Latin America

There are still alarming levels of violence against transgender people, and a lack of recognition of their rights. During a visit to UNAIDS headquarters in Geneva, Switzerland, on 18 September, Marcela Romero and Venus Tejada, representatives of the Latin American and Caribbean Network of Transgender People (REDLACTRANS), shared the startling fact that transgender women in the region have a life expectancy of only 35 years.

During the visit, Ms Romero and Ms Tejada met with the UNAIDS Executive Director, Michel Sidibé, and spoke about REDLACTRANS’ work in 13 countries. A grant to REDLACTRANS from the Global Fund to Fight AIDS, Tuberculosis and Malaria helped to establish a centre that collects testimonies and follows up cases of human rights violations committed against transgender women in Latin America and the Caribbean.

“Stigma, discrimination and violence against sexual and gender minorities prevent them from accessing health services,” said Mr Sidibé. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Ms Romero and Ms Tejada also presented Mr Sidibé with a copy of REDLACTRANS’ report, Waiting to die, which compiles cases of human rights violations against transgender people and gives recommendations to decision-makers.

“Stigma and discrimination is a barrier to the services we need to stay healthy. Some transgender women are dying due to lack of access to treatment. Without comprehensive health care, there are no equal rights nor true democracy,” said Ms Romero

Since its creation in 2006, REDLACTRANS has promoted the development of gender identity laws. In Argentina, the Plurinational State of Bolivia, three federal districts of Mexico and Uruguay, where gender identity laws have been enacted, transgender rights are increasingly enforced and, consequently, transgender people can access health-care services. Such laws have brought about positive changes in the services provided to transgender people and resulted in less stigma and discrimination in health-care settings. “Without identification, one cannot travel, register for school or access many services that are essential to function in society,” said Ms Tejada.

Ms Romero and Ms Tejada called on UNAIDS to address how forced migration, persistent inequalities and poverty affect the quality of life of transgender women.

Antiretroviral stock-outs are a serious public health problem in the Latin America region and represent an important risk to the sustainability of the HIV response, according to participants at AIDS2018.

On July 26, a session titled Sustainability of the response to HIV in Latin America; factors that impact access to drugs and health supplies addressed and analyzed the magnitude, the structural causes and the impact of stock-outs on the sustainability of the HIV response in Latin America. Participants discussed strategies to pave the way forward and highlighted best practices on joint purchases of antiretroviral (ARV) treatment like the PAHO/OMS strategic fund, which has helped prevent stock-outs.

In Latin America, one of the most important achievements in the HIV response has been the recognition that accessing HIV treatment is part of the right to health in the public health system, resulting in an increased number of people receiving antiretroviral treatment in recent years. However, a major challenge to fulfill the right to health is to guarantee uninterrupted supplies of ARV drugs and other essential health commodities.

According to the Pan American Health Organization (PAHO), in 2012 45% of the countries reported at least one stock-out episode; the figure had been 54% in 2010. Although some improvements are seen from 2010 to 2012, the region is still experiencing a high frequency of stock-outs.

Shortages of ARVs and other essential supplies result in changes and interruptions in patient treatment, threaten the lives of people with HIV and hamper the reduction of new HIV infections and AIDS-related deaths.

Participants at the session stressed the need for greater health system strengthening and joint procurement processes, including the incorporation of TRIPS flexibilities to reduce ARV costs, aligned with policies for simplified treatment regimens. According to participants, all these factors are essential to prevent and respond to stock-outs of ARVs and medical supplies.

Staff from Globo Television visited UNAIDS headquarters in Geneva, Switzerland, on their way to Cannes, France, for the 2018 Emmy Kids Awards. Globo and UNAIDS were nominated for an Emmy Kids Award in the digital category for the web series Young Hearts—I Just Want to Love, which focuses on a high school romance between a teenager living with HIV and his girlfriend. 

The series was a spin-off from Brazil’s longest running soap opera, Malhação—Seu Lugar No Mundo (Young Hearts—Your Place in the World), a production developed and broadcast by Globo. Among several teen love stories in the season, the one between Henrique and Camilla became a hit with the audience. The soap averages a daily audience of 24 million viewers, mainly pre-adolescents and their parents. UNAIDS, an official partner with Globo since 2015, gave technical advice and support to the writers of the show.

UNAIDS, Globo and Gshow produced the web spin-off, which is available on the Globo streaming platform. The five-episode web series became the third most watched original series on the platform, with almost 1 million views.

Michel Sidibé, UNAIDS Executive Director, congratulated Globo, explaining how media plays a key role in stopping HIV stigma and exclusion. He praised the Globo partnership for using edutainment to reach young people with compelling and relevant HIV information.

Emmanuel Jacobina, the writer of Young Hearts—Your Place in the World for the 2015–2016 season and the web series, said that the idea came from a conversation he had with the UNAIDS team about HIV in Brazil. It disturbed him, he said, that despite there being methods for prevention, tens of thousands of people still become infected with HIV each year in Brazil. As a result, the web series, he said, seemed the best place to push the debate further and speak bluntly about relationships, sexuality and HIV.

