Justice Michael Kirby (left) and Professor Brian Gazzard during the expert meeting. Geneva, 02 September 2011.

World leading scientists and medical practitioners joined legal experts and civil society representatives to discuss the scientific, medical, legal and human rights aspects of the criminalization of HIV non-disclosure, exposure and transmission. The meeting, organized by UNAIDS, took place in Geneva from 31 August to 2 September.  

Participants reviewed key scientific, medical, public health and legal principles that should inform the application of the criminal law to HIV. They also discussed recent developments in a number of countries where the criminalization of HIV is being reconsidered.

The meeting is part of a project to ensure that the application, if any, of criminal law to HIV exposure or transmission is appropriately circumscribed by the latest scientific evidence and legal principles in order to guarantee justice and protection of public health. The key points emanating from the expert meeting will be presented during a High Level Policy Consultation on the criminalization of HIV non-disclosure, exposure and transmission that will take place in Norway in the first quarter of 2012.

UNAIDS.org seized the opportunity to interview Professor Brian Gazzard (scientist and medical expert) and Justice Michael Kirby (a legal expert) to find out about their views on the significance, expected outcomes and potential impact of the expert meeting.

UNAIDS.org - As a scientist, what brings you to an expert meeting on the criminalization of HIV non-disclosure, exposure and transmission?

Professor Brian Gazzard (BG) - I'm not only a scientist, I'm a clinician. And I suppose as a clinician I'm interested for two reasons. One, it's become a very important agenda for most patients that I talk to. They want to know what the rules are about criminalization and the risks that it presents to them. Hopefully I've contributed to a more secure scientific knowledge about what the risks of transmission of HIV are, what the health status of somebody who's HIV infected are. I'm staggered about how little the courts still seem to know about these issues.

UNAIDS.org - What do you consider to be the role of scientists on addressing the overly broad criminalization of HIV non-disclosure, exposure and transmission?

BG - I think they have a role in pointing out what the science is. So what we're really trying to do is saying that HIV has become a manageable condition which should produce a near-normal lifespan if people have access to HIV treatment and of course, take it. This is a very different thing from the vision of the court where this is murder and the patient will die within a few months of the diagnosis and life is a disaster. Quality of life for most HIV patients, I'm pleased to say, is extremely good. And so, to actually have a situation where jurisdictions are still prosecuting people for attempted murder because HIV has been transmitted is totally unrealistic in my view.

UNAIDS.org - In light of recent developments including evidence of the benefits of highly active antiretroviral treatment (HAART), can HIV transmission or exposure still be characterized as murder or attempted murder under the criminal law?

BG - In my view clearly not and I think any prosecutions for that would fail, but of course, even being put up for prosecution is a pretty painful process. I think it's important that prosecutorial guidelines say that this is not reasonable.

UNAIDS.org - More broadly, in your view, how should a better understanding of scientific evidence inform the criminal law in the context of HIV?

BG – Defining the intention to do harm is a complex legal issue. The probability of transmission of HIV to another person is quite low, particularly in the context of safer sex with a condom, or for people who are on HIV treatment.   Whether a given individual transmits HIV or not would be a very rare and arbitrary event. So I think science is important in clarifying these facts. It isn't that the risk is so high that you have an intent when you have sex with somebody; the risk is actually very low indeed.

UNAIDS.org - In your opinion, is there any legal evidence to support the criminalization of HIV?

Justice Michael Kirby (MK) - There are some exceptional cases where the criminal law has a role to play. However, the criminal law has been pushed into a whole range of other activities which are counter-productive from the point of view of a public health response to HIV. The use of criminal law is also likely to lead to disproportionate and highly punitive measures which are not helpful in responding to the epidemic in a way that prevents the spread of HIV.

UNAIDS.org - Criminalization of HIV non-disclosure, exposure and transmission has been enforced for a number of years. Is there anything new or different in 2011?

MK - There are a number of developments which make for difference. For example, when in 2008 the original guidelines on criminalization of HIV transmission were adopted, the suggestion was not to have specific laws against HIV but to leave it to the general criminal law to deal with any egregious cases, very serious cases. We now realize that the general criminal law will often have concepts in it which are very uncertain concepts, such as criminal intention, and will also have provisions in it which are difficult to apply in the context of HIV.

