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As the COVID-19 pandemic continues, the ongoing global health crises and resulting economic consequences of the measures imposed to contain COVID-19 have highlighted the vast and rapidly growing inequities threatening the livelihoods of the most vulnerable.   

This has been especially true for transgender people around the world, who have disproportionally borne the socioeconomic hardships of the pandemic. Speaking about the transgender community in India, transgender activist Laxmi Narayan Tripathi said, “People didn’t have money to pay rent. Not even to buy rice. People may die of COVID-19, but they may die of hunger even sooner.” The Kineer Services, an initiative created by Mrs Tripathi focusing on creating employment for the transgender community in India, organized and created a platform to provide food to the transgender community across several states in India in order to tide people over the immediate hardship. Sustainable support, however, is a challenge. “What else would be better than us empowering our own people, those that are living on the margins of society, to become entrepreneurs?” Ms Tripathi added.

Recognizing that access to finance is a critical factor towards supporting vulnerable populations to survive the immediate crisis and the impact of lockdowns, UNAIDS and partners launched the Solidarity Fund for Key Populations Social Entrepreneurships and will support eight proposals for transgender-led social enterprises in its pilot phase. The pilot is being rolled out in Brazil, Ghana, India, Madagascar and Uganda. It will finance a series of selected social enterprise grants led by key populations, which will be announced in early April.

“The solidarity fund is a small step towards addressing the economic inequities faced by transgender communities. It is about building and supporting entrepreneurs from within the transgender community to address the extreme discrimination and vulnerability that the transgender community faces,” said Pradeep Kakkattil, Director, Office of Innovations, UNAIDS

The variety of social enterprises received through the solidarity fund’s first proposal call from transgender communities is a testament to the ingenuity of community-led organizations in the face of special hardship. In Uganda, Tranz Network Uganda has established the Transgender Resilience and Economic Empowerment (TREE) pilot programme in order to contribute to the economic transformation of transgender people in Uganda. The TREE project will build social capital and the resilience of transgender people in Uganda through the formation of saving groups, the promotion of financial inclusion, entrepreneurship, vocational skills development and linkages to other social economic empowerment activities.

The selected applicants for the pilot phase of the solidarity fund have shown how civil society organizations and networks are playing a critical role in providing essential social safety nets for vulnerable communities and transgender populations during the pandemic.

In Ghana, the Hope Alliance Foundation (HAF) and the OHF Initiative have been working together for the past nine years on implementing numerous HIV-related programmes that include emergency support, home-based care, capacity-building and peer support. As the ongoing pandemic and the subsequent lockdowns continue to heavily impact the Ghanaian labour market, particularly vulnerable workers, HAF and the OHF Initiative are aiming to address the resulting economic challenges through capacity-building programmes and the implementation of income-generating activities. Through the Community Economic Empowerment Program, the two organizations will work with lesbian, gay, bisexual, transgender and intersex people and people living with HIV to provide them with vocational skills training and to revitalize small- and medium-sized business that have been adversely impacted by the economic downturn due to COVID-19-related lockdowns.

In Bihar, India, Reshma Prasad sees a unique opportunity for the transgender community, which has developed unique skills in dancing, singing, art and entertainment within the local culture and across the country. Through Nachbaja, Ms Prasad wants to bridge the current gap between transgender communities and digital media by providing a centralized online platform on which they can market their skills, allow people to directly connect with the artists themselves and provide the artists with an opportunity to receive fair pricing and wider exposure for their services. Nachbaja.com has already registered more than 1000 artists for its platform and aims to grow the platform to reach all of India.

In Brazil, Grupo De Trabalhos em Prevenção Posithvo (GTP+) has been supporting people living with HIV by providing them with food security since 2016 through their Cozinha Solidaria (Solidarity Kitchen). Noticing a vast and sudden drop of the income of their beneficiaries in the past year due to the ongoing pandemic and related lockdowns in Brazil, GTP+ saw a unique opportunity to combine their knowledge of confectionary and gastronomy with entrepreneurial ventures for their beneficiaries. Through Confeitaria Escola–Cozinha Solidária (Confectionary School–Solidarity School), the organization will aim to commercialize and grow its operations by creating confectionary and food baskets for commemorative occasions while proving relevant entrepreneurial training guidance for all members.

“UNICEF recognizes the critical importance of HIV prevention among young key populations if we are to end the AIDS epidemic. We believe that this can be best accomplished by empowering communities directly. The solidarity fund is a unique resource that will do just that. For young people, these investments will yield lifelong opportunities,” said Chewe Luo, Associate Director and HIV Programme Chief, United Nations Children’s Fund.

As transgender communities become increasingly marginalized, especially during the ongoing global pandemic and subsequent lockdown measures, UNAIDS is committed to eradicating all forms of discrimination faced by transgender communities and stands behind them to drive workplace equality forward. 

“If you want to know that [Keem] is a man, just snatch away his phone and run,” taunted an Internet troll under Keem Love Black’s new profile picture on Facebook. 

As a transgender woman living in Uganda, Ms Black is no stranger to the homophobia and transphobia that the lesbian, gay, bisexual and transgender (LGBT) community receives in the east African country. 

“There is a lot of cyberbullying,” Ms Black says; for example, people often attack her for posting pictures of her in dresses and makeup. 

Trolling is one motivation for Ms Black’s social media activism. She runs Trans Positives Uganda, a community organization that cares for transgender women sex workers and refugees who are living with HIV.

