2021 Global AIDS Strategy 2021-2026

UNAIDS PCB
25 March 2021

Deci­sion UNAIDS/PCB (EM)/3.3

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Spe­cial ses­sion meet­ing report

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Analysis of precedential value

UNAIDS is guided by its Pro­gramme Coor­di­nat­ing Board (PCB) with rep­re­sen­ta­tives of 22 gov­ern­ments from all geo­graphic regions, the UNAIDS Cospon­sors, and five rep­re­sen­ta­tives of non­govern­men­tal orga­ni­za­tions, includ­ing asso­ci­a­tions of peo­ple liv­ing with HIV. The PCB estab­lishes the broad poli­cies and pri­or­i­ties for UNAIDS.

The Global AIDS Strat­egy was adopted unan­i­mously by deci­sion of the PCB. As noted in the fore­word to the adopted Strat­egy, it “sets out evi­dence-based pri­or­ity actions and bold tar­gets to get every coun­try and every com­mu­nity on-track to end AIDS as a pub­lic health threat by 2030.” In the deci­sion adopt­ing the Strat­egy, the PCB reaf­firmed “that, in imple­ment­ing the Global AIDS Strat­egy 2021-2026, national strate­gies and con­texts of the coun­tries con­cerned should be con­sid­ered”.

Used as precedent

human rights, negative legal determinants, positive legal determinants

• “Less than 10% of coun­tries have puni­tive legal and pol­icy envi­ron­ments that deny or limit access to ser­vices:
  (i) Less than 10% of coun­tries crim­i­nal­ize sex work, pos­ses­sion of small amounts of drugs, same-sex sex­ual behav­iour, and HIV trans­mis­sion, expo­sure or nondis­clo­sure by 2025;
  (ii) Less than 10% of coun­tries lack mech­a­nisms for peo­ple liv­ing with HIV and key pop­u­la­tions to report abuse and dis­crim­i­na­tion and seek redress by 2025;
  (iii) Less than 10% of peo­ple liv­ing with HIV and key pop­u­la­tions lack access to legal ser­vices by 2025;
  (iv) More than 90% of peo­ple liv­ing with HIV who expe­ri­enced rights abuses have sought redress by 2025.” (annex 1, 2025 tar­gets)

stigma and discrimination

• “Less than 10% of peo­ple liv­ing with HIV and key pop­u­la­tions expe­ri­ence stigma and dis­crim­i­na­tion;
  (i) Less than 10% of peo­ple liv­ing with HIV report inter­nal­ized stigma by 2025;
  (ii) Less than 10% of peo­ple liv­ing with HIV report expe­ri­enc­ing stigma and dis­crim­i­na­tion in health care and com­mu­nity set­tings by 2025;
  Less than 10% of key pop­u­la­tions (i.e., gay men and other men who have sex with men, sex work­ers, trans­gen­der peo­ple and peo­ple who inject drugs) report expe­ri­enc­ing stigma and dis­crim­i­na­tion by 2025;
  (iii) Less than 10% of the gen­eral pop­u­la­tion reports dis­crim­i­na­tory atti­tudes towards peo­ple liv­ing with HIV by 2025;
  (iv) Less than 10% of health work­ers report neg­a­tive atti­tudes towards peo­ple liv­ing with HIV by 2025;
  (v) Less than 10% of health work­ers report neg­a­tive atti­tudes towards key pop­u­la­tions by 2025;
  (vi); Less than 10% of law enforce­ment offi­cers report neg­a­tive atti­tudes towards key pop­u­la­tions by 2025.” (annex 1, 2025 tar­gets)

bodily autonomy and integrity, gender equality, key and vulnerable populations

• “Less than 10% of women, girls, peo­ple liv­ing with HIV and key pop­u­la­tions expe­ri­ence gen­der inequal­ity and vio­lence;
  (i) Less than 10% of women and girls expe­ri­ence phys­i­cal or sex­ual vio­lence from an inti­mate part­ner by 2025;
  Less than 10% of key pop­u­la­tions (i.e., gay men and other men who have sex with men, sex work­ers, trans­gen­der peo­ple and peo­ple who inject drugs) expe­ri­ence phys­i­cal or sex­ual vio­lence by 2025;
  (ii) Less than 10% of peo­ple liv­ing with HIV expe­ri­ence phys­i­cal or sex­ual vio­lence by 2025;
  (iii) Less than 10% of peo­ple sup­port inequitable gen­der norms by 2025;
  (iv) Greater than 90% of HIV ser­vices are gen­der-respon­sive by 2025.” (annex 1, 2025 tar­gets)

key population and community leadership

• “30% of test­ing and treat­ment ser­vices to be deliv­ered by com­mu­nity-led orga­ni­za­tions, with focus on: enhanced access to test­ing, link­age to treat­ment, adher­ence and reten­tion sup­port, treat­ment lit­er­acy, and com­po­nents of dif­fer­en­ti­ated ser­vice deliv­ery, e.g. dis­tri­bu­tion of ARV (anti­retro­vi­ral treat­ments).” (annex 2, 2025 tar­gets)