Other developments have been the advances in antiretroviral treatment and, of course, a better understanding of the validity and limitations of the phylogenetic test.

So there have been technological, scientific developments, but also the realization that the 2008 guidelines didn't cover all of the issues.  

UNAIDS.org - Do you think this meeting will advance efforts against the overly broad use of criminal law in the context of HIV? And if so, what needs to be done?

MK - I think the value of the group has been that it has a mixture of science and law [experts] and it has a good representation of people living with HIV. That has allowed us to look again at how and what we can do to explain the new realities of the epidemic and put forward new guidelines to help countries react appropriately regarding the criminalization of HIV.

HIV infection is not the death sentence that it was thought to be when HIV first appeared and we have to modify our policies in accordance with the developments in science and technology.

UNAIDS.org - As a member of the UNDP-led Global Commission on HIV and the Law, how do you see this meeting contributing to the overall objective of addressing punitive laws that negatively impact the HIV response?

MK - This issue has not been a big feature of the Global Commission’s work in which I’ve been involved to date. The value of the UNAIDS driven expert meeting is that it fills an important gap. What has been discussed around our table with the inter-disciplinary people who have participated can be fed into the debates of the Global Commission and that’s exactly what I’m going to be doing.

Professor Brian Gazzard is the Clinical Research Director of the HIV Unit at the Chelsea and Westminster Hospital, one of the largest clinical units in Europe. He was also the founding Chair of the British HIV Association (BHIVA) and chaired the BHIVA Executive from 1995-2004. Brian Gazzard is also Chair of the Expert Advisory Group on AIDS (EAGA), an advisory body to the Department of Health in the United Kingdom.

Justice Michael Kirby is a retired judge of the High Court of Australia. At the time of his retirement, Justice Kirby was Australia’s longest serving judge. Since the early days of the epidemic, Justice Kirby served on many national and international bodies concerned with HIV. He currently serves as a member of the Global Commission on HIV and the Law. He is also a member of the UNAIDS Reference Group on HIV and Human Rights.

UNAIDS Executive Director Michel Sidibé meets with Finland’s Minister for International Cooperation Heidi Hautala and her delegation.

During a one day visit to Helsinki, UNAIDS Executive Director Michel Sidibé met with the Minister for International Development, the Ministry of Health, members of the Finnish Parliament, and civil society to strengthen Finland’s partnership with UNAIDS and the country’s role in the global AIDS response.

In a meeting with the newly appointed Minister for International Development, Heidi Hautala, Mr Sidibé expressed his gratitude to Finland for its longstanding involvement in the AIDS response—in particular in sub-Saharan Africa and Eastern Europe—and its support to UNAIDS.

“The Government of Finland has been a longstanding partner in the global AIDS response and has shown leadership both at home and abroad in championing evidence-based HIV programmes grounded in human rights,” said Mr Sidibé. “UNAIDS values its relationship with Finland and looks forward to strengthening our cooperation”.

Finland is a current member of the UNAIDS governing body, the Programme Coordinating Board (PCB), where it also represents Denmark and Norway. The sixth largest donor to UNAIDS, Finland has made consistent contributions to the Joint Programme and in 2010 provided more than US$ 12 million.

Mr Sidibé briefed Minister Hautala on an upcoming Forum on Millennium Development Goal 6 in Moscow from 10-12 October that will assess Eastern Europe and Central Asia’s progress on the goal focused on HIV, malaria, tuberculosis and other diseases. He encouraged Finland to participate in the Forum, stating it represents a key opportunity to work with countries in Eastern Europe to address HIV infection among key populations at higher risk.  

With the Ministry of Health, Mr Sidibé commended the Permanent Secretary, Kari Välimäki, on Finland’s public health approach to HIV and its pragmatic response to the epidemic among people who inject drugs, in particular its support for harm reduction programmes. He encouraged the Ministry to consider Finland's experience in HIV control and services with governments and civil society in Eastern Europe and called attention to the dual epidemics of HIV and tuberculosis in nearby Russia and Central Asia.

