Young people

Ending the AIDS epidemic among children, adolescents and young women requires ambitious targets and a Super-Fast-Track approach. Building on the successes of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners* launched Start Free Stay Free AIDS Free in 2016 to provide a framework for the urgent work ahead.

Start Free Stay Free AIDS Free prioritizes action in 23 countries** that account for 87% of new HIV infections among children aged 0–14 years and approximately 87% of all children and adolescents living with HIV globally. In 2016, 2.1 million children were estimated to be living with HIV.

In its first progress report, Start Free Stay Free AIDS Free reflects on the achievements made during the first year of implementation and highlights areas where urgent action is needed.

“The world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy, but we need to do more to ensure that all children living with HIV have access to treatment immediately,” said Michel Sidibé, Executive Director of UNAIDS.

The report shows that globally in 2016, there were 160 000 new HIV infections among children and that 140 000 occurred in the 23 priority countries. Although there was an overall decline in new HIV infections, the decline was at a much slower rate than in previous years.

The report highlights concerns around new HIV infections among young women and girls. In 2016, around 200 000 adolescents between the ages of 15 and 19 years were newly infected with HIV in the 23 priority countries, 72% of whom were young women.

Most—more than 70%—of all new HIV infections among young people are in sub-Saharan Africa, which also has the fastest growing youth population in the world.

“A high number of new HIV infections among adolescents and a fast-growing population could make for an HIV explosion among young women in Africa,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “The United States Presidents Emergency Plan for AIDS Relief is driving harder and smarter to prevent HIV infections and ultimately help end AIDS among children, adolescents and young women. Every person deserves the chance to survive, thrive and pursue their dreams.”

Gains seen in access to treatment

The report shows that while important gains have been made in access to antiretroviral therapy for pregnant women living with HIV, much more needs to be done to reach children.

In 2016, around 78% of pregnant women living with HIV had access to antiretroviral therapy in the 23 priority countries.

Start Free targets

Reduce new HIV infections among children to 40 000 by 2018.

Reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018.

Stay Free targets

Reduce the number of new HIV infections among adolescents and young women to less than 100 000 by 2020.

Provide voluntary medical male circumcision for HIV prevention to 25 million additional men by 2020 globally, with a focus on young men aged 10–29 years.

AIDS Free targets

Ensure that 1.6 million children (0–14 years) and 1.2 million adolescents (15–19 years) living with HIV have access to antiretroviral therapy by 2018.

The increase in the roll-out and uptake of antiretroviral therapy during pregnancy and throughout breastfeeding is estimated to have averted around 270 000 new HIV infections among children in 2016 alone.

The numbers of children on treatment has also increased, but not on a big enough scale. In 2010, only 17% of children aged 0–14 years had access to treatment. By 2016, that had risen to around 43%, with around 920 000 children accessing antiretroviral therapy. Although this is a marked improvement, access to treatment for children still falls far behind access for adults. In 2016, around 54% of adults living with HIV had access to treatment.

The report cites multiple reasons for the slow growth of access to treatment for children, including poor testing rates. Only nine of the 23 priority countries managed to test and diagnose 50% or more of children who were exposed to HIV in 2016. There are particularly low rates of early infant diagnosis in the first two months of life, when it is most important to test, as HIV-related mortality is at its highest. Without access to testing and treatment, half of all children living with HIV will die before their second birthday.

Ways forward

The report offers a set of important actions countries can take to eliminate new HIV infections among children, to test and diagnose children and young people who may have been exposed to HIV and to ensure that children and young people access HIV prevention, quality medicines and age-appropriate sexual and reproductive education and care and support throughout their lives, free from stigma and discrimination.

Other important actions include accelerating new medicines and diagnostics, promoting community engagement and services, voluntary medical male circumcision, access to information on sexual and reproductive health and access to pre-exposure prophylaxis for young people at a higher risk of HIV.

“The future for children and adolescents depends on actions we take collectively today,” said Mr Sidibé.

The latest estimates, for the end of 2017, will be released in July 2018 and will provide further insight into the progress of Start Free Stay Free AIDS Free.

* United Nations Children’s Fund, World Health Organization and the Elizabeth Glaser Pediatric AIDS Foundation.

**Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

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.

For the Transgender Day of Visibility, UNAIDS talked to transgender activists about the challenges they face and the importance of improving the visibility of transgender people.

