Sexual and reproductive health

Human rights experts have called for concerted efforts to end human rights violations based on sexual orientation and gender identity.

A report launched today during the 58th Ordinary Session of the African Commission on Human and Peoples’ Rights, being held in Banjul, Gambia, summarizes a historic dialogue that took place in November 2015 between United Nations human rights experts and representatives of the African Commission on Human and Peoples’ Rights and the Inter-American Commission on Human Rights.

The report, Ending violence and other human rights violations based on sexual orientation and gender identity, highlights grave violations that take place in all regions of the world against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

The report notes the impact of these abuses on the health of LGBTI people and their access to HIV prevention and care, but also emphasizes positive developments made around the world in protecting the rights of LGBTI people.

In 2014, the African Commission on Human and Peoples’ Rights adopted a resolution calling for the protection of people against violence and other violations on the basis of their real or perceived sexual orientation or gender identity. Commenting on the launch of the report, Pansy Tlakula, Chairperson of the African Commission on Human and Peoples’ Rights, said, “Violence and other human rights violations based on sexual orientation and gender identity constitute universal challenges that require concerted responses by national, regional and United Nations human rights institutions.”

The Inter-American Commission on Human Rights has established a rapporteurship on the rights of LGBTI people. James Cavallaro, President of the Inter-American Commission on Human Rights, highlighted a fundamental element of the work of the Commission. “Bringing the voices of lesbian, gay, bisexual, transgender and intersex people into our work is to challenge the invisibility of the serious human rights violations that they continue to face throughout the Americas and hold States accountable for these violations,” he said.

The United Nations Human Rights Council has passed two resolutions condemning violence and discrimination based on sexual orientation and gender identity. “The dialogue allowed us to share good practices to guide our common struggle to combat impunity and to ensure the protection and realization of the human rights of all individuals, including lesbian, gay, bisexual, transgender and intersex people,” said Christof Heyns, United Nations Special Rapporteur on extrajudicial, summary or arbitrary executions.

The UNAIDS Executive Director, Michel Sidibé, and the United Nations High Commissioner for Human Rights, Zeid Ra’ad Al Hussein, said on the launch of the report, “Ending violence, criminalization, discrimination and other human rights violations against lesbian, gay, bisexual, transgender and intersex people are priorities for our organizations and for the entire United Nations system.”

Civil society organizations have also welcomed the report. “Ongoing collaboration and openness to experience-sharing between regional and international human rights systems reinforces the idea of the universality of human rights, and can only help advance the protection of human rights for everyone, including for LGBTI people,” said Sibongile Ndashe, Executive Director of the Initiative for Strategic Litigation in Africa.

In collaboration with UNAIDS and other partners, the United Nations Development Programme (UNDP) and IRTG, a Global Network of Trans Women and HIV, have released a new publication today entitled Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions. The publication presents concrete steps that public health officials, health workers and nongovernmental organizations can adopt to implement HIV and sexually transmitted infection (STI) programmes with transgender people.

Topics covered in the publication include community empowerment and human rights, addressing violence, stigma and discrimination, and delivering transgender-competent services, especially for HIV and STI prevention, diagnosis, treatment and care. The publication also covers community-led outreach, safe spaces and the use of information and communications technology in service delivery. It describes how to manage programmes and build the capacity of organizations led by transgender people and shows how services can be designed and implemented to be acceptable and accessible to transgender women. Wherever possible, it gives particular attention to programmes run by transgender organizations.

The publication was developed in collaboration with transgender people and advocates, service providers, researchers, government officials and representatives of nongovernmental organizations from all over the world. UNDP and IRTG coordinated its production, with the support of the United Nations Population Fund, the University of California, San Francisco, Center of Excellence for Transgender Health, the Johns Hopkins Bloomberg School of Public Health, the World Health Organization, the United States Agency for International Development, the United States President’s Emergency Plan for AIDS Relief and UNAIDS.

The document is based on recommendations included in the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, published in 2014 by the World Health Organization.

Transgender women continue to be heavily affected by HIV, being 49 times more likely to become infected with HIV than non-transgender adults.

