‘ There is an increasing recognition that public health often provides and added and compelling justification for safeguarding human rights, despite the respect, protection and fulfilment which they merit in their own right. In the context of HIV/AIDS, an environment in which human rights are respected ensures that vulnerability to HIV/AIDS is reduced, those infected with and affected by HIV/AIDS live a life of dignity without discrimination and the personal and societal impact of HIV infection is alleviated.’ UNAIDS International Guidelines on HIV and Human Rights 2006 HIV and Human Rights

Human Rights & HIV: The AIDS Paradox “ In order to prevent and control the spread of HIV, we must protect and promote the human rights of those most vulnerable, typically marginalized”

EXPENDITUTURES FOR HIV PREVENTION: UNGASS 2008 Country reporting Data UNGASS reports from 38 countries MSM: 1.2% SW: 1% IDU: 2% Other prevention services: 96%

Findings: Global Commission on HIV and the Law and key populations

Findings: sex workers

Recommendations: sex workers

Findings: men who have sex with men

Who are the most vulnerable?

$3 million spent in these 38 countries for MSM prevention services $29 million needed in these 38 countries for MSM USD 0 USD 5 USD 10 USD 15 USD 20 USD 25 USD 30 USD 35 USD millions) Comparison of AIDS Expenditures and Resource Needs for programs aimed at / involving Men who have sex with Men (38 countries reporting detailed spending and comparison with resource needs estimates for MSM preventive services) ExpendituresResource Needs

Median percentage of MSM reached with HIV prevention services Countries HAVING non- discrimination laws/regs protecting MSM Countries NOT HAVING non- discrimination laws/regulations for MSM Adapted from UNAIDS 2008 Global Report

Recommendations: MSM

Findings: transgender

Recommendations: transgender

HIV testing and HIV status in Southern African lesbian and other women who have sex with women: outcomes of a community-based study HIV affects Southern African lesbian and bisexual women: they get tested, some are afraid to be HIV positive, and a substantial number of women report to be HIV positive. Not sex with men per se but non-consensual sex (with men and women) is a crucial risk factor for HIV infection. Not all HIV infections among lesbian and bisexual women could be explained by sex with men or injecting drug use. In the Southern African context, HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women, while HIV prevention should be broad, including for instance non-consensual sex.

Findings: WSW A large proportion of the women reported to have been tested for HIV (78.3%); independent factors associated with having been tested include lifetime number of female and male partners; women who had engaged in transactional sex with women only or with women and men were likely to test. Self-reported HIV prevalence among the tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was ever having experienced non-consensual sex with men, with women, or with both men and women. Despite the image of lesbian women as invulnerable, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

WSW project partners The project was funded by Open Society Initiative for Southern Africa, United Nations Development Programme, and Open Society Foundations these organizations also participated in the study. The research project was designed and implemented in collaboration with the following community organizations: Behind the Mask SA, Durban Lesbian and Gay Community & Health Centre SA, Forum for the Empowerment of Women SA, Gays and Lesbians of Zimbabwe, LeGaBiBo (Lesbians, Gays and Bisexuals of Botswana), OUT LGBT Well-Being SA, Out-Right Namibia, and Triangle Project SA. We thank all women who participated in the study.

Key Lessons Stigma and discrimination continue to beset people living with HIV and individuals most at risk of infection — men who have sex with men, transgender people, injecting drug users and sex workers. Social and legal challenges to human rights create significant barriers to an effective national AIDS responses. A sustainable response must address punitive laws and the social drivers of the disease as well as the local and municipal regulations that bolster and excuse persecution

Conclusions “We can empower men who have sex with men, sex workers and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy: by ensuring that men who have sex with men, sex workers and transgender people are empowered to both access and deliver comprehensive and appropriate packages of HIV prevention, treatment, care and support services and by ensuring that law enforcement agencies and the judicial system protect their rights.” UNAIDS Joint Action for Results