Erika Castellanos is a transgender woman from Belize who recently moved to the Netherlands to work at GATE (Global Action for Trans Equality) as the Director of Programmes. She has been engaged in transgender and HIV advocacy at the local, regional and international levels.

What are the challenges that transgender people face?

Transgender people are subjected to stigma, discrimination, hate and violence—the number of transgender deaths because of hate crimes is alarming. In many parts of the world, being transgender is criminalized, which makes transgender people invisible in those places and forces them underground.

Many people do not understand what transgender people are, which translates into fear, the cause of stigma and discrimination. From their childhood, transgender people frequently experience rejection by their families, friends and society, finding themselves ostracized.

Why do you think it is important to give visibility to transgender people?

Visibility is power. Only when given visibility can we raise our voices and advocate for the enjoyment of our human rights. Visibility gives us presence, visibility gives us a voice. Ultimately, visibility gives us hope for a better life. Transgender people are an integral part of society who can no longer be ignored.

What do you think of the representation of transgender people by the media?

Almost all media coverage of transgender people is negative, demeaning or focused on the high murder rates and violence that our communities experience. While it is necessary to highlight the violence, negative and demeaning media coverage that dehumanizes transgender people only serves to perpetuate that violence. By portraying transgender people as objects of ridicule, media coverage places our community in further danger of social isolation, rejection from friends and family and violence.

Rena Janamnuaysook is a Thai transgender advocate at the Thai Red Cross AIDS Research Centre. She has extensive local, national and international experience working with HIV organizations.

What are the challenges that transgender people face in your country?

Thai transgender people face multiple challenges. Our country has no gender recognition law. Stigma and discrimination remains a barrier and leads to inequality. A survey conducted in 2015 by the Thai Transgender Alliance and Transgender Europe reported that 50% of transgender people who participated in the survey had a negative experience with health-care providers. In addition, transgender people experienced physical violence and harassment from families and in school and the workplace.

Why do you think it is important to give visibility to transgender people?

It is important to give visibility to transgender people as transgender people are less visible in all aspects of life—family, education, employment, health and the law. The International Day of Transgender Visibility raises public awareness of the needs of transgender people.

How easy is for transgender people in your country to get tested for HIV and get treatment?

A survey conducted by the Thai Ministry of Public Health in 2014 showed that 15% of health-care workers believed that HIV-positive transgender women should be ashamed of their gender identity and HIV status. This resulted in stigma and discrimination in public health facilities and prevented transgender people accessing health-care services, including HIV testing, treatment and support.

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The Transgender House: a community centre for transgender people in Buenos Aires

Kirit Solanki is an Indian politician who represents the Ahmedabad West constituency of Gujarat.

Can you tell us about your work with transgender people in India?

I trained as a doctor and became a surgeon. A patient came in and said that she had difficulty going to the bathroom. I realized that she was a transgender person and her sex change operation had not been properly done, effectively blocking her urethra. After a successful insertion of a catheter, word got around that I had saved the woman’s life. I suddenly had queues of transgender women come to my clinic with similar conditions.

What did you observe regarding treatment and care for transgender people?

I saw that so many transgender people needed various operations, but I found out that many of them were avoiding clinics and hospitals. When I finally got them to the hospital, they settled in the female ward. Within a day, the other patients complained, so the hospital sent them to the men’s ward. They fared no better there. That’s when it really dawned on me how pervasive discrimination against transgender people is.

What are you and other members of parliament trying to do?

It took 10 years for the Indian parliament to pass the HIV/AIDS bill, which makes life-saving treatment a legal right and criminalizes anyone who discriminates against someone based on their HIV status. We also have reintroduced a transgender persons bill to ensure zero discrimination, legal recognition and access to social services for India’s transgender community. It’s time for people to change their attitude and respect transgender people

The H6 combines the strengths of six international organizations to help countries to realize the United Nations Secretary-General’s Every Woman Every Child strategy. The partnership mobilizes political commitment and resources to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being.

High-level representatives of the six organizations met in New York, United States of America, to shape a shared vision for the H6. During the meeting, which took place on 21 March, health leaders committed to jointly deliver more and faster results in countries.

The Chair of the H6, Michel Sidibé, shared his vision for the partnership, including how it can evolve to meet the demands of the Sustainable Development Goals, including in humanitarian settings, and be a leading platform to advance United Nations reform.

“As a transformative platform, I see the H6 as an outstanding opportunity to rapidly bring United Nations reform to life and deliver results for every woman, child and adolescent on the ground,” said Michel Sidibé, Executive Director of UNAIDS.