As part of the global effort to achieve the Millennium Development Goals (MDGs), countries around the world reported major gains in the health and wellbeing of women and children between 1990 and 2015. The global rate of maternal mortality fell by 47 per cent and child mortality declined by 49 per cent. However, any celebration of progress is tempered by the reality that millions of women, children, newborns, and adolescents continue to die every year; mostly from preventable causes. As the world transitions from the MDGs to the Sustainable Development Goals (SDGs), we must uphold our commitment to keep reproductive, maternal, newborn, child, and adolescent health (RMNCAH) at the heart of the global agenda. Fulfilling this promise is both a practical imperative and a moral obligation.

The UN Secretary-General's Global Strategy for Women's, Children's, and Adolescents' Health sets out a plan to give every woman, child, and adolescent the opportunity to not only survive, but to thrive and transform his or her community. Implementing the Global Strategy and achieving the SDG targets requires an unprecedented level of alignment and coordination amongst each and every one of us working in the field of RMNCAH.

On behalf of the six organizations responsible for promoting and implementing the global health agenda across the UN system, UNAIDS, UNFPA, UNICEF, UN Women, WHO, and the World Bank Group, we, the undersigned, stand united in our commitment to operationalize the Global Strategy.

Building on our tradition of working together to support countries in achieving the MDGs, we, as members of the H6 (previously known as the H4+), will provide coordinated technical support to country-led efforts to implement the Global Strategy and achieve the ambitious targets of the health-related SDGs. At the same time, we will continue to advocate for evidence-based RMNCAH programmes and policies at the global, regional, and national levels.

As the current H6 chair (2016-2018), UNAIDS will lead the partnership in fulfilling its mandate to leverage the strengths and capacities of each of the six member organizations in order to support high-burden countries in their efforts to improve the survival, health, and well-being of every woman, newborn, child, and adolescent.

As representatives of the H6, we renew our commitment to implement this mandate in support of the Global Strategy. We call on RMNCAH activists and advocates worldwide to join us in fulfilling this shared pledge to women, children, and adolescents everywhere.

Michel Sidibé, Executive Director, UNAIDS

Babatunde Osotimehin, Executive Director, UNFPA

Anthony Lake, Executive Director, UNICEF

Phumzile Mlambo-Ngcuka, Executive Director, UN Women

Margaret Chan, Director General, WHO

Tim Evans, Senior Director, Health, Nutrition and Population Global Practice, The World Bank Group

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.

A powerful message about the need to progress on both the response to HIV and the sexual and reproductive rights of young people came out of the seventh Africa Conference on Sexual Health and Rights, which took place in Accra, Ghana, from 8 to 12 February.   

The theme of the conference was “Realizing demographic dividend in Africa: the critical importance of adolescents and youth sexual and reproductive health and rights”. It was hosted by the First Lady of Ghana, Lordina Mahama, who is also the President of the Organisation of African First Ladies against HIV/AIDS (OAFLA), and brought together a broad range of stakeholders from government, the diplomatic community, youth groups, organizations of people living with HIV, the private sector, academia and the media.

The conference concluded that it was possible to end AIDS as a public health threat by 2030 only if the sexual and reproductive rights of young people were respected. The need for multisectoral investment in services for young people, including comprehensive sexuality education, was underlined.

Of the total number of adolescents living with HIV globally in 2014, 83% lived in sub-Saharan Africa. AIDS is now the leading cause of death among adolescents in Africa, and adolescents are the only age group in which AIDS-related deaths are not decreasing. In low- and middle-income countries, one in every three girls is married before reaching the age of 18, and one in nine is married before reaching their 15th birthday. Only a quarter of girls and a third of boys are reported to have a full understanding of how HIV is transmitted or how it can be prevented.

During the conference, Ms Mahama championed OAFLA’s launch of the continental All In campaign to end AIDS among adolescents. OAFLA also launched an initiative to end child marriage by 2020. 

