Men who have sex with men

“If I want to see the change, I need to be the change,” said Aniz Mitha, the Executive Director of Community Health Rights Advocacy (CHeRA), an organization that works with male sex workers in Malawi. When Mr Mitha speaks of change, he does so with the quiet and unwavering authority of someone who knows what he is talking about.

From a conservative Muslim family in Malawi, Mr Mitha was thrown out of the house at a young age when his parents found out that he was gay. With nowhere to go and no means to support himself, he fled to Johannesburg, South Africa, where he spent many years as a sex worker. “For me, I was looking to survive; I wasn’t thinking about my health,” he said.

When he became ill, he took an HIV test, and he learned that he was living with HIV. Being an illegal immigrant, he couldn’t access health-care services in South Africa. He returned to Malawi, where he began HIV treatment and started CHeRA. “I thought: how can I help others not go through the same experience that I did?” he said.

CHeRA raises awareness and builds the capacity of male sex workers on HIV prevention and treatment, sexual and reproductive health and rights, economic empowerment, psychosocial support and access to justice. Through a UNAIDS funding arrangement, it recently reached more than 250 male sex workers in three priority districts in Malawi, distributed more than 30 000 condoms and lubricant and linked six male sex workers living with HIV to care and treatment. In another programme funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the organization has trained 50 peer educators and distributed more than 6000 condoms and condom-compatible lubricant.

Mr Mitha is keenly aware of the many challenges that face male sex workers, having faced them himself. “In Malawi, sex work is not recognized as work, so there are no laws to protect sex workers. Also, most of our male sex workers are gay men or men who have sex with men, so they live in fear of arrest because homosexuality is illegal in Malawi,” he said.

Stigma and discrimination is institutional, he said. “Male sex workers are not recognized as a key population in the HIV response in Malawi, so we are not prioritized in government plans. And negative attitudes from health-care workers push us away from care.”

“Say I am being abused or beaten and I go to a police station,” continues Mr Mitha, “I will get questions like “Why you are dressed like this or why do you speak like this?” The abuse is institutionalized. It pushes us away, so even in terms of health care, we go to private hospitals where we pay money even if we don’t have money.”

CHeRA is now registered as a nongovernmental organization. Although started in 2016, it was only registered in 2017 after UNAIDS played a pivotal role in amending provisions in the Malawi HIV and AIDS Management Control Act of 2018 that criminalized or discriminated against certain groups, such as sex workers. This paved the way for organizations of lesbian, gay, bisexual, transgender and intersex people and sex workers to be registered.

Like many people who serve others, his work has spilled over into his private life. Knowing what it feels like to be disowned by one’s family, Mr Mitha gives shelter to people who have nowhere else to go, who stay as long as it takes until they can look after themselves.

He has built an unshakeable sense of self, family and community through his work and his life. “I am living openly with HIV and as a gay person; I am a role model to so many. They see that it is possible. I see a lot more people like me opening up and living openly as gay and with HIV,” he said.

Mr Mitha wants to grow CHeRA into an organization that is a strong advocate for equitable access to health care for male sex workers.

“We need more financial support to expand the work we do,” he said. “We provide access to HIV prevention information and services to a population that is being left behind. It is making a difference. When you are working as a community organization, it means what affects my community affects me too,” he said.

“The job has just begun. We have come a long way, but we still have a lot to do.” That was the message from Ajit Prakash Shah, who delivered the Delhi High Court judgement in 2009 that led the way to the eventual annulling in 2018 of Section 377 of the Indian Penal Code, which criminalized same-sex sexual relations.

The retired Chief Justice of Delhi High Court was speaking at a meeting hosted by UNAIDS and partners in New Delhi, India, on 15 and 16 May on the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people in India.

“Our aim is to mobilize and organize the community so they can together help each other,” said Bilali Camara, UNAIDS Country Director for India.

The speakers noted that despite recent legal judgements―including the annulling of Section 377 and the decision by the Supreme Court of India in 2014 on the rights of transgender people―the situation for LGBTI people in India had not changed drastically. However, it was noted that there is a perception that there is an increasing understanding of the issues of transgender people among the general public.

“The reason for the spike in crimes against lesbian, gay, bisexual, transgender and intersex people is partly due to a lot of cases now being reported, while earlier they were not being reported. The National AIDS Control Organisation has worked with communities that at one time in history fell onto the other side of the law. It has built models that have worked and are being replicated around India,” said Shree Alok Saxena, the Joint Secretary of the National AIDS Control Organisation.

