Key and vulnerable populations

Definition

Cer­tain pop­u­la­tions are at greater risk of acquir­ing HIV and oth­ers are more vul­ner­a­ble to HIV. Those pop­u­la­tions that are at greater risk of acquir­ing HIV and are more vul­ner­a­ble to HIV are referred to in the Lan­guage Com­pendium as Key and vul­ner­a­ble pop­u­la­tions. Many of these com­mu­ni­ties have inter­sect­ing iden­ti­ties, and their behav­iors and iden­ti­ties are crim­i­nal­ized, dis­crim­i­nated against, and stig­ma­tized. This makes them more at risk of and vul­ner­a­ble to HIV. When liv­ing with HIV, peo­ple in these com­mu­ni­ties are also more likely to remain unde­tected, be denied health­care, lose hous­ing, unem­ploy­ment, and be sub­ject to fur­ther crim­i­nal­i­sa­tion.

Rec­og­niz­ing that cer­tain pop­u­la­tions are at greater risk of acquir­ing HIV and are more vul­ner­a­ble to HIV has sev­eral legal, pol­icy, and prac­ti­cal impli­ca­tions. Bio­med­ical, social and legal responses to HIV need to serve and uplift key and vul­ner­a­ble pop­u­la­tions. Uplift­ing these com­mu­ni­ties is cru­cial for improv­ing equi­table health out­comes, pro­tect­ing their human rights and respond­ing effec­tively to HIV. This has been sub­stan­ti­ated in sev­eral inter­na­tional prece­dents. Prece­dents reflected in the Lan­guage Com­pendium rec­og­nized the need for tai­lor­ing HIV com­bi­na­tion pre­ven­tion approaches “to meet the diverse needs of key pop­u­la­tions, includ­ing among sex work­ers, men who have sex with men, peo­ple who inject drugs, trans­gen­der peo­ple, peo­ple in pris­ons and other closed set­tings and all peo­ple liv­ing with HIV.” Lan­guage reflected in inter­na­tional doc­u­ments also high­light the need to elim­i­nate stigma and dis­crim­i­na­tion in health­care set­tings, ensure access to com­bi­na­tion pre­ven­tion, treat­ment, care and sup­port for peo­ple liv­ing with, at risk of and affected by HIV, pre­vent depri­va­tion in terms of social deter­mi­nants of health, lib­erty, auton­omy and more.

Precedents

2023 HRC Resolution on mental health and human rights

• “Deeply con­cerned that per­sons with psy­choso­cial dis­abil­i­ties and cur­rent or poten­tial users of men­tal health ser­vices con­tinue to be sub­ject to, inter alia, wide­spread, mul­ti­ple, inter­sect­ing and aggra­vated dis­crim­i­na­tion, stigma, stereo­types, prej­u­dice, vio­lence, abuse, social exclu­sion and seg­re­ga­tion, unlaw­ful and arbi­trary depri­va­tion of lib­erty, and insti­tu­tion­al­iza­tion, over­med­ical­iza­tion and treat­ment prac­tices that fail to respect their auton­omy, will and pref­er­ences” (p. 3)

• “Acknowl­edg­ing the inter­sec­tions between men­tal health and HIV and that the mul­ti­ple or aggra­vated forms of dis­crim­i­na­tion, stigma, vio­lence and abuse often faced by peo­ple liv­ing with, pre­sumed to be liv­ing with or affected by HIV/AIDS and mem­bers of key pop­u­la­tions have neg­a­tive con­se­quences on their enjoy­ment of the high­est attain­able stan­dard of men­tal health, and under­lin­ing the impor­tance of improv­ing psy­choso­cial well-being and the qual­ity of life of peo­ple affected by and liv­ing with HIV through the imple­men­ta­tion of com­mu­nity-, evi­dence- and human rights-based and peo­ple-cen­tred poli­cies and pro­grammes in the con­text of HIV pre­ven­tion, diag­no­sis, treat­ment and com­pre­hen­sive care ser­vices” (p. 4)

• “Also urges States to pro­mote a par­a­digm shift in men­tal health, inter alia, in the fields of clin­i­cal prac­tice, pol­icy, research, med­ical edu­ca­tion and invest­ment, through the pro­mo­tion of com­mu­nity-, evi­dence- and human rights-based and peo­ple-cen­tred ser­vices and sup­port that respect, pro­tect and ful­fil the human rights, auton­omy, will and pref­er­ences of per­sons with psy­choso­cial dis­abil­i­ties and cur­rent or poten­tial users of men­tal health ser­vices, includ­ing by pro­vid­ing a range of vol­un­tary sup­ported deci­sion-mak­ing mech­a­nisms, such as peer sup­port, and safe­guards against abuse and undue influ­ence within sup­port arrange­ments, over a model based on the dom­i­nance of bio­med­ical inter­ven­tions, coer­cion, med­ical­iza­tion and insti­tu­tion­al­iza­tion” (p. 5)

2022 HRC Res­o­lu­tion on the human rights and Indigenous Peoples

• “Bear­ing in mind the impor­tance of sup­port­ing the empow­er­ment and build­ing the capac­ity of indige­nous women, young per­sons, older per­sons, per­sons with dis­abil­i­ties, per­sons in vul­ner­a­ble sit­u­a­tions and chil­dren, in accor­dance with their age and matu­rity, includ­ing for their full and effec­tive par­tic­i­pa­tion in deci­sion-mak­ing processes in mat­ters that affect them directly, includ­ing poli­cies, pro­grammes and resources, where rel­e­vant, that tar­get their well-being, in par­tic­u­lar in the areas of uni­ver­sal and equi­table access to qual­ity pub­lic ser­vices, health ser­vices, men­tal health, food secu­rity and improved nutri­tion, includ­ing through fam­ily farm­ing, edu­ca­tion, employ­ment and the trans­mis­sion of lan­guages and tra­di­tional knowl­edge, inno­va­tions and prac­tices, and also the impor­tance of tak­ing mea­sures to pro­mote aware­ness and under­stand­ing of their rights” (p. 3)

2022 HRC Res­o­lu­tion on ensuring equitable, affordable, timely and universal access for all countries to vaccines in response to the coronavirus disease (COVID-19) pandemic

• “Rec­og­niz­ing that per­sons with dis­abil­i­ties face ableism and a greater risk of COVID-19 infec­tion and have higher mor­tal­ity rates, and face aggra­vated bar­ri­ers to access to timely and qual­ity health care and ser­vices” (p. 4)

