Latin America

The Organization of American States (OAS)—the world’s oldest regional mechanism comprising 35 independent states of the Americas—has adopted a bold new Resolution on the Promotion and Protection of Human Rights of People Vulnerable to or Living With or Affected by HIV.

Meeting at its 43^rd General Assembly, delegates approved the Resolution which puts human rights, gender equality and social justice at the heart of the region’s HIV response. The new agreement emphasizes the importance of the greater involvement and participation of the most affected populations in the response to the epidemic.

In spite of progress addressing HIV in the region—treatment coverage is high, and new HIV infections have begun to decline in parts of the Caribbean—the Resolution recognizes the still significant challenges that remain to ensure equitable access to HIV services, particularly among most at risk groups as well as women and girls.

Opening the Assembly, Secretary General of the OAS, Jose Miguel Insulza noted the frequent ‘disregard’ of the rights of minorities but highlighted the critical opportunity the OAS provides "for frank, open policy dialogue on these issues in the Hemisphere".

Deeply rooted stigma and discrimination is still all too pervasive among community and religious leaders, service providers and state agents. This impedes access to services, employment, and in some cases, leads to social exclusion for people most vulnerable to HIV, including sex workers, men who have sex with men, transgender people, drug users and indigenous populations. The Resolution calls for specific measures to promote gender equality and address the needs of women, adolescents and girls, noting the strong inter-relation between gender-based violence as both a cause and consequence of HIV.

As discussions continue globally around the sustainability of the AIDS response, the Resolution flags the ‘exorbitant’ cost of antiretroviral treatment in some countries and the challenge of securing generic alternatives. Furthermore, despite increases in domestic funding for the AIDS response, the Resolution notes that resources are still not being sufficiently invested in programmes that support and sustain education, behavior change and other HIV prevention strategies.

The Resolution looks at ways to strengthen collaboration with international bodies such as the Inter-American Commission on Women and the Inter-American Commission on Human Rights to advocate for greater protective laws and policies. These include the exchange of experiences and best practices, the organization of joint activities, and the coordination of efforts and capacities to attain the greatest possible impact.

OAS Member States called upon UNAIDS and the Pan American Health Organization (PAHO) to join efforts in the implementation of the Resolution as well as to provide countries with support to eliminate new HIV infections among children, to ensure access to affordable treatment, to end stigma and discrimination and to promote gender equality.

"This Resolution comes at an opportune time, when global discussions on development and health are shifting, but also demonstrates that new opportunities are emerging to maintain the momentum to reach UNAIDS vision of zero discrimination, zero new HIV infections, and zero AIDS-related deaths," said UNAIDS Executive Director Michel Sidibé.

Mr Sidibé met with Secretary General Insulza in Washington DC, prior to the OAS General Assembly where he remarked that "The OAS has been a leader in driving forth discussions around affordable medicines, and is breaking new ground in terms of addressing stigma and discrimination, and recognizing the intersection between gender-based violence and HIV".

The Confederation of North, Central America and Caribbean Association Football (CONCACAF) and UNAIDS signed a Memorandum of Understanding on 19 April in Panama City, Panama and agreed to engage football in the AIDS response, particularly among young people.

The agreement was signed on the sidelines of the 2013 CONCACAF Under-17 Championship in the presence of CONCACAF President Jeffrey Webb and Senior Adviser Dr Djibril Diallo, who represented UNAIDS Executive Director Michel Sidibé. It was signed in the presence of FIFA President Sepp Blatter, FIFA Secretary General Jerome Valcke and Confederation of African Football (CAF) Secretary General Hishram ElAmrani.

The two organizations agreed to carry out joint advocacy and communication activities in competitions organized by CONCACAF in support of the UNAIDS “Protect the Goal” campaign. This initiative was launched in January at the 2013 Orange Africa Cup of Nations in South Africa and is part of UNAIDS’ sport for global advocacy programme. The campaign promotes HIV prevention and treatment, in advance of the 2014 FIFA World Cup in Brazil.

Honduras has adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

Honduras is moving a step closer to the UNAIDS vision of ‘zero discrimination’. Its Congress has recently adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

"This has been a historic step for Lesbian, Gay, Bisexual, Transexual and Intersex (LGBTI) populations that have suffered from widespread violence and impunity in Honduras,” said Donny Reyes, Coordinator at Arcoiris, a civil society organization advocating for greater LGBTI rights. “Finally our right to freedom and to live in peace has been formally recognized,” he added.

