The world has seen the ways inequality has played out during the COVID-19 pandemic: who contracts the disease, who has access to vaccines and medical care and testing, who can’t work from home or who loses their job because of the pandemic’s effects on the economy, who has an underlying condition that makes them more vulnerable to the coronavirus – the list goes on.
It’s no different for HIV/AIDS, which has been around since the first case was reported in 1981. And while strides have been made – a few countries have reached epidemic control, 26 million of the 38 million people living with HIV can access life-saving antiretroviral therapy – AIDS-related causes claimed nearly 700,000 lives in 2019.
According to UNAids, “The risk of acquiring HIV is 26 times higher among gay men and other men who have sex with men… 30 times higher for sex workers, and 13 times higher for transgender people. Every week, about 4,500 young women aged 15 – 24 years acquire HIV.
‘’In sub-Saharan Africa, 5 in 6 new infections among adolescents aged 15 – 19 years are among girls. Young women are twice as likely, to be living with HIV than men. Only 53 per cent of children 0 – 14 years who are living with HIV have access to the HIV treatment that will save their lives.”
To tackle social, economic, racial and gender inequities is to tackle HIV/AIDS by expanding access to prevention and treatment for vulnerable groups.
United Nations Population Fund (UNFPA) has seen how discrimination and stigma can undermine the fight against HIV/AIDS and works to fuel the fight. In Bangladesh, a UNFPA-supported wellness centre reached more than 2,500 transgender and gender-diverse people with HIV prevention and treatment services in 2020; this year, it launched an initiative on HIV self-testing, treatment, care, and support for more than 1,300 third gender individuals.
A transgender woman living in Dhaka, Bangladesh, who left her family when she was 11, Shohan Hijra, said ”I have never been loved or respected by anyone in my life except a few early years by my mother.”
Her experience is not exceptional in this country, where despite the fact that transgender people – locally known as “hijra” – are legally recognized as “third gender,” discrimination, harassment and violence run rampant.
One person showed UNFPA a cut on her hand inflicted by locals; another’s hair had been chopped off. Stigma against persons living with HIV and AIDS and higher-risk populations poses a barrier for accessing health services, especially for the transgender and gender-diverse community.
Sexual and reproductive health and rights and HIV prevention
In recent years, UNFPA has worked to ensure the sexual and reproductive health and rights (SRHR) of such populations in this largely conservative country. In the southeast coastal city of Cox’s Bazar, for example, which shelters over 1 million Rohingya refugees living alongside Bangladeshi host communities, the agency implemented a programme that integrated SRHR and HIV prevention and treatment through a wellness centre in partnership with Bandhu Social Welfare Society and funded by Global Affairs of Canada.
The centre’s outreach services, including advocacy, HIV and sexually transmitted infection testing and treatment, condom promotion, gender-based violence response and psychosocial support, benefited more than 2,500 transgender and other gender-diverse people in 2020. Two people were diagnosed HIV-positive and are currently receiving treatment.
The programme also addressed COVID-19 by launching a mass awareness campaign, establishing hand-washing stations and distributing cloth masks after training 20 transgender and gender-diverse participants to sew them and donating sewing machines to local groups.
For an ostracized community often already living hand-to-mouth, a natural disaster can heighten daily living challenges. After last summer’s monsoon floods in northern Bangladesh, groups of transgender individuals were displaced and dispersed, unable to take refuge in shelters that shunned them. Earning a living had been curtailed by COVID-19 so they could not buy essentials.
As part of relief efforts, UNFPA distributed 5,900 dignity kits with such essentials to women and transgender people in three flood-affected districts, the first time dignity kits were specifically designed to meet third gender needs. Kajli, a transgender woman, who didn’t have an income or a proper place to live because of the flooding, received a tailored dignity kit. “My only hope is that interventions like this can change the way society thinks and can help include us into the mainstream,” she said.
Testing, treatment, tracing
This year, UNFPA and Bandhu started a wide-ranging programme, funded by UNAIDS, targeting 1,300 young transgender and gender-diverse populations in Dhaka, Sylhet, Khulna, Chittagong and Mymensingh cities, which in addition to HIV self-testing, focuses on treatment, care and support for people living with HIV, education and awareness and access to information and services.
Before the project, third gender individuals could only be tested at a government hospital after being referred by a service centre. Now they can get tested at the centre itself; those testing positive will be referred to the hospital for treatment, and the programme will try to trace their partners for testing, too.
Programme participant Shohan, now 21, has found acceptance in a group of other transgender and gender-diverse people. She’s also found a partner: “Amidst the frustration, Arif came into my life with love and affection. I don’t know the fate of this relationship, but for now, I am very happy.”
In the Philippines, UNFPA piloted an entrepreneurship programme to help marginalized populations including female sex workers, women living with HIV, transgender women and men who have sex with men. It helped blunt the economic impact of losing sex work during the pandemic but was also meant to help reduce HIV transmission by providing an alternative to transactional sex as a source of income.
Necessity is the mother of invention, as the saying goes, and COVID-19 created needs of sweeping depth and breadth all over the globe. Many newly unemployed had to reinvent themselves to find an alternative stream of income as old jobs shrunk or disappeared completely because of the pandemic.
Be your own boss
In the Philippines, some found livelihoods under new bosses: themselves. Piloted in Pasay and Caloocoan in Metro Manila last October by UNFPA and the Center for Health Solutions and Innovations, Inc., the Economic Opportunities for Women and Key Populations Disadvantaged by COVID programme first began to aid women engaging in transactional sex and women living with HIV to blunt both the socio-economic impact of the health crisis and the risk of contracting the coronavirus by earning a living in a field other than sex work.
Instead of handing out money, the programme provided training, including skills like accounting, signage and products to launch micro-businesses, which include mobile phone reloading services, food stalls and shops selling basic sundries (called sari-sari) or handicrafts. The newly minted entrepreneurs then use profits to support their ventures, which are monitored by programme coordinators.
The programme has since expanded to Cebu City and Angeles City and to populations at risk for HIV, including transgender women and men who have sex with men (MSM), and has benefited more than 250 people so far. These key populations who are more likely to have underlying health conditions because of poverty or a lack of health care because of discrimination are particularly vulnerable to COVID-19.
Paying dividends
Julio (not real name), 41, is a MSM who started a mini-store outside of his house in Cebu City after hearing about the initiative from the city’s health department. “Even though I started small, I will do my best to sustain it so I can support my family and extend help to others in our community,” says the former government worker who had trouble securing employment because of COVID-19.
Carmen, (not real name) a 44-year-old transgender woman also in Cebu City, lost her job as a volleyball referee given social restrictions and couldn’t find work. In addition to covering her daily needs, the snack stand she opened also presented a valuable lesson:
“This experience taught me that our most painful struggles can grant us necessary growth. What seems like a curse in the moment can actually be a blessing, that the end of the road is a discovery that we are meant to travel down a different path. No matter how difficult things seem, there is always hope. No matter how powerless we feel, we can’t give up.”
Neither pandemic is the last one the world will ever see. But global solidarity toward eliminating inequalities, to granting every person their human right to health, is a better vision than the alternative.
