This week's International Aids Conference in Melbourne has heard that laws which criminalise homosexual sex are undermining efforts to prevent and treat HIV.
Men having sex with men remains illegal in more than one-third of all Pacific countries and territories.
Advocates argue such laws lead to discrimination and stigma against gay and transgender people and stops them from having HIV tests or treatment.
They also want community attitudes to shift and point to Samoa's acceptance of the Fa'afafine as an example.
In Samoa, around 3,000 people identify as Fa'afafine; they are neither male nor female but a specific third gender.
The Fa'afafine are generally considered to be an important and long-standing part of Samoan culture.
Roger Stanley is president of the Samoan Fa'afafine Association and is attending the 2014 Aids Conference in Melbourne.
"We are culturally accepted very well, it has been all these years and before Christians, and even post-Christianity, we've been living in harmony," he said.
But up until last year when Roger wore dresses, he was technically committing a crime even though the police were not enforcing Section 58N of Samoa's Crimes Ordinance Act.
In March last year, Samoa's government repealed that law which made it an offence for a male to impersonate a female.
But sex between men, regardless of consent, remains illegal.
Ken Moala from the Pacific Sexual Diversity Network argues the law, and those like it in other Pacific countries, are outdated.
"It's something we inherited from the colonial powers, why are we still holding onto these archaic laws? There should be new laws celebrating who we are," Mr Moala said.PNG's punitive laws
One of the countries Mr Moala accuses of being most prohibitive is Papua New Guinea - where it's also illegal for men to have sex with men.
There, they face up to 14 years in jail if caught.
That makes it a tough life for people like Parker Hou, a gay man who is now committed to advocacy work.
He's a project officer with Friend's Frangipani, a group working with PNG's sex workers.
"I guess most of the people see us from the perspective of what the law says in the country," Mr Hou said.
"Even if you're not doing anything, just being yourself, walking in the streets, people tend to look at you differently.
"I've been called names and at one point, I was actually being physically abused."
Ken Moala says the punitive laws lead to widespread stigma and discrimination which means Pacific nations are failing in trying to reach the UNAid's vision of achieving the 'three zeroes' which include zero new HIV infections, zero AIDS-related deaths and zero discrimination.
"We believe they're addressing the first two but not addressing the third - that's stigma and discrimination - and that's a real issue in the Pacific," Mr Moala said.
"A lot of people are still ignorant of the fact that people living with HIV are still stigmatised. It's like a double whammer [sic] - being gay and also having the virus. They are stigmatised twice".
Mr Moala says that attitude prevents gay and transgender people from accessing vital HIV services, whether it be testing or treatment.
"It prevents us getting the message across because they feel internalised homophobia and that is a risk for them and leads to infection," he said.
Parker Hou says he sees that issue in action amongst his peers.
"I think the law is doing that to my friends. They have that fear of going to get information, to access information and health care," he said.
While progress has been made in collaboration with PNG's National Aids Council that is trying to make health services more accessible for PNG's gay and transgender people, advocates attending the International Aids Conference say repealing punitive laws across the Pacific still needs to be the main objective.
"We want to be part of the planning of strategic plans for HIV on a national level included in conversation and globally want to be united with other colleagues from all over the world," Mr Moala said.
"We are there, we're not going away. We want to be visible and accepted.
"We have to be very careful in the Pacific because we are working within a traditional framework.
"The idea is to advocate with politicians, with church leaders and with traditional leaders. It's small steps, we have to take it very slowly."
But Mr Moala is confident the laws will be repealed.
"It's a work in progress, down the track it will eventually change."