Latin America

The University of San Carlos de Guatemala (USAC) Faculty of Medical Sciences, in collaboration with UNAIDS, the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), launched an online course titled "Conceptos clave sobre VIH, Género y Derechos Humanos" (Key Concepts on HIV, Gender, and Human Rights). The four-module course is designed to provide teaching staff with detailed knowledge about key concepts related to HIV, its treatment and prevention, and the national and international legal framework guiding the response to HIV, as well as the gender and human rights dimensions of the epidemic.

With an estimated three new HIV infections each day in Guatemala and only 73% of the estimated 31,000 people living with HIV receiving antiretroviral treatment and persisting high level of stigma and discrimination towards people living with HIV, the course is a significant step towards addressing the country's HIV challenges. The course aims to provide teaching staff and students with the necessary resources to promote, protect, and fulfill the human rights of adults, adolescents, and children living with or at risk of acquiring HIV, in all their diversity.

The course consists of 140 hours of study, including 70 hours of theory and 70 hours of practice, and will be undertaken between May and August 2023. Course participants will join virtual classes and synchronous group workshops and will have to submit the required tasks according to a work schedule.

The course covers four modules: Module 1 - Update on HIV and AIDS; Module 2 - National and international legal framework for the response to HIV; Module 3 - Health sector Policy framework for HIV response; Module 4- Key concepts on gender and human Rights.

During the inauguration, Marie Engel, UNAIDS Country Director, expressed her hope that participants would enjoy taking the course as much as she and other partners had in developing it. She also emphasized that "the course will be enriched with participants' individual knowledge and experiences, their doubts and concerns. There is obviously a lot of knowledge and wisdom among course participants that the facilitators will strive to capture."

Dr. José María Gramajo, General Coordinator of the USAC Faculty of Medical Sciences' Area of Teachers and Postgraduate training, highlighted that "this refresher course will contribute to the professional development of faculty teachers, sharing with them the latest knowledge about innovations related to HIV prevention, detection, and care, and ensuring an in-depth understanding of cross-cutting issues relevant to HIV and other public health problems."

Teaching staff and students are catalysts with the power to change the national response to HIV. As stated by Dr. Mirna Herrarte, Coordinator of the national HIV, STI, and AIDS program, "I am glad to know that there are so many professionals who want to know more about HIV. In the country, HIV treatment schemes are constantly reviewed. As an anecdote, Guatemala had more than 200 antiretroviral schemes a year ago. Under my leadership, we have reduced those schemes by 75%."

Inequalities persist in the most basic health and HIV services, such as access to screening, treatment, and condoms. USAC's collaborative initiative is an important step towards ensuring that all sectors, including academia, are engaged in ending social, economic, and legal inequities. The University of San Carlos de Guatemala is the largest and oldest university in Guatemala, and the only national and public university in the Central American country. 

In 1988, a group of activists came together in Fortaleza, the fifth largest city in Brazil and capital of Northeastern state of Ceará, to create the local chapter of the National Network of People Living with HIV and AIDS (RNP+CE). The aim was to ensure that people living with HIV could be guaranteed the right to care, treatment adherence, and legal assistance.

Currently, the NGO (Non-Government Organizations) also offers educational workshops, support for the combination prevention of sexually transmitted infections (STIs), and other activities for more than 1,000 registered people. Among them is Carlos Salmão, an HIV activist living in Fortaleza, who felt individually and collectively welcomed by the organization. "This support was very important to me and is fundamental for people living with HIV here in Ceará because it is a reference of the response to the AIDS epidemic. That is why I feel pleasure in contributing", he explains.

The RNP+CE was one of five Brazilian NGOs that received resources from the Fast-track Cities grants initiative, launched by UNAIDS in 2022. With the award, the organization developed actions around two objectives: increasing linkage and adherence of vulnerable key-populations to HIV prevention, diagnosis, and treatment by disseminating and sharing information with health professionals as well as the general public; and improving the knowledge of the Undetectable Equals Untransmittable (U = U) strategy in the city of Fortaleza by carrying out communication campaigns.