Geneva, 11 December 2015—UNAIDS and the International Planned Parenthood Federation (IPPF) have signed a memorandum of understanding to Fast-Track access to HIV services by 2020. Under the partnership, UNAIDS and IPPF will support the delivery of high-impact HIV advocacy, prevention and treatment services, particularly in sub-Saharan Africa.

The partnership will boost collaboration in four specific areas: integrating HIV and sexual and reproductive health services and ensuring that people can realize their sexual and reproductive rights; stopping new HIV infections among children and keeping mothers alive; expanding HIV services for young people; and ensuring key populations—gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs—are reached with life-saving HIV prevention, treatment, care and support. In each of these areas UNAIDS and IPPF will work jointly to ensure that there is prompt and concrete joint action on the ground.

“This partnership is about turning targets to results so that no one is left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Many young people, women and key populations are still out of reach and in need of access to sexual and reproductive health and HIV services.”

UNAIDS and IPPF will aim to ensure that young people have the knowledge, agency and means to protect themselves from HIV and that all women have access to sexual and reproductive health and rights, including HIV, services. Ensuring that all people live in equality and dignity, free from discrimination and violence, will also be a goal. Progress on the objectives of the partnership will be reviewed annually.

“We are delighted that we are entering this partnership with UNAIDS,” said IPPF’s Director-General, Tewodros Melesse. “It isn’t about making a difference in London or Geneva. It’s about making a real difference on the ground, so we are able to work together to provide more integrated HIV prevention, testing and treatment services, especially for the most marginalized and underserved in society.”

The partnership will advance the UNAIDS Fast-Track Strategy to end the AIDS epidemic as a public health threat by 2030. To do this will require front-loading investments over the next five years, reaching the UNAIDS 90–90–90 treatment target, expanding access to HIV prevention and ensuring zero discrimination.

The memorandum of understanding was signed at UNAIDS headquarters in Geneva during an event on the rights, roles and responsibilities of men in Fast-Tracking the end of AIDS, organized by UNAIDS, IPPF and Sonke Gender Justice. 

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 to end the AIDS epidemic by 2030 as part of the Sustainable  Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter and Instagram.

IPPF

International Planned Parenthood Federation (IPPF) is the world’s largest sexual and reproductive health and rights provider. Since 1958, IPPF has served the poorest and most vulnerable, delivering health services that empower women and girls, including 149.3 million services to 61.8 million people in 2014.

Condoms are a critical component in a comprehensive and sustainable approach to the prevention of HIV and other sexually transmitted infections (STIs) and are effective for preventing unintended pregnancies. In 2013, an estimated 2.1 million people became newly infected with HIV^[i] and an estimated 500 million people acquired chlamydia, gonorrhoea, syphilis or trichomoniasis.^[ii] In addition, every year more than 200 million women have unmet needs for contraception,^[iii] leading to approximately 80 million unintended pregnancies.^[iv] These three public health priorities require a decisive response using all available tools, with condoms playing a central role.

Male and female condoms are the only devices that both reduce the transmission of HIV and other sexually transmitted infections (STIs) and prevent unintended pregnancy.

Laboratory studies show that condoms provide an impermeable barrier to particles the size of sperm and STI pathogens, including HIV.^[v] [vi] Condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. Research among serodiscordant couples (where one partner is living with HIV and the other is not) shows that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men^{[vii] [viii] [ix]} Consistent and correct use of condoms also reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer.^[x] With a failure rate of about 2% when used consistently and correctly, condoms are very effective at preventing unintended pregnancy.^{[xi] [xii]}

Condoms have played a decisive role in HIV, STI and pregnancy prevention efforts in many countries.

