Men who have sex with men

How to build stigma-free key population services

23 June 2023

At his previous factory job, Tom Wang (not his real name) says coworkers gossiped about his sexuality and made fun of him. When he visited a public health facility for an HIV test, the nurse peppered him with questions like “Why do you need it? Have you been sleeping with many partners?”

Thailand is a country famed for its tolerance. It is among the world’s top locations for gender affirming care. Same-sex sexual activity hasn’t been criminalised since 1956. And the policy tide is turning on other key population issues. A 2021 Drug Law allows for harm reduction as opposed to automatic imprisonment, while a bill is in the pipeline to affirm the rights of sex workers. Yet stigma and discrimination persist. In homes, communities, schools, workplaces and—critically—healthcare settings, discriminatory attitudes can take their toll.

“Microaggressions—intentional or unconscious verbal or behavioural slights toward stigmatised groups—can drive people away from HIV prevention and treatment,” noted UNAIDS Regional Human Rights and Law Adviser, Quinten Lataire. “There are evidence-based approaches for measuring and lowering both overt and subtle stigma and discrimination in healthcare settings.”

It was this need for stigma-free services that led to the establishment of the Rainbow Sky Association of Thailand (RSAT). RSAT offers sexual healthcare for men who have sex with men, migrants, people who use drugs, sex workers and transgender people. It also advocates for the full rights and equity of lesbian, gay, bisexual and transgender (LGBT) communities. Tom Wang is amongst the clients who have benefited from their support.

This work is critical if HIV programmes are to reach and retain key population communities. In Thailand, as in the rest of Asia, these groups carry the heaviest HIV burden. Nationally HIV prevalence is 1% for sex workers, 8% for people who use drugs, 11% for transgender women and 12% for men who have sex with men.

A one stop shop for sexual health services

RSAT’s approach demonstrates how programmes can improve outcomes by implementing strategies to affirm and empower clients. They are jointly supported by PEPFAR, USAID, EpiC, the National Health Security Office (NHSO) and Thailand’s Institute of HIV Research and Innovation (IHRI).

There are no depressing charts or drab walls at their five key population clinics. At the Bangkok site the rainbow motif appears on the floors and walls. There are swarms of cut-out butterflies. Signs are either upbeat and multi-coloured or a soothing blue.

Most of the staff are themselves members of key population groups. All staff receive anti-stigma and discrimination training which even addresses the fine point of body language. Nothing about staff’s interactions should make a client feel judged or uncomfortable. The entire team is retrained annually. There is an internal complaint mechanism that allows clients to confidentially flag issues, as well quality assurance staff to ensure Standard Operating Procedures are followed. Every team member signs a confidentiality agreement.

RSAT’s service package includes on-site testing for HIV and other sexually transmitted infections, Hepatitis C, Tuberculosis and Covid-19. For transgender clients they offer hormone level monitoring. Mental health screenings which evaluate for depression, anxiety and stress have been integrated into the HIV service package. Where required, clients are referred for additional mental healthcare.

“Many of our clients engage in chem sex (recreational drug-use during intercourse). Some clients inject meth so we need to provide more than condoms. They also need clean syringes and needles which are part of our harm reduction package,” said Deputy Director, Kao Kierati Panpet.

Pre- and post-test counselling are critical. All counsellors are certified and accredited by the Ministry of Public Health according to Counsellor Supervisor, Sasiprapha Khamthi. Even before receiving HIV test results, clients know that treatment is available. Following a positive test, the counsellors reassure clients that with treatment they can live a normal life, explained Niphon Raina, Care and Counselling Supervisor.

“We also ask what their concerns are and give basic information about how HIV is and is not transmitted, using a picture book so they are clear on the facts,” Care and Counseling Officer, Bussarin Poonvisitkun added.

RSAT keeps a stock of antiretroviral therapy drugs onsite and can initiate new clients’ treatment on the day of diagnosis by giving them one month’s supply. Although HIV care is provided at the Ratchaphiphat Hospital, RSAT is able to dispense right away in accordance with instructions from a hospital doctor, delivered via telemedicine. Clients living with HIV receive help from the care and support team to navigate their next steps, including attending hospital visits.

RSAT also provides pre-exposure prophylaxis or PrEP services with hospital supervision. Mr. Tom Wang explains how this has protected his health: “I decided to get on PrEP because I am changing partners. To me PrEP is another means of protection in case you are intoxicated or the condom breaks. It’s a way to ensure I stay HIV-free.”