• “Deeply con­cerned that the COVID-19 pan­demic per­pet­u­ates and exac­er­bates exist­ing inequal­i­ties and that those most at risk are per­sons in vul­ner­a­ble and mar­gin­al­ized sit­u­a­tions, such as older per­sons, migrants, refugees, inter­nally dis­placed per­sons, per­sons with dis­abil­i­ties, per­sons belong­ing to minori­ties, indige­nous peo­ples, per­sons deprived of their lib­erty, home­less per­sons and per­sons liv­ing in poverty, and rec­og­niz­ing the need to ensure non-dis­crim­i­na­tion and equal­ity while stress­ing the impor­tance of age-respon­sive, gen­der-respon­sive and dis­abil­ity-sen­si­tive mea­sures in this regard” (p. 4)

• “Empha­siz­ing the need for full respect for and the pro­tec­tion and ful­fil­ment of human rights, and stress­ing that there is no place for any form of stigma­ti­za­tion, dis­crim­i­na­tion, racism and xeno­pho­bia in response to the pan­demic, fur­ther exac­er­bat­ing the neg­a­tive impact on the right to health, includ­ing men­tal health” (p. 4)

2022 Resolution on Violence Against Women Migrant Workers

• “Also calls upon Gov­ern­ments to rec­og­nize the right of women migrant work­ers and their accom­pa­ny­ing chil­dren, regard­less of their migra­tory sta­tus, to have access with­out dis­crim­i­na­tion to emer­gency health care, includ­ing in times of human­i­tar­ian crises, nat­ural dis­as­ters, pan­demics and other emer­gency sit­u­a­tions, and in this regard to ensure that women migrant work­ers are not dis­crim­i­nated against on the grounds of preg­nancy and child­birth and, in accor­dance with national leg­is­la­tion, to address the vul­ner­a­bil­i­ties to HIV expe­ri­enced by migrant pop­u­la­tions and sup­port their access to HIV pre­ven­tion, treat­ment, care and sup­port.” (para­graph 22)

2021 Global AIDS Strategy 2021-2026

• “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)

2021 HRC Global call for concrete action against racism, racial discrimination, xenophobia and related intolerance

• “Express­ing con­cern at the loss of life and liveli­hoods and the dis­rup­tion to economies and soci­eties by the COVID-19 pan­demic, and its neg­a­tive impact on the enjoy­ment of human rights around the world, dis­pro­por­tion­ately affect­ing cer­tain indi­vid­u­als, includ­ing those fac­ing racism, racial dis­crim­i­na­tion, xeno­pho­bia and related intol­er­ance, which the pan­demic has high­lighted and exposed, includ­ing under­ly­ing deep and long-stand­ing struc­tural inequal­i­ties and fun­da­men­tal prob­lems in var­i­ous areas of social, eco­nomic, civil and polit­i­cal life, and exac­er­bated exist­ing inequal­i­ties, and recall­ing that sys­temic and struc­tural racism and racial dis­crim­i­na­tion fur­ther exac­er­bate inequal­ity in access to health care and treat­ment, lead­ing to racial dis­par­i­ties in health out­comes and a higher rate of mor­tal­ity and mor­bid­ity among indi­vid­u­als and groups fac­ing racial dis­crim­i­na­tion” (p. 2)

2021 HRC Res­o­lu­tion on ensuring equitable, affordable, timely and universal access for all countries to vaccines in response to COVID-19

• “Calls for inten­si­fied inter­na­tional coop­er­a­tion and sol­i­dar­ity to con­tain, mit­i­gate and over­come the pan­demic and its con­se­quences, includ­ing the human rights impli­ca­tions, through responses that are peo­ple-cen­tred, gen­der-respon­sive, mul­ti­di­men­sional, coor­di­nated, inclu­sive, inno­v­a­tive, swift and deci­sive at all lev­els, with full respect for human rights, includ­ing by sup­port­ing the exchange of infor­ma­tion, sci­en­tific knowl­edge and best prac­tices and enhanc­ing main­te­nance capac­ity, in par­tic­u­lar to assist peo­ple in vul­ner­a­ble sit­u­a­tions, includ­ing all migrants, and the poor­est and most vul­ner­a­ble coun­tries, to build a more equi­table, inclu­sive, sus­tain­able and resilient future and to real­ize the 2030 Agenda for Sus­tain­able Devel­op­ment” (p. 4)

2021 HRC Res­o­lu­tion on the human rights of migrants

• “Also calls upon all States to pro­mote and pro­tect the right of every­one, with­out dis­crim­i­na­tion of any kind, to the enjoy­ment of the high­est attain­able stan­dard of phys­i­cal and men­tal health, and encour­ages them to pro­mote equi­table access to health ser­vices, dis­ease pre­ven­tion and care for migrants, includ­ing equi­table access for all migrants to COVID-19 diag­nos­tics, treat­ment and vac­cines” (p. 4)

2021 Political declaration on equitable global access to COVID-19 vaccines

• “We also com­mit to ensur­ing trans­par­ent and fair access to vac­cines to those at a higher risk of devel­op­ing severe COVID-19 symp­toms and the most vul­ner­a­ble, on the basis of med­ical and eth­i­cal stan­dards.” (para­graph 12)

2021 HRC resolution on human rights in the context of HIV and AIDS

• “Calls upon States to address the inequities and vul­ner­a­bil­i­ties faced by chil­dren affected by or liv­ing with HIV, pro­vid­ing those chil­dren and their fam­i­lies with social pro­tec­tion, sup­port and reha­bil­i­ta­tion, includ­ing social and psy­cho­log­i­cal reha­bil­i­ta­tion and care, pae­di­atric ser­vices and med­i­cines, free from stigma and dis­crim­i­na­tion, and inten­si­fy­ing efforts to elim­i­nate ver­ti­cal trans­mis­sion and to develop and pro­vide early diag­no­sis tools, child-friendly med­i­cine com­bi­na­tions and new treat­ments for chil­dren, par­tic­u­larly for infants liv­ing in resource-lim­ited set­tings, and build­ing, where needed, and sup­port­ing social secu­rity sys­tems that pro­tect them.” (para­graph 14)

2021 Political declaration on HIV and AIDS

• “Note that each coun­try should define the spe­cific pop­u­la­tions that are cen­tral to their epi­demic and response, based on the local epi­demi­o­log­i­cal con­text and note with con­cern that global epi­demi­o­log­i­cal evi­dence demon­strates that key pop­u­la­tions are more likely to be exposed to HIV or to trans­mit it, and that these include peo­ple liv­ing with HIV, men who have sex with men who are at 26 times higher risk of HIV acqui­si­tion, peo­ple who inject drugs who are at 29 times higher risk of HIV acqui­si­tion, female sex work­ers who are at 30 times higher risk of HIV acqui­si­tion, trans­gen­der peo­ple who are at 13 times higher risk of HIV acqui­si­tion, and peo­ple in pris­ons and other closed set­tings who have six times higher HIV preva­lence than the gen­eral pop­u­la­tion, and fur­ther note with con­cern that these pop­u­la­tions and their sex­ual part­ners account for 62 per cent of new HIV infec­tions glob­ally” (para­graph 25)

