Norwegian report

REPORT TO THE NORWEGIAN GOVERNMENT “Latin America responding to the Agenda for Accelerated Action for Women and Girls, Gender equality and HIV”

Index 01 02 03 04

Executive summary Looking forward, consolidating results.

Background Context of the regional response to HIV and gender inequality

04

Internal environment: increased leadership for addressing gender inequality through the HIV response

05

The Unaids Agenda For Accelerated Country Action For Women, Girls, Gender Equality And HIV

05

External environment: Increased Political Commitment to Achieving Gender Equality in Latin America

07

07 07

Significan results and achievements Component 1: Strengthening strategic guidance and support to national partners to “know their epidemic and response� in order to effectively meet the needs of women and girls.

Using evidence as a tool for advocacy and policy guidance

08

Universal access to prenatal testing for HIV and Syphilis: information to end transmission

08

Violence and its Relation to HIV: Information gap hindering policy efficiency

09

Bolivia a story of violence since childhood:

10

Peru: research showing the need for new prevention intervention approaches for women.

11

Venezuela: study among youth establishes worrying levels of abuse.

12

Participatory and empowering qualitative studies provides a voice to the women affected

12

Gender equality and poverty

13

2. Assisting countries to ensure that national HIV and development strategies, operational plans, M&E frameworks and budgets address the needs and rights of women and girls.

Costa Rica taking AIDS out of isolation

13

Chile, new actors at local level create joint action

14

Peru: Integrating women living with HIV and Trans in the National Gender Equality Plan 2012-17:

15

Mexico: National and Federal engagement for HIV and GBV

15

Nicaragua, strengthening decentralized stigma free health services for trans sex workers

16

3. Advocacy, capacity strengthening and mobilization of resources to deliver

18

Panama: local police in dialogue with the Trans.

Strengthening organizations of Women Living with HIV to impact the broader development agenda.

20 20

CILA. The Communication Initiative Latin America reaching media professionals with gender and HIV information in Spanish.

21

IMLAS, 32 channels in Latin America in one Network in a powerful partnership to promote knowledge on HIV and confront discrimination:

22

Shared Responsibility and South-South collaboration.

22

Supporting women’s organizations to access Global Fund grants and mobilize resources

22

Monitoring and Evaluation of the project Conclusion Continued implementation in Latin America: capitalising on the mobilisation pushing for increased action for transformative gender action towards the Post 2015 agenda Continued Partnership with Norway on gender equality and diversity

23 24

24 25

Executive summary The present report describes the UNAIDS Regional Support Team (RST) for Latin America’s achievements under the Norwegian grant “Latin America responding to the agenda for accelerated action for women and girls, gender equality and HIV.” The project funded by the Norwegian Ministry of Foreign Affairs was called: “Enhanced Action on Women & AIDS in Latin America”. A total of $1,081,276 was allocated to the RST in 2007 for implementation in 2008-2009. With the approval of an exceptional extension in December 2010 to December 2011, the implementation of the grant was realigned grant to the Agenda for accelerated action for women and girls and gender equality and HIV. The grant has been closed with an implementation rate of 99.4 %.

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The Norwegian grant has allowed the UNAIDS secretariat and cosponsors to ensure a renewed focus on gender by providing the necessary resources to translate the UNAIDS Agenda for Accelerated Action for Women, Girls, Gender Equality and HIV into concrete actions and results in Latin America, following its launch in 2010.

Women in Latin America counts for 31 % of People Living with HIV, with a total estimated number of 427,763. The epidemic in Latin America is concentrated, with the transgender population showing a prevalence rate between 21-27 %, men having sex with men a prevalence ranging between 9-22 %, while the prevalence among sex workers range between 0,3 to 5,4 %. These rates have to be viewed against a prevalence rate of 0,4 % in the general population. For all the mentioned population groups sex is the main route of transmission. Female sex workers, including Trans-sex workers are particularly affected, as are the wives or partners of men using the services of sex workers or men having sex with men, as many women living with HIV report having been infected by their husbands or partners.

The RST has provided a clear voice in the response to HIV, based on human rights and informed by evidence, ensuring due focus on interventions addressing the situations which make transgender women and sex workers vulnerable as well as ensuring increased attention to women in the general population. The Agenda has provided us with a tool for a more explicit strategy to address women within a broader development framework.

The grant provided from Norway has been the main financial support available for UNAIDS and cosponsors in Latin America in the area of gender, and has been instrumental in catalysing targeted political action to promote women’s empowerment and gender equality, ensuring sexual orientation and gender identity is addressed as an integral part of the work, as a critical factor to overcoming the HIV epidemic in the region.

At country level, the grant has allowed UNAIDS and cosponsors to significantly develop access to in-depth strategic evidence on women, including around sexual orientation, HIV and gender based violence and accelerate the move towards evidence based gender-sensitive national HIV responses. Integration of HIV into overall development plans has progressed, with women living with HIV and transgender women being included in National Plans for Equal opportunities, as shown in Peru. Nationally owned and decentralized plans and actions to integrate HIV and GBV have progressed in Mexico and Chile. Moreover, sectoral policies and interventions are under development based on the evidence established through an investigation on the impact of HIV on male and female sex workers in Costa Rica.

The grant has also consolidated the capacity of several Regional Networks of Women living with HIV, like the International Coalition of Women Living with HIV, Latin American Chapter (ICW Latina), the Movement of Latin American and Caribbean Women Living with HIV (MLCM+), the Latin American and Caribbean Network of Transgender (REDLACTRANS), and the Latin American and Caribbean Network of Sex Workers (RedTraSex); and facilitated new, vibrant, action-oriented partnerships among them and gender equality advocates.

Built on a human rights based approach this strengthening has – among others - resulted in scaled-up actions on issues such as sex workers and transgender populations in Latin America.

Equally important is the successful establishment of new partnerships, engaging new allies, including trans and sex workers, around common challenges in the region related to gender based violence and the links to HIV.

Looking forward, consolidating results Significant results have been obtained to further gender equality with the funds from the Norwegian grant. However, in an effort to reach the targets set in the UN 2011 Political Declaration on HIV/AIDS it is imperative to consolidate the results obtained and ensure maximum impact of the momentum reached in Latin America, the RST is thus is seeking continued collaboration with the government of Norway in the following areas: i) Complement the development of critical evidence to firmly position gender equality, including sexual orientation, in close collaboration with the Inter American Commission on Human Rights and the Inter American Commission on Women; ii) Using the information collected for action, ensuring gender equality, diversity, social justice and HIV forms part of the ICPD and Post 2015 agenda, with a particular focus on themes related to equality and health, and consolidating gains made in reaching the HLM targets in Latin America, as well as further enhancing the human rights based and gender equality approach; iii) Continued political advocacy around the HIV-specific vulnerabilities of women and girls and sexual diversity, creating public policy dialogue and enhanced integration in overall development policies to promote sustainability of programmes. This includes the ongoing work on high level engagement to strengthen financial sustainability of inter ventions related to health, education and social protection with government; iv) Acceleration of gender-transformative national HIV responses to catalyze social change in line with the Agenda using data established ; v) Strengthening of the enforcement of legal protection related to gender based violence and;

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Internally, the grant has been managed by the UNAIDS Regional Partnership Adviser and programme analysts’ to ensure a close follow-up on activities and the integration of the Agenda work at Regional level among cosponsors, including the Regional UNITE Campaign working group.