A redress mechanism for rights violations

The organisation advocates for structural changes to eliminate stigma and discrimination. For example, they are currently making recommendations for the Gender Recognition Draft Bill.

“But the reality is that policy and legal changes take a lot of time,” said RSAT Director, Tanachai Chaisalee.

While this longer-term work proceeds, a redress mechanism helps clients address current concerns. RSAT is tapped into the Crisis Response System (CRS) initiated by the Ministry of Public Health in collaboration with the Office of the Attorney General, Ministry of Justice. People with complaints about prejudice or rights violations in any sphere can scan a QR code and report their experience. Reports may also be sent via Facebook, email or LINE, Thailand’s answer to WhatsApp. A multi-disciplinary team conducts investigations and works with the client and other stakeholders to help.

The lion’s share of reports made via RSAT come from transwomen (78%) while gay men have lodged 17% of reports. The most common challenges relate to requirements for gender confirming attire, social exclusion (particularly during job application processes) and HIV status.

RSAT’s Human Rights Manger, Watcharawit Waraphattharanon, shares that they have been able to resolve some cases very quickly. For instance, if a person living with HIV is being forced to take an HIV test as a requirement for work, the Attorney General’s office does an emergency intervention.

“We can close these cases within one week,” he said.

“The work of key population-led, community-based organisations like RSAT is critical to reach those who most need HIV services,” UNAIDS Country Director, Patchara Benjarattanaporn stressed. “The Government’s progress in funding Community-led Health Services and building partnerships between these organisations and the public health system puts us on the path to end AIDS.”

A group of journalists visited the Ozone Foundation as part of the UNAIDS, UNDP, APN Plus and USAID/PEPFAR Southeast Asia Regional Workshop on HIV-related Stigma and Discrimination in Bangkok, Thailand on June 8, 2023. Learn more about this novel training

UNAIDS celebrates Pride Month and calls for decriminalization of same-sex relationships

31 May 2023

GENEVA, 1 June 2023—As the world comes together to celebrate Pride Month, UNAIDS stands in solidarity with lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities around the globe. Pride Month provides an opportunity to celebrate the resilience, diversity, and achievements of LGBTQI individuals, while also reflecting on the challenges they continue to face. This momentous occasion serves as a reminder of our collective commitment to human rights, equality, and the urgent need to decriminalize same-sex relationships.

Cleiton Euzebio, Senior Advisor for Communities and Key Populations, UNAIDS said, “As a gay man, and as an activist for social justice for all, I am so proud to work for the UN’s Joint Programme to end AIDS. The UN is standing with communities, supporting them in leading the HIV response, confronting stigma, and building societies where every person is valued. This month and every month, may everyone feel pride in who they are.”

Thanks in large part to efforts led by key populations, the world has seen substantial progress in the HIV response. The end of AIDS is possible. However, inequalities stand in the way. Discrimination, violence, and stigma against LGBTQI people persist in many parts of the world, limiting access to essential services, including HIV prevention, treatment, care, and support.

Criminalization of same-sex relationships remains a significant barrier to achieving social justice and equality for LGBTQI individuals, and to ensuring health for all. Laws that criminalize consensual same-sex activity perpetuate stigma, contribute to violence and discrimination, and obstruct access to vital healthcare services. UNAIDS calls on all governments to urgently repeal discriminatory laws and policies, and to work towards creating an enabling legal and social environment that respects and protects the rights of LGBTQI people.

The decriminalization of same-sex relationships is a crucial step in our collective efforts to end the AIDS pandemic. When marginalized communities are criminalized or stigmatized, their vulnerability to HIV infection increases, and their access to HIV prevention, treatment, care, and support services is obstructed.

Significant gains that have been won in advancing LGBTQI rights in many parts of the world, including the decriminalization of same-sex relationships in several countries—from Angola to Singapore to Barbados. However other countries are imposing harsher criminal laws on same sex relationships. Decriminalizing homosexuality is essential to ensuring the end of AIDS.

UNAIDS will be taking part in the Geneva Pride march on 10th June. Pride Month is a vital reminder of the need for governments, civil society organizations, and individuals to join together for the protection and promotion of human rights for all, irrespective of sexual orientation, gender identity, or expression. Together, we can build a world that upholds equality, justice, and dignity for everyone.