The online abuse mirrors the violence most transgender women experience in Uganda at the hands of their partners and even health-care providers. The marginalization has created a myriad of issues for transgender people in the country.

“I have been persistent on social media because I wanted to tell the world about transgender issues,” she says.

HIV disproportionately affects female sex workers and transgender women. The 2020 Global AIDS Update reports that in eight sub-Saharan countries nearly one in three transgender women said they had been physically attacked and 28% had been raped.

It is not only sexual violence that Ms Black relates, but also intimate partner violence. 

“Our boyfriends really violate us,” Ms Black says. 

She adds that transgender sex workers also meet the same fate at the hands of clients. However, while she believes that violence against transgender women needs to be addressed, the criminalization of LGBT people and sex work in Uganda stops survivors from speaking out. 

“Sex work is illegal and our kind of sex is very, very illegal. You might end up getting arrested,” she says. 

The stigma and discrimination often follows transgender people to consulting rooms at health facilities, where, while seeking treatment, they can be degraded and shamed.

“You tell a doctor, “I have anal gonorrhoea” and they will all be shocked. They'll call everyone, all the doctors, to see because they don’t believe in anal sex. They’ll say it’s against their religion,” says Ms Black.

When Ms Black lost an HIV-positive transgender friend to medical negligence in 2013, it was the final straw. Her friend was classified as a gay man, resulting in her not accessing health care that could have saved her life. 

“I was like, “Okay, I have to start a campaign on social media” because people only knew about lesbians and gays,” Ms Black says. 

That campaign grew from about 100 followers on Facebook to 50 000 followers today.

Ms Black’s Facebook page is mix of speaking about contemporary Ugandan issues, advocating for transgender people and fashion.

Despite her success on Facebook, Ms Black is turning to other social media platforms. “I am starting to use my Instagram page to advocate and sensitize people on transgender and health issues. I have noticed that social media is strong for advocacy,” she says.

In the last year, COVID-19 lockdowns had a big effect on women and girls and key populations. Sex workers, transgender men and women, people who use drugs and gay men lost livelihoods, faced violence and often are scapegoated as the transmitters of COVID-19.

“We are still suffering as sex workers who used to get clients from bars and clubs. The president hasn’t decided when bars will officially open yet,” she says. “During the lockdown we were all depressed; it came as a shock to us and we were not prepared at all. Some of us had a few savings, others didn’t have anything.”

Ms Black says people living with HIV faced many challenges in obtaining their treatment as public transport had stopped. “Many people stopped taking their HIV treatment,” she observes.

As with many communities across eastern and southern Africa, the transgender sex worker community displayed remarkable resilience in the face of adversity, somehow surviving the loss of livelihoods and food insecurity.

Without any formal financial support, Trans Positives Uganda teamed up with a sex-worker-led organization called Lady Mermaids, started a GoFundMe page and raised more than €5000 to buy and supply food to their members. They pulled through and, “Now that the lockdown has been eased, we are slowly getting back on our feet,” says Ms Black.

Through it all, Ms Black keeps it playful and often laughs at her naysayers. However, the memes on social media are not just fun and games for her. “Activism happens in many ways,” she says. 

Find her on Facebook here and Instagram here.

The night before filming began, the producer, Swati Bhattacharya, spent long hours with one of the actresses to make sure she understood the spirit of her movie.

“Because of COVID-19, I could not join, so we spoke on the phone and I told her that using no words she had to convey fright followed by acceptance,” Ms Bhattacharya said.

The film, the Mirror, portrays a young boy who is pouting and opts out of playing with other children during an Indian kite festival. His mother eggs him on, but he sneaks off downstairs alone. He drapes himself in a woman’s scarf and smiles as he sees his reflection in a mirror.

Moments later, his mother and his grandmother catch him dancing dressed up. The music stops and the women stare at the boy. A few seconds of dread pass by and suddenly the women join him.

“You see, this story plays out on many levels,” Ms Bhattacharya said. “The broad point is we have to accept children as they are and, in this case, build up their confidence.” She pointed to the fact that 98% of transgender people in India leave their homes or are thrown out. Inevitably, many live on the street with no money or education, often relying on sex work.

“Visibility is also an important thing,” the long-time advertising executive said. “Either you dislike the body you live in or you hate the society that you live in.” She wanted to capture the pivotal moment of self-recognition. Often, she explained, we look at children as our projects and want to make them extrovert and studious and obedient, refusing to see them for who they are and how they want to grow up.

“I wanted to show how they (transgender people) are seeing what they want to see and not the way the world sees them,” Ms Bhattacharya said.

Quoting an often-used phrase, she added, “It is easier to accept a child than mend a broken adult.”

In her opinion, most adults have been battered and bruised in some way or another, but transgender people in her country and across the world particularly suffer—from homelessness, from sexual violence and from mental illness.

Statistics show that transgender teenagers are much more likely to attempt suicide than teenagers whose identities match what is written on their birth certificates. In addition, transgender people face discrimination and in certain countries can be arrested. And transgender women have some of the highest rates of HIV, up to 40% in some cases.

Ms Bhattacharya knows these grim figures all too well. One of her earlier advertising campaigns focused on challenging long-time traditions of exclusion. Her team took a celebration traditionally restricted to married women and opened it to all women.

“As an ad person, I realized that we were using the cookie cutter version of an ideal woman, when, in fact, women are very diverse,” she said. Chuckling, she said that she realized that for years she had not catered to consumers like herself. That drove her to get to know more women and seek out their stories.

