UNFPA The United Nations Population Fund

Government leaders reaffirm their commitment to accelerate HIV prevention efforts to reduce new HIV infections

10 November 2023

With just two years left to attain the 2025 HIV prevention target of fewer than 370 000 new HIV infections annually, the world is not on track. In 2022, 1.3 million people became infected with HIV – the urgency to accelerate progress cannot be overemphasized. The Global HIV Prevention Coalition co-convened by UNAIDS and UNFPA ensures a strengthened and sustained political commitment for primary prevention across key policy makers and programme implementers. It includes countries such as Botswana, Cameroon, Eswatini, Lesotho, Malawi, Rwanda South Africa, and Zimbabwe – which have reduced new HIV infections by more than 70% since 2010.  

However, there were disparities across populations and regions. No significant declines were seen among key populations (sex workers, men who have sex with men and people who inject drugs).

Globally, 4,000 new HIV infections occurred among adolescent girls and young women aged 15-24 years, every week – 3,000 of these occurred in Sub-Saharan Africa. Approaches and investments for HIV prevention are currently insufficient to meet global targets.

The directors of National AIDS Coordinating Agencies, Ministry of Health HIV leads from the Global HIV Prevention Coalition focus countries and development partners were convened by the HIV Prevention Leadership Forum, with support from UNAIDS and UNFPA, to reinforce their commitment to stopping new HIV infections. This is part of efforts to ensure effective implementation of expanded HIV programmes with a focus on key and priority populations .

During the meeting, each country identified commitments  that they will drive and will be held accountable for in 2024 as well as technical level actions necessary for programme optimization.  Donors and global technical partners identified opportunities for technical and financial resources available at country level to supplement national resources to drive the action plans. 

The first lady of Namibia and UNAIDS Special Advocate for Adolescent Girls, and Young Women, Her Excellency Monica Geingos urged the country leaders in the HIV response to adapt solutions tailored to their national needs culturally, socio-economically, and politically. Whilst strengthening global collaboration, leaders should strengthen partnerships across sectors within the countries. Success in HIV prevention is possible, however, not only does it require leadership at government level, but also communities must lead.

The Global Prevention Coalition co-chair and former Minister of Health of Botswana, Prof. Sheila Tlou encouraged government leaders to follow the science, make data-driven decisions and ensure community leadership and participation in HIV prevention programming. This will secure gains made, bridge disparities and expedite progress needed for success in HIV prevention.

Dr Ruth Laibon Masha, Co-Chair of the HIV Multi-Sector Leadership Forum and Director, National Syndemic Disease Control Council, underscored the need to secure gains made by extraordinary leaders from multiple sectors who have played a crucial role in advancing the HIV movement and achieving significant progress. “By continuing to lead from the front we can work together towards the goal of delivering a future free of new HIV infections and AIDS-related deaths. It’s time to recommit and finish the race against time “, she added.

Vice Minister, National Disease Control and Prevention Administration (NDCPA) affirmed China’s commitment towards strengthened multisectoral leadership and promotion of a nationally led HIV prevention and health agenda.

Quotes

“In this moment, community leadership counts, country leadership counts in making the commitments of this meeting and our Action Plans a reality”

Winnie Byanyima UNAIDS Executive Director

“While scientists, policymakers and funders will continue to drive and be essential to this work, it’s community leadership and mobilization that will end this epidemic. But no matter how good the science or community leadership, HIV will not end if we don’t have significant policy change to reverse criminalization and lessen stigmatization of affected populations. If we can’t protect human rights, then we can’t end HIV. This is never just about the virus—it’s about people, and the people must lead.”

Mitchell Warren GPC Co-Chair and Executive Director AVAC

Position paper

The United Nations welcomes the Supreme Court’s decision to decriminalize same sex relations in Mauritius

04 October 2023

This will speed up progress to end the AIDS pandemic and save lives.