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.

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Discover which countries criminalize key populations

Joint Statement by the Leaders of the Global Fund, UNAIDS and PEPFAR on Uganda’s Anti-Homosexuality Act 2023

29 May 2023

GENEVA | WASHINGTON, D.C., 29 May 2023— The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) are deeply concerned about the harmful impact of the Ugandan Anti-Homosexuality Act 2023 on the health of its citizens and its impact on the AIDS response that has been so successful up to now.

Uganda’s Leadership Towards Ending the AIDS Pandemic as a Public Health Threat

Uganda and President Yoweri Museveni have been leaders in the fight to end AIDS. Progress has been made thanks to the implementation of large-scale prevention, diagnosis, treatment and care programs, all provided on the principle of access to health care for all who need it, without stigma or discrimination. This approach has saved lives. The strong health systems built to support the AIDS response serve the entire population of Uganda. This was evident as community health workers and health systems developed for the AIDS response played a key role in tackling COVID-19 and other disease threats. Maintaining this is vital: Failures in the HIV public health response will have system-wide impacts that could negatively affect everyone.  

Success Is Possible

We know that we will be able to overcome this public health threat when we ensure that 95% of people living with HIV know their status, 95% of them are on treatment, and 95% of those on treatment have achieved viral suppression. Uganda can reach that. By 2021, 89% of people living with HIV in Uganda knew their status, more than 92% of people who knew their HIV status were receiving antiretroviral therapy, and 95% of those on treatment were virally suppressed.  Uganda is well on track to achieve the UNAIDS HIV treatment targets if progress can be maintained. 

Discrimination Threatens Progress in the AIDS Response

Uganda’s progress on its HIV response is now in grave jeopardy. The Anti-Homosexuality Act 2023 will obstruct health education and the outreach that can help end AIDS as a public health threat. The stigma and discrimination associated with the passage of the Act has already led to reduced access to prevention as well as treatment services. Trust, confidentiality, and stigma-free engagement are essential for anyone seeking health care. LGBTQI+ people in Uganda increasingly fear for their safety and security, and increasing numbers of people are being discouraged from seeking vital health services for fear of attack, punishment and further marginalization.

Uganda has repeatedly demonstrated leadership and commitment to ending AIDS – and has achieved great success – by leaving no one behind. Together as one, we call for the Act to be reconsidered so that Uganda may continue on its path to ensure equitable access to health services and end AIDS as a public health threat by 2030.  

Peter Sands, Executive Director, The Global Fund

Winnie Byanyima, Executive Director, UNAIDS, and Under-Secretary General of the United Nations

Ambassador John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, U.S. Department of State

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.

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Discover which countries criminalize key populations

UNAIDS urges all countries to decriminalise homosexuality as a vital step in ensuring health for all

17 May 2023

Released ahead of the International Day against Homophobia, Transphobia and Biphobia – 17 May 2023

GENEVA, 15 May 2023—Around the world, 67 countries still criminalise same sex relations, with 10 imposing the death penalty. 20 countries criminalise gender diversity. Such laws hurt the public health of everyone, costing lives. Public health and human rights go hand in hand.

“The importance of decriminalising homosexuality and gender diversity cannot be underestimated,” said Christine Stegling, Deputy Executive Director, Policy, Advocacy and Knowledge, UNAIDS. “Decriminalising will save lives and is a crucial step towards equality, dignity, and health for all.”

Across all cultures, sexual orientation, gender identity, and expression are diverse. LGBTQI+ people are part of every society in every country since time immemorial, yet LGBTQI+ people continue to be marginalised and excluded—be it legally, culturally, socially or a combination of all.

Criminalisation, along with pervasive discrimination and violence, obstructs LGBTQI+ people from accessing life-saving services. In a growing number of cases, health service providers are also experiencing being harassed by vigilantes or police for providing life-saving services to LGBTQI+ people.

UNAIDS reports that in countries where same sex relations are criminalised, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalised. Where there have been recent prosecutions, this increases to 12 times higher.

Recognizing that criminal laws have a detrimental impact on the HIV response, United Nations member states at the UN General Assembly committed to ambitious targets in the 2021 Political Declaration on HIV to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalisation as a critical element in the HIV response, countries made a commitment that by 2025, less than 10% of countries would have punitive legal and policy environments that affect the HIV response.