The Executive Director completed his visit by participating in an interactive meeting with the All-Party Parliamentary Group on Population and Development, chaired by Parliamentarian Jani Toivola. Mr Sidibé briefed Parliamentarians and civil society representatives, including the Finnish network of people living with HIV, on the UNAIDS Strategy, the 2011 Political Declaration on HIV/AIDS, and the challenges and opportunities in the global response. The participants discussed health and HIV integration as a way to shape the broader debate on antiretroviral treatment. Mr Sidibé called on the Parliamentarians and civil society representatives to continue supporting the AIDS response and find ways to keep HIV on Finland’s development and political agendas.

UNAIDS Executive Director Michel Sidibé (pictured left) with President Armando Emilio Guebuza of Mozambique.

In a meeting with Armando Emilio Guebuza, President of Mozambique, UNAIDS Executive Director Michel Sidibé commended the Government of Mozambique on progress in the national response to HIV, which has resulted in a reduction in new HIV infections and expanded access to antiretroviral treatment.

According to the latest estimates from UNAIDS, the rate of new HIV infections in Mozambique fell by more than 25% between 2001 and 2009. More than 200 000 people living with HIV in Mozambique were receiving life-saving treatment, care and support services at the end of 2010, according to government estimates.

“Commendable coordination between the Government of Mozambique, development partners and civil society has led to the scaling up of programmes for HIV prevention, treatment and care on the ground,” said the UNAIDS Executive Director.

Despite progress, Mozambique continues to have the second highest rate of new HIV infections in the world. In his meeting with the President, Mr Sidibé stressed the need for multi-faceted HIV prevention programmes based on local knowledge of the epidemic. Such programmes would require political commitment and leadership at the highest levels, he said.

In recent years, the Government of Mozambique has made improvements in the country’s primary health care system to meet the growing demand for HIV treatment, care and services. However, bottlenecks continue to hamper the AIDS response, including weak financial and supply management systems and an inadequate health workforce. Mr Sidibé called on President Guebuza and his Government to strengthen the national health care system and increase domestic resources for the HIV response.

During the meeting, the UNAIDS Executive Director briefed the President on the launch of “Give AIDS the Red Card”—a campaign that uses the universal appeal of sports for advocacy around the UNAIDS vision of Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths. Mr Sidibé presented the President with a pledge of support for the “Red card” campaign signed by the heads of delegations from 47 countries participating in the 10^th All-Africa Games in Mozambique.

Mr Sidibé informed the President of the planned appointment of up to 12 athletes as African Goodwill Ambassadors for the “Red Card” campaign across the continent.  He urged the President to secure additional support for the “Red card” campaign from other world leaders at a UN General Assembly meeting in September 2011 and at the next African Union Commission Summit in Addis Ababa.

The meeting with the President Guebuza concluded Mr Sidibé's four-day official visit to Mozambique. While in Mozambique, the UNAIDS Executive Director also met the Prime Minister, other government officials, development partners and civil society groups to exchange views on opportunities and challenges in the national AIDS response.

A central concern raised by government officials and partners during the visit was the risk of stock-outs of antiretroviral drugs. “Drug stock-outs could potentially reverse the gains in Mozambique’s HIV treatment programme,” said Mr Sidibé. “Urgent steps must be taken to manage the risk of drug stock outs,” he added.

Executive Director Michel Sidibé and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano with athletes from various African countries who signed the Give AIDS the Red Card initiative.
Credit: UNAIDS/A.Joe

UNAIDS Executive Director Michel Sidibé and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano launched the UNAIDS initiative Give AIDS the Red Card. The announcement was made on the eve of the 10^th All-Africa Games, the continent’s largest multi-sports tournament bringing together more than 5 000 athletes.

“Reducing the numbers of new HIV infections is nowhere more imperative or urgent than in Africa,” said Mr Sidibé. “The All-Africa Games are a great occasion to raise awareness about intensifying efforts to reach UNAIDS’ vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.”

The launch took place under the patronage of Dr. Aires Aly Bonifácio, Prime Minister of Mozambique. Attending the launch were former Mozambican President Joaquim Alberto Chissano as well as many leading athletes.