The Director of Corporate and Social Responsibility at Globo, Beatriz Azeredo, reiterated the company’s commitment to mobilize Brazilian society around major social issues with television series and public service announcements. Globo’s Director of Communications, Sergio Valente, noted Globo’s presence in more than 100 countries and said that it has a 99% reach in Brazilian homes.

Of the three nominees in the digital category, the award went to the Norwegian series Jenter (Young Girls), produced by NRK.

UNAIDS is working towards ensuring that 90% of young people have the skills, knowledge and capacity to protect themselves from HIV and have access to sexual and reproductive health services by 2020.

Kimi Avalos is a young transgender woman who lives in Buenos Aires, Argentina. Because of stigma and discrimination, she couldn’t continue with her studies and complete high school. She says that she experienced bullying and harassment; her classmates insulted and physically assaulted her, under the indifferent eye of her teachers. “I really wanted to learn, but I had to drop out of school. Now, thanks to the Transgender House, my dream of finishing high school will soon come true,” said Ms Avalos.

Ms Avalos is one of 30 transgender students who recently started a new educational programme through which they can study for primary and secondary school diplomas by attending a combination of face-to-face and virtual classes. This innovative project is implemented in the Transgender House, a community centre for training and empowerment of transgender people founded in Buenos Aires in June 2017 by Marcela Romero, Coordinator of ATTTA (Association of Argentinian Transvestites, Transsexuals and Transgender) in collaboration with the City Council of Buenos Aires.

“To have this house has meant that as transgender people, we can come out from the darkness. The centre is in a visible space, on one of the main streets of Buenos Aires, in the San Cristóbal neighbourhood. This is our achievement; it shows that we exist as a community and that we have the right to a space like any other organization,” explains Ms Romero.

In Argentina, as well as in the rest of Latin America and the Caribbean, stigma and discrimination undermine learning opportunities and educational achievement of transgender people, thus affecting their future employment prospects. Discrimination and stigmatization also prevent transgender people from accessing appropriate health care, including HIV prevention, social protection and justice services.

In the region, transgender people experience frequent physical and sexual violence and hate crimes. According to data from ATTTA, 20 transgender people have been killed in Argentina since the beginning of 2018 and gender-based violence is increasing. Discrimination, gender-based violence and exclusion also contribute to increasing the vulnerability of transgender people to HIV. Transgender women continue to be heavily affected by HIV.

The Transgender House was created with the aim of providing a safe space where transgender people can be empowered and acquire knowledge and skills without the fear of being discriminated against, rejected or attacked. It works in partnership with governmental agencies, civil society and the private sector to provide a wide range of services and programmes based on the specific needs of transgender people.

MORE ON TRANSGENDER DAY OF VISIBILITY

Voices of activists for transgender rights

Among other initiatives, the Transgender House has established integrated counselling services and professional guidance for job searching, as well as legal advice from lawyers, who are available 24 hours a day. In collaboration with the Ministry of Education, Transgender House has recently begun educational projects that range from the implementation of primary and secondary education programmes to professional training, such as on providing care services to the elderly.

Other important activities include the promotion of prevention of HIV and other sexually transmitted infections, HIV testing and vaccination campaigns. The Transgender House also provides continuous psychological assistance and, through a partnership with Fernández Hospital, counselling services on hormone therapy. In addition, the house engages in outreach work with a team of community health promoters that visit sex workers at their places of work at night, distributing condoms and informative material on HIV prevention.

While the Transgender House is currently a successful project, a point of reference for transgender people in Buenos Aires and has multiple partnerships in the city, it hasn’t been an easy process to get to this point. Ms Romero says that she first approached the Buenos Aires City Council eight years ago, advocating for a space where transgender people could meet. Finally, two years ago, the council approved the remodelling and refitting of one of their buildings, and with the help of an architect and the vision of the ATTTA Coordinator, the Transgender House became a reality.

“The Transgender House is a best practice of community service delivery that is contributing to the achievement of the Fast-Track Targets, leaving no one behind,” said Carlos Passarelli, the UNAIDS Country Director for Argentina, Chile, Uruguay and Paraguay.

Around 400 people visit the Transgender House each month to receive counselling and information and approximately 600 people regularly participate in workshops, group meetings and courses there. “I couldn’t be happier and more grateful for the opportunity that I am given at the Transgender House. I hope that this model of respect and promotion of human rights serves as an example to transform and change society so that all of us can live with dignity,” said Ms Avalos.

The United Nations Women for Peace Association (UNWDPA) has honoured Lorena Castillo de Varela, the First Lady of Panama and UNAIDS Special Ambassador for AIDS in Latin America, with its Leadership Award. The award was made in recognition of her work in the response to HIV and the promotion of human rights and women’s empowerment.

Presented at the UNWDPA Annual Award Luncheon, held at United Nations Headquarters in New York, United States of America, on International Women’s Day, the award honours people who have made a difference to the lives of women and girls.