There has been a positive wave of progress. In the past year Antigua & Barbuda, St Kitts & Nevis, Singapore, Barbados and the Cook Islands have repealed old colonial laws which had criminalised same-sex relations. Kuwait’s court overturned a law that had criminalised “imitating the opposite sex”.

Brazil is amongst the countries driving forward progress in advancing the human rights of LGBTQI+ people. The Minister of Health and the Minister of Human Rights will announce that the country will be joining the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination during an event on 17 May. The event will focus on access to care and justice for trans and gender-diverse communities.

However, running counter to the wave of progress is a renewed, well-funded, well-organised international drive to sow prejudice and push discriminatory and harmful new anti-homosexuality legislation and anti-trans legislation.

If enacted into law, this legislation will have extremely damaging consequences for public health, obstructing LGBTQI + people from accessing health services, and obstructing health workers from providing, life-saving services including services to prevent and treat HIV. It is vital for public health that this harmful push be stopped.

On International Day against Homophobia, Transphobia and Biphobia, UNAIDS is calling on all countries to remove punitive laws and tackle prejudices against lesbian, gay, bisexual, transgender and intersex people. A more just, equitable and kind world is a healthier one, for everyone.

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.

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Uganda’s new Anti-Homosexuality Bill would harm public health

03 May 2023

GENEVA/JOHANNESBURG, 3 May 2023—Responding to the passing of the Anti-Homosexuality Bill by the Ugandan Parliament, UNAIDS has warned that its passing into law would undermine Uganda’s efforts to end AIDS by 2030, by violating fundamental human rights including the right to health and the very right to life.   

UNAIDS East and Southern Africa Director Anne Githuku-Shongwe said:  

Uganda has made excellent progress in tackling the AIDS pandemic. This new Bill, if passed into law, would undercut that progress.  

It would drive communities away from life-saving services, and obstruct health workers, including civil society groups, from providing HIV prevention, testing and treatment.    

The evidence is crystal clear: the institutionalization of discrimination and stigma will further push vulnerable communities away from life-saving health services. Research in sub-Saharan Africa shows that in countries which criminalize homosexuality HIV prevalence is five times higher among men who have sex with men than it is in countries without such laws.   

By undermining public health, this law would be bad for everyone.   

The harmful Bill stands in marked contrast to a positive wave of decriminalization taking place in Africa and across the world, in which harmful punitive colonial legislation is being removed in country after country. Decriminalization saves lives and benefits everyone.  

Public health organizations welcomed the President’s rejection of the earlier Bill. As this new Bill, like the earlier Bill, would hurt public health, it too should not be enacted.”  

Cook Islands’ original path toward equality

27 April 2023

On April 14th members of the Cook Islands rainbow community assembled at parliament with colourful flags and cautious optimism. It turned out to be the day they’d been working toward for the last twelve years. Parliament removed laws prohibiting consensual sex between men, striking out sections of the Crimes Act that had been on the books since the turn of the 20th century.

“This decision by Cook Islands is part of a wave of global progress around abolishing harmful laws,” noted UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

“This was a huge historical moment,” said Valery Wichman, President of the Te Tiare Association, the nation’s oldest lesbian, gay, bisexual and transgender (LGBT) organisation. “It’s not just a win for the community, but also a shift in terms of our nation maturing and upholding the constitutional rights of all people.”

Ms Wichman, an attorney and public servant, is also an akava'ine—a Māori word meaning transgender woman. She attests that the anti-LGBT laws which made so-called “sodomy” and “indecent acts” punishable by imprisonment reinforced prejudices. This contributed to the LGBT community’s exclusion, harassment and bullying. She has herself experienced being mocked and assaulted.

“A lot of people chose not to live here. It was too hard for them to endure their family’s and society’s judgment. The idea that you are not worthy has carried down from parents to children and has affected how we have been treated by our peers. A lot of trans women have not gone to the doctor because they have been misgendered and have felt disrespected. There have been cases where they ended up dying,” she said.

The journey toward law reform started in 2011. The spark was the discriminatory response to the nation’s first HIV diagnosis. Te Tiare led the advocacy charge with support from organisations including the Cook Islands Family Welfare Association.