• “Note that, depend­ing on the epi­demi­o­log­i­cal and social con­text of a par­tic­u­lar coun­try, other pop­u­la­tions may be at ele­vated risk of HIV, includ­ing women and ado­les­cent girls and their male part­ners, young peo­ple, chil­dren, per­sons with dis­abil­i­ties, eth­nic and racial minori­ties, indige­nous peo­ples, local com­mu­ni­ties, peo­ple liv­ing in poverty, migrants, refugees, inter­nally dis­placed per­sons, men and women in uni­form and peo­ple in human­i­tar­ian emer­gen­cies and con­flict and post-con­flict sit­u­a­tions.” (para­graph 26)

• “Tai­lor­ing HIV com­bi­na­tion pre­ven­tion approaches to meet the diverse needs of key pop­u­la­tions, includ­ing among sex work­ers, men who have sex with men, peo­ple who inject drugs, trans­gen­der peo­ple, peo­ple in pris­ons and other closed set­tings and all peo­ple liv­ing with HIV.”” (para­graph 60(b))

2020 Resolution on comprehensive and coordinated response to the coronavirus disease (COVID-19) pandemic

• “Rec­og­niz­ing that the COVID-19 pan­demic has a dis­pro­por­tion­ately heavy impact on women, older per­sons, youth and chil­dren, as well as the poor, vul­ner­a­ble and mar­gin­al­ized seg­ments of the pop­u­la­tion, and that responses to the COVID-19 pan­demic need to take into account mul­ti­ple and inter­sect­ing forms of vio­lence, dis­crim­i­na­tion, stigma­ti­za­tion, exclu­sion and inequal­i­ties” (p. 5)

• “Calls for inten­si­fied inter­na­tional coop­er­a­tion and sol­i­dar­ity to con­tain, mit­i­gate and over­come the pan­demic and its con­se­quences through responses that are peo­ple-cen­tred, gen­der-respon­sive, with full respect for human rights, mul­ti­di­men­sional, coor­di­nated, inclu­sive, inno­v­a­tive, swift and deci­sive at all lev­els, includ­ing by sup­port­ing the exchange of infor­ma­tion, sci­en­tific knowl­edge and best prac­tices through, inter alia, the devel­op­ment of new inter­op­er­a­ble data tools and the strength­en­ing of plat­forms to inform mit­i­ga­tion and response actions and con­tin­u­ously mon­i­tor the impact of the pan­demic, espe­cially to assist peo­ple in vul­ner­a­ble sit­u­a­tions and the poor­est and most vul­ner­a­ble coun­tries, to build a more equi­table, inclu­sive, sus­tain­able and resilient future and to get back on track to real­ize the 2030 Agenda for Sus­tain­able Devel­op­ment” (p. 5)

• “Calls upon Mem­ber States to ensure pro­tec­tion for those most affected, women, chil­dren, youth, per­sons with dis­abil­i­ties, peo­ple liv­ing with HIV/AIDS, older per­sons, indige­nous peo­ples, refugees and inter­nally dis­placed per­sons and migrants, and the poor, vul­ner­a­ble and mar­gin­al­ized seg­ments of the pop­u­la­tion, and pre­vent all forms of dis­crim­i­na­tion, espe­cially in the con­text of timely, uni­ver­sal, inclu­sive, equi­table and non-dis­crim­i­na­tory access to safe, qual­ity, effec­tive and afford­able health care and ser­vices and med­ical sup­plies and equip­ment, includ­ing diag­nos­tics, ther­a­peu­tics, med­i­cine and vac­cines, and to leave no one behind, with an endeav­our to reach the fur­thest behind first, founded on the dig­nity of the human per­son and reflect­ing the prin­ci­ples of equal­ity and non-dis­crim­i­na­tion” (p. 8)

2020 Resolution on violence against women migrant workers

• “Urges Gov­ern­ments to sup­port enhanced recep­tion and rein­te­gra­tion assis­tance for those who return, with par­tic­u­lar atten­tion to the needs of vic­tims of traf­fick­ing in per­sons and of migrants in vul­ner­a­ble sit­u­a­tions, inter alia, chil­dren, older women and women with dis­abil­i­ties.” (para­graph 28)

2019 Political declaration of the HLM on UHC

• “Rec­og­nize the con­se­quence of the adverse impact of cli­mate change, nat­ural dis­as­ters, extreme weather events as well as other envi­ron­men­tal deter­mi­nants of health, such as clean air, safe drink­ing water, san­i­ta­tion, safe, suf­fi­cient and nutri­tious food and secure shel­ter, for health and in this regard under­score the need to fos­ter health in cli­mate change adap­ta­tion efforts, under­lin­ing that resilient and peo­ple-cen­tred health sys­tems are nec­es­sary to pro­tect the health of all peo­ple, in par­tic­u­lar those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, par­tic­u­larly those liv­ing in small island devel­op­ing States.” (para­graph 15)

• “Imple­ment the most effec­tive, high-impact, qual­ity-assured, peo­ple-cen­tred, gen­der- and dis­abil­ity-respon­sive and evi­dence-based inter­ven­tions to meet the health needs of all through­out the life course, and in par­tic­u­lar those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, ensur­ing uni­ver­sal access to nation­ally deter­mined sets of inte­grated qual­ity health ser­vices at all lev­els of care for pre­ven­tion, diag­no­sis, treat­ment and care in a timely man­ner.” (para­graph 25)

• “Take mea­sures to reduce mater­nal, neona­tal, infant and child mor­tal­ity and mor­bid­ity and increase access to qual­ity health-care ser­vices for new­borns, infants and chil­dren, as well as all women before, dur­ing and after preg­nancy and child­birth.” (para­graph 29)

• “Scale up efforts to pro­mote healthy and active age­ing, main­tain and improve qual­ity of life of older per­sons and to respond to the needs of the rapidly age­ing pop­u­la­tion, espe­cially the need for pro­mo­tive, pre­ven­tive, cura­tive, reha­bil­i­ta­tive and pal­lia­tive care as well as spe­cial­ized care and the sus­tain­able pro­vi­sion of long-term care, tak­ing into account national con­texts and pri­or­i­ties.” (para­graph 30)

• “Ensure that no one is left behind, with an endeav­our to reach the fur­thest behind first, founded on the dig­nity of the human per­son and reflect­ing the prin­ci­ples of equal­ity and non-dis­crim­i­na­tion, as well as to empower those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions and address their phys­i­cal and men­tal health needs which are reflected in the 2030 Agenda for Sus­tain­able Devel­op­ment, includ­ing all chil­dren, youth, per­sons with dis­abil­i­ties, peo­ple liv­ing with HIV/AIDS, older per­sons, indige­nous peo­ples, refugees and inter­nally dis­placed per­sons and migrants.” (para­graph 70)