Project actions and participation of municipal government

The project involved 10 local HIV-positive activists in the development and implementation of the communication campaigns. They also were involved in preparing a seminar that brought together 120 people from civil society to dialogue about and to present to municipal government representatives proposals to improve the care for people living with HIV, based on the perspectives and actual needs of the users of public health services in Fortaleza. An additional theme of discussion was the challenges and the importance of guaranteeing a satisfactory level of adherence to HIV treatment to avoid abandonment.

Still as part of the project, a booklet on HIV, self-esteem and health was produced and distributed, providing practical information for people who receive a positive diagnosis for HIV. Additionally, in coordination with the municipal government, RNP + CE printed and distributed more than 3,000 copies of posters on HIV treatment adherence and on U = U. This material was displayed in places with high concentrations of people, such as bus terminals, reaching about 1.1 million people daily.

Participation of local government officials was a strategic element to the project’s success, as they are in direct contact with reality and the existing challenges. "We are still far from reaching an ideal level where there is less need to reinforce these [HIV] actions, but we are advancing in this direction through constant and well-structured work", says Carlos Paiva, coordinator of IST/AIDS at the Municipal Health Secretariat of Fortaleza.

Ariadne Ribeiro, UNAIDS Officer for Equality and Rights for All People, agrees and adds: "It is rewarding to see how the dialogue between communities, civil society, and the municipal government is moving towards a common goal, which is the improvement of public policies in the city of Fortaleza for people living with HIV and to end AIDS as a threat to public health."

Standing outside of the cinema house, Rodrigo de Oliveira felt exhilarated by his attendance at more than 40 film festivals around the world to promote his HIV-themed feature film, “The First Fallen.”

“A sense of community is an abstract thing but I have seen the faces of many LGBTQI people during my tour,” he said. “And in a way that is what I tried to show in my movie.”

The film opens on New Year’s eve in 1983. A young man is back in his Brazilian hometown having returned from Paris. He is feeling a bit gloomy and distant. He fears he has come down with something. There are rumblings of an unknown illness but AIDS or HIV is never mentioned until the last scene. De Oliveira chronicles the slow unravelling of the young man’s health who “disappears” and hides in a country house. He is joined by a transgender woman and another acquaintance also feeling ill.  They get various pills from a boyfriend in Paris. Some are early anti-retroviral pills but there are also vitamins and shark fin pills. All three despair at being struck down by a random disease.

“For me there is hope in knowledge, that is fundamental, but as you can see community and support are key to overcome anything,” Mr de Oliveira said.

Rubbing his bald head with his hand he reflected that after seven feature films, this was his first one addressing LGBTQ and HIV issues.

"It took longer for my films to come out of the closet than myself,” he said. “In 2021 I was still fresh-faced on the scene as an out gay man and I lost people to AIDS so this felt like a responsibility to the people I saw disappear in my life.”

Born in 1985, Mr de Oliveira said he thought about HIV every week of his life. For him (as shown in the film) HIV meant death in the 80s and 90s. Since life-saving HIV treatment became readily available, living a healthy life with HIV has become the norm.

Mr de Oliveira explained that during one film screening young people did not know what it meant when two of the characters in his movie showed signs of Kaposi’s Sarcoma (flat, discolored reddish patches on the skin, an indication of cancer triggered by a weak immune system in people living with HIV who are not taking medicine.)

“It was a shock for me this gap in knowledge,” he said. Showing a slice of life from the mid-80s in his native country made even more sense to him following that conversation.

“The LGBTQI community is so used to being left out, we have to document ourselves and this is a testimony of this,” Mr de Oliveira said. “My film with its three main characters approach their ‘random illness’ differently...one is a fighter, the other an archivist and the third an artist/scientist,” he explained.

The three perspectives were important for him to document the fear, the dread and the conscious effort to overcome the crisis. By barely mentioning HIV, de Oliveira wanted to illustrate the ‘grand silence’ around the illness at the time.

In one scene, the young man’s sister demands to see her brother in a run-down clinic but she is frozen out with staff saying, ‘shame will close them down.’ 

“I wanted to talk about the stigma and discrimination, but I could not imagine staging actual aggression,” he said.  

