Reproductive Health Matters recently attended the 22nd International AIDS Conference in Amsterdam. The theme of AIDS 2018 is “Breaking Barriers, Building Bridges”, drawing attention to the need of rights-based approaches to more effectively reach key populations. This year, the conference has also emphasized the need to join the SRHR and HIV response specifically. “Poor sexual and reproductive health and HIV share common root causes, and yet, the respective responses to HIV and to sexual and reproductive health and rights remain largely unaligned, uncoordinated, and under-resourced” (Daniel McCartney, IPPF).

RHM identified a number of perspectives and voices from the SRHR community and asked them to reflect on the SRHR relevance at AIDS 2018.

Sofia Gruskin, Director of the Institute for Global Health and its Program on Global Health & Human Rights at the University of Southern California

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The other thing that I want to raise is this focus on U=U which is this idea of undetectable means untransmissable and I think that that is incredibly exciting but I think it also raises a danger. I think there is something that we, within the human rights community, need to be able to talk about, which is that while this is an incredible scientific advance, and it’s an incredible advance for non-stigmatization of people who do not have a detectable viral load, for people who do have a detectable viral load, I fear without proper attention it will increase stigma. And I fear that what it may do inadvertently is set up different communities and approaches to people living with HIV. And I think it’s something that we not only need to address but that we need to think through very carefully.

Aditi Sharma, International Advocacy Strategist & Campaigner – GNP+, The Global Network of People Living with HIV

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So 30 years into the epidemic and more, stigma remains a really big issue, as you will hear from session after session. In all the community research that is done by the networks of people living with HIV, stigma remains one of the top barriers for people living with HIV in terms of access. Access to treatment, access to prevention services, access to testing, but also to realise their rights as individuals.

So GNP Plus, ICW, which is the International Coalition for Women living with HIV and UNAIDS collaborate on a tool that measures stigma in communities. And what’s unique about this tool is that the research is done by people living with HIV and the interviewees are also people living with HIV. So it’s a community-led research process to measure stigma. Of course, measuring stigma is not enough, we then need to use that evidence to advocate for initiatives to reduce stigma whether it’s in churches and mosques, or in schools, or in workplaces, or in our communities where often people are left out of weddings and social occasions because of their HIV status.

In 2017 we began work, 10 years after the stigma index was first launched, it’s 10 years old this year, we have now got a new stigma index 2.0. What’s new about this is that it also looks much deeper in to the stigma that key populations living with HIV face and the intersectionality of that. So, it’s not just women living with HIV but are they also potentially women who use drugs, or women who do sex work or is it a young woman living with HIV. So you can disaggregate data by that and really come up with interventions to address the problem.

For women living with HIV, the stigma index has revealed a lot of discrimination in the healthcare settings, right from forced and coerced sterilization, which is not just happening in individual countries but across,  to lack of confidentiality around their status and their status being disclosed to their partners. So a range of problems are highlighted by the stigma index. It is then up to the world, the governments, as well as communities,  to then use this evidence to reduce stigma. End HIV stigma.

Laura Ferguson, Associate Director of the Programme on Global Health and Human Rights, University of Southern California,

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So we’re here at the AIDS conference in Amsterdam, and everyone is very focused on these 90-90-90 targets. The world wants to diagnose 90% of people living with HIV so that they know their status, they want 90% of those people on treatment, they want 90% of them virally suppressed, which means that they’re adhering to treatment and they’re taking control. But we’re off track and now people are asking why, and they’re beginning to pay attention to some of the harder to reach populations who’ve been a little bit neglected up until now.

So what’s really exciting is that we’re beginning to see attention to decriminalization. Decriminalization of HIV transmission, decriminalization of certain behaviours like drug use, sex work, sex between men, obviously there’s still a long way to to there but at least it’s on the agenda now.