Marietou Satin, Deputy Director of USAID, India, said, “Excluding any section of society is not only a moral evil, but it also impacts a country as a whole. You are denying a large population from being productive members of society. By including them, you are also investing in your economy. They have a right to contribute. For that, people need access to jobs and safety in the workplace.”

The meeting also saw the establishment of an LGBTI taskforce to provide strategic advice to UNAIDS and the United Nations Development Programme in India on current and emerging LGBTI issues in India, and on policy, programmes and services to address those issues.

The participants noted the need end discrimination, sensitize political leaders and policy-makers and ensure that the LGBTI community has access to all services, including health and education, and employment.

Discriminatory laws drive key populations out of reach of critical health and social services

GENEVA, 16 May 2019—Ahead of the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), on 17 May, UNAIDS is calling on all countries to remove discriminatory laws against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

Stigma towards key populations—gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people—is reinforced by criminal laws. These in turn fuel violence, exploitation and a climate of fear, hindering efforts to make HIV services available to the people who need them.

“We all have a moral and legal obligation to remove discriminatory laws and enact laws that protect people from discrimination,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “To end the AIDS epidemic, people need to be protected from harm. We need justice and equality for all.”

More than 65 countries criminalize same-sex sexual relations, including at least eight that impose the death penalty. Globally, gay men and other men who have sex with men are around 28 times more likely to acquire HIV than the general population and are much less likely to access HIV services. In 2017, gay men and other men who have sex with men accounted for 18% of new HIV infections worldwide.

“It is critically important that we create a world where all people can access the health and social services they need without the threat of violence and discrimination. Universal health coverage means reaching all people―sexual and gender minorities have the same right to health as everyone else,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

Transgender people, who account for an estimated 0.1–1.1% of the global population, often face stigma, discrimination and social rejection in their homes and communities. Discrimination, violence and criminalization prevent transgender people from accessing the HIV services they need to stay healthy. It is estimated that transgender women are 13 times more likely to acquire HIV than other adults of reproductive age and that 16.5% of transgender women are living with HIV.

“Justice and protection for all are central to driving progress on the 2030 Agenda for Sustainable Development and the Sustainable Development Goals. Enacting and enforcing non-discriminatory laws and policies, repealing punitive laws and ensuring access to justice for all are critical to delivering on the commitment to leave no one behind,” said Achim Steiner, Administrator of the United Nations Development Programme.

UNAIDS joins with the United Nations Secretary-General and the United Nations High Commissioner for Human Rights in calling for the decriminalization of LGBTI people and for LGBTI people to be protected from violence and discrimination and to have full access to health and other social services.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May.

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.

New global survey aims to fill the data gap on the mental well-being of lesbian, gay, bisexual, transgender and intersex (LGBTI) people to create better conditions and improve health

GENEVA, 14 May 2019—UNAIDS and the LGBT Foundation have launched an online survey to evaluate happiness, sex and quality of life for LGBTI people. The survey, the first of its kind, is part of a campaign to gain more information and insight into the challenges faced by LGBTI people. The data gathered will help to voice the concerns and advocate for improving the conditions and treatment of LGBTI people, including ensuring access to inclusive health and social services.

“Many lesbian, gay, bisexual, transgender and intersex (LGBTI) people face stigma and discrimination daily in education, work, health and social settings. We want to understand how this affects wellness, including mental well-being, and also their responses and resiliencies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “By examining in depth how economic, socioecological, homophobic and other variables impact the lives of LGBTI people, we will be able to advocate more strongly for meaningful change to improve their lives.”

LGBTI people have to contend with stigma and discrimination and are often faced with a lack of economic opportunities and a lack of access to health and social care. They are also at much higher risk of HIV infection. Estimates show that the risk of acquiring HIV is 27 times higher among gay men and other men who have sex with men and 13 times higher among transgender people, yet studies show that many gay men and other men who have sex with men and transgender people avoid seeking health services for fear of stigma and discrimination.

Although there are studies that evaluate the well-being of LGBTI people through measuring levels of violence, legal status and health―often HIV risk and status―few look at the mental well-being of LGBTI people, which is essential to ensuring their overall health and access to economic opportunities.

Data are also lacking on LGBTI people in Africa, Asia and Latin America, which the survey hopes to address. Available in more than 17 languages, the survey has been distributed through social media to more than 25 million people around the world and will run until the end of July 2019.

“We want progress in lesbian, gay, bisexual, transgender and intersex (LGBTI) health and well-being. We want it now and this survey will help in this direction. It is a great initiative, where LGBTI people can confidentially speak up and build the knowledge to empower, raise public awareness and advocate, with an ultimate goal of eliminating stigma and discrimination against LGBTI people. It will be extremely helpful to the community,” said Sean Howell, Chief Executive Officer of the LGBT Foundation.