Suki Beavers, UNAIDS Director of Gender Equality, Human Rights and Community Engagement, who shared the stage with Mr de Oliveira at a recent film screening in Geneva during the Everybody’s Perfect film festival, said that the movie reflected people’s lack of rights. And that intersecting inequalities like being poor or being transgender or being gay or not having gone to school only compounded the hardships (the transgender character is fuming at being thrown off a bus after an altercation in one scene.)

“You see a clear violation of rights in Brazil during the 80s as well as activism to reclaim those rights,” she said. “This phenomena is still very much alive in many parts of the world to this day, which is why we cannot give up on the fight to end AIDS.”

Mr de Oliveira added that despite his film’s more sombre note, he wanted people to walk away with the feeling that love is universal. “The kiss between budding friends exemplifies that we will overcome,” he said.

He said that he would like to do two more feature films focusing on the evolution of the AIDS response like chronicling the 90s and then the last two decades.

“It takes me four to five years to make a film but know that I am on the same page as UNAIDS... ending AIDS,” he said. “I just wish I could make a film a day like you save a life a day.”

"My name is Jonathan. Today I'm not going to tell you how I got monkeypox, but how complicated it is to carry this disease", says the activist and crossdresser Jonathan Albinagorta. He is also known as Samantha Braxton, one of the influencers supporting the Ministry of Health in its video campaigning on monkeypox prevention in Peru.

With more than 2300 confirmed cases of Monkeypox by the end of September, Peru had the world's highest infection rate per million people, according to Our World in Data, a collaborative online platform led by researchers at the University of Oxford.

The response to the outbreak in Peru was set up under the leadership of the national HIV strategy team, which developed a plan to raise awareness of the disease. Its public real-time data dashboard, inspired by the COVID-19 response, provided concrete evidence for the rapid of an awareness campaign. However, the same data, mainly from HIV-specialized centres, also had the unwelcome side-effect of increasing stigma and discrimination for some groups of people.

"The data created a biased sample at the beginning. Evidence showed that people living with HIV and some key populations, such as gay men, were among the most affected in Peru", recalls Andrea Boccardi, UNAIDS director for Peru, Bolivia, Ecuador and Colombia. "But these are the very people who have the culture of going to the HIV-friendly services for consultations, for periodical examinations and HIV treatment."

Referral Centers for Sexually Transmitted Infections, known as Cerits, and Periodic Health Care Units provide HIV services for Peru's most vulnerable and key populations. "These groups of people do not go to hospitals where they tend to suffer discrimination. They go to these centres, where the greatest number of monkeypox diagnoses came from at first", explains Boccardi.

Experience in dealing with the HIV pandemic shows that data must be accompanied by adequate information-sharing to the public and impacted groups in a non-stigmatizing way. An inclusive approach and the correct use of language are key to engage with communities so that they become an integral part of the response instead of being driven away.

UNAIDS supported the country in quickly setting up a strategy that included meetings between health officials and civil society representatives. Community leaders also contributed by reviewing messages coming out of the ministry of health.  People also received training to act as spokespeople in media interviews.  

“Often, the communication from the ministry of health ends up being very institutional or quite distant. Something that the community cannot fully digest”, says Mauricio Guitierrez, a GayLatino network activist. “We elaborated friendly visual materials for dissemination. It is important to translate and personalize the information for people and that was what we tried to do by supporting the ministry in these campaigns.”

”As well as informing and clinically diagnosing the most at-risk populations in saunas, hotels, and other sites, monkeypox working group convinced mayors to keep these establishments open and to use them as critical platforms for the dissemination of relevant information on monkeypox directing people to the information and services made available.”

In Peru, LGBTIQ+ people and people living with HIV are the most discriminated against, with 71% and 70% of them, respectively, reporting to have suffered discrimination at some level, according to the National Human Rights Survey released in 2021 by the Ministry of Justice and Ipsos Peru.

“Out of fear of stigma and of what people will say, a lot of us don’t ask and fall into the same trap of ignorance”, says Albinagorta. “It was great that the Ministry placed QR codes in LGBT establishments, for example.”

Alliances with telecom companies and social networking apps, such as Grindr, created opportunities to inform the most vulnerable populations through an estimated 40 million messages focused on monkeypox prevention and treatment. Former COVID-19 spaces were also used for the 21-day isolation period for people not able to comply with thisrequirement, including migrants and refugees.

