Latin America

Transgender women face significant barriers that limit their access to health services and/or increase their vulnerability to HIV: stigma and discrimination, gender-based violence and gender inequities. As a result, the percentage of transgender women reached with HIV prevention and treatment services is very low.

To address the HIV prevention gap for transgender people, the Peruvian Ministry of Health organized a national consultation on combination HIV prevention in 2014 in partnership with Cayetano Heredia University and UNAIDS. This consultation opened a dialogue between stakeholders and community leaders on the future of HIV prevention in Peru. During the consultation, the Ministry of Health expressed its commitment to improve HIV combination prevention programming for transgender women. In 2015, it launched a targeted strategic plan for prevention and comprehensive care for HIV and other sexually transmitted infections (STIs) for transgender women .

The plan addresses the leading causes of the HIV epidemic among transgender women in Peru, including their poor socioeconomic conditions, their difficult living and working environments and the low accessibility of health services. In the plan, consideration is given to identifying effective strategies to respond to specific legal and human rights challenges, stigma and violence. The development of the plan was the result of a decade-long process of evidence generation, policy dialogue and capacity-building with the transgender community.

The plan is being translated into practice. Activities already implemented include special trainings of health personnel at STI treatment centres and community peer educators in how to address the HIV needs of transgender people, the provision of prevention services, including condoms and lubricants, HIV testing and linkage to health services for antiretroviral therapy and awareness-raising of local law enforcement personnel on the respect of human rights and prevention of gender-based violence for the transgender community.

Mao, a transgender women activist and peer educator of the Ministry of Health, said, “The focused plan is bringing services closer to the community. Some transgender women who could not go to the sexually transmitted infection treatment centres are now asking for condoms and testing, for information and for comprehensive health services. We are proud of being part of this initiative.”

The next phase of the transgender health plan will include an increase in the number of decentralized prevention and treatment service sites and a demonstration study on pre-exposure prophylaxis. The plan will be incorporated into and aligned with the national HIV programme.

UNAIDS has announced that Lorena Castillo de Varela, First Lady of Panama, will continue her commitment to the response to HIV as UNAIDS Special Ambassador for AIDS in Latin America. Since her appointment in November 2015, Ms Castillo de Varela has contributed to accelerating the AIDS response in Panama and to raising awareness about zero discrimination, calling for fairer and more inclusive societies.

Ms Castillo de Varela is leading the national Be the Transformation You Want to See campaign, which brings together political and religious leaders, celebrities, government institutions, nongovernmental organizations, key populations, health workers and people living with HIV to stand up for human rights and dignity for all. The campaign aims to remove obstacles that block access to health-care services, including HIV testing, and to ensure that health-care settings are safe and caring environments.

Ms Castillo de Varela has also made important contributions to increasing access to HIV testing through the nationwide Tests Save Lives campaign and the Love on Wheels initiative. The latter provides access to health-care services, including HIV testing, for women living in rural and remote areas through mobile clinics.

In the past year Panama has shown progress towards ending AIDS as a public health threat by 2030 and has invested more than US$ 38 million in the AIDS response. The Ministry of Health has created 15 clinics to provide health care-services to members of key populations and has put in place a training programme for health-care workers to strengthen primary health care for people living with HIV.

The First Lady of Panama has advocated for investing more in the HIV response at the regional and global levels.

The Tests that Save Lives campaign in Panama, launched within the framework of the Global ProTest HIV initiative, aims to reduce the number of new HIV infections and AIDS-related deaths by offering free HIV testing and counselling every June. When the campaign was rolled out in June 2015, more than 13 100 people were tested for free across the country. That number increased to more than 16 200 in 2016.

Health fairs are held and mobile clinics tour as part of the campaign, which is led by the Ministry of Health, the Social Security Fund, the Office of the First Lady, the Inter-Governmental Network for HIV Prevention, the private sector and civil society.

Owing to the campaign’s success, the government decided in 2015 to make HIV testing free for adolescents and members of key populations in all public health-care facilities. From 2018, HIV testing will be free for everyone in Panama. 