The participants were united in their ambition to make the H6 a one-stop shop for countries for strategic policy advice, technical assistance and strategic information. Adolescent health, particularly for 10–18-year-olds, was discussed as a key focus area.

“I see an effective H6 partnership as an important way to drive health impact at the country level for all children, including by better addressing gaps in services for the age group from 10 to18 years old, and by planting the seeds of development in humanitarian contexts,” said Henrietta Fore, the Executive Director of the United Nations Children’s Fund.

The participants also committed to ensure policy-making in which communities have a voice and decided to build innovative partnerships with stakeholders beyond the United Nations.

Enhanced transparency and accountability of the H6 and reducing fragmentation and duplication in the United Nations system, as well as between the United Nations and the World Bank, will be key to success, as will a strong focus on joint reporting of results. The H6 will also work in close collaboration with the Global Financing Facility and the Partnership for Maternal, Newborn & Child Health.

“The United Nations Population Fund is strongly committed to the H6 partnership, which has proven that working in close collaboration and bringing different expertise and experience to the table is not only effective in enabling countries to deliver quality care for the women and girls left furthest behind, but also ensures strong country ownership,” said Natalia Kanem, the Executive Director of the United Nations Population Fund.

The H6 principals will now develop a results framework and reconvene in May to review and endorse it. They are aiming to adopt a road map to roll out new ways of working by mid-year.

On International Women’s Day, which is celebrated on 8 March every year, Yosweri Museveni, President of Uganda, affirmed his commitment to empower women in the work place and in the domestic sphere. At an International Women’s Day celebration in Mityana District, in the Central Region of Uganda, President Museveni outlined the action taken by government to promote women in the civil service, including the army, police and in Parliament. Government is also currently developing legislation to promote the rights of women in the home.

During the event the President, in the presence of UNAIDS Executive Director, Michel Sidibé, launched the Presidential Fast-Track Situation Room, a data visualisation platform which draws from multiple sources to provide real-time data for monitoring the implementation of the Presidential Fast-Track Initiative to End AIDS in Uganda by 2030. The initiative is a multi-sectoral effort to consolidate progress on key areas of HIV prevention revitalize HIV prevention, testing and treatment.

In a special ceremony, the President awarded Mr Sidibé the Most Excellent Order of the Pearl of Africa, the highest civilian award of the Ugandan Honours System, in recognition of Mr Sidibé’s contribution to the global AIDS response and his continued support to the Government of Uganda and its partners.

A new index to measure levels of homophobia that can show the impact that homophobia has on countries has been developed.

Homophobia—defined here as any negative attitude, belief or action towards people of differing sexual orientation or gender identity—has long been known to affect public health. Gay men and other men who have sex with men who face stigma are more likely to engage in sexual risk behaviours, are less likely to adhere to antiretroviral therapy and have lower HIV testing rates. Knowledge of levels of homophobia, especially in low- and middle-income countries, is scant, however.

The new index, published in the European Journal of Public Health, combines both data on institutional homophobia, such as laws, and social homophobia—relations between people and groups of people. Data for the index were taken from a wide range of sources, including from the United Nations, the International Monetary Fund and the International Lesbian, Gay, Bisexual, Trans and Intersex Association. More than 460 000 people were asked questions on their reactions to homosexuality through regionwide surveys that were also used as sources for the index.

The Homophobic Climate Index gives estimates for 158 countries. Western Europe was found to be the most inclusive region, followed by Latin America. Africa and the Middle East were the regions with the most homophobic countries, with the exceptions of South Africa and Cabo Verde, which were among the top 10 most inclusive low- and middle-income countries. Among low- and middle-income countries, Colombia was the most inclusive, and Sweden was the most inclusive of all countries.

From comparing the results of the index with other data, the researchers found that countries with higher levels of homophobia were the same countries that face higher levels of gender inequality, human rights abuses, low health expenditures and low life satisfaction. Increases in a country’s Homophobic Climate Index were found to be associated with a loss of male life expectancy and a lower economic output.

The index therefore shows the damaging effects that homophobia has on the lives and well-being of everyone in a county, not just gay men and other men who have sex with men. “This index provides communities with sound data that can help them in their advocacy for more inclusive societies,” said Erik Lamontagne, Senior Economist Adviser at UNAIDS.

With knowledge of the harmful effects of homophobia, countries will be in a much better position to respond to it and improve the lives of all.

