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Oral pre-exposure prophylaxis (PrEP) has shown considerable impact in reducing new HIV infections when provided as an additional HIV prevention choice to gay men and other men who have sex with men, transgender people and sex workers.

PrEP is now being rolled out in sub-Saharan Africa for serodiscordant couples and adolescent girls and young women who are at higher risk of HIV infection. Uptake is high when community-level stigma and misconceptions are addressed, when women and girls are provided with accurate and relevant messaging about PrEP and when PrEP is framed as an empowering prevention method and a positive life choice.

However, further global expansion of PrEP requires countries to address regulatory issues and other barriers that are stopping people who want to use PrEP from doing so.

For people living with HIV, being on treatment has two advantages: they stay healthy and, if their viral load is suppressed to undetectable levels, they can’t pass on the virus to their sexual partners.

The number of people living with HIV who are on treatment continues to rise, with an estimated 24.5 million on antiretroviral therapy in mid-2019—more than double the number on treatment in 2012. However, treatment scale-up is still not on track to meet the target by the end of 2020 of 30 million people living with HIV on treatment, and with 37.9 million people living with HIV at the end of 2018, the unmet need for treatment is still worryingly large.

Despite the availability of a widening array of effective HIV prevention tools and methods—and a massive scale-up of antiretroviral therapy in recent years—there has been insufficient progress in reducing global new HIV infections, which have fallen by only 16% since 2010.

The United Nations General Assembly’s 2016 Political Declaration on Ending AIDS calls on countries to ensure that 90% of those at risk of HIV infection are reached by comprehensive prevention services by 2020. However, sex workers―and other key populations―often haven’t been accessing the prevention services they need. Country data reported to UNAIDS within the last three years show a widely varying coverage of combination HIV prevention services.

With female sex workers having a 21 times higher relative risk of HIV acquisition compared to the general population, access to suitable HIV prevention options is vital.

In the early days of the HIV epidemic, pervasive stigma and discrimination against people at higher risk of HIV infection and people living with HIV nearly paralysed the AIDS response. HIV-related discrimination stops people accessing the HIV services they need to stay healthy and can affect incomes and livelihoods and a whole range of other aspects of people’s lives.

Discriminatory attitudes towards people living with HIV remain extremely high in far too many countries. Across 26 countries with recent population-based survey data, the percentage of people aged 15–49 years with discriminatory attitudes towards people living with HIV ranged from 16.9% in South Africa to 80% in Guinea.

Environmental, social, cultural, human rights and biological factors all lead to a greatly increased risk of contracting tuberculosis and HIV in prisons.

Risk behaviours such as sharing of used needles and syringes, unprotected sex, sexual violence and lack of access to comprehensive HIV prevention and harm reduction services put people in prisons at heightened risk of HIV and other infections. Globally, HIV prevalence among people in prison is much higher than among the general population, with incarcerated people on average five times more likely to be living with HIV compared with adults outside. Key populations―people who inject drugs, sex workers and, in some countries, transgender people and gay men and other men who have sex men―tend to be overrepresented among incarcerated populations.

Despite the relative ease of reaching people within prisons, HIV services are not provided in prisons in many countries. Across the last three years of country reports to UNAIDS, very few countries reported programme data on the provision of condoms (32 countries), opioid substitution therapy (24 countries) and sterile injecting equipment (three countries) in prisons, but 74 countries reported programme data on antiretroviral therapy coverage and 83 countries reported HIV testing in prisons.

Voluntary medical male circumcision (VMMC)―the removal of all or part of the foreskin of the penis by a trained health-care professional―reduces heterosexual male vulnerability to HIV infection by approximately 60%. Its effects last a lifetime. VMMC is also an entry point for providing men and boys with broader health packages to improve their health, and indirectly benefits women and girls.

VMMC can have a major impact on HIV epidemics in high-prevalence settings. VMMC services incorporate a package of prevention interventions, including safer sex education, education on and provision of condoms, HIV testing and the management of sexually transmitted infections.

About 11 million VMMCs have been performed in 15 priority countries in eastern and southern Africa since the beginning of 2016. In 2018 alone, about 4.1 million voluntary circumcisions were performed among males of all ages, a slight increase from the 4 million carried out in 2017.

There has been progress towards the target of 25 million additional circumcisions for HIV prevention from 2016 to 2020. However, at the end of 2018, when 15 million circumcisions should have been performed, the world was off-target by 4 million circumcisions.

Although several countries in Latin America have shown impressive declines in HIV incidence, the number of new HIV infections in the region increased by 7% between 2010 and 2018, with 100 000 people contracting HIV in 2018.

Roughly half of the countries in the region saw increases in incidence between 2010 and 2018, with the largest increases occurring in Brazil (21%), Costa Rica (21%), the Plurinational State of Bolivia (22%) and Chile (34%). At the same time, there were impressive declines in El Salvador (–48%), Nicaragua (–29%) and Colombia (–22%).

Forty per cent of new HIV infections in Latin America in 2018 occurred among gay men and other men who have sex with men―key populations and their sexual partners account for the majority of new infections in the region.

Fifty years after the Stonewall riots in New York, United States of America―a major milestone in the modern struggle to recognize the human rights of lesbian, gay, bisexual, transgender and intersex people―more people are benefiting from the rights that the Stonewall protesters campaigned for. The number of people living in countries that criminalize consensual same-sex sexual relationships has steadily declined since 1969.

