We have a lot to celebrate this Pride season. Thanks to hard-fought activism in recent years, the World Health Organization will no longer consider transgender people "mentally ill," which will go a long way in global efforts to push back stigma. The European Court of Justice has extended residency rights to same-sex spouses throughout the European Union. The African Commission on Human and Peoples' Rights now emphasizes the need to protect all human rights defenders, including those working for the protection of lesbian, gay, bisexual, transgender, intersex, queer and/or questioning and other (LGBTIQ+) people. We witnessed further sweeping legal and political change in Angola, India, Mozambique, South Korea, Taiwan and Zimbabwe.
But there is still so much to do.
The last 24 months ushered in fatal crackdowns on LGBTIQ+ people in Brazil, Chechnya, Egypt, Indonesia, Iraq, Tanzania, Turkey and Uganda. We saw disappointing setbacks in Brunei, where our already marginalized communities were threatened with the punishment of death; and Kenya, where the country's high court ruled against a long-awaited repeal of discriminatory penal laws banning same-sex behavior. In the United States, the human rights of black and brown people, Muslims, and immigrants are under attack by the Trump administration. Shamefully, the U.S.'s egregious assault on the sexual and reproductive health and rights of cis women and trans people is unraveling years of progress. Attacks on gender equity have a corrosive effect on everyone's civil liberties, because they are built on falsehoods and strike at the basic human rights pillars of self-determination and bodily autonomy.
Globally, communities are being systematically dismantled. Some countries use "LGBT propaganda" laws to limit the right to freedom of association. In a recent survey of 194 countries, only 55 countries permit LGBTIQ+ organizations to register legally. Other governments refuse to register organizations led by or serving people who use drugs and sex workers, because these groups are also criminalized. Being unable to register impedes community-based organizations' ability to receive funding. In addition, these groups are barred from civic participation.
Setbacks on the human rights and gender equity fronts are mirrored in the slowing progress on the HIV front. Gay and bisexual men, migrants, people who use drugs, sex workers, transgender people, and women have higher HIV prevalence and incidence rates than the general population in most parts of the world, but we are less likely to have access to tailored information and comprehensive prevention programs. Many of the world's poorest are charged money they do not have to get the treatment, care and support they need. Forty percent of people living with HIV globally are still without treatment. And for those who do get health care, the social consequence can often be humiliation, marginalization, blackmail, and violence, while community-based organizations are limited in their efforts to protect survivors of such violations.
Budget cuts at national and international levels further undermine HIV responses. Governments have failed to invest in community-led sexual health services. In addition, life-saving resources like pre-exposure prophylaxis, opioid substitution therapies, and antiretroviral treatment remain largely out of reach of our communities. Instead, access to these interventions is often controlled by regressive governments or considered to be the exclusive purview of health care professionals.
While we bear witness to slowing progress on the HIV front, UNAIDS has become embroiled in a leadership crisis, as outgoing executive director Michel Sidibé failed to sufficiently investigate allegations of sexual harassment among staff. This has jeopardized the legitimacy of an organization meant to be the standard bearer in the global response to HIV. In a field that has always advocated against sexual violence across the world, we should all be outraged.
The global response to HIV, and the industry that drives it, must undergo a fundamental shift in mindset and approach. We need to push ourselves to reimagine and reclaim the global HIV response as a struggle to protect our rights and our dignity. We must work to promote human rights by redressing inequity and changing harmful laws, policies and practices.
We must fight for gender equality, with humility and an understanding that without sexual and reproductive health and rights, there will be no LGBTIQ+ rights. We must see health as a human right, advocate for universal health coverage, and reject profit-driven schemes that subordinate poor people.
We must demand accessible, affordable, high-quality, evidence-informed, and rights-based services.
We must insist that communities, not governments, control the tools that can end AIDS.
We must fund community-led, peer-based sexual and reproductive health programs at the local and global levels.
The unfinished business of HIV is a hard and sometimes unbelievable story to tell. But it is one that should be understood against the ebbs and flows of social change worldwide. As we observe this Pride season, which marks the 50th anniversary of the Stonewall riots in New York City, let's remember the people we have lost along the way. Let's elevate the voices of LGBTIQ+ people, migrants, people who use drugs, poor people, sex workers, and cisgender women. And, let's embrace human rights and gender equity as inherently critical prerequisites to ending the AIDS pandemic.