• “Address the par­tic­u­lar needs and vul­ner­a­bil­i­ties of migrants, refugees, inter­nally dis­placed per­sons and indige­nous peo­ples, which may include assis­tance, health care and psy­cho­log­i­cal and other coun­sell­ing ser­vices, in accor­dance with rel­e­vant inter­na­tional com­mit­ments, as applic­a­ble, and in line with national con­texts and pri­or­i­ties;” (para­graph 71)

• “Pro­mote strong and resilient health sys­tems, reach­ing those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, and capa­ble of effec­tively imple­ment­ing the Inter­na­tional Health Reg­u­la­tions (2005), ensur­ing pan­demic pre­pared­ness and the pre­ven­tion and detec­tion of and response to any out­break.” (para­graph 72)

• “Rec­og­nize that uni­ver­sal health cov­er­age implies that all peo­ple have access, with­out dis­crim­i­na­tion, to nation­ally deter­mined sets of the needed pro­mo­tive, pre­ven­tive, cura­tive, reha­bil­i­ta­tive and pal­lia­tive essen­tial health ser­vices, and essen­tial, safe, afford­able, effec­tive and qual­ity med­i­cines and vac­cines, while ensur­ing that the use of these ser­vices does not expose the users to finan­cial hard­ship, with a spe­cial empha­sis on the poor, vul­ner­a­ble and mar­gin­al­ized seg­ments of the pop­u­la­tion.” (para­graph 9)

2019 UNESC Resolution on UNAIDS

• “Calls for urgent action and part­ner­ship by Mem­ber States, the United Nations sys­tem, civil soci­ety, local com­mu­ni­ties, the pri­vate sec­tor and other stake­hold­ers to scale up evi­dence-based HIV pre­ven­tion, test­ing, treat­ment, care and reten­tion, includ­ing access to safe, effec­tive, qual­ity and afford­able med­i­cines, includ­ing gener­ics, viral load test­ing in pur­suit of achiev­ing viral load sup­pres­sion, and tuber­cu­lo­sis pre­ven­ta­tive treat­ment, to ensure that those ser­vices reach the peo­ple who need them the most, includ­ing key pop­u­la­tions that epi­demi­o­log­i­cal evi­dence shows to be glob­ally at higher risk of HIV infec­tion, ado­les­cent girls and young women, and calls for rein­vig­o­rated efforts to pro­tect human rights and pro­mote gen­der equal­ity and to address social risk fac­tors, includ­ing gen­der-based vio­lence, as well as social and eco­nomic deter­mi­nants of health.” (para­graph 4)

2018 Political declaration of the third HLM on NCDs

• “Acknowl­edge the impact of non-com­mu­ni­ca­ble dis­eases on older per­sons, which is of par­tic­u­lar con­cern, given the grow­ing pro­por­tion of older per­sons and rec­og­niz­ing that they have an increased risk of mul­ti­ple non-com­mu­ni­ca­ble dis­eases, which con­sti­tutes a major chal­lenge for health sys­tems.” (para­graph 13)

• “Imple­ment, accord­ing to own-coun­try-led pri­or­i­ti­za­tion, a set of cost-effec­tive, afford­able and evi­dence-based inter­ven­tions and good prac­tices, includ­ing those rec­om­mended by the World Health Orga­ni­za­tion, for the pre­ven­tion and con­trol of non-com­mu­ni­ca­ble dis­eases, that can be scaled up across pop­u­la­tions to pro­mote health, treat peo­ple with non-com­mu­ni­ca­ble dis­eases and pro­tect those at risk of devel­op­ing them, with a par­tic­u­lar empha­sis on the needs of those in vul­ner­a­ble sit­u­a­tions.” (para­graph 19)

• “Take mea­sures to bet­ter pre­pare the health sys­tems to respond to the needs of the rapidly age­ing pop­u­la­tion, includ­ing the need for pre­ven­tive, cura­tive, pal­lia­tive and spe­cial­ized care for older per­sons, tak­ing into account the dis­pro­por­tion­ate bur­den of non-com­mu­ni­ca­ble dis­eases on older per­sons, and that pop­u­la­tion age­ing is a con­tribut­ing fac­tor in the ris­ing inci­dence and preva­lence of non-com­mu­ni­ca­ble dis­eases.” (para­graph 29)

2018 Political declaration of the HLM on the fight against TB

• “Com­mit to pre­vent­ing tuber­cu­lo­sis for those most at risk of falling ill through the rapid scal­ing up of access to test­ing for tuber­cu­lo­sis infec­tion, accord­ing to the domes­tic sit­u­a­tion, and the pro­vi­sion of pre­ven­tive treat­ment, with a focus on high-bur­den coun­tries, so that at least 30 mil­lion peo­ple, includ­ing 4 mil­lion chil­dren under 5 years of age, 20 mil­lion other house­hold con­tacts of peo­ple affected by tuber­cu­lo­sis, and 6 mil­lion peo­ple liv­ing with HIV, receive pre­ven­tive treat­ment by 2022, and with the vision of reach­ing mil­lions more, and fur­ther com­mit to the devel­op­ment of new vac­cines and the pro­vi­sion of other tuber­cu­lo­sis pre­ven­tion strate­gies, includ­ing infec­tion pre­ven­tion and con­trol and tai­lored approaches, and to enact­ing mea­sures to pre­vent tuber­cu­lo­sis trans­mis­sion in work­places, schools, trans­porta­tion sys­tems, incar­cer­a­tion sys­tems and other con­gre­gate set­tings.” (para­graph 21)

• “Com­mit to pro­vid­ing spe­cial atten­tion to the poor, those who are vul­ner­a­ble, includ­ing infants, young chil­dren and ado­les­cents, as well as elderly peo­ple and com­mu­ni­ties espe­cially at risk of and affected by tuber­cu­lo­sis, in accor­dance with the prin­ci­ple of social inclu­sion, espe­cially through ensur­ing strong and mean­ing­ful engage­ment of civil soci­ety and affected com­mu­ni­ties in the plan­ning, imple­men­ta­tion, mon­i­tor­ing and eval­u­a­tion of the tuber­cu­lo­sis response, within and beyond the health sec­tor; we fur­ther acknowl­edge the link between incar­cer­a­tion and tuber­cu­lo­sis and there­fore reaf­firm the United Nations Stan­dard Min­i­mum Rules for the Treat­ment of Pris­on­ers (the Nel­son Man­dela Rules) as defined in Gen­eral Assem­bly res­o­lu­tion 70/175 of 17 Decem­ber 2015.” (para­graph 29)

