HIV/AIDS continues to be one of the greatest threats within the LGBTI community across the globe, and statistics show that the situation has further intensified given the Covid-19 pandemic. A report presented by Johns Hopkins University at the recently concluded AIDS Conference indicates that the risk of having HIV is nearly five times as high for LGBTI persons in Sub-Saharan nations that severely criminalise consensual same sex relations in comparison to those in countries where homosexuality is legal.
The UNAIDS latest report on the global AIDS epidemic further supports these statistics. It shows that 2020 targets will not be met because of deeply unequal success; COVID-19 risks blowing HIV progress way off course with missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.
According to the UNAIDS report, investments in sexual and reproductive health yield enormous social and economic returns for all. Access to sexual and reproductive health information and services is however often impeded by multiple intersecting forms of inequality and stigma and discrimination, creating barriers at the individual, interpersonal, community and societal levels. Rural and urban poor, minority ethnic groups, adolescents and lesbian, gay, bisexual, transgender and intersex (LGBTI) people are particularly underserved. In the majority of countries with recent survey data, women are less likely to have their demand for family planning satisfied by modern methods if they live in rural areas, have not attained a secondary or higher level of education, and/or are in the lowest wealth index quintile. The fact that the poorest women in some countries (e.g., Zimbabwe) have greater access to family planning than the wealthiest women in other countries (e.g., Columbia) suggests that good policies and programs can expand service access across all income levels.
EXCERPT FROM THE REPORT
Women living with HIV also face particular challenges, as HIV stigma and gender inequality intersect and negatively impact their health. While health-care settings should be safe spaces, as many as one in three women living with HIV across 19 countries reported experiencing at least one form of discrimination related to their sexual and reproductive health in a health-care setting within the past 12 months. Health rights abuses documented by various studies include unauthorized disclosure of status, being advised to not have children, forced and coerced sterilization or termination of a pregnancy, denial of sexual and reproductive health services, and related psychological violence.
The gaps between the commitments made by all countries at the 2016 United Nations (UN) General Assembly High-Level Meeting on Ending AIDS and the progress achieved thus far reflect the many barriers faced by people living with HIV and those at risk of HIV infection. Multiple and intersecting other forms of discrimination—such as those based on income, race, age, ethnicity, disability, immigration status, sexual orientation and gender identity—are holding back HIV responses.
Gender inequality, underpinned by harmful gender norms and unequal power or relationship dynamics that reinforce notions of masculinity based on male control and strength and female vulnerability, continue to restrict women’s control in deciding how, when and with whom they have sex. It also shapes women’s use of HIV and other health services, and it limits their ability to lead lives that are free from violence. Calls for change are growing louder as women leaders and community mobilizers mark the 25th anniversary of the Beijing Declaration and Platform for Action.
For all genders, laws and policies aimed at discouraging or criminalizing individual behaviours—such as sex work, drug use and same-sex sexual relationships—can legitimize stigma and give license to discrimination and harassment. This isolates people who are at particularly high risk of acquiring HIV and hinders them from accessing the services they need, further elevating their risk of infection.
The COVID-19 pandemic threatens to magnify existing inequalities, including those related to gender and poverty. A rights-based and gender-responsive approach is needed to overcome these barriers. Empowering women in all of their diversity requires action on multiple fronts, from uprooting the harmful gender norms and patriarchal systems that perpetuate gender-based discrimination and violence, to confronting racism, providing comprehensive sexual and reproductive health services, keeping girls in school, achieving economic empowerment and reforming laws, policies and institutional practices. Securing the rights of all people creates an enabling environment for successful HIV responses, affirming the dignity and agency of individuals, creating more equitable access to services and leaving no one behind.
To read the whole report, please visit https://aids2020.unaids.org/chapter/chapter-4-securing-rights/sexual-and-reproductive-health-and-rights/