“Cross-dressing” Case Raises Deep Issues of Human Rights and Social Justice for Region

By Joel Simpson, Managing Director, SASOD 

On Thursday, June 28, 2018, a five-member panel of the Caribbean Court of Justice (CCJ), chaired by Justice Adrian Saunders, President, held a hearing in the appeal by Angel (Seon) Clarke, Gulliver (Quincy) McEwan, Peaches (Joseph) Fraser and Isabella (Seyon) Persaud, at the CCJ’s headquarters in Port of Spain, Republic of Trinidad and Tobago.

Click here for the audio recording of the hearing.

In February 2009, four transgender women were convicted for the offence of being “a man” appearing in female attire in a “public place” for an “improper purpose.” This offence falls under the 1893 Summary Jurisdiction (Offences) Act section 153(1) (xlvii) and, in its application, disproportionately targets Trans women. Labeling the law “hopelessly vague,” and constitutionally invalid, the litigants argued that the offence infringes on their rights to due process, freedom of expression and non-discrimination and equality. The litigants further argued that the law is not formulated with enough precision and clarity to allow the ordinary person to regulate their conduct.

It is important to note that “man” under this summary offence has been treated by state officials as including persons whose birth certificates describe them as “male” at birth and who identify as transgender persons or Trans women. However, there is growing acceptance and respectful treatment of persons whose gender identity does not correspond with the gender marker on their birth certificate.

It is a common and respectful practice to refer to a transgender person in a manner that is consistent with the gender that matches the individual’s identity, which in this case is female.

The four litigants, who were all present at the CCJ hearing on June 28, were represented by attorneys-at-law Douglas Mendes, S.C. (Republic of Trinidad and Tobago), lead counsel, C.A. Nigel Hughes (Guyana), Mishka Puran (Guyana), Clay Hackett (Trinidad and Tobago) and Isat Buchanan (Jamaica). Solicitor General Kim Kyte-Thomas, Kamal Ramkarran, and Selwyn Peiters represented the State.

In addition to the four litigants, over twenty representatives from civil society organizations and universities were present to observe the proceedings. Civil society organizations (CSOs) present included the Society Against Sexual Orientation Discrimination (SASOD), one of the original litigants in this case, Guyana Trans United (GTU), Guyana Rainbow Foundation (GuyBow), Promoting Empowerment Through Awareness For Les/Bi Women (PETAL) from Belize and the Alliance for Justice and Diversity (ADJ), which is a coalition of seven organisations in Trinidad and Tobago. The Faculty of Law The University of the West Indies Rights Advocacy Project (U-RAP) was also present.

Ifasina Efunyemi, an educator and representative from PETAL Belize, said, “Even though this was a case coming out of Guyana, it involves issues that are relevant to the LGBT community, and other social justice movements, throughout the region.” In a public forum held in the evening of 28 June at the City Hall in Port of Spain, hosted by Trinidad and Tobago’s AJD, on “Administrative Violence and Structural Inequality,” panellist David Abdulah, leader of the Movement for Social Justice, commented on the intersections of social justice claims.

The well-known labour rights leader said that “You cannot be fighting for workers’ rights and then discriminate between one worker and another.” Highlighting the need to recognize difference and diversity, the Very Reverend Shelley-Ann Tenia, Dean of the Holy Trinity Cathedral, also a panellist at the evening forum said, “There is space for us, even if we are different.”

One of the major hurdles for the appellants in their challenge to the 125-year-old law was the existence of a savings law clause in the Constitution that made it harder to use the Guyana Constitution to question laws in force before the 1980 Constitution. However, the ground-breaking decision of the CCJ on Wednesday 27 June, in the case of Nervais and Severin vs. AG of Barbados, provides an interpretation of savings law clauses that significantly limits their negative impact in cases challenging colonial laws. The CCJ declared that the mandatory death penalty in Barbados was unconstitutional and that the general savings law clause was not a barrier to that declaration.

Substantively, both sides appeared to agree that dress consistent with one’s gender identity, even if that identity is different from the gender assigned at birth, was wholly legal.

As a result, the focus of the hearing became the element of an “improper purpose.” Mendes SC in his presentation argued that criminalizing just thought—an “improper purpose”—was impermissible. He also highlighted that no offence was committed if a “man” was dressed in “male attire” for an “improper purpose;” likewise if a “woman” was dressed in “female attire” for an “improper purpose.”