GENEVA, 4 October 2023—The United Nations in Mauritius—which includes UNAIDS, UNFPA, OHCHR, UNDP and WHO—welcome today’s ruling by the Supreme Court of Mauritius that a discriminatory law criminalizing consensual same sex relations is unconstitutional and will be immediately struck from the legal code. Previously, under Section 250 of the Mauritian Criminal Code (which dated back to 1898) anyone convicted could have faced up to five years in prison.

“The Supreme Court today overturned an obsolete colonial law and demonstrated its commitment to non-discrimination and leaving no-one behind,” said Lisa Singh, United Nations Resident Coordinator in Mauritius. “The UN in Mauritius and internationally welcomes the decision of Mauritius to join the growing list of African countries protecting the human rights of everyone, including LGBTQI+ people.”

The ruling noted that “Section 250 was not introduced in Mauritius to reflect any indigenous Mauritian values but was inherited as part of our colonial history from Britain. Its enactment was not the expression of domestic democratic will, but was a course imposed on Mauritius and other colonies by British rule.” It also noted that a growing number of countries have decriminalized consensual same sex sexual relations, including the United Kingdom which overturned its law in 1967. 

“Mauritius' decision to decriminalize homosexuality is an important step forward for public health and a step towards equal rights, respect and dignity for the LGBTQI community,” said Anne Githuku-Shongwe, Director of UNAIDS’ Regional Support Team for Eastern and Southern Africa. “UNAIDS applauds Mauritius for today’s decision which will mean that men who have sex with men will have much easier access to the health and social services they need without fear of arrest or criminalization. Work will need to continue to break down the barriers of stigma and discrimination towards the LGBTQI community, but today’s ruling is a positive step in the right direction. It will save lives.”

Mauritius becomes the latest in a growing list of countries to declare that laws which have criminalized LGBTQI people are unconstitutional. However, UNAIDS estimates that 66 countries still have laws which criminalize consensual same sex relations. In addition to contravening the human rights of LGBTQI people, these laws impede access to health and social services, including HIV services. Such laws fuel stigma and discrimination against LGBTQI people and put them under constant fear of being punished or detained.

The case was brought forward by Abdool Ridwan Firaas Ah Seek, President of Arc-en-Ciel, the largest and longest-standing organisation in Mauritius championing the human rights of LGBTQI people, and was supported by partners including the Human Dignity Trust.

Civil society organizations, especially community-led organizations, are at the forefront of a global wave of progress that advances access to health for all. UNAIDS urges all countries to decriminalise same sex sexual relations. Decriminalization saves and changes lives.

Maneesh Gobin, Attorney General and Minister of Foreign Affairs and Regional Integration in Mauritius said, “In keeping with its internationally acclaimed respect for the rule of law, Mauritius will indeed report to United Nations Member States at the next cycle of the Universal Periodic Review.” The Universal Periodic Review is a unique mechanism of the Human Rights Council that calls for each UN Member State to undergo a peer review of its human rights records every 4.5 years.

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.

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Judgment

Supporting women and girls affected by gang violence in Haiti

29 June 2023

At Refuge des Femmes d'Haiti, a small women's community-based organization in the commune of Croix-des-Bouquets, Port-au-Prince, Martha Norcimè, a 34-year-old pregnant woman from the nearby commune of Delmas, completes her training in sewing and macramé—a form of textile produced using knotting techniques.

She is part of a group of vulnerable women deeply affected by the gang violence and warfare that has impacted several areas of the capital since early 2022. Most of her peers came from Croix-de-Bouquets. All of them—including women with HIV—living in challenging circumstances, who have seen their livelihood completely disappear throughout these past two years as violence rose.

"I will soon give birth to my first child. I used to sell food and cleaning products that I was buying on the Haitian-Dominican border between Jimani and Malpasse, and I was then selling in markets in the city and in my neighborhood,” recalls Martha. “But I could no longer continue, given the blockade of the North city entry controlled by armed gangs. So many women traders are raped, kidnapped, or robbed by them."

In the fall of 2022, a joint UN project coordinated by the UNAIDS Country Office in Haiti, with participation from UNFPA, UNDP, and UNICEF, has been launched in partnership with Refuge des Femmes d’Haiti and with the support of FOSREF, a Haitian non-governmental organization. The goal is to support women and girls living this daily reality by empowering and giving them the tools to remain healthy and overcome the feminization of HIV in Haiti.