Not only did the Sindoor Khela campaign win accolades and awards, it opened her eyes to the diversity and also the many divides. “Married vs unmarried women, mothers vs non-mothers, divorcees vs widows, etc.,” Ms Bhattacharya said.

She wanted to bring these factions together and stressed that sisterhood is an untapped resource. Her film, the Mirror, alludes to this.

“In a way, the mother is aspirational, she is making the decision to accept her son and turning it into a celebration,” Ms Bhattacharya said. “The film has a strong feminist agenda because the two women are like a cloak, or two stage lights if you will.”

Tea Uglow, above, described the film as brazen. “Ultimately it is a fairy tale and we know it is a fairy tale and yet you wonder, what is really stopping this from being perfectly fine?” As a transgender woman based in Australia she wishes families would react just like this. What also struck her about the movie is that it has no negative emotional tones. No rage, no fear. “No one has any reason to fear a trans child… yet we are told to again and again.”

For Jas Pham, above, a transgender woman living in Bangkok, Thailand, the video struck a chord. “Basically, I teared up watching the video. It reminded me of my childhood,” she said.

She said that she focused on the child, but afterwards thought more about the mirror. “It is just a reflection; you see yourself and there is no judgement,” she said, adding that this is a powerful message of recognition and acceptance to families of transgender and gender-diverse children around the world.  

Cole Young, a transgender American man, knows that parents do not always embrace their children in this open, accepting way, but he likes the positive, happy feel of the movie. “We know the bad reactions, we’ve experienced them, so we don’t need to re-traumatize trans people.”

Both work for the Asia Pacific Transgender Network, a nongovernmental organization pushing for the rights of transgender and gender-diverse people. They agreed that even though the film is filmed in India, the message is universal.

Keem Love Black, above, a Ugandan transgender woman, said the film resonated with her because at the same age she lived similar moments, and still does to this day. “I have mirror moments all the time, especially when I am going out,” she said.

Ms Black runs Trans Positives Uganda, a community organization that cares for transgender women sex workers and refugees who are living with HIV. She has used social media to raise awareness about issues concerning lesbian, gay, bisexual, transgender and intersex (LGBTI) people because few people dare speak out. Uganda criminalizes homosexuality, so she deals with persistent homophobia and transphobia among her peers and community and in health-care facilities. Reflecting upon the movie she said, “We should take up all the opportunities that come our way for visibility.”

UNAIDS is releasing the Mirror on the International Transgender Day of Visibility. Gender diversity is not a lifestyle choice but an inherent right of all people. Gender stereotypes, especially towards LGBTI people, lead to stigma and discrimination. This is more pronounced in children and adolescents, as diversity among them is not commonly understood and society puts massive pressure on them to conform to their assigned gender norms.

Above, Kanykei (who preferred not to give a last name) is one of the few transgender people who lives openly in Kyrgyzstan’s capital of Bishkek. She recalls putting on scarves when little, a bit like the boy in the film. However, her family did not take it seriously. Ever since she can remember, before she realized the difference between boys and girls, she felt like a girl. “They would laugh as in a small child is playing, but, over time, it was perceived differently, both in the family and in society,” she said.

She had to adjust her behaviour and behaved like a man. Before her grandmother’s death, five years ago, she started to consider transitioning, but she could not tell her the truth. “I lived with this gender identity conflict all the time until I decided to make the transition and live as I feel,” she said.

Ariadne Ribeiro, above, a Brazilian transgender woman, likens her own mirror moment as trying to search for herself within. That said, it scared her too. “There was always a very big fear that people might see me through the mirror as I saw myself and my secret would be revealed, and I was not ready,” she said. “I feel that the video brings a reality closer to the ideal of acceptance, something that I, at the age of 40, have not experienced.”

As a long-time transgender activist and now a Community Support Adviser at UNAIDS, Ms Ribeiro said that change is happening, but there needs to be more engagement.

That is exactly what Ms Bhattacharya aimed to show in her film. For her, when the work gains traction, that is what makes it all worthwhile. She also stressed that the “growing pains” that so many of her gender fluid friends have endured over the years are real. “I wanted to open the gates and get people to carry on the dialogue.”  

Watch the film. Join the campaign #Seemeasiam on this #TransDayOfVisibility #TDOV2021.

The global health emergency caused by the COVID-19 pandemic has brought existing inequalities to the forefront, has exposed transgender and gender-diverse communities to a heightened risk of social exclusion, stigma and discrimination, has reduced access to health care and has caused financial insecurity.

“COVID-19 has created an existential threat to many transgender people in Asia and the Pacific. But trans-led organizations and groups have found creative ways to assist their communities, to offer support against social isolation and to support trans and gender-diverse people, especially those unable to work due to COVID-19. We recognize the importance of trans leadership and their response to communities greatly affected by the pandemic,” said Joe Wong, Executive Director of the Asia Pacific Transgender Network (APTN).

When COVID-19 reached India, Maya, a young transgender woman living with HIV volunteering at Basera Samajik Sansthan, a transgender-led community-based organization in Uttar Pradesh, was living in rented accommodation after being rejected by her family. “During the COVID-19 outbreak, my friends and I had to leave our homes because we couldn’t afford the rent,” she said. Basera Samjik Sansthan provided her and her friends with shared accommodation and supplied them with food and medicine. The community-led organization also established a peer support programme to help homeless transgender young people and provide them with hand sanitizer, masks and access to free HIV and COVID-19 testing.

