This year’s International Day against Homophobia, Biphobia and Transphobia (IDAHOT) focuses on the family, including the role of families in the well-being of their lesbian, gay, bisexual, transgender and intersex (LGBTI) members and respect of the rights of LGBTI families.

UNAIDS has been a strong supporter of LBGTI equality and has been a champion of the cause within the United Nations system. To celebrate the diversity of families at UNAIDS, we have talked to LGBTI staff about what family means to them.

Shane Hebel

When I think of family I think of my chosen family, friends who became loved ones through our shared experiences, joys and trials. We support each other, we push each other to be our best selves, we help each other move. These people have taught me that families come in all forms and that love can exist boundlessly among those you choose to surround yourself with, even if they aren’t tied to you by blood. 

Chris Mallouris

Family for me means safety, unconditional love and acceptance for who I am, acceptance when I succeed and acceptance when I fail. As we grow older, our family expands from those with whom we are linked genetically to those who come to our lives by mutual choice. In the last few years, it has been heart-warming to see LGBTI people in some regions of the world celebrate publicly their definition of family. But it has also been heart-breaking to see LGBTI people in other regions losing their families, being persecuted and having their lives threatened by those who should be there to protect them and love them unconditionally. Families protect each other, they don’t turn against one another for being born LGBTI.

Carlos Passarelli

When I met Marc, almost three years ago, I always acted as if his kids, his grandchildren, and his stepsons were his family, not mine. One day, Manon, his daughter, introduced me to a colleague of hers, presenting me as her “stepfather”. I must admit that I was touched by her spontaneity. Her three daughters, Marc’s grandchildren, also treat me as the partner of their grandfather, and it is very natural to them. And then I realized that Marc and I were more than a couple: we were part of the same family, including my own family in Brazil. And I felt good about that.

Alberto Stella

The family is the primary social context for growth development of the person in its wonderful diversity. My family has been growing along my journey: I found my son in Africa and my partner in central America and we got married in Argentina. Today, we are a family, a refuge that provides security, love and a real possibility of fully exercising human rights. No matter how the family is composed, what makes family functional is the strength of ties.

UNAIDS’ policy

Starting in 2009, UNAIDS actively promoted the equal recognition of marriages and unions at the United Nations system level. UNAIDS was one of the pioneers in extending benefits to staff members who entered a civil union or marriage recognized by a competent legislative authority, irrespective of the staff member’s nationality. The United Nations Secretariat and other entities later adopted a similar policy in 2014. UNAIDS was also one of the first United Nations organizations to establish a diversity policy. UNAIDS’ Policy on Diversity and Inclusion makes specific reference to same-sex partnerships and UNAIDS’ policy of zero tolerance for discrimination.

UNAIDS staff member

Family to me is my immediate family, but it’s also the many gay and lesbian friends I have made over the years. The two are essential to my life. I have the unconditional love of my parents, who accept me for who I am, a lesbian, but they stay silent about my life and lifestyle. That is why I feel a reassuring sense of community with my gay friends. At UNAIDS, the sense of acceptance has been overwhelmingly positive and I wish everyone could work in such an environment. No labels, no stigma.

UNAIDS staff member

A few months ago, I delivered training on sexual orientation and gender identity in western Africa. I shared with the participants my experience of coming out to my family in my twenties and then pursuing a life and a career. One of the participants asked me if there had been a nongovernmental organization that had helped me when I came out. The question caught me off guard. I realized that it presupposed that I had been rejected by my family and that I must have needed external help to survive. I replied that I did not need any help because as soon as I came out I was embraced, reassured and supported by my family at all times. This made me reflect on how fortunate I am to have my parents and siblings, to have been born in a time and in a place where that family was possible, and to have been resilient enough to come out to my family and to society without much fear. I know these factors are not a reality for all LGBTI youth worldwide, and for that we need to continue advocating for universal human rights, education, services and justice.