Haiti’s significant gains made over the past decade in controlling its HIV epidemic are now under threat, particularly in the capital, where a third of the 11.8 million Haitians reside. The brunt of an ongoing socio-economic and security crisis triggered by the assassination of former President Jovenel Moïse in July 2021 is borne by adolescent girls, young and adult women.

The feminization of HIV has long been a feature of the Haiti pandemic with HIV prevalence for females at 2.3%, compared to 1.6% among men. Still, the continuing multi-faced and profound crisis, fueled by such levels of violence, is exposing thousands of women to HIV infection.

In October 2022, a joint human rights report published by the United Nations Integrated Office in Haiti (BINUH) and the Office of the United Nations High Commissioner for Human Rights (OHCHR), entitled Sexual violence in Port-au-Prince: a weapon used by gangs to instill fear denounced collective rape by gangs in the capital as a weapon of war. In May 2023, research conducted by the Global Initiative Against Transnational Organized Crime in Cité-Soleil, another impoverished commune in Port-au-Prince deeply hit by gang activity, found that 80% of the women and girls who participated in the study had been victims of one or more forms of gender-based violence by one or multiple perpetrators.

"We work closely with UN Agencies to support women, victims of violence, make them financially independent and thus reduce the feminization of HIV, sexual and gender-based violence and maternal and neonatal mortality," says Novia Augustin, President of Ref-Haiti, and of the Federation of Women Organizations for the Equality and Human Rights (FEDOFEDH). "Difficulties are several, but the biggest is insecurity and the lack of financial resources. My motivation comes from our results: When I look at the satisfaction on the faces of the women we have accompanied, the recognition they show, I tell myself that it is worth it, despite all the difficulties encountered and the risks incurred."

Martha recalls how Novia opened the door to her for intensive training every day from 8 a.m. to 4 p.m. At the time, she was already pregnant. And despite the pregnancy-related fatigue, she did not miss a single day of class. “I can sew skirts, bonnets, blouses and even sandals!" she says proudly. "But I can't do anything now because of this crisis. Sometimes I even miss my pre-natal appointments with the doctor just because I am afraid to go out."

Besides training, Ref-Haiti also included discussions  on HIV risk and prevention, gender-based violence, sexual and reproductive health, family planning, and cholera. The awareness-raising activities targeted women beneficiaries and hundreds of young girls of other affected communes.

"We are working to support an integrated health response for women and girls so severely affected by gang violence and by socio-economic inequality”, says Christian Mouala, UNAIDS Country Director for Haiti. “We are proud of women-led local organizations such as Refuge des Femmes and their immeasurable efforts to support women to overcome the challenges they face."

All photos by UNDP Haiti

Virtual course on HIV, gender and human rights: empowering medical teachers in Guatemala

18 May 2023

The University of San Carlos de Guatemala (USAC) Faculty of Medical Sciences, in collaboration with UNAIDS, the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), launched an online course titled "Conceptos clave sobre VIH, Género y Derechos Humanos" (Key Concepts on HIV, Gender, and Human Rights). The four-module course is designed to provide teaching staff with detailed knowledge about key concepts related to HIV, its treatment and prevention, and the national and international legal framework guiding the response to HIV, as well as the gender and human rights dimensions of the epidemic.

With an estimated three new HIV infections each day in Guatemala and only 73% of the estimated 31,000 people living with HIV receiving antiretroviral treatment and persisting high level of stigma and discrimination towards people living with HIV, the course is a significant step towards addressing the country's HIV challenges. The course aims to provide teaching staff and students with the necessary resources to promote, protect, and fulfill the human rights of adults, adolescents, and children living with or at risk of acquiring HIV, in all their diversity.

The course consists of 140 hours of study, including 70 hours of theory and 70 hours of practice, and will be undertaken between May and August 2023. Course participants will join virtual classes and synchronous group workshops and will have to submit the required tasks according to a work schedule.