In June 2019, Botswana became the latest country to decriminalize same-sex relationships, but Africa still accounts for about half of the world’s population living in countries with anti-homosexuality laws. In 2018, the proportion of the world’s population that lives in countries that criminalize same-sex sexual relations plummeted from about 40% to 23% following the Indian Supreme Court’s decision that decriminalized all consensual sex among adults. This was the largest annual decline since China decriminalized same-sex sexual relationships in 1997.

Prohibitive laws and policies against key populations increase their vulnerability to HIV. It is therefore vital to ensure the full respect of the human rights of all people, regardless of their sexual orientation and gender identity, including through repealing laws that prohibit sex between consenting adults in private, enforcing laws to protect people from violence and discrimination and addressing homophobia and transphobia.

Consensual same-sex sexual relations remain criminalized in at least 67 countries and territories worldwide.

New data show that in 2019 around 48* countries and territories still have restrictions that include mandatory HIV testing and disclosure as part of requirements for entry, residence, work and/or study permits

GENEVA, 27 June 2019—UNAIDS and the United Nations Development Programme (UNDP) are urging countries to keep the promises made in the 2016 United Nations Political Declaration on Ending AIDS to remove all forms of HIV-related travel restrictions. Travel restrictions based on real or perceived HIV status are discriminatory, prevent people from accessing HIV services and propagate stigma and discrimination. Since 2015, four countries have taken steps to lift their HIV-related travel restrictions—Belarus, Lithuania, the Republic of Korea and Uzbekistan.

“Travel restrictions on the basis of HIV status violate human rights and are not effective in achieving the public health goal of preventing HIV transmission,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “UNAIDS calls on all countries that still have HIV-related travel restrictions to remove them.”

“HIV-related travel restrictions fuel exclusion and intolerance by fostering the dangerous and false idea that people on the move spread disease,” said Mandeep Dhaliwal, Director of UNDP’s HIV, Health and Development Group. “The 2018 Supplement of the Global Commission on HIV and the Law was unequivocal in its findings that these policies are counterproductive to effective AIDS responses.”

Out of the 48 countries and territories that maintain restrictions, at least 30 still impose bans on entry or stay and residence based on HIV status and 19 deport non-nationals on the grounds of their HIV status. Other countries and territories may require an HIV test or diagnosis as a requirement for a study, work or entry visa. The majority of countries that retain travel restrictions are in the Middle East and North Africa, but many countries in Asia and the Pacific and eastern Europe and central Asia also impose restrictions.

“HIV-related travel restrictions violate human rights and stimulate stigma and discrimination. They do not decrease the transmission of HIV and are based on moralistic notions of people living with HIV and key populations. It is truly incomprehensible that HIV-related entry and residency restrictions still exist,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV.

The Human Rights Council, meeting in Geneva, Switzerland, this week for its 41st session, has consistently drawn the attention of the international community to, and raised awareness on, the importance of promoting human rights in the response to HIV, most recently in its 5 July 2018 resolution on human rights in the context of HIV.

“Policies requiring compulsory tests for HIV to impose travel restrictions are not based on scientific evidence, are harmful to the enjoyment of human rights and perpetuate discrimination and stigma,” said Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health. “They are a direct barrier to accessing health care and therefore ineffective in terms of public health. I call on states to abolish discriminatory policies that require mandatory testing and impose travel restrictions based on HIV status.”

The new data compiled by UNAIDS include for the first time an analysis of the kinds of travel restrictions imposed by countries and territories and include cases in which people are forced to take a test to renew a residency permit. The data were validated with Member States through their permanent missions to the United Nations.

UNAIDS and UNDP, as the convenor of the Joint Programme’s work on human rights, stigma and discrimination, are continuing to work with partners, governments and civil society organizations to change all laws that restrict travel based on HIV status as part of the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. This is a partnership of United Nations Member States, United Nations entities, civil society and the private and academic sectors for catalysing efforts in countries to implement and scale up programmes and improve shared responsibility and accountability for ending HIV-related stigma and discrimination.

*The 48 countries and territories that still have some form of HIV related travel restriction are: Angola, Aruba, Australia, Azerbaijan, Bahrain, Belize, Bosnia and Herzegovina, Brunei Darussalam, Cayman Islands, Cook Islands, Cuba, Dominican Republic, Egypt, Indonesia, Iraq, Israel, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Lebanon, Malaysia, Maldives, Marshall Islands, Mauritius, New Zealand, Oman, Palau, Papua New Guinea, Paraguay, Qatar, Russian Federation, Saint Kitts and Nevis, Samoa, Saudi Arabia, Saint Vincent and the Grenadines, Singapore, Solomon Islands, Sudan, Syrian Arab Republic, Tonga, Tunisia, Turkmenistan, Turks and Caicos, Tuvalu, Ukraine, United Arab Emirates and Yemen.

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.

Achieving universal health coverage in a country is an ambitious, but transformative, goal. Communities are essential to the AIDS response and will be essential to the successful roll out of universal health coverage (UHC). When national governments establish a committee to coordinate UHC, it is important to ensure that all relevant communities are involved—civil society, including people living with HIV, should be included in decision-making. If civil society is not engaged early in the development of initiatives for UHC, decisions will be made about health services without the voice of the people most affected by those decisions. The graph below shows four ways in which communities contribute to the design and implementation of UHC.