This has been part of the core functions of the staff supported through UNAIDS core funding.

vi) Creating space for and continue to build leadership among partners, with a particular focus on young women, to ensure mutual accountability for results. This will include networks of women and girls living with HIV, women’s groups, young transgender women and rural girls and networks of men and boys working for gender equality, for their meaningful engagement.

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Background Recognizing that harmful gender norms and inequalities are major drivers of the HIV epidemic, the international community has identified the HIV response as a well-placed strategic platform to advance Millennium Development Goal 3 and 6. As such, the Norwegian Ministry of Foreign Affairs provided the UNAIDS Secretariat in December 2007 with a total budget of US$ 1.081.000 to support the project “Enhanced Action on Women and AIDS in Latin America”. The grant was made available for the period of December 2007 to November 2009. In January 2010 a dialogue concerning an exceptional extension was initiated and consequently approved in November 2010 for implementation of the grant to December 2011. In 2010 the grant was fully aligned with the then recently launched “Agenda for Accelerated Action for Women, girls, gender Equality and HIV”, hereafter called the Agenda. The implementation focused on ensuring the aspects of sexual orientation and gender identity being fully addressed within the Agenda in line with the activities originally included in the proposal.

On December 16th 2010 a Regional Committee of UNAIDS Co-sponsors, chaired by UNFPA, revised and qualified country based proposals based on the Agenda for Women and Girls and Gender Equality and HIV to be granted funds through this project. The following seven countries were identified for country based action: Bolivia, Chile, Costa Rica, Mexico, Nicaragua, Peru and Venezuela. The respective countries were informed on the 28th December 2010. The proposal from Panama was revised and requested major improvements before it was resubmitted was and approved in the beginning of 2011.

At the RST specific steps were taken to ensure involvement of co-sponsors in the identification and implementation of the proposals to be supported. This has been core to further enhance aligned work around the Agenda among co-sponsors both at Regional and Country level.

The Norwegian funds complemented the support by UNAIDS HQ to Argentina, Guatemala, Honduras and Brazil ensuring that a total of 13 out of 17 Latin American countries managed funds for accelerating action towards women and girls and gender equality.

The original grant implemented in 2008-09 was structured around five key actions towards an accelerated gender response: institutional capacity building, strategic information, enhancing policy development on human rights, GBV, stigma and discrimination, developing resource mobilization strategies and finally strengthening monitoring and evaluation. These areas falls within the three Result Areas of the Agenda along which the present report is structured.

Context of the regional response to HIV and gender inequality Gender inequality and related gender-based violence are recognized as structural drivers of the HIV epidemic, not only underlying the spread of HIV but also fuelling ill-health and underdevelopment more broadly. Despite considerable progress in overall human development in Latin America, the region has two appalling records: being the most inequitable region in terms of distribution of wealth and thereby opportunities, and secondly the most violent continent without experiencing any wars. These two facts are reflected in the findings of the studies undertaken, highlighting the intrinsic link between women and trans and marginal living conditions exposing them further to risk behaviours and vulnerabilities related to HIV.

The grant funded projects document the challenges that States confront in guarantying the basic responsibilities of fulfilling, protecting and enforcing the human rights of all their citizens, with women living with HIV being a group falling outside the overall positive trend in development.

This recognition has led to an urgent call for gender-transformative actions based on social justice, in accordance with local epidemics and socio-cultural context.

Internal environment: increased leadership for addressing gender inequality through the HIV response UNAIDS in Latin America is highly committed to addressing the impact of gender inequality, with a strong emphasis on ‘zero tolerance for gender-based violence, on the HIV epidemic. With the support from the Norwegian Government, UNAIDS and cosponsors in Latin America have intensified leadership in moving forward on gender equality and HIV, reinforcing country and regional level commitment and actions, as demonstrated through the developments described below.

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The Economic Commission in Latin America and the Caribbean (ECLAC) estimates based on household surveys available as of 2011 put the regional poverty rate at 29.4%, including 11.5% living in extreme poverty or indigence.

The Unaids Agenda For Accelerated Country Action For Women, Girls, Gender Equality And HIV The UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, the “Agenda”, was developed through a highly consultative process, under the leadership of the UNAIDS Executive Director, Michel Sidibé.

The UNAIDS Action Framework: Addressing Women, Girls, Gender Equality and HIV, provides concrete guidance on how to scale-up policies and programming for women, girls, gender equality and HIV. The Action Framework emphasizes actions in three areas: 1. Strengthening strategic guidance and support to national partners to “know their epidemic and response” in order to effectively meet the needs of women and girls;

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2. Assisting countries to ensure that national HIV and development strategies, opera tional plans, monitoring and evaluation frameworks and associated budgets address the needs and rights of women and girls in the context of HIV; 3. Advocacy, capacity building and mobilization of resources to deliver a comprehensive set of measures to address the needs and rights of women and girls in the context of HIV. The UNAIDS Regional Support Team (RST) for Latin America has been advocating for, and supporting the implementation of the Action Framework and the Agenda for Accelerated Action on Women, Girls, Gender Equality and HIV by providing technical support and funding; the support from the Norwegian government being the most substantial contribution to countries and regional civil society networks to implement related activities.

Through partnerships between governments, civil society, including Networks of Women living with HIV and the women’s rights movement, and the UN system, the Agenda is currently being operationalized in 13 out of 17 Latin American countries. The Norwegian funding directly contributed to the acceleration in 7 countries between 2010-11 and to regional level interventions, impacting on the region as a whole.

It has given prominence to issues previously under-addressed in National HIV responses such as violence against women and girls, sexual and reproductive health and rights of women and girls living with HIV, capacity strengthening of networks of women living with HIV, and it has also had the effect of uniting previously fractured efforts on gender inequality and HIV both within the UN system and of governments and civil society partners. These areas still need considerable strengthening.

External environment: Increased Political Commitment to Achieving Gender Equality in Latin America Several developments in the external environment have resulted in increased regional attention to the challenges faced by women, transgender women and girls, and have in the process augmented the regional political commitment to advance gender equality.

UNAIDS has in the period of reporting, with a particular emphasis on 2010-11, strengthened the work with The Inter American Commission on Human Rights (IACHR) and the Inter American Commission on Women, to promote the work on human rights, gender equality and HIV. The Inter-American Commission of Women (CIM) is the main body that provides technical support to gender mainstreaming policies, processes and activities, both within the Organization of American States (OAS) and its member states. In 2007, CIM adopted the San Salvador Declaration on Gender, Violence and HIV, where it is stated that “it is essential and urgent to develop HIV related initiatives with a gender focus, in coordination with existing international organizations, especially the PAHO and UNAIDS”. With an enhanced focus on the Declaration, a strategic alliance between CIM and UNAIDS was established in 2010, as part of the broader UNITE campaign, mutually reinvigorating the work on GBV and HIV.

