A/HRC/44/48/Add.1 the Special Rapporteur to conclude that many such persons do not use the health services for fear of stigma and rejection, which can have negative consequences for the health of the persons concerned and for society at large. 60. The Special Rapporteur was informed that so-called dehomosexualization clinics continue to operate, despite public knowledge of their existence. Lesbian, gay, bisexual and transgender persons are allegedly placed involuntarily in private centres in which “sexual reorientation or dehomosexualization therapies” are practised. The Special Rapporteur deeply regrets such practices, which may amount to ill-treatment, and urges Ecuador to close such centres immediately. In line with the recommendations of the Committee against Torture, he recommends that all cases of violence against persons on the basis of sexual orientation or gender identity should be investigated, with the aim of prosecuting and punishing the perpetrators of such acts. Awareness-raising activities for the general public should also be carried out to combat the social stigmatization of lesbian, gay, bisexual and transgender persons (CAT/C/ECU/CO/7, para. 50). D. People living with HIV/AIDS 61. According to available data, the HIV/AIDS epidemic is concentrated in key populations: men who have sex with men, women sex workers, persons deprived of their liberty and transgender women. According to a report done for the Global Fund to Fight AIDS, Tuberculosis and Malaria, in 2017 it was estimated that over 36,000 people were living with HIV, of which only 61 per cent knew their HIV status. Of the people living with HIV, only 57 per cent had access to health services and 53 per cent had received antiretroviral treatment, of whom 33 per cent had an undetectable viral load. 29 62. The Special Rapporteur was informed by multiple sources that people with HIV/AIDS faced stigma and discrimination in society and in general there was little information, dialogue or training on how to address and overcome this situation. The Special Rapporteur received information about the lack of antiretroviral medicines in the health services of the social security system, particularly for lesbian, gay, bisexual and transgender persons who faced discrimination and rejection by health-care personnel. He also received information on barriers to accessing HIV testing, owing to attitudinal prejudices on the part of health-care professionals. The Special Rapporteur recommends eliminating those and combating the stigma and discrimination faced by persons living with HIV/AIDS. E. Persons with psychosocial, intellectual and cognitive disabilities 63. The Special Rapporteur heard with concern of cases of women with intellectual disabilities subjected to forced sterilization without their consent or with the consent of third parties between 2005 and 2017. According to the information received, sterilization of women with disabilities is perceived as a natural and necessary procedure, as well as a means of protecting women from pregnancy in cases of sexual violence. These women are thus denied their legal capacity and their will is substituted by the decision of third parties. The Special Rapporteur notes that the 2012 Organic Act on Disabilities does not recognize the sexual and reproductive rights of persons with disabilities. Such omissions may reproduce the stereotype that people with disabilities have no sexuality or reproductive potential. The 2017 manual on sexual and reproductive health care for persons with disabilities provides that the informed consent process requires, among other elements, the “capacity to consent”.30 However, in light of article 1463 of the civil code, persons with intellectual disabilities are considered incapable and thus do not have the capacity to consent prior to a medical procedure. The Special Rapporteur recalls the recommendations of the Committee on the Rights of Persons with Disabilities calling on Ecuador to explicitly recognize the rights of persons with disabilities, including those with intellectual or 29 30 14 See MCP Ecuador, Pharos Global Health Advisors and Bitrán & Asociados, “Ruta crítica del plan de trabajo para la transición, Ecuador” (April 2019). See www.salud.gob.ec/wp-content/uploads/downloads/2017/09/manual-ss-discapacidadesFINALWEB-1.pdf.