Sexual minorities

Kimi Avalos is a young transgender woman who lives in Buenos Aires, Argentina. Because of stigma and discrimination, she couldn’t continue with her studies and complete high school. She says that she experienced bullying and harassment; her classmates insulted and physically assaulted her, under the indifferent eye of her teachers. “I really wanted to learn, but I had to drop out of school. Now, thanks to the Transgender House, my dream of finishing high school will soon come true,” said Ms Avalos.

Ms Avalos is one of 30 transgender students who recently started a new educational programme through which they can study for primary and secondary school diplomas by attending a combination of face-to-face and virtual classes. This innovative project is implemented in the Transgender House, a community centre for training and empowerment of transgender people founded in Buenos Aires in June 2017 by Marcela Romero, Coordinator of ATTTA (Association of Argentinian Transvestites, Transsexuals and Transgender) in collaboration with the City Council of Buenos Aires.

“To have this house has meant that as transgender people, we can come out from the darkness. The centre is in a visible space, on one of the main streets of Buenos Aires, in the San Cristóbal neighbourhood. This is our achievement; it shows that we exist as a community and that we have the right to a space like any other organization,” explains Ms Romero.

In Argentina, as well as in the rest of Latin America and the Caribbean, stigma and discrimination undermine learning opportunities and educational achievement of transgender people, thus affecting their future employment prospects. Discrimination and stigmatization also prevent transgender people from accessing appropriate health care, including HIV prevention, social protection and justice services.

In the region, transgender people experience frequent physical and sexual violence and hate crimes. According to data from ATTTA, 20 transgender people have been killed in Argentina since the beginning of 2018 and gender-based violence is increasing. Discrimination, gender-based violence and exclusion also contribute to increasing the vulnerability of transgender people to HIV. Transgender women continue to be heavily affected by HIV.

The Transgender House was created with the aim of providing a safe space where transgender people can be empowered and acquire knowledge and skills without the fear of being discriminated against, rejected or attacked. It works in partnership with governmental agencies, civil society and the private sector to provide a wide range of services and programmes based on the specific needs of transgender people.

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Voices of activists for transgender rights

Among other initiatives, the Transgender House has established integrated counselling services and professional guidance for job searching, as well as legal advice from lawyers, who are available 24 hours a day. In collaboration with the Ministry of Education, Transgender House has recently begun educational projects that range from the implementation of primary and secondary education programmes to professional training, such as on providing care services to the elderly.

Other important activities include the promotion of prevention of HIV and other sexually transmitted infections, HIV testing and vaccination campaigns. The Transgender House also provides continuous psychological assistance and, through a partnership with Fernández Hospital, counselling services on hormone therapy. In addition, the house engages in outreach work with a team of community health promoters that visit sex workers at their places of work at night, distributing condoms and informative material on HIV prevention.

While the Transgender House is currently a successful project, a point of reference for transgender people in Buenos Aires and has multiple partnerships in the city, it hasn’t been an easy process to get to this point. Ms Romero says that she first approached the Buenos Aires City Council eight years ago, advocating for a space where transgender people could meet. Finally, two years ago, the council approved the remodelling and refitting of one of their buildings, and with the help of an architect and the vision of the ATTTA Coordinator, the Transgender House became a reality.

“The Transgender House is a best practice of community service delivery that is contributing to the achievement of the Fast-Track Targets, leaving no one behind,” said Carlos Passarelli, the UNAIDS Country Director for Argentina, Chile, Uruguay and Paraguay.

Around 400 people visit the Transgender House each month to receive counselling and information and approximately 600 people regularly participate in workshops, group meetings and courses there. “I couldn’t be happier and more grateful for the opportunity that I am given at the Transgender House. I hope that this model of respect and promotion of human rights serves as an example to transform and change society so that all of us can live with dignity,” said Ms Avalos.

Young sex workers, transgender people, lesbian women, gay men and other men who have sex with men, people who inject drugs and people living with HIV from across Africa came together on 2 and 3 December for a preconference meeting ahead of the 19th International Conference on AIDS and STIs in Africa (ICASA), being held in Abidjan, Côte d’Ivoire, from 4 to 9 December.

The meeting, entitled Onto the African Map: Youth Key Populations and HIV, was a way for young people to express the challenges that they face, from a lack of opportunities to discrimination and social and legal injustices.