Between 2009 and 2012, more than 90 homophobia-related killings were reported in the country, according to the Human Rights Observatory of Lesbian Cattrachas Network. These incidents, which are among the highest in the region, are attributed to the high levels of homophobia and transphobia that exists in Honduran society.

The high number of violent deaths and human rights violations against LGTBI people prompted Ana Pineda, the Minister of Justice and Human Rights to promote the reform of the Penal Code.

The amended code establishes as an offence with aggravating circumstances the “discrimination with hatred or contempt on the basis of sex, gender, religion, national origin, belonging to indigenous and Afrodescendant groups, sexual orientation or gender identity”.  This offence may be punishable by up to 3–5 years imprisonment and a monetary fine. The penalty increases if it is a violent crime.

Dialogue between the government, civil society and UNAIDS led to the creation of special units within the General Attorney’s Office to strengthen the investigation of allegations of violence on the basis of sexual diversity. Each unit comprises a qualified legal advisor, an analyst and three investigators. The Units are currently investigating 17 cases of killings on the basis of sexual orientation and/or gender identity.

“Strengthening investigation, establishing a legal framework which sanctions discrimination and making sure that judges will apply the new provisions are both crucial steps to prevent and reduce violence against members of the LGTBI community,” said Ms Pineda.

Reducing vulnerability to HIV

The amended Penal Code is expected to improve access to HIV-related services, education and employment for LGTBI people. The discrimination, exclusion and violence against LGTBI people have exacerbated their vulnerability to HIV infection by discouraging them from accessing health services out of fear.

In Honduras the HIV epidemic seriously affects men who have sex with men (MSM), where the prevalence of HIV has reached 9.9% compared to the 0.6% among the general population.

A recent report in The Lancet highlights that transgender people have at least 50 times the odds of men and women in the general population of becoming infected with HIV—due to biological as well as structural risks for HIV infection such as social exclusion, economic marginalization, and unmet health-care needs.

"This ruling will provide LGTBI people with greater access to HIV related services" said Nicole Massoud, UNAIDS Country Coordinator for Honduras and Nicaragua. “UNAIDS congratulates the State of Honduras for its commitment to promote and defend human rights. The challenge now is to ensure that all professionals are informed and trained on these new provisions to help ensure we reach zero stigma and discrimination.”

The countries of the South are shifting the global power balance with massive strides in economic growth, poverty reduction, education and health.

The world is changing rapidly with developing nations spearheading global economic growth, impressive poverty reduction and the rise of a healthier, better educated middle class, says the UN Development Programme’s (UNDP) Human Development Report 2013.

According to the publication, The Rise of the South: Human Progress in a Diverse World, this rise is “unprecedented in its speed and scale. Never in history have the living conditions and prospects of so many people changed so dramatically and so fast.” 

The momentum of such achievements in poverty reduction, education, income and tackling health issues like HIV, is increasing. It can be seen as an overdue “global rebalancing” with new actors “shaping the development landscape” and gaining in political and economic influence.  

There has been notably rapid progress in more than 40 countries of the South—traditionally referred to as developing nations—whose advancement has been markedly better than expected, the report notes. Coming from all continents and ranging widely in size, they include:  Bangladesh, Brazil, Chile, China, Ghana, India, Mexico, Rwanda, Uganda and Vietnam.  Uganda, for example, through a series of economic, health, education and social measures, has managed to halve extreme poverty before the Millennium Development Goal deadline of 2015. It fell from 56% in 1992-93 to 25% in 2009-10.

The report was launched in Mexico City on March 14 by the UNDP’s Administrator Helen Clark and Mexican President Enrique Peña Nieto.  As well as an extensive analysis of original research, it also contains an updated Human Development Index which measures the progress of nations in terms of health, education and income. In addition, the publication contains data on the critical gender aspect of development in its Gender Inequality Index which shows that despite serious inequities persisting, there has been progress in equality almost everywhere.

As with general development, the pace of success in the AIDS response is quickening in an unprecedented way. The 2012 UNAIDS global report showed that the rate of infection across 25 low- and middle-income countries has been cut by half.

The accelerated development of the South is critical to the success of the global AIDS response as the most heavily burdened countries are low-and middle income. UNAIDS maintains that getting to zero new infections, zero discrimination and zero AIDS-related deaths will need advances not only in the sphere of health and HIV but in terms of poverty reduction, education, gender equality and enhanced life opportunities

Image of one of the promotional images of the campaign featuring the Carnival queens.
Credit: UNAIDS

Last week was Carnival in Panama.  As part of the celebrations during 11-12 February, the Queens of “Calle Arriba” and “Calle Abajo” —representing opposite neighbourhoods— competed against each other in a variety of contests. However when it comes to HIV, the two rivals joined forces to prevent new HIV infections among women.