2018 HRC Resolution on human rights in the context of HIV and AIDS

• “Urges States to ensure full and unim­peded access for all per­sons liv­ing with, pre­sumed to be liv­ing with, at risk of or affected by HIV, includ­ing key pop­u­la­tions, to HIV pre­ven­tion, diag­no­sis, treat­ment, care and sup­port, in a pub­lic health envi­ron­ment free from dis­crim­i­na­tion, harass­ment or per­se­cu­tion against those seek­ing HIV-related ser­vices, while respect­ing and pro­tect­ing their right to pri­vacy, con­fi­den­tial­ity and free and informed con­sent.” (para­graph 4)

• “Calls upon States to address as a pri­or­ity the vul­ner­a­bil­i­ties faced by chil­dren affected by or liv­ing with HIV, pro­vid­ing those chil­dren and their fam­i­lies with social pro­tec­tion, sup­port and reha­bil­i­ta­tion, includ­ing social and psy­cho­log­i­cal reha­bil­i­ta­tion and care, pae­di­atric ser­vices and med­i­cines, free from stigma and dis­crim­i­na­tion, and inten­si­fy­ing efforts to elim­i­nate ver­ti­cal trans­mis­sion and to develop and pro­vide early diag­no­sis tools, child-friendly med­i­cine com­bi­na­tions and new treat­ments for chil­dren, par­tic­u­larly for infants liv­ing in resource-lim­ited set­tings, and build­ing, where needed, and sup­port­ing social secu­rity sys­tems that pro­tect them.” (para­graph 5)

2018 CND On mother-to-child transmission among women who use drugs

• “Fur­ther calls upon Mem­ber States to offer women who use drugs, espe­cially those who have recently shared inject­ing equip­ment, and/or have been sex­u­ally assaulted, access to health clin­ics and, where pos­si­ble, assisted refer­ral, and access to post-expo­sure pro­phy­laxis, in accor­dance with national leg­is­la­tion and tak­ing into account the United Nations Office on Drugs and Crime guide­lines in the pub­li­ca­tion Address­ing the Spe­cific Needs of Women who Inject Drugs: Prac­ti­cal Guide for Ser­vice Providers on Gen­der-Respon­sive HIV Ser­vices.” (para­graph 8)

• “Calls upon Mem­ber States to develop and imple­ment strate­gies to help iden­tify and respond to gen­der-based vio­lence by pro­vid­ing direct sup­port to women who use drugs or are exposed to risk fac­tors asso­ci­ated with drug use and who expe­ri­ence sex­ual vio­lence, includ­ing appro­pri­ate mea­sures and pro­tec­tions as may be required to enable women who use drugs to report abuse.” (para­graph 9)

2016 Resolution on Women, the Girl Child and HIV and AIDS

• “Calls upon gov­ern­ments, inter­na­tional part­ners and civil soci­ety to give full atten­tion to the high lev­els of new HIV infec­tions among young women and ado­les­cent girls and its root causes, bear­ing in mind that women and girls are phys­i­o­log­i­cally more vul­ner­a­ble to HIV, espe­cially at an ear­lier age, than men and boys, and that this is increased by dis­crim­i­na­tion and all forms of vio­lence against women, girls and ado­les­cents, includ­ing sex­ual exploita­tion and harm­ful prac­tices.” (para­graph 1)

2016 Outcome Document of the Session on the World Drug Problem

• “Also take effec­tive and prac­ti­cal mea­sures to pre­vent pro­gres­sion to severe drug use dis­or­ders through appro­pri­ately tar­geted early inter­ven­tions for peo­ple at risk of such pro­gres­sion.” (para­graph 1(a))

• “Pro­mote and strengthen regional and inter­na­tional coop­er­a­tion in devel­op­ing and imple­ment­ing treat­ment-related ini­tia­tives, enhance tech­ni­cal assis­tance and capac­ity-build­ing and ensure non-dis­crim­i­na­tory access to a broad range of inter­ven­tions, includ­ing psy­choso­cial, behav­ioural and med­ica­tion-assisted treat­ment, as appro­pri­ate and in accor­dance with national leg­is­la­tion, as well as to reha­bil­i­ta­tion, social rein­te­gra­tion and recov­ery-sup­port pro­grammes, includ­ing access to such ser­vices in pris­ons and after impris­on­ment, giv­ing spe­cial atten­tion to the spe­cific needs of women, chil­dren and youth in this regard.” (para­graph 1(k))

• “Encour­age the devel­op­ment of viable eco­nomic alter­na­tives, par­tic­u­larly for com­mu­ni­ties affected by or at risk of illicit cul­ti­va­tion of drug crops and other illicit drug-related activ­i­ties in urban and rural areas, includ­ing through com­pre­hen­sive alter­na­tive devel­op­ment pro­grammes, and to this end con­sider devel­op­ment-ori­ented inter­ven­tions, while ensur­ing that both men and women ben­e­fit equally from them, includ­ing through job oppor­tu­ni­ties, improved infra­struc­ture and basic pub­lic ser­vices and, as appro­pri­ate, access and legal titles to land for farm­ers and local com­mu­ni­ties, which will also con­trib­ute to pre­vent­ing, reduc­ing or elim­i­nat­ing illicit cul­ti­va­tion and other drug-related activ­i­ties.” (para­graph 7(j))

2016 Political Declaration on HIV and AIDS

• “Com­mit to elim­i­nat­ing bar­ri­ers, includ­ing stigma and dis­crim­i­na­tion in health-care set­tings, to ensure uni­ver­sal access to com­pre­hen­sive HIV diag­nos­tics, pre­ven­tion, treat­ment, care and sup­port for peo­ple liv­ing with, at risk of and affected by HIV, per­sons deprived of their lib­erty, indige­nous peo­ple, chil­dren, ado­les­cents, young peo­ple, women, and other vul­ner­a­ble pop­u­la­tions.” (para­graph 62(j))

• “Rec­og­nize the role that com­mu­nity orga­ni­za­tions play, includ­ing those led and run by peo­ple liv­ing with HIV, in sup­port­ing and sus­tain­ing national and local HIV and AIDS responses, reach­ing all peo­ple liv­ing with HIV, deliv­er­ing pre­ven­tion, treat­ment, care and sup­port ser­vices and strength­en­ing health sys­tems, in par­tic­u­lar the pri­mary health-care approach.” (para­graph 9)