Those barriers make young members of key populations particularly vulnerable to HIV, violence, harassment and a lack of hope. Despite these challenges, attention to the protection of human rights and to the health needs of key populations remains limited in national HIV responses.

The meeting reviewed those challenges and identified key areas of action and recommendations that were compiled in the joint declaration adopted at the meeting. The declaration calls, among other things, for urgent action to stop violence, harassment and other human rights violations towards young people and key populations. It further calls for the participation of young key populations in health, policy and other decision that affect them and stresses the need to increase programmes and investments for services that address the needs of young key populations.

From 14 to 21 October, almost 25 000 young people from 188 countries gathered in Sochi, Russian Federation, for the XIX World Festival of Youth and Students. The festival provided a space for young people to unite in addressing global challenges, with a special focus on the Sustainable Development Goals (SDGs).

Through the leadership of the PACT youth coalition against HIV and with support from UNAIDS and participation of UNFPA and UNESCO, the issues of ending AIDS and sexual and reproductive health and rights were high on the agenda.

Three sessions focused on comprehensive sexuality education, modern epidemics and the role of young people in ending AIDS by 2030. The overarching theme of the discussions was that although much progress has been achieved in the response to HIV, there are still persistent challenges that put young people at risk, including discrimination, exclusion, violence and lack of access to services such as comprehensive sexuality education.

Speakers at the comprehensive sexuality education session highlighted that the absence of quality comprehensive sexuality education remains one of the largest gaps in ensuring that young people know how to protect themselves from HIV. Speakers also presented key new products and platforms, including a comprehensive sexuality education hub, teensLIVE.info, a video lesson developed for schoolchildren in eastern Europe and central Asia featuring UNAIDS Goodwill Ambassador Vera Brezhneva and a series of videos by the NauchPok channel.

The PACT youth coalition met with the United Nations Secretary-General’s Envoy on Youth, Jayathma Wickramanayake, who said, “I am looking forward to working with all of you through UNAIDS and other partners. My goal is to ensure that young people have a voice in all United Nations processes and to help them address issues that are relevant to them and their communities, including those issues that may be perceived as sensitive or challenging.”

Lack of access to information on HIV leads to new HIV infections and sustains the root causes that put young people at risk, including inequality, discrimination, violence and exclusion. Dilyara Vagapova, from the Russian rock group Murakami, said, “Without open conversations with young people about HIV, sex and the harm done by drugs, we will not succeed in ending the HIV epidemic in eastern Europe and central Asia.”

To ensure that the targets in the 2016 United Nations Political Declaration on Ending AIDS are met, accountability is key. Young leaders from Bulgaria, India, South Africa, Tajikistan, Ukraine and the United Kingdom of Great Britain and Northern Ireland shared best practices in peer education and youth-led accountability for the SDGs and the HIV response. Yana Mladenova from Bulgaria, said, “A policy on paper is not the same as a policy in practice. Successful advocacy results in action in practice.” Yana Valchuk, from the Teenergizer adolescent network, said, “To end the epidemic, we need to end discrimination, so adolescents stop living in fear.”

Vinay P. Saldanha, the UNAIDS Regional Director for Eastern Europe and Central Asia, spoke at several sessions. “Achieving the Sustainable Development Goals, including ending AIDS by 2030, does not depend on those that negotiated them. It depends on the personal commitment of each young person at this festival. This is your world—these are your goals!,” he said.

While running a legal clinic for refugees 10 years ago, Kene Esom, former Director of African Men for Sexual Health and Rights (AMSHeR), saw how difficult it was for marginalized or vulnerable people to access health-care services. “That is where I realized that as a lawyer and a human rights defender, I could play a role in increasing access to health-care services and defending human rights.” In his more recent role as Strategic Initiatives Adviser to the AMSHeR Board, he is still at the forefront against discrimination, especially discrimination against gay men and other men who have sex with men in Africa.

Mr Esom makes it clear that when he is talking about human rights in the context of HIV, it is not just the right to health that matters. “There is a pattern of human rights violations towards gay men in many countries, owing particularly to the criminalization of consensual same-sex conduct,” said Mr Esom. “For example, when a newspaper decided to publish a sensational story about gay men having a party, the men were arrested. detained and forcibly tested for HIV. All their due process rights were violated and their right to privacy breached to the extent that their names, addresses and pictures were published in the newspaper.”