UNAIDS, in partnership with the Panamanian Carnival Boards of “Calle Arriba” and “Calle Abajo”—the national institutions in charge of planning and coordinating activities related to this festivity— the National AIDS Programme, and PROBIDSIDA, launched a national campaign entitled “I decide, I take care of myself” (Yo decido, yo me cuido).

The campaign, which will run until the end of February, aims to help reduce gender inequalities, empower women and promote sexual and reproductive rights. One of the major goals is to ensure women can make informed decisions in relation to their sexual health, especially when it comes to preventing HIV.

“If we want that no more women get infected with HIV in Panama we need to join efforts at all levels, including institutions, civil society organizations and international agencies. This is why we decided to endorse this initiative,” said Pilar De Amores, Legal Representative of “Calle Arriba” Carnival Board.

In the last decade the number of new HIV infections has been on the rise among young women in Panama. A national survey on sexual and reproductive health held in 2009 and 2010 found that only 9% of women use condoms as a preventive measure during sex. Gender inequality is a major driving force behind the lack of reproductive and sexual rights of women in the country.

“Gender inequalities affect women´s power to insist on and negotiate safe sex practices like condom use, and thus protect themselves from HIV” explains Ricardo Garcia, UNAIDS Country Coordinator for Panama and Costa Rica. “We have created this campaign to increase the recognition of women as having sexual rights and capable of exercising them, in line with the UNAIDS action framework on women, girls, gender equity and HIV”.

The campaign includes television spots that are being broadcast on national networks as well as posters in schools, organizations and on the streets featuring the Carnival queens calling on Panamanian young women to take the lead and protect themselves from HIV.  As part of the campaign, the Queens received special training on issues related to HIV prevention and gender inequalities, in order to participate in public events and media programmes promoting the campaign.

“Women need access to HIV information, education, and services to have control over our bodies and be able to negotiate the use of condoms with our partners,” said Maruquel Madeleine González Velásquez, Queen of “Calle Arriba”. “I feel extremely accomplished to be part of this project,” she added.

Under the revised penal code young people between the age of 14 and 18 years old will be able to exercise their sexual and reproductive rights.
Credit: UNAIDS

The Constitutional Tribunal of Peru is amending an article in its penal code which for many years had criminalized consensual sexual activity among young people. Sentencing was particularly severe with adolescents facing up to 30 years in prison. Article 173 of the penal code was also preventing young people from accessing essential health and reproductive services for fear of prosecution.

Under the revised penal code young people between the age of 14 and 18 years old will be able to exercise their sexual and reproductive rights providing the two parties are consenting. Non-consensual sexual relations will still constitute a crime in Peru with lengthy sentencing for people found guilty.

"The Constitutional Tribunal ruling generates a protective effect in relation to adolescents, because it provides them with greater access to sexual and reproductive health services as well as guidance and information to avoid sexually transmitted infections, including HIV," said Mima Barnechea from the United Nations Population Fund (UNFPA).

In 2012, UNFPA and UNAIDS presented a formal request before the Constitutional Tribunal advocating for the declaration of unconstitutionality of Article 173.  This process was part of a wider effort particularly from the Office of Peru’s Ombudsman, Eduardo Vega Luna as well as legal demands presented before the Tribunal by more than 10 000 Peruvian citizens.

"UNAIDS welcomes the Constitutional Tribunal’s decision and congratulates the magistrates for their determination to protect adolescents’ human rights,” said UNAIDS Coordinator for Peru and Bolivia, Regina Castillo. “The Tribunal’s decision reinforces young people’s right to make decisions regarding their health and sexuality and the need to construct policies and programmes that recognize young people as active actors of change.”

According to a National Demography and Health Survey of 2011 a large percentage of Peruvians initiate sexual relations before the age of 18.  More than 12% of female adolescents (ages between 15 and 19) have been pregnant at least once.

"This decision is a milestone that sets the basis for plans and programs at national level to prevent teen pregnancy and reduce sexually transmitted infections including HIV and maternal mortality," said Carlos Tacuri Calderon, youth activist in Peru and member of INPPARES.

