On Zero Discrimination Day 2023, commemorated on March 1, UNAIDS highlights the need to remove laws that criminalize people living with HIV and key populations.* The 2023 theme, “Save lives: Decriminalize”, points to the positive impact on health and life outcomes when discriminatory and punitive laws are removed.

In 2021, the world set ambitious law reform targets to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognizing decriminalization as a critical element in the response, countries made a commitment that by 2025 less than 10% of countries would have punitive legal and policy environments that affect the HIV response.

Winnie Byanyima, Executive Director of UNAIDS, said:

"Criminalizing laws chase people away from life-saving treatment. Those need to be removed. The only reason people are still dying of AIDS is the inequalities in society, from social norms, from the lack of opportunities in school, etc. and all these come together to make them more at risk."

"At the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.”

These targets are ambitious but they are necessary

Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalize same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions.

Criminalization of sex work increases both the risk of sex workers acquiring HIV and their vulnerability to violence perpetrated by clients, police and other third parties. The criminalization of the clients of sex workers has also been repeatedly shown to negatively affect sex workers’ safety and health, including reducing condom access and use, and increasing the rates of violence.

Decriminalization of drug use and possession for personal use is associated with significant decreases in HIV incidence among people who inject drugs, including through greater access to harm reduction services, reductions in violence and arrest or harassment by law enforcement agencies.

Winnie Byanyima said:

"We have the evidence that when you repeal criminal laws on same-sex relations that the risk of contracting HIV falls, the risk of new infections amongst gay men, MSM, drops significantly.

"To me HIV is a disease but it's more a social injustice. It's driven by inequalities in society. These are not things that can happen without a consensus in the society, so we need everybody on board."

Law reform is therefore critical if we are to end AIDS as a public health threat by 2030.

The targets are ambitious but not impossible

Indeed, recent experience is proving just how possible they are.  In 2022 alone Belgium and Australia have removed laws criminalizing sex work; Zimbabwe decriminalized HIV exposure, non-disclosure, and transmission and the Central Africa Republic reduced the scope of its HIV criminal laws; Antigua & Barbuda, St Kitts & Nevis, Singapore and Barbados have repealed old colonial laws criminalizing same-sex sexual activity. Kuwait repealed a law criminalizing the imitation of the opposite sex, a law used to target transgender persons while New Zealand removed travel restrictions relating to HIV.

However, despite such encouraging reforms, the world is not on track to ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services. In 2021, 134 reporting countries explicitly criminalized or otherwise prosecuted HIV exposure, non-disclosure or transmission; 20 reporting countries criminalized and/or prosecuted transgender persons; 153 reporting countries criminalized at least one aspect of sex work; and 67 countries now criminalize consensual same-sex sexual activity, according to UNAIDS. In addition, 48 countries still place restrictions on entry into their territory for people living with HIV, while 53 countries report that they require mandatory HIV testing, for example for marriage certificates or for performing certain professions. 106 countries report requiring parental consent for adolescents to access HIV testing.

Such laws and sanctions violate international human rights norms and stigmatize and discriminate against already marginalized populations.

Decriminalisation saves lives and helps advance the end of the AIDS pandemic.

* Key populations are communities at higher risk of HIV infection including gay men and other men who have sex with men, people who use drugs, sex workers, transgender people and people in prisons and other closed settings.