The state of human rights in relation to key populations, HIV and sexual and reproductive health

This year marks the 70th anniversary of the Universal Declaration of Human Rights (UDHR) and the bold acknowledgement by all the nations of the world that “the recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”. As we celebrate the UDHR anniversary, we also need to take stock to reflect on humanity’s journey on this incredible path of realising human rights for all. In doing so, we must acknowledge that whilst the rhetoric has been on the inalienable rights of all members of the human family, the reality on the ground has been different, often characterised by the violation of rights of sexual minorities and other marginalised groups. Increasingly, humanity accepts the proposition that a fair, prosperous, secure and sustainable future is not possible if the rights of every person are not recognised in practice and in law. Perhaps no other public health epidemic has tried this assertion as well as the proclamation of “the equal and inalienable rights of all members of the human family” by the UDHR, as has HIV. HIV is not just a public health matter, it is also a human rights and social justice challenge perpetuated by stigma and discrimination and the failure to guarantee the rights of thosemost at risk of the disease. As a result, HIV continues to be a major global public health concern, having claimed more than 35 million lives so far. In 2017, 940,000 people died from HIV-related causes globally. Globally, there were approximately 36.9 million people living with HIV at the end of 2017, including 1.8 million people who became newly infected in 2017. Key populations are groups who are at increased risk of HIV infection, irrespective of epidemic type or local context. According to UNAIDS, key populations include gay, bisexual and other men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and their clients, and transgender people. They often have legal and social issues related to their behaviours that increase their vulnerability to HIV and reduce access to testing and treatment programmes. These behaviours are often criminalised, making it difficult for people to freely access health services for fear of arrests. Young people, due to specific higher risk behaviours, such as inconsistent use of condoms, are often regarded as part of key or vulnerable populations. What these populations have in common is that in many jurisdictions, they are marginalised, criminalised or in conflict with the criminal justice system, and subject to serious violations of the rights enshrined in the Universal Declaration of Human Rights – equality, dignity, non-discrimination, life, liberty, security of the persons, effective remedy, fair trial, freedom from torture, cruel, inhuman and degrading treatment and punishment, arbitrary arrest and detention, freedom of movement, expression, assembly and association, and so on. Key populations are “key” for a reason. Men who have sex with men, sex workers, transgender people, and people who inject drugs not only face HIV risks 14–50 times the general population but are often confronted with double, triple, or quadruple compounded stigma and discrimination, which severely affects their ability to access HIV prevention and treatment resources. The situation is perpetuated primarily by discriminatory and punitive legal and policy frameworks that undermine an effective HIV response for key COMMENTARY