First Lady Lorena Castillo de Varela’s Love on Wheels is a complementary initiative offering HIV testing and integrated health care through mobile clinics to women living in marginalized and rural communities.

Panama adopted the Fast-Track Targets in 2015, which, if met by 2020, will allow the world to end the AIDS epidemic by 2030. 

Representatives of Bogotá and Medellín joined the UNAIDS Hands up for #HIVprevention campaign during the World Summit of Local and Regional Leaders, which was held in Bogotá, Colombia, from 12 to 15 October. While participating in a side event entitled HIV and Cities: a Contribution to Healthy and Inclusive Societies, they also discussed what needs to be done to strengthen HIV prevention in urban settings. 

The session identified innovative strategies to address the social and urban determinants of the HIV epidemic and to prevent new HIV infections through community-based services in cities. For example, the city of Medellín supports youth-friendly centres that provide a comprehensive package of HIV and sexual and reproductive health services. The city of Bogotá, for its part, has held since 2013 an HIV testing campaign targeting key populations and other people affected by HIV.

The participants agreed that cities will play a critical role in accelerating the HIV response and ending the AIDS epidemic by 2030. They underscored that adopting a Fast-Track response to HIV offers a platform to address other public health challenges, including sexual and reproductive health, maternal health and gender-based violence.

UNAIDS, UN-Habitat and the International Association of Providers of AIDS Care have supported the Fast-Track cities initiative since 2014. The initiative is aimed at engaging mayors and other urban leaders to accelerate the HIV response. Working together, cities can take local actions for global impact.

UNAIDS and Globo have partnered in Brazil to launch an original series for the Internet called Eu Só Quero Amar (All I Want is Love). The web series focuses on Henrique and Camila, a young serodiscordant couple who decide to fight for their relationship despite the obstacles in their way, including stigma and discrimination.

The web series—a spin-off of the TV series Malhação: Seu Lugar no Mundo (Malhação: Your Place in the World), which airs every weekday to an estimated daily audience of 20 million people—is comprised of five episodes, to be released each Saturday during April.

Mixing fiction and documentary elements, the series will tell the stories of young serodiscordant couples, in which one member is living with HIV and the other is not. The aim of the web series is to reach out to a young audience and deepen the debate on social life and relationships among serodiscordant couples, showcasing not only the social challenges they face but also the possibilities for people who want to enjoy a healthy and well-informed sexuality with their HIV-positive partners.

As part of the partnership with Globo, UNAIDS is providing advice for the AIDS-related scenes, supporting the author, screenwriters and producers in fine-tuning language and terminology, and contributing ideas for new topics, scenes and real stories that can add value to dialogues and characters.

Globo is the largest media group in Brazil and owner of one of the world’s most influent TV channels in terms of audience. More than 91 million people, just under half the country’s population, tune in to it every day. In recent years, Globo has started to invest in its Internet branch, Gshow, through which original web series and spin-offs of its soap operas are helping the cannel to strengthen its outreach.

UNAIDS has appointed CNN news anchor Alejandra Oraa as a UNAIDS Regional Goodwill Ambassador for Latin America and the Caribbean. The announcement was made on the occasion of World Health Day 2016.

In her new role, Ms Oraa will work towards promoting an integral approach to HIV based on human rights, as part of the health agenda for women and youth, and will raise public awareness and understanding of gender inequality.

During the coming year, Ms Oraa will visit several countries in the region, where she will have the opportunity to hear about best practices and lessons learned from the HIV response, especially with regard to women and girls.

Alejandra Oraa, born in Vargas, Bolivarian Republic of Venezuela, is anchor of Café CNN, a morning news programme on CNN in Spanish broadcast from Atlanta, United States of America, and Destinos CNN, a weekly TV programme on the world’s most popular tourist destinations. 

Transgender people often face violence, unemployment and poverty, owing to ignorance and prejudice. Such stigma and discrimination places transgender women at a higher risk of HIV infection.

