Key Populations Under Threat: A Central Theme at AIDS 2026

VIEWPOINT

Joseph J. Amon

Woven throughout the presentations and poster sessions at AIDS 2026 was an inescapable theme of continuing, and escalating, threats facing key populations, including criminalization, anti-LGBTQ+ legislation, and funding disruptions. The result: decades of HIV progress undermined and imperiled.

Anti-LGBTQ+ legislation

Multiple presentations documented the devastating impact of recent anti-LGBTQ+ legislation across Africa. In Uganda,research from Save the Youth Uganda presented an assessment of the mental health toll on MSM following the passage of the 2023 Anti-Homosexuality Act by the Ugandan Parliament. The Act criminalizes the identities and behavior of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people in the country, imposing a life sentence for those convicted of consensual same-sex conduct among adults, and adds the death penalty for so-called “aggravated homosexuality” where same-sex acts involve children or people with disabilities, or where drugs or alcohol may impair judgment. It further criminalized activities that promote homosexuality with up to 20 years in prison.1

The research by Save the Youth found that following passage of the Act, 31% of MSM surveyed had moderate-to-severe depression and 15% reported suicidal ideation. After 2025 donor funding cuts, researchers found that mental health deteriorated further, with 44% of individuals reporting moderate-to-severe depression and 24% reporting suicidal ideation. The authors concluded that while legal criminalization alone severely harms mental health, the withdrawal of community-based services magnifies this harm exponentially.2

AIDS 2026, the 26th International AIDS Conference. Rio de Janeiro, Brazil. Monday, 27 July 2026. YLPKO. Young Leaders Programme Kick-off. In the photo: Group photo of Young Leaders. ©️ Rogério von Krüger / IAS

In Ghana researchers also looked at mental health among LGBTQ+ individuals,developing a “Criminalization Social Stressor Index” to examine how social stressors due to Ghana’s anti-LGBTQ+ legislation impacted antiretroviral therapy (ART) adherence and mental health outcomes (depression, alcohol use disorder, suicide risk). The research, among sexual minority men (SMM), trans women, and gender-diverse people living with HIV (PLHIV), found both direct and indirect effects of criminalization social stress on ART adherence.3

Research in Senegal, from researchers at the National Council for the Fight Against AIDS and National AIDS Control Council Monitoring, Evaluation and Research Unit in Dakar, demonstrated the impact of anti-LGBTQ+ policing, tracing the impact of the arrests of MSM on 4 February 2026 for alleged “unnatural acts” and intentional HIV transmission. Within weeks after the arrests, the researchers found that patients seeking care dropped precipitously: from 2,425 (January) to 512 (March). In their survey they found that among those avoiding health services, 52.2% feared being identified as MSM, 47.8% feared verbal or physical harassment, and 39.1% feared police arrest. Reports of depression and anxiety among MSM increased from 44.4% to 78.1% following the arrests.4

Responding to similar threats to LGBTQ+ individuals in Côte d’Ivoire, researchers from the NGO “Espace Confiance” reported that anti-LGBT violence was fueled by social media disinformation, leading to physical assaults, forced displacement, extortion, and threats. The NGO implemented an emergency, community-led response, providing shelter for individuals facing imminent threats and home-based ART/PrEP delivery to prevent treatment interruptions. The organization documented impacts including physical violence, job loss, family rejection, cyber-harassment, and avoidance-behaviors with significant mental health implications.5

HIV criminalization as structural violence

The HIV Justice Network presented findings from their Global HIV Criminalization Database, arguing that HIV criminalization persists despite scientific evidence that it deters HIV testing, delays treatment initiation, entrenches stigma, and disproportionately harms women, migrants, and other key populations.6 The organization highlighted that while recent reforms demonstrate that change is feasible, progress is uneven, and reform efforts increasingly operate within a hostile environment marked by a coordinated backlash against science, gender equality, sexual and reproductive rights, and civil society space, underscoring the need for legislative repeal or modernization of HIV-specific offences.