Mr Esom said that incidents such as this can roll back years of progress in providing HIV services for key populations. “You cannot provide health services without taking into consideration the human rights context of the populations you are providing the services for. You can build the best health-care facility, but gay men will not come to that facility if they are worried that police will arrest them or that doctors will report their sexual behavior.”

Globally, gay men and other men who have sex with men are 24 times more likely to acquire HIV than adults in the general population. Stigma, discrimination, violence and the criminalization of same-sex sexual practices make it more difficult for these men to access HIV prevention, testing and treatment services.

AMSHeR supports human rights organizations to undertake evidence-informed advocacy. “Human rights defenders play a key role in bringing these issues to light and showing the impact that human rights violations can have on HIV responses, especially on services targeting key populations,” said Mr Esom.

Although there is still a lot of silence around issues surrounding sexuality, sexual orientation and gender identity, there is hope. “When I started this work six years ago it was a completely different context. There were very few people who wanted to advocate on these issues. Now, we have a greater pool of people in countries all over Africa and the world, and the communities are standing up for their rights and demanding access to services and a rights-based approach to service delivery.”

In its work, AMSHeR emphasizes the role of communities in advocating for change and speaking directly to policy-makers. “They are the voices and faces of the issues that affect them.”

The right to come together is key. “Many gay men think they are alone. Isolation increases their vulnerability. Bringing people together to discuss their issues creates a community that is empowered to speak up. If that space is not there, engaging policy-makers and service providers becomes more challenging.”

Mr Esom will be speaking about the promotion and protection of human rights in the context of HIV and other communicable disease at the Human Rights Council Social Forum, which is being held from 2 to 4 October. To hear more from Mr Esom and other human rights activists, register to participate at the Human Rights Council Social Forum at https://reg.unog.ch/event/6958/.

Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.

Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people.

The code of conduct provides for health personnel from public health facilities to be trained in avoiding discriminatory expressions and attitudes and to respect the confidentiality of patients. Among various provisions, it clearly stipulates that so-called treatment to “cure homosexuality or transexuality” must be avoided. It establishes that health centres should maintain a policy of zero tolerance for discrimination and must investigate accusations of discrimination. Health centres should also promote ongoing sexual and reproductive health and HIV prevention campaigns focused on LGBTI people.

The code of conduct was developed through a broad participatory process that included the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals, the National Center for HIV Prevention and Control, Specialized Condesa Clinic of Mexico City, the National Council for Preventing Discrimination and representatives of civil society and LGBTI organizations.

The next steps include a training process on its practical application, with the involvement of civil society and community-based organizations. The implementation will have a pilot phase and will begin in the largest cities in the country.

There is a quiet hum in the room from the mostly young men sitting in chairs, eyeing their smartphones and chatting. Suddenly, a cheerful figure bursts into the executive lounge of the high-rise building in Taguig City, Philippines.

“Thank you, thank you,” said Ronivin (Vinn) Garcia Pagtakhan, the Executive Director and Founder of LoveYourself, a community-based organization providing health and empowerment services to men who have sex with men and transgender people. The team were wrapping up after a major event promoting HIV testing.

Mr Pagtakhan, with his shock of brown hair, frosted with a light green tint, bounced from one group to the next, joking and repeating his thanks.

Almost everyone here is a volunteer,” explained Mr Pagtakhan. “I get really moved when I talk about my volunteers. I owe everything to them.”

LoveYourself provides HIV testing and treatment services, as well as oral pre-exposure prophylaxis (PrEP) and tuberculosis screening. It has 25 staff members, who are supported by around 800 volunteers. Mr Pagtakhan founded LoveYourself in 2011, modelling it on a lesbian, gay, bisexual and transgender youth centre he volunteered in while living in San Francisco, United States of America.

“At the time, I felt there was a real problem with the way we were handling HIV prevention among the gay community in the Philippines,” said Mr Pagtakhan. “It was all about fear. I wanted something more optimistic and encouraging. I wanted a place that was lively, where people would want to hang out.”

He was only 25 years old at the time. “As they say, I know my market, because I am part of the community.”

He graduated from nursing school in the Philippines when he was 18 and got the fourth highest score on the national nursing board examinations. “This meant that I was in high demand by other candidates as a teacher helping to prepare people for their licensing exams. I travelled around the Philippines giving classes and I used social media to reach out to students as well,” said Mr Pagtakhan.

He became a celebrity on social media, with 600 000 followers on Twitter, and won the prestigious international Twitter Shorty Awards as the Nurse of the Year. The prize money helped start LoveYourself.

