Key populations are at higher risk of HIV

Vulnerable and key populations in the HIV response include:

  • gay and bisexual men and other men who have sex with men
  • transgender people
  • sex workers
  • people who inject drugs
  • prisoners
  • migrants
  • adolescent women and young girls, and
  • young people.

Laws, policies and practices that reinforce inequality, marginalize and even criminalize key populations make it difficult for these populations to access appropriate treatment, prevention, care and support and to protect themselves from HIV infection.

Example: Sex workers as key populations in HIV responses

Sex work, or aspects of sex work, is criminalized in many countries across the world. Sex workers report experiences of stigma, discrimination and violence from health care workers and law enforcement officers.

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They experience denial of health care, discrimination and humiliation, as well as violence, rape, harassment, extortion and detention by police. This deters them from accessing and being able to use HIV prevention services effectively, increasing their vulnerability to HIV.

Rights-based health programmes that seek to, for example a) strengthen the protection of sex workers’ rights in law and policy b) train health care workers to treat sex workers with dignity and respect, and c) sensitize law enforcement officials to the human rights and health rights of sex workers, will support access to HIV-related health care for sex workers.

HIV infection leads to further rights violations for key populations

Due to the stigma and prejudice surrounding HIV, people living with HIV experience discrimination and violations of their rights. These human rights challenges are exacerbated when people living with and affected by HIV become ill, lose their jobs and are impoverished by the costs of health care. They become increasingly vulnerable, with less agency to protect their rights and limited ability to cope with the impact of HIV.

The Global Commission on HIV and the Law

On behalf of the Joint United Nations Programme on HIV/AIDS (UNAIDS) family, UNDP established an independent Global Commission on HIV and the Law in June 2010 to examine the impact of law on HIV responses and to catalyse country level action for legal environments that protect human rights and halt and reverse HIV.

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The Commission was built on three mutually reinforcing axes:

  1. a high-level Commission that analysed evidence and added insight and weight to develop findings and recommendations, chaired by President Cardoso of Brazil
  2. a Technical Advisory Group that helped generate evidence and build consensus
  3. Regional Dialogues that ensured inclusion and participation of affected communicates and law- and policy-makers

The Commission issued its landmark 2012 report, Risks, Rights and Health, which includes key findings and recommendations on evidence-informed and rights-based responses to HIV. The report called on countries to outlaw discrimination, repeal punitive laws and enact protective laws to promote public health and human rights for effective HIV responses. Between 2012 and 2018, UNDP and its partners have supported 89 countries to advance the Commission’s recommendations. The GCHL Fact Sheet and UNDP’s Issue Brief: Advancing Human Rights, Equality and Inclusive Governance to End AIDS provide information and examples of across the globe of UNDP’s work with country stakeholders.

In 2018, the Commission released a Risks, Rights and Health Supplement that was launched in July 2018 at the International AIDS Conference in Amsterdam. The Supplement highlights developments since the 2012 report in science, technology, law, geopolitics and funding that affect people living with HIV and its co-infections. Its 30 recommendations add to those of the 2012 report which Commissioners noted were as relevant as they had been in 2012.

Discrimination against people living with HIV

The People Living with HIV Stigma Index studies documents the stigma and discrimination faced by people living with HIV across the globe, including verbal and physical harassment and abuse within their communities, denial of sexual and reproductive health care services and discrimination within their working environments. An updated Stigma Index research tool has recently been developed that, amongst other things, includes a strong focus on vulnerable and key populations.

Addressing migrants' health needs is critical to achieve the 2030 goals

According to the WHO, there are an estimated 1 billion migrants in the world, of whom 258 million are international migrants and 763 million internal migrants—one in seven of the world’s population. The rapid increase of population movement has important public health implications and must be addressed in order to achieve the vision of the 2030 Agenda and the Sustainable Development Goals.

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Migrants enjoy the same rights as all people to the highest attainable standard of physical and mental health. International human rights standards, such as the 1951 Refugee Convention protect the rights of migrants to health equivalent to that of others.

Nevertheless, many refugees and migrants often lack access to health services, including services for HIV. According to the Migration Health Annual Report 2017 of the UN-related agency, the International Organization for Migration (IOM) migrants and mobile populations face many obstacles in accessing essential health-care services due to a number of factors, including:

  • lack of migrant-inclusive health policies
  • language barriers
  • poor continuity of care due to mobility
  • lack of portability of health insurance or no social protection

The GCHL (2018) Supplementary Report noted the adoption of discriminatory and restrictive laws and policies by some countries, such as visa denials, screenings, and deportation based on health status, including HIV and TB status. It recommended that governments review and reform all discriminatory and punitive laws, policies and requirements that create barriers to entry or access to health care for migrants. They should provide migrants with access to the full range of health services, including for HIV, TB and viral hepatitis.

See Enabling Legal Environments for more information on creating an inclusive and effective environment for access to health care for all vulnerable and key populations.

The UNAIDS Reference Group on HIV and Human Rights

The UNAIDS Reference Group on HIV and Human Rights, which is co-managed by UNDP, advises UNAIDS on matters relating to HIV and human rights.

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The Reference Group has discussed and examined critical human rights and gender equality issues and produced leading guidance on protecting human rights in various aspects of effective responses to HIV.

The Reference Group also provides advice on the implementation of the human rights elements of the UNAIDS 2016-2021 Strategy. The Strategy highlights structural interventions required to address human rights and gender-related barriers for key populations with specific targets linked to the Sustainable Development Goals. The strategy has a specific focus on prevention, treatment and support services, social protection programmes and gender equality. The strategy also has a specific result area focused on ensuring that punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV are removed.

UNAIDS Reference Group on HIV and Human Rights

Key resources