Despite some early signs of stabilization, the Pan American Health Organization (PAHO) said recently that it is too early to proclaim victory. It called on countries "to intensify the response actions, prioritizing detection, surveillance and community engagement to reduce new cases and put an end to the outbreak in the region." The United States still accounts for more than half of cases, but rapid increases have been witnessed in Brazil, Peru, Colombia, Mexico and Chile in the past month.

The Ministry of Health of Peru is purchasing vaccines through the PAHO Strategic Fund, but the total number of vaccines available for the entire region is 100 000.  The main challenges are the criteria for prioritization as the expected number of vaccines per country will be no more of 5000.

"Many people contacted me after my first video for the ministry of health in Peru. For those who are suspicious, it inspires more confidence to approach someone like me, who has had monkeypox and talks freely about it, than to go to a hospital, an institution or the ministry itself, " says Samantha. "Of course, there are also haters. Some people believe that when a gay man shares that he has had monkeypox, he is stigmatizing himself. But that's not it.”

It was a proud day for Stacy Velasquez the Executive Director of OTRANS Reinas de la Noche in June as she opened the doors to the community clinic that had just been officially approved as a health post by the Ministry of Public Health and Social Assistance. This meant that a full-time doctor was now in position.  

Around 40 transgender women and sex workers have come to the clinic since the doctor's arrival. The clinic has existed for several years, but with the approval by the Ministry of Health and financial support from the Global Fund and OXFAM, patients now have access to comprehensive care: HIV prevention and diagnosis; prevention, diagnosis and treatment of sexually transmitted infections; psychosocial counselling; medical consultations including hormone therapy; a laboratory service for sexual health testing and a pharmacy.

The clinic offers pre-exposure prophylaxis (PrEP), a biomedical intervention within the combination prevention approach, which refers to the use of antiretroviral drugs by HIV-negative individuals to reduce the risk of contracting the virus.

"In 2016, a comprehensive health strategy for trans people was approved with technical support from UNAIDS. It includes a manual of guidelines for the health care of trans people,” said Stacy. “The community clinic and this strategy are the fruit of the work of almost 18 years of advocacy by the trans community."

OTRANS contributes to the Centro de Documentación y Situación Trans de América Latina y el Caribe (CEDOSTALC), a community-based system for collecting information, monitoring and responding to human rights-related barriers faced by the transgender population in 26 countries in Latin American and the Caribbean.

In Guatemala, transgender women still face exclusion, discrimination, stigma, verbal and physical violence, criminalization, marginalization and a lack of recognition of their rights, resulting in a life expectancy of only 35 to 40 years old. The average life expectancy in the country is 74 years old.

During a visit to the clinic, UNAIDS country director, Marie Engel praised the work of the site and paid tribute to Andrea Gonzalez, the OTRANS legal representative who was murdered in 2021.  

“In Guatemala, the HIV prevalence rate is 22.2% among the transgender population, compared to 0.2% for the general population,” said Ms Engel. “And although new HIV infections declined by 23% among all women between 2010 and 2019 globally, they have not declined among transgender women. And yet, transgender people have less access to HIV services than the rest of the population.”

Stigma and discrimination have a profound negative effect on the mental health of transgender people, which in turn can influence their vulnerability to HIV infection. Data reported to UNAIDS in recent years show that the percentage of transgender people who avoid seeking HIV testing due to stigma and discrimination ranges from 47% to 73%.

4 July 2022—UNAIDS congratulates the Argentinian Congress on the approval of a new law on a comprehensive response to HIV, viral hepatitis, tuberculosis and sexually transmitted infections (STIs). The bill, which has had input from a number of civil society organizations, replaces 30-year-old legislation and changes the country’s health approach from a biomedical approach to an approach more focused on gender and human rights. The new law calls for an end to stigma and discrimination against people living with HIV or STIs and aims to stop criminalization of HIV exposure or transmission.

By prohibiting mandatory testing for HIV and other STIs as part of pre-employment exams, the new law also seeks to protect against discrimination in all areas (with emphasis on the workplace) and ensures the privacy of the diagnosis.