Moreover, UNAIDS advocates for the inclusion of issues faced by Transgender women in the work of women’s rights, and the reporting mechanisms to hold states accountable have been core to this end throughout the period.

To address the work on sexual orientation and gender identity, the UNAIDS RST has engaged with the IACHR to support the work on the Resolution, AG/RES. 2653 “Human Rights, Sexual Orientation and Gender Identity” first adopted in 2008 and repeatedly approved in each General Assembly of the OAS. This Resolution condemns discrimination against persons by reason of their sexual orientation and gender identity and urges states to adopt the necessary measures to prevent, punish, and eradicate such discrimination, including judicial protection for victims and protection for human rights defenders. UNAIDS is involved in the technical and political work providing funding for both IACHR and the Civil Society LGTBI Coalition to ensure HIV is mainstreamed throughout this work.

UNAIDS leadership on gender equality and HIV has contributed to, and is capitalising on, the growing recognition of the centrality of gender equality for health and development. This is being done forging continued alliances with UN Women and the UNiTE Campaign, the Inter American Commission on Human Rights and the Inter American Commission on Women.

It is worth noting that UNAIDS has partnered with development partners on regional initiatives related to women, girls, gender equality and HIV, including the SISCA early infancy regional plan, Maternal and Child Health, the Regional Initiative for the Virtual Elimination of Vertical Transmission of HIV and Congenital Syphilis, and the Together for Girls Initiative, focusing on sexual violence against girls.

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Further work at regional level to integrate HIV within the reporting towards the Inter‐American Convention on the Prevention, Punishment and Eradication of Violence against Women (hereafter the Convention of Belém do Pará) in conjunction with CEDAW at global level is under way.

Significant results and achievements Through the three components of the Norwegian grant, cosponsors and UNAIDS have translated the Agenda to action at country and regional level. UNAIDS partners have greatly appreciated the support received, which has allowed them to better address the HIV-related vulnerabilities caused by gender inequality and thus produce positive outcomes.

Component 1: Strengthening strategic guidance and support to national partners to “know their epidemic and response� in order to effectively meet the needs of women and girls

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Understanding of how gender norms define the impact of HIV on the lives of women and girls is at the cornerstone of a gender-sensitive national HIV response. Through the Norwegian grant, UNAIDS has supported several countries in strengthening their knowledge base on women, girls, gender equality and the aspect of sexual orientation and gender identity and HIV. Utilizing a diverse range of innovative approaches to gather strategic information, this support has generated critical insights on gender-focused HIV data, data collection methods, and data use for programme planning and implementation. As a result, UNAIDS has not only guided more effective programming, but also built capacities among national partners and fostered new alliances to address gender inequality and HIV, as further detailed below.

Using evidence as a tool for advocacy and policy guidance In 2009 UNICEF, PAHO and UNAIDS produced a situational analysis and progress report on the HIV response in Latin America focusing on key populations, including sex workers, MSM, IDU, as well as on PMTCT and treatment. This was the first publication gathering evidence on key populations in the region. This was a crucial document as it came at a point in time where the National AIDS Programmes worked to reorient and ensure funding for the most affected groups in Latin America, and the collected evidence was used to influence policy decisions. (Publication available) The same year a total of 6 countries were trained on conducting Modes of Transmission (MoT) studies in the MERCOSUR covering Brazil, Colombia, Ecuador, Mexico, Paraguay, Peru, resulting in a pool of capacitated country staff to lead the national MoT studies. In Peru the results of the MoT showed that trans women, sex workers and women in the general population having intimate relationships with MSM, IDU or men having relationships with sex workers are the most vulnerable. The results of the initial MoT in Peru were used to do a further study to identify the vulnerability factors of women in the general population. This second study was also carried out with the Norwegian grant (Further explained below).

In Chile a second generation surveillance study on men who have sex with men (MSM) was completed with PAHO and the National AIDS Programme and Ministry of Health and civil society.

The Respondent-Driven Sampling (RDS) methodology enabled identification of social networks and identified entry points for prevention programmes covering the core affected population and the female bridging population. A second phase is required for further details.

Universal access to prenatal testing for HIV and Syphilis: information to end transmission The Latin American and Caribbean Prenatal Testing Initiative for HIV and Syphilis, a joint collaboration between the National AIDS Programmes of Brazil, Colombia, Cuba, Nicaragua, Paraguay, Peru, Dominican Republic and Uruguay, UNICEF, UNAIDS, the Latin American Centre of Perinatology of the Pan American Health Organization, and Harvard Medical School was completed with support from this grant. The study analyzed barriers to increased testing, treatment and care of HIV, syphilis and other STIs among pregnant women in order to develop interventions to achieve universal coverage of testing and treatment of HIV and syphilis among pregnant women, and improve access and quality of care. (Publication available)

Violence and its Relation to HIV: Information gap hindering policy efficiency Over the past few years, increased attention has been paid to the problem of gender-based violence (GBV) in Latin America. Governments have expressed commitment to eliminating GBV, and have devoted resources and created governmental bodies responsible for addressing it.

However, these programs and policies often overlook the link between GBV and vulnerability to HIV. In Bolivia and Mexico, where projects supported by Norwegian funds focused on studying this link, evidence revealed that violence directly contributes to women’s vulnerability to HIV. The studies further showed that gender-based violence often increases among women once they are diagnosed with HIV. The types of violence reported to contribute to HIV vulnerability include physical, sexual, economic, and institutional violence. Many women participating in the Bolivia and Mexico studies reported that violence had been an intrinsic part of their lives since childhood, and that it was practically accepted as the norm. In other countries (such as Costa Rica, Chile and Venezuela) where the projects had not meant to target issues related to HIV and violence, the issue of gender-based violence continued to come up, and it was reported by several participants that further studies on violence and HIV are necessary to help gauge the extent to which the issue affects vulnerability in women.

Despite indications of the link between violence and HIV, institutions, CSOs, programmes, and policies aimed at both gender-based violence and HIV (and sexual and reproductive health as well in some instances) experience something of a “silo-ing effect” because interventions are aimed at only one theme, not taking the interconnections into account. For example, although a national response might have very robust programs around HIV prevention and elimination of gender-based violence, they are unable to operate outside their narrowly defined mandates. This lack of transversalization of themes is likely to result in ineffective policies in addressing GBV’s effects on vulnerability to HIV and vice-versa.

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The results of the assessment have provided the basis for policy guidance for improving women’s access to testing, treatment and care services and contributed to guide the Elimination Initiative launched in 2010 by PAHO and UNICEF.

Bolivia a story of violence since childhood The endemic nature of gender-based violence in Bolivia is a well-documented phenomenon. The Demographic and Health Survey conducted in Bolivia in 2008 found that 39.7% of women married or living with a stable partner at some point during their lives reported being exposed to emotional violence by their partner, and 47.3% of women reported being exposed to some form of violence (emotional, physical, sexual) by their partner or another person.

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However, despite the government’s commitment to eradicate violence against women, some efforts to address the inter linkages between GBV and HIV by the Juridical Office of Women, as well as prior studies with populations such as Sex Workers and Transgendered Women that indicated a link between violence and HIV, there has been a lack of concerted efforts by the government bodies and civil society organizations working in HIV to address HIV and GBV in an integrated manner.