Condoms have helped to reduce HIV transmission and curtailed the broader spread of HIV in settings where the epidemic is concentrated in specific populations.^[xiii] Distribution of condoms has been shown to reduce rates of HIV and other STIs in sex workers^{[xiv] [xv] [xvi]} and men who have sex with men.^[xvii] In India^{[xviii] [xix]} and Thailand^[xx] increased condom distribution to sex workers and their clients in combination with other prevention interventions were associated with reductions of transmission of both HIV and other STIs. Zimbabwe^[xxi] and South Africa are two high-prevalence countries where increased condom use was found to contribute to reductions in HIV incidence.^[xxii]

A recent global modelling analysis estimated that condoms have averted around 50 million new HIV infections since the onset of the HIV epidemic.^[xxiii] For 2015, 27 billion condoms expected to be available globally through the private and public sector will provide up to an estimated 225 million couple years protection from unintended pregnancies.^{[xxiv] [xxv]}

Condoms remain a key component of high-impact HIV prevention programmes.

Recent years have seen major scientific advances in other areas of HIV prevention. Biomedical interventions including antiretroviral therapy (ART) for people living with HIV can substantially reduce HIV transmission. While the success of ART may alter the perception of risk associated with HIV, studies have shown that people living with HIV who are enrolled in treatment programmes and have access to condoms report higher condom use compared to those not enrolled.^[xxvi]

Condom use by people on HIV treatment and among serodiscordant couples is strongly recommended. ^[xxvii] Only when sustained viral suppression is confirmed and very closely monitored, and when the risk of other STIs and unintended pregnancy is low, it may be safe not to use condoms.^{[xxviii] [xxix] [xxx]}

Oral pre-exposure prophylaxis (PrEP)—where antiretroviral drugs are used by HIV-negative people to reduce their risk of acquiring HIV—is also effective in preventing HIV acquisition, but is not yet widely available and is currently only recommended as an additional tool for people at higher risk, such as people in sero-discordant relationships, men who have sex with men and female sex workers, in particular in circumstances in which consistent condom use is difficult to achieve.^[xxxi] Voluntary medical male circumcision (VMMC) can reduce the risk of HIV acquisition by 60% among men, but because protection is only partial, should be supplemented with condom use. ^[xxxii]

Hence, condom use remains complementary to all other HIV prevention methods, including ART and PrEP, in particular when other STIs and unintended pregnancy are of concern. The roll-out of large-scale HIV testing and treatment, VMMC and STI control programmes, and efforts to increase access to affordable contraception all offer opportunities for integrating condom promotion and distribution.

Quality-assured condoms must be readily available universally, either free or at low cost.

To ensure safety, efficacy and effective use, condoms must be manufactured according to the international standards, specifications and quality assurance procedures established by WHO, UNFPA and the International Organization for Standardization^{[xxxiii] [xxxiv]} and made available either free or at affordable cost. Condom use in resource-limited settings is more likely when people can access them at no cost or at subsidized prices.^{[xxxv] [xxxvi]}

Most countries with high HIV rates continue to heavily depend on donor support for condoms. In 2013, only about 10 condoms were made available to every man aged 15-64, and on average only one female condom per eight women in sub- Saharan Africa. HIV prevention programmes need to ensure that a sufficient number and variety of quality assured condoms are accessible to people who need them, when they need them. Adequate supplies of water based-lubricants also need to be provided to minimize condom usage failure, especially for anal sex, vaginal dryness and in the context of sex work.^[xxxvii]

Despite generally increasing trends in condom use over the past two decades, substantial variations and gaps remain. Reported condom use at last sex with non-regular partners ranges from 80% use by men in Namibia and Cambodia to less than 40% usage by men and women in other countries, including some highly affected by HIV. Similarly, among young people aged 15 to 24 years, condom use at last sex varies from more than 80% in some Latin American and European countries to less than 30% in some West African countries.^[xxxviii] This degree of variation highlights the need for countries to set ambitious national and subnational targets and that in many settings there are important opportunities for strengthening demand and supply of condoms.

Programmes promoting condoms must address stigma and gender-based and socio-cultural factors that hinder effective access and use of condoms.

Effective condom promotion should be tailored for people at increased risk of HIV and other STIs and/or unintended pregnancy, including young people, sex workers and their clients, injecting drug users and men who have sex with men. Many young women and girls, especially those in long-term relationships and sex workers, do not have the power and agency to negotiate the use of condoms, as men are often resistant to using condoms. Within relationships, the use of condoms may be taken to signal a lack of trust or intimacy.

