By Anton Pozniak and Brenda Crabtree, IAS 2019 Co-chairs
Lesbian, gay, bisexual and transgender (LGBT) rights in the Latin American and Caribbean region are striding forward, with Mexico leading on many fronts. Since August 2010, Mexico City has legalized same-sex marriage and many states in the country are also moving forward with this. More recently, the law for fundamental spousal rights is also being recognized as applying to same-sex couples. Just a decade ago, however, this would have been hard to imagine.
That was when Jorge Saavedra, then head of Mexico’s Centro Nacional para la Prevención del VIH/SIDA (CENSIDA), caught many delegates by surprise by declaring his homosexuality during a plenary session at the 2008 International AIDS Conference (AIDS 2008) in Mexico City.
A window of opportunity
Today, there is growing recognition in the region of LGBT rights around same-sex unions and marriages. There are laws that prohibit discrimination on the grounds of sexual orientation or living with HIV.
Sex work too is legal in almost every country in Latin America, but its regulation varies across the continent. And a recent decision has asserted that governments should allow people, through a fast, easy and cost-free process, to change their name and gender marker on official documents in accordance with their self-perceived gender. This has opened a window of opportunity for Latin America to lead the way on transgender equality.
Thirty-five years of HIV/AIDS has taught scientists, researchers, doctors, political leaders and funders that driving the LBGT community, people who inject drugs and sex workers underground via oppressive laws and policies is a recipe for driving the HIV/AIDS epidemic upwards. As Mr Saavedra noted in his speech at AIDS 2008, Latin American men who have sex with men were at that time 33 times more likely to be infected with HIV than the rest of the population.
We’ve certainly seen some of the progress on LGBT rights in Mexico. But across the Latin and American Caribbean region, progress has been uneven. Amid a series of challenges, including inter-country migration and migration to the United States via Mexico, there lies the potential to destabilize the HIV/AIDS response if groups vulnerable to HIV are not protected.
Mexico has led the way in the region with a national policy on HIV treatment, providing universal access to antiretroviral therapy (ART) through the national health system since 2003. The Universal Access to ART Programme ensures a predictable supply of antiretroviral medicines and tests people without social security.
Headway has certainly been made: since 2010, new HIV infections in Mexico have decreased by 22% with 13,000 cases of new HIV infections reported in 2017.
At the same time, despite the tremendous efforts to deliver ART to all who need it (which has also resulted in a decline in AIDS mortality over the past decade by 30-50%), late diagnosis of HIV still occurs in almost half of detected cases; 4,200 people died of AIDS-related causes in Mexico last year.
Think about this. Across the border, a few hundred kilometres away in San Diego, the quality of HIV care is among the best in the United States. On the other side of the border, in Tijuana, there’s still an AIDS hostel called Las Memorias, still full of patients: some are treated and some die.
Like so much of the region, the progress is still not being shared by the more vulnerable groups, those key populations affected by the impact of stigma or repressive policies or both.
We’ve long known what the solutions are and that they need to be evidence based. Promising overtures have been made by President-elect Andrés Manuel López Obrador to move towards drug decriminalization in Mexico and take a public health approach to drug use. This is a clear sign that he is keen to move policy forward on evidence-based science. On the HIV front, he can count on a strong and dynamic research community in Mexico that has been central to the country’s response to date.
At the 10th IAS Conference on HIV Science (IAS 2019) to be held in Mexico City next July, some 6,000 scientists, policy makers and affected communities will convene to chart the next wave of prevention and treatment tools that, combined with good policy, can help us meet the challenges in the region.
It is well worth considering that all those things that Mr Saavedra advocated for a decade ago – more funding, improved disease surveillance, protection of patients’ rights and activism to promote political will to meaningfully address the problem – remain as vital as ever if we are serious about moving towards ending the HIV/AIDS epidemic in the Latin American and Caribbean region.