“We join the civil society and community movements in this important celebration. The new law is evidence-based and written from the perspective of human rights,” celebrates Alberto Stella, UNAIDS Country Director for Argentina, Chile, Paraguay and Uruguay. “The HIV response in the country now counts on a broad framework of social protection, very much in line with the Global AIDS Strategy (2021-2026), which focuses on ending inequalities to end the AIDS epidemic.”

Besides eradicating discriminatory practices, the new legislation also includes the possibility of early retirement at 50 years old for people who have been living with the virus for ten years and who have paid at least 20 years of pension contributions. It also allows access to a non-contributory pension for life in cases of social vulnerability.

The new bill pays a historical debt for dozens of activists who occupied the balconies of Congress in recent voting sessions and the thousands of people living with HIV they represent. “We are one step closer to eliminating barriers to the implementation of self-testing and promoting prevention strategies such as Pre-Exposure Prophylaxis (PrEP)”, celebrated Fundación Huesped, an Argentinian organization with a regional reach that has advocated for the right to health since 1989.

The new law also recognizes specific rights of women, guarantees the right to health of their children and ensures compliance with the rights recognized in the law for the Integral Protection of Women.

“This is the result of the articulated work conducted by civil society who not only led its elaboration but who also did excellent and hard work on advocacy,” says Stella. “Along with the National HIV, TB, Hepatitis and STI department of the Ministry of Health, UNAIDS was able to contribute with advocacy efforts and the facilitation of dialogues, providing evidence and the informing on international guidelines.”

The new bill also proposes the national production of medication and supplies.

The latest estimates from the UNAIDS 2021 Global AIDS Update report show that 140 000 people are living with HIV in Argentina and 65% of whom are on antiretroviral treatment. Every year 5600 people are newly infected with HIV, and 1400 people die from AIDS-related illnesses.

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.

GENEVA, 27 May 2022—UNAIDS welcomes the Chilean Government’s public acknowledgement of international responsibility in the emblematic case of violations of the rights of women living with HIV who were sterilized without their consent. The President of Chile, Gabriel Boric Font, has issued a public apology as part of a settlement resulting from a case brought before the Inter-American Commission on Human Rights against the Chilean state by Francisca, a Chilean woman living with HIV who was sterilized without her consent shortly after giving birth in 2002.

“We welcome the recognition of international accountability in this emblematic case of human rights violations that women living with HIV and their reproductive autonomy have long suffered,” said Luisa Cabal, Director of the UNAIDS Regional Support Team for Latin America and the Caribbean. “It vindicates a journey of more than 10 years, both for Francisca and the organizations that accompanied her, in her quest for justice.” 

When Francisca—a young woman from a rural town in Chile—turned 20 years old, she and her partner received the happy news of the arrival of their first child. She was diagnosed with HIV in a routine prenatal test. Francisca took all appropriate measures to minimize the risk of vertical transmission of HIV and gave birth to an HIV-negative baby boy in November 2002. However, the day after the caesarean section, Francisca received the devastating news that the surgeon on duty had decided to sterilize her during delivery and without her consent. 

In 2009, the Center for Reproductive Rights and the Chilean organization Vivo Positivo took Francisca’s case to the Inter-American Commission on Human Rights. This case was part of a documentation of stories of Chilean women living with HIV who were often pressured not to become pregnant, as well as to undergo surgical sterilization. One of the documented accounts tells of another woman, identified as Daniela, who, after giving birth, was told that she could not hug or kiss her newborn child because she would transmit HIV to her baby. She said in interviews that this was how she understood what discrimination was. 

After more than a decade of international litigation and after the Inter-American Commission on Human Rights studied the case, a friendly settlement agreement was signed with the Chilean state, in which the government accepted its responsibility and committed to redress the violations and to take measures to ensure that such acts would not happen again. 

UNAIDS intervened in this case with an amicus curiae (friend of the court) brief that informed the Inter-American Commission on Human Rights on the health guidelines and human rights standards that each country must follow to respect, protect and guarantee the human rights of people living with HIV. 

“I would like to start by apologising to Francisca, who I understand is on the other side of the camera, for the serious violation of your rights and also for the denial of justice and for all the time you had to wait for this,” Mr Boric said at the opening of his speech during the official ceremony, broadcast live on social media. “How many people like you do we not know? It hurts to think that the state, which today I have the honour to represent, is responsible for these cases. I pledge to you, and to those who today represent you here in person, that while we govern, we will give the best of each one of us as authorities so that something like this will never happen again and certainly so that in cases where these atrocities have already been committed, they will be properly redressed.” 