The survey was developed in collaboration with Aix-Marseille University and the University of Minnesota and was designed in collaboration with representatives of the LGBTI community, including people living with HIV. To ensure the highest standards with respect to privacy and the protection of personal data, the survey complies with the General Data Protection Regulation.

To secure and safeguard anonymity, access is provided via a secured weblink, which establishes an encrypted link between a web server and a browser. The research protocol for the survey has been approved by the Research Board of Ethics of Aix-Marseille University and by the Research Ethics Review Committee of the World Health Organization.

The survey is open for participation until 31 July 2019 and takes about 12 minutes to complete.

To participate in this groundbreaking survey, click on the following link: https://www.research.net/r/LGBTHappinessResearch.

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.

Results from a large-scale European study among serodiscordant gay couples show that adherence to effective treatment prevents transmission of HIV

GENEVA, 3 May 2019—UNAIDS warmly welcomes the PARTNER2 study results that show that HIV transmission does not occur when a person living with HIV is on effective antiretroviral therapy. The study, which enrolled nearly 1000 gay couples in which one partner was living with HIV and the other was not, showed that where the person living with HIV was taking effective antiretroviral therapy and had a suppressed viral load, there was no HIV transmission within the couple.  

“This is excellent news. People living with HIV now have confirmation that provided they take treatment regularly and are virally suppressed, they are not infectious,” said Michel Sidibé, Executive Director of UNAIDS. “This gives a strong, positive message that will help to reduce the stigma around HIV and improve the self-esteem and self-confidence of people living with HIV.”

By the end of the eight-year study, 15 people did become infected with HIV. Virus screening showed that none of the new infections were linked to the HIV-positive partners in the study, but came from a sexual partner outside of the couple. The researchers estimate that within the study, which took place across 14 European countries, around 472 HIV transmissions were averted over the eight years.

UNAIDS hopes that the results will encourage more people to get tested early and take effective treatment. In recent years there has been a huge scale-up in the roll-out and uptake of antiretroviral therapy. In 2017, of the 36.9 million people living with HIV, 59% (21.7 million) had access to treatment and 47% were virally suppressed. Concerted efforts are needed to ensure that all people living with HIV have access to and adhere to effective antiretroviral therapy.

A large proportion of HIV transmission still occurs before people know their HIV status. The risk of HIV transmission is highest in the weeks and months immediately after infection, when the viral load is high and the person who has contracted the virus is unlikely to know their status, is not on treatment and is not virally suppressed. This demonstrates the critical importance of continuing HIV prevention efforts, including condom use and pre-exposure prophylaxis—medicine taken by an HIV-negative person to prevent HIV.

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.

For the past four months, Benjamin Sana has been regularly attending the Oasis Clinic in Ouagadougou, Burkina Faso, where he sees a doctor who gives him a full check-up.

The doctor and peer educators also check whether Mr Sana has any questions regarding his pre-exposure prophylaxis (PrEP) regimen. PrEP is taken by people who are HIV-negative but at higher risk of infection, and has proved to be very effective at keeping people free from HIV.

“Two plus one plus one,” answers Mr Sana, referring to when he needs to take the pills—two pills two hours before sex, then one the day after and one again the following day or one a day until his last sexual encounter. After his check-up, the 34-year-old gay man said, “PrEP protects me and I feel reassured.” He still uses condoms and lubricant, but when he doesn’t he said he feels safer.

Mr Sana is one of 100 men taking part in the PrEP pilot project at the Oasis Clinic, run by the Association African Solidarité (AAS). Health clinics in Côte d’Ivoire, Mali and Togo are also taking part in the pilot project, which has been running since 2017.

Camille Rajaonarivelo, a doctor at AAS, said that PrEP is part of a combination prevention approach that also involves trained peers from his community. The project will gauge adherence to treatment and whether participants take PrEP correctly, she explained.

“The final aim of this pilot project is to scale up and roll out PrEP nationally once the authorities give the green light,” she said. 

The study aims to evaluate whether the preventive option gains traction and how feasible it would be to roll it out nationally and regionally. Financed by the French National Agency for Research on AIDS and Expertise France in partnership with Coalition PLUS and three European health institutes, the pilot project will provide data and ascertain if the treatment lowers the number of new HIV infections among gay men and other men who have sex with men.

Burkina Faso does not penalize homosexuality, but stigma against it is high. As a result, gay men and other men who have sex with men often hide their sexuality and tend to avoid health services. HIV prevalence in Burkina Faso among gay men and other men who have sex with men stands at 1.9%, more than double the rate among the general population.

