Sexual transmission of HIV

GENEVA/BANGKOK, 13 December 2019—UNAIDS congratulates Sri Lanka for achieving the elimination of vertical transmission of HIV and congenital syphilis. “Sri Lanka’s remarkable achievement gives me hope and shows that change is possible. It is clear that when a country ensures that services are accessible and stigma-free for women, including for women living with or affected by HIV, results follow that benefit women’s health, their children’s health and society as a whole,” said Winnie Byanyima, UNAIDS Executive Director.

According to the Ministry of Public Health of Sri Lanka, in 2018 all pregnant women diagnosed with HIV started antiretroviral therapy and 97% of pregnant women diagnosed with syphilis received treatment. The country has not reported any case of mother-to-child transmission of HIV since 2017 and the rate of congenital syphilis has been reduced to less than 50 cases per 100 000 live births in 2017 and 2018.

“The elimination of mother-to-child transmission of HIV is the result of strong political commitment, a successful multisectoral integrated approach built upon the foundations of the public health system and technical expertise,” said Anil Jasinghe, Director General of Health Services in Sri Lanka.

Sri Lanka becomes the fourth country in the Asia–Pacific region after Thailand, Malaysia and the Maldives to be validated for eliminating vertical transmission of HIV and congenital syphilis.

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.

“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.”

Originally published by UNESCO on 16 October 2019

On 9 October, Po Pravde Govorya, an educational show by UNESCO, UNAIDS and OK.RU, went live on air to discuss how to talk with teenagers about health and sexual relations. The Russian social network Odnoklassniki hosted Po Pravde Govorya, [Telling the Truth], a live talk show co-organized by the UNESCO Institute for Information Technologies in Education (UNESCO IITE) and the UNAIDS Regional Office for Eastern Europe and Central Asia (UNAIDS EECA). Experts and celebrity parents discussed ways of talking with kids and teens about complex issues such as puberty, sexual relationships, personal boundaries, HIV and AIDS, and much more. The two-hour show hosted by TV presenter and journalist Lika Dlugach, received some 1.3 million views and 1,320 likes from OK.RU users.

The talk show guests included film and theater actress Elena Borshcheva, journalist Tatiana Nikonova, family therapist Marina Travkova, obstetrician-gynecologist Tatiana Rumyantseva, Alfiya Maksutova, editor-in-chief of DVOR, a social media page for youth, Vinay Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia, and Tigran Yepoyan, UNESCO Regional Health Education Advisor.

They used examples from their personal life and professional practice to illustrate how to discuss sensitive issues with kids and teens in an atmosphere of trust and without embarrassment, how to help young people make sense of what happens to their minds and bodies as they reach the challenging period of puberty, and how to educate them, honestly and non-judgmentally, about the basics of health and relationships.

Should we talk with kids and teens about sex and if so, how to do it right?

Marina Travkova, family therapist

We should tell them the truth in a way that is adapted to their age. But I would like really like all parents to understand that they do not need their child to be a certain age or to pick a special time and place for this conversation. Like it or not, you have been communicating with your kids about sex all the time since the moment they were born, because understanding sexuality is not only about technical knowledge of where babies come from. There is a lot more to it, including how your children feel about themselves, their personal boundaries, whether or not they tolerate uncomfortable clothes, how they feel about being hungry, whether they can refuse to kiss a granny who loves them. All of these are integral parts of our sexuality. The hands of the father and mother who hold and caress the baby build the first layer of what will later become his or her sexuality. How they feel about themselves, their body, the world around, their personal boundaries. We’ve been having this conversation with our kids all the time by sending them messages about the way to live their lives, to make choices, to fall in love, and to treat their bodies. When your child approaches you with a concrete question, this is a moment not to be missed – a moment of trust. Parents who feel at a loss or afraid to say the wrong thing should remember that it’s always possible to say, “I don’t really know, to be honest,” and perhaps find and offer your child a good book on the topic. You also need to understand that today, teens live in an incredibly open world, and the average age they are introduced to pornography is 9 to 11. Indeed, many teens today say or write, “How can I explain to my mom that she needs to read something about sex?” This is the way teens take care of their parents.

What questions do teens want answered?