“I would love to have been me, with my voice, my face and my body, the one who after so many years of struggle stood present to lead this act in my own name. However, making my identity known would have closed endless doors for me,” said Carmen Martinez, the Associate Director of Legal Strategies for Latin America and the Caribbean for the Center for Reproductive Rights, as she read the words shared by Francisca to the audience. “To this day, people who carry HIV are still looked down upon with contempt as if it was our decision to become infected. However, I want to believe with conviction that this will change.” 

“Finally, justice was done; through this case we call on all governments to continue to invest in the elimination of HIV discrimination in all services, including health care,” said Sara Araya, the Coordinator of Live Positive Gender. “The message is clear: the autonomy and physical integrity of women and all people living with HIV must be secured without discrimination. No more rights violations against women living with HIV.”  

HIV-related stigma and discrimination has a significant impact on the health, lives and well-being of people living with or at risk of HIV. Stigma and discrimination hinders the HIV response by limiting access to broader sexual and reproductive health and other health services. UNAIDS continues to work daily to ensure that governments invest in preventing and responding to violations linked to the forms of intersectional discrimination to which people living with HIV have been subjected.

Francisca delivered a healthy baby boy in 2002 and was then sterilized without her consent by the doctor who carried out her caesarean section, making the decision that a woman living with HIV should not be able to have children. The friendly agreement announced this week comes after more than a decade’s litigation by the woman and her legal teams.

“This settlement is a significant moment for women around the world who have been fighting for reproductive justice for decades. Coercive sterilization of women living with HIV is a violation of women’s most fundamental human rights,” said the Executive Director of UNAIDS, Winnie Byanyima. “Unfortunately, this practice is still happening in many countries and efforts to stop it and bring justice to more women must be stepped up.”

This settlement comes after years of efforts before the Inter-American Commission on Human Rights after an earlier complaint in the Chilean justice system was unsuccessful. The case was litigated by the Chilean organization Vivo Positivo and the international human rights organization Center for Reproductive Rights.

The Global AIDS Strategy 2021–2026: End Inequalities, End AIDS is based on the promotion of human rights, gender equality and dignity, free from stigma and discrimination for all people living with and affected by HIV. It is a commitment by UNAIDS to an ambitious vision to end gender inequalities and realize human rights, including the right to health, calling on all partners and stakeholders in the HIV response in all countries to transform unequal gender norms and end stigma and 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.

Iranilde Pereira Fonseca and Michele Almeida are two middle-aged women who come from different parts of Brazil but share a common childhood memory: they used to collect scraps of cloth to make dresses for the few dolls they had. It was a way to revive their handmade toys since their families rarely had spare money for new ones.

But it was not until the COVID-19 pandemic that they had the opportunity to reconnect with their past and use it as a source of survival and income. They are among the 35 women who participated in the Mulher Empreendedora (Women Entrepreneur) project, a social entrepreneurship project implemented by the Movimento Nacional das Cidadãs Posithivas (MNCP) Brazilian HIV nongovernmental organization as a part of the UNAIDS Solidarity Fund. Along with Ms Fonseca and Ms Almeida, they were trained in artisanal doll techniques and in entrepreneurship, so that they could sell their products and obtain resources to address the impact of COVID-19 on their household incomes.

“I used to get scraps of cloth from my mother and loved to make clothes for the dolls I had, but I had not done any of that for many years,” remembered Ms Fonseca. “Now, with the MNCP project, I learned the process of making a doll completely from scratch. With the isolation imposed by COVID-19, it was important to be able to connect, even if only virtually, with women from various parts of Brazil and exchange ideas and experiences through this initiative.”

Of the initial group, 28 women are already selling their handmade dolls independently. The initiative was funded by the Solidarity Fund, launched in 2020 by UNAIDS to support entrepreneurship activities led by people living with HIV and key populations.