To celebrate IDAHOT 2017, UNAIDS has released a video message (https://youtu.be/DGbO0qt7EQo) by Michel Sidibé, UNAIDS Executive Director, on the diversity and importance of all families.  

Mr Sidibé in the video statement said, “Families come in all shapes and sizes … we all have a responsibility to respect and protect one another.” He added, “Ending AIDS means we need to end the stigma and discrimination of lesbian, gay, bisexual, transgender and intersex people.”

Veena has been living with HIV for more than 15 years. The community educator, who lives in Bangalore, India, has been on HIV treatment for more than a decade and says antiretroviral medicine has given her back her health and happiness.

“This medicine is very good. I am very happy,” said Veena. “My life has changed. I am learning three languages and working.”

There are 2.1 million people living with HIV in India, which has the third largest HIV epidemic in the world. On 28 April, during an event in New Delhi, Jagat Prakash Nadda, the Minister of Health and Family Welfare, announced a new test-and-treat policy that commits to providing access to HIV treatment for everyone living with HIV in the country. Prior to the change in policy, people living with HIV could only access antiretroviral medicine for free if their CD4 cells had decreased to less than 500 cells/mm³.

Mr Nadda also said that the ministry’s 90–90–90 strategy will identify 90% of people living with HIV, place 90% of people identified as living with HIV on treatment and ensure that 90% of people on treatment have sustained viral load suppression. “This strategy will offer us an opportunity to work towards our commitment made during the United Nations High-Level Meeting on Ending AIDS.”

People living with HIV in India often access treatment late. This was the case for Veena when she began taking medicine.

“I had lost a lot of weight and I had a high fever. I was tired and I couldn’t work,” said Veena. Initially she did not respond well to treatment, but slowly her weight started to increase and her immune system became better.

UNAIDS has called on all countries to provide HIV treatment to anyone who tests positive for HIV, because treatment keeps a person living with HIV healthy and has the double benefit of stopping the transmission of the virus to other people.

“The Government of India is showing bold leadership and commitment to people living with HIV,” said Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “This new policy will bring life-saving treatment within reach of more than one million people living with HIV. It will keep individuals, families and communities healthy and productive and ensure that India ends its AIDS epidemic by 2030.”

To rapidly scale-up treatment, India will rely on its network of facilities spread across the country providing HIV services. Rolling out the new policy will also entail strengthening the procurement and supply chain management system as well as sustained community participation.

According to the country’s national AIDS programme, annual AIDS-related deaths declined by 54% between 2007 and 2015, while new HIV infections dropped by 32%. As more people living with HIV follow Veena onto treatment, the double benefits of antiretroviral medicines are expected to lead to a further decline in deaths and new HIV infections.

Veena has managed what she never thought possible: watch her daughter grow into a young adult.

“My life has a future. I don’t have a proper education, but my daughter has completed her degree. She is working. She is an empowered woman,” said Veena.

UNAIDS is working with countries to ensure that 30 million people living with HIV have access to HIV treatment by 2020.

An exhibition at the Red Cross and Red Crescent Museum in Geneva, Switzerland, traces the AIDS response through posters and art from around the world over the past 30 years. The Fight against AIDS in Images explores the evolution of how HIV has been portrayed in campaigns encompassing sexuality, politics, stigma and HIV prevention—from using an image of a skull to the red ribbon, from depicting HIV as a death sentence to showing people living positively with HIV and from spreading fear to using humour.

“The point of our exhibition is not the disease itself, but all the communication materials around it,” said the Red Cross and Red Crescent Museum Director, Roger Mayou. “The many posters are a true mirror of society through the ages.”

The exhibition begins with Nan Goldin photographs from the mid-1980s as part of the first thematic, Other People’s Disease, highlighting how HIV was seen at the time to be concentrated among key populations.

The second theme, Silence is Broken, highlights how civil society and public figures raised their voices to address HIV. The iconic image of the pink triangle with the saying “Silence = Death” dates back to 1987 and was a part of the New York AIDS Coalition to Unleash Power (ACT UP) campaign.