The first definitive results of the PrEP pilot project in Ouagadougou should be available in 2020. Mr Sana said that many of his friends had shown interest in taking PrEP. “Because the pilot project has limited participants, a lot of people have been turned away,” he said.

He believes that PrEP will save lives, especially those of young men. “Nowadays, young men take a lot more risks and they don’t protect themselves,” Mr Sana said. Ms Rajaonarivelo agreed and added that this applies to young men and young women. “I am stunned to see new cases of HIV every week,” she said. “We have to beef up HIV prevention and awareness again.”

“I am lucky,” Charles Somé said. The hyperactive human rights advocacy worker from Burkina Faso recalls going to a training event and chiding some of the men there about their sexual orientation. “I had pre-conceived ideas and asked them “Don’t you want to get married?”, “Don’t you want to have kids?”” he said. One young man opened up to him and, after days of honest conversations, Mr Somé had a sea change in his views.

“It dawned on me that if I am not judged, why should I judge others,” Mr Somé said. From then on, when lobbying on behalf of gay men and other men who have sex with men, he has used the word “we”.

“I defend them and respect them,” Mr Somé, who works for the REVS PLUS/Coalition PLUS nongovernmental organization, said. 

Homosexuality is not illegal in Burkina Faso, but stigma and discrimination remains high. Many men marry and hide their double life. Support groups for lesbian, gay, bisexual and transgender people have popped up, but discretion is key.

“I am forced to hide because I am not accepted,” Rachid Hilaire (not his real name) said. He joined an informal conversation group in his home town, Bobo-Dioulasso, where young men talked about relationships, sex, HIV and other issues. “I had many doubts about myself, but once I had more confidence in myself, I felt I could help others,” he explained. Standing outside the REVS PLUS meeting room, he joked with Mr Somé about keeping an eye on him. Mr Hilaire is one of 50 REVS PLUS peer educators who facilitate informal talks like the one he had attended tailored to gay men and other men who have sex with men. After being trained, he and another peer educator led frank talks with men.

Mr Hilaire’s biggest challenge, he said, remains educating the general public, along with political and religious leaders. “I blame the older generation for their lack of awareness,” he said. “Everyone deserves to be free and I long to feel that freedom,” he said. 

Yacuba Kientega (not his real name) fled his home in Bobo-Dioulasso and moved to Ouagadougou when his family found out he had relationships with men. “I eventually came back to pursue my studies in Bobo-Dioulasso, but am living in a different neighborhood,” he said. For him, he felt things had become better for gay men, but he would not give up the fight.

As a lobbyist for an HIV umbrella network, Mr Somé’s battle for people’s rights never ends.

“I really try to have underrepresented communities heard by the government and parliamentarians,” he said. He believes support groups and peer education have helped to reach key populations, such as people who inject drugs, gay men and other men who have sex with men and sex workers. “We have seen an uptick in health-care services by focusing on certain communities and I hope it will stay that way,” Mr Somé said. “Ending AIDS will necessitate really tackling stigma and putting the onus on prevention,” he added.

The UNAIDS Country Director for Burkina Faso, Job Sagbohan, couldn’t agree more. “The HIV response must follow the evolution of the epidemic,” he said. At one time, we had to save lives and we succeeded by concentrating on treatment for all, he explained. “To end the HIV as a public health threat, we need to zero in on prevention and awareness,” he added. “It’s the only way to maintain our progress and end AIDS.”

Only one third of gay men and other men who have sex with men know their HIV status in the Lao People’s Democratic Republic, partly because stigma and discrimination remains a barrier for accessing HIV testing in public hospitals and clinics. Complicated protocols, uneven and at times judgemental treatment by health providers and non-confidentiality of testing results further impact on HIV testing.

“Many of our friends are scared of getting an HIV test because they think the testing steps are challenging and often unfriendly,” said Phoulikhan Siphabouddy, a community-based supporter of LaoPHA, a Lao nongovernmental organization.

To address this, USAID supported the government and LaoPHA to pilot oral fluid screening in three provinces.

Most people assume that testing involves taking a blood sample. But oral fluid testing detects antibodies for HIV, not the virus itself. A test swab is gently wiped along a person’s upper and lower gums once, then the swab is placed inside a test tube containing a reagent. The result is known within 20 minutes.

Members of the community, so-called peer educators, train volunteers for the oral fluid screening. The screening is fast, easy and can be done anywhere.

Around 82% of people reached agreed to have an HIV test through oral fluid screening, compared to only 17% of referrals to clinics, according to the Ministry of Health.