The course covers four modules: Module 1 - Update on HIV and AIDS; Module 2 - National and international legal framework for the response to HIV; Module 3 - Health sector Policy framework for HIV response; Module 4- Key concepts on gender and human Rights.

During the inauguration, Marie Engel, UNAIDS Country Director, expressed her hope that participants would enjoy taking the course as much as she and other partners had in developing it. She also emphasized that "the course will be enriched with participants' individual knowledge and experiences, their doubts and concerns. There is obviously a lot of knowledge and wisdom among course participants that the facilitators will strive to capture."

Dr. José María Gramajo, General Coordinator of the USAC Faculty of Medical Sciences' Area of Teachers and Postgraduate training, highlighted that "this refresher course will contribute to the professional development of faculty teachers, sharing with them the latest knowledge about innovations related to HIV prevention, detection, and care, and ensuring an in-depth understanding of cross-cutting issues relevant to HIV and other public health problems."

Teaching staff and students are catalysts with the power to change the national response to HIV. As stated by Dr. Mirna Herrarte, Coordinator of the national HIV, STI, and AIDS program, "I am glad to know that there are so many professionals who want to know more about HIV. In the country, HIV treatment schemes are constantly reviewed. As an anecdote, Guatemala had more than 200 antiretroviral schemes a year ago. Under my leadership, we have reduced those schemes by 75%."

Inequalities persist in the most basic health and HIV services, such as access to screening, treatment, and condoms. USAC's collaborative initiative is an important step towards ensuring that all sectors, including academia, are engaged in ending social, economic, and legal inequities. The University of San Carlos de Guatemala is the largest and oldest university in Guatemala, and the only national and public university in the Central American country. 

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United for ending cervical cancer, HIV and inequities for women and girls

17 November 2022

On this Day of Action, as we celebrate a two-year anniversary of the launch by the World Health Organization (WHO) of the Global Strategy to accelerate the elimination of cervical cancer as a public health problem, we are reminded that despite the availability of the knowledge, tools and technologies, cervical cancer still kills more than 342 000 women a year (in 2020) globally. Every two minutes one woman loses her life to cervical cancer - a disease that is preventable and curable.

The high burden of cervical cancer is driven by gender, social and economic inequalities and health disparities in access to HPV vaccines, screening, care and modern prevention and treatment technologies. Because of those inequalities, women and girls in low- and middle-income countries (LMICs) remain most affected. Nine out of 10 women who die of cervical cancer reside in LMICs.  Cervical cancer is the number one cause of cancer-related death among women living in sub-Saharan Africa.

The WHO Global Strategy to eliminate cervical cancer launched by the WHO on 17 November, 2020 was supported among many by the UN partner organizations including IAEA, UNAIDS, UNFPA , UNICEF, and Unitaid. The UN Joint Action Group comprised of these six UN entities each bringing in its unique mandates and resources, is committed to supporting countries efforts in meeting by 2030 the global cervical cancer elimination targets – whereby 90% of girls are fully vaccinated against HPV by age 15, 70% of women are screened with a high-performance test between the ages of 35 to 45, and 90% of women identified as having cervical disease receive treatment. If these targets are met, 300 000 deaths from cervical cancer could be averted by 2030, 14 million by 2070, and over 62 million by 2120.

“In countries with high rates of HIV, over 50% of cervical cancer cases are reported among women living with HIV.  Women living with HIV are six times more likely to develop cervical cancer and to develop it at younger age than those without HIV. It is unacceptable to claim that we have saved a woman’s life by enabling access to antiretroviral therapy for HIV alone, if we then leave her to die from cervical cancer. Our joint focus is on breaking down silos, building bridges between HIV and cervical cancer programmes, and bringing the two communities together because we know that linkages save lives.” – Winnie Byanyima, UNAIDS Executive Director 