Next comes AIDS and the Media. The death in 1990 of an American boy named Ryan White, who was infected with HIV by contaminated blood, crystallized the fact that the virus can affect anyone. More women and heterosexual couples appeared on posters and many countries crafted messages for national campaigns, as shown by the German posters from 1990 that emphasize “Don’t give AIDS a chance”.

The Virus, the second to last theme, focuses on explaining the science behind AIDS. A rendition of a normal T-cell and an HIV-infected T-cell by the Cancer Institute in 1991 has the slogan “Visualize this”. An Algerian World AIDS Day poster from 1994 likens the virus to mines floating in the ocean with a tagline “Protect the family”.

The last theme, Living Together, introduces the fact that, with the advent of antiretroviral medicines in 1996, HIV need not be fatal. As a result, the Swiss Stop Sida (End AIDS) campaign began to incorporate a “Love life” message on their posters in 2005. A black and white UNAIDS World AIDS Day poster shows a close-up of a man with the tagline “I am accepted”—part of the I am Living My Rights campaign stressing the normality of living life as an HIV-positive person.

“HIV has become invisible, a fatigue has almost set in,” Alexandra Calmy from the HIV unit at the Geneva University Hospitals said. “And yet 2.1 million people are infected with HIV every year, so it is important to talk about AIDS, and this exhibition does just that.”

UNAIDS is working with countries towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.

UNAIDS has appointed Pia Wurtzbach, Miss Universe 2015, as a Goodwill Ambassador for Asia and the Pacific. The announcement was made at a special event with students at Ateneo de Manila University in Quezon City, Philippines.

“I am very happy to be a UNAIDS Goodwill Ambassador for Asia and the Pacific,” said Ms Wurtzbach. “I’m overwhelmed. It’s been a dream of mine to work with the United Nations. I will do my best. I will use my voice for this cause.”

In her new role, Ms Wurtzbach will raise HIV awareness among young people and promote zero discrimination towards people living with HIV and key populations, including men who have sex with men and transgender people.

“Many young people still do not have the skills and knowledge to protect themselves from HIV,” said Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “With her huge popularity among young fans and immense following on social media, Ms Wurtzbach will amplify our efforts and help end the AIDS epidemic in the region.”

Ms Wurtzbach has been actively involved in humanitarian affairs, speaking out against cyberbullying and supporting people living with HIV, as well as the lesbian, gay, bisexual, transgender and intersex (LGBTI) community. During her reign as Miss Universe, she had an HIV test in front of cameras to encourage people to know their HIV status, and attended the United Nations General Assembly High-Level Meeting on Ending AIDS in New York, United States of America.

The appointment event was attended by young people from different universities in the Metro Manila area, as well as representatives of the United Nations, government officials, the media and the Act!2030 Philippines network and other community groups representing young people and key populations.

The Asia and Pacific region has made progress in its HIV response, with new infections dropping by 5% among people of all ages between 2010 and 2015. However, in 2015, young people accounted for 37% of new HIV infections and data analysis indicates that there is a significant epidemic of HIV among an increasingly younger group of gay men and other men who have sex with men in urban areas of South-East Asia and China.

Surveys conducted in eight countries in Asia found that comprehensive knowledge of HIV among young people is low, increasing their vulnerability to HIV. UNAIDS and its partners are conducting an HIV awareness campaign for youth on social media with the hashtag #Live2LUV and Ms Wurtzbach will be helping to promote this campaign as part of her new advocacy role.

Victoria is a nurse who provides opioid substitution therapy (OST) to 50 people a day. The OST programme in Belarus started in 2007 as a pilot project with a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Today, the programme has grown to 19 sites across the country providing OST to nearly 900 people; however, that is less than 5% of people who use opiates in the country.

Thirty-seven per cent of all people accessing OST in Belarus are living with HIV. Victoria says that OST helps people living with HIV who used to inject drugs to keep taking their antiretroviral therapy. People who are HIV-negative also rely on the programme to avoid HIV infection through injecting drug use.