• “80% of ser­vice deliv­ery for HIV pre­ven­tion pro­grammes for key pop­u­la­tions to be deliv­ered by com­mu­nity-led orga­ni­za­tions” (annex 2, 2025 tar­gets)

• “If we are to reduce HIV-related inequal­i­ties and get the response on-track to end AIDS by 2030, com­mu­ni­ties liv­ing with or affected by HIV must lead the way. Com­mu­ni­ties liv­ing with and affected by HIV have been the back­bone of the HIV response at every level, from global to national to com­mu­nity. They advo­cate for effec­tive action; they inform local, national, regional and inter­na­tional responses regard­ing com­mu­ni­ties’ needs; and they plan, design and deliver ser­vices. They also advance the real­iza­tion of human rights and gen­der equal­ity, and sup­port the account­abil­ity and mon­i­tor­ing of HIV responses. Com­mu­ni­ties give voice to peo­ple who are often excluded from deci­sion- mak­ing processes. Effec­tive com­mu­nity-led HIV responses must be ade­quately resourced and sup­ported to enable com­mu­ni­ties to play their vital roles as equal, fully- inte­grated part­ners in national sys­tems for health and social ser­vices.” (para­graph 132)

• “Progress in recent years demon­strates the essen­tial role of com­mu­nity-led HIV responses in global efforts to end AIDS. Com­mu­ni­ties have led efforts to iden­tify and address key inequal­i­ties; expanded the evi­dence base for action to end AIDS as a pub­lic health treat; sup­ported the plan­ning and imple­men­ta­tion of national HIV responses; iden­ti­fied key issues and gaps for national and mul­ti­lat­eral gov­er­nance and coor­di­na­tion bod­ies; expanded the reach, scale, qual­ity and inno­va­tion of HIV ser­vices; and played a vis­i­ble role as defend­ers of human rights. As of 2019, com­mu­nity and key pop­u­la­tion-led HIV pre­ven­tion pro­grammes that exceeded 80% cov­er­age in many coun­tries were among the most effec­tive. With acute resource con­straints, it is crit­i­cal to pri­or­i­tize HIV pro­grammes that deliver opti­mal results in pre­ven­tion, test­ing, link­ages to treat­ment, treat­ment lit­er­acy and adher­ence sup­port that are led by peo­ple liv­ing with HIV, key pop­u­la­tions and women.” (para­graph 133)

• “Fully imple­ment the GIPA (Greater Involve­ment of Peo­ple liv­ing with AIDS) prin­ci­ple to put the lead­er­ship of peo­ple liv­ing with HIV at the cen­tre of HIV responses, ensure that net­works of peo­ple liv­ing with HIV and key pop­u­la­tions are rep­re­sented in deci­sion-mak­ing bod­ies and can influ­ence the deci­sions that affect their lives, and have access to tech­ni­cal sup­port for com­mu­nity mobi­liza­tion, strength­ened orga­ni­za­tional capac­i­ties, and lead­er­ship devel­op­ment.” (para­graph 137(a))

gender equality, key population and community leadership, positive legal determinants, stigma and discrimination

• “80% ser­vices for women, includ­ing pre­ven­tion ser­vices for women at increased risk to acquire HIV, as well as pro­grammes and ser­vices for access to HIV test­ing, link­age to treat­ment (ART), adher­ence and reten­tion sup­port, reduc­tion/elim­i­na­tion of vio­lence against women, reduc­tion/elim­i­na­tion of HIV related stigma and dis­crim­i­na­tion among women, legal lit­er­acy and legal ser­vices spe­cific for women- related issues, to be deliv­ered by com­mu­nity-led orga­ni­za­tions that are women-led” (annex 2, 2025 tar­gets)

key population and community leadership, positive legal determinants, societal enablers, stigma and discrimination

• “ 60% of the pro­grammes sup­port­ing the achieve­ment of soci­etal enablers, includ­ing pro­grammes to reduce/elim­i­nate HIV-related stigma and dis­crim­i­na­tion, advo­cacy to pro­mote enabling legal envi­ron­ments, pro­grammes for legal lit­er­acy and link­ages to legal sup­port, and reduc­tion/elim­i­na­tion of gen­der-based vio­lence, to be deliv­ered by com­mu­nity-led orga­ni­za­tions.” (annex 2, 2025 tar­gets)