However, few programmes adequately address the barriers that hinder access and use of condoms by young people,^[xxxix] key populations^[xl] and men and women in relationships. In some contexts, sex workers are forced to have unprotected sex by their clients.^{[xli] [xlii]} and carrying condoms is criminalized and used as evidence by police to harass or to prove involvement in sex work^{[xliii] [xliv]} These practices undermine HIV prevention efforts and governments should take actions to end these human rights violations.^[xlv] Condom programmes should ensure that condoms and lubricants are widely available and that young people and key populations have the knowledge, skills and empowerment to use them correctly and consistently.^[xlvi] Condoms should also be made available in prisons and closed settings,^{[xlvii] [xlviii]} and in humanitarian crises situations.^[xlix]

Adequate investment in and further scale up of condom promotion is required to sustain responses to HIV, other STIs, and unintended pregnancy.

Despite the low cost of condoms, international funding for condom procurement in sub-Saharan Africa has stagnated in recent years.^[l] Collective actions at all levels are needed to support the efforts of countries that depend on external assistance for condom procurement, promotion, and distribution and to increase domestic funding and private sector investment in condom distribution and promotion.^[li]

Although condoms are part of most national HIV, STI and reproductive health programmes, condoms have not been consistently distributed nor promoted proactively enough.^[lii] National condom distribution and sales can be strengthened by applying a total market approach that combines public sector distribution, social marketing and private sector sales.^{[liii] [liv]} Administrative barriers that prevent programmes and organizations from providing sufficient quantities of condoms for distribution need to be removed. In high-HIV prevalence locations condom promotion and distribution should become systematically integrated in community outreach and service delivery, and in broader health service provision.

^[i] UNAIDS. 2014. World AIDS Day Report 2014.

^[ii] WHO, Dept. of Reproductive Health and Research. Global incidence and prevalence of selected curable sexually transmitted infections.

^[iii] UNFPA/Guttmacher Institute. 2012. Adding It Up: Costs and Benefits of Contraceptive Services.

^[iv] Sedgh G et al. Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends. Studies in Family Planning, 2014, Vol 45. 3, 301–314, 2014.

^[v] Carey RF et al. Effectiveness of latex condoms as a barrier to human immunodeficiency virus-sized particles under conditions of simulated use. Sex Transm Dis 1992;19:230-4.

^[vi] WHO/UNAIDS. 2001. Information note on Effectiveness of Condoms in Preventing Sexually Transmitted Infections including HIV.

^[vii] Holmes K et al. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 2004, 82 (6).

^[viii] Weller S et al. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255.

^[ix] Smith DK et al. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):337-44.

^[x] Also see: http://www.cdc.gov/condomeffectiveness/brief.html

^[xi] Trussell J. Contraceptive efficacy, in: Hatcher RA et al., eds., Contraceptive Technology: Twentieth Revised Edition, New York: Ardent Media, 2011, pp. 779–863.

^[xii] Kost K et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception, 2008; 77:10-21.

^[xiii] Hanenberg RS et al. Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet, 1994, 23;344(8917): 243-5.

^[xiv] Ghys PD et al. Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Cote d’Ivoire, 1991–1998. AIDS, 2002, 16(2):251–258.

^[xv] Levine WC et al. Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project. AIDS, 1998, 12(14):1899–1906.

^[xvi] Fontanet AL et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS, 1998, 12(14):1851–1859.

^[xvii] Smith D et al. Condom efficacy by consistency of use among MSM: US. 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, abstract 32, 2013.

^[xviii] Boily M-C et al. Positive impact of a large-scale HIV prevention programme among female sex workers and clients in South India. AIDS, 2013, 27:1449–1460.

^[xix] Rachakulla HK et al. Condom use and prevalence of syphilis and HIV among female sex workers in Andhra Pradesh, India - following a large-scale HIV prevention intervention. BMC Public Health, 2011; 11 (Suppl 6): S1.

^[xx] UNAIDS. 2000. Evaluation of the 100% Condom Programme in Thailand, UNAIDS Case Study.