Research from the ARCHES cohort (n=1,000 sexual minority men living with HIV in the United States) found that criminalization operates as a “lived regime of governance” reshaping intimacy, disclosure, and self-worth even without prosecution, with participants describing anxiety, self-imposed isolation, and strategies like limiting sexual encounters to avoid legal risk.7

Transgender communities under attack

A significant focus within the AIDS 2026 meeting was on the global threat posed by anti-gender movements. The Global Action for Trans Equality (GATE), in partnership with UNAIDS, presented findings from a multi-country initiative supporting 15 trans-led organizations across multiple regions. Key conclusions focused on the role that anti-gender movements play targeting trans communities through criminalization, surveillance, violence, and funding restrictions, resulting in inequitable HIV responses. The research also highlighted the importance of investment in trans-led capacity and protection infrastructure to strengthen resilience and the need for legal literacy, psychosocial support, and digital security efforts as core elements to sustain transgender-led programs.8

Sex workers facing intersecting harms

Researchers from Zimbabwe’s Open University presented research on sex workers in peri-urban mining communities around Bulawayo who experience intensified risks from criminalization, stigma, and routine violence including harassment and exploitation by clients, third parties, and authorities. The research highlighted the work of Adult Glam Divas (AGD), a sex worker-led network, which implemented a rights-based community model featuring moderated WhatsApp daily dialogues and safety alerts, rapid-response escalation pathways, peer psychosocial first-line support with counselling referrals, and HIV/SRH and GBV/legal service integration as strategies to improve safety and increase HIV/SRH and GBV service uptake in high-stigma environments. The presentation noted the need to formalize clinic and GBV/legal referral protocols, expand to more sites, strengthen peer supervision and trauma support, and improve confidential monitoring of referral-completion.9

The Indonesia AIDS Coalition (IAC) presented lessons learned from the implementation of a human rights program serving sex workers supported under the Community System Strengthening–Human Rights (CSS HR) framework of the Global Fund. The initiative resulted from the recognition that key populations in Indonesia face persistent human rights–related barriers including stigma, discrimination, gender-based violence (GBV), and broader human rights violations within healthcare settings and social environments that undermine service uptake, delay treatment initiation, and discourage survivors from reporting abuses. The program provided support from paralegals to document and respond to human rights violations, efforts to increase rights awareness through sensitization and socialization activities, service quality monitoring using a digital Community Led Monitoring (CLM) platform, and medical ethics training and human rights training for health officials. A total of 987 human rights–related cases were documented in 2024, with most addressed through survivor-centered, non-litigation mechanisms.10

People who use drugs

A 10-country study across Latin America, led by the Latin American and Caribbean Network of People Who Use Drugs, provided the first regional analysis linking drug criminalization to HIV treatment outcomes. The study concluded that drug criminalization functions as a “structural determinant undermining ART continuity” and called for decriminalization, legal protection for harm reduction workers, and safeguards ensuring ART continuity during detention. Participants noted that systemic failures included persistent stigma in health setting, punitive policing practices and ineffective accountability and redress mechanisms for filing complaints. Fifty-two percent reported experiencing arbitrary detention events that directly disrupted ART adherence.11

In Myanmar, researchers from the Myanmar Positive Group, reported that 28% of people who inject drugs (PWID) have been tested for HIV and just 14% are on ART. Notably, they also found that of 256 validated cases of rights violations, 75% were resolved. Unresolved cases, however, included physical abuse, extortion, and arbitrary arrest by police and armed groups. PWID also reported violence and discrimination from family members, barriers in accessing methadone treatment, and employment discrimination. The researchers also found that donor reprioritization has disrupted harm reduction services, legal aid, and referral systems precisely when they are most needed.12

Carceral settings

Research presented at the conference highlighted the significant burden of HIV in carceral settings and lack of access to treatment. For example, researchers reported on conditions in prisons in Kyrgyzstan where 10% of the carceral population have HIV and one third have opioid use disorder, but only 15% of eligible prisoners receive treatment.13

Researchers from the Latin American and Caribbean Network of People Who Use Drugs in El Salvador and Fundación Ancla, Educación e Investigación in Colombia, presented research from Latin America that quantified the direct impact of incarceration on HIV care, finding that 52% of detainees experienced disrupted ART adherence.14 The researchers identified three systemic failures, including: ineffective complaint mechanisms and low institutional trust; persistent stigma within healthcare services; and punitive policing practices. Overall, 74% of participants reported distrust in formal reporting mechanisms and 52% reported experiencing arbitrary detention events that directly disrupted ART adherence. Non-binary and trans participants consistently reported higher levels of harassment and rights violations.15

Data from San Francisco illustrated that even in well-resourced settings, progress for PWID lags other populations: HIV infections decreased only 38% among PWID compared to 65% among MSM between 2012-2020. Intersecting marginalizations, including housing insecurity and incarceration undermine prevention and treatment efforts.14

Conclusion

A recurring theme across presentations was the critical role and resilience of community-led organizations in sustaining HIV services during crisis, maintaining programs in the face of budget cuts and persecution. Across diverse crisis contexts—armed conflict, anti-LGBT violence, political instability, and funding collapse—community-driven models maintained service continuity where formal health systems could not.