The UNAIDS Give AIDS the Red Card campaign aims to raise awareness and mobilize action to strengthen the response to HIV and accelerate progress across Africa. The campaign was introduced at the 2010 FIFA World Cup in South Africa with the support of 28 team captains. Captains of six teams at the 2011 FIFA Women’s World Cup in Germany also endorsed the initiative.

At the Maputo event, heads of national delegations to the Games, including presidents of National Olympic Committees and Ministers of Sport from 47 participating countries, agreed to sign a pledge to support the Give AIDS the Red Card campaign for Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths.

By signing the pledge, each delegation is agreeing to set up a national plan of action on the Give AIDS the Red Card campaign in consultation with UNAIDS offices upon return to their respective countries.

The 2012 Africa Cup of Nations hosted by Equatorial Guinea and Gabon will be the next platform for pan-African mobilization of the initiative.

Youth participation critical to Mozambique’s AIDS response

UNAIDS Executive Director Michel Sidibé (left) and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano launched the UNAIDS initiative Give AIDS the Red Card.
Credit: UNAIDS/A.Joe

The importance of youth and sporting community participation in the response to AIDS was emphasized by the UNAIDS Executive Director during his meeting with Mozambique’s Minister of Youth and Sports, H.E. Pedrito Fuleda Caetano.

Mr Sidibé asked the Ministry to use the All-Africa Games to promote this initiative across all sports disciplines during the Games and beyond. Mr Sidibé emphasised that “sport events should be viewed as key platforms to link with other social movements to drive the prevention revolution including reducing vulnerability of women and girls, scaling-up HIV testing and counselling, reduction of multiple partnership and accelerating medical male circumcision.”

Sub-Saharan Africa continues to be the region most affected by HIV, with an estimated 22.5 million people living with HIV in the region representing 68% of the global total. However significant progress is being made in the region. In 22 countries, the HIV incidence rate has declined by more than 25% between 2001 and 2009.

UNAIDS Executive Director Michel Sidibé with Prime Minister of Mozambique, H.E. Aires Aly Bonifácio

UNAIDS Executive Director Michel Sidibé met with Mozambique’s Prime Minister, H.E. Aires Aly Bonifácio as part of his four-day official visit to the country. During the meeting Mr Sidibé stressed the importance of high level political leadership, ownership and commitment to long-term predictable financing as a prerequisite for sustainable national AIDS response.

Mr. Sidibé applauded the Government’s commitment and rapid follow-up action to implement the Political Declaration adopted in June at the UN General Assembly High-Level Meeting on AIDS. “The urgency demonstrated by the Government of Mozambique to align their national strategies with the outcomes of the Political Declaration should be a model to other countries” said the Executive Director. 

Mr Sidibé underscored the importance of a prevention revolution to stop new HIV infections as well as the need to integrate the AIDS response with health and social development efforts.  “Mozambique has the second highest rate of new adult HIV infections in the world. There is a need to accelerate prevention programmes,” said Mr Sidibé.

By the end of 2010, more than 200,000 people living with HIV were receiving life-saving treatment, care and support services in the country. The national programme to prevent new HIV infections in children has rapidly expanded with the opening of 909 sites in 2010 providing 67 percent coverage to pregnant women. However, Mozambique remains one of the top five countries in the world contributing to new HIV infections among children.

Expressing concern about the fact that 97 percent of Mozambique’s AIDS budget is generated from external sources, Mr Sidibé stressed the country’s need to increase domestic resources to ensure sustainable national AIDS responses in the coming years. “Mozambique needs to develop an innovative transitional plan for sustainable financing, which includes increased national budgets, private sector contribution and social health insurance,” said the Executive Director.  

The Executive Director reiterated the commitment of the United Nations together with other key partners, including the Global Fund, PEPFAR and other bilateral partners to establishing a transparent and accountable mechanism to ensure the implementation of the third National Strategic Plan (PEN III 2010-2014) and accelerate the country’s progress towards MDG 6.