UNAIDS estimates that around 74 000 people are living with HIV in Peru of which approximately half became infected before the age of 20. This situation stresses the need to raise awareness on HIV and its modes of transmission among teenagers. In December 2012, the Ministry of Health in collaboration with UNAIDS and other partners launched the campaign “take an HIV test––it’s better to know” which aimed to reach young men with key HIV prevention messages and provided free HIV tests.

Vice-Minister of Health José del Carmen Sara launching the campaign “It is better to know: Get an HIV test.”

In the lead up to this year’s World AIDS Day, the Ministry of Health of Peru in collaboration with Asociación Dignidad, UNAIDS and the Pan American Health Organization (PAHO), launched the campaign “It is better to know: Get an HIV test.” The initiative aims to increase HIV testing coverage in the country, particularly among men, by providing free HIV tests.

Men aged 18 to 25 years are the main focus of the campaign, which aims to test 10 000 people by 1^st December (World AIDS Day). The testing will take place in 16 different venues set up by the Ministry, including in various universities, in order to reach as many young men as possible.

“This is an effort by the Ministry of Health to make HIV testing more accessible for men,” said Vice-Minister of Health José del Carmen Sara during the event.

There are 74 000 people living with HIV in Peru, 77% of whom are men. 56% of new infections occur in men who have sex with men and 9 out of 10 women acquire HIV from their stable partners, who may engage in high-risk behavior such as buying sex or having sex with other men. It is estimated that half of the people living with HIV in Peru were infected before the age of 21.

Although men are at higher risk of HIV infection than women, their access to health services has traditionally been poorer. Despite the fact that 3 of 4 people living with HIV are men, only 7% of men reported having been tested for HIV in 2008. Increased testing would provide greater opportunities for HIV prevention and early treatment.

Peru introduced rapid HIV testing and counseling for pregnant women in 2006, and in 2008 a large scale HIV testing and counseling campaign was organized focusing on women of reproductive age. In the same year the Ministry of Health also increased access to HIV testing and counseling for men who have sex with men, transsexuals and sex workers, but so far HIV tests have only been free for women.

“Half of the people living with HIV in Peru do not know their HIV status. It is important to save lives by increasing access to both HIV diagnosis and treatment,” said Regina Castillo, UNAIDS Country Coordinator for Peru and Bolivia.

The launch on November 21^st brought together people living with HIV, UN representatives, government officials, journalists, international organizations, and renowned artists, including entertainer and HIV activist Ernesto Pimentel and singer Eva Ayllon.

L to R: Luiz Loures, UNAIDS Director of the Political and Public Affairs branch; César Antonio Núñez, Director of the Regional Support Team for Latin America; Dr Carissa Etienne, Director elected of the Pan American Health Organization; Michel Sidibé, Executive Director of UNAIDS; and Ernest Massiah, Director of the Regional Support Team for the Caribbean.

UNAIDS Executive Director Michel Sidibé met on 7 November with the recently appointed Director of the Pan American Health Organization (PAHO) Dr Carissa Etienne at the UNAIDS Headquarters in Geneva to strengthen collaboration towards putting an end to AIDS in the Americas.

"We can build on the successes of the Americas, a region that was one of the first to eliminate measles and polio,” said Mr Sidibé. “There is no reason why this region cannot be the first to end AIDS.”

During the meeting, they exchanged ideas on how to increase joint efforts to achieve the Millennium Development Goals by 2015 and to ensure that health and HIV are part of the post 2015 agenda.

"As we look forward, HIV and health are key for the region, and for global development,” said Dr Etienne. “PAHO will play a key role in moving this agenda forward and with UNAIDS, the Americas can be the first region to see the end of AIDS.”

Dr Carissa Etienne, a native of Dominica, was elected as the new PAHO Director during the 28th Pan American Sanitary Conference that took place from 17-21 September 2012 in Washington D.C. and will begin her five-year term on 1 February 2013. Dr Etienne is currently Assistant Director General, Health Systems and Services, of the World Health Organization (WHO) in Geneva.

UNAIDS Executive Director Michel Sidibé and the Minister of Health of Costa Rica, Dr Daisy Corrales. UNAIDS HQ, Geneva. 6 November 2012. Credit: UNAIDS

The Minister of Health of Costa Rica, Dr Daisy Corrales, aims to strengthen the AIDS response among key populations at higher risk in her country, which is where the epidemic remains concentrated. During a meeting with UNAIDS Executive Director Michel Sidibé on 6 November at the UNAIDS Headquarters in Geneva, Dr Corrales highlighted the focus of her Ministry in developing HIV communications and educational strategies for organizations working with male sex workers.

