Dr Richard Amenyah
Socio-cultural and religious norms and archaic policies and laws that criminalise and don’t protect the rights of vulnerable populations contribute significantly to the HIV epidemic in the Caribbean. These societal barriers are fault lines which allow inequalities to widen and fester as a canker.
The Caribbean is the second highest region globally, outside sub–Saharan Africa, where HIV is prevalent. A little under half of people in the region do not show acceptable attitudes to people living with HIV. This is happening within the context of significant progress the region is making in reducing new HIV infections by 28% between 2010 and 2021. AIDS-related deaths reduced by over half in the same period.
Can you imagine how this region would have performed without an environment with punitive laws, stigma and discrimination and gender-based violence?
It is important to identify and address the inequalities that exist in the region by promoting inclusion and respect for diversity. Building a just society involves understanding socio-cultural and gender norms and how they are changing and shaping how we interact to advance our civic, political, and economic rights. These norms, policies and practices affect how people access the services they need to safeguard their health, livelihood, and well-being and, importantly, enjoy their rights.
The Caribbean region cannot end the AIDS epidemic as a public health threat by 2030 without dealing with these societal barriers preventing the region from fulfilling the promise made by its leaders in the 2021 Political Declaration. This is how we build equal and just societies.
The focus of this year’s Zero Discrimination Day, which is observed annually on March 1, is on decriminalization and how it saves the lives of vulnerable and marginalized populations and people living with HIV (PLHIV).
The Joint United Nations Programme on HIV/AIDS (UNAIDS) believes criminal laws targeting key populations and people living with HIV violate their human rights, make them vulnerable, increase their risk to HIV transmission and exacerbate the stigma people face. This put people in danger by creating barriers to the support and services they need to protect their health. These are the key elements of structural inequalities which are unfortunately driving the HIV epidemic globally and therefore preventing people from realizing improvement in their health and wellbeing. The Caribbean is no exception. However, political leaders in the region can lead and show the world how being inclusive is a strength and not a weakness or threat to building an equal and just society committed to ending AIDS as a public health threat.
UNAIDS data show that 134 countries, including six in the Caribbean, still explicitly criminalize or otherwise prosecute HIV exposure, non-disclosure, or transmission. Twenty countries criminalize and/or prosecute transgender persons. Data show as well that 153 countries, including 14 countries from the Caribbean, criminalize at least one aspect of sex work and sixty-seven countries, including eight in the region, that criminalize consensual same-sex sexual activity. Furthermore, forty-eight countries, including five countries in the Caribbean, still place restrictions on entry into their territory for people living with HIV while 53 countries report that they require mandatory HIV testing, for example for marriage certificates or for performing certain professions. Finally, 106 countries require parental consent for adolescents to access HIV testing. All Caribbean countries apart from Guyana require parental consent for HIV testing. These legal and policy barriers are making it difficult for the world to close the chapter on the AIDS epidemic.
World leaders made a promise to address these difficult issues by agreeing for the first time to achieving the “10-10-10 targets.” They made a commitment that by 2025 less than 10% of countries would have punitive legal and policy environments that affect the HIV response; less than 10% of countries reporting stigma and discrimination against key populations and persons living with HIV and finally less than 10% of countries report gender-based violence against women and girls.
As we celebrate Zero Discrimination Day under the theme ”Save lives: Decriminalize”, we are reminded of these commitments. Punitive and discriminatory laws across the region are harmful, they help to strip people living with HIV and key populations of their rights and are inimical to accelerating the end of AIDS as a public health threat in the region. UNAIDS therefore calls on all Caribbean governments to re-commit to the principles of rights and take steps to fulfil their obligations to protect and promote human rights for all.
The Caribbean region can end the AIDS epidemic by improving the human rights environment through legal and policy reforms to respect, protect and fulfil the rights of vulnerable key populations and persons living with HIV to enhance access to critical health services they need. This is the pathway to building an equal and just society and to leave no one behind.
Dr Richard Amenyah is medical doctor and public health specialist from Ghana. He is the UNAIDS Multi-Country Director for the Caribbean. Send feedback to firstname.lastname@example.org or follow him on Twitter @RichardAmenyah and @UNAIDSCaribbean.