Led by REDBOL, the Network of People living with HIV in Bolivia, and with technical support from the Cayetano Heredia Peruvian University, a qualitative study on sexual, psychological and physical violence against women living with HIV, sex workers and trans was conducted with the participation of 322 women in 2011. Data was gathered in La Paz, Santa Cruz and Cochabamba.

Regardless of the population they belonged to, participants uniformly stated that the experienced violence began in childhood, and left emotional and psychological scars that impacted their daily lives. An overwhelming majority had suffered some form of sexual or physical violence at least once. Only two percent of the focus group participants reported no experience of violence at all.

Violeta Ross, President of REDBOL, during a workshop as part of the qualitative study on sexual, psychological and physical violence against women living with HIV, sex workers and transgender.

Participants at the workshop draw the marks of sexual, psychological and physical violence.

The study has informed decision makers and health care workers in La Paz, Cochabamba and Santa Cruz and policy actions have been agreed. As part of the National Campaign against violence, specific attention will be given to the vulnerabilities of women living with HIV, Transgender and Sex Workers.

The National AIDS Programme in Bolivia has agreed to be one of 5 National Aids Programmes globally to pilot the new UNAIDS tool for integrating gender in National HIV planning, programming and evaluation. The process will initiate in September 2012. (Publication and summary of project available)

Peru: research showing the need for new prevention intervention approaches for women

The project captured key data on the economic, social, and cultural determinants of women living with HIV and links to vulnerability.

The information collected is now being used to outline a roadmap for more efficient HIV prevention interventions among women as part of the new National Strategic Plan. Following the study the Municipality of Lima has made a commitment to pilot a protocol for HIV risk assessment among women of childbearing age being tested in coordination with the Cayetano Heredia University.

The study also found that rates of violence were higher among women living with HIV than among women in the general population. On the basis of this information, as well as indications that stigma and discrimination towards, and economic dependence of, women living with HIV are higher than among women in the general population, UNAIDS has started to coordinate activities with the Ministry of Women to incorporate women living with HIV in the national program against violence. The Ministry of Health will work towards incorporating HIV testing in the protocol for care of victims of violence currently being developed in collaboration with the Ministry of Women.

Information on sexual practices of women living with HIV, including related to anal sex, as well as the sexual networks of women living with HIV, introduces a new understanding of women’s sexual life and the need for defining new prevention messages that include protection during heterosexual anal sex.

The study in Peru also revealed a high frequency of women living with HIV who have been infected by a truck driver. This information was the background for a new proposal to conduct a prevalence and behavior study covering this very mobile population group moving along the economic corridors of the country. Partners involved in this proposal are IOM, PAHO, USAID and UNAIDS. In

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Peru had established an information, policy and programming gap in terms of women of childbearing age and their vulnerability to HIV. To address this information vacuum, and to inform future policy, the study supported with funding from Norway included information provided by the sexual partners of women recently diagnosed with HIV as well as their sexual networks.

addition, the Ministry of Health has expressed interest in participating. This population is currently not included in the HIV epidemiological map of the country. The results of this study will be linked to the work in Arequipa and Parinacota in Chile and pervious work with truck drivers. The full study is available, as well as a more complete description of the project and its results.

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Venezuela: study among youth establishes worrying levels of abuse Venezuela has observed a worrying increase of 26 % (from 1833 to 2487 in absolute numbers) of new HIV cases reported among women between 2008 and 2009. This made the Joint Team and the National AIDS Programme, under the Ministry of Health issue the need for a study among youth to understand the characteristics of the vulnerabilities affecting women in Venezuela. The study was conducted in 5 metropolitan districts of Caracas (Chacao, Sucre, Libertador, Baruta and El Hatillo) covering 945 adolescents and youth, both girls and boys, attending secondary school and university. The study found that 60.3% of the adolescents and youth report having suffered any form abuse by a male family member, and 20.8% from their partners. This is a disturbing finding and the Ministry with assistance from the UN is now working on developing interventions to prevent GBV and HIV in response to these findings. A new prevention strategy specifically designed for youth and attending in particular young girls is under development and will further strengthen the new National Strategic Plan on AIDS for 2012-16.

The study also established that there is a high degree of knowledge, but there is a relatively low perception (51 %) of risk of infection among girls. Venezuela is recognised for having one of the most comprehensive integrated sexual education curricula in Latin America. The findings will serve to revise the overall prevention messages with a particular focus on how it is being imparted, as young girls do not seem to be properly informed in terms of risks.

UNAIDS facilitated innovative data collection and analysis, led by women’s groups, which are also in the process of building their skills and capacity. This approach was employed in Argentina, Bolivia and Mexico, as well as at Regional level. UNAIDS – through Norwegian and Danish grants supported members of the Movement of Women living with HIV from 14 countries in Latin America and Cuba to lead a study and systematically gather data, for the first time ever, on the real-life impact of HIV on women. Through the project “With our own words: The situation of Women living with HIV in 14 Latin American countries”, women living with HIV developed their own quantitative and qualitative investigation tools for focus group discussions and in-depth interviews: http://www.unaids.org/en/resources/presscentre/featurestories/2011/april/20110429womenstu dyla/ . The project gathered information on access to health care and treatment, quality of service received, their sexual and reproductive health as HIV positive women, violence, and discrimination. Additional funding was provided from UNHCR to expand the study to include internally displaced and migrant women living with HIV. The study provides a solid background for country level advocacy and includes recommendations for actions for different actors. Country based advocacy to act on the recommendations was supported by UNAIDS core funds in 2012 focusing on the use of the study in national policy development, strategic planning processes and human rights reporting like Belem do Para, CEDAW and UPR. The full report is available on the ONUSIDA Latina website

Gender equality and poverty The investigative projects that have taken place, using community dialogues, qualitative and quantitative studies related to the Agenda on Women and girls under the Norwegian grant have made it very clear that the population of women living with HIV have, to a large extent, grown up with social norms and family values where women do not access information about sexuality. This becomes a socio-cultural disadvantage resulting in a systematically enforced ignorance about sexuality and HIV, creating barriers for women in assessing their own risks related to HIV and opportunistic infections. The shock and subsequent frequent isolation that women suffer as they get to know their HIV diagnosis has been documented as part of the Stigma Index of People Living with HIV.

The capacity of the State to respect, guarantee and protect the full enjoyment of basic human rights of women living with HIV needs strengthening as the current access to education, health and social services is not reaching the most vulnerable and contribute to exacerbating the vulnerabilities of these populations in most Latin American countries. The information collected has been crucial in informing broader National Plans and policies.

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All the studies conducted on women living with HIV under this grant revealed that education levels are lower (with a high percentage of women who have never finished their primary studies), and they often find themselves on lower socio-economic tiers than the average — making them more likely to be exposed to factors that increase vulnerability, such as gender-based violence, economic hardship, and reduced social and political power.

2. Assisting countries to ensure that national HIV and development strategies, operational plans, M&E frameworks and budgets address the needs and rights of women and girls As shown in the examples above, building on the evidence base, the next step for addressing gender inequality through HIV responses is integrating gender into national planning and sectorial policies or operational plans at national and/or decentralized levels.

