Sexual minorities

“Is it safe to do their work?” Renaè Green and Donique Givans go silent for several seconds. “I am still scared,” says Ms Green, the Associate Director for Policy and Advocacy at TransWave Jamaica. “I don’t like to go to certain spaces. If anyone wants to participate in one of our campaigns, we explain the risks. You don’t know what kind of backlash you might experience.”

Ms Givans, who is the organization’s community liaison officer, knows this all too well. She wasn’t up front about her gender identity with her father when she began becoming more visible in her advocacy work.

“He doesn’t want anything to do with me now,” she says, her voice shaking a little. “He told me to go and not to come back to his house. So, we do let people know they might have difficulties.”

TransWave was formed in 2015 following a lesbian, gay, bisexual and transgender health and gender-based violence training, conducted by WE-Change and supported by the Jamaica Forum for Lesbians, All-Sexuals and Gays and Jamaica AIDS Support for Life.

TransWave’s Executive Director, Neish McLean, is the only transgender man at the helm of a Caribbean transgender organization. Recently Mr McLean discussed his personal journey publicly, exploring issues ranging from the distinction between gender identity and sexuality to top surgery. This is largely unchartered territory in a Caribbean nation famed for its social conservatism.

“For a long time, people actually said that transgender people didn’t exist in Jamaica because people could not put a face to them or identify anyone who was transgender. Now we have so many people who identify. It has helped in terms of explaining who transgender people are,” explains Ms Green. 

In addition to increasing transgender visibility, TransWave advocates on a wide range of subjects that affect the community—the lack of access to transgender-oriented housing, education and employment, for example, as well as initiatives to reduce poverty and violence. HIV is a huge challenge. A 2018 Integrated Biological and Behavioral Surveillance Survey conducted by the University of San Francisco found that 51% of Jamaican transwomen tested were living with HIV.

TransWave advocates strongly for all members of the community to access health care.

“Many are aware that they are HIV-positive but don’t seek treatment. They are just waiting to die. People cannot stomach not being able to live their lives as their real selves and won’t put themselves through the distress of going to a clinic,” says Ms Green. “It becomes difficult because all eyes are on you and you are putting yourself at risk for people to attack or hurt you,” explains Ms Green.

In July, UNAIDS Jamaica supported TransWave’s Transgender Health and Wellness Conference. The event helped launch a toolkit on how health-care providers can provide holistic, non-discriminatory services, along with dialogue around the rights and inclusion of transgender people. The organization has also met some employers to gauge the degree of acceptance for the inclusion of transgender workers.

Ms Givens paints a mixed picture of what life is like for transgender people in Jamaica. 

“It is very difficult, but people try to align themselves with society’s gender norms. They might do a little makeup to feel comfortable, but they don’t go heavy. Some workplaces allow people to be themselves, but you don’t have transwomen wearing skirts,” she said.

Public transportation is often challenging. When TransWave books a taxi, for example, they are never sure if the driver will be tolerant. Renting an apartment can be a landmine. Lower-priced housing often means living in a less safe area. Landlords and neighbours can be judgemental.

At the extreme, homelessness remains a major problem, with some young transgender people being thrown out of their homes before they even become teenagers. This is often the starting point for a frightening array of vulnerabilities, including a lack of schooling, poor job prospects and bad health, with some turning to sex work.

Asked about their hopes for the future, Ms Givans and Ms Green list adequate funding for TransWave and being able to further their education. Ms Green adds that she would like to emigrate.

“But not everybody wants to leave Jamaica and not everybody should leave,” she says pointedly. “That’s why we are working so hard. So that we can get to a point where everybody is accepted.”

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.

A new regional civil society cooperation network for the Americas and the Caribbean to support nongovernmental organizations working to end AIDS was launched on 30 October in Quito, Ecuador. Launched by Coalition PLUS, the initiative will support coordination and capacity-building among community organizations involved in the AIDS responses of North, Central and South America and the Caribbean.

“Although we have HIV services available, people do not have access because they are criminalized and stigmatized. The community movement is helping us to end the conspiracy of silence about discrimination. We need civil society to increase efforts to achieve the progressive policies that will clear the way for us to end AIDS,” said Michel Sidibé, UNAIDS Executive Director.

Since 2014, Coalition PLUS—an international alliance of more than 100 nongovernmental organizations contributing to the AIDS response—has been building and strengthening mechanisms for regional collaboration. Such networks already exist in western Africa, central Africa, the Middle East and North Africa, the Indian Ocean and Europe.

The President of Coalition PLUS, Hakima Himmich, said that the network will increase access by organizations to new resources and approaches relevant to their local contexts. She noted that it was especially important to strengthen civil society’s capacity around addressing the needs of the most vulnerable.

“We have huge challenges around stigma and discrimination against entire populations. In order to achieve epidemic control, we must also address human rights,” said Ms Himmich.

UNAIDS data show that in 2017 key populations and their sexual partners accounted for three quarters of new HIV infections in Latin America and two thirds of new infections in the Caribbean. Gay men and other men who have sex with men and transgender women are disproportionately affected, with a few countries reporting HIV rates of above 15% among those communities.

The activities of the network in the region will be coordinated by the Kimirina Corporation, a Ecuadorian organization focused on people-centred combination prevention and advocacy. Amira Herdoiza, Director of the Kimirina Corporation, explained that the platform will place strong emphasis on coordinated research, skills-building and advocacy, particularly around issues affecting young people and key populations. 

“We need more multicountry research to show the nuances of our epidemics,” Ms Herdoiza said. “Through this network our organizations’ capacities to share and analyse data will be strengthened. We will also focus on sharing experiences and planning joint programmes.”