Her testimony is part of a collection of stories published in Dignity amidst COVID-19: Trans Youth Leading The Response, developed by APTN and Youth LEAD, and supported by the UNAIDS Regional Support Team for Asia and the Pacific, to bring visibility to the voices and experiences of transgender and gender-diverse youth leaders and showcase the efforts of transgender-led organizations throughout the region during COVID-19.

“Many transgender people living with HIV were not able to afford transportation to medical centres to receive treatment during the COVID-19 outbreak,” said Della, a young transgender woman living with HIV from Indonesia who works for the Srikandi Sejati Foundation, whose testimony is also collected in the Dignity amidst COVID-19 series. The Srikandi Sejati Foundation established a community support programme that covered transport costs to medical centres to ensure that transgender people could access HIV services. It also implemented local workshops to support and empower transgender women in five districts in Jakarta with knowledge on COVID-19, HIV, mental health and adherence to antiretroviral therapy.

In Thailand, measures taken to curb the spread of COVID-19 and the consequent decline in tourism have forced many entertainment shows and venues to close, leaving many transgender people out of work. “The decline in tourism has heavily affected not only businesses but sources of income for transgender people. Many trans women have returned to rural areas to be with their families due to loss of employment,” said Garfield, a young transgender woman working for the Sisters Foundation, a transgender-led organization in Pattaya that provides a range of HIV services to transgender people, including check-ups for general health, HIV and sexually transmitted infections, hormone therapy and harm reduction. As described in the collection of stories, since the beginning of the pandemic, Garfield and other volunteers have been at the forefront of the COVID-19 relief efforts, distributing food supplies and hygiene products to transgender women.

Basera Samajik Sansthan, the Srikandi Sejati Foundation and the Sisters Foundation are all beneficiaries of the COVID-19 Community Support Fund established by APTN to support transgender people and community-based organizations to ease the burden of the COVID-19 pandemic in the region. APTN provided grants to 22 transgender-led and transgender-inclusive community groups and organizations across 14 countries, enabling them to assist more than 2300 people across Asia and the Pacific. The grant supported various initiatives, including access to essential supplies, food and personal protective equipment, social and mental health relief support, financial assistance and funding support to sustain organizations.

The community-led initiatives and outcomes of the response to COVID-19 are summarized in the Trans Resilience Report—Stories of Hope, Pain, and Survival from the Trans Movement during the COVID-19 Pandemic, developed with financial support from the UNAIDS Regional Support Team for Asia and the Pacific, and in APTN’s multi-week social media campaign.

“On International Transgender Day of Visibility, UNAIDS recognizes the indispensable contributions made by transgender communities in the HIV and COVID-19 response. The leadership and resilience of transgender and gender-diverse communities continues to be an inspiration for our region,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific. UNAIDS will continue to work with APTN and transgender-led organizations to work towards a region where transgender people and gender-diverse people can thrive as equals.

“For a moment, imagine with me. Imagine finding out that you acquired HIV from a boy who did not even know that he was positive and wouldn’t believe that you contracted it from him,” Akosua Agyepong, a youth leader from Ghana, said at a virtual event with key partners of a new flagship initiative, Education Plus.

Ms Agyepong shared her friend’s journey, an 18-year-old struggling to study, access treatment and beat the discrimination that young people living with HIV all too often face in homes, schools, health systems and the community. 

This experience, though, is not something of the past. In sub-Saharan Africa every week, an estimated 4500 adolescent girls and young women between the ages of 15 and 24 years acquire HIV, an epidemic that is fuelled by gender injustices and violence. Five in six new HIV infections among adolescents are among girls. Sub-Saharan Africa is also the region with the highest rates of child marriage and teenage pregnancy.

At the event, the UNAIDS Executive Director, Winnie Byanyima, while introducing Education Plus, a new game-changing initiative set up in response to those realities, made worse by the COVID-19 pandemic, implored the audience to reflect on those facts.

“Education Plus brings together governments to demonstrate leadership to make commitments to roll out secondary education that is free and calls on financial institutions and donor countries to support the leadership of African governments. It brings together girls’ movements, women’s movements, human rights movements, all those who care about the human rights of girls and the right to equal opportunity,” Ms Byanyima said.

“This situation is not inevitable. It can change, and it has been changing. We need leadership; we need solidarity; we need partnerships to change it,” she added.

Education Plus—led by the heads of UNAIDS, the United Nations Educational, Scientific and Cultural Organization, the United Nations Population Fund, the United Nations Children’s Fund and UN Women—calls for multisectoral commitments to ensure free quality secondary schooling for all girls and boys. It calls for guaranteed violence-free environments, access to comprehensive sexuality education, the fulfilment of sexual and reproductive health and rights and securing the economic empowerment of young women through successful school-to-work transitions.

Ministers of gender, education and health from African countries echoed the importance of the holistic approach of Education Plus, as did representatives of key partner institutions, including the African Union Commission, the African Development Bank, the European Union and the Global Partnership for Education. 

Khumbize Kandodo-Chiponda, the Minister of Health of Malawi, drew from her life experience, calling Education Plus a timely intervention. “It is very close to my heart because I was 16 years old when I got pregnant. So, I can put myself in the shoes of our girls, especially in rural areas. I was lucky that I had an opportunity to go back to school, and indeed stayed in school, graduated up to college,” she said. “Many of our young girls lack the same opportunity. So, I’m very happy about the Education Plus initiative.”  

Valentine Uwamariya, Rwanda’s Minister of Education, said that secondary education shouldn’t be a luxury. “To end the threat to the well-being of adolescent girls, including to protect them against HIV, completion of secondary education is key and quality of education means integrating comprehensive sexuality education, as Rwanda has done in the new competency-based curriculum.”