Since her appointment as a UNAIDS Special Ambassador in 2016, Lorena Castillo de Varela has led a zero discrimination campaign that has gone beyond the borders of Panama and become internationally recognized. In her role as Chairwoman of the National AIDS Commission, she catalysed support from 45 governmental institutions to sign an act of commitment to promote HIV prevention and zero discrimination. 

When Camila fell in love with her high school classmate Henrique, she didn’t know he was born with HIV. It was only after an incident at school that his HIV status was revealed to everyone. She then made an informed decision to take his side and live their love story together facing the challenges imposed by stigma and discrimination among friends and family.

Their love story was one of the main plots of the 2015–2016 season of the teen soap opera Malhação—Seu Lugar No Mundo (Malhação—Your Place in the World), from author Emanuel Jacobina. The serodiscordant couple interpreted by actors Thales Cavalcanti (Henrique) and Manuela Llerena (Camila) became some of the most loved characters of the season, which counted on the consultancy support of UNAIDS for the zero discrimination and HIV-related scenes.

Success among fans was such that the couple #Camique won a spin-off web series on Globo’s online entertainment platform Gshow called Eu Só Quero Amar (Young Hearts—I Just Want to Love). The five-episode web series soon became a bit hit—from April to June 2016, it was the third most watched original series on the platform, with almost 1 million views. On 16 October 2017, it was nominated for the Emmy Kids 2017 in the digital category.

The project is a result of an effort to get HIV back on the agenda for young people in Brazil. For that, UNAIDS teamed up with Globo’s social responsibility branch and worked with Mr Jacobina and writers Filipe Lisboa and Giovana Moraes to tailor HIV and zero discrimination messages to a young audience. In the spin-off production, the serodiscordant couple from fiction are invited to be part of a web documentary, alongside real serodiscordant couples, talking about their relationships, sexuality and the impact of HIV in their daily lives.

“The message and the narrative of today’s HIV epidemic have to be adapted to young people,” explains Georgiana Braga-Orillard, UNAIDS Country Director in Brazil. “The web series managed to capture the essence of this communication.”

"The idea of the web series came from all the discussions I had with UNAIDS about HIV in Brazil in the 21st century. We realized that everything that needed to be told would fit better and more clearly in a specific series on the subject,” says Mr Jacobina. “I think it is a very important work that has helped Brazil to resume the discussion about HIV, clarifying the issue of prevention. I feel honored and proud with the nomination.”

Malhação is Globo’s longest running soap opera—on air for over two decades—and reaches an estimated daily audience of 20 million people in Brazil.

Watch the series

Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.

Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people.

The code of conduct provides for health personnel from public health facilities to be trained in avoiding discriminatory expressions and attitudes and to respect the confidentiality of patients. Among various provisions, it clearly stipulates that so-called treatment to “cure homosexuality or transexuality” must be avoided. It establishes that health centres should maintain a policy of zero tolerance for discrimination and must investigate accusations of discrimination. Health centres should also promote ongoing sexual and reproductive health and HIV prevention campaigns focused on LGBTI people.

The code of conduct was developed through a broad participatory process that included the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals, the National Center for HIV Prevention and Control, Specialized Condesa Clinic of Mexico City, the National Council for Preventing Discrimination and representatives of civil society and LGBTI organizations.

The next steps include a training process on its practical application, with the involvement of civil society and community-based organizations. The implementation will have a pilot phase and will begin in the largest cities in the country.

UNAIDS Regional Goodwill Ambassador for Latin America and the Caribbean and CNN Anchor Alejandra Oraa visited El Salvador from 9 to 11 August to raise awareness about strengthening HIV prevention efforts for adolescents and young people.

In El Salvador, there is a growing concern about the increase in new HIV infections reported since 2011 among adolescents aged between 15 and 19 years. Young people are not receiving the information they need to protect themselves from HIV: only 36.5% of young people aged 15–24 years know how to prevent HIV transmission.

During her visit, Ms Oraa met with youth leaders in order to analyse gaps in access by adolescents and young people to sexual and reproductive health and HIV-related services and comprehensive sexuality education. Young people stressed the need to urgently accelerate efforts to provide youth with the tools they need to make informed decisions to protect their health, rights and dignity.

Young people also talked about the initiatives in place to contribute to the HIV response from their perspective. For example, to improve access to information and education on HIV and sexual and reproductive health, the National Network of Positive Youth, in coordination with UNAIDS, the United Nations Population Fund and the National Youth Institute, organizes outreach awareness initiatives in public places and schools. Between Friends (Entre Amigos), a community-based organization, uses face-to-face approaches and offers combination prevention options for key populations, including young men who have sex with men and young transgender people.

In El Salvador, Ms Oraa leveraged her social media power to launch a new online survey to assess young people’s knowledge about HIV prevention and transmission. The findings of that United Nations Children’s Fund and UNAIDS joint initiative will be used to inform national public policies and strategies to prevent and reduce new HIV infections among young people.