negative legal determinants, stigma and discrimination

• “Reach­ing the soci­etal enabler tar­gets in this Strat­egy is cru­cial. Mod­el­ling indi­cates that fail­ure to reach the tar­gets for stigma and dis­crim­i­na­tion, crim­i­nal­iza­tion and gen­der equal­ity will pre­vent the world from achiev­ing the other ambi­tious tar­gets in the Strat­egy and will lead to an addi­tional 2.5 mil­lion new HIV infec­tions and 1.7 mil­lion AIDS-related deaths between 2020 and 2030.” (para­graph 85)

gender equality, negative legal determinants, stigma and discrimination

• “Rec­og­niz­ing the equal worth and dig­nity of every per­son is not only an eth­i­cal imper­a­tive and an oblig­a­tion aris­ing from inter­na­tional human rights instru­ments, it is cen­tral for end­ing AIDS as a pub­lic health threat. SDG 3 can­not be achieved if stigma, dis­crim­i­na­tion, crim­i­nal­iza­tion of key pop­u­la­tions, vio­lence, social exclu­sion and other human rights vio­la­tions in the con­text of HIV are allowed to con­tinue and if HIV-related inequal­i­ties per­sist. The evi­dence con­sis­tently shows that the crim­i­nal­iza­tion of peo­ple liv­ing with HIV and key pop­u­la­tions reduces ser­vice uptake and increases HIV inci­dence. Gen­der inequal­i­ties also increase the HIV vul­ner­a­bil­ity of women and girls, with women who expe­ri­ence inti­mate part­ner vio­lence in high-preva­lence set­tings more than 50% more likely to be liv­ing with HIV.” (para­graph 129)

key population and community leadership, societal enablers

• “With its new tar­gets for soci­etal enablers, the Strat­egy demands that the same com­mit­ment and atten­tion to tech­ni­cal detail that has char­ac­ter­ized the HIV response’s pro­gram­matic efforts be applied to the urgent busi­ness of address­ing the social and struc­tural fac­tors that slow progress against AIDS. The Strat­egy pri­or­i­tizes lessons from recent suc­cesses and applies them more broadly, espe­cially in coun­tries where inequal­i­ties are enabled by puni­tive legal and pol­icy frame­works. Com­mu­ni­ties of peo­ple liv­ing with, affected by, or most at risk of HIV must be sup­ported and effec­tively resourced to gal­va­nize actions that can reduce inequal­i­ties in the response and to ensure that responses meet the needs of all peo­ple.” (para­graph 131)

key population and community leadership, negative legal determinants

• “As seen dur­ing COVID-19 pan­demic, under-uti­liza­tion of the poten­tial of com­mu­ni­ties is com­pounded by an acute short­age of resources for com­mu­nity-led responses. Shrink­ing space for civil soci­ety in many coun­tries, as well as per­sis­tent social and struc­tural fac­tors, exac­er­bate the pres­sures on com­mu­nity-led HIV responses and increase the risk of vio­lence against orga­ni­za­tions that serve key pop­u­la­tions or other mar­gin­al­ized groups.” (para­graph 135)

negative legal determinants

• “Puni­tive laws, the absence of enabling laws and poli­cies, and inad­e­quate access to jus­tice con­trib­ute to the inequal­i­ties that under­mine HIV responses. At least 92 coun­tries crim­i­nal­ize HIV expo­sure, nondis­clo­sure and/or trans­mis­sion, and 48 coun­tries or ter­ri­to­ries con­tinue to block peo­ple liv­ing with HIV from entry, stay or res­i­dence. Among coun­tries report­ing data to UNAIDS in 2019, 32 crim­i­nal­ized and/or pros­e­cuted trans­gen­der per­sons, 69 crim­i­nal­ized same-sex sex­ual activ­ity, 129 crim­i­nal­ized some aspect of sex work, and 111 crim­i­nal­ized the use or pos­ses­sion of drugs for per­sonal use. The health and well-being of peo­ple liv­ing in pris­ons or other closed set­tings are rou­tinely put at risk by puni­tive laws and poli­cies, includ­ing denial of access to essen­tial health ser­vices.” (para­graph 140)

human rights, key population and community leadership, positive legal determinants

• “Efforts to anchor HIV responses in human rights prin­ci­ples and approaches, includ­ing the pri­or­ity actions out­lined below, can only be achieved through strong polit­i­cal lead­er­ship and the active engage­ment and lead­er­ship of com­mu­nity-led responses that are ade­quately resourced to advo­cate for, mon­i­tor and imple­ment rights-based responses.” (para­graph 141)

key population and community leadership, negative legal determinants

• “Cre­ate an enabling legal envi­ron­ment by remov­ing puni­tive and dis­crim­i­na­tory laws and poli­cies, includ­ing laws that crim­i­nal­ize sex work, drug use or pos­ses­sion for per­sonal use and con­sen­sual same-sex sex­ual rela­tions, or that crim­i­nal­ize HIV expo­sure, nondis­clo­sure or trans­mis­sion. Intro­duce and enforce pro­tec­tive and enabling leg­is­la­tion and poli­cies, and end the overuse of crim­i­nal and gen­eral laws to tar­get peo­ple liv­ing with HIV and key pop­u­la­tions.” (para­graph 144(c))