“Every girl deserves the right to an education that is not only inclusive but affordable, available and accessible, as well without fear of judgement and disrespectful treatment, so girls let’s power up!” said Hazel Jojo, a peer educator from Zimbabwe.

Vanessa Moungar, the Director of Gender, Women & Civil Society at the African Development Bank, called for smart investments. “We need to keep working with our governments so that investing in girls’ education is as much a priority as building roads and bridges.”

“We need more of these targeted interventions that tackle the root causes of gender inequality and have a direct pay-off,” said Franz Fayot, the Minister for Development Cooperation of Luxembourg. Véronique Tognifodé Mewanou, Benin’s Minister of Social Affairs and Microfinance and Chair of the African Union Specialized Technical Committee on Gender Equality, pledged support for the initiative.

In line with the initiative’s emphasis on placing the leadership of young women at the centre, the event was moderated by two young leaders, Jennifer Kayombo, from the United Republic of Tanzania, and Lorence Kabasele, from the Democratic Republic of the Congo. The event was hosted by the Governments of Benin and Luxembourg on 17 March and was held on the sidelines of the 65th session of the United Nations Commission on the Status of Women.

Among key backers of the initiative were Pauline Nalova Lyonga Egbe, Minister of Secondary Education, Cameroon, Sarah Mbi Enow Anyang, African Union Commissioner of Education, Science and Technology, and Innovation, Henriette Geiger, Director, Directorate on Human Development, Migration, Governance and Peace at the European Commission, and Alice Albright, the Chief Executive Officer of the Global Partnership for Education.

Education Plus—a chance to fully seize the transformative power of investing in adolescent girls and young women—will be launched during the Generation Equality Forum in Paris, France. 

On Zero Discrimination Day this year, governments, civil society organizations and communities highlighted the urgent need to take action to end the inequalities that continue to persist around the world.

Among them were several countries and partners of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination (Global Partnership) that commemorated the day by organizing webinars, launching initiatives to accelerate the implementation of commitments to end HIV-related stigma and discrimination or raising awareness about the imperative need to achieve dignity for all.

At the global level, the Global Network of People Living with HIV (GNP+) launched #MoreThan, a global online campaign to celebrate and showcase the diversity of the lives, achievements, interests and dreams of people living with and affected by HIV. And UNAIDS, the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria organized a webinar to showcase the potential of evidence-informed programmes as well as community-led responses to end HIV-related stigma and discrimination. The event used best practices from countries as diverse as the Democratic Republic of the Congo, Jamaica and Ukraine.

At the country and regional levels, Zero Discrimination Day was marked by a number of initiatives. For example, in western and central Africa, Senegalese artist Coumba Gawlo launched a single to raise awareness of and promote action to respond to HIV in the region, together with fellow artists Wally Seck (Senegal), Djelly Mady Kouyate (Gambia) and Nestor Lendjy (Guinea Bissau).

In Senegal, the Network of People Living with HIV (RNP+) held a dialogue to raise awareness on the impact of HIV-related stigma on women and girls. The dialogue brought together people living with HIV and representatives of women’s movements, key populations, human rights advocates, policymakers and health service providers. The outcomes of the dialogue will be used to inform the advocacy strategy that RNP+ will develop on human rights and gender issues to better respond to the expectations of its members and communities affected by HIV.

Evidence shows that in Senegal women living with HIV face obstacles in accessing reproductive health services, that sex workers face high levels of stigma in health-care settings and that the economic and social vulnerability of women living with HIV is not sufficiently considered in HIV programming. “Discrimination continues to affect women and girls and this is the reason why they are often excluded from the labour market, are isolated in their communities or experience stigma in health centres. Key populations are also historically the target of discrimination in Senegal,” said Soukèye Ndiaye, President of RNP+.

In Côte d’Ivoire, UNAIDS, in collaboration with the Programme National de Lutte contre le Sida, the Alliance Côte d’Ivoire, Enda Santé Côte d’Ivoire and Ligue Ivoirienne des Droits de l’Homme, presented the Global Partnership and its added value to representatives of the Ministry of Health and the Ministry of justice, as well as to civil society partners. The meeting led to a report that will inform Côte d’Ivoire’s strategy to eliminate stigma and discrimination.

In the Central African Republic, which was the first country to join the Global Partnership, the Minister of Health and Population, Pierre Somse, above, issued a declaration recalling the government’s commitment to non-discrimination and equality. “It is only by addressing inequalities that we can achieve the Sustainable Development Goals, including those related to well-being and health for all,” said Mr Somse.

Other events in the Central African Republic included a civil society consultation to identify priorities for eliminating stigma and discrimination and a round-table discussion on a radio show to highlight that stigma and discrimination is a barrier to people taking up HIV prevention, treatment, care and support services. Dedicated trainings on the National Charter for Quality of Care and Patients’ Rights took place for medical staff in two major health-care centres in Bangui. In the Central African Republic, more than 80% of people living with HIV in the country have reported experiencing discrimination or stigma.  

In the Islamic Republic of Iran, the country’s new anti-discrimination regulation was disseminated on social media to mark Zero Discrimination Day. In Thailand, UNAIDS, the Ministry of Foreign Affairs and the Ministry of Public Health cosponsored a panel discussion on the Global Partnership to showcase the power of governments, civil society and the United Nations to tackle HIV-related stigma and discrimination in Asia and the Pacific. And in the Republic of Moldova, an updated road map was developed to address the remaining barriers related to stigma and discrimination, gender mainstreaming and equality, considering the commitments made under the National AIDS Program and the Global Partnership.