Tatiana Nikonova, journalist

Most of the time, teens seek answers to questions which have little to do with what adults want them to ask about. What are most parents concerned about? Pregnancy, bad company, sexually transmitted diseases. But teenagers are interested in relationships. What to do and say, how to tell a person you love them, how to survive rejection, how to say no, and how to deal with the fact that everyone knows something about you that you’d rather keep private. Very often, teens struggle with the issues of bullying and aggression. What happens on a date and what can happen besides being offered sex – this is also something they’d like to know.

How to be more confident talking with your children?

Marina Travkova, family therapist

I can share two lifehacks with parents of teenagers. The first is to speak honestly about yourself, e.g. about the first time you fell in love, the first time you said no to a boy who was in love with you and how it made you feel – all of this has great value for your child. The second lifehack is to be honest with them about your fears.

Tatiana Nikonova, journalist

Discuss TV serials with them – something is always happening there! Like, unplanned pregnancies, complex diseases, breakups, misunderstandings – these are the most common stories in TV shows and a virtually endless source of topics for discussion.

Is it true that sex education can encourage young people to have sex earlier in life?

Vinay Saldanha, UNAIDS Regional Director for EECA

Numerous studies in different countries have found that not only sexuality education programs do not lead to an earlier or more active onset of sexual life, but have the opposite effect: adolescents tend to have a later sexual debut, fewer partners, a lower incidence of risky behaviors, and they are more responsible about the use of condoms and contraception. Together, this reduces the risks of contracting HIV and other sexually transmitted infections. Of course, such programs must be age-appropriate, evidence-based and, most importantly, they must be timely, i.e. before children become adults, otherwise it will be too late. This is what is said in the International Technical Guidance on Sexuality Education developed by several UN organization led by UNESCO.

Why do we need to talk with children about HIV if most people who get infected are adults?

Vinay Saldanha, UNAIDS Regional Director for EECA

In EECA countries alone, dozens of thousands of children and adolescents live with HIV. Therefore, we cannot say that this disease does not concern children. But it is essential to have a high-quality sexuality education program to make sure that a discussion of these complex issues brings positive outcomes.

What can we do if a kid does not believe that HIV exists, because they have read on the internet that “HIV is a hoax”?

Tatiana Rumyantseva, obstetrician-gynecologist

Give this kid a link to the website of the World Health Organization, to other sites which discuss infections. There are many organizations of people living with HIV who work to help others. You can take the kid to such an organization and let him or her meet people there. This approach might work well with someone who responds to emotions more than to words.

How to talk about HIV and not scare people?

Tatiana Rumyantseva, obstetrician-gynecologist

This information serves as a warning. Speaking about infections, I would say that some of them cannot be cured but require lifelong treatment. It makes good sense to plant a grain of concern for their future in young people’s minds. We usually spell out the dangers which we want to protect children from, and the same should apply to sex.

What source of information would a teenager trust the most?

Elena Borshcheva, actress

Bloggers. All teens are watching bloggers. Good educational programs for teens on TV are lacking, so young people learn a lot from bloggers. It makes sense to share essential information through their idols.

Recently, I came across a book and read it before giving it to my daughter. The author is American, and some realities are different from ours, but the concept of personal boundaries in relationships not only between a boy and a girl but also between friends is very well explained. And I thought, “Where was this book when I was a child?” It explains, plain and simple, how to act in certain situations, how to check what’s right, and what to say.

We all want relationships in the first place, warm relationships in which we need and love each other, and sex is part of such relationships. But many people – especially young people — do not quite understand why sex is special and whether a girl can refuse a guy, although it is her right. They need to learn how to tell real love from being taken advantage of in a relationship.

Can websites help parents in educating their children, and how can we teach children to safely navigate the diverse resources?

Tigran Yepoyan, UNESCO Regional Health Education Advisor

Absolutely yes. There is an increasing number of such resources available for parents and for teenagers. As far as teenagers are concerned, media literacy is the key, and UNESCO has been working to help countries educate teachers about media literacy, so that they may teach their students. Here are some basic lifehacks: it is essential to help children develop an ability to critically assess and analyze information, never take it for granted but double-check and look at the source of information: who created the website, who are the authors of posted materials, whether they provide links to primary sources and refer to relevant experts and research findings; ask yourself whether the main purpose of the website is to provide objective information or to impose a particular behavior pattern or lifestyle, manipulate the reader, or sell a product or service.