“No woman should die of cervical cancer when we have a highly effective HPV vaccine and quality diagnostics. We need prevention and early detection - this is how we ensure that this disease is eliminated globally.  Governments and partners need to invest in accelerated access to resilient primary health care that delivers integrated care like routine immunization and sexual and reproductive health. And we must commit robust long-term human resources for adequate and accessible health care workers in communities and at facility level. Funding for health and health equity are prerequisites for cervical cancer elimination around the world.” - Dr Aboubacar Kampo, Director of Health Programme, UNICEF New York HQ

“We have the tools and technologies to end cervical cancer. Now it is a question of access. Unitaid stepped up the moment WHO issued its call to action, and within just a few years we have introduced effective technologies and developed screen-and-treat models that work in resource-limited settings. The last piece of the puzzle is scale up – we need to see a concerted global effort so every last woman can benefit from life-saving preventive care and we can end cervical cancer for generations to come.” – Dr Philippe Duneton, Executive Director, Unitaid

“Despite being one of the leading causes of death from cancer for women in low- and medium-income countries (LMICs), cervical cancer is also one of the most preventable and treatable cancer types. Nuclear applications such as diagnostic imaging can help detect the cancer at an early stage and increase survival rates. Radiotherapy can successfully treat women with cervical cancer, even in advanced cases. With our Rays of Hope initiative, we aim to increase access to these technologies worldwide and close the unacceptable gap of inequality.”- Najat Mokhtar, IAEA Deputy Director General and Head of the Department of Nuclear Sciences and Applications

“On this second anniversary of the Global Strategy for Cervical Cancer Elimination, the UN Joint Action Group (UNJAG)* celebrates the successes achieved. As the world population continues to grow, more girls and women will require life-saving vaccination, screening and treatment. We acknowledge the need for effective mobilization of resources and partners to achieve the 90-70-90 global elimination targets. Going forward we will continue to focus our attention and joint efforts on ensuring full prevention, high quality life-saving services and equity in access to modern technologies for women and girls across the world.” – Petra ten Hoope-Bender, UNJAG Chair, Technical Adviser Sexual and Reproductive Health and Rights, UNFPA.

* IAEA, UNAIDS, UNFPA, UNICEF, UNITAID and WHO 

Infographic: HIV and cervical cancer

Global strategy to accelerate the elimination of cervical cancer as a public health problem

UNAIDS Executive Director visits projects in Namibia that empower adolescent girls and young women

05 May 2021

Winnie Byanyima, the UNAIDS Executive Director, recently visited the Hakahana Clinic in Katutura, Windhoek, Namibia, where she saw the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) project in action, a project funded by the United States of America. The clinic is a government health facility and a DREAMS participating clinic that has provided health services to 10–24-year-old adolescent girls and young women since September 2020.

Together with the United States Ambassador, Lisa Johnson, and the Executive Director of the Namibian Ministry of Health and Social Services, Ben Nangombe, Ms Byanyima met with DREAMS girls and community care workers at the facility.

“I am very impressed by the confidence and optimism the young women express as a result of the support they receive through the DREAMS programme,” said Ms Johnson.

The DREAMS project seeks to reduce new HIV infections among adolescent girls and young women in Namibia and other countries in sub-Saharan Africa. In 2019, there were 1400 new HIV infections among adolescent girls and young women aged 15–24 years in Namibia—more than double the number of HIV infections among their male peers. It is therefore critical that the HIV response continues to gain momentum.

DREAMS uses a core package of evidence-informed, multisectoral interventions that are proven to reduce new HIV infections among adolescent girls and young women. This includes empowering them with social protection, safe spaces, education and economic skills and with access to family planning and sexual and reproductive health services.

“The knowledge I learnt from DREAMS has taught me about making the right decision. I feel empowered,” said Johanna Shinana, a DREAMS Ambassador.

DREAMS is implemented in five districts in three regions of Namibia and the Hakahana Clinic provides eight safe spaces for young women mostly between the ages of 19 and 24 years.

Ms Byanyima, together with Sheila Roseau, the Country Representative of the United Nations Population Fund (UNFPA), Aina Heita, the United Nations Educational, Scientific and Cultural Organization National Programme Officer for HIV/AIDS, and Thomas Ukola, the Deputy Director at the Directorate of Special Programmes within the Ministry of Health and Social Services, also visited the Namibia Planned Parenthood Association (NAPPA) clinic, which is also in Katutura.