At AJD’s public forum of 28 June, panellist and Managing Director of the Lloyd Best Institute of the West Indies, Sunity Maharaj, said that, “To one degree or another, people of the Caribbean have been living lives of improper purpose,” making reference to histories of resistance and struggle in response to colonial oppression.

Much of the discussion earlier that day between the CCJ judges and the attorneys focused on whether the term “improper purpose” was sufficiently certain to allow persons to know what was being prohibited. In his comments and questions, Justice Wit emphasized that the test must be based not on legal experts as the standard, but ordinary citizens and charges should stem from crimes and not one’s manner of dress.

Mendes SC strenuously argued that those applying the law specifically targeted the appellants as Trans women. The State suggested that any arbitrary and discriminatory enforcement of this law could be addressed through appeals and applications for judicial review. During the hearing, President Saunders commented that transgender persons who are not of great means or social influence might lack meaningful access to these procedures and thereby be at risk if the law is not sufficiently certain. Justice Wit gave the example of a rich person and a poor person, both of whom in principle could reserve a room at the Waldorf Astoria Hotel, but of course, in real terms, this hotel was entirely out-of-reach to the poor person because of lack of means.

It is important to recognize the experiences and efforts of the four transgender women leading this litigation over the past eight years.

Being a part of an extremely marginalized community, they have faced significant barriers to legal representation and accessing justice due to various contributing factors such as poverty and discrimination. While they were successful in accessing partnerships and resources to help further their challenge of the law, the larger community of Transgender persons still face many of these barriers. This litigation is an important step towards a more progressive and accepting society but we should remain cognizant of the everyday realities of those who are still marginalized due to their identities.

The CCJ has reserved judgment in this appeal. If the CCJ finds for the appellants, it can declare that the summary offence in section 153(1) (xlii) is inconsistent with the Constitution and therefore null and void. Alternatively, the CCJ may seek to modify the offence to bring it in conformity with the Guyana Constitution. The written decision in the McEwan appeal could be delivered during the remainder of 2018 or the first half of 2019, based on CCJ’s practice in other cases.

HFG project supporting 3 Caribbean countries to produce first-ever Health Accounts

Image: Health Accounts technical team members trained in Guyana, June 2017.

The USAID-funded Health Finance and Governance (HFG) project has been supporting three countries in the Caribbean region to produce their first ever Health Accounts. This support will enable the Republic of Trinidad and Tobago, Guyana and Suriname to understand how the health sector is financed, to plan for future financing needs and to benchmark their health financing performance with peer countries. In addition, health spending for specific diseases such as HIV will be analyzed. This will help the governments to plan for domestic financing for HIV in the context of decreasing donor funding and to ensure more efficient allocation of those funds.

The Health Accounts are being produced using the internationally-recognized framework of the System of Health Accounts 2011 and will provide analysis on the sources of health spending, as well as how health spending is distributed to different health providers, goods and services and diseases or conditions. All three Health Accounts are expected to be completed by the end of September 2018. HFG is also supporting Barbados to update their 2012/13 Health Accounts for an updated analysis of spending for fiscal year 2016/17, using a new approach to analyze health spending in a quick and cost-effective way to respond to health ministries’ needs.

HFG is working with multiple partners to institutionalize Health Accounts in these countries, including UNDP in Trinidad and Tobago and PAHO in Guyana and Suriname, as well as co-producing the Health Accounts in Trinidad and Tobago with The University of West Indies’ Health Economics Unit. HFG’s support will help ensure that the University can be a source of technical support for Health Accounts for the region in the future. Health Accounts results have already been used by countries in the Caribbean to increase government allocation to health (e.g. in Saint Kitts and Nevis) and to introduce taxes on sugary foods and drinks (e.g. in Barbados and Dominica). HFG-supported Health Accounts analysis with partner countries is one component of USAID’s programs designed to strengthen the sustainability of the HIV response in the region, including targeted prevention, care, and support for key populations and the achievement of countries’ commitment to 90-90-90 goals.