^[xxi] Halperin DT et al. A surprising prevention success: Why did the HIV epidemic decline in Zimbabwe? PLoS Med. 2011. 8;8(2).

^[xxii] Johnson LF et al. 2012. The effect of changes in condom usage and antiretroviral treatment coverage on human immunodeficiency virus incidence in South Africa: a model-based analysis, Journal of the Royal Society Interface. 2012, 7;9(72):1544-54.

^[xxiii] Stover J. 2014. Presentation. UNAIDS Global Condom Meeting, Geneva, November 2014.

^[xxiv] In line with standard assumptions, 120 condoms are required for 1 couple year of protection. Projected condom sales for 2015 cited based on: Global Industry Analysts. 2014. Global Condoms Market. May 2014.

^[xxv] Stover J et al. Empirically based conversion factors for calculating couple-years of protection. Eval Rev. 2000 Feb; 24(1):3-46.

^[xxvi] Kennedy C et al.  Is use of antiretroviral treatment (ART) associated with decreased condom use? A meta-analysis of studies from low- and middle-income countries (LMICs). July 2014 h International AIDS Conference. Melbourne, WEAC0104 - Oral Abstract Session.

^[xxvii] Liu H et al. Effectiveness of ART and condom use for prevention of sexual HIV transmission in sero-discordant couples: a systematic review and meta-analysis. PLoS One. 2014 4;9(11):e111175.

^[xxviii] Swiss AIDS Federation Advice Manual: Doing without condoms during potent ART. Swiss AIDS Federation, 2008.

^[xxix] Fakoya A et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection. HIV Medicine, 2008, 9: 681-720, 2008.

^[xxx] Marks G et al. Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care. AIDS 2015, 29:947–954.

^[xxxi] WHO. 2015. Technical update on Pre-exposure Prophylaxis (PrEP), February 2015. WHO/HIV/2015.4.

^[xxxii] WHO. 2007. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. WHO/UNAIDS Technical Consultation on Male Circumcision and HIV Prevention: Research Implications for Policy and Programming Montreux, 6 – 8 March 2007 Conclusions and Recommendations.

^[xxxiii] WHO, UNFPA and Family Health International. 2013.  Male Latex Condom: Specification, Prequalification and Guidelines for Procurement, 2010 revised April 2013.

^[xxxiv] International Organisation for Standardisation. 2014. ISO 4074:2014 Natural rubber latex male condoms -- Requirements and test methods. http://www.iso.org/iso/catalogue_detail.htm?csnumber=59718.

^[xxxv] Charania MR et al. Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998–2007. AIDS Behav, 2011, 15:1283–1297.

^[xxxvi] Sweat MD et al. Effects of condom social marketing on condom use in developing countries: a systematic review and meta-analysis, 1990–2010. Bulletin of the World Health Organization 2012, 90:613- 622A. doi: 10.2471/BLT.11.094268.

^[xxxvii] Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 Advisory note. 2012.

^[xxxviii]Source: Data from a database of Demographic and Health Surveys (DHS) available at statcompiler.com (verified January 2015).

^[xxxix] Dusabe J, et al.  “There are bugs in condoms”: Tanzanian close-to-community providers’ ability to offer effective adolescent reproductive health services. J Fam Plann Reprod Health Care 2015;41:e2.

^[xl] Key populations are defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviours that increase their vulnerability to HIV. These guidelines focus on five key populations: 1) men who have sex with men, 2) people who inject drugs, 3) people in prisons and other closed settings, 4) sex workers and 5) transgender people. In consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. World Health Organization 2014.

^[xli] Global Commission on HIV and the Law. Risks, Rights & Health. 2012

^[xlii] UNAIDS. 2014. The Gap report.

^[xliii] Open Society Foundations. 2012. Criminalizing condoms. How policing practices put sex workers and HIV services at risk in Kenya, Namibia, Russia, South Africa, the United States and Zimbabwe. http://www.opensocietyfoundations.org/reports/criminalizing-condoms.

