed his support for LGBTI rights with a message delivered during last year’s UN General Assembly. “The fight for human rights—and the fight against discrimination—lies at the core of the mission of the United Nations. The fight for equal rights demands global engagement. That is why the United Nations actively works to tackle homophobia and transphobia around the world,” he said.

The UN entities that have signed the joint statement on ending violence and discrimination against LGBTI people are: the International Labour Organization (ILO); the Office of the High Commissioner for Human Rights (OHCHR); the United Nations Development Programme (UNDP); the United Nations Educational, Scientific and Cultural Organization (UNESCO); the United Nations Population Fund (UNFPA); the Office of the United Nations High Commissioner for Refugees (UNHCR); the United Nations Children’s Fund (UNICEF); the United Nations Office on Drugs and Crime (UNODC); the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women); the World Food Programme (WFP); the World Health Organization (WHO); and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Read the joint statement

United Nations entities call on States to act urgently to end violence and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI)[1] adults, adolescents and children.

All people have an equal right to live free from violence, persecution, discrimination and stigma. International human rights law establishes legal obligations on States to ensure that every person, without distinction, can enjoy these rights. While welcoming increasing efforts in many countries to protect the rights of LGBTI people, we remain seriously concerned that around the world, millions of LGBTI individuals, those perceived as LGBTI and their families face widespread human rights violations. This is cause for alarm – and action.

Failure to uphold the human rights of LGBTI people and protect them against abuses such as violence and discriminatory laws and practices, constitute serious violations of international human rights law and have a far-reaching impact on society – contributing to increased vulnerability to ill health including HIV infection, social and economic exclusion, putting strain on families and communities, and impacting negatively on economic growth, decent work and progress towards achievement of the future Sustainable Development Goals. States bear the primary duty under international law to protect everyone from discrimination and violence. These violations therefore require an urgent response by governments, parliaments, judiciaries and national human rights institutions. Community, religious and political leaders, workers’ organizations, the private sector, health providers, civil society organizations and the media also have important roles to play. Human rights are universal – cultural, religious and moral practices and beliefs and social attitudes cannot be invoked to justify human rights violations against any group, including LGBTI persons.

PROTECTING INDIVIDUALS FROM VIOLENCE

States should protect LGBTI persons from violence, torture and ill-treatment, including by:

• Investigating, prosecuting and providing remedy for acts of violence, torture and ill-treatment against LGBTI adults, adolescents and children, and those who defend their human rights;
• Strengthening efforts to prevent, monitor and report such violence;
• Incorporating homophobia and transphobia as aggravating factors in laws against hate crime and hate speech;
• Recognizing that persecution of people because they are (or are perceived to be) LGBTI may constitute a valid ground for asylum, and not returning such refugees to a place where their life or freedom might be threatened.

The United Nations and others have documented widespread physical and psychological violence against LGBTI persons in all regions - including murder, assault, kidnapping, rape, sexual violence, as well as torture and ill-treatment in institutional and other setting. LGBTI youth and lesbian, bisexual and transgender women are at particular risk of physical, psychological and sexual violence in family and community settings. LGBTI persons often face violence and discrimination when seeking refuge from persecution and in humanitarian emergencies. They may also face abuse in medical settings, including unethical and harmful so-called "therapies" to change sexual orientation, forced or coercive sterilization, forced genital and anal examinations, and unnecessary surgery and treatment on intersex children without their consent. In many countries, the response to these violations is inadequate, they are underreported and often not properly investigated and prosecuted, leading to widespread impunity and lack of justice, remedies and support for victims. Human rights defenders combatting these violations are frequently persecuted and face discriminatory restrictions on their activities.

REPEALING DISCRIMINATORY LAWS

States should respect international human rights standards, including by reviewing, repealing and establishing a moratorium on the application of:

• Laws that criminalize same-sex conduct between consenting adults;
• Laws that criminalize transgender people on the basis of their gender expression;
• Other laws used to arrest, punish or discriminate against people on the basis of their sexual orientation, gender identity or gender expression.

In 76 countries, laws still criminalize consensual same-sex relationships between adults, exposing individuals to the risk of arbitrary arrest, prosecution, imprisonment – even the death penalty, in at least five countries. Laws criminalizing cross-dressing are used to arrest and punish transgender people. Other laws are used to harass, detain, discriminate or place restrictions on the freedom of expression, association and peaceful assembly of lesbian, gay, bisexual and transgender people. These discriminatory laws contribute to perpetuating stigma and discrimination, as well as hate crime, police abuse, torture and ill-treatment, family and community violence, and negatively affect public health by impeding access to health and HIV services.

PROTECTING INDIVIDUALS FROM DISCRIMINATION

States should uphold international human rights standards on non-discrimination, including by:

• Prohibiting discrimination against LGBTI adults, adolescents and children in all contexts – including in education, employment, healthcare, housing, social protection, criminal justice and in asylum and detention settings;
• Ensuring legal recognition of the gender identity of transgender people without abusive requirements;
• Combating prejudice against LGBTI people through dialogue, public education and training;
• Ensuring that LGBTI people are consulted and participate in the design, implementation and monitoring of laws, policies and programmes that affect them, including development and humanitarian initiatives.

LGBTI people face widespread discrimination and exclusion in all contexts - including multiple forms of discrimination based on other factors such as sex, race, ethnicity, age, religion, poverty, migration, disability and health status. Children face bullying, discrimination or expulsion from schools on the basis of their actual or perceived sexual orientation or gender identity, or that of their parents. LGBTI youth rejected by their families experience disproportionate levels of suicide, homelessness and food insecurity. Discrimination and violence contribute to the marginalization of LGBTI people and their vulnerability to ill health including HIV infection, yet they face denial of care, discriminatory attitudes and pathologization in medical and other settings. Transgender people are frequently denied legal recognition of their preferred gender or face abusive requirements such as forced sterilization, treatment or divorce to obtain it, without which they suffer exclusion and marginalization. The exclusion of LGBTI people from the design, implementation and monitoring of laws and policies that affect them perpetuates their social and economic marginalization.

UNITED NATIONS SUPPORT

Our organizations stand ready to support and assist Member States and other stakeholders as they work to address the challenges outlined in this statement – including through constitutional, legislative and policy changes, strengthening of national institutions, and education, training and other initiatives to respect, protect, promote and fulfil the human rights of all LGBTI people.

[1] While this statement refers to lesbian, gay, bisexual, transgender and intersex people, it should also be read to refer to other people who face violence and discrimination on the basis of their actual or perceived sexual orientation, gender identity and sex characteristics, including those who may identify with other terms.

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.