SCLAN creates alliances for health initiatives

Image:  (R-L) Spouse of the Prime Minister of Belize and Chair of SCLAN, Mrs. Kim Simplis Barrow, First Lady of Guyana and Vice Chair of SCLAN, H.E. Mrs. Sandra Granger,  Dr. David Walcott (Jamaica), Mrs. Elizabeth Murray (Gilead Sciences), Dr. Edward Greene (PANCAP) and Mr. Ramon Zertuce (Gilead)

Since the Launch of the Spouses of CARICOM Leaders Action Network (SCLAN) in Belize in September 2017 emphasis has been placed on establishing partnerships to advance the objectives of the Network. On June 26, 2018, a Dialogue between the Business Centre for International Understanding (BCIU) and Spouses of CARICOM Leaders Action Network (SCLAN) was held in the Grand Ballroom, Inter-Continental Barclay Hotel, New York. SCLAN was represented by Her Excellency Mrs. Kim Simplis Barrow, Spouse of the Prime Minister of Belize (Chair) and Her Excellency Mrs. Sandra Granger, First Lady of Guyana (Vice Chair). BCIU was represented by its President and CEO Mr Jirair Tichansky who chaired the Dialogue.

Also in attendance were members of Gilead Sciences Inc., including Mrs. Elizabeth Murray, Director of Latin America Access and Emerging Markets. Since the Network’s Inception in 2017, Gilead Sciences Inc. has committed to assist the First Ladies in building stronger collaborations to maximize synergies across the regions. Through their access programs, the company assists developing countries to address high incidences of HIV, including the elimination of mother-to-child transmission by offering HIV medications at substantially reduced prices.

The aim of the dialogue in New York City was to form alliances with the Business Centre in support of the four main pillars of the “Every Caribbean Woman Every Caribbean Child” Initiative for which SCLAN advocates. These include reducing adolescent pregnancies, violence against women and girls, cervical cancer and eliminating mother-to-child transmission of HIV. These pillars fall within the priorities of the PANCAP JFA Roadmap.

Other participants at the Dialogue also expressed support for SCLAN’s Programme. Among them were representatives from Chevron Corporation, Hess Corporation, AB INBEV Ltd, IHG, ORBIS, Henry Schein Inc., Rabin Martin, UNAIDS, PANCAP and a number of NGOs including AIDS for Life, Infiniti Partnership, Global Coalition of the Ageing, Thirty Steve East, Mount Sinai Medical System, UNIDOS EN RED and Physicians for Human Rights.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General and his Team, also responded positively to the initiative and agreed to foster links with  SCLAN in the context of WHO’s 5-year Development Plan which includes the goals of achieving Universal Health Coverage and responding to the health challenges of climate change especially among the SIDS in the Caribbean and the Pacific.

Mrs Barrow in thanking the participants, said ‘this dialogue has opened the doors for worthwhile partnerships that would contribute to the viability of SCLAN in its efforts to make a difference in the lives of women, girls, and adolescents in the Caribbean.”

Caribbean voices from AIDS 2018

Laboratory and Quality Systems Specialist at the Caribbean Med Labs Foundation (CMLF), Ms. Wendy Kitson-Piggott attended the 22nd International AIDS Conference, 23 – 27 July, as a self-sponsored delegate.  The Trinidad-based microbiologist has participated in several of the International AIDS Conferences since 1992 after assuming the regional laboratory advisory function for the Special Programme on Sexually Transmitted Infections (SPSTI) at the Caribbean Epidemiology Centre (CAREC).  

Speaking to the editor of the PANCAP Newsletter, Wendy shared that her consistent attendance has been quite rewarding.  She highlighted that the discussions, decisions and advocacy shared at the global event have resulted in significant actions and responses in the Caribbean aimed at the prevention and control of the HIV epidemic. These have ranged from innovations in lab diagnostic technology, which improved timeliness and reliability to significant cost reductions and access to antiretroviral medication (ARVs).

Wendy believes that it is important for Caribbean professionals in related STI and HIV professions engaged in the response to make a personal effort to continue to participate and influence the ongoing debates about effective and relevant approaches to HIV control and prevention.