Finally, on the eve of Zero Discrimination Day, Kazakhstan officially joined the Global Partnership. For Baurzhan Baiserkin, the Director of the Kazakh Scientific Center for Dermatology and Infectious Diseases of the Ministry of Health of Kazakhstan, the initiative will make a positive difference for people living with HIV, prisoners, migrants and other key populations.  

“Kazakhstan supports the Global Partnership initiative to eliminate all forms of HIV-related stigma and discrimination. I am confident that it will help to achieve the Sustainable Development Goals,” said Mr Baiserkin.

The Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination is an initiative whose goal is to catalyse and accelerate the implementation of commitments made to end HIV-related stigma and discrimination by United Nations Member States, United Nations agencies, bilateral and international donors, nongovernmental organizations and communities.

The recent regional launch of the global AIDS report 2020, Prevailing against pandemics by putting people at the centre, in eastern Europe and central Asia provided a platform for the proposal of a joint revision of social and legal enablers in the region to achieve the proposed 2025 targets. UNAIDS Cosponsors, governments and civil society partners presented their views on the issue and the joint action to be taken. 

Based on the regional data, the 90–90–90 treatment cascade in the region is far off the targets, having reached only 70–44–41. Lev Zohrabyan, the UNAIDS Strategic Information Adviser for Eastern Europe and Central Asia, noted that one of the reasons for this is late diagnosis: in 2019, 53% of all new HIV cases in the region were registered in the later stages. In his opinion, it shows that testing strategies need revision and require enabling societal conditions.

Societal and service enablers have been given prominence in the proposed 2025 targets; in particular, it is outlined in the 10–10–10 targets that:

• Less than 10% of countries have punitive legal and policy environments that deny access to justice.
• Less than 10% of people living with HIV and key populations experience stigma and discrimination.
• Less than 10% of women, girls, people living with HIV and key populations experience gender inequality and violence.

Achieving these goals includes having enabling laws, policies and public education campaigns that dispel the stigma and discrimination that still surrounds HIV, empower women and girls to claim their sexual and reproductive health and rights and end the marginalization of people at higher risk of HIV infection.

“Interventions in these areas create conditions for people to be more active in HIV testing, seek help and start antiretroviral therapy immediately upon diagnosis, adhere to a treatment regimen or proactively seek HIV prevention services, including pre-exposure prophylaxis,” said Mr Zohrabyan.   

Rosemary Kumwenda, the Regional HIV/Health Team Leader at the United Nations Development Programme Istanbul Regional Hub, presented an analysis of the legislation in the eastern Europe and central Asia region on the criminalization of HIV and key populations, noting that the situation in the region remains unfavourable for an effective HIV response. The criminal codes have changed in many countries, but discriminatory laws are changing very slowly. Although many countries revisited their legislation regarding HIV exposure, HIV transmission is criminalized in virtually every country in the region. The Russian Federation and Belarus remain “leaders” in the criminalization of HIV and key populations. Criminal penalties for sex between adult men remain in Uzbekistan and Turkmenistan. The biggest challenge for the region, where more than 48% of new HIV cases are among people who inject drugs, is the criminalization of drug use and possession.

In the presentation An Inventory of Existing Tools for Creating a Favourable Social and Legal Environment in the Eastern Europe and Central Asia Region, given by Tatiana Deshko, the Director of the Department of International Programs, ICF Alliance for Public Health, Ukraine, the ReACT mechanism, which comprehensively works for the rights of key populations, was presented. ReACT (Rights, Evidence, Actions) is the programme’s principle for monitoring violations of rights and is being implemented in 37 cities in seven countries of the region with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Cases of rights violation are registered in a mobile application and then lawyers work with specific cases at the individual level or at the system level of revising legislation. Last year, about 2000 cases were registered. The analysis shows that law enforcement agencies are the primary violators of the rights of key populations in almost all countries, using threats, intimidation, illegal detention and abuse of authority. The health-care system, with denials of medical services, discrimination based on HIV status or disclosure of HIV status, is ranked after law enforcement. “Strategic analysis of cases based on the ReACT-collected data allows not only help for specific people to protect their rights but also formulating recommendations for revising legislation in countries,” said Ms Deshko.

As part of the discussion of the second 10, Alexandra Volgina, the Manager of the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination, Global Network of People Living with HIV, spoke about the People Living with HIV Stigma Index 2.0 study and the role of the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination.

Four countries of the region, Kazakhstan, Kyrgyzstan, the Republic of Moldova and Ukraine, have entered the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination. “If we compile the ReACT system, the Stigma Index and other instruments you’ll get a clear picture of what exactly needs to be done to make a difference. We need to address this issue jointly, all partners together. If we change the situation in the area of ​​stigma and discrimination, we will be able to stop the epidemic,” said Ms Volgina.

An example of such an integrated approach, from data to policies and action, was shared by Evghenii A. Golosceapov, a member of the Equality Council in the Republic of Moldova, the first state institution in the post-Soviet countries dealing with discrimination against various groups.

As part of the Equality Council’s work, studies on the People Living with HIV Stigma Index were carried out, where, through public opinion polls and in-depth interviews, categories of people who are marginalized by society were determined. People living with HIV ranked the second among those categories, after lesbian, gay, bisexual, transgender and intersex people. The Equality Council also uses data from the People Living with HIV Stigma Index, the ReACT registration system and research on the legal environment on HIV.