About DVOR, an online community for teens

In June 2019, more than 3 million people took to the streets of São Paulo, Brazil, to celebrate lesbian, gay, bisexual, transgender and intersex (LGBTI) pride and to mark the 50th anniversary of the Stonewall riots, a turning point in the struggle for LGBTI rights. For gay entrepreneur Almir Nascimento, 2019 marked a return to involvement in the event’s organization after a 20-year break.

What prompted Mr Nascimiento’s pride comeback was a rising unease about the increasing number of new HIV infections in Brazil among young people, especially among young gay men and transgender women. For many years, he thought that the mobilization of the 1990s and the arrival of antiretroviral therapy would be enough to end the HIV epidemic.

“The epidemic was at its height when I first joined pride as one of the organizers in 1999 and 2000. Back then, it seemed to me that we had made significant achievements, and I thought it would be enough to stop HIV”, recalls Mr Nascimento. “But four to five years ago, I began to notice that a lot of young gay, bisexual and transgender people were getting infected with HIV again, and even worse they were dying of AIDS-related illnesses at a really young age. This situation motivated me to come back and support the parade organizers in promoting an open discussion about HIV and AIDS inside our community.”

In 2018, there were around 900 000 people living with HIV in Brazil, with new HIV infections up by more than 20% since 2010. While HIV prevalence in Brazil among the adult population is estimated to be 0.5%, among transgender people it stands at around 30% and among gay men and other men who have sex with men at round 18.3%.

Mr Nascimento is the owner of a gay sauna in São Paulo and says he has always made efforts to ensure that his customers have the knowledge and tools to prevent HIV and other sexually transmitted infections. He partners with the São Paulo health authorities to distribute free condoms, for example. More recently, health researchers have been welcomed to the sauna to recruit people interested in participating in pilot programmes for PrEP (pre-exposure prophylaxis), a pill that can prevent people becoming infected with HIV.

“There is no denying that gay men and transgender people are the most affected populations here in Brazil. And I realized that the lesbian, gay, bisexual and transgender parades, including the São Paulo one, no longer had effective HIV initiatives within their associations,” he says. “Because of that, we decided to call a meeting with the 27 parades representing each of Brazil’s state capitals and a dozen others from the most important cities in São Paulo State. Altogether, we estimate they reach over 18 million people every year.”

Because the numbers are so huge, Mr Nascimento believes there is not only an opportunity but also a responsibility to convey HIV prevention and zero discrimination messages to the LGBTI community.

“There is still resistance among some parade organizers to link the festivities with AIDS-related discussions because of the fear of stigma and discrimination. But everyone is together during these events and we must take advantage of that to generate candid discussions to educate people about HIV prevention, which can save lives.”

With the support of the UNAIDS office in Brazil and other key partners, Mr Nascimento and the São Paulo LGBT Pride Parade Association are now preparing for the third LGBTI Youth Health and Prevention Meeting, to be held in November.

“After our first meeting in 2017 focusing on HIV prevention among young lesbian, gay, bisexual and transgender people, over a fifth of the participating parade associations have now started the same discussions in their cities. That’s what we want: that every pride president learns how to conduct them and that they hold their own meetings during pride week and indeed throughout the year.”

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

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

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

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

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

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

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

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

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

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

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

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

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

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

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

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

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

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

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Comprehensive sexuality education plays a central role in preparing adolescents and young people for a safe, productive and fulfilling life, and it is an important component of an HIV prevention package for young people. It provides opportunities to learn and acquire complete, accurate, evidence-informed and age-appropriate knowledge on sexuality and sexual and reproductive health issues.

Comprehensive sexuality education―defined as a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality―have been shown to contribute to delayed initiation of sexual intercourse, decreased frequency of sexual intercourse, decreased number of sexual partners, reduced risk taking, increased use of condoms and increased use of contraception among young people.

Despite the importance of comprehensive sexuality education, however, access to it is far from universal.

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.