NAPPA is a welfare organization established in 1996 to complement the Ministry of Health and Social Services to provide sexual and reproductive health services and information to young people aged 15‒24 years and lesbian, gay, bisexual, transgender and intersex people from the marginalized and underserved area around Katutura.

“I encourage young people to take advantage of the services that are offered for them and encourage others to take up these services,” said Ms Byanyima while she was at the NAPPA clinic.

Ms Byanyima was introduced to the Condomise Campaign at the clinic. The campaign, supported by UNFPA, is led by young people and provides young people with key messages on sexual and reproductive health and rights, HIV and skills on how to use condoms correctly.  

Klaivert Muandingi, the President of the African Youth and Adolescents Network in Namibia, called on young people to be free in accessing condoms and other commodities. “Condomize, do not compromise. Love smart and play safe,” he said.

UNAIDS welcomes the United States of America’s decision to support women’s health, safety and rights

03 February 2021

GENEVA, 3 February 2021—UNAIDS warmly welcomes the announcement by the President of the United States of America, Joe Biden, that he has rescinded the Protecting Life in Global Health Assistance Policy (PLGHA, previously known as the Mexico City Policy). The policy required foreign nongovernmental organizations to certify that they would not perform or actively promote abortion using funds from any source (including non-United States funds) as a condition of receiving United States Government funding.

“Rescinding the PLGHA is a strong demonstration of the new United States Administration’s commitment to supporting women to claim their rights and to access sexual and reproductive health and rights information and services,” said Winnie Byanyima, UNAIDS Executive Director. “We look forward to working closely with the new United States Administration to ensure that all women and girls can exercise their human rights and get the sexual and reproductive health information and services they want and need.”

The former United States Administration took previous restrictions established by the Mexico City Policy to a new level by applying the policy to global health assistance provided by all executive departments and agencies. This severely limited access to critical sexual and reproductive health-care services and stifled local advocacy efforts, in turn undermining human rights in general and sexual and reproductive health and rights in particular worldwide.

UNAIDS welcomes the White House’s call to waive conditions related to the PLGHA in any current grants with immediate effect, to notify current grantees, as soon as possible, that these conditions have been waived and to cease imposing these conditions in any future assistance awards.

“Women and girls having full access to their sexual and reproductive health and rights is closely connected to their overall safety, health and well-being. We hope that this will inform the passage of the Global Health, Empowerment and Rights Act—legislation designed to permanently repeal the PLGHA,” added Ms Byanyima.

UNAIDS also warmly welcomes the announcement by the President that the United States will restore funding to the United Nations Population Fund (UNFPA), a key UNAIDS cosponsoring organization working around the world to provide reproductive health care for women and young people. UNAIDS appreciates the commitment by the United States Secretary of State, Anthony Blinken, to appropriate US$ 32.5 million in support for UNFPA this year.

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.

First-ever Jamaica transgender strategy looks beyond health

08 January 2021

Imagine using a health-care system that has no concept of you as a person, or of your unique needs. Nurses might not ask important questions. Doctors might overlook the solutions you really require. You might feel unwelcome.

That has always been the reality for transgender people in Jamaica. A new strategy seeks to change this.

With support from UNAIDS and the United Nations Population Fund (UNFPA), TransWave Jamaica has launched the Trans and Gender Non-Conforming National Health Strategy, the first of its kind in the English-speaking Caribbean. The five-year plan is a rights-based road map for how the health and well-being of transgender people can be advanced. It moves beyond recommendations for the health-care system to the structural and societal changes necessary to achieve equitable access to services and opportunities for the transgender community.

“Too many transgender people stay home and suffer or change who they are to access public health-care spaces,” explained TransWave Associate Director of Policy and Advocacy, Renae Green. “We need improvement to basic services, including psychosocial support. And we need transgender people to be able to access public health services as their authentic selves.”