Credit: Sonke Gender Justice

A new documentary film following the lives of four people in Africa aims at challenging patriarchy, end men’s violence against women and promote gender equality. Produced by Sonke Gender Justice and MenEngage, the film titled A Way to Justice: Engaging Men for Women’s Rights and Gender Transformation focuses on gender, HIV and human rights issues.

“We need to build creative initiatives, to transform gender norms and break through cultural barriers to create new masculinities. By fostering women and men’s leadership for gender equality, we can succeed in creating safer, more just societies and stopping violence against women and girls.” said Michel Sidibé, Executive Director of UNAIDS.

In the film individuals speak about the difficulties they confronted and transcended. David Tamba, a Sierra Leonean fleeing from civil war whose wife was gang-raped by rebels, began working with other men in refugee camps. “All men were viewed as bad men. But there were also men who were peaceful, who equally suffered, so the way to turn the story around was to start talking to our colleague men and go out and campaign for gender equality and empowerment of women,” said Mr Tamba.

Violence and the threat of violence hamper women and girls’ ability to adequately protect themselves from HIV infection and assert healthy decision making. The prevalence of forced first sex among adolescent girls younger than 15 years ranges between 11% and 45% globally. Adolescent girls and young women are among the most vulnerable groups to HIV infection.

UNAIDS Executive Director Michel Sidibé (right) met with H.E. KIM Sung-Hwan, Minister of Foreign Affairs and Trade in the Republic of Korea, on 29 August in Seoul.

In an official meeting on 29 August with the Minister of Foreign Affairs and Trade in the Republic of Korea, H.E. KIM Sung-Hwan, UNAIDS Executive Director Michel Sidibé commended the Korean Government for its emerging global and regional role in the AIDS response. 

“The Republic of Korea is increasingly showing leadership in the international response to both HIV and broader health and development goals,” said Mr Sidibé. “UNAIDS counts on countries like yours to accelerate a new wave of progress towards Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.”

The Republic of Korea has low HIV prevalence, with an estimated 7000 people living with HIV. Over the past decade, Korea has partnered with a number of international development agencies on a range of projects focused on AIDS, malaria and tuberculosis, particularly in sub-Saharan Africa. In his meeting with the Minister, Sidibé underscored that Korea could strengthen its contribution to global development by sharing technology and technical expertise with resource-poor countries.

During the meeting, Mr Sidibé thanked Korea for convening the 10^th International Congress on AIDS in Asia and the Pacific (ICAAP) — a gathering this week in Busan of more than 2000 AIDS experts and activists from across the Asia Pacific region. He also noted that Korea will host a High Level Forum on Aid Effectiveness later this year.

The UNAIDS Executive Director expressed appreciation for the steps that the Korean government has taken in the past years to remove restrictions on entry, stay and residence that have blocked HIV-positive people from living and working in Korea. He noted that foreigners living with HIV are now eligible to obtain all types of visas to visit Korea.  “Many people living with HIV from across the region participated in the ICAAP conference — a sign that the Republic of Korea, in practice, is taking this issue very seriously,” he said.

Mr Sidibé and Korea's Minister of Foreign Affairs said they looked forward to a strengthened partnership between UNAIDS and the Republic of Korea.

JYJ do the Love Always sign on the launch date of the campaign.
Credit: Korean Herald/H.Park

Newly appointed UNAIDS Regional Goodwill Ambassadors, Korean pop group JYJ joined UNAIDS to launch a social media campaign, that has taken the Twitter world by storm.

Inspired by JYJ hit song lyrics, the “LoveAlways” campaign encouraged fans to download a specially designed Twibbon heart icon to their Twitter profile, and to tweet messages to break down HIV-related stigma and discrimination such as: “Be the one—stop HIV discrimination with JYJ and UNAIDS. Show you LoveAlways.”

The campaign ran from 26-30 August 2011, coinciding with the 10^th International Congress on AIDS in Asia and the Pacific which was held in Busan, Republic of Korea and where JYJ were officially announced as UNAIDS Goodwill Ambassadors on the opening day.

At the launch of the campaign, the three members of JYJ—Jae joong, Yuchun and Junsu—all tweeted messages to their personal Twitter accounts, grabbing the interest of their collective 1.4 million followers on Twitter.