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Through the Norwegian grant, UNAIDS supported 5 countries to integrate gender and HIV, based on each country’s national context, in identified strategic policies or operational plans including HIV plans.

Gender inequality and harmful gender norms affect access to services of key affected populations, such as sex workers and transgender people. Due to cultural and legal constraints, overall health responses, including HIV responses, have not adequately addressed the needs of these populations. The grant enabled UNAIDS to advocate for more favorable environments for key affected populations within the framework of national HIV programming in Costa Rica, Panama and Nicaragua. Moreover, it succeeded in integrating HIV in broader strategies related to Gender Equality in Peru, and in enhancing social security for key vulnerable populations in Costa Rica.

Costa Rica taking AIDS out of isolation Policy and service integration addressing the particular vulnerabilities of key populations related to HIV was at the core of the Costa Rica proposal. With support of the Norwegian grant, UNAIDS played a catalytic role in “kick-starting� programming for gender equality and HIV, and assisted the country in translating political commitment into scaled-up programming. The social security system has been strengthened, and laws and directives that hinder Universal Access to HIV prevention, treatment, care and support, with a particular emphasis on violence against women and girls including trans and female and male sex workers are now being addressed.

For the first time, sex workers, transgender and women living with HIV, the Department of Social Security, the National Institute of Women and the Ministry of Justice, worked together to establish an overview of the situation among these populations and agree on actions.

The Inter Institutional plan for promoting access to testing and male and female condoms to sex workers, including the migrant sex workers and trans has been agreed upon and initial roll out initiated. An overall agreement and action plan with the Social Security System to prevent stigma and discrimination assuring access to services is in place.

The strategy for integral management of GBV and HIV has been developed through a consultative process, responding to a policy and programming gap in the current response. Under the Agenda on Women, girls, gender equality and HIV Costa Rica is showing the way in terms of how investing in the AIDS response supports a comprehensive social protection and health development agenda in the country.

Chile, new actors at local level create joint action Arica and Parinacota are one of the most affected regions by HIV in Chile. It has shown a mortality rate far beyond other regions and the HIV infection growth is the highest in the country, particularly in the case of young adolescents and girls (aged 10-14). Issues such as migratory populations, transactional sex for survival, drug trafficking and sexual and gender-based violence have created a high degree of vulnerability.

The dialogues involved migrant and refugee women, indigenous women and young girls, all contributing their experience in terms of their vulnerabilities to HIV. The discussions and document produced cover gender roles and stereotypes, access to health and information services, and the emotional and sexual lives of women. The findings were used to develop information material to benefit women in the region not participating in the dialogues. The material was also used as part of the commemoration of the 25th November in 2011 under the umbrella of the UNiTE Campaign to end violence against women and girls reaching more than 250 people.

As in the study in Peru and Mexico, the project found that there is a need for developing specific prevention approaches for house wives, who reported having limited knowledge of HIV prevention methods and facing challenges in accessing sexual and reproductive health services.

As a result of the project, UNESCO will provide support through 2012-2013 to the region in developing and implementing a regional program on sexuality education. This was part of the recommendations of the dialogues and will address particular issues related to young and adolescent girls and boys (10-14).

In 2012 a Regional Multi Sectorial plan for prevention, treatment, care and support with a focus on women and girls that live or transit through the Arica and Parinacota Region was carried out.

The report is available on the UNAIDS Latin America web site.

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The Project “Know your epidemic and response in the region Arica and Parinacota”, established strategic information related to the vulnerabilities of women and youth in the border area with Peru and Bolivia. An inter sectorial alliance at local level, including a social organization specialized in knowledge generation and social development, women’s organisations working on HIV, the Chilean Network against domestic and sexual violence together with the National Women’s Service got together in participatory community dialogues to address the situation in the border area to Peru. The National Women’s Service had not previously been engaged in HIV, but their presence and active participation ensured immediate mechanisms for follow up and enhancing local ownership and sustainability of the intervention.

Peru: Integrating women living with HIV and Trans in the National Gender Equality Plan 2012-17 Beside the study previously mentioned, the UNAIDS office in Peru supported the Ministry of Women and Social Development (MIMDES) in the development of the new National Gender Equality Plan 2012-17. The Norwegian funds ensured the first ever participation of women living with HIV and Trans throughout Peru to engage in the development of the new plan. This groundbreaking work ensured integration of Women living with HIV and Trans in national policy formulation outside the usual HIV area. It provides a unique opportunity to address HIV prevention, treatment and care, stigma and discrimination and hate crimes within the Gender Equality Plan.

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Mexico: National and Federal engagement for HIV and GBV Where it was not possible to immediately integrate gender equality into national strategic HIV plans due to the timing of the national HIV programming cycle, UNAIDS and the Joint Team supported countries to develop national plans to operationalize the UNAIDS Agenda for Women and Girls and Gender Equality based on the context of the country. In Mexico, the UN Joint Team developed their proposal to respond to the CEDAW recommendations to the government of Mexico, looking at the links between HIV, violence and women. It was agreed to implement a decentralized project in three federal states with high levels of both HIV and gender based violence and with incipient local responses.

“Women, Violence and HIV” supported under the Norwegian grant mapped policies, programmes and actions in Mexico addressing HIV and gender based violence. The mapping revealed that federal and regional programs for HIV concentrate on Sex Workers and Preventing Vertical transmission, creating a gap in terms of addressing the general population of women living with HIV. Subsequent evidence from focus groups in Jalisco, Guerrero and Oaxaca with women living with HIV revealed that many women were infected with HIV by a spouse or stable partner. The women were often poor, had left school early, married young and lived most of their lives in monogamous relationships, and had received little or no prevention education.

Technical section for the elaboration of the Agenda on Women and HIV in Jalisco Tlaquepaque Jalisco, México

Forum on Women and HIV at the National Congress on HIV and AIDS; Villahermosa Tabasco, México

Based on these two documents, assessing the situation and response, recommendations for the Federal State Public policy interventions on women, violence and HIV were developed.

Three strategic decentralized forums were conducted to promote the UNITE campaign and the Agenda on Women and girls, establishing local leadership and commitment. A training manual for women living with HIV was developed based on all the information gathered, customizing it to their needs and empowering them to engage in policy debates with federal and local governments in promoting and demanding their rights. (Manual: “My right to be treated well and live a good life�)

The work in Mexico has created concrete changes in the way HIV and GBV are being addressed. The UN joint team has used the information and new policy as an opportunity to develop further material that will be used in other Federal States this year 2012.

At the regional level the Inter American Commission on Women CIM included the Mexican experience in their document about promising practices in integration of GBV and HIV. It can be found at: http://www.onusida-latina.org/images/2012/septiembre/VIH-VAW-PracticasPromisorias-SP.July24 2012.pdf

Nicaragua, strengthening decentralized stigma free health services for trans sex workers The National AIDS Programme, Ministry of Health, The Ombudspersons office for Women, The Network of Sex Workers in Nicaragua, Center of Investigations on Health (CIES) and the Ombudsperson for sexual diversity together with the UN established a working group to strengthen the access of sex workers to HIV prevention, treatment and care. The activities were implemented in Managua, Masaya, Chinandega and Granada, the regions with the highest HIV prevalence in Nicaragua. A particular focus was put on Transgender sex workers. More than 120 sex workers forming part of three NGOs (ADESENI, Nicaraguan Association for sexual diversity rights REDLACTRANS, Latin American and Caribbean Network of Transgender, ANIT, Nicaraguan Association of Transgender and ADINIC) were trained in human rights and sexual and reproductive health, including the use of male and female condoms and lubricants.