Ms Almeida agrees on the importance of connection and mutual support. “I really enjoyed meeting and interacting with the group of women participating in this project. In addition to reconnecting with my origins and my childhood, the techniques I learned helped me to develop a product that people enjoy. I sell my dolls to relatives and friends and through social networks,” she said.

The initiative emerged from the realization that the COVID-19 pandemic had a disproportionate impact on women. The pandemic has especially affected the service sector, such as hospitality, food, beauty and domestic services, for which the majority of the workforce is female. In 2020, the absence of jobs in those areas reduced the active participation of women in the workforce in Brazil to less than 45%.

“The project was extremely important for women living with HIV, as many of them were unable to access the job market, lived with an overload of domestic work, experienced situations of violence and had to deal with the interruption of specialized health services,” said Fabiana Oliveira, the MNCP Secretary of Communication and Technical Coordinator of Mulher Empreendedora.

Claudia Velasquez, the UNAIDS Country Director for Brazil, highlighted that the Solidarity Fund’s support to MNCP is in line with the strategic vision of putting people and communities at the centre of the HIV response while building sustainable income-generating mechanisms. “This approach is particularly important for the most vulnerable populations, such as these women living with HIV served by the MNCP, who have strongly felt the drop in income caused by the COVID-19 pandemic. Providing these women with their own access to financial resources and financial security ends up having a positive impact on their adherence and permanence in the HIV monitoring and treatment processes,” she said.

Ms Oliveira highlighted that Mulher Empreendedora had created an opportunity for participants to restructure and rewrite their personal stories. “Rag dolls have this power to stimulate imagination and creativity and even offer the equivalence of a real hug,” she said.

Sasha wishes to have two children. Deusa wants to go to business school. Rihanna's dream is to be respected and be who she wants to be. And all Alicia wants is to fulfill her dreams. In the lead-up to the May 17 celebrations of the International Day against Homophobia, Transphobia and Biphobia (IDAHOBIT), UNAIDS echoes the voices and dreams of four transgender women. They, like many others, are in search of a dignified life, full of opportunities able to love who they wish to love, and not endure violence, stigma and discrimination.

Inspired by the Unbox Me campaign, launched by UNAIDS on the International Transgender Day of Visibility, 31 March, UNAIDS gave four Brazilian transgender women a small box with their portraits from a photo shoot session in 2021 with Sean Black, a photographer from the United States who specializes in LGBTQI+ subjects. As the portraits were revealed to the transgender women, they reflected on the importance of their bodies, of self-care, and of their right to live healthy and empowered lives.

"This insecurity comes from our experiences, and from our past. But with each passing day I had the opportunity to strengthen myself, to discover the beauty that I sometimes thought I didn't have, so I felt more confident," recalled Alicia Kalloch, when unboxing her self-portraits.

“There are so many bad things that we go through,” said another participant, Sasha Santos. “My portraits from the photo sessions gave me the certainty that I'm capable of many things like going to college, owning a house and having children,” she added.

Alicia, Sasha, Rihanna and Deusa were chosen to represent the 24 women from the transgender shelter, Casa Florescer, in São Paulo, who participated in the FRESH Project. Developed by UNAIDS in partnership with Black and Casa Florescer, the initiative included photo sessions as part of a therapeutic approach to provide positive reinforcement and stimulate behavior change. All the photos are being released virtually today in cooperation with the United Nations Educational, Scientific and Cultural Organization (UNESCO) office in Brazil, marking the IDAHOBIT celebrations.

"When I saw my picture, I saw an empowered woman,” said Rihanna Borges, who currently works with other transgender women to provide counseling and peer support. “I think the role I play today is incredible, working with other sisters, talking to them about the importance of self-care and HIV combination prevention." Their plea is to have society see transgender people for who they are. “I want us to feel empowered and say, ‘Today I am somebody’ and leave this invisibility behind,” she added.   

Inequalities, stigma, and discrimination disproportionately affect populations in situations of greater vulnerability, such as transgender women. A report by the Brazilian National Association of Transsexuals and Transgender People (ANTRA) shows that 140 transgender people were murdered in 2021 in the country, 99% of whom were transgender women. HIV prevalence among transgender women in Brazil is above 30%, whereas for the general population prevalence is at 0.4%.

Most of the transgender women at Casa Florescer were forced to leave their homes against their will and many ended up using drugs or suffering various types of violence.