The OST programme in Belarus is available to adults dependent on opioids. It includes the provision of methadone, regular medical check-ups, psychological support and the services of social workers. Eugene Halubitski has been the head of the OST programme at a clinic in Minsk since 2010. He provides medical and psychological support to many clients, including Sergey.

Sergey first enrolled in the OST programme in 2009. Since then he has found a job, got married and became a father. A 2014 study found that every US$ 1 invested into OST saves around US$ 6 from the consequences of drug dependence, such as crime, unemployment, the provision of antiretroviral therapy and AIDS-related deaths.

People who adhere to OST programmes come every day to a clinic to take a dose of methadone, which helps to alleviate their dependence on opioids.

The World Health Organization recommends increasing OST coverage to 40% of people who inject drugs in order to lower the number of new HIV infections.

The financing of harm reduction in Belarus is steadily transitioning from the Global Fund to Fight AIDS, Tuberculosis and Malaria to domestic resources. OST is almost completely funded by the state.

Thirteen years ago, Alexander took part in a rehabilitation programme. Today, he is a psychologist and helps others to recover from drug dependence through peer counselling, meditation and psychotherapy. His experience shows that a life free from drugs is possible.

During a visit to Belarus, UNAIDS Executive Director Michel Sidibé‏ met with the staff and clients of an OST centre in Minsk, where he congratulated the work of the centre’s staff.

He said, “I can say with confidence that this is one of the best opioid substitution therapy programmes I have visited. It provides comprehensive and holistic serves which are people centred.”

Clients shared personal testimonies with Mr Sidibé. “They believe in their future now. The opioid substitution therapy programme respects people’s dignity and restores social capital,” he said.

He added that, “We see that the harm reduction programme in Belarus works and needs to be scaled up.”

The evidence of the effectiveness of harm reduction is the basis for a comprehensive package of interventions for preventing the spread of HIV and reducing other harms associated with drug use.

Photo credits: UNAIDS/Alexandr Konotop

The National Health Service (NHS) in Scotland, United Kingdom, announced on 10 April that pre-exposure prophylaxis (PrEP) would become available in Scotland.

PrEP is taken as a daily pill to significantly reduce the chances of contracting HIV. UNAIDS recommends PrEP use by people who are HIV-negative but at higher risk of becoming infected. The people who can benefit most from PrEP include gay men and other men who have sex with men, transgender people, sex workers and serodiscordant couples before the partner living with HIV becomes virally suppressed.

Since government estimates show that a large proportion of new HIV infections in Scotland are among gay men and other men who have sex with men, the introduction of PrEP could make a significant impact on the number new HIV infections in Scotland.

PrEP has been made available in a number of countries around the world as choice for HIV prevention. It cannot currently be obtained from the NHS in the rest of the United Kingdom, but can be accessed from some private clinics.

Countries agreed in the 2016 United Nations Political Declaration on Ending AIDS to reach 3 million people with PrEP by 2020.

During their visit to Namibia, President George W. Bush and Ms Bush visited the Ella du Plessis High School in Windhoek to see how students are learning the life skills they need to help them make responsible decisions as they transition into adulthood.

The students had a lively discussion with their high-profile guests, explaining how the classes helped to teach them respect for others and expose them to sensitive issues, such as unintended pregnancy, HIV infection and gender-based violence. Answering a direct question from President Bush, male students in the class said the classes taught them respect for young women.

The First Lady of Namibia, Monica Geingos, and the Executive Director of UNAIDS, Michel Sidibé, accompanied President Bush and Ms Bush on the visit. Mr Sidibé praised President Bush for setting up the United States President’s Emergency Plan for AIDS Relief.

“When President Bush established the United States President’s Emergency Plan for AIDS Relief in 2003, just 50 000 people in Africa were accessing medicines to keep them healthy and alive,” said Mr Sidibé. “Today, more than 12 million people in Africa, and 18 million globally, are accessing antiretroviral medicines.”