AIDS 2018 provided a vast landscape of activities, panel discussions and presentations on innovations in the Global HIV response.  However, it was important for Wendy to secure her spot at events that provided a wealth of knowledge on the continuum of care for the 90-90-90 Targets.  She attended sessions that presented new knowledge on innovative and cost-effective approaches to scaling up HIV testing including experiences with and effectiveness of self-testing across the globe, the future of CD4 and viral load testing and the continuing importance of timely testing and diagnosis of Opportunistic Infections (OIs) and Sexually Transmitted Infections (STIs).  She was also exposed to sessions on the acceptability and feasibility of ‘Treat all’ as well as Pre-exposure prophylaxis (PrEP) in resource-limited environments.

Wendy was also grateful for the experience since it provided critical updates for the role of laboratories in the HIV response.  There were sessions that provided critical data that can aid the Caribbean region’s ability to apply global experiences and evidence to review and improve current lab approaches, programmes and services that support the achievement of treatment cascade targets.

At the culmination of AIDS 2018, Wendy does not regret her investment in attending, she stated, “I look forward to the application of innovative, relevant and cost-effective strategies to expand and improve testing support across the region for every step in the treatment cascade. I hope that professionals from all of the relevant disciplines who attended this conference – lab, clinical, behavioural, economic etc. – return and aggressively and collectively advocate for the region to take ultimate responsibility for the sustainability of efforts and capacities if we are to end AIDS by 2030”.

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Older Adults Living With HIV in the Region Highlighted at AIDS 2018

The Region continues to have a prominent voice at the 22nd International AIDS Conference 2018. The conference heard from Mr. Jason Shepherd from Guyana during a special panel discussion, “The Gray Zone: Ageism as a Human Rights Issue in the Global Response to HIV”. Jason is the Senior Project Officer for the Caribbean Regional Network of People Living with HIV and AIDS (CRN+).

The discussion focused on older adults living with or vulnerable to HIV because of discrimination against the elderly and HIV stigma; a societal problem referred to as the “Gray Zone”. Jason was joined by four global panellists who presented on how present-day HIV responses compromise the right to health of older people and the potential strategies to promote social justice for this population.

Jason shared his experience in the region on discrimination experienced by older adults living with HIV and advocated for more attention on the impact of HIV stigma on the older population. He urged that the region invest in collecting necessary data, which would inform how policymakers can enact strategies to protect the human rights and dignity of this vulnerable group.

He challenged advocates within the Region to propagate messages aimed at placing a spotlight on older adults living with and vulnerable to HIV and the negative health outcomes they experience because of stigma and discrimination. Jason challenged all advocates to bring the issue to the forefront as the region risks leaving this population behind in the HIV response.

Jason forms part of a large contingent of civil society representatives and advocates at AIDS 2018 who are providing a powerful voice for People Living with HIV in the region.

Guyana’s First Lady and PANCAP Champion, Her Excellency Mrs. Sandra Granger chaired “From Scientific Innovation to Implementation” at AIDS 2018

Guyana’s First Lady and PANCAP Champion, Her Excellency Mrs. Sandra Granger has become a familiar presence at the 22nd International AIDS Conference.  Earlier this week, Mrs. Granger and Belize’s First Lady Mrs. Kim Simplis-Barrow participated in a session hosted by MTV Shuga on “Finding and Reaching Men with HIV services”.  The First Lady then helmed the “Building bridges from scientific innovation to implementation” Plenary Discussion as the chair.

In her opening remarks, Mrs. Granger highlighted that the response to HIV has been ongoing for the past 30 years with advances made that allow anyone on treatment to live a normal, healthy life.  She had nothing but praise for the doctors and scientists who have dedicated their lives to working on breakthroughs in HIV treatment.  She urged that these advances must continue until there is a vaccine, which can cure HIV.

One such pioneer in advancing HIV treatment was the first speaker, Dr Brad Jones, Assistant Professor, Infectious Diseases, Cornell University, New York.  Dr Jones presented on the “New Science for a Cure” and was described by Mrs. Granger as a stalwart in the response to HIV who has dedicated a significant portion of his career to studying the immune response to HIV.

Other speakers included Dr Pedro Cahn, Professor of Infectious Diseases, Buenos Aires University Medical School, Argentina and Dr. Nduku Kilonzo, Chief Executive Officer of the AIDS Council, Kenya.