A Crimes Bill drafted around 2013 removed the discriminatory clauses. In 2017 parliament set up a Standing Committee to review its raft of proposed revisions. Support for civil society to prepare submissions outlining public health grounds for reforms was provided by the United Nations Development Programme (UNDP), the lead agency amongst the United Nations Joint Programme on HIV and AIDS working on effective democratic governance and issues affecting sexual and gender minorities.

But following a political change the next year, the committee’s Chair recommended retaining the ban on gay sex. What’s more, he proposed a new section criminalising sex between women. The bill remained in limbo for years. Reform efforts seemed to hit a wall.

A strategy of public dialogue and political engagement rooted in Cook Islands culture enabled a breakthrough. Pride Cook Islands (PCI) was formed as a sister organisation to Te Tiare, focusing on this public advocacy branch of work.

“Obviously we are in a unique situation as a small, conservative, religious population,” PCI President, Karla Eggelton began. “The work of advocacy becomes more delicate when you are living beside people making these decisions for you. We welcomed support from international allies, but we knew we had to do this our own way and have our own approach that is mindful of the situation and culture we live in.”

First TCI tackled messaging. There were deep deliberations around word choice. The mandate was to keep the conversation simple. Ultimately the cause was framed as an equality issue. The rallying cry became, ‘don’t make us criminals in our own country’.

The organisation stayed in communication with policymakers on both sides of aisle. They not only explained their position, but sought to understand politicians’ concerns.

The group met with traditional leaders who are grassroots decision-makers. Village communities were invited to have conversations during public meetings.

“It offered an opportunity for us to understand the misperceptions. We were able to explain that all we are asking for is to not be made criminals. People said, ‘we don’t want to send you to jail, we love our neighbours and our family’,” Ms Eggelton remembered.

The organisation’s patron is Lady Tuaine Marsters whose husband, Sir Tom Marsters, is the British King’s Representative. Lady Marsters frequently attended consultations. Other spokespersons included parents and people with standing in the church. At times supporters were invited to simply stand in solidarity. But anyone who would speak was carefully prepared.

“We spent hours articulating what we would say. We reaffirmed our pledge to not become emotional. We had to keep each other in check to make sure we did not say anything we could regret,” Ms Eggelton outlined.

Then came an effort to increase visibility. The call for equality was largely coming from the LGBT community. They needed other people to demand the same. So PCI embarked on a campaign for people to show their support either by lending their voice to the public dialogue or flying the rainbow flag.  The group distributed free flags, urging people to fly one for their daughter, son or grandchild. From restaurants to bars, t-shirts to earrings, the display of support resonated.  

A first-of-its-kind pride ad on TV, newspapers and radio challenged Cook Islanders: “We are good enough to be your teachers, nurses, choreographers, dressmakers and orators… but not good enough in the eyes of the law. We are already part of your community, we are just asking you to recognise us as equals.”

This visibility and advocacy work was supported by UNDP through the Being LGBTI in Asia and the Pacific program. PCI developed a project to strengthen the digital capacities of community organisations. A critical outcome was the Pride Pledge Cook Islands initiative with the business community which provides visible safe spaces for LGBT people.

“The UNDP support was instrumental in promoting acceptance and awareness and utilising digital tools to share our message,” Ms Eggelton said.

TCI conducted frequent polls to gauge public sentiment. At the start of the process they lagged behind reform opponents. But by the time would-be Prime Minister, Mark Brown, made an election promise to change the law last year, public sentiment had tilted.

“Once we were able to establish that it was really about equality, then we saw a changing of the tide,” Ms Eggelton reflected.

Ultimately the entire government bench voted in favour of an Amendment Bill while opposition leader, Tina Brown, and two of her Members of Parliament also supported.

Renata Ram, UNAIDS Country Director for Fiji and the Pacific, noted that seven other countries in the Pacific region retain laws criminalising same-sex relations.

“The Cook Islands example proves that along with law reform we can have national dialogues about inclusion, justice and equity,” Ms Ram said.

At a national ceremony marking the end of the South Pacific cyclone season the rainbow community gathered once more, this time to give thanks.

“We want to make sure people understand our gratitude for everything that has transpired and for everyone who worked hard to achieve this,” Ms. Eggelton said. “Our community is now recognised through the eyes of the law as being equal. Now people can feel safe, not like second class citizens.”

