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Where the world stands on the '10-10-10' social enabler policies: mapping and analyzing progress and gaps

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BACKGROUND: Criminalization and stigma/discrimination against PLHIV and key and marginalized populations create significant barriers to achieving global HIV/AIDS goals. In the 2021 UN Political Declaration on HIV/AIDS, governments committed to address these barriers by adopting the UNAIDS-proposed '10-10-10' societal enabler targets. We identify seven laws/policies that countries should adopt in order to create a legal/policy environment conducive to achieving these targets. They are: non-criminalization of
(1) same-sex sex,
(2) sex work,
(3) drug use,
(4) HIV transmission;
(5) creation of national human rights institutions; and legal protections against
(6) discrimination and
(7) gender-based violence.
METHODS: Using data from Georgetown University's HIV Policy Lab on 194 countries, we analyze whether each country has adopted each law/policy. We then map and compare policy adoption globally and across regions and other country groupings to describe the current state of policy progress towards the 10-10-10 goals and pinpoint where policy change is needed.
We then apply network analysis methods to map the co-occurrence, clusters and intersections of different sets of policies to deepen and quantify our '3D' understanding of how policies overlap and interact in practice and pinpoint underlying cross-national patterns in policy adoption. Finally, we investigate correlations between the adoption of different combinations of social enabler policies and key HIV outcomes (e.g., % of PLHIV who know their status, are on ART, and are virally suppressed).
RESULTS: Preliminary descriptive findings indicate that, on average, countries have adopted three of the seven laws/policies (range: 1-6 policies). The adoption rates for individual policies vary widely; whereas 78% of countries have gender-based violence laws, only 3% and 4% do not criminalize drug use and sex work, respectively. Regionally, we observe the greatest variation in adoption rates for: same-sex sex non-criminalization, where WCENA and EECA countries have significantly higher rates of policy adoption than other regions; and HIV transmission non-criminalization, where sub-Saharan African countries have significantly higher rates of policy adoption than other regions.
CONCLUSIONS: These findings will further deepen our understanding of the patterns and political, economic, and geographic factors that shape policy adoption and the importance of supportive law/policy environments in the fight against HIV. They also inform policy change advocacy around the 10-10-10 targets.