“The first three years, it was like sending your child off to college. I basically supported the organization on my earnings. We didn’t have any donors,” said Mr Pagtakhan. “I like to think out of the box and I had a particular vision. I didn’t want grants to dictate what we did or became. I wanted to create ripples of positive change in the community. LoveYourself isn’t just about HIV, but rather about increasing a person’s self-worth.

The organization has three community centres in the Manila, Philippines, area offering HIV testing and other services. Anyone can drop in, even on the weekends and in the evenings, for free health services.

LoveYourself tested about 20 000 people in 2016 and diagnosed around 1500 new HIV infcetions, which represent around 50% of the newly diagnosed HIV cases reported by the Department of Health in Manila. LoveYourself also works with companies and schools to help them develop HIV policies and to conduct on-site HIV tests.

In July, the organization began piloting PrEP and with support from UNAIDS and the World Health Organization plans to start a demonstration project offering self-testing before the end of the year.

In just six years, LoveYourself has grown to become an important HIV service provider in Manila. Mr Pagtakhan is proud of the organization’s achievements and has bigger ambitions. “We are still renting. I want LoveYourself to own a place, which is a community centre, where we can have health services but also original events and activities,” he said.

For more information on LoveYourself, go to http://www.loveyourself.ph.

Although new HIV infections and AIDS deaths among young people have decreased, in many places knowledge about how to prevent HIV remains worryingly low. Ahead of International Youth Day UNAIDS spoke to four young people about the challenges they face around HIV.

Pavel Gunaev is 16 years old and lives in St. Petersburg, where he is part of the youth-led network of adolescents and young people living with HIV Teenergizer! Pavel said that in his city young people are not aware about HIV.

“AIDS isn't talked about so young people don’t know about the risks or how to protect themselves from HIV,” he said. “As a result, so many uninformed young people are acting and making decisions based on rumors.” Pavel believes that if everyone does more to inform adolescents and young people and dispel the myths around HIV, ending AIDS will be possible.

Chinmay Modi was born with HIV twenty-three years ago. He is a member of the National Coalition of People Living with HIV in India and country focal point for the Youth LEAD Asia Pacific Network.

“The biggest problem is raising awareness and giving young people age-appropriate information,” he said. In his view, parents are not comfortable talking with their children about sex and society shies away from it too. As a result, he explained, young people are engaging in sex and experimenting new things but with little knowledge of the risks involved.

“Condoms need to be promoted and partners should support youth empowerment so that everyone is held accountable,” Chinmay said. He is also frustrated because in India people cannot access stigma-free HIV services at an early age.

In his view, self-stigma is hampering efforts to tackle discrimination, violence and inequalities related to HIV. That’s why, he explained, he wants more people to share their stories and be positive about being positive.

Moises Maciel couldn’t agree more with Chinmay. He is a 20-year-old LGBT and HIV activist. He became a  member of the National Network of Adolescents and Youth Living with HIV/AIDS in Brazil after discovering his positive HIV status two years ago. Since then, he has been on a journey against HIV-related stigma. He has also been motivating his peers to get tested.

“Young people are still at great risk of HIV infection due to a variety of factors such as social marginalization related to gender and racial inequalities,” he said. “In Brazil, young transgender and gay people are particularly targeted,” he explained.

He said that it baffles him to see how stigma and prejudice still dominate despite people living with HIV living healthy lives with the help of antiretroviral therapy. “We should start talking to young people in an open and responsible way about sexuality, sexually transmitted infections, teenage pregnancy and life responsibilities,” Moises said.

Lorraine Anyango, a Boston-based youth health and rights advocate, works to ensure that young people's voices, specifically around HIV, get heard.

“Young people continue to be left out of spaces and discussions on issues that impact their lives,” Lorraine said. “Their autonomy as individual human beings continues to go unacknowledged, leaving them susceptible to the risk of HIV infection.”

In her opinion, young people’s participation in decisions that affect their health can contribute to strengthen national-level accountability, by ensuring that programmes are effectively responding to their needs. Lorraine concluded by saying, “Recognizing youth sexual and reproductive health and rights, and continuing the conversation on HIV will get us closer to ending AIDS by 2030.”