President Bush encouraged young people to get tested for HIV, learn how to protect themselves from the virus and get treatment if necessary.

During the visit, Ms Bush announced that the Laura Bush Foundation for America’s Libraries planned to fully stock the Ella du Plessis High School’s library. The first books donated were a book of paintings by her husband and her daughter Jenna’s book called Ana’s story: a journey of hope.

The school’s life skills class is part of the First Lady of Namibia’s Be Free campaign, which encourages young people to talk about sensitive issues facing them and to seek help and guidance to help them navigate life choices.

When Pres Bush set up @PEPFAR in 2003 50K ppl in #Africa had access 2 life-saving meds. Today 12M in #Africa are on treatment. #legacy pic.twitter.com/cJ9TvINVa3

— Michel Sidibé (@MichelSidibe) April 6, 2017

Patience Eshun, a widowed grandmother from Ghana who lost her daughter last year to HIV, knows how destructive HIV-related discrimination can be. “My daughter refused to go hospital to receive medicines. My daughter died because of the fear of stigmatization and discrimination,” she said.

Ms Eshun is one of thousands of widows living in Ghana who have experienced the effects of stigma and discrimination on people living with HIV. Ms Eshun and a group of women joined UNAIDS Deputy Executive Director Jan Beagle at a dialogue organized through the Mama Zimbi Foundation (MZF)—a nongovernmental organization that seeks to empower and support widows through its Widows Alliance Network (WANE) project—to discuss the challenges faced by widows and women living with HIV.

Ms Beagle visited Ghana to engage with the government and other stakeholders in light of Ghana’s Chairmanship of the UNAIDS Programme Coordinating Board.

In Ghana, women are among the people most affected by HIV. Prevalence among women aged 15–49 is nearly double that among men of the same age (2.0% versus 1.3%). Widows are among the poorest women in Ghana—their poverty is linked to the deprivation of their rights and lack of access to justice through discriminatory customs, traditions and religious codes. Widows in Ghana are often faced with legal regulations that do not support the protection of their rights. Widows regularly lose land and possessions and are evicted from their homes once they lose their spouse. For widows living with HIV, stigma and discrimination is often exacerbated.

Responding to these challenges, Akumaa Mama Zimbi, a Ghanaian women’s rights leader, television and radio talk show host, launched a network (WANE) to support sustainable socioeconomic development for widows. The project equips widows in Ghana with employable skills, human rights education, reproductive health and social integration programmes. Through WANE, more than 400 widow groupings have been formed in Ghana, with membership swelling to more than 8000 nationwide. The organization also provides small income generating and training workshops for widows in dressmaking, bread baking, beekeeping and small-scale farming.

“We are passionately committed to striving for advocacy of a comprehensive policy and legal direction for elevating the standards of widows, and all women, in Ghana. We need to empower women, and make sure men are also fully part of the discussion—we need to work together for a better future,” Ms Zimbi said.

During the meeting, Ogyedom Tsetsewah, a Queen Mother (traditional community leader) and advocate for women’s rights, explained that if a widow is facing injustice, she has little or no recourse within her community and within the courts, and that traditional leaders have an important role to play. “There is a clear role for traditional leaders in advocating with the national political leadership on the situation of widows and the critical importance of investing in social protection of widows to allow them to contribute to community resilience,” she said.

Women and young people shared their experiences of HIV-related discrimination and hardship. It was a very honest discussion, where many women shared their own impressions of experiencing friends being stigmatized and discriminated against, even by themselves. 

Ms Beagle commended the courage and resilience of the widows, while reflecting that, “Widows living with HIV often face triple discrimination: because they are widows, because they are women and because of their HIV status. Through economic empowerment, they become self-reliant and even leaders in their communities, can build awareness of HIV and stand up against stigma and discrimination.”

MZF is currently working on establishing a permanent location to provide vocational training, human rights education, reproductive health and social integration programmes for the daughters of vulnerable widows in Ghana. This initiative when implemented will provide skills and jobs for more than 3000 vulnerable young women.