Through the Unified Budget, Results and Accountability Framework Country Envelope for Jamaica, UNAIDS collaborated with UNFPA to support a robust year-long process of research, community engagement and strategy development, including a monitoring and evaluation framework. The strategy development process was informed by a multisectorial steering committee composed of civil society organizations, international cooperation partners and government authorities.

HIV is a major priority for the Jamaica transgender community. Around 50% of transgender women participants in two recent studies were living with HIV. But there are other pressing concerns. Two surveys found that around half of transgender respondents were unemployed. One third skip meals. One in ten sells sex to survive. Research conducted in 2020 by TransWave found that half of respondents had been physically assaulted in the past year, with 20% reporting sexual assault. More than 80% had been verbally abused.

“The needs go beyond HIV and health care. Other factors affect people’s ability to be safe, to be adherent or to remain HIV-negative. We should take into account the whole person, not just a part,” said Denise Chevannes-Vogel, HIV and AIDS Officer for the UNFPA Sub-Regional Office for the Caribbean.

“We value the fact that we were able to bring together the community to have a discussion about their needs beyond HIV,” said Ms Green.

The TransWave team led the community needs assessment. Some community requests, such as hormone replacement therapy or gender assignment surgery, are unique. But others are common to all people. They want access to health care and housing, education and employment. And they want to see themselves represented in the civil society spaces where many access care and support.

“We will not reach any AIDS-related targets if we do not prioritize transgender health as a whole. People are dying because of violence, living on the streets, lack of jobs and lack of opportunities. Even the HIV prevention knowledge that most people would acquire through formal education settings is not available to transgender people when they are bullied and forced to drop out. So this process was about reflecting on the impact indicators. What would it take for them to live longer, better lives?” said Ruben Pages, UNAIDS Jamaica’s Community Mobilization Adviser.

But what chance does this comprehensive and forward-thinking strategy have of succeeding in a country famed for its social conservatism? The partners are optimistic. On one hand, the approach calls for longer-term goals, including law reform around issues such as gender identity recognition and decriminalizing sex between same-sex partners. But the strategy is also a practical guide for transgender inclusion in systems and frameworks that are already in place. With targeted action there can be quick wins.

Manoela Manova, the UNAIDS Country Director for Jamaica, said the strategy will help the country accelerate progress to end AIDS.

“Going forward, there will be renewed focus on ensuring that excellent prevention, testing and treatment outcomes are achieved across all communities, especially key and vulnerable populations,” Ms Manova said. “This is an opportunity to make good on our commitment to leave no one behind.”

Vulnerability mapping to help sex workers in Bangladesh and Myanmar

12 January 2021

Warm smiles greet Lily as she approaches her first stop of the day—one of the 11 brothels scattered across the country that Lily, the President of the Bangladesh Sex Worker Network, visits quarterly to check in with the women and see what assistance they need. Though her visits have been limited in recent months due to movement restrictions to curb the spread of COVID-19, Lily knows well enough that those smiles are a brave front for the troubling times that her peers have experienced.

“I see the sex workers as my sisters—I feel their happiness and pain and I try my best to solve any issue they face,” Lily said. During the COVID-19 pandemic, Lily and the 29 community-based organizations serving sex workers in the country have struggled to respond to the increased calls for support. In March, government countrywide movement restrictions meant that sex workers could no longer have clients, leaving most of them without a source of income and unable to provide for themselves or their families.

“Sex workers’ children faced challenges during the COVID situation because their mothers couldn’t arrange to provide them with food. When we [the Bangladesh Sex Worker Network] learned about this issue, we reached out to many organizations and the private sector for assistance,” explained Lily. Responding to the call to action, the network mobilized funds to support 2100 sex workers across the country. Community-led support in Bangladesh has also garnered global recognition. Most recently, a former sex worker, Rina Akter, was recognized by the BBC for her efforts, and those of her team of helpers, to serve 400 meals a week to sex workers in need.