In the lead-up to IDAHOT (the International Day against Homophobia, Transphobia and Biphobia) 2017, UNAIDS spoke with Kene Esom, the Executive Director of AMSHeR. AMSHeR promotes non-discrimination, particularly discrimination based on sexual orientation and gender identity, and advocates for access to quality health services for lesbian, gay, bisexual and transgender people in Africa.

Question: Tell us about the changes across the African continent since AMSHeR started nine years ago

AMSHeR was established to address discrimination and human rights violations based on sexual orientation and gender identity, the disproportionate vulnerability to HIV of men who have sex with men and the policy and social barriers that hinder access to services for lesbian, gay, bisexual and transgender (LGBT) people in Africa.

African LGBT people are bringing the issues of sexual orientation, gender identity and human rights into regional and global policy and legal spaces and are making the African LGBT experience the basis of policy, service delivery and funding decisions on Africa.

Never before has there been more visibility and interest in LGBT issues and understanding of the experience and needs of African LGBT people and effective representation of African LGBT communities in the global discourse. This is largely because of AMSHeR’s courageous mandate to make African LGBT people the faces and voices of inclusion in Africa and by so doing put LGBT inclusion on the agenda of African states and policy-makers as well as human rights and social justice movements.

Question: What made you focus your recent campaign on engaging with faith leaders?

It is widely accepted that religion and religious leaders have a great influence on political leaders and in African society. The widespread intolerance, discrimination and violence against people based on their real or perceived sexual orientation, gender identity and expression, and lack of access to health services, may be attributed to a highly religious environment that has normalized heterosexuality and patriarchy while demonizing sexual diversity.

Religion-inspired discrimination is very rife, particularly in Africa. The experiences of African LGBT people have been varied, from torture and inhumane treatment in the form of exorcism and conversion therapy, to mob violence incited by religious leaders from the pulpits, to the experiences of religious leaders sitting on national health agencies blocking attempts to provide health and rights services to LGBT people, to religious leaders actively sponsoring discriminatory legislation. 

Religious leaders, because of their respected positions in society, are critical in addressing issues of stigma and discrimination as well as upholding the rights of all people regardless of sexual orientation, and, even more importantly, have emerged as strategically placed in discourses on HIV, sexuality and spirituality.

AMSHeR appreciates the role that religious leaders play, but at times they perpetuate discrimination based on sexual orientation and gender identity, and that is why, since 2015, under our Integrating Spirituality and Sexuality project, we have been working with religious leaders and LGBT people of faith to address these issues.

We have partnered with leaders of faith-based communities to initiate dialogue between institutions and LGBT communities in order to find common ground to integrate spirituality and sexuality. This has been done following lessons learned on how faith-based organizations have been integral in advocating for non-discrimination and stigma against people living with HIV. Faith-based organizations have proved to be allies to many civil society organizations in pushing for non-discrimination and stigma against people living with HIV.

As part of its work, AMSHeR has released a documentary, Queer Voices of Faith, for IDAHOT 2017.

Question: You are a Nigerian working in South Africa for a pan-African organization. What motivates you?

Whether in Nigeria, South Africa, Mozambique or Morocco, I am amazed at the remarkable kindred spirit that connects African societies. I consider myself a pan-Africanist, I believe there is more that connects us than otherwise, despite our diversities, and I celebrate Africa’s diversity and the values that unite us.

AMSHeR has been a perfect vehicle to express my pan-African ideals and promote the quest for social justice across Africa.

Question: What do you see as the future on the continent for LGBT people?

The future of LGBT people in Africa is to strengthen the movement that is now under way in which LGBT people, their leaders and other advocates are steadily seeking to realize their fundamental human rights, including the rights to equality and non‐discrimination, the highest attainable standard of health, freedom of expression, freedom of association and assembly, freedom from unlawful arrest and detention and equal access to justice.

I see a future and it is a bright one. A lot has changed since 2009, when AMSHeR came into operation. We have taken and continue to take incremental steps towards achieving the full inclusion of African LGBT people as equal citizens of Africa. The tide is flowing in one direction and it is in the right direction.

Question: This year’s theme for IDAHOT is family. What does family mean to you?

Family is a bond of love as opposed to biology and all families, in whatever shape or form, should be afforded the same protection and recognition from a legal and ideological perspective. Africa is replete with different expressions of family and we celebrate the role that families play in shaping society. It is also imperative to acknowledge that it is through families that we can reframe respect for diversity and unlearn the prejudice that is at the root of the discrimination that LGBT people face today.