Enhancing integration for financial and programmatic sustainability, work in progress In conclusion, the development of nationally owned action plans on gender inequality and HIV, integration of HIV in National Gender Equality plans and social security systems has been a critical achievement in the operationalization of the UNAIDS Agenda for Women and Girls. Without the support of the Norwegian government, UNAIDS would not have been able to achieve several of

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At national level, under the facilitation of the UNAIDS technical officer, a joint working group led

by INMUJERES (The National Institute of Women), civil society and the UN developed a 5 year action plan aligned with the Agenda on Women and girls with a particular focus on Violence. In August 2011, they conducted the first ever Forum on Women and HIV. This in itself is a major change in Mexico where attention had until then been focused on interventions among MSM.

these results as the funding facilitated the processes that put these changes into place.

In Latin America, investing in issues of women living with HIV and key populations, mapping their vulnerabilities and subsequently developing and informing policies to address these vulnerabilities, provide an opportunity for enhancing overall development policies reaching populations still in dire needs creating healthier and more equitable countries.

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Integrating HIV in broader development sectors is tedious work, but work that pays off in the long run. Showing States that it makes sense investing in vulnerable populations is the first of many steps in contributing to closing the inequality gap that exists in Latin America.

3. Advocacy, capacity strengthening and mobilization of resources to deliver

At the core of all the work supported at regional and country level with the grant from Norway, and reflected throughout the report, is community ownership as a cornerstone to build an inclusive and sustainable social sector. The grant has enabled us to invest in processes putting people at the center, allowing Networks to build their capacity over time to gather information, dialogue, and influence and mobilize resources for their actions. Since 2008, three out of the four Regional Networks of Women and Trans have developed proposals to the Global Fund, which was submitted by the Network of Sex Workers and successfully approved in 2011. One Network has developed their own Resource mobilization strategy and trained their national representatives.

The trans population has received support in this area since 2008, and under the umbrella of the Agenda on women and girls and gender equality since 2010.

Transgender in Latin America: “Making rights a reality”, capacity building and advocacy efforts supporting the most excluded and discriminated.

The transgendered community is one of the most vulnerable populations in Latin America with regards to HIV. While there is a lack of data in regards to the percentage of the transgendered population living with HIV, estimates place HIV prevalence at between 25 to 36.5 percent. The vulnerability of transgendered men and women to HIV is directly related to the stigma and discrimination experienced in their daily lives, lack of recognition of their identity, low levels of formal education, few opportunities for employment outside of sex work, and their overall invisibility in regards to public policies and programs. For instance, transgendered men and women have little or no access to health services.

To address this, UNAIDS has been working closely with REDLACTRANS, the Regional Network of Trans Populations in Latin America. REDLACTRANS is comprised of fifteen national transgendered organizations from Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, the Dominican Republic, and Uruguay.

Part of the support under this grant in 2008, supported the first ever Regional Transgender meeting as part of the Regional HIV Forum in Lima in December 2009. A common platform was created enhancing the organization’s ability to share experiences and mobilize resources for regional activities. The organization was supported by Danish funds to develop their Global Fund

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HIV advocates in Latin America have catalyzed reflections on gender, sexuality, citizenship and social protection, producing evidence that tackling these issues is key to a healthier population and a more equal Latin America in the future. At regional level the HIV Forum in Lima in 2009 gave a push to the rights based approach in the HIV response with the slogan “Health our right, Universal Access our goal, No discrimination our challenge” gathering more than 600 activists, government representatives, UN and bilaterals and where for the first time the Trans organized a pre-conference. The Regional Media Initiative, IMLAS, the communication platform CILA, the Network of Trans, all developed complementary advocacy campaigns and messages to address gender inequality and HIV. At national level activists from civil society organizations have mobilized around the Gender Identity Law, influenced policies related to HIV and GBV and created space for participation in decision making bodies.

proposal in 2010. The proposal was recommended for resubmission. Funds under the Norwegian grant were given for REDLACTRANS to revise and resubmit their proposal. A participatory approach to strengthening the National Representatives of REDLACTRANS resource mobilization capacities was part of the revision process. The GFATM round was postponed and the revised proposal has been used and adapted to other funding mechanisms like the EU and the new Diversity fund under the US President. Responses to these proposals are still to be communicated.

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Back to back with the resource mobilization training, PAHO and UNAIDS supported REDLACTRANS to produce a video-spot, using the model of “Just like you” (“Igual a voce”) featuring the focal persons from the Network of Trans in Latin America. This short spot, around 2 minutes, is now being used as an ice-breaker and an advocacy tool in the work around stigma and discrimination related to trans. “Just like you” was shown to 11 ambassadors of the Organization of the American States (OAS) as part of the sensitization work related to the Resolution on Gender Identity and Sexual Orientation. Later that year the Trans for the first time in the history of the OAS were given the floor to address the OAS General Assembly. The video has over 10 000 hits on its You Tube page: http://www.youtube.com/watch?v=kihTTsBvyI8 REDLACTRANS has since its start worked to increase visibility of the situation and needs of the trans community with the objective of increasing “active and effective participation of the trans community in the achievement and application of Human Rights” as expressed in their workplan of 2009-11. In addition to the video spot, six case studies were developed, co-financed with German GIZ funds from UNAIDS HQ, in partnership with the AIDS Alliance and REDLACTRANS. Two REDLACTRANS members from each sub region (Central America, Andean region, Southern Cone), were trained in case study development, and management of strategic information. At country level a local consultant was hired to assist the process. The result was the Regional Case Study “Making Rights a Reality”, covering work by Trans organizations in 6 countries; Argentina, Bolivia, Ecuador, El Salvador, Honduras and Uruguay. This work complements UNAIDS RSTs work with the IACHR and the Resolution on Sexual Diversity and Gender Identity. The document was launched on the 17th of May, the International Day against homophobia and transphobia. Video of the webex launch and a video “The forgotten by the democracy” http://www.youtube.com/watch?v=lBBZoi4HEGQ from the event in Guatemala City. The regional study is available in both Spanish and English.

Redlactrans, comprised of fifteen national transgendered organizations from Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, the Dominican Republic, and Uruguay.

Through a virtual platform, Alliance, Redlactrans and UNAIDS launched the publication at regional level. More than 50 media accessed the virtual event.

Trans and sex worker community advocating for Universal Access in Panama.

Together with the civil society organization representing Trans in Panama (APPT) and PROBIDSIDA, UNAIDS developed a programme to empower the trans and sensitize local government, police and bar and night club owners on the rights of the trans.

