HIV response up against ‘political and religious movements’

Protecting human rights is central to the HIV response, but in several places, the opposite is happening with the introduction of legislation that risks further increases in infections. This includes the recent introduction of punitive bills and laws targeting LGBTQ+ people. In Uganda, the anti-gay bill signed into law in May has driven LGBTQ+ people into hiding and to not seek care and treatment. In the United States, multiple bills have been put forward in different states targeting LGBTQ+ people, including bans on transgender youth seeking gender-affirming care. These laws not only violate people’s human rights but also hinder organizations from providing health care to targeted populations, said Chris Beyrer, a co-chair of the IAS-Lancet Commission on Health and Human Rights, during last week’s IAS Conference on HIV Science. “We are not in a place where we've had a number of important wins in enough countries on human rights to really help bring this epidemic to an end. So I think it's fundamental to the work that's ahead for all of us,” he said. It’s in the data The proof is in the data. A study published earlier this year from 10 countries in Africa collected from 2011 to 2020 showed HIV prevalence among men having sex with men was five times higher in settings where same-sex acts are criminalized, and 10 times higher in settings where there are legal barriers for civil society organizations to provide services. “We can't be in a position where health care is silent on this issue because this is undermining the work that we have all been doing for 30 years.” --— Chris Beyrer, co-chair, IAS-Lancet Commission on Health and Human Rights HIV prevalence among gay men and other men who have sex with men is 11 times higher than the general adult population ages 15 to 49 years old, according to a recent UNAIDS report. It is also four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people, according to the report. “We are up against political and religious movements that are actively opposing human rights and the HIV response,” Beyrer said, adding that “The U.S. is playing an outsized role in the promotion of these anti-gay legislation.” “I'm very sorry to have to say as an American citizen and a taxpayer that a significant amount of the money that is going into promoting these anti-gay laws and in parliaments across Africa and the rest of the world is being led by U.S. religious conservatives, principally evangelicals, but … also conservative Catholics, conservative Mormons,” he said. Adeeba Kamarulzaman, the former president of the International AIDS Society and co-chair of the IAS-Lancet Commission, told Devex that donors such as the U.S. President's Emergency Plan for AIDS Relief can engage domestically with these organizations while using diplomacy in countries where such laws are being introduced and passed. “Especially if you're bringing large amounts of aid, I think you will have some clout without pulling out and causing more harm,” she said. Some hope Beyrer called for a strengthening of bonds between the HIV community and those working on LGBTQ+ rights. Health providers should also try their best in continuing to provide care prevention information as well as treatment services for those living with HIV, and serve as “active voices” for LGBTQ+ rights. “We can't be in a position where health care is silent on this issue because this is undermining the work that we have all been doing for 30 years,” he said. But while the IAS-Lancet commission has documented rollbacks on human rights, particularly affecting LGBTQ+ people, there are some areas for hope, Kamarulzaman said. Some governments in recent years have repealed laws criminalizing same-sex relations. Governments in Malaysia and Scotland, for example, have also started to consider decriminalizing drug use, she said. “There are more and more countries looking sensibly at decriminalization and regulation of possession of personal nonviolent drug use,” she said. “It's a mixed bag, but we must always continue to have hope,” she added.