Image: First Lady of Guyana, Her Excellency Mrs. Sandra Granger as taken by an audience member at AIDS 2018 

While performing her duties as chair of the discussion, the First Lady also championed one of her causes, Mother-to-Child Transmission of HIV.  She advocated for continued attention on the issue in order to maintain the gains achieved including seven Caribbean countries being certified for the elimination of “Mother-to-Child” transmission of HIV.

This aligns with the First Lady’s duties as Vice Chair of the Spouses of CARICOM Leaders Action Network (SCLAN), which recently held a dialogue between the Business Centre for International Understanding (BCIU) in New York to advance the causes championed by the organization.

The First Lady of Guyana has effectively utilized her participation at AIDS 2018 to highlight the pillars of SCLAN, which in addition to Mother-to-Child Transmission also include reducing adolescent pregnancies, violence against women and girls and cervical cancer.  These pillars fall within the priorities of the PANCAP Justice for All (JFA) Roadmap.  To view the entire discussion on “From Scientific Innovation to Implementation”, CLICK HERE.

Guyana’s First Lady and PANCAP Champion Mrs. Sandra Granger calls for health curriculum to be implemented in schools

Guyana’s First Lady and PANCAP Champion, Mrs. Sandra Granger called for a comprehensive health curriculum to be implemented in the education system at the early childhood level. Mrs. Granger delivered this charge while addressing attendees of the United Nations Population Fund’s (UNFPA) observance of World Population Day, themed “Family planning is a human right”. The event was held at the Cara Lodge Hotel, Georgetown.

“I am an advocate for teaching [family health] at the nursery level, but it does not mean that our parents must be [excluded]… Parents have a large role to play in how our children are socialised… Let us hope that the Caribbean region will come up with a comprehensive health and family life education curriculum which they can implement in all our schools, so that our children will have the much-needed education and the knowledge that they deserve… [Let us hope] that our communities [and] our parents are educated [on] how they can protect [their] children and… how they should socialise their children, boys and girls, to be responsible human beings and, hopefully, productive adults,” the First Lady said.

Mrs. Granger also highlighted the benefits of accessible family planning. “It has been estimated that if the need for modern contraception was met, there would be 70 percent less unintended pregnancies, 74 percent less unsafe abortions, [and] 25 percent less maternal deaths… There would be an increase in educational opportunities for girls and women, greater participation by women and girls in the labour force, and an increase in their earning potential,” she said.

Notwithstanding the importance of including men in the family planning process, the First Lady said that family planning gives women more control over their lives. “Our men and boys must also be educated to participate actively in family planning and to understand and accept their roles and responsibilities as fathers when children are born… Family planning empowers women and supports their right to decide when and where they will have children if they do want children. In addition, they can set goals for themselves, whether they relate to education, their career, or their well-being,” she said.

Liaison Officer at the UNFPA, Mr. Adler Bynoe delivered the World Population Message on behalf of the organisation’s Executive Director, Dr. Natalia Kanem, who pointed out that accessible family planning can only be realised through collaboration. “Family planning is not only a matter of human rights, it is also central to women’s empowerment, reducing poverty, and achieving the sustainable development… the UNFPA is fully committed to continuing to support countries’ efforts to uphold the right to plan a family. We are striving end all unmet needs for voluntary family planning in developing countries by 2030… We cannot do this alone. Governments, parliamentarians, the private sector and civil society must join forces to make it happen,” he said.

Minister within the Ministry of Public Health, Dr. Karen Cummings said that the Ministry will be doing more to educate young people about the importance of family planning. “The Ministry of Public Health has a health promotion unit that engages in integrated health promotional activities. One of the areas in which it will be placing greater emphasis will be… generating more awareness about sexual reproductive health and the importance of family planning… At the Ministry, we are cognisant that effective and informed family planning has multiple health and social benefits… Through various health promotion activities, the Ministry of Public Health is ensuring that… accurate, unbiased information, to assist in preventing unplanned pregnancies, as well as empowering young people to make educated decisions about sexual and reproductive health, is disseminated countrywide,” she said.

Panellists and teen mothers from Women Across Differences (WAD), Ms. Makeda Perune, Ms. Tishana Peters, and Ms. Adriana Chappelle were in attendance to offer their perspective on the importance of family planning.