On the eve of Zero Discrimination Day on 1 March, more than 890 000 viewers joined the online platform OK.ru/test to discuss zero discrimination and join the launch of the UNAIDS regional #YouAreNotAlone campaign. The discussion was live-streamed on Odnoklassniki, the leading Russian-language social media platform for countries across eastern Europe and central Asia.

The #YouAreNotAlone campaign is raising awareness about the stigma and discrimination faced by children, adolescents and families affected by HIV in eastern Europe and central Asia. The campaign features young Russian artists who each retell the personal story of an adolescent living with HIV in the Russian Federation. Most adolescents in eastern Europe and central Asia still face stigma and discrimination that prevents them from being open about their HIV status.

The broadcast also featured an interactive online film, It’s Complicated. Based on the lives of adolescents and young people living with HIV in the Russian Federation, the film tells the story of Katya, a Russian girl born with HIV who faces stigma and discrimination but also finds love and support as she grows up and adjusts to life with HIV. Some of the film’s crew and lead actors joined UNAIDS and United Nations Educational, Scientific and Cultural Organization staff in the OK.ru discussion.

“The goal of the #YouAreNotAlone campaign is to promote solidarity with children, adolescents and families affected by HIV in eastern Europe and central Asia for them to live with safety and dignity,” said Vinay P. Saldana, Director for the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

The campaign has been promoted through social media by Vera Brezhneva, UNAIDS Goodwill Ambassador for Eastern Europe and Central Asia, Victoria Lopyreva, UNAIDS Ambassador for the 2018 FIFA World Cup, and others. Everyone is encouraged to support the campaign by posting a photo on social medial with the hashtag #тыНЕодинок (#YouAreNotAlone).

“These young people are inspiring and strong,” said Ms Brezhneva. “Something is very wrong with a society where the human rights and dignity of people living with HIV are not respected. Every person living with HIV should feel our support, #YouARENotAlone!”

The campaign was also launched in Armenia, where it was supported by actors, television presenters and others. Armen Aghajanov is the first person living with HIV in Armenia who publicly disclosed his HIV status during the launch of the #YouAreNotAlone campaign on Zero Discrimination Day. He said: “People are not dying from HIV, they die from discrimination, late diagnosis, lack of access to treatment or from not taking medicines.”

During the Global Partnership for Education meeting on 2 February, hosted by Senegal and France, UNAIDS Executive Director Michel Sidibé discussed the importance of education and health. “Integrating education and health is key for our success in controlling the epidemic among young people. Without effective, quality and sustainable health and education systems we are failing young people”, Mr Sidibé said. Credit: UNAIDS/B. Deméocq.

The First Lady of Senegal, Marieme Faye Sall, and the First Lady of France, Brigitte Macron, inaugurate a cardio-paediatric centre that provides surgical treatment for children affected by cardiologic diseases. The centre, funded by the Cuomo Foundation in Monaco, supports women and children in Senegal. Credit: UNAIDS.

Preventing mother-to-child transmission of HIV is crucial, as is community involvement, stressed Mr Sidibé during his meeting with Ms Sall. The western and central Africa region lags behind in access to treatment and prevention, which is why UNAIDS and partners launched a western and central Africa catch-up plan. Credit: UNAIDS/B. Deméocq.

Mr Sidibé also met with the Minister of Health and Social Action of Senegal, Abdoulaye Diouf Sarr, stressing that no matter who you are or where you are from, everyone has the right to health, the right to an education, the right to equal opportunities and the right to thrive. Credit: UNAIDS/B. Deméocq.

The Secretary General of the Organisation Internationale de la Francophonie, Michaëlle Jean, will raise the issue of counterfeit medicines at the upcoming World Health Assembly in May. Credit: UNAIDS/B. Deméocq.

Minister of International Development of Norway, Nikolai Astrup, and Mr Sidibé met on the sidelines of the meeting. Credit: UNAIDS/B. Deméocq.

Mr Sidibé, along with the Ambassador of Luxembourg, Nicole Bintner. Luxembourg has been an active participant and donor in the western and central Africa catch-up plan. Credit: UNAIDS/B. Deméocq.

Good health enables a girl to thrive, to grow, to think, to explore and to contribute to her community. Knowledge of how to stay healthy and access to quality health services enable her to prevent illness, to eat well, to manage her sexual health, to have healthy babies when and if she chooses to and to nurture her own well-being. Education and health are two of the most transformative elements of a girl’s life. Credit: UNAIDS/B. Deméocq.