So many harms, so little benefit: a global review of the history and harms of HIV criminalisation

Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk

To end AIDS as a public health threat by 2030, we must leverage both the impactful message of U=U (undetectable equals untransmittable) and viral suppression to improve the wellbeing of individuals living with HIV, increase engagement with HIV services, and reduce barriers such as stigma, discrimination, and criminalisation. This message requires clear and unambiguous evidence-based narratives that emphasise the message that there is zero risk of sexual transmission when an undetectable viral load is maintained and negligible risk when viral suppression (as defined by 200-1000 copies per mL) is maintained. Dissemination of this information to individuals living with or affected by HIV, health-care workers, communities, the general public, and policy makers will increase awareness and credibility of this message and challenge deep-seated misperceptions. Furthermore, understanding the impact of this evidence underscores the necessity to urgently prioritise universal access to quality care, including viral load testing; leverage community leadership to address structural barriers; and monitor for ongoing success. Responsible and equitable messaging, which includes attention to women and marginalised groups, should be used to realise benefits for personal wellbeing and work towards an AIDS-free future.

Towards a Feminist Global Health Policy: Power, intersectionality, and transformation

In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice.

Criminal Code reform of HIV non-disclosure is urgently needed: Social science perspectives on the harms of HIV criminalization in Canada

The criminalization of HIV non-disclosure represents a significant issue of concern among people living with HIV, those working across the HIV sector, public health practitioners, and health and human rights advocates around the world. Recently, the government of Canada began a review of the criminal law regarding HIV non-disclosure and invited feedback from the public about potential reforms to the Criminal Code. In light of this public consultation, this commentary examines social science research from Canadian scholars that documents the intersecting damaging effects of HIV criminalization. Canadian social scientists and other researchers have shown that HIV criminalization is applied in uneven and discriminatory ways, impedes HIV prevention efforts, perpetuates HIV stigma, and has a damaging impact on the daily lives of people living with HIV. We argue that there is an urgent need for reforms that will significantly restrict how the criminal law is applied to HIV non-disclosure.

Stigmatisation and resistance processes: Reflections on the field of HIV research and an agenda for contemporary stigma studies

Stigmatisation processes constitute key barriers to effectively addressing the HIV pandemic. In this article, we provide a critical overview of this field's current state of the art, highlighting some key emerging issues that merit greater research attention in the future to ensure that contemporary research on stigmatisation and resistance processes continues to engage with changing social and political circumstances. We look at how resistance to stigma has developed in the context of HIV and highlight some of the most important programmatic strategies that have emerged over the history of the pandemic. We present the key concepts of 'moral panics' and 'necropolitics', and we articulate them in relation to new global phenomena that deepen the processes of stigmatisation. Moreover, we identify an agenda for investigation which merits greater attention in future research, intervention, and advocacy: 1) changing political environments, neoliberalism, growing political polarisation, and the rise of political extremism; 2) the rise of the information age, technological change, and social media; and 3) rebuilding civil society and governmental responses to stigma.

Political homophobia and the effect on GBMSM programmes in Kenya: The significance of a community-led rapid agency assessment

A recent Supreme Court ruling that permitted LGBTQ + rights organisations to officially register as non-governmental organisations has led to rises in political homophobia in Kenya. Community leaders initiated and led a rapid agency assessment to examine the effects of this rising political homophobia on sexual health services access for gay, bisexual and other men who have sex with men (GBMSM). This survey assessment engaged directors and programme managers running 20 community-based organisations (CBOs) representing 19 Kenyan counties, serving the sexual health needs of more than >25,000 GBMSM. In addition to prevalent shutdowns of health services, respondents reported growing religious tensions, fears and threats of attack, withdrawal of local county government support, and rising religious tensions. At a moment when highly oppressive anti-LGBTQ + legislation has been drafted and debated in parliament, in the name of 'family protection', this commentary makes an appeal to allied health officials and global funding partners to make more explicit statements that call attention to the negative consequences of political homophobia on the grounds of public health and human rights.