"At the shelter we seek to work with people in a cycle of self-discovery and empowerment so that they can overcome past vulnerabilities,” explained Beto Silva, Coordinator of Casa Florescer. “Photographic art, which was an important part of the FRESH Project, was an efficient way to mobilize and engage them.”

"Participating in the photo shoot not only served to show the internal and external beauty of this group of transgender women, it was also an important step to help them gain control over their bodies and their lives," said Claudia Velasquez, Director and Representative of UNAIDS in Brazil. Deusa de Souza could not agree more.  As a participant in the photography workshop, she said, she felt recognized as a beautiful transgender woman. “It was important for me to see myself in these photos and how they reflect my empowerment and my own personality and beauty.”

Una is a coastal city of just over 20 000 inhabitants in the Brazilian state of Bahia. Fourteen years ago, Rihanna Borges left her little piece of paradise behind, to arrive at a much larger metropolis: São Paulo. “I needed to be reborn as a person and have the freedom to be who I really was. I wanted to be Rihanna, this trans woman whose essence could not safely emerge in my home town.”

Her decision reflects the decisions made by many transgender people, who, at some point, need to move away from their families to live life fully. When she recognized herself as a transgender woman, she had her mother’s unspoken support and recognition, but got no support from her father, triggering conflict and rejection that brought her a lot of suffering.

“Imagine coming out in a small town, with deep conservative and sexist roots. I could suffer any kind of violence. When I left Una I knew I was not that person my father expected. I had to leave my roots and throw myself into the world, so that I could be entirely me,” said Ms Borges. She has now reconciled with her father and has, in her words, a “nice” relationship with her family.

“Stigma and discrimination steals our identity as human beings, destroying us, turning us into unimportant people, who can be abused, mistreated, violated. So, the support of our families is critical because the world outside is cruel and destructive,” she said.

Ms Borges is one of the residents of Casa Florescer, a pioneering transgender welcoming centre located in the city of São Paulo, which hosts them while providing housing and access to mental health and other health-care support. Owing to increased vulnerabilities, stigma and discrimination, inequalities and disrupted family ties, among other reasons, the transgender women served by Casa Florescer come from extremely vulnerable backgrounds, having a history of adopting, and being exposed to, higher risk behaviours, including unsafe sex and use of drugs.

In this context, UNAIDS launched in 2021 an innovative initiative, the FRESH Project, to engage transgender women in understanding combination HIV prevention, focusing on pre-exposure prophylaxis, post-exposure prophylaxis and harm reduction. Through the project, the participants are rewarded for positive behaviour change to reinforce positive behaviours and reduce their vulnerability and the impact of inequalities.  

The first initiative of the FRESH Project in Brazil saw the voluntary participation of 22 of the 30 transgender women residents of the Casa Florescer, including Ms Borges.

The participants were trained in photography in sessions promoted by the American photographer Sean Black, who specializes in portraying lesbian, gay, bisexual, transgender and intersex people, especially people living with HIV. During the sessions, the participants reflected on their daily lives through their photographs.

“It was incredible to realize, over the days, how many of the women had a very negative opinion of themselves, reflecting the stigma they suffer from society. They discovered themselves as the beautiful and unique people they are and understood how fundamental it is to take care of themselves,” said Mr Black. “The photographs that I took, and the ones that they also took, reveal the essence of each one of them and how they are people who dream and want to be happy, like everyone else,” he added.

Ariadne Ribeiro Ferreira, the UNAIDS Brazil Community, Gender and Human Rights Officer, who is a transgender woman, highlighted that one of the objectives of the FRESH Project was to show that transgender sisterhood also means strengthening the path of self-respect, self-love and self-care. “Stigma and discrimination, associated with society’s punitive logic, only increases the social abyss that the most vulnerable groups are forced to face. Therefore, positive reinforcement, in this case represented by photographic art, is transformative and a path to a process of personal and collective change.”

“When I saw my photos after the photography sessions, I realized how powerful is to show our essence, the beauty that each one of us has. I felt it strengthened in me the certainty of how important it is, first of all, that we take care of ourselves, love ourselves, in order to pass this love on to other people and face stigma and discrimination,” said Ms Borges.