Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services. As a result, he is HIV-negative.
Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development Goals which expire later this year).
Goal 3 of the SDGs is to "ensure healthy lives and promote well-being for all ages." Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world -- like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).
If healthcare is not accessible to these groups, the global commitment to ending AIDS and deliver UHC by 2030 will simply not be achieved.
Individuals and groups advocating for the rights of these key groups to access HIV services are rallying around two big events in May.
On May 17, the International Day Against Homophobia and Transphobia (#IDAHOT) will be an opportunity "to draw the attention of decision makers, the media, the public, opinion leaders and local authorities to the alarming situation faced by lesbian, gay, bisexuals, transgender and intersex (LGBTI) people and all those who do not conform to majority sexual and gender norms."
The next day, May 18, marks the first day of the week-long World Health Assembly, the annual meeting of the world's health ministers at the World Health Organization (WHO) in Geneva, an unparalleled advocacy opportunity.
The International HIV/AIDS Alliance is leveraging that opportunity by launching a campaign, #WriteUsIn, that calls on WHO Director-General Margaret Chan and World Bank President Jim Yong Kim to include a UHC indicator that ensures that the groups most vulnerable to HIV are covered.
"Decades of hard-won progress in the fight against AIDS could unravel unless governments commit quickly to including LGBTI people and other marginalized groups in the new development goals," said Karen Johnson, the Alliance's global campaign coordinator.
The Alliance and other groups who are making this an issue are certainly doing it because they believe these key populations deserve the basic human right of health care. But it also makes very good public health sense.
Evidence shows that marginalized populations face a greater burden of HIV prevalence. When they are denied HIV services and other healthcare, and structural barriers are put in their way, such as punitive laws criminalizing their behavior, HIV prevalence does not go down.
The only way to make it go down, and end AIDS once and for all, is to ensure that the needs of such groups are addressed explicitly in health policies, and especially with the Sustainability Development Goals which will guide international development efforts for the next 15 years.
Rokonol, 23, a LGBTI youth community leader in Bangladesh, knows all too well the double burden of being young and LGBTI in a culture in a conservative society that is not always supportive of either group.
"The health system in Bangladesh is not so friendly to young people who are most vulnerable to HIV," he said. "If the health provider knows you belong to LGBT or another marginalized group, the doctor will not behave in a positive manner and may not examine you properly. At government hospitals, transgender people also face barriers to get services. The health provider ignores them and tells them to go elsewhere, there is no treatment for you, the doctor is busy."
But it doesn't have to be that way. The International HIV/AIDS Alliance says there is still time to lobby for a more inclusive UHC indicator and that the heads of the WHO and World Bank "have an opportunity to change the course of history and improve the health of millions."
For more details of the quest to leave no one behind in the post-2015 Sustainability Development Goals, see this policy brief.