“Being a teen mom was a real struggle and the road was very hard… I encourage young persons who are sexually active to… use family planning. [It] will benefit you to [avoid] any unplanned pregnancies. You will have the opportunity to plan your future and set your goals,” Ms. Perune said.

Ms. Peters pointed out some of the risks of ignoring the use of contraceptives while being sexually active. “The [risk] of not using family planning is that it makes you exposed… to STDs, HIV, [and] unwanted and unplanned pregnancies… If I only knew earlier about contraceptives, I would’ve been, maybe, a better young woman today… [Contraceptives] save lives,” she said.

Ms. Chappelle commented on the empowerment that family planning provides. “I thank God for putting WAD in my path because I now know the importance of family planning [as a] human right… It has empowered me in such a way that I know what I deserve as an individual… and I have the courage to stand up for it… This is my body and I have the right to plan my pregnancies,” she said.

World Population Day, observed on July 11, was introduced by the United Nations Development Programme (UNDP) to focus attention on the urgency and importance of population issues. This year marks the 50th anniversary of the affirmation of family planning as a human right.

UNAIDS warns that progress is slowing and time is running out to reach the 2020 HIV targets

GENEVA, 18 July 2018—UNAIDS is issuing countries with a stark wake-up call. In a new report, launched today in Paris, France, at an event co-hosted with Coalition PLUS, UNAIDS warns that the global response to HIV is at a precarious point. At the halfway point to the 2020 targets, the report, Miles to go—closing gaps, breaking barriers, righting injustices, warns that the pace of progress is not matching global ambition. It calls for immediate action to put the world on course to reach critical 2020 targets.

“We are sounding the alarm,” said Michel Sidibé, Executive Director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”

HIV prevention crisis

Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. Although this is nearly half the number of new infections compared to the peak in 1996 (3.4 million), the decline is not quick enough to reach the target of fewer than 500 000 by 2020.

The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010. However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.

Treatment scale-up should not be taken for granted

Due to the impact of antiretroviral therapy roll-out, the number of AIDS-related deaths is the lowest this century (940 000), having dropped below 1 million for the first time in 2016. Yet, the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 AIDS-related deaths.

In just one year, an additional 2.3 million people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7 million. Almost 60% of the 36.9 million people living with HIV were on treatment in 2017, an important achievement, but to reach the 30 million target there needs to be an annual increase of 2.8 million people, and there are indications that the rate of scale-up is slowing down.

West and central Africa lagging behind

Just 26% of children and 41% of adults living with HIV had access to treatment in western and central Africa in 2017, compared to 59% of children and 66% of adults in eastern and southern Africa. Since 2010, AIDS-related deaths have fallen by 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half (51%) of the HIV burden in the region and there has been little progress in reducing new HIV infections in recent years. New HIV infections declined by only 5% (9000) in seven years (from 179 000 to 170 000) and only one in three people living with HIV is on treatment (33%), although HIV treatment coverage has increased from just 24% two years ago.

Progress for children has slowed

The report shows that the gains made for children are not being sustained. New HIV infections among children have declined by only 8% in the past two years, only half (52%) of all children living with HIV are getting treatment and 110 000 children died of AIDS-related illnesses in 2017. Although 80% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2017, an unacceptable 180 000 children acquired HIV during birth or breastfeeding—far away from the target of fewer than 40 000 by the end of 2018.

“One child becoming infected with HIV or one child dying of AIDS is one too many,” said Mr Sidibé. “Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”

Key populations account for almost half of all new HIV infections worldwide

The report also shows that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

“The right to health for all is non-negotiable,” said Mr Sidibé. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programmes. More investments are needed in reaching these key populations.”

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.

“Communities are echoing UNAIDS’ call,” said Vincent Pelletier, positive leader and Executive Director of Coalition PLUS. “We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”

Stigma and discrimination persist

Discrimination by health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing young people, people living with HIV and key populations from accessing HIV prevention, treatment and other sexual and reproductive health services.

Across 19 countries, one in five people living with HIV responding to surveys reported being denied health care and one in five people living with HIV avoided visiting a health facility for fear of stigma or discrimination related to their HIV status. In five of 13 countries with available data, more than 40% of people said they think that children living with HIV should not be able to attend school with children who are HIV-negative.