And one of the other issues which people are beginning to talk about is discrimination in healthcare settings. We’ve been seeing increased documentation of maltreatment within healthcare settings, people being coercively tested for HIV, people’s HIV status being disclosed to others without any consent, physical and verbal abuse within healthcare settings, the provision of treatment being contingent upon the uptake of family planning, all sorts of things. Now, with all that going on, people aren’t going to adhere to their treatment. And so the world is finally paying attention to that because they want to reach these targets. This of course is a wonderful thing. The next step, which we hope we might get to, is that people are paying attention to these things because they care about these people’s lives, not just about the global targets.

Mauro Cabral Grinspan, Executive Director of Global Action for Trans Equality (GATE)

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GATE is an international organisation working on trans in diversity and intersex issues. This is a key conference, not only because of the big number of activists that we have here but also because of the opportunities of engaging with key processes from the opportunity of introducing depathologization as a key issue going on with the international classification of diseases produced by the World Health Organisation but also with the U=U pre-conference and all the actions, GATE is supporting that work as well.

In my case specifically, my work here is focused in asking a question that we are forced to ask everywhere, all the time, which is ‘where is the money for trans movements?’ For us there is no opportunity of realising trans people’s human rights including their sexual and reproductive rights without getting paid jobs for trans people and without getting adequate funding for the different issues the trans movement is addressing, including issues that go from reproductive health and rights, to what’s going on with our sexuality in the context of the HIV response.

So during the next days, we are going to have a series of presentations in panels, sessions in the trans networking, workshops and parallel meetings including key meetings on trans men and HIV, and GATE  is announcing this week the convening of an international working group on trans men who have sex with men and HIV. So, we are quite proud and happy for that.

Luisa Cabal, Chief, Human Rights and Law at UNAIDS

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“I’ve been thinking that Amsterdam is about water, canals and bridges, and we’ve been crossing a lot of bridges in the past two days since we arrived. And I kept thinking that if we’re really going to put the person at the centre, and the women and girls at the centre, it really demands from us that we cross bridges, that we build those bridges, or we strengthen the bridges. And that keeps being a recurring theme. 

What do I mean by those bridges and areas where we’re not doing enough to strengthen those connections and reach out?

One, is we need to break the silos. We talk a lot about it but we need to do more between reproductive health, HIV, issues of cervical cancer. I was recently in a meeting where I was reminded that over 260 000 women are dying of cervical cancer every year, and mostly in the global south. Women living with HIV are more vulnerable to cervical cancer, yet we need for visibility, more action and investments. So how do we make sure that reproductive rights activists are demanding more action for women and girls to prevent HPV but then to also screen and address cervical cancer. So are we making those connections between reproductive rights, cervical cancer, HIV, and other needs of people including women and girls? 

In the legal part, we also talk a lot about the misuse and overuse of criminal laws but we seem to be working in silos, whether it’s HIV criminalization, criminalization of adultery , criminalization of reproductive health services, criminalization of HIV transmission. And I think that while the dialogues and discussions are ongoing, we really need to do more to make those connections and to work hand in hand to see how the overuse of criminal law does not affect any community in particular but it is affecting across sectors, the most marginalised and vulnerable women and men. 

And last but not least, I want to raise the need to build bridges and make more connections around stigma and discrimination. Stigma and discrimination, we’ve worked from the UN perspective and activists have been working around stigma and discrimination in healthcare and in healthcare settings in particular. And this is another area where we need to stop silo-ing issues, whether it’s stigma based on gender, stigma based on HIV status, to actually look at the intersectionality of discrimination and how many of these forms of discrimination are compounded and we need to be activists and demand action on the multiple and intersecting forms of discrimination because a women does not hold just one identity or a girl does not hold just one identity. When she goes to a healthcare service, shes discriminated against because she’s young, because of her ethnic background, because she might have a disability or she might be a migrant, so we all need to figure out how, in our advocacy and in our work, we’re more inclusive and we’re building those bridges with the different communities to join forces and demand more action together.