On this comprehensive basis, more than 70 recommendations on practical steps in the field of legislative changes were developed. These data were used to develop a new national HIV programme and a country proposal to the Global Fund. In addition, the Equality Council considers specific cases of discrimination and complaints (e.g. dismissal due to HIV status) and supports civil society organizations in defending the rights in court. In recent years, the restriction on artificial insemination for people living with HIV has been lifted in the Republic of Moldova, as well as the ban on adoption and guardianship.

All the data collected shape the Roadmap for the Elimination of Discrimination, a government programme in which people living with HIV play a critical role. In the Republic of Moldova, the ScorCard system has also been launched, which allows real-time tracking of the implementation of recommendations and progress towards the adopted targets in reducing stigma and discrimination.

Regional gender gaps in the context of the HIV response were presented by Enkhtsetseg Miyegombo, a Programme Specialist at the UN Women Europe and Central Asia Regional Office.

According to her, the COVID-19 pandemic has largely erased progress in this area and exacerbated existing inequalities: lockdowns disproportionately affected the workload of women who do unpaid domestic work, reduced women’s economic opportunities due to job losses, limited their mobility and increased documented violence against women. These new circumstances were superimposed on existing problems—a lack of awareness about HIV, barriers to discussing safer sex with a partner, revival of patriarchal stereotypes, religious restrictions—as a result of which, women find themselves under growing pressure. Ms Miyegombo highlighted that investment in gender equality programmes is critical to the effectiveness of the regional HIV response.

A study conducted by the Eurasian Women’s Network on AIDS helped to identify the key characteristics of violence and the specifics of organizing assistance to victims of violence in 12 countries of the eastern Europe and central Asia region. The results of the study supplemented the available international data on violence and equipped national civil society organizations with real facts for political advocacy. Elena Rastokina, a specialist in advocacy and community mobilization from the Almaty Model of HIV Epidemic Control project in Kazakhstan, presented successful practices of community-based monitoring in the eastern Europe and central Asia region, concluding that this approach is important as it allows communities to know their rights and barriers and to have systematic data to advocate for systematic change.

Alexander Goliusov, the Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia, stressed that the new 10–10–10 targets are addressing the inequalities that are fuelling the spread of HIV, COVID-19 and other pandemics. “Testing and treatment remain our priorities; however, now our fast track to them lies in combatting inequalities,” he said.

The recording of the launch in Russian and English, along with all presentations and materials, can be found here.

The Democratic Republic of the Congo has been plagued by political instability since the 1990s and has seen widespread attacks against civilians, violence between ethnic factions, rape and other forms of sexual violence, and murder. Sexual violence against adolescent girls and young women is common.

Violence against women and girls continues to be a global pandemic that affects one in three women in their life. Violence against women is a major factor for contracting HIV—in areas with a high HIV burden, such as sub-Saharan Africa, women subjected to intimate partner violence are 50% more likely to be living with HIV. And men who are perpetrators of violence against women tend to be at a higher risk of HIV themselves and to use condoms less frequently, thus increasing the risk of HIV transmission.

According to the latest Demographic and Health Survey of the Democratic Republic of the Congo, HIV prevalence is three times higher among women aged 15–49 years (1.1%) than among men of the same age (0.4%) and twice as high among young women aged 15–24 years (0.46%) than among young men of the same age (0.22%).

RENADEF (Réseau National des ONG pour le Développement de la Femme), a platform of approximately 350 non-state groups working for women, is tackling this issue front and centre. As a subrecipient of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, RENADEF is running a project to strengthen awareness around sexual and reproductive health and rights, including HIV, to facilitate access to support services and to encourage behaviour change among adolescent girls and young women in 16 HIV high-burden provincial divisions.

In collaboration with health-care providers, almost 200 peer educators and mentors have been trained on sexual and reproductive health and more than 600 educational talks in different settings, including schools and communities, have been facilitated, reaching more than 6500 people, including 2500 girls.

“I was not informed about sexually transmitted infections and their consequences on my life, but I had the chance to participate in an awareness session organized by the peer educators and mentors in my neighbourhood; at the end of the session, I approached one of the sensitizers to explain my problem to her. She gave me advice and referred me to a health training, where I was taken care of for free and I feel good now,” said Nathalie Nyembwe (not her real name), who attended one of the educational talks.

The project also supports clinics giving psychosocial, legal and judicial support to survivors of sexual violence. Since 2018, clinics have been held that have provided psychological support to almost 5500 people and legal/judicial support to more than 3500 survivors of sexual violence.

The community sensitization, capacity-building of legal clinics and support for survivors of sexual violence have contributed to an increase in the reporting of rape.

“It’s particularly important, particularly as we reflect on our experience with COVID-19, that we acknowledge the important role that women have played to protect others from violence, to ensure continued support to vulnerable families and to ensure access to food and medicine. Women have provided invaluable support to keep people connected to neighbours, services and information, all the while ensuring that homes remain a safe space for children and families to continue to learn and grow socially,” said Susan Kasedde, the UNAIDS Country Director for the Democratic Republic of the Congo.

As a champion country of the Global Partnership for Action to Eliminate all Forms of HIV-Related Discrimination, the Democratic Republic of the Congo has a unique opportunity to strengthen its implementation of coordinated, comprehensive and scaled-up action involving a range of stakeholders and to build synergies on action on gender equality across sectors. 

On 1 March, people around the world join together to celebrate Zero Discrimination Day, which this year highlighted the urgent need to take action to end inequalities.

