A/HRC/4/110 page 10 24. Many regional and country consultations identified homophobia, gender inequalities and discrimination against people in vulnerable groups as major barriers. UNAIDS confirmed that the low status of women in many societies fuels the transmission of HIV and worsens its impact. The Africa regional consultation emphasized that scaling up towards universal access would not be possible on the continent without a central focus on the needs of women and girls. The Middle East and North Africa consultation reported that gender inequality, discriminatory laws, and stigma and discrimination were constraining AIDS programmes. During the country consultation in Pakistan, participants reported that gender discrimination was blocking access to health services. The Asia and Pacific consultation called attention to the fact that marriage and women’s own fidelity are not enough to protect them against HIV infection. Women and girls do not have widespread access to HIV-protective methods they can easily afford, initiate and control. Female condoms are not yet widely accessible, and far greater urgency is required in the development of new prevention technologies such as microbicides. 25. Many consultations stressed that the development and enforcement of supportive laws and protection of human rights - including the rights of women and children - must remain priorities. The Asia and Pacific consultation called on Governments in the region to review legislation that is inconsistent with national AIDS-control policies. The need for new laws that protect people living with HIV and members of vulnerable groups, or the strengthening and enforcement of existing legislation, was noted in the country consultations in Bosnia and Herzegovina, the Dominican Republic, Ghana, the Democratic Republic of the Congo, Haiti, Madagascar, Nigeria, the Russian Federation, Senegal, Sierra Leone, Swaziland and the United Nations administered province of Kosovo. 26. UNAIDS reaffirmed the position that increasing the number of people who know their HIV status is critical for reaching more people in need of treatment, preventing mother-to-child transmission and providing intensive prevention services, especially for discordant couples. As such, access to testing is a human rights imperative. Civil society participants in national, regional and global consultations emphasized that HIV testing must be informed and voluntary. Insufficient access to confidential HIV testing was cited in consultations in Albania, Bangladesh, Botswana, Cambodia, Ethiopia, Gabon, Papua New Guinea, Moldova, Romania, Somalia, Suriname, The former Yugoslav Republic of Macedonia, Trinidad and Tobago and the United Nations administered province of Kosovo. Some high-burden countries reported that they now routinely offer HIV testing to patients in all clinical and community-based health-service settings. 27. Numerous consultations identified user fees for health and education as an obstacle restricting access, especially for people living below the poverty line. Even small user fees can impose a significant financial burden on individuals and families and undermine adherence to HIV-treatment regimens and the use of prevention commodities. Countries such as Botswana, Brazil, Ethiopia, Senegal, Thailand, the United Republic of Tanzania and Zambia have all adjusted health-financing policies to eliminate user fees for HIV treatment at the point of service delivery. The country consultation in China applauded the Government’s new “Four Frees and One Care” policy, which calls for free antiretroviral therapy for rural residents or people with financial difficulties living in urban areas; free voluntary counselling and testing; free services to prevent mother-to-child transmission and HIV testing of newborn babies; free schooling for children orphaned by AIDS; and care and economic assistance for affected households.