Punitive Laws, Key Population Size Estimates, and Global AIDS Response Progress Reports: An Ecological Study of 154 Countries

Davis SLM et al. Journal of the International AIDS Society 2017, 20:21386, DOI/10.7448/IAS.20.1.21386

8 Pages Posted: 24 Nov 2018

See all articles by Sara L.M. Davis

Sara L.M. Davis

Davis Consulting; CERAH

William C Goedel

New York University (NYU) - School of Global Public Health

John Emerson

New York University (NYU) - Center for Human Rights and Global Justice

Brooke Skartvedt Guven

New York University (NYU) - Center for Human Rights and Global Justice

Date Written: March 17, 2017

Abstract

Introduction: UN global plans on HIV/AIDS have committed to reducing the number of countries with punitive laws criminalizing key populations. This study explores whether punitive laws are associated with countries’ performance on targets set in the global plans.

Methods: The study used chi-square tests of independence to explore associations between legal status, key population size estimates, and HIV service coverage for 193 countries from 2007 to 2014. We used data reported by countries on United Nations Global AIDS Progress Report (GARPR) indicators, and legal data from UNAIDS, UNDP, and civil society organizations.
Due to lack of sufficiently reliable legal data, only men who have sex with men (MSM) could be studied. The study utilized public data aggregated at the national level. Correspondence with individual experts in a subset of countries stated the purpose of the study, and all responses were anonymized.

Results and Discussion: A significantly larger proportion of countries that criminalize same-sex sexual behavior reported implausibly low size estimates or no size estimates for MSM. This is consistent with findings in qualitative research that MSM are marginalized and reluctant to be studied in countries where same-sex sexuality is criminalized. Size estimates are often used as the denominators for national HIV service coverage reports. Initially, countries that criminalized same-sex sexuality appeared to have higher HIV testing coverage among MSM than did countries where it is not criminalized. However, investigation of a subset of countries that have reported 90–100% HIV testing coverage among MSM found that most were based on implausibly low or absent size estimates.

Conclusions: Criminalization of same-sex sexuality is associated with implausibly low or absent MSM size estimates. Low size estimates may contribute to official denial of the existence of MSM; to failure to adequately address their needs; and to inflated HIV service coverage reports that paint a false picture of success. To enable and measure progress in the HIV response, UN agencies should lead a collaborative process to systematically, independently and rigorously gather data on
laws and their enforcement.

Keywords: Human Rights; HIV; Key Populations; Men Who Have Sex With Men; Law; Indicators

Suggested Citation

Davis, Sara L.M. and Goedel, William C and Emerson, John and Guven, Brooke Skartvedt, Punitive Laws, Key Population Size Estimates, and Global AIDS Response Progress Reports: An Ecological Study of 154 Countries (March 17, 2017). Davis SLM et al. Journal of the International AIDS Society 2017, 20:21386, DOI/10.7448/IAS.20.1.21386, Available at SSRN: https://ssrn.com/abstract=3275341

Sara L.M. Davis (Contact Author)

Davis Consulting ( email )

Geneva
Switzerland

HOME PAGE: http://megdavisconsulting.com

CERAH

Rue Rothschild 22
Geneva
Switzerland

William C Goedel

New York University (NYU) - School of Global Public Health

United States

John Emerson

New York University (NYU) - Center for Human Rights and Global Justice ( email )

245 Sullivan St
New York, NY 10012
United States

HOME PAGE: http://chrgj.org

Brooke Skartvedt Guven

New York University (NYU) - Center for Human Rights and Global Justice

245 Sullivan St
New York, NY 10012
United States

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