human rights, positive legal determinants

• “Ensure account­abil­ity for HIV-related human rights vio­la­tions by increas­ing mean­ing­ful access to jus­tice and account­abil­ity for peo­ple liv­ing with or affected by HIV and key pop­u­la­tions. This includes increas­ing col­lab­o­ra­tion among key stake­hold­ers, sup­port­ing legal lit­er­acy pro­grammes, increas­ing access to legal sup­port and rep­re­sen­ta­tion and sup­port­ing com­mu­nity mon­i­tor­ing for peo­ple liv­ing with or affected by HIV.” (para­graph 144(e))

gender equality

• “Gen­der inequal­ity is a key dri­ver of the AIDS epi­demic. Unequal power dynam­ics between men and women and harm­ful gen­der norms increase the HIV vul­ner­a­bil­ity of women and girls in all their diver­sity, deprive them of voice and the abil­ity to make deci­sions regard­ing their lives, reduce their abil­ity to access ser­vices that meet their needs, increase their risks of vio­lence or other harms, and ham­per their abil­ity to mit­i­gate the impact of AIDS.” (para­graph 145)

gender equality, negative legal determinants

• “Pol­icy bar­ri­ers, such as age-of-con­sent laws for access­ing HIV test­ing or sex­ual and repro­duc­tive health ser­vices, as well as the social stigma asso­ci­ated with using those ser­vices, hin­der ado­les­cent girls from mak­ing deci­sions about their own sex­ual and repro­duc­tive health. Dis­crim­i­na­tory laws and prac­tices should be repealed, using the Con­ven­tion on Elim­i­na­tion of All Forms of Dis­crim­i­na­tion Against Women as a mon­i­tor­ing tool to high­light vio­la­tions of the rights of women liv­ing with and affected by HIV.” (para­graph 148)

comprehensive sexuality education, gender equality

• “A lack of edu­ca­tion and eco­nomic oppor­tu­ni­ties and insuf­fi­cient or nonex­is­tent access to com­pre­hen­sive sex­u­al­ity edu­ca­tion also increase women and girls’ vul­ner­a­bil­ity to HIV. Research evi­dence con­firms that com­ple­tion of sec­ondary edu­ca­tion can help pro­tect girls against HIV acqui­si­tion, while also yield­ing broader social and eco­nomic ben­e­fits. Com­pre­hen­sive sex­u­al­ity edu­ca­tion helps improve young peo­ple’s knowl­edge about HIV and coun­ters mis­in­for­ma­tion about sex­ual and repro­duc­tive health. A grow­ing body of data has val­i­dated numer­ous, inter­sec­toral, gen­der-trans­for­ma­tive inter­ven­tions. Impor­tant, though still inad­e­quate, invest­ments by the Global Fund, the United States Pres­i­dent’s Emer­gency Plan for AIDS Relief (PEP­FAR), UN Women, UNICEF and other part­ners are sup­port­ing the empow­er­ment, mobi­liza­tion and lead­er­ship of women liv­ing with HIV, women from key pop­u­la­tions, and ado­les­cent girls and young women.” (para­graph 150)

gender equality, intersectionality

• “Pri­or­i­tize peo­ple who are left behind due to their gen­der, age, sex­ual ori­en­ta­tion or gen­der iden­tity or occu­pa­tion. Ensure that women and girls who face inter­sect­ing forms of dis­crim­i­na­tion and vio­lence (e.g. indige­nous women, women with dis­abil­i­ties, women who use drugs, women in prison, female sex work­ers and trans­gen­der women) receive the tai­lored ser­vices and sup­port they need, and ensure that they are mean­ing­fully engaged in HIV-related deci­sion-mak­ing. Ensure access to rights lit­er­acy and mean­ing­ful com­plaint and redress mech­a­nisms for vio­la­tions of their human rights in the con­text of HIV.” (para­graph 153(f))

gender equality, negative legal determinants, reproductive rights, sexual rights

• “Repeal dis­crim­i­na­tory laws and poli­cies that increase women and girls’ vul­ner­a­bil­ity to HIV and address vio­la­tions of their sex­ual and repro­duc­tive health and rights.” (para­graph 153(h))

gender equality, key population and community leadership

• “Invest in women-led responses to HIV and in ini­tia­tives to sup­port and build women’s lead­er­ship––par­tic­u­larly net­works of women and girls liv­ing with HIV, and women in key pop­u­la­tions––in the design, bud­get­ing, imple­men­ta­tion and mon­i­tor­ing of the HIV response at regional, national, sub­na­tional and com­mu­nity lev­els.” (para­graph 153(i))

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