Related: UNAIDS welcomes the decriminalisation of same-sex relations by the Cook Islands parliament

UNAIDS welcomes the decriminalisation of same-sex relations by the Cook Islands parliament

15 April 2023

BANGKOK, 15 April 2023—UNAIDS applauds today’s decision by Cook Islands lawmakers to remove laws prohibiting consensual sexual acts between men from the Crimes Act. By decriminalising sex between same-sex partners, the Pacific nation joins a global movement toward affirming the human rights to non-discrimination and privacy.

“Cook Islands’ latest move is part of a wave of global progress around removing laws that harm. It will inspire countries across the Pacific, Asia and the world to follow suit. Decriminalise, save lives," said UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

Criminalisation of same-sex relations undermines the human rights of lesbian, gay, bisexual and transgender (LGBT) people. Punitive laws reinforce stigma and discrimination against LGBT people, undermining their access to the rights, remedies and opportunities available to other people. Such laws also obstruct access to vital services, including sexual and reproductive healthcare.

"This decision by Cook Islands will save lives,” said Mr Murphy. “The abolition of punitive and discriminatory colonial laws across the world is essential for public health, including for ensuring the end of AIDS.”

Bi-partisan support for the Crimes (Sexual Offences) Amendment Bill demonstrates that policy-makers, civil society and communities can dialogue to develop laws that create more just and equitable societies. 

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.

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UNAIDS
Cedriann Martin
MartinC@unaids.org

UNAIDS urges the Government of Uganda to not enact harmful law that threatens public health

22 March 2023

GENEVA/JOHANNESBURG, 22 March 2023 —  Responding to the passing of the Anti-Homosexuality Bill by the Ugandan Parliament, UNAIDS has warned that, if the Bill is enacted into law, it will have extremely damaging consequences for public health, by curtailing the human rights of people living with HIV and some of the most vulnerable people of Uganda to access life-saving services. 

UNAIDS East and Southern Africa Director Anne Githuku-Shongwe said: 

“If enacted, this law will undermine Uganda’s efforts to end AIDS by 2030, by violating fundamental human rights including the right to health and the very right to life.   

It will drive communities away from life-saving services, and obstruct health workers, including civil society groups, from providing HIV prevention, testing and treatment.   

The evidence is crystal clear: the institutionalization of discrimination and stigma will further push vulnerable communities away from life-saving health services. Research in sub-Saharan Africa shows that in countries which criminalize homosexuality HIV prevalence is five times higher among men who have sex with men than it is in countries without such laws.  

By undermining public health, this law will be bad for everyone.  

This law, if enacted, will hurt Ugandans. It will cost lives and it will drive up new HIV infections. We urge Government to not enact this harmful law.” 

The law would impose a penalty of life imprisonment for homosexual acts and the death penalty for so-called “aggravated offences”. It even includes a duty to report acts of homosexuality, with failure to do so punishable by up to 6 months in prison.  

The harmful Bill stands in marked contrast to a positive wave of decriminalization taking place in Africa and across the world, in which harmful punitive colonial legislation is being removed in country after country. Decriminalisation saves lives and benefits everyone. 

Although the Anti-Homosexuality Bill has been passed by parliament, it is not yet enacted as a law and can, in the interest of promoting public health and equal rights of Ugandan citizens, be rejected by the President. It is not too late for this Bill to be rejected and lives to be saved.  

UNAIDS congratulates Barbados on its decision to repeal colonial-era laws that criminalised same sex sexual relations

13 December 2022

GENEVA, 13 December 2022—UNAIDS welcomes the judgement by the High Court in Barbados to strike down the country’s colonial-era gross indecency and buggery laws that criminalised consensual same-sex relations.

“This historic decision is a significant step towards protecting the human rights and dignity of LGBT people in Barbados,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “It will also strengthen the country’s HIV response by helping to reduce stigma and discrimination faced by LGBT people and increasing the uptake of HIV testing, treatment and prevention services.”

Under section 9 of the Barbados Sexual Offences Act, punishment could lead to life imprisonment for men engaging in same-sex sexual activity. Under section 12, both men and women were criminalised and liable to up to 10 years imprisonment. Laws that punish consensual same sex relations, in addition to contravening the human rights of LGBT people, act as a barrier to improving health outcomes, including in the HIV response. Such laws sustain stigma and discrimination against LGBT people and stop LGBT people seeking and receiving healthcare for fear of being punished or detained. Decriminalisation saves and changes lives and builds stronger societies.