Three trainings were conducted in the cities of Panama, Colon and David to empower the trans by increasing knowledge on their human rights, building skills for fighting stigma and discrimination and HIV prevention, treatment and care. For the first time ever trans in Colon were reached with activities. A small booklet about Human Rights, HIV information and contact details of the Ombudsperson in Panama, PROBIDSIDA and APPT was developed and is being distributed in the trainings and outreach done by APPT. (Attached) Officials from health institutions, community leaders, and local police were invited to participate in order to raise their awareness of the issues Transgendered Women face in regards to vulnerability to HIV. This decision proved to be very beneficial, as community stakeholders — the police in particular — voiced their commitment to the human rights of transgendered women.

Because of the positive outcome of advocacy work with these stakeholders and national authorities, new relationships have been created that allow for the opportunity to address the issue of violence and HIV among Transgendered Women.

Strengthening organizations of Women Living with HIV to impact the broader development agenda Ensuring official registration of the different national chapters of International Coalition of Women Living with HIV (ICW+) was initiated in 2008 and Uruguay, Brazil, Ecuador, Bolivia and Nicaragua received support to complete the process with funds for the grant. Today Nicaragua holds the leadership of ICW Latina, managing funds from Ford Foundation, UNFPA and others.

Several national organizations of Women living with HIV were involved in the development of information related to the conditions of Women Living with HIV. In Costa Rica the three main organizations of women living with HIV, Ministry of Health, The Institute for Women, the Human Rights Ombudspersons Office, UNFPA and UNAIDS implemented a study among 83 women with HIV from 6 provinces in the country. The study found that a majority of the women and their families lived in poverty or even extreme poverty. The women lack education and less than 50% have remunerated work. They are mainly supported by NGOs and public institutions like the health clinics. These same clinics, which constitute their main line of support, are perceived as discriminatory and insensitive to their needs, regularly breaching the women’s sexual and reproductive health rights and needs and right to confidentiality.

The fear and the guilt associated with the diagnosis, experiencing violence and consequently resorting to drugs were repeated in the qualitative research. At the same time, these women were not offered any integrated services. Jointly with the National authorities engaged in the study, the women living with HIV developed an advocacy plan for 2012-14 to address all of these issues with the relevant government authorities.

The study among women living with HIV in the province of Colon in Panama found the same

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Panama: local police in dialogue with the Trans

worrying links between HIV and poverty as the study in Costa Rica. In Colon, only 17 % of the women interviewed had formal work, which explains how 53 % of them reported that they had not been adhering to their treatment schedule at the local clinic due to lack of money. The study was later expanded to cover 6 additional provinces in Panama with support from UNFPA, confirming the findings from Colon. Actions to overcome the economic barriers to treatment adherence is under development and the civil society organisations engaged in the study have used the findings to advocate for specific actions related to women living with HIV in the new Gender Equality Policy under development in Panama.

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The studies from Panama and Costa Rica both point to the need for better and more integrated health services for women, but equally important they point to the need for engagement beyond the health sector ensuring that social protection mechanisms and financial stimulus packages for women’s employment cater for women living with HIV, as these women are often among the most marginalized in the society.

In both studies the women have been empowered through the new dialogue created between governmental sectors, human rights institutions and the UN. The women’s organizations have been equipped to play their advocacy role in a more efficient way and the new data is used to promote accountability vis-à-vis the national authorities. On the other side government actors have taken immediate actions as they have used the new evidence to improve their policies. These steps have been important in creating sustainability of the projects and transforming information to policy based on the joint work.

The Regional Coalition of Women Leaders and First Ladies initiated the development of a regional advocacy and resource mobilization strategy for the AIDS response targeting women living with HIV and key populations. The Coalition received high level support throughout Latin America, and included active participation of the first ladies from Paraguay, Mexico, Guatemala, Dominican Republic, Panama and El Salvador. USAID, the Health Communication Partnership and UN agencies all collaborated to the Coalition lead by the First Lady of Honduras at the time advocating for the rights of women living with HIV. Due to the political circumstances in Honduras, where the presidency was held, the work of this coalition had to be suspended.

CILA. The Communication Initiative Latin America reaching media professionals with gender and HIV information in Spanish CILA is a registered network joined by around 40 000 people and organizations where 65% are media and communication professionals and 35% are policy makers, funders and technical experts in other areas. CILA strengthened the work around women and girls and HIV in two focus areas: Expanded Knowledge and Expanded Media engagement. By December 2011, 57 new, relevant knowledge summaries were published on The Communication Initiative Latin America’s web portal. Three bulletins were developed and distributed to close to 40 000 subscribers all focusing on GBV and HIV. (Son de tambora) A virtual dialogue on Human rights, gender and HIV was made available to the full number of subscribers to CILA. The feedback from the users was very positive and the project managed to enhance our reach substantially and promote the work around the Agenda among media and communication professionals. (Detailed report can be made available).

IMLAS, 32 channels in Latin America in one Network in a powerful partnership to promote knowledge on HIV and confront discrimination IMLAS is the Latin American branch of the Global Media Initiative on AIDS. This media initiative has an ongoing alliance with 32 television channels in 13 countries, which includes capacity building of journalists, script developers and producers to address HIV. As part of a joint UN initiative with UNICEF, UNFPA, UNHCR, UNESCO and UNDP, IMLAS developed a massive campaign for 2011 where the core message was linked to stigma and discrimination, gender based violence, sexual education and youth. The spots were developed pro bono by MTV’s creative director Juan Frontini.

The campaign used the slogan, “If we don´t talk about what happens, we will let it happen.” The campaign also included eight short documentaries and one 48 minute programme. All the material has been made available for free to the 32 Latin American television channels to be screened around World AIDS Day. Pasion por la vida: http://www.pasionporlavida.org/hablemosdeloquepasa/

Locally sourced solutions and south-south, or horizontal, cooperation has been at the core of the Latin American response to HIV since its start. The Horizontal Technical Cooperation Group (GCTH in Spanish), composed by the National AIDS Programme Directors in Latin America and the Regional Networks of Civil Society, entrenched horizontal cooperation promoting more sustainably financed health systems as well as catalyzing the development of platforms and regulatory regimes for enhanced drug security within developing countries. Under this grant GCTH was instrumental in promoting the discussion addressing key populations. Following the Foro in Lima in 2009, they used the situational analysis and progress on the HIV response in Latin America focusing on key populations, including sex workers, MSM, and IDU, to initiate joint action among National Responses to reorient their national strategies.

In the second half of 2011, the RST supported the re-establishment of the MERCOSUR NGO Forum for the civil society. One of the issues presented and consequently prioritized by the forum was gender inequality, gender based violence and HIV and how to share experiences and opportunities for a better integrated and more efficient response among countries in the Southern Cone.

Supporting women’s organizations to access Global Fund grants and mobilize resources As the Global Fund grants started to become the predominant source of external funding available for HIV programming, UNAIDS, other UN agencies and bilaterals jointly with the International Center for Technical Cooperation (ICTC), facilitated technical and financial resources for regional entities to develop proposals for submission to the Global Fund. This mechanism was used to support ICW Latina and RedTraSex to develop proposals for the Global Fund in 2008. The RedTraSex proposal was recommended for resubmission and in 2010 they were successfully awarded a Regional Grant under Round 9. Funds from Norway were used to assist in the grant negotiation process, ensuring they had access to a skilled financial analyst resulting in a solid and empowering process led by RedTraSex themselves. The grant agreement was successfully signed

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Shared Responsibility and South-South collaboration

and implementation is under way. The successes in assuring a successful GFATM grant application process for RedTraSex had an important multiplier effect of the investments through the Norwegian grant.