In the six days of the campaign, more than 32 500 fans showed their support via the Twibbon application; followers of the UNAIDS Twitter account nearly doubled.

So rapidly successful was the campaign that the Twibbon site itself both tweeted and posted on Facebook that the LoveAlways campaign was one of their “fastest-ever growing campaigns.” This message went out to some 1.1 million people on Facebook and Twitter, and LoveAlways has been featured on the Twibbon site since.

“The impact of this campaign with JYJ’s involvement has been just amazing,” said Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and Pacific. “The reach JYJ have is extremely important in supporting our global goals of ending stigma and discrimination and we are delighted to have JYJ as our Goodwill Ambassadors for the region.”

The LoveAlways campaign has seen JYJ fans being creative and motivated through their tweets and messages. Many have pledged solid support to JYJ and UNAIDS to help eliminate HIV-related stigma and discrimination and encourage other young people to be more aware about HIV.

JYJ underlined their appreciation for their fan’s commitment: “We want to thank our fans for their great support for this campaign—they are showing that they LoveAlways and are ready to stop HIV discrimination. Their action makes us proud,” said band member Jae joong. “We hope our fans will continue to support us as we work on important AIDS issues with UNAIDS. This is a great start to our work and we are looking forward to more activities where we can speak out about AIDS,” he added.

Credit: UNAIDS/Kim Doo Ho

Serving its theme "Different Voices, United Action", the 10th International Congress on AIDS in Asia and the Pacific (ICAAP) brought together voices and perspectives of more than 2 000 delegates from 65 countries towards the development of greater joint action for AIDS.

The biennial conference that took place in Busan, Republic of Korea, ended on 30 August after five days of symposia, skills-building workshops and satellite meetings – 131 sessions took place in total. Discussions entered on a number of central themes including: the evolving epidemiology of HIV in Asia and the Pacific; advances in basic and clinical services, meeting the challenges of reaching universal access, building and supporting leaders and advocated, engaging communities for effective responses and overcoming human rights, legal and policy barriers.

Recalling a number of key and emerging issues covered during the Congress, such as pervading stigma and discrimination in the region, access to affordable treatment and hepatitis C-HIV co-infection, Geoffrey Manthey of the UNAIDS Regional Support Team for Asia and the Pacific said, “These issues are real and need our immediate action. Although progress has been made, HIV is still a significant challenge for the region. Not only do we need measurable progress by the next ICAAP, we need to see a full commitment to non-discrimination against people living with and affected by HIV.”

The objectives of ICAAP10 were to create an opportunity to enhance AIDS responses to at the local, regional and global levels. The conference was cosponsored by the AIDS Society of Asia and the Pacific (ASAP) and UNAIDS.

Thanking participants for their participation, Local Organizing Committee co-chair, Chul-soo Kim encouraged everyone to work towards ‘Getting to Zero’, “ Let’s work even more, for a world free of HIV!” 

ICAAP is the second largest forum for HIV in the world and encourages the release and discussion of scientific, programmatic and policy developments in the global response to AIDS. It offers a platform where different voices from diverse counterparts across the Asia and the Pacific region can assemble to deliver a united action.

Dr Subhasree Sai Raghavan of the International AIDS Society summed up some of the challenges that were highlighted during the congress, including TB-HIV and the implementation of new PMTCT guidelines, saying that “our region needs to do better — we have no excuse.” 

All the speakers at the closing ceremony welcomed the fact that young people, especially from key populations at higher risk, were present in significant numbers — at least 95 delegates were under 25, as were most of the many Korean volunteers — and were taking an increasing leadership role through organizations such as YouthLEAD and Youth Voices Count, as well as through new social media initiatives.

HIV figures in Asia and the Pacific

In 2009, an estimated 4.9 million people in Asia were living with HIV, including 360 000 who became newly infected that year. The overall trends in this region hide important variation in the epidemics, both between and within countries. In many countries in the region, the epidemic is concentrated in a relatively small number of provinces. Injecting drug users, men who have sex with men, sex workers and their clients and transgender people have accounted for most of the new infections.