In recent years, the Central African Republic has made the reduction of health inequalities a national priority. In mid-2019, 10 priority areas towards universal health coverage were established. These include the objective of ensuring that every citizen in the country has access to a health centre within 5 km of his or her home.

The country was the first to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, which through harnessing the combined power of, and using the unique skills of, governments, civil society and the United Nations aims to consign HIV-related stigma and discrimination to history.

To mark Zero Discrimination Day this year, the country organized several activities ahead of and during the day. A declaration recalling the government’s commitment to non-discrimination and equality was issued by the Minister of Health and Population on television and radio. “It is only by addressing inequalities that we can achieve the Sustainable Development Goals, including those related to well-being and health for all,” said Pierre Somse, the Minister of Health and Population.

Recent studies show that inequality and stigma are major obstacles to access to health services. For example, more than 80% of people living with HIV in the country report having experienced discrimination or stigma. “These challenges are further compounded by conflicts and attacks on populations and health personnel that deprive hundreds of thousands of our citizens of their rights, including the right to life, dignity and health,” Mr Somse added.

A civil society consultation was organized to flesh out the priorities for the elimination of stigma and discrimination in the country. A round-table meeting was also held on a national network of human rights journalists radio programme to raise awareness on the negative impact of stigma and discrimination as a major barrier to people taking up HIV prevention, treatment, care and support services. Speaking on the programme, Aminata Adoum, of the National Association of Women Lawyers, highlighted the work of her organization in supporting women living with HIV against discrimination and violence.

On Zero Discrimination Day 2020, health professionals, including professional organizations of doctors, nurses and midwives, as well as patients’ associations, signed a National Charter for Quality of Care and Patients’ Rights that sets the principles of humanism, ethics and respect for dignity to guide relations between patients and health-care providers. This year, the patients’ charter was posted in health facilities in the capital city, Bangui, and dedicated sensitization sessions on the charter took place for medical staff in two major health-care centres in the capital.

“This Zero Discrimination Day campaign is part of a comprehensive set of priority activities to address human rights barriers to HIV services that the country will be implementing over the next three years, including community-led monitoring of human rights violations, know your rights education, legal services, the development of anti-discrimination law and engagement with community leaders, legislators and opinion-makers,” said Patrick Eba, the UNAIDS Country Director for the Central African Republic.

The Islamic Republic of Iran has issued a new regulation prohibiting stigma and discrimination against people living with HIV in health-care settings.

Global experience has shown that stigma and discrimination limits access to HIV services at every step and stops people exercising their basic human rights, including the right to health. Studies in the Islamic Republic of Iran have identified health-care settings as an important venue where HIV-related stigma and discrimination needs to be addressed. 

In 2019, the Islamic Republic of Iran joined the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination and set three priority areas—health settings, humanitarian settings and communities—for action. This new regulation is a direct result of the work in the partnership by both the country and UNAIDS.

The regulation covers all private and public health institutions and requires them to protect people living with HIV and key populations from stigma and discrimination. The regulation also covers a number of other areas, including raising awareness about HIV and the rights of people living with HIV, protecting the rights of people living with and affected by HIV and ensuring the discrimination-free provision of health care and treatment to people at higher risk of HIV and people living with HIV.

“This important breakthrough in the national response to HIV lays the ground for significantly controlling HIV in the country in the future,” said Fardad Doroudi, the UNAIDS Country Director for the Islamic Republic of Iran.

The UNAIDS country office has supported the efforts to eliminate stigma and discrimination in the country over many years. In 2010, to help understand the problem, the country office, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) through the United Nations Development Programme (UNDP) and the National AIDS Programme (NAP) supported the Iranian Research Center for HIV and AIDS (IRCHA) and the Global Network of People Living with HIV (GNP+) to conduct the first People Living with HIV Stigma Index study, which clearly showed that people living with HIV faced discrimination in health-care settings. A follow-up study conducted in collaboration with Harvard University on the root causes of stigma introduced a mathematical model on discrimination and showed the route to overcoming stigma. Currently, an Iranian coalition of people living with HIV, with support from NAP, IRCHA, GNP+, ICW, Johns Hopkins University and the UNAIDS country office, is conducting the country’s second People Living with HIV Stigma Index, using the updated 2.0 methodology.

With the knowledge from these studies, UNAIDS has worked against stigma and discrimination in the country in a variety of ways. With support of the Global Fund through UNDP, UNAIDS established “positive clubs” to provide services by and with people living with HIV in a stigma-free environment, advocated with policymakers and religious leaders and held national sensitization campaigns on stigma and discrimination in collaboration with civil society. UNAIDS also invested in the next generation of medical students, working with the International Federation of Medical Students through a series of workshops and courses to help to change the attitude of university students about HIV and stigma and discrimination.

In 2020, the UNAIDS country office technically and financially supported NAP to develop an ethical framework for the fifth National HIV Strategic Plan (2021–2025), as well as the anti-discrimination regulation, in a process backed by a team of national experts in the fields of law and ethics.

“It has been a long journey to get to this stage, but this is what I have waited so long for—a structural change, something that we could refer to if discrimination occurs in a health-care setting,” added Mr Doroudi.

UNAIDS continues to support and collaborate with the Government of the Islamic Republic of Iran to achieve its objectives to eliminate HIV-related stigma and discrimination in other areas.

“I pledge not to allow any interruption to occur on delivery, quality or quantity of HIV services across the country,” said Saeed Namaki, the Minister of Health and Medical Education of the Islamic Republic of Iran.