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These people are increasingly marginalised, not only from society, but from the services they need to protect themselves from HIV.For example, in 2016, 60% of countries in the European Economic Area reported that health care professionals’ negative and discriminatory attitudes towards men who have sex with men and people who inject drugs hampered the provision of adequate HIV prevention services for these groups.13 More than 90% of new HIV infections in Central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, who accounted for 45% of new HIV infections worldwide in 2015.14 Recent studies suggest that, globally, people who inject drugs are 24 times more likely to acquire HIV than the general population, sex workers are 10 times more likely and men who have sex with men are 24 times more likely.

20 In 2015, WHO released new treatment guidelines that reflect the need to address stigma and discrimination as a barrier to accessing HIV treatment.21 HIV and AIDS-related stigma can lead to discrimination, for example, when people living with HIV are prohibited from travelling, using healthcare facilities or seeking employment.

Self-stigma, or internalised stigma, has an equally damaging effect on the mental wellbeing of people living with HIV or from key affected populations.

I am afraid of giving my disease to my family members-especially my youngest brother who is so small. I am aware that I have the disease so I do not touch him. In 2014, 64% of countries reporting to UNAIDS had some form of legislation in place to protect people living with HIV from discrimination.28 While, conversely, 72 countries have HIV-specific laws that prosecute people living with HIV for a range of offences.29 Criminalisation of key affected populations remains widespread with 60% of countries reporting laws, regulations or policies that present obstacles to providing effective HIV prevention, treatment, care and support.30 As of 2016, 73 countries criminalised same sex activity,31 and injecting drugs use is widely criminalised, leading to high incarceration levels among people who use drugs.32 More than 100 countries criminalise sex work or aspects of sex work.33 Even in countries where sex work is at least partially legal the law rarely protects sex workers and many are at risk of discrimination, abuse and violence from both state and non-state actors such as law enforcement, partners, family members and their clients.34 For example, some 15,000 sex workers in China were detained in so-called custody and education centres in 2013.35 Case study: Ending criminalisation of HIV transmission in Australia Laws that criminalise HIV non-disclosure, exposure and transmission perpetuate stigma and deter people from HIV testing and puts the responsibility of HIV prevention solely on the partner living with HIV.36In May 2015, the Australian state of Victoria repealed the country’s only HIV-specific law criminalising the intentional transmission of HIV.

The repealed law - Section 19A of the Crimes Act 1958 - carried a maximum penalty of 25 years imprisonment, even more than the maximum for manslaughter (which is 20 years).37The legislation to repeal the law was developed through the collaboration of several stakeholders, including legal, public health and human rights experts and representatives of people living with HIV.

This hinders, in no small way, efforts at stemming the epidemic.

It complicates decisions about testing, disclosure of status, and ability to negotiate prevention behaviours, including use of family planning services.Your usage has been flagged as a violation of our terms of service.For inquiries related to this message please contact support.Moreover, transgender people are 49 times more likely and prisoners are five times more likely to be living with HIV than adults in the general population.15 UNAIDS and the World Health Organization (WHO) cites fear of stigma and discrimination as the main reason why people are reluctant to get tested, disclose their HIV status and take antiretroviral drugs (ARVs).16 One study found that participants who reported high levels of stigma were over four times more likely to report poor access to care.17 This contributes to the expansion of the global HIV epidemic and a higher number of AIDS-related deaths.An unwillingness to take an HIV test means that more people are diagnosed late, when the virus may have already progressed to AIDS.Self-stigma affected a person's ability to live positively, limits meaningful self agency, quality of life, adherence to treatment and access to health services.23 In Zimbabwe, Trócaire and ZNNP designed, implemented and evaluated a 12-week pilot programme to support people living with HIV to work through self-stigmatising beliefs.

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