The HIV epidemic in the Pacific region is small, but the number of people living with HIV in this region nearly doubled between 2001 and 2009 — from 28 000 to 57 000. However, the number of people newly infected with HIV has begun to decline from 4700 in 2001 to 4500 in 2009. The HIV epidemics in the region are mainly driven by sexual transmission.

“HIV-related stigma is pervasive in the lives of people living with HIV. Stigma marks people as different and as disgraced... Stigma manifests in discriminatory and sometimes violent treatment of people living with HIV, their families and others affected by HIV.”

These are the opening words of the report entitled the People Living with HIV Stigma Index: Asia Pacific Regional Analysis launched on the fourth day of the 10th International Congress on AIDS in Asia and the Pacific (ICAAP), held in Busan, Republic of Korea.

Although data in the analysis often differs widely depending on country context, the analysis shows that stigma and discrimination remain rife across the region as a whole and are evidenced in many environments, including family and community life, as well as employment and health care.

For example, the study found that high percentages of people living with HIV had lost jobs or income in the last 12 months based on their HIV status: from 16% of those surveyed in Fiji to 50% in Cambodia. Elsewhere, people have experienced being refused the opportunity to work – from 9% in Bangladesh to 38% of those surveyed in the Philippines.

“Stigma and discrimination based on HIV status, sexual orientation or lifestyle choice is unacceptable and hampers the AIDS response,” said Michel Sidibé, when sharing some of the findings at an earlier session of ICAAP. “The Stigma Index is an important initiative to increase the evidence base that will enable governments and civil society partners to work more effectively to reduce HIV-related stigma and discrimination,”

Nine-country analysis

The report is a synthesis of nine country studies conducted across the Asia and the Pacific region — Bangladesh, Cambodia, China, Fiji, Myanmar, Pakistan, Philippines, Sri Lanka, and Thailand — and provides the first large-scale regional comparison of standardized HIV-related stigma indicators.

Across the nine countries, discrimination in health care settings is documented as a recurring issue. Across countries in the analysis, data shows that many people living with HIV avoided clinics and hospitals for fear of being discriminated against because of their HIV-positive status. In health-care settings, confidentiality and involuntary testing for HIV were also cited as issues of concern.

The report shows discrimination is a reality for all ages. Up to 35% of people living with HIV in China under the age of 25, for example, reported that teachers were discriminatory to them based on their HIV status.

A pervading issue across the nine-country analysis was the incidence of verbal insults and threat felt by people living with HIV: in Myanmar up to 45% of those surveyed said they had experienced such discrimination.

Even when study respondents had not experienced direct discrimination, they had a generalized fear of discrimination and modified their behaviour accordingly, the report suggests.

The analysis examines how ‘self’ stigma is also an issue for people living with HIV. According to the country reports analysed, over a third of people living with HIV in Thailand decided not to marry. In Bangladesh this figure is even higher — to up to 77% — with 85% of people living with HIV in the country also deciding not to have any more children because of their sero status.

At the launch of the analysis, Positive Women’s Network youth coordinator Sangeeth Dolapihilla underlined how such stigma is common for people living with HIV.  “The Stigma Index showed that people living with HIV have a lot of internal stigma — we feel we can’t have sex, we can’t have kids,” she said. “What is it going to take for our needs to be addressed, and get rid of this internalized stigma?”   

Evidence for action

With the aim of documenting HIV-related stigma and discrimination and providing a mechanism to compare experiences in different settings and across time, the analysis findings will be used to inform national HIV responses. The studies can also act as a baseline against which progress on decreasing stigma and discrimination can be measured.

The report includes recommendations for countries, such as ensuring that stigma remedies are embedded in cohesive national HIV policy and programmatic responses, improving legal and policy responses to HIV-related stigma and discrimination and strengthening policy and practice to reduce HIV-related stigma and discrimination in health-care settings.

The Stigma Index initiative is a collaboration between the Global Network of People Living with HIV, the International Community of Women Living with HIV/AIDS, the International Planned Parenthood Federation, and UNAIDS.

The initiative is important not only in findings but also in process: the Stigma Index employs a wholly participatory approach where the research strategy and data collection is led by organizations of people living with HIV with support of domestic and international partners.