Transgender people are continuing to face widespread stigma, discrimination and social rejection in Latin America and the Caribbean. In most countries in the region, there is no legal recognition of transgender people’s affirmed gender identity. Without official documents that recognize their gender identity, transgender people are often denied access to basic rights, including the right to health, education, justice and social welfare. Transgender people are also more susceptible to violence, including physical and sexual violence.

Transgender women are also particularly affected by HIV. Estimates show that HIV prevalence for transgender women in the region range from 8% to 31% and there are few support programmes that address their specific needs. Where programmes do exist, they rarely include access to sexual and reproductive health services or HIV prevention, testing and treatment services.

However, the transgender community is increasingly speaking out about the challenges they face. Marcela Romero, Coordinator of REDLACTRANS, the Latin American and Caribbean Network of Transgender People, said, “Countries must take urgent steps to enact robust laws for non-discrimination with respect to gender identity and pass gender identity laws to guarantee access to education, work, housing and health services. These laws give transgender people the right to health and to access all the benefits and opportunities that any other citizen has. Without this right, we cannot access HIV prevention, care and treatment services.”

In 2012 in Argentina, REDLACTRANS and ATTTA, the Argentine association for transvestites, transsexuals and transgender people, played a key role in the passing of a law that gives transgender people the right to request that their recorded sex, first name and image be amended to match their self-perceived gender identity.

Such gender identity laws greatly improve the quality of life of transgender people. “In countries where legal recognition of affirmed gender identity has been achieved, transgender people are enjoying a higher life expectancy. Gender identity laws recognize transgender people as human beings—as citizens—put transgender people on the agendas of governments and reduce transphobia, stigma and discrimination,” Ms Romero explained.

The International Transgender Day of Visibility celebrates transgender people and raises awareness of the discrimination faced by transgender people worldwide on 31 March each year. To mark the day, Ms Romero has a simple but powerful message: “We do not ask for other rights—we ask for the same rights as any other citizen. A person who does not have an identity does not exist. We are part of society!”

UNAIDS is working to ensure that the target in the 2016 United Nations Political Declaration on Ending AIDS of ensuring access to combination prevention options to at least 90% of people by 2020—especially young women and adolescent girls in high-prevalence countries and key populations, including transgender people—is met.

UNAIDS welcomed a group of prominent British parliamentarians from the cross-party International Development Committee to discuss the role of lawmakers in ending AIDS and contributing to global health. The parliamentarians were Labour Member of Parliament and Shadow Secretary of State for International Development Kate Osamor, Stephen Twigg, Labour Member of Parliament and Chair of the International Development Committee, Conservative Members of Parliament David Mackintosh and Paul Scully, and Baroness Sheehan, member of the House of Lords and the Liberal Democrat spokesperson for international development.

Deputy Executive Director Luiz Loures chaired an informal discussion that began with the Members of Parliament sharing their own experiences of visiting AIDS programmes in Africa and Asia. They spoke of their acute awareness of the complicated nature of the AIDS response, and Mr Twigg highlighted the role that discriminatory laws played in creating barriers to services. Mr Loures noted that one of the biggest challenges to the AIDS response was the risk of complacency. Baroness Sheehan expressed her concern about the increased vulnerability of girls and young women. The discussion explored the role of civil society and the shrinking space for civil society and Mr Scully noted the increasing need to mobilize domestic resources. 

Mr Loures highlighted the critical role of parliamentarians in ensuring that health and development international assistance is maintained and scaled up. Mr Mackintosh highlighted the need for increased efficiency and analysis on returns on investment to enable parliamentarians to advocate for sustained and increased funding.

Ms Osamor thanked Senior Adviser David Chipanta for sharing his personal story of living with HIV and the life-changing impact that access to treatment has had on his life.

The visit was organized by STOPAIDS, STOP AIDS Alliance, Results UK and Malaria No More. The United Kingdom is the fourth largest donor to UNAIDS.