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The Norwegian funds also supported development of a Resource Mobilization Strategy and training for 20 members of ICW throughout the Latin American Region. Two regional proposals for funding were developed and countries developed at least one funding proposal as part of this process. The proposal development and resource mobilization training was done back to back with the Latin American Feminist encounter in Colombia in November 2011, enabling many of the members of ICW to interact with the women’s movement around the broader development agenda thus ensuring integration of HIV. The Aid for AIDS Observatorio Latino programme produced a multi-country situational analysis to establish the participation of women and other key populations excluded due to discrimination based on gender diversity in Global Fund processes. The document “Make your voice heard� identified participation in the actual CCM, in the proposal development process and access to resources. The study has been an important advocacy tool used to promote training of CCM members, inclusion of members in proposal development processes and in accessing funds.

Monitoring and Evaluation of the project As part of the M&E of this grant, the RST Latin America conducted a participatory programmatic review of gender and HIV projects supported by UNAIDS during the period 2008-2011, including those supported through this grant. The purpose of this review was to monitor progress of implementation of projects supported and evaluate results at different levels of interventions in national responses to the epidemic. Information was collected through a desk review of reports and available written documentation and stakeholder interviews. Country missions involving in-depth interviews with key stakeholders were conducted in Bolivia, Mexico and Panama.

Information raised through this review, as well as lessons learned, challenges and key recommendations identified, have been integrated in this report, and will be used to reorient where necessary, inform future strategies and guide current implementation on gender and HIV at country level and in the region.

Conclusion The support provided by the Government of Norway has been highly instrumental in moving forward the work on gender equality and HIV in Latin America. The country and regional support for the operationalization of the UNAIDS Agenda for Women and Girls and Gender Equality has been critical in promoting the use of the new research, in creating a broader dialogue nuancing the discourse around HIV in Latin America and in showing how the entrenched gender inequalities, promoted by the current harmful gender roles, create a vicious cycle linking HIV, GBV and inequality. Addressing HIV within a social justice framework will contribute to address broader developmental issues in Latin America.

Lessons learned from many of the countries point to systematic capacity enhancement of national partners – particularly civil society – as one major outcome, ensuring country-driven ownership supported by a proactive and unified UN. With its specific role in engaging partners, setting strategic priorities and facilitating discussions on sensitive issues, supporting the integration of HIV responses in the broader development agenda, mobilizing resources, and supporting grant implementation, the RST is a key player in moving forward the gains made from the implementation of the Agenda so far.

The women’s organizations have been strengthened and are mobilizing themselves to demand improvements in their situation. The continued support from Norway would make a difference ensuring that the gains made during the implementation of the Norwegian grant lead to a sustainable response and the attainment of the targets set in the UN 2011 Political Declaration on HIV/AIDS.

Continued implementation in Latin America: capitalising on the mobilisation pushing for increased action for transformative gender action towards the Post 2015 agenda Whilst the overall global response to HIV has demonstrated impressive results in terms of increased access to services for women, girls and their partners resulting in substantial declines in some regions, HIV infection rates have stabilized in Latin America when we should be seeing a more significant reduction in new infections.

One million four hundred thousand people were living with HIV in the region in 2011, compared to 1.2 million in 2001. Despite progress achieved so far, in 2011 there were still approximately 83,000 new HIV infections in Latin America.

A median proportion of 30% of young people can correctly identify how to prevent sexual transmission of HIV and reject erroneous concepts regarding HIV transmission, while a median

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Political will at regional level through the Inter American Commission on Women and the Inter American Commission on Human Rights and at national level garnering support to address gender inequality and related gender-based violence through the HIV response must therefore be further strengthened to make a difference to the lives of women and girls, trans and men and boys, living with and affected by HIV, in all their diversity towards 2015. We are only mid-way in the Agenda implementation and we can show important results, but only if we do more!

proportion of 21% of teenagers between 15-19 years of age in selected countries in the region were reported to be pregnant or to have children in data available from 2005-2010.

Hate crimes based on sexual orientation and gender identity are increasingly being reported in Central and South America, and perpetrators still act with impunity.

The findings from the studies on HIV among women and trans in Latin America have showed us a picture of the consequences of living in the most unequal region in the world. These challenges are a clear indication of why explicit attention to gender issues is essential in addressing HIV. More must be invested in youth and prevention based on gender transformative approaches to break the vicious cycle between gender inequality, GBV and increased vulnerability to HIV.

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The “UNAIDS Strategy 2012-2015: Getting to Zero” and the 2011 “UN General Assembly Political Declaration: Intensifying our Efforts to Eliminate HIV/AIDS” will drive UNAIDS work over the next 3 years to reach the targets set during the HLM and contribute to the MDGs. In the current financially constrained environment, prioritized and continued investment in gender equality and diversity will be crucial in Latin America.

The UNAIDS Strategy has the vision of eliminating vertical transmission of HIV and reducing AIDS-related maternal mortality by half by 2015, whilst targeting zero tolerance of gender-based violence.

Governments in Latin America finance 94 % of National HIV responses, but there are crucial areas related to prevention, key populations and gender equality where countries need assistance.

Developing and scaling-up programmes, showing return on investment for countries, will be critical to move ahead. Integrating the needs of women, girls, trans and positioning gender equality as a critical enabler for broader developmental goals will require enhancing our work on integrating HIV in overall development work.

Continued Partnership with Norway on gender equality and diversity Latin America, in an effort to reach the targets set in the UN 2011 Political Declaration on HIV/AIDS, is seeking continued collaboration with the government of Norway in the following areas: 1. Complement the development of critical evidence to firmly position gender equality, including sexual orientation, in close collaboration with Inter American Commission on Human Rights and the Inter American Commission on Women, in regional and national in policy making for a at regional and national level.

2. Using the information for activities that ensure gender equality, social justice and HIV forms part of the Post 2015 agenda discussion and in preparation for the ICPD consolidating gains made in reaching the targets of the HLM in Latin America, as well as further enhancing the human rights based and gender equality approach.

3. Continued political advocacy around the HIV-specific vulnerabilities of women and girls and sexual diversity to create public policy dialogue and enhanced integration in

overall development policies to promote sustainability of programmes.

4. Acceleration of gender-transformative National HIV responses to catalyze social change in line with the Agenda using data established; 5. Creating space for and continue to build leadership among partners, with a particular focus on young women in all their diversity, to ensure mutual accountability for results.

6. Put more emphasis to promote the work with networks of men and boys working for gender equality and key affected populations, for their meaningful engagement.

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UNAIDS in Latin America looks forward to continued engagement and discussion with Norway on moving forward the agenda on women and girls and gender equality.

REPORT TO THE NORWEGIAN GOVERNMENT “Latin America responding to the Agenda for Accelerated Action for Women and Girls, Gender equality and HIV”