“We need to develop our strategies to reach male sex workers with HIV information and education that is relevant to their needs and in agreement with their particular work schedules,” said Dr Corrales.

Costa Rica’s HIV prevalence among adults 15 to 49 years of age is 0.3%. The country’s HIV epidemic is concentrated among key populations at higher risk of infection such as the migrant indigenous population, men who have sex with men (MSM), sex workers and their clients. A study conducted in 2010 found HIV prevalence among MSM of 10.9% and 11% among female sex workers.

“It is not always easy to talk about men who have sex with men, sex workers or drug users but we have an obligation to ensure they have access to HIV services that are free from stigma and discrimination,” said Mr Sidibé.

Mr Sidibé also commended the Government of Costa Rica for its efforts in scaling up HIV treatment for people with HIV—an estimated 65% coverage—as well as their success in stopping new HIV infections among children. “Costa Rica’s transmission rate of HIV from mother-to-child is consistently under 2%, a very impressive feat and a bold example for Latin America that an HIV free generation is within our reach.”

Mr Sidibé assured the Minister of Health that UNAIDS will continue providing support to Costa Rica to design its strategy for an effective and sustainable response to AIDS.

The Network of Positive Youth for Latin America and the Caribbean has launched a regional consultation for young people living with HIV. The aim of the consultation is to obtain information on the realities that young people living with HIV face in their everyday lives in order to develop new and more effective HIV strategies focused on their specific needs.

The consultation tool, developed with support from UNAIDS, UNICEF and UNFPA, consists of an online and confidential survey of roughly 40 questions that focuses on young people aged 18 to 29 years old and living with HIV from 17 Latin American and two Spanish-speaking Caribbean countries. The online platform is designed to run on any computer and has a special program to facilitate access from mobile devices.

The tool will collect information related to the socio-demographic aspects of young people living with HIV, their access to health services, experiences with stigma and discrimination, and their leadership and community participation. Young people living with HIV will be able to participated in the survey until 30 November 2012 at the following website: http://consulta.jovenespositivos.org

“Usually, positive youth remain invisible to research and data collection exercises.  This consultation is an opportunity to make our voices heard,” explained Mariana Iacono, a founding member of the Network of Positive Youth. “To be able to develop HIV strategies and programs that meet our needs we must know our situation, needs and realities in our communities.”

A team of young people from the Network of Positive Youth will analyze the results of the online consultation and will design a short and long term action plans for the region. The results will also serve as advocacy tools to demand the development of national strategies that focus on the needs of young people living with HIV. “We know that sometimes it is difficult to share feelings and memories, but we believe it is from our own experiences that we can bring new ideas and solutions to address HIV in a more inclusive and cost effective way,” said Pablo Aguilera, member of the Network.

In Latin America, an estimated 68 000 adolescents (10-19 years) are living with HIV. Of these, 34 680 are women. In 2011, 34 440 new HIV infections occurred among young people between 15 to 24 years, accounting for 41% of all adult HIV infections. “A generation of young people born with HIV is growing up with its specific needs being largely neglected,” noted Mark Connolly, UNICEF Senior Adviser for Latin America and the Caribbean. In 2011, an estimated 2 000 children were born with HIV in the region.

As young people living with HIV transition from childhood through adolescence to young adulthood, they face a range of specific needs, including accessing treatment, tackling stigma and discrimination, and accessing youth-friendly integrated HIV and sexual and reproductive health services. “Young people living with HIV are a heterogeneous group, with diverse populations that needs urgent attention in many areas, especially those who are more affected by stigma and discrimination, such as transgender, gays and drug users,” said Cesar A. Núñez, UNAIDS Regional Director for Latin America. 

The UNFPA Regional Director for Latin America and the Caribbean, Marcela Suazo emphasized that the epidemic on positive young people is worsened because of social exclusion, as well as gender inequality, stigma and discrimination related to HIV. “It is necessary to ensure a human rights platform that extends strongest non-discriminatory access of young people to education, counseling and adequate sexual and reproductive health," she said.

In Latin America, a new wave of youth-led community mobilization is emerging, advocating for human rights and demanding access to HIV services. The Regional Network of Positive Youth is organizing youth to participate in decision-making and consultation spaces beyond national spheres. In December 2012, the Network is organizing the first regional meeting of young people to define coordinated actions across the region, enhance leadership and mobilization towards meeting the global targets for 2015.