When you are rejected and discriminated against so many times, it is not easy to trust.

These are the words of Cecilia Chung, a transgender woman living with HIV, talking about the multiple challenges faced by a stigmatised key population, layered with the stigma of HIV. Cecilia was speaking at a satellite session hosted by the Global Network of People (GNP+) at the 2014 AIDS Conference.

As an outspoken campaigner for transgender rights, and a Senior Strategist with the Transgender Law Center in San Francisco, Cecilia deplores the poor levels of access to HIV services for transgender populations, which results in 34 percent of transgender people living with HIV in San Francisco having a CD4 count below 350, despite the high state budget which can afford their treatment and care.

Why are these populations so invisible? Cecilia proffers that stigma, including self-stigmatisation, which also affects injecting drug users and younger people living with HIV, keeps them from accessing services at the same level as traditionally hard-to-reach populations of women of colour and low income living with HIV. In addition, there is no network for transgender women living with HIV, so it is hard for them to mobilise to demand better care.

Unemployment

The lived experience of these communities is often quite different to other marginalised populations, and as such, it is important that transgender communities can have input into how they access HIV prevention, treatment and care services. According to Cecilia, unemployment amongst the transgender community is a big driver of the multi-layered problems of stigmatisation, invisibility and poverty, and she proposes a transgender job fair as a safe space to seek employment.

The satellite session brought together a number of people living with HIV to discuss the People Living with HIV Global Advocacy Agenda, and deliver an update of progress towards its ideals. Initially agreed upon at the 9th International Conference of People Living with HIV/AIDS in 1999 in Warsaw, the Global Advocacy Agenda (GAA) 2013–2015 is based on broad consultation at the Global Advocacy Implementation meeting in Morocco in 2012.

Challenges under New Funding Model

Rachel Ong from the Global Fund Advocacy Network described the challenge that key populations in some countries may face under the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria, as the decision-making is deferred to Country Coordinating Committees (CCMs) at the national level. If the CCM doesn’t support key populations groups, then they could lose out on funding. She also highlighted the increasing number of middle-income countries, which are expected to invest counterpart funding, and which could be under internal political pressure to cease funding to key population groups.

The session highlighted that, despite enormous political will at the global level to support key populations around HIV prevention, treatment, care and support, the reality for many at the national and local level is very challenging, and that support of local and national level advocacy remains crucial in challenging stigma and punitive laws, and enabling key populations to access the services that they need.

Watch the highlights of the satellite session at AIDS 2014 in this 6-minute video