Transgender people

Discriminatory laws drive key populations out of reach of critical health and social services

GENEVA, 16 May 2019—Ahead of the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), on 17 May, UNAIDS is calling on all countries to remove discriminatory laws against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

Stigma towards key populations—gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people—is reinforced by criminal laws. These in turn fuel violence, exploitation and a climate of fear, hindering efforts to make HIV services available to the people who need them.

“We all have a moral and legal obligation to remove discriminatory laws and enact laws that protect people from discrimination,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “To end the AIDS epidemic, people need to be protected from harm. We need justice and equality for all.”

More than 65 countries criminalize same-sex sexual relations, including at least eight that impose the death penalty. Globally, gay men and other men who have sex with men are around 28 times more likely to acquire HIV than the general population and are much less likely to access HIV services. In 2017, gay men and other men who have sex with men accounted for 18% of new HIV infections worldwide.

“It is critically important that we create a world where all people can access the health and social services they need without the threat of violence and discrimination. Universal health coverage means reaching all people―sexual and gender minorities have the same right to health as everyone else,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

Transgender people, who account for an estimated 0.1–1.1% of the global population, often face stigma, discrimination and social rejection in their homes and communities. Discrimination, violence and criminalization prevent transgender people from accessing the HIV services they need to stay healthy. It is estimated that transgender women are 13 times more likely to acquire HIV than other adults of reproductive age and that 16.5% of transgender women are living with HIV.

“Justice and protection for all are central to driving progress on the 2030 Agenda for Sustainable Development and the Sustainable Development Goals. Enacting and enforcing non-discriminatory laws and policies, repealing punitive laws and ensuring access to justice for all are critical to delivering on the commitment to leave no one behind,” said Achim Steiner, Administrator of the United Nations Development Programme.

UNAIDS joins with the United Nations Secretary-General and the United Nations High Commissioner for Human Rights in calling for the decriminalization of LGBTI people and for LGBTI people to be protected from violence and discrimination and to have full access to health and other social services.

IDAHOT, a worldwide celebration of sexual and gender diversity, is commemorated annually on 17 May.

UNAIDS

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

In a landmark ruling in April 2014, India’s Supreme Court introduced recognition of a third gender and directed that transgender people must have access to the same rights to social welfare schemes as other minority groups in the country.

Now, the State of Gujarat has established a Transgender Welfare Board to increase access to essential services for transgender people, including to health care, housing, education and employment. The Ministry of Social Justice and Empowerment created the board following consultations with the transgender community and community groups, including the Lakshya Trust and Vikalp. UNAIDS and the United Nations Development Programme provided technical support and guidance throughout the process.

The new board aims to improve cross-departmental coordination to improve the delivery and provision of services for the transgender community. The 16-member board will include 8 civil society representatives, including representatives from the third gender community and will be chaired by the Minister for Social Justice and Empowerment.

"The new welfare board is a great effort to help in day-to-day issues faced by transgender people. We hope that issues of livelihood, employment, social security and the protection of human rights will be addressed by the board," said Aakriti Patel of the Lakshya Trust.

Part of the board’s work will be to work on the development of an agreed legal definition of who can be designated as transgender.

“UNAIDS looks forward to working with the new Transgender Welfare Board in Gujarat. I applaud the ministry and all partners for the work they have done in helping to create the board, which will greatly improve the lives of the transgender community,” said UNAIDS Country Director for India, Bilali Camara.

UNAIDS will continue to provide support to the board with the development of a policy road map and the roll-out of social protection programmes for transgender people. UNAIDS is also working with the private sector in Gujarat to provide skills training for around 3000 transgender people.

In India, HIV prevalence among transgender people is 3.1%, compared to the national HIV prevalence among all adults of just 0.2%.

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

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

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

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

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

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

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

Undetectable = untransmittable is the message of a new UNAIDS Explainer. With 20 years of evidence demonstrating that HIV treatment is highly effective in reducing the transmission of HIV, the evidence is now clear that people living with HIV with an undetectable viral load cannot transmit HIV sexually.

Three large studies of sexual HIV transmission among thousands of couples, one partner of which was living with HIV and the other was not, were undertaken between 2007 and 2016. In those studies, there was not a single case of sexual transmission of HIV from a virally suppressed person living with HIV to their HIV-negative partner. The Explainer cautions, however, that a person can only know whether he or she is virally suppressed by taking a viral load test.

For many people living with HIV, the news that they can no longer transmit HIV sexually is life-changing. In addition to being able to choose to have sex without a condom, many people living with HIV who are virally suppressed feel liberated from the stigma associated with living with the virus. The awareness that they can no longer transmit HIV sexually can provide people living with HIV with a strong sense of being agents of prevention in their approach to new or existing relationships.

The new UNAIDS Explainer series aims to inform readers about key or emerging issues in the AIDS response. With recommendations for programme managers and advice for national responses, they are short but informative snapshots of the current knowledge about an area of the AIDS response.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UNAIDS

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

GENEVA/ISLAMABAD, 10 May 2018— UNAIDS congratulates the Parliament of the Islamic Republic of Pakistan on the passage of the Transgender Persons (Protection of Rights) Bill, 2018. The bill is transformational for transgender people who, in the past, either had to live with formal identification papers which did not accurately reflect their gender  or go without identity papers. The change in the law will enable transgender people to apply for a driver’s license and passport. They will also be able to apply to the National Database and Registration Authority to have their records changed to reflect their gender.  

Transgender people frequently face discrimination when they are required to use identity documents, such as driver’s license and passport, that do not match their gender identity or gender expression. Transgender people have been denied access to services or support, for example in health care settings, because they do not have official identity documents that recognize their gender identity or gender expression.

The new bill is very important for transgender people because it gives them legal protection. The groundbreaking changes provide access to rights previously denied to transgender people. They will now be entitled to inherit property, have the right to vote in all national, provincial and local government elections and to run for public office. All without fear of discrimination. The bill also allows for measures that are designed to meet the specific needs of transgender people. This includes the establishment of protection centres and safe houses and special vocational training programmes.   

“This bill provides an enabling environment for transgender people to access health care, social justice, equality and dignity in society while enjoying productive lives,” said Michel Sidibé, Executive Director of UNAIDS. “This is a positive move that will support Pakistan in achieving the end of AIDS as a public health threat by 2030.”  

Transgender people have a HIV prevalence rate 7.1 percent in Pakistan.  Fifty-two percent of transgender people report facing stigma and discrimination. The figure increases to 55.8 percent for transgender sex workers.

The bill prohibits harassment of transgender people in the home and in public. It is now against the law for employers, educational institutions, health services, traders, public transport and property owners or sellers to discriminate transgender people in anyway.

“The passing of this bill is a dream come true for many transgender people,” said Bubbly Malik, Executive Director of the Wajood Society. “We have come a long way and fought hard to get this. We will not stop now. This is the first step towards empowerment.  We will be there to see its effective implementation. The bill addresses health, employment and educational services which makes me happy.” 

In June 2016, Member States of the United Nations committed in the Political Declaration on Ending AIDS to “promoting laws and policies that ensure the enjoyment of all human rights and fundamental freedoms for children, adolescents and young people, particularly those living with, at risk of and affected by HIV, so as to eliminate the stigma and discrimination that they face.”

UNAIDS urges all governments to fully implement the human rights of people living and affected by HIV, including by providing strong legal protections and implementing programmes to end discrimination and advance access to justice . 

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

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

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

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

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

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

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Voices of activists for transgender rights

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

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

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

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

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