2016 Resolution on the girl child

• “Rec­og­nizes that a con­sid­er­able num­ber of girl chil­dren are par­tic­u­larly vul­ner­a­ble, includ­ing orphans, chil­dren liv­ing on the street, inter­nally dis­placed and refugee chil­dren, chil­dren affected by traf­fick­ing and sex­ual and eco­nomic exploita­tion, chil­dren liv­ing with or affected by HIV and AIDS, and chil­dren who are incar­cer­ated or who live with­out parental sup­port, and there­fore urges States, with the sup­port of the inter­na­tional com­mu­nity, where rel­e­vant, to take appro­pri­ate mea­sures to address the needs of such chil­dren by imple­ment­ing national, sub­re­gional and regional poli­cies and strate­gies to build and strengthen gov­ern­men­tal, com­mu­nity and fam­ily capac­i­ties to pro­vide a sup­port­ive envi­ron­ment for such chil­dren, includ­ing by pro­vid­ing appro­pri­ate coun­sell­ing and psy­choso­cial sup­port, and ensur­ing their safety, enrol­ment in school and access to shel­ter, good nutri­tion and health and social ser­vices on an equal basis with other chil­dren.” (para­graph 24)

• “Urges all States and the inter­na­tional com­mu­nity to respect, pro­mote and pro­tect the rights of the girl child, tak­ing into account the p artic­u­lar vul­ner­a­bil­i­ties of the girl child in pre-con­flict, con­flict and post-con­flict sit­u­a­tions and in cli­mate- related and other haz­ards and nat­ural dis­as­ters, as well as in other human­i­tar­ian emer­gen­cies, all of which may result in the cre­ation of child-headed house­holds, and also urges States to take spe­cial mea­sures for the pro­tec­tion of girls in all phases of human­i­tar­ian emer­gen­cies, from relief to recov­ery, and in par­tic­u­lar to ensure that chil­dren have access to basic ser­vices, which include clean water, includ­ing safe drink­ing water, san­i­ta­tion and hygiene, to pro­tect them from sex­u­ally trans­mit­ted infec­tions, includ­ing HIV infec­tion, gen­der-based vio­lence, includ­ing rape, sex­ual abuse and sex­ual exploita­tion, tor­ture, abduc­tion and traf­fick­ing, i nclud­ing forced labour, pay­ing spe­cial atten­tion to refugee and dis­placed girls, and to take into account their spe­cial needs in dis­ar­ma­ment, demo­bi­liza­tion, reha­bil­i­ta­tion assis­tance and rein­te­gra­tion processes.” (para­graph 25)

2015 UNESC Resolution on UNAIDS

• “Rec­og­nizes that in order to ensure that no one is left behind, responses and resources need to be focused on evi­dence-based inter­ven­tions and on pop­u­la­tions and loca­tions where they will have the great­est impact, in accor­dance with spe­cific national and regional epi­demi­o­log­i­cal pat­terns.” (para­graph 6)

2012 Resolution on women in development

• “Expresses con­cern at the over­all expan­sion of the HIV and AIDS epi­demic and the fact that women and girls are still the most affected by HIV and AIDS, that they are more eas­ily infected, that they bear a dis­pro­por­tion­ate share of the care­giv­ing bur­den and that they are more vul­ner­a­ble to vio­lence, stigma­ti­za­tion and dis­crim­i­na­tion, poverty and mar­gin­al­iza­tion from their fam­i­lies and com­mu­ni­ties as a result of HIV and AIDS, and tak­ing into account that despite sub­stan­tial progress, the 2010 dead­line of uni­ver­sal access has not been met, calls upon Gov­ern­ments and the inter­na­tional com­mu­nity to urgently scale up responses towards achiev­ing the goal of uni­ver­sal access to com­pre­hen­sive HIV pre­ven­tion pro­grammes, treat­ment, care and sup­port and, in line with the 2011 Polit­i­cal Dec­la­ra­tion on HIV and AIDS: Inten­si­fy­ing Our Efforts to Elim­i­nate HIV and AIDS, to ensure that national responses to HIV and AIDS meet the spe­cific needs of women and girls, includ­ing those liv­ing with and affected by HIV and AIDS across their lifes­pan.” (para­graph 32)

2011 Political Declaration of the HLM on NCDs

• “Note with con­cern that the rapidly grow­ing mag­ni­tude of non-com­mu­ni­ca­ble dis­eases affects peo­ple of all ages, gen­der, race and income lev­els, and fur­ther that poor pop­u­la­tions and those liv­ing in vul­ner­a­ble sit­u­a­tions, in par­tic­u­lar in devel­op­ing coun­tries bear a dis­pro­por­tion­ate bur­den and that non-com­mu­ni­ca­ble dis­eases can affect women and men dif­fer­ently.” (para­graph 14)

• “Express deep con­cern that women bear a dis­pro­por­tion­ate share of the bur­den of care-giv­ing and that, in some pop­u­la­tions, women tend to be less phys­i­cally active than men, are more likely to be obese and are tak­ing up smok­ing at alarm­ing rates.” (para­graph 15)

• “Acknowl­edge also the exis­tence of sig­nif­i­cant inequal­i­ties in the bur­den of non-com­mu­ni­ca­ble dis­eases and in access to non-com­mu­ni­ca­ble dis­ease pre­ven­tion and con­trol, both between coun­tries, and within coun­tries and com­mu­ni­ties.” (para­graph 17)

• “Pur­sue and pro­mote gen­der-based approaches for the pre­ven­tion and con­trol of non-com­mu­ni­ca­ble dis­eases founded on data dis­ag­gre­gated by sex and age in an effort to address the crit­i­cal dif­fer­ences in the risks of mor­bid­ity and mor­tal­ity from non-com­mu­ni­ca­ble dis­eases for women and men.” (para­graph 45(e))

2011 Political Declaration on HIV and AIDS

• “Wel­come the adop­tion of the Con­ven­tion on the Rights of Per­sons with Dis­abil­i­ties, and rec­og­nize the need to take into account the rights of per­sons with dis­abil­i­ties as set forth in that Con­ven­tion, in par­tic­u­lar with regard to health, edu­ca­tion, acces­si­bil­ity and infor­ma­tion, in the for­mu­la­tion of our global response to HIV and AIDS.” (para­graph 23)

• “Note with con­cern that pre­ven­tion, treat­ment, care and sup­port pro­grammes have not been ade­quately tar­geted or made acces­si­ble to per­sons with dis­abil­i­ties.” (para­graph 31)

• “Com­mit to address, accord­ing to national leg­is­la­tion, the vul­ner­a­bil­i­ties to HIV expe­ri­enced by migrant and mobile pop­u­la­tions and sup­port their access to HIV pre­ven­tion, treat­ment, care and sup­port.” (para­graph 84)