At present, there are three other members of the regional network: the Coalition of Quebec Community Organizations against AIDS in Canada; AIDES in the French Caribbean; and the Institute for Human Development in the Plurinational State of Bolivia. Other regional organizations are invited to be part of the initiative.

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

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

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

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

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

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

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

The World Health Organization released the new International Classification of Diseases, ICD-11, on 18 June.

The new version no longer defines issues associated with transgender identity as a mental disorder. Instead, there are new categories of gender incongruence of adolescence and adulthood and gender incongruence of childhood, which are classified as conditions related to sexual health.

The ICD provides a holistic look at every aspect of life that can affect health and supports decision-making for programming services and the allocation of spending.

“A shameful history of pathologization, institutionalization, “conversion” and sterilization begins to come to a close,” said Mauro Cabral Grinspan, the Executive Director of GATE, an international organization working on issues of gender identity, gender expression and sex characteristics. 

Michel Sidibé, the UNAIDS Executive Director, welcomed the decision. “This is an important step to increase access to health services by transgender people,” he said.

According to the World Health Organization’s report Transgender people and HIV, transgender people are 49 times more likely to acquire HIV than all adults of reproductive age. They often face, from a young age, stigma, discrimination and social rejection in their homes and communities for expressing their gender identity. Such discrimination, violence and criminalization prevent transgender people from getting the HIV services they need to stay healthy.

Although the new ICD version will be presented for final approval at the World Health Assembly in May 2019, transgender activists are already working on the next steps, including the revision of the categories and definitions, as well as reception at the national level.

Mauro Cabral Grinspan said, “We will work with our allies to ensure effective implementation at the country level to improve regulations while ensuring full access to legal gender recognition and to gender-affirming health care.”

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.

One of the most watched events of the year got Cynthia Weber wondering: can the use by Sky News of artificial intelligence (AI) at the wedding of Prince Harry and Meghan Markle be a good thing?

For the first time in history, a news broadcaster used AI facial recognition technology during a live broadcast. Cynthia, a professor of international relations and gender studies at the University of Sussex, explained that using software to name wedding guests may be a nifty trick, but there are worries about the implications.

“Some claim that this technology can identify a person’s sexual orientation,” Cynthia said while speaking during an event for the International Day against Homophobia, Transphobia and Biphobia in Geneva at UNAIDS headquarters.

Referring to a Stanford University study that analysed more than 35 000 images on a United States dating website of white, able-bodied, 18–40-year-olds, the researchers compared their AI-generated sexual orientations against sexual orientations researchers found in dating profiles. The study claimed that AI facial recognition technology could determine a person’s sexual orientation with up to a 30% greater accuracy than people can.

Cynthia said that LGBTI advocacy organizations labelled the study junk science—the study used a skewed sampling in terms of race and age and the study equates sexual orientation with sexual activity. “The result is that the study’s artificial intelligence algorithm only finds what it was programmed to find: stereotypes about straights, gays and lesbians,” said Cynthia.

Cynthia believes that AI knowledge may generate opportunities in many fields, but sees far more risks and dangers than advantages for LGBTI people.

When AI meets facial recognition technology and a sexual orientation algorithm, at least four issues arise. First, privacy. In national and international law, a person’s face is not protected by privacy laws. That allows faces to be scanned and read by everyone, from governments to Sky News.

Secondly, accuracy. “In a world beyond the royal wedding, artificial intelligence facial recognition technology is far from perfect, even when it just tries to match names with faces, much less when it tries to match presumed sexual orientations with faces,” Cynthia said.

For Cynthia, the key issue is knowledge. How does a sexual orientation algorithm know better than an individual his or her sexuality? Cynthia considers the binary approach of code and computer-readable data not compatible with the vast gender and sexuality spectrum.

Finally, the issue of what the AI information will be used for worries Cynthia. “Let Sky News use it for wedding commentary, but what if the police use it in countries where homosexuality is outlawed?” Cynthia asked.

For Cynthia, AI and sexual orientation are not necessarily mutually beneficial. Cynthia understands that AI influences imagination and drives innovation, but believes that categorization of people usually introduces more harms than benefits.

Cynthia concluded by saying, “People have to make sure that artificial intelligence is ethically driven, not just technologically driven.”

The event was organized with the Swiss LGBTI Pride@Work association and UN Globe, a United Nations-wide LGBTI organization, and was held on 16 May.

GENEVA, 16 May 2018—On the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), UNAIDS is calling for strengthened partnerships to support lesbian, gay, bisexual, transgender and intersex (LGBTI) people and their families living with or affected by HIV or facing discrimination.

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

Gay men and other men who have sex with men and transgender women are among the populations most affected by HIV worldwide.

More than 40% of the 100 countries responding to UNAIDS criminalize same-sex relationships. Criminalizing people because of their gender or sexual orientation drives people underground and out of reach of essential health and social services, making them vulnerable to poor health and homelessness.

To end AIDS, it is essential to ensure that people can access HIV prevention technologies, including condoms and PrEP, and quality HIV treatment and care free from discrimination. UN Women, the United Nations Development Programme and UNAIDS are working with the Global Network of People Living with HIV to end all forms of HIV-related stigma and discrimination. The initiative will require rapid multisectoral support and civil society leadership and will contribute to achieving the time-bound commitments of United Nations Member States to end AIDS as a public health threat by 2030.

Increasing political commitment and investments for the health and well-being of some of the most vulnerable people in society will help to ensure that no one is left behind.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May. This year’s theme is alliances for solidarity to bring respect for LGBTI people and their families.

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.