New agenda needed to stop violence against women

In 2017, around 58% of all new HIV infections among adults more than 15 years old were among women and 6600 young women between the ages of 15 and 24 years became infected with HIV every week. Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners.

“Inequality, a lack of empowerment and violence against women are human rights violations and are continuing to fuel new HIV infections,” said Mr Sidibé. “We must not let up in our efforts to address and root out harassment, abuse and violence, whether at home, in the community or in the workplace.”

90–90–90 can and must be achieved

There has been progress towards the 90–90–90 targets. Three quarters (75%) of all people living with HIV now know their HIV status; of the people who know their status, 79% were accessing treatment in 2017, and of the people accessing treatment, 81% had supressed viral loads.

Six countries, Botswana, Cambodia, Denmark, Eswatini, Namibia and the Netherlands, have already reached the 90–90–90 targets and seven more countries are on track. The largest gap is in the first 90; in western and central Africa, for example, only 48% of people living with HIV know their status.

A big year for the response to tuberculosis

There have been gains in treating and diagnosing HIV among people with tuberculosis (TB)—around nine out of 10 people with TB who are diagnosed with HIV are on treatment. However, TB is still the biggest killer of people living with HIV and three out of five people starting HIV treatment are not screened, tested or treated for TB. The United Nations High-Level Meeting on Tuberculosis in September 2018 is an opportunity to bolster momentum around reaching the TB/HIV targets.

The cost of inaction

Around US$ 20.6 billion was available for the AIDS response in 2017—a rise of 8% since 2016 and 80% of the 2020 target set by the United Nations General Assembly. However, there were no significant new commitments and as a result the one-year rise in resources is unlikely to continue. Achieving the 2020 targets will only be possible if investments from both donor and domestic sources increase.

Ways forward

From townships in southern Africa to remote villages in the Amazon to mega-cities in Asia, the dozens of innovations contained within the pages of the report show that collaboration between health systems and individual communities can successfully reduce stigma and discrimination and deliver services to the vast majority of the people who need them the most.

These innovative approaches continue to drive the solutions needed to achieve the 2020 targets. When combination HIV prevention—including condoms and voluntary medical male circumcision—is pursued at scale, population-level declines in new HIV infections are achieved. Oral pre-exposure prophylaxis (PrEP) is having an impact, particularly among key populations. Offering HIV testing and counselling to family members and the sexual partners of people diagnosed with HIV has significantly improved testing access.

Eastern and southern Africa has seen significant domestic and international investments coupled with strong political commitment and community engagement and is showing significant progress in achieving the 2020 targets.

“For every challenge there is a solution,” said Mr Sidibé. “It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”

In 2017, an estimated:

36.9 million [31.1 million–43.9 million] people globally were living with HIV

21.7 million [19.1 million–22.6 million] people were accessing treatment

1.8 million [1.4 million–2.4 million] people became newly infected with HIV

940 000 [670 000–1.3 million] people died from AIDS-related illnesses

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on FacebookTwitterInstagram and YouTube.

Utilizing ‘Treatment as Prevention’ can stop the spread of HIV and AIDS

Putting an end to the spread of HIV and AIDS would be rather simple, if persons simply adhered to the motto of “Test, Treat, Defeat”, which allows persons to know their status and take action, allowing health professionals to treat them with antiretroviral medication, to prevent HIV transmission to others.

Professor Clive Landis, Deputy Principal of the UWI, Cave Hill Campus spoke of the latest scientific understanding of the prevention effectiveness  of HIV treatment that results in viral suppression, to reduce the risk of sexual transmission of HIV, as he delivered an address at the Barbados
National Faith Leaders Consultation, held at the Radisson Aquatica Resort. This he referred to as,“Treatment as Prevention”.

“So treatment as prevention is that the viral load in your body is suppressed to point where you cannot detect it anymore. It is just no longer detectable.  If you were to stop your drugs, it would come back, but it is no longer detectable in any of your body fluids and it can’t be transmitted. So there is a personal benefit because AIDS is eliminated in that person and there is a public benefit as well because if you are not infectious, you certainly cannot transmit to anybody,” Professor Landis pointed out.