All people are equal and no one should be discriminated for any reason. “In our country it will take a lot to make this affirmation a reality,” the Peru’s Ombudsman Eduardo Vega Luna said in response to the situation. However, he called for “more awareness campaigns that encourage citizens to look at the future with hope and without violence and discrimination.”

One such activity was recently organized by United Nations organizations in Peru, including UNAIDS, UNDP, OHCHR and United Nations Information Centre, and civil society organizations, like PROMSEX, IESSDEH, Center for Interdisciplinary Studies in Sexuality, AIDS and Society of the Cayetano Heredia University, transgender people, the Magnum Foundation and the European Union. An exhibition, “Yo tengo derechos”, meaning “I have rights”, presented photographs taken by Danielle Villasana, an award-winning photojournalist whose work focuses on gender, identity, health and social politics. A recent graduate of the University of Texas, Austin, she has worked with transgender communities since 2012.

The photographs in the exhibition—part of the United Nations Free and Equal campaign, which advocates for lesbian, gay, bisexual and transgender equality—showed transgender people with their colleagues and family members in their daily lives as students, artists, professionals and activists. In their testimonies for the exhibition, transgender people spoke about happiness, love and how they cope with daily struggles.

María del Carmen Sacasa, United Nations Resident Coordinator in Peru, said, “For us, the main human rights theme is non-discrimination. It’s not a minor issue, particularly when it comes to transgender people, who are rejected in many fields.”

The exhibition reminded people of one of the main human rights principles: discrimination is unacceptable. 

Edith Tristán is a Panamanian woman who has been living with HIV for more than two decades. When she was diagnosed HIV-positive, antiretroviral therapy wasn't available in Panama and both her husband and son died of AIDS.

“It was a very difficult time, especially because of the lack of information about HIV,” Ms Tristán said. “My neighbours avoided me. At that time I ran a small food store and people would not buy from me. I struggled to support my mom and daughter with my job.”

Ms Tristán was one of the first people with HIV in the late 1990s to talk openly in Panamanian media about HIV and advocate for improved living conditions. “I started going to health institutions, looking for other people who were in my situation, to provide and receive support,” she said.

She then approached  PROBIDSIDA, one of the first organizations in the country to promote and defend the human rights of people living with and affected by HIV. Later on she was named the focal point in Panama for the International Community of Women Living with HIV/AIDS.

Ms Tristán is now a well-known human rights defender. Since 2011, she works as an HIV Counsellor in the Specialized Unit of the Ombudsman’s Office. One of her main duties is to handle complaints of women living with HIV. “Women are still stigmatized and discriminated at work, at home by their partners and at health care centres,” Ms Tristán said. “In 2015 I have followed up on six cases of women living with HIV whose human rights were violated and haven’t resolved any of them.”      

Panama has a concentrated HIV epidemic, with a low HIV prevalence rate in the general population but a markedly higher prevalence rate in key populations such as transgender women and men who have sex with men. Nevertheless, the number of new HIV infections among women over 15 years old has been increasing.

In Latin America, the vulnerability of women to HIV infection is associated with barriers they face. These include accessing information about HIV transmission, making decisions about their sexual and reproductive health, accessing testing and treatment services and obtaining the economic and social autonomy to protect themselves from violence. The risk of being infected with HIV is even higher for women who are victims of domestic violence.

Ms Tristán stressed, “The main problem is the lack of women’s empowerment. Fear limits their decision-making power. Women need to build up their self-esteem. With self-esteem a woman can defend her rights and seek information and help.”

To increase women’s empowerment, Ms Tristán coordinates a self-help group in Panama City and maintains regular contact with women living with HIV from around the country. Part of her job at the Ombudsman’s Office is to monitor clinics and pharmacies to check the quality of health care and services, visit antiretroviral therapy clinics and carry out home visits to talk with women and inform them about human rights, health and staying on treatment.

“When I look back, my fight has not been in vain,” Ms Tristán said. “I have taken advantage of every opportunity, not only for me but also to help others.”   