^[xliv] Bhattacharjya, M et al. The Right(s) Evidence – Sex Work, Violence and HIV in Asia: A Multi-Country Qualitative Study. Bangkok: UNFPA, UNDP and APNSW (CASAM). 2015.

^[xlv] WHO; UNFPA; UNAIDS; NSWP; World Bank. 2013. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative intervention. 2013.

^[xlvi] Vijayakumar G et al. A review of female-condom effectiveness: Patterns of use and impact on protected sex acts and STI incidence. International Journal of STD and AIDS, 2006, 17(10):652-659.

^[xlvii] UNODC/WHO/UNAIDS. 2006. HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings A Framework for an Effective National Response.

^[xlviii] UNODC/ILO/UNDP/WHO/UNAIDS. 2012. Policy brief. HIV prevention, treatment and care in prisons and other closed settings: A comprehensive package of interventions.

^[xlix] Inter-Agency Standing Committee (IASC). 2003. Guidelines for HIV/AIDS interventions in emergency settings. Task Force on HIV/AIDS in Emergency Settings.

^[l] UNFPA. 2015. Contraceptives and condoms for family planning and STI/HIV prevention. External procurement support report 2013.

^[li] Foss AM et al. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect 2007, 83:510–516.

^[lii] Fossgard IS et al. Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia. BMC Public Health 2012, 12:1030.

^[liii] UNFPA-PSI.  2013. Total Market Approach Case Studies Botswana, Lesotho, Mali, South Africa, Swaziland, Uganda. http://www.unfpa.org/publications/unfpa-psi-total-market-approach-case-studies

^[liv] Barnes, J et al. 2015. Using Total Market Approaches in Condom Programs. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates.

UNAIDS and partners called for the elimination of forced and coerced sterilization of women and transgender people at the Commission on the Status of Women (CSW) in New York, United Sates of America.

During a side event hosted on 19 March by UNAIDS, the International Community of Women Living with HIV, Global Action for Trans Equality, the Center on Law and Social Transformation and the Action Program for Equality and Social Inclusion, participants discussed strategies and recommendations to fast-track the end of the practice in the context of the post-2015 development agenda. The dialogue brought together civil society activists, CSW delegates, ministers of gender and United Nations representatives.

The practice of forced and coerced sterilization continues to occur in many parts of the world. The participants discussed how it is a form of institutional violence and a human rights violation, which has been shrouded in silence and protected by societal acceptance.

The practice, however, has been garnering international attention in recent years, with increasing commitment to its elimination affirmed in several statements and resolutions. For example, in November 2014 the Namibian Supreme Court ruled in favour of three women living with HIV who had been subjected to coercive sterilization in public hospitals without their informed consent.  

It was also highlighted that the 2014 United Nations interagency statement on eliminating forced, coercive and otherwise involuntary sterilization, to which UNAIDS is a signatory, is also contributing to the global efforts to eliminate this practice by providing guiding principles for prevention and recommendations for legal policy and service delivery.

GENEVA, 18 November 2014—UNAIDS welcomes the recent ruling by the High Court of Botswana upholding the right of an organization that supports lesbian, gay, bisexual, transgender and intersex (LGBTI) people to register in the country.

In its groundbreaking judgement, the court held that the refusal by the government in 2012 to register the organization known as LEGABIBO (Lesbians, Gays and Bisexuals of Botswana) violates the rights to freedom of expression, assembly and association protected by the country’s constitution. The ruling represents the first time a high jurisdiction in Africa has upheld the freedom of assembly and association for LGBTI people.

“Through the courage of civil society organizations and the boldness of its judiciary, Botswana is sending an important message of inclusiveness and freedom,” said Michel Sidibé, UNAIDS Executive Director.

A valuable lesson learned in over 30 years of the HIV response is that civil society, particularly organizations of people living with and vulnerable to HIV, is essential to advancing health, dignity and development.

While Botswana has sharply increased access to antiretroviral therapy in the past decade, HIV prevalence in the country is still one of the highest in the world, at 21.9%. In response, Botswana is implementing a national strategic framework that includes the protection of human rights for all as a guiding principle.

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.