2010 HRC On the rights of the child: the fight against sexual violence

• “Calls upon States to pay spe­cial atten­tion to the pro­tec­tion from sex­ual vio­lence and abuse of mar­gin­al­ized and vul­ner­a­ble chil­dren, such as chil­dren belong­ing to minori­ties, chil­dren with dis­abil­i­ties, migrant chil­dren, indige­nous chil­dren, chil­dren work­ing and/or liv­ing on the street, refugee, asy­lum-seek­ing and inter­nally dis­placed chil­dren, in par­tic­u­lar those who are unac­com­pa­nied, and chil­dren held in deten­tion, and to take all nec­es­sary actions, includ­ing the use of deten­tion as a mea­sure of last resort, and to ensure that those who are vic­tims of sex­ual vio­lence receive spe­cial pro­tec­tion and assis­tance in accor­dance with inter­na­tional law.” (para­graph 4)

2007 WHA Resolution on tuberculosis control: progress and long-term planning

• “Requests the direc­tor-gen­eral to strengthen mech­a­nisms to review and mon­i­tor esti­mates of impact of con­trol activ­i­ties on the tuber­cu­lo­sis bur­den, includ­ing inci­dence, preva­lence and mor­tal­ity with spe­cific atten­tion to vul­ner­a­ble groups highly at risk, such as poor peo­ple, migrants and eth­nic minori­ties.” (para­graph 2(3))

2005 Resolution on the World Summit outcome

• “We rec­og­nize the need to pay spe­cial atten­tion to the human rights of women and chil­dren and under­take to advance them in every pos­si­ble way, includ­ing by bring­ing gen­der and child-pro­tec­tion per­spec­tives into the human rights agenda.” (para­graph 128)

• “We will put into place poli­cies to ensure ade­quate invest­ment in a sus­tain­able man­ner in health, clean water and san­i­ta­tion, hous­ing and edu­ca­tion and in the pro­vi­sion of pub­lic goods and social safety nets to pro­tect vul­ner­a­ble and dis­ad­van­taged sec­tors of soci­ety.” (para­graph 25(b))

2001 Declaration of Commitment on HIV/AIDS

• “By 2003, develop and/or strengthen national strate­gies, poli­cies and pro­grammes, sup­ported by regional and inter­na­tional ini­tia­tives, as appro­pri­ate, through a par­tic­i­pa­tory approach, to pro­mote and pro­tect the health of those iden­ti­fi­able groups which cur­rently have high or increas­ing rates of HIV infec­tion or which pub­lic health infor­ma­tion indi­cates are at great­est risk of and most vul­ner­a­ble to new infec­tion as indi­cated by such fac­tors as the local his­tory of the epi­demic, poverty, sex­ual prac­tices, drug-using behav­iour, liveli­hood, insti­tu­tional loca­tion, dis­rupted social struc­tures and pop­u­la­tion move­ments, forced or oth­er­wise.” (para­graph 64)

• “By 2003, develop and by 2005 imple­ment national poli­cies and strate­gies to build and strengthen gov­ern­men­tal, fam­ily and com­mu­nity capac­i­ties to pro­vide a sup­port­ive envi­ron­ment for orphans and girls and boys infected and affected by HIV/AIDS, includ­ing by pro­vid­ing appro­pri­ate coun­sell­ing and psy­choso­cial sup­port, ensur­ing their enrol­ment in school and access to shel­ter, good nutri­tion and health and social ser­vices on an equal basis with other chil­dren; and pro­tect orphans and vul­ner­a­ble chil­dren from all forms of abuse, vio­lence, exploita­tion, dis­crim­i­na­tion, traf­fick­ing and loss of inher­i­tance.” (para­graph 65)

Expert precedents

2019 OHCHR Annual report on human rights and HIV

• “States should remove struc­tural bar­ri­ers, includ­ing dis­crim­i­na­tory laws and poli­cies, and apply human rights-based approaches to the response to HIV, putting peo­ple liv­ing with HIV at the cen­tre of their poli­cies, pro­grammes and prac­tices. In order not to leave any­one behind, States should increase their efforts to reach the most mar­gin­al­ized women and ado­les­cents, key pop­u­la­tions vul­ner­a­ble to HIV, includ­ing gay men and other men who have sex with men, sex work­ers, peo­ple who use drugs, trans­gen­der peo­ple, and per­sons in pris­ons and other closed set­tings. Com­mu­ni­ties should be involved in the design, imple­men­ta­tion and deliv­ery of poli­cies, pro­grammes and prac­tices.” (para­graph 47(a))

Evidence

2022 WHO Consolidated Guidelines on Person-centred HIV Strategic Information

• “While the over­all inci­dence of new infec­tions has been declin­ing since the peak in 1997, the pro­por­tion of these new infec­tions that occur among peo­ple from key pop­u­la­tions (men who have sex with men, sex work­ers, peo­ple who inject drugs, trans and gen­der diverse peo­ple, and peo­ple in pris­ons and other closed set­tings) con­tin­ues to increase. In 2021 peo­ple from key pop­u­la­tions and their sex­ual part­ners accounted for 70% of new infec­tions glob­ally and 94% of new infec­tions out­side of sub-Saha­ran Africa. In sub-Saha­ran Africa as well, key pop­u­la­tions and their sex­ual part­ners make up an increas­ing pro­por­tion of new infec­tions, from 25% in 2016 to 51% in 2021.” (p. 21)

2021 WHO Updated Recommendations on HIV Prevention, EID and ART

• “Ado­les­cent girls and young women are still dis­pro­por­tion­ately affected by HIV and sub­ject to many forms of dis­crim­i­na­tion across the globe. In 2017, 79% of the ado­les­cents 10 to 19 years old newly infected with HIV in east­ern and south­ern Africa were female.” (p. 1)

• “Sub­stan­tial risk of HIV infec­tion is pro­vi­sion­ally defined as HIV inci­dence greater than 3 per 100 per­son-years in the absence of PrEP. HIV inci­dence greater than 3 per 100 per­son-years has been iden­ti­fied among men who have sex with men, trans­gen­der women and het­ero­sex­ual men and women who have sex­ual part­ners with undi­ag­nosed or untreated HIV infec­tion. Indi­vid­ual risk varies within groups at sub­stan­tial risk depend­ing on indi­vid­ual behav­iour and the char­ac­ter­is­tics of sex­ual part­ners.” (p. 7)