The evidence he said, has been borne out by numerous studies and the fact that mother-to-child transmission of HIV has been significantly reduced in Barbados.  Cuba became the first country in the world to receive validation from the World Health Organisation that it has eliminated mother-to-child transmission of HIV and late last year, six Caribbean countries joined the group of countries, successfully ending mother-to-child transmission of both HIV.

“So by suppressing the virus in a person’s body, there are really noninfectious, even to the life that’s within their womb,” Landis commented.

“So Test, Treat, Defeat is really what it is all about. We will eliminate HIV from the whole of our country, if we can provide the environment in which people feel comfortable to be tested and then they are able to access treatment and be comfortable being treated and then we will just treat our way out of this disease,” Professor Landis said.

Good Response to Faith Leaders Consultation

The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), with funding from the CARIFORUM 10th European Development Fund (EDF) Programme of Support for Wider Caribbean Co-operation, recently hosted the Barbados National Faith Leaders Consultation at the Radisson Aquatica Resort in Barbados.

According to the PANCAP Co-ordinating Unit, the Consultation formed part of a series of engagements with faith leaders in Barbados, under the PANCAP Justice for All programme. As such, participants included numerous faith leaders, representing national faith leaders’ networks from across Barbados.

“The action plan (included, but was not) limited to the establishment of the main goals for an inter-religious faith leaders network in Barbados with emphasis on contributing toward the end of AIDS; identification of the lessons learned for ending AIDS from faith leaders’ engagements with People Living with HIV and with other groups such as parliamentarians, youth leaders, civil society and members of church communities; challenges for developing a viable Faith Leaders Network and proposals for overcoming them; specific recommendations to achieve the goals of the inter-religious/faith leaders network and priorities and timelines for achieving the goals of the Network.”

Now it was during this Faith Leaders Consultation, that the point was made that when it comes to tackling HIV and AIDS, faith-based organisations have a pivotal role to play. Such was the suggestion made by Minister of People Empowerment and Elder Affairs, Cynthia Forde, who delivered the feature address. She was at the time speaking as the Minister responsible for People Empowerment, the co-ordination of the National AIDS Programme and Ecclesiastical Affairs.

“Your work is certainly poised to pay a pivotal role at all levels of the response, if we are to meet the agreed 90-90-90 fast track targets towards delivering an AIDS-free generation, by 2030. Officials from the National AIDS Programme have advised me that this is an achievable goal. However, to be successful, we will need all sectors of society and our partners to play their part in the response,” the Minister told faith leaders.

Minister Forde then referenced a study carried out with faith-based organisations (FBOs) in four countries – Antigua and Barbuda, Barbados, St. Kitts and Nevis and St. Vincent and the Grenadines- by the Caribbean HIV&AIDS Alliance, noting that it confirms that religious leaders still have considerable influence and that many FBOs are already engaged at various levels in HIV prevention and service provision or have acknowledged their potential leadership role and are engaging in HIV prevention and care services, including working towards stigma and discrimination reduction.

However, she said, “The findings of that study highlighted the need to address issues such as moral judgements regarding populations that were most vulnerable to HIV infection, a still lingering fear of transmission via casual contact with a person living with HIV and lack of confidentiality, even in the church.”

She then added, “Based on the premise, ‘Love your neighbour as yourself’, we must therefore continue to develop HIV policies and programmes within our churches and places of worship, promote ongoing education using the pulpit and all church organisations. We also have to address myths, misconceptions, gender and social-cultural norms that fuel stigma and discrimination and reduce the effectiveness of national programmes.”

The Minister also spoke of the need for church groups to be empowered to discuss sexual health and behaviours and other related issues in a much more free and open manner and she made a call for faith leaders to also target “vulnerable seniors”, in their talks on HIV and AIDS.

Participants also heard from Professor Clive Landis, Deputy Principal of the UWI, Cave Hill Campus, who spoke of the latest scientific understanding of the prevention effectiveness of HIV treatment that results in viral suppression, to reduce the risk of sexual transmission of HIV. Putting an end to the spread of HIV and AIDS would be rather simple, he said, if persons simply adhered to the motto of “Test, Treat, Defeat”, which allows persons to know their status and take action, allowing health professionals to treat them with antiretroviral medication, to prevent HIV transmission to others.

Given the response by faith leaders and the information presented, we can all agree that it was quite a productive session. Hopefully, the stated goals were reached.