“While a few sex workers had savings, most could not provide for themselves,” said Rahat Ara Nur, Technical Officer for the United Nations Population Fund in Bangladesh. “Through the United Nations Population Fund, we provided sex workers with COVID-19 prevention commodities, such as masks and handwashing materials, and we also developed public service announcements which were aired on community radio to ensure we raised awareness about COVID-19 precautionary measures among the community."

With the closure of entertainment venues, a classification that includes brothels, some sex workers have resorted to street-based sex work, which increases the risk of violence, condom-less sex and no pay or low pay.

Sex workers are also experiencing increasing vulnerability to gender-based violence. Without a source of income, conflicts about finances arise, and sex worker networks report that their members have experienced abuse at the hands of their spouses, partners and brothel owners.

Some sex workers report that they have become homeless because the brothels have been closed, or in some cases the residents were evicted because rent could not be paid. Many sex workers cite stigma and discrimination as a barrier for other forms of employment. Health outreach services that once provided brothels with sexual and reproductive health services, including HIV testing and prevention, have been suspended due to travel restrictions.

Bangladesh, October 2019. Credit: UNFPA Bangladesh/Naymuzzaman Prince

These developments are not unique to Bangladesh, however. Throughout the Asia–Pacific region, national and regional networks of sex workers are reporting that the COVID-19 outbreak has exacerbated the inequalities faced by sex workers, and many are either not eligible or excluded from social protection services.

“There is no government support specifically targeting sex workers. There is support for the general public, particularly those that are low income, but sex workers are not eligible for these social protections because they work in the informal economy,” said Hnin Hnin Yu, the Chairperson of Sex Workers in Myanmar (SWiM), a nongovernmental advocacy group for sex workers’ rights.

Additionally, many sex workers are migrants (international or internal) and lack the necessary papers or registration with local authorities to access the government’s support. Eligibility criteria for social support, such as documentation of income, proof of residence, national identification, contribution to existing social protection schemes and filing taxes, are all reasons given for excluding sex workers from government support. An online consultation of female sex workers from across the country, organized by UNAIDS and SWiM, revealed that apart from limited funds from humanitarian actors, none of the sex workers had received social support.

“When Global Fund to Fight AIDS, Tuberculosis and Malaria assistance for COVID-19 was allocated, funds for people living with HIV included the most vulnerable sex workers to receive food provisions,” said Mr Myo, Community Support Adviser for UNAIDS in Myanmar. “However, we recognized that this was an ad hoc solution that reached a small portion of the vulnerable population and there is a need for more sustainable support, such as social protection, for sex workers.”

It has become clear that focused support for sex workers must be prioritized. Recognizing that more needs to be known about the gaps in social protection for sex workers, UNAIDS in collaboration with the United Nations Population Fund and the World Food Programme are exploring the possibility of conducting a needs assessment and vulnerability mapping initiative of female sex workers during the COVID-19 pandemic. Data from the community-led mapping initiative will be used to inform programming for livelihood support, food security, improved access to antiretroviral therapy, sexual and reproductive health services and gender-based violence prevention and response services.

Commenting on the prospects of the United Nations agencies joining forces to coordinate a vulnerability mapping exercise with sex worker networks, Ms Nur expressed excitement about how this advocacy tool will not only help to identify the challenges that sex workers face during the COVID-19 outbreak, but it would also catalyse further work to mobilize resources for programmes and address injustices that pre-date the COVID-19 pandemic.

Hnin Hnin Yu cites discrimination and harassment from police as a long-standing challenge facing sex workers’ rights. During the COVID-19 outbreak, communities have reported increased police surveillance, harassment, including physical violence, and demands to pay fees to conduct sex work. In response, SWiM provides community-led, peer-to-peer legal aid for sex workers who have been arrested, educating them about their rights.

For those working closely with community-led organizations it has been inspiring to see that although sex worker networks and the sex workers they represent have seen challenges all around them, they have done their best to support their peers. There is hope that the data gathered in a vulnerability mapping exercise would not only generate the evidence needed to advocate for expanding the reach of social protection and humanitarian response services to be inclusive of sex workers, but could also inform the scale-up of community-led programming. 

Infographic: Sex workers have rights

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