“The new approach dramatically exceeded Laos’ HIV testing targets by more than 200%,” said Bounpheng Philavong, Director of the Lao Centre for HIV/AIDS and STI.

He, along with LaoPHA, are convinced that community-led services provide an enabling environment for key populations to access HIV services in a non-discriminatory manner. Linkages to care and support for people living with HIV has also improved for people who test positive, with the same community volunteers providing support for referral to trusted clinics.

GENEVA, 6 September 2018—UNAIDS welcomes the decision of the Supreme Court of India to annul key provisions of Section 377 of the Indian Penal Code. Section 377 criminalizes sexual relations between lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

“Today is a day of gay pride, a day of celebration, a day when respect and dignity was finally restored in India for lesbian, gay, bisexual, transgender and intersex people,” said Michel Sidibé, Executive Director of UNAIDS. “I applaud the brave activists, civil society organizations and community groups that have fought long and hard for this injustice to be reversed.”

Criminalization of consensual same-sex sexual relations is a violation of human rights and legitimizes prejudice and violence against LGBTI people. Criminalization hinders people from accessing and using HIV prevention, testing and treatment services and increases their risk of acquiring HIV.

In India, HIV prevalence among gay men and other men who have sex with men is 2.7% and among transgender people is 3.1%, compared to the national HIV prevalence among all adults of just 0.26%. Around three out of ten gay men and four out of ten transgender people in India who are living with HIV do not know their HIV status. Many LGBTI people living with HIV do not have access to HIV treatment.

Gay men account for 18% of all new HIV infections worldwide. UNAIDS urges countries to ensure the full respect of the human rights of all people, regardless of their sexual orientation, through repealing laws that prohibit sex between consenting adults in private, enforcing laws to protect people from violence and discrimination, addressing homophobia and transphobia and ensuring that crucial health services are made available.

“I hope this decision sets the trend and is followed by similar decisions in other countries that remove unjust laws criminalizing homosexuality,” said Mr Sidibé.

In June 2016, United Nations Member States committed in the Political Declaration on Ending AIDS to promote laws and policies that ensure the enjoyment of all human rights and fundamental freedoms for children, adolescents and young people, particularly those living with, at risk of and affected by HIV, so as to eliminate the stigma and discrimination that they face.

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.

Papua New Guinea has published the results of its first comprehensive survey on key populations in the country. The report is the conclusion of a study that collected estimates of the sizes of key population and biobehavioural data, which will be used to inform prevention and treatment services and policies for HIV and other sexually transmitted infections.

“Only when we ensure that Papua New Guinea’s HIV programming reaches the right people in the right way and place, and at the right time, will the increasing HIV infection rates amongst key populations be slowed,” said David Bridger, the UNAIDS Country Director for Papua New Guinea, at the report’s launch.

The study, Kauntim mi Tu (count us), was carried out in the three largest urban areas of the country—Port Moresby, Lae and Mount Hagen. It revealed that female sex workers, gay men and other men who have sex with men and transgender people often do not seek health care, get tested for HIV or other sexually transmitted infections or use condoms.

Members of key populations in the country face real and perceived stigma, discrimination and violence from police, clients and others in their communities on a daily basis, according to the report. High rates of stigma, discrimination and violence are deterring them from seeking or accessing health-care services.

A member of Friends Frangipani, an organization of sex workers, said, “Many of us live very difficult lives. We don’t all have access to clean water, healthy food or a safe space. We are struggling. Yet we are told to look after ourselves, protect ourselves from HIV and, if HIV-positive, stay healthy. That is very hard for many of us. People need to understand our lives better, and Kauntim mi Tu has done that.”

While adult female HIV prevalence is estimated at 1.1% nationally, the study found that prevalence was nearly 20% among female sex workers in Mount Hagen and almost 15% in the capital, Port Moresby. More than half of gay men and other men who have sex with men and transgender people were found to have never been tested for HIV. Three out of four men in the second largest city, Lae, reported having experienced violence related to their sexuality or sexual identity.

The study included biological testing, with participants offered point-of-care tests and, if needed, same-day treatment for syphilis, chlamydia and gonorrhoea. The research team included members of key populations.

The study’s principle investigator, Angela Kelly-Hanku, noted that much work remains to be done. “This work must be done in the context of safe, respectful and enabling environments that support adequate public health responses and invest in new and dynamic ways to increase HIV testing and ensure that treatment is continuously available, that viral load testing is standard HIV care and that prevention is paramount to everything. We cannot be complacent,” she said.

The report is available at http://www.aidsdatahub.org/sites/default/files/publication/PNG_Kauntim_mi_tu_Multi-Site_Summary_Report_from_the_Key_Population_IBBS_2018.pdf.