activities with partners of the same HIV status as oneself

more detailed analysis of reported behaviours in some high-income settings has identified trends with time
across a range of behavioural indicators. The behavioural data show that although some increase was reported in
partner numbers and anal intercourse during the 1990s, this has levelled off in recent years. In some MSM
communities, recent approaches to perceived risk reduction include serosorting (seeking to engage in sexual
activities with partners of the same HIV status as oneself) and strategic positioning (assuming the insertive or
receptive position for anal sex based on perceived serostatus). Some data presented at the Consultation indicated
that there may be a higher incidence of new infections among those who use serosorting compared with those
who use other behavioural measures for risk reduction.The legal framework
A presentation on the legal frameworks and a review of the situation of human rights in relation to sexual minorities
highlighted the following issues:
• Fundamental human rights of people in sexual minority groups include, but are not limited to, the rights to
respect and dignity, non-discrimination, equality, participation, life, identity, self-determination and access to
health.
• Respect, protection and fulfilment of human rights (and recognition of human rights’ violations) are key
determinants of the HIV epidemic.
• Social exclusion means that many people in sexual minority groups are among the most marginalized and
discriminated against in many parts of the world. This, in turn, leads to an increased vulnerability to many
social and health problems, including an increased risk of HIV transmission. This vulnerability is compounded
by a number of linked features:15
Membership in groups or subcultures with higher HIV prevalence, so that the likelihood of pairing with a
partner living with HIV is higher;
Lower quality and coverage (in total numbers and in terms of population groups covered) of services and
programmes;
Higher-level social/environmental influences such as laws, public policies, social norms, culture (e.g.
discrimination), which configure an environment hostile to the integration and needs of certain groups.
• People belonging to sexual minorities suffer high levels of physical and structural violence in many parts of the
world.
Worldwide, MSM and transgender people suffer high levels of social exclusion and challenges to equality. Their
ability to realize their full health potential is limited in a number of settings by laws that criminalize same-sex
relationships and sexual/gender diversity. A review16 found that 85 Member States of the UN criminalized consensual
same-sex acts among adults. Penalties ranged from fines and imprisonment to physical and capital punishment.
In such settings, programme coverage for, or resources devoted to, sexual minorities are unlikely to be adequate.
The absence of laws criminalizing sexual minorities does not guarantee a life free from discrimination. Cultural
norms at a societal level may result in self-segregation of people belonging to sexual minorities and, at a more
specific level, at health facilities not offering a welcoming service for members of sexual minorities, or by health
planners failing to recognize the specific needs of such populations.
The review 16 also considered the legal frameworks and human rights’ status with respect to sexual minorities and
classified countries according to the legal status of their sexual minorities.
Repressive – countries whose laws prohibit sexual intercourse between people of the same sex
• Highly repressive – countries whose laws consider sodomy a crime and impose severe penalties such as
death, heavy labour, imprisonment for at least five years
• Moderately repressive – countries whose laws consider sodomy a crime and impose penalties of less than
five years or fines
Neutral – countries that do not have any legal prohibition of same-sex behaviour nor address sexual diversity
Protective – countries whose laws prohibit discrimination against sexual diversity in the constitution or legislation,
with or without positive measures of recognition
• Protective with protection measures – countries whose laws prohibit discrimination against sexual diversity,
but which do not demonstrate any positive measures of recognition
• Protective with recognition measures – countries whose laws include an explicit prohibition of discrimination
against sexual diversity, with positive measures such as marriage, civil union, recognition of the rights of
transgender people.