Several key approaches emerged as critical enablers. Peer networks and local leadership allowed rapid adaptation to changing conditions, with organizations pivoting to secure home-based delivery, emergency shelter provision, and mobile outreach when facility-based care became inaccessible or unsafe. Digital integration enhanced real-time communication and feedback loops, enabling coordinated responses across dispersed populations. Partnerships between civil society and national health systems—rather than parallel structures—proved essential for sustainability, embedding community expertise within state frameworks while preserving operational flexibility.

Financial sustainability models also evolved. Cross-subsidization approaches, where revenue-generating services fund free access for marginalized populations, reduced donor dependence in some settings, ensuring uninterrupted care despite external funding shocks. But resilience stretches only so far: funding cuts disproportionately impact often already precarious community-based organizations.

As always, the AIDS Conference highlighted both successes and the long distance yet to go to realize the right to health for all and the end of the AIDS pandemic.

Joseph J. Amon, MSPH, PhD, is Desmond M. Tutu Professor in Public Health and Human Rights, director of the Center for Public Health and Human Rights, and a distinguished professor of the practice in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, and editor-in-chief of Health and Human Rights.

Please address correspondence to the author. Email: joe.amon@jhu.edu.

References

  1. A. Shaw. Uganda Anti-Homosexuality Bill of 2023: No Basis in Evidence. April 2023. UCLA Williams Institute School of Law. Available: https://williamsinstitute.law.ucla.edu/wp-content/uploads/Uganda-Anti-LGBT-Bill-Apr-2023.pdf .
  2. D. Kazibwe, R. Kikonyogo, A. Nanyonjo, et al., “One Shock After Another! From the Anti-Homosexuality Act to Donor Cuts: Mental Health and Suicidality Among MSM in Uganda,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAD3902).
  3. A. O. Gyamerah, P. Prado, H. H. Leslie, et al., “Anti-LGBTQ+ Legislation, Mental Health and ART Adherence Among Sexual Minority Men, Trans Women and Gender-Diverse People Living With HIV in Ghana,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAD3906LB).
  4. C. B. D. Gueye, A. Sagna, C. T. Koulibaly, et al., “Rapid Assessment of MSM Crisis on HIV Services in Senegal,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF3206LB).
  1. V. Keipo, C. Anoma, L. Zougouri, et al., “Community Resilience Amid Anti-LGBT Backlash in Côte d’Ivoire,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAD3903).
  2. E. J. Bernard, S. V. Villanueva, S. Beaumont, et al., “HIV Criminalization as Structural Violence: Science, Geopolitics and Community-Led Pathways to Justice,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF3202).
  3. D. Etwaru, H. Schmidt, M. J. Heise, et al., “HIV Criminalization Law Enforcement Associated With Increased Stigma Among Sexual Minority Men Living With HIV in the United States,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF3204).
  4. B. Chitsanupong, E. Castellanos, C. Euzebio de Lima, et al., “Strengthening Trans-Led Organizational Resilience to Anti-Gender Movements to Safeguard HIV-Related Rights and Access: Lessons From a Global Capacity-Building and Advocacy Programme,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF1705).
  5. B. Runya, “Against the Grain: From Policing to Partnership—Community-Led Safety, Rights and Service Access for Sex Workers in Peri-Urban Mining Communities Near Bulawayo, Zimbabwe,” Journal of the International AIDS Society 29/Suppl 4 (2026).
  1. A. A. Cindy, “Community-Led Approaches to Reducing Human Rights–Related Barriers in HIV Services in Indonesia,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF0604).
  2. M. S. Quintanilla Cantizano and R. E. Valencia Gil, “Criminalization and HIV Treatment Among People Who Use Drugs in Latin America,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF1702).
  3. P. A. Hein, M. S. Tun, T. Win, et al., “Community Feedback Mechanisms (CFM) to Protect People Who Inject Drugs in Conflict-Affected Myanmar: Rights-Based, Peer-Led Model,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAF2504).
  4. J. Rozanova, S. Shenoi, M. Sabirova, et al., “Addiction Management During Incarceration: Learnings From Help OAT Prison Engagement Intervention,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAD3605).
  5. See note 11.
  6. Ibid.
  7. L. Sheira, B. Supraset, R. Ruiz, et al., “Community Insights on Acceptability of Location-Enabled Devices to Improve Retention Among People Who Inject Drugs in Oakland and San Francisco, California,” Journal of the International AIDS Society 29/Suppl 4 (2026). (Abstract OAC2202).