Barbados becomes the third Caribbean country this year to announce the repeal of such discriminatory legislation. The case was filed by two Barbadian LGBT advocates with local organisation Equals Barbados providing community support, and the regional LGBT umbrella organisation, the Eastern Caribbean Alliance for Diversity and Equality, convening the process.

Earlier this year, courts in Antigua and Barbuda and St Kitts and Nevis also struck down as unconstitutional laws that criminalised gay men and other men who have sex with men. There now remain six countries in the Caribbean that criminalize gay sex between consenting adults, all of them former British colonies. They are Dominica, Grenada, Guyana, Jamaica, St. Lucia, and St. Vincent and the Grenadines.

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.

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Thailand’s Mplus: HIV services delivered in style

13 December 2022

“This isn’t your mother’s clinic!” said one amazed visitor.

From banners to brochures, all promotional materials are slick and cheerful. Smiling faces and toned torsos are everywhere. A purple colour scheme covers the whole building. Even files and staff face masks are colour coordinated. A pair of Facebook Live hosts have the good looks and energy of K-pop stars. And the organization’s slogan is decidedly upbeat: “where community fulfills your happiness”.

Over almost two decades, Thailand’s Mplus Foundation has refined a unique approach to providing comprehensive HV services to key population clients including men who have sex with men and transgender women.

Their method goes far beyond a cool brand identity. Mplus has leveraged domestic and international partnerships to create a key population-led health service with impressive results. They dispense more than half of the PrEP in Thailand’s Chiang Mai province.

This year they tested 95% of the almost 8000 people they reached with face-to-face services. Of those who tested positive, 91% were placed on treatment while the other 9% are in follow-up case management. And 100% of their clients who received viral load testing were found to be virally suppressed.   

“Community organizations can best reach key populations to receive services. We find that people who do not want to get tested at the hospital are comfortable with peers who they know understand their  life,” explained Pongpeera Patpeerapong, Director of the Mplus Foundation.   

Since its formation in 2003 Mplus has evolved to deliver a full range of services. They now have health centres in four provinces, while their mobile testing units serve clients in another five districts. They support a local hospital in each province, linking people to care and helping them with adherence. Mplus provides rapid testing, CD4 and viral load monitoring, and is also authorized to dispense medication. A small fleet of motorcycles even makes PrEP deliveries to clients in remote areas.

Both their online and offline engagements are anchored by a peer-led strategy. Their social media presence is commanding—everything from Twitter to Tik Tok. There are closed Facebook groups and special applications for clients to connect with community. Offline, they go beyond information booths to host parties and sport meet-ups. These aren’t just bonding exercises. Clients book appointments online and face-to-face interactions usually result in receiving an HIV test.

Mplus also provides technical assistance to other countries. It has supported an organization in Laos with online interventions and helped community groups in Cambodia develop campaigns to promote PrEP.

They played a key role in advocating nationally for the accreditation of community health workers. All Mplus staff are certified by the Department of Disease Control following a rigorous programme of study, evaluation and practice.

The programme continues to progress.  Mplus is strengthening their mental and emotional health support offering, and is working towards becoming certified to provide HIV and sexually transmitted infection (STI) treatment.

While in the past the programme was more heavily funded by the U.S. President's Emergency Plan for AIDS Relief through the United States Agency for International Development, today half of their investments come from branches of the National Health Security Office.

“Domestic funding is very important to develop our systems,” Mr. Patpeerapong said. “Community-based organizations have to be able to access domestic funding to cover more issues, including stigma and discrimination.”

Empowering key population-led health services has been crucial in improving Thailand’s HIV programme results. One of five people living with HIV in Thailand were identified and referred by a key population-led health service under the domestic health financing scheme. Four out of five people on PrEP in the country are served by community-led organizations. These services play a critical role in Thailand’s  strategy of Reach, Recruit, Test, Treat, Prevent, Retain.

“Thailand is well-positioned to be a leader in addressing the need for a sustainable community-led response as a critical part of the health infrastructure,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “By creating an enabling system for health outreach we can address the challenge of late diagnosis and better reach key population communities with services.”

Thailand has integrated HIV services into its Universal Health Coverage scheme and increased investments in key population- and community-led health services. UNAIDS Programme Coordinating Board (PCB) members visited Mplus and other community-led health services ahead of the 51st PCB meeting in Chiang Mai, Thailand.

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