Friday is World AIDS Day and this year’s motto is My Health, My Right. It might sound like a simple phrase but the UNAIDS theme for 1 December 2017 is actually sending us a powerful reminder. Your health is not just one metric, like your blood pressure or your heart rate. It is a combination of lots of very personal factors, including your sexual health.
For us at ILGA-Europe, (the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association) – the right to health and sexual health is a vital part of our work. We have been advocating for policies and laws that fully respect, protect and fulfill the right to health of LGBTI people for over 20 years. To fight for the right to health also means pushing for legal gender recognition for trans people, ensuring the bodily integrity of intersex people is protected and everyone’s right to family recognition, education and information.
I think it’s important for me to be really clear from the start, when we talk about our work on sexual health as an organisation, we aren’t just thinking about the ‘what’ – medical terminology around testing, treatment and prevention. We are thinking about the ‘who’ as well. Often in discussions around sexual health, the less visible members of the LGBTI communities can be left out (who are often the communities that conversations on sexual health are most relevant to in the first place!).
The LGBTI movement is sometimes challenged for shying away from working on sexual health. The stigma that has come with the topic for our community can often deter NGOs from being vocal about their work. From ILGA-Europe’s point of view, what we really need is a constructive conversation about how to decrease risks and ensure non-discrimination. We in the LGBTI movement still need to work to encourage all within the community to break the silence!
Stigma around HIV within the LGBTI community is one prime example of this – it still makes people reluctant to get tested and HIV transmission continues. The taboo around HIV means LGBTI people might not access testing (or health services in general). It also has an impact on discussing safe sex with partners and with health practitioners. Internalised homonegativity, lack of self-confidence and well-being all lead to more risky sexual practices.
The UNAIDS 90-90-90 target to end AIDS by 2030 is an ambitious goal, but one that has already been met in London. What it means is that by 2020:
· 90% of HIV positive people should be aware of their sero-status,
· 90% of people who are aware of their status will receive treatment,
· and 90% of those people receiving antiretroviral treatment should have an undetectable viral load.
It is now up to LGBTI organisations working on issues of sexual health (like ILGA-Europe), governments and health professionals to ensure that this ambitious goal is met. At the same time, we also need to make sure that the most under-represented members of the LGBTI community are not missing out. Young and older LGBTI people, those who come from a minority ethnic or religious background, LGBTI sex workers, gender non-conforming people – they must not end up in the 10%; they must be involved in this strategy. The risk is real.
Unfortunately, many sexually transmittable infections are still or again on the rise: hepatitis, syphilis, gonorrhea, etc. The cases of new HIV infections amongst men who have sex with men are continuing to increase in most countries across Europe. Even countries that were, in the past, considered to be ‘low prevalence’ (in particular in the Western Balkans) are now becoming high prevalence countries. Worldwide, the HIV prevalence is estimated to be at 19% among trans women, and trans women are 49 times more likely to be living with HIV than the general population.
Many LGBTI organisations are actively working towards the UNAIDS targets with a range of activities and programmes, from community-based testing to promotion of sexual health and advocacy work on access to treatments. Support, including financial support, is needed to expand that work. The Global Fund (a huge financial resource for HIV-AIDS work in the Western Balkans and Eastern Europe) has been withdrawn from the region, which may lead to less targeted prevention and treatment programmes focused on LGBTI people and other key populations. Urgent concerns like increasing prevalence of HIV and limited resources underline exactly why working on sexual health, HIV and STD issues is so important for ILGA-Europe.
This picture might sound worrying – but we can all play a role in shattering the stigma, on World AIDS Day and during the entire year.
We recognise the need to talk openly about other health issues in order to encourage people to get tested, for cancers for example. Why not talk more frankly about sexual health too? Prevention, testing and treatment are ways of taking care of your body. Medical professionals, the LGBTI community, our friends, families, allies and neighbours – if we can all start having more non-judgmental conversations about sexual health, the taboos start to fade away, bit by bit.