2020 Evidence Review of the UNAIDS Strategy 2016-2021

• “The epi­demic’s dis­pro­por­tion­ate bur­den among key pop­u­la­tions (includ­ing gay men and other men who have sex with men, peo­ple who inject drugs, sex work­ers, trans­gen­der peo­ple and pris­on­ers) con­tin­ues to grow. In 2019, these pop­u­la­tions and their sex part­ners accounted for an esti­mated 62% of new HIV infec­tions glob­ally. Com­pared to the gen­eral pop­u­la­tion, the risk of acquir­ing HIV is on aver­age about 26 times higher for gay men and other men who have sex with men, 29 times higher for peo­ple who inject drugs, 30 times higher for sex work­ers and 13 times higher for trans­gen­der peo­ple than for adults in the gen­eral pub­lic. Glob­ally, HIV inci­dence among peo­ple who inject drugs, sex work­ers and trans­gen­der peo­ple since 2010 has remained high but rel­a­tively sta­ble since 2010. New infec­tions are on the rise among gay men and other men who have sex with men, who com­prised 23% of new infec­tions glob­ally in 2019, includ­ing more than 40% of new infec­tions in Asia and the Pacific and Latin Amer­ica, and nearly two thirds (64%) of new infec­tions in west­ern and cen­tral Europe and North Amer­ica. Marked increases in new infec­tions among gay men and other men who have sex with men were reported in Brazil, Mex­ico, Pak­istan and Philip­pines.” (p. 50)

• “Pre­ven­tion cov­er­age is notably lim­ited for key pop­u­la­tions. In six of 13 coun­tries that have con­ducted sur­veys since 2016 and reported those data to UNAIDS, less than half of trans­gen­der women stated that they were able to access at least two HIV pre­ven­tion ser­vices in the pre­vi­ous three months, as did sim­i­lar pro­por­tions of female sex work­ers (in 16 of 30 coun­tries), gay men and other men who have sex with men (in 26 of 38 coun­tries) and men who inject drugs (in 10 of 14 coun­tries).” (p. 56)

• “Women who belong to key pop­u­la­tions are at par­tic­u­lar risk of expe­ri­enc­ing vio­lence. Women who use drugs are up to five times more likely to expe­ri­ence vio­lence than non-drug-using women. It is esti­mated that 45–75% of female sex work­ers are assaulted or abused at least once in their life­time, although mech­a­nisms for report­ing abuse or access­ing sur­vivor ser­vices are often blocked due to the crim­i­nal­iza­tion of sex work. Women belong­ing to eth­nic and other minori­ties, trans­gen­der women and women with dis­abil­i­ties face higher risks of vio­lence.” (p. 69)

• “The evi­dence base for remov­ing puni­tive laws and poli­cies has expanded. Numer­ous stud­ies and meta-analy­ses on the impact of puni­tive laws on HIV responses (sum­ma­rized in the sta­tus report above) pro­vide evi­dence that bol­sters the efforts of advo­cates and pub­lic health experts to remove such coun­ter­pro­duc­tive laws. The pub­li­ca­tion of a con­sen­sus state­ment on the sci­ence of HIV in the con­text of crim­i­nal law has strength­ened lit­i­gants’ and advo­cates’ argu­ments that HIV crim­i­nal­iza­tion laws are not grounded in sci­ence. The 2018 release of a sup­ple­ment to the pre­vi­ous report of the Global Com­mis­sion on HIV and the Law under­scored the con­sen­sus of pub­lic health experts that puni­tive laws under­mine HIV responses, cause need­less suf­fer­ing and should be removed.” (p. 76)

• “Puni­tive laws under­mine HIV responses and increase the vul­ner­a­bil­ity of mar­gin­al­ized pop­u­la­tions. Gay men and other men who have sex with men who live in coun­tries that crim­i­nal­ize same-sex rela­tions are 2.2 times more likely to acquire HIV than their coun­ter­parts in coun­tries with­out such legal restric­tions. Severe crim­i­nal penal­ties for same-sex rela­tions are asso­ci­ated with a 4.7 times higher risk of HIV infec­tion, com­pared with set­tings lack­ing such penal­ties. Accord­ing to an analy­sis of 75 coun­tries, the exis­tence of anti-LGBT laws is also asso­ci­ated with sub­stan­tially lower uptake of HIV test­ing ser­vices. Evi­dence-based mod­el­ling indi­cates that decrim­i­nal­iza­tion of all aspects of sex work could avert 33–46% of new HIV infec­tions among sex work­ers and their clients over 10 years. Another meta-analy­sis found that repres­sive polic­ing of sex work increased the preva­lence of HIV and other sex­u­ally trans­mit­ted infec­tions by 87% and increased the risk of sex­ual or phys­i­cal vio­lence nearly three-fold. A 2020 study exam­in­ing 10 coun­tries in sub-Saha­ran Africa linked increas­ingly repres­sive laws regard­ing sex work with increased preva­lence of HIV infec­tion. Accord­ing to a 2017 sys­tem­atic review, more than 80% of per­ti­nent stud­ies have cor­re­lated crim­i­nal­iza­tion of drug use with an increased risk of HIV, while a sep­a­rate analy­sis found that repres­sive polic­ing of drug use is asso­ci­ated with HIV infec­tion, nee­dle shar­ing and avoid­ance of harm reduc­tion pro­grammes. In some coun­tries in east­ern Europe and cen­tral Asia, laws require indi­vid­u­als seek­ing harm reduc­tion ser­vices to reg­is­ter with author­i­ties, a step that in turn makes the indi­vid­ual inel­i­gi­ble for a dri­ver’s license. Although study evi­dence of the HIV-related impact of puni­tive laws on trans­gen­der peo­ple is scarce, the harm asso­ci­ated with repres­sive polic­ing of trans­gen­der peo­ple is well-doc­u­mented. Approx­i­mately 40% of trans­gen­der cor­rec­tional inmates have expe­ri­enced sex­ual vio­lence in the pre­vi­ous 12 months, com­pared to 4% of the gen­eral prison pop­u­la­tion.” (pp. 72–73)

2016 Prevention Gap Report

• “Among gay men and other men who have sex with men, in 7 of 10 coun­tries with avail­able data, treat­ment cov­er­age was con­sid­er­ably lower than cov­er­age among all men liv­ing with HIV. Treat­ment cov­er­age lev­els among peo­ple who inject drugs were more sim­i­lar to cov­er­age among men gen­er­ally, but dif­fer­ences were still observed in 4 of 8 coun­tries. Female sex work­ers were also less likely to access treat­ment than the gen­eral adult female pop­u­la­tion, with just 3 of 12 coun­tries hav­ing sim­i­lar lev­els of cov­er­age. In Cam­bo­dia, trans­gen­der peo­ple had higher treat­ment cov­er­age than female sex work­ers but lower than the gen­eral adult female pop­u­la­tion.” (p. 57)

• “Recent stud­ies sug­gest that peo­ple who inject drugs are 24 times more likely to acquire HIV than adults in the gen­eral pop­u­la­tion, sex work­ers are 10 times more likely to acquire HIV and gay men and other men who have sex with men are 24 times more likely to acquire HIV. In addi­tion, trans­gen­der peo­ple are 49 times more likely to be liv­ing with HIV and pris­on­ers are five times more likely to be liv­ing with HIV than adults in the gen­eral pop­u­la­tion.” (p. 7)