End of AIDS Requires Addressing LGBTI Safety

Like many around the world, I was horrified by the terrorist attack on a gay club in Orlando on June 12. The killer deliberately targeted the club—allegedly in support of ISIS and in line with their attacks on lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals. This attack highlighted the continuing, daily threats to the safety of LGBTI in the United States. Those threats are not limited to this country of course. Threatened by legal penalties, insensitive or even hostile health workers, and societal stigma and discrimination, many LGBTI choose to live in the shadows in countries around the world. Many either do not seek or are barred from essential health services.

Access to essential health services is a key determinant in the success of the global fight against HIV. Despite the historic achievement of 17 million people on antiretroviral treatment (ART), an estimated 20 million people living with HIV are not on ART. Achieving UNAIDS’s 90:90:90 goals and an end to AIDS by 2030 requires targeted interventions at the most granular levels of society to find those most at risk and get them access to services, including ART for those who are HIV positive.

HIV is an opportunistic disease that affects populations in vastly divergent ways even within a generalized epidemic. It is no secret that LGBTI populations are particularly vulnerable to HIV because of fear, repression, and denial of rights and protections. In the United States, gays, bisexuals, and men who have sex with other men accounted for 81 percent (30,689) of the 37,887 estimated HIV diagnoses among all males aged 13 years and older in 2013. “Men who have sex with men, …are 24 times more likely to acquire HIV, [and] transgender people, …are 49 times more likely to be living with HIV.…”

UNAIDS’s fast-track approach calls for an end to HIV-related discrimination as a key pillar for ending the pandemic by 2030. Therefore, one would expect engagement among a wide range of stakeholders on the context of discrimination at the UN High-Level Meeting on Ending AIDS in New York, which occurs every five years. The attack in Orlando came just a day after the conclusion of this year’s meeting, which showcased the huge divide between various stakeholders on recognition, inclusion, and action toward LGBTI.

In preparation, diplomats struggled to reach a clear, unified statement on the urgent need to reach LGBTI as key populations. The Political Declaration referenced men who have sex with men (MSM) and transgender individuals only one time in the entire document. Further, it seemingly gives governments flexibility to remove MSM and transgender individuals from the categories of key populations in their countries. Given that identified key populations are usually targeted with additional services and interventions within country strategies and program efforts, the possibility of removal raises many concerns, including that MSM and transgender people could be further excluded from services.

LGBTI-focused civil society groups, excluded from deliberations and upset by the final Political Declaration, issued their own Global Civil Society Organization (CSO) Declaration . The reality is that the High-Level Meeting reflects a regressive shift of opinion against gay rights and protections in many countries around the world. There was active opposition from Russia, Saudi Arabia, Iran, China, Nigeria, and Uganda during the deliberations—some of the same countries that have enacted or attempted to enact legislation penalizing LGBTI activities with jail or even death.

The U.S. government is to be commended for its strong human rights stance in support of LGBTI-inclusion at the High-Level Meeting inremarks from Ambassador Deborah L. Birx and in its written statement, as well as for PEPFAR’s announcement of a new targeted fund. The $100 million Key Populations Investment Fund will support “innovative, tailored, community-led approaches to address these critical issues and gaps that exist for key populations in the HIV/AIDS response.” Other countries and leaders should follow the U.S. lead and not only acknowledge the LGBTI community but take a more active approach to addressing their vulnerabilities and to providing enabling environments that allow LGBTI individuals to live safely.

The fight against bigotry and in pursuit of safe, discrimination-free environments has to be fought at individual and community levels. Orlando clearly demonstrated how much damage even one lone individual can do. The UN High-Level Meeting demonstrated how important political-level engagement is as well. Governments and their leaders set the tone for the type of society LGBTI experience. If we all truly ascribe to the stated global HIV goals, there is no choice but to engage in meaningful, constructive dialogue on reaching all key populations. The dialogue should translate to efforts in all countries that address the safety issues that prevent LGBTI from living freely and the stigma and discrimination that hinder access to critical health services. We will have difficulty ending AIDS if we do not.

Sara M. Allinder is a senior fellow and deputy director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C.

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