Israel is an indigenous community leader living in Veracruz, Panama City. He was diagnosed with HIV 7 years ago, when he was 24. At that time, Israel had no knowledge of HIV. “I thought I would die soon after and I wouldn't see my children grow up,” he said.

Israel looked for support and started to get involved with local civil society organizations advocating for improved sexual and reproductive health for young people and promoting the human rights of key populations. He became an active member of Genesis+ Panama, bringing to the organization the voice of indigenous people.

“Indigenous youth continue to encounter significant barriers in accessing comprehensive sexuality education and services in our language and according to our own practices and model of well-being,” Israel said. “This is a missed opportunity, since our communities can contribute to the HIV response and the development of our society.”

HIV among indigenous populations is an emerging public health concern, as data show that indigenous people are particularly vulnerable to HIV. The government reports that indigenous people have little knowledge of how HIV is transmitted, negative attitudes towards people living with HIV and low HIV testing rates. Reporting on indigenous people’s rights, the Economic Commission for Latin America and the Caribbean found that more indigenous girls initiate sexual activity before the age of 15 than their non-indigenous peers. The rate of teenage pregnancies is more than twice as high for indigenous girls. Another matter of concern is that violence against women, which has links to HIV infection, is prevalent among indigenous populations in Panama. 

Israel works hard to change the situation in his community. He organizes meetings with indigenous young people and teenagers, either at a home or the beach, to discuss health and other important topics. “I want to give my children and other young people access to information and tools to prevent HIV,” he said.

Israel also coordinates a football team of young indigenous women. Each weekend the team participates in local leagues. Before the games start, Israel and the other coaches provide the players with training related to HIV prevention. He said, “There are many young people at risk in my community and I feel that by leveraging the power of football we are creating opportunities to improve their well-being and strengthen social capital.”

Israel also dedicates his time to raising awareness about respect and solidarity towards key populations and people living with HIV. “In indigenous communities, myths still persist around HIV,” he said. “The fear of being excluded or rejected prevents people from taking an HIV test or going to health facilities.”

Reflecting on what he has learned since his diagnosis, Israel said, “HIV has not limited me. It opened my eyes to social justice and motivated me to become the person I am today.”

The First Lady of Panama, Lorena Castillo de Varela, has been named as a UNAIDS Special Ambassador for AIDS in Latin America. UNAIDS Executive Director Michel Sidibé appointed her during a visit to Panama, noting her commitment to expanding HIV testing coverage and bringing services closer to people. More than 15 000 people were tested for HIV in June 2015 as part of the Tests Save Lives campaign, which was led by the First Lady and the Ministry of Health.

The ceremony was held at the Presidential Palace on 16 November with the participation of President Juan Carlos Varela, Vice-President Isabel de Saint Malo de Alvarado and Minister of Health Francisco Terrientes. The dignitaries, along with the First Lady, reaffirmed their commitment to Fast-Track the AIDS response and work towards ending the epidemic as a public health threat by 2030.

Panama has made important progress in the AIDS response. HIV prevalence was 0.6% in 2014, with an estimated 53% of adults living with HIV receiving antiretroviral therapy. Mr Sidibé lauded Panama’s efforts and noted that the country is in a position to eliminate mother-to-child transmission of HIV. These figures hide large disparities by geographic region and population group, however. For example, HIV prevalence among men who have sex with men was 7.7% in 2014.

Mr Sidibé said that social issues that increase vulnerabilities need to be addressed and that improved comprehensive sexuality education can have a significant impact on reducing new HIV infections. He also encouraged increasing sustainable funding to civil society organizations working on HIV and on human rights issues related to the epidemic.

The government agreed that it is important to include vulnerable and marginalized people in the AIDS response. Nationwide there are six primary health centres for key populations, such as men who have sex with men, sex workers and transgender people. An additional three centres will open soon. The clinics focus on the unique needs of the clients, provide accessible health care and offer HIV testing and treatment for sexually transmitted infections.

While in Panama, Mr Sidibé also met with representatives of civil society, applauding their role in advocating for the adoption of a legal framework for the HIV response.