Transcript What is UNAIDS?

The global context of HIV and
Human Rights in 2010
Susan Timberlake
Senior Human Rights and Law Advisor, UNAIDS
Secretariat, Geneva
Symposium on HIV and Human Rights in the Caribbean
13-14 September 2010
Declaration of Commitment on HIV/AIDS
(2001), Political Declaration (2006)
• Ensure universal access to prevention,
treatment, care and support
• Protect human rights and end discrimination for
PLHIV and vulnerable populations
• End violence against women and gender
inequality
• Ensure full participation in the response
• Revise laws that act as obstacles
• Reduce vertical transmission and meet the
needs of children
Political Declaration: Pledge to promote….a social
and legal environment that is supportive of and
safe for voluntary disclosure of HIV status
Human rights commitments largely
unfulfilled
• 29% of UNGASS countries report no legal protection
against HIV-related discrimination
• 67% UNGASS countries report “laws and regulations
that present obstacles for vulnerable sub-populations”
• 79 countries criminalize same sex sex; 6 death penalty
• 116 countries criminalize some aspect of sex work
• 51 countries have HIV-related travel restrictions
• 56 have HIV-specific laws criminalizing HIV
transmission
• Numerous countries criminalize harm reduction
measures in context of drug use
• High levels of stigma and discrimination
Accountability –flawed, but growing (?)
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UNGASS commitments
UNGASS reporting
Universal access
UA national targets
Epidemiology and surveillance
Disaggregation by sex and sometimes by age
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Human Rights Count
GIPA Report card
Stigma Index by and for people living with HIV
Criminalization of transmission scan
HIV travel restrictions database
ILGA list of countries that criminalize of sexual minorities
 BUT no explicit HIV and human rights indicators
Getting to a rights-based approach
through many back doors
• “Engender the response” – reach women, girls, sexual
minorities
• “Attain universal access” – reach everyone in need
• “Do combination prevention” – address structural issues
• “Remove punitive law, policies, etc” – challenge govts
• “Know your epidemic and response” – address the really
affected
• “The prevention revolution” - create demand for protection
• “Positive Health, Dignity and Prevention” – protect and
empower PLHIV
• “Treatment equals prevention” – break down barriers
• “Treatment 2.0” – push into new forms of accessibility,
availability, affordability
A Rights-Based Approach to HIV IS about
human rights obligations
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Address the needs of the most affected
Further human rights goals through programmes/funding
Ensure meaningful participation of those affected
Implement specific programmes to empower
Ensure accountability mechanisms
Disaggregate by sex, age, marital status, rural/urban,
economic status, ethnicity, participation.
• Support/push governments to protect/realize rights.
• Support civil society to claim rights.
What rights?
• Human rights necessary to avoid infection (“right to prevention”)
Education and information (HIV, sexuality, life-skills, human rights);
Health (HIV prevention services/commodities; prevention of vertical
transmission); Privacy (confidentiality); Liberty (autonomy and informed
consent); Non-discrimination (e.g. based on race, religion….and other
status, such as health status, sexual orientation); Freedom from cruel
and inhuman treatment (denial of health care in prison, drug detention
centres); Freedom from gender-based and sexual violence; Security and
due process
• Human rights necessary to live successfully with HIV (“right to
treatment, care and support”)
Non-discrimination (e.g. Employment, Education, Social protection);
Health (treatment, palliative care, TB, drug dependence; Privacy
(confidentiality, prohibition of unlawful disclosure); Liberty (autonomy and
informed consent); Sexual and reproductive rights; Security and freedom
from violence
NOT the rights of the uninfected AGAINST
the rights of the infected:
The AIDS Paradox: Only by protecting the rights of those living with
HIV will we protect the rights of all. – Michael Kirby, Jonathan Mann
early ‘80s
The rights of the uninfected through the rights of the infected and vice
versa
By protecting the rights of PLHIV, address HIV for what it is – a
transmissible health infection. De-stigmatize it, treat it, and
support long, productive lives and non-infectious lives.
By doing this, ALSO bring HIV out of secrecy and shame where
uninfected can get information, education, services, and act on
them to protect themselves.
New focus on People living with HIV
Positive Health, Dignity and Prevention
• Linking together the social, legal, health and prevention
needs of the individual living with HIV within a human rights
framework to improve health, dignity and security
• ALSO, BUT NOT ONLY, with goal of preventing new
infections
• By supporting PLHIV holistically also support person to:
• Acquire complex skills re. communication and decisionmaking around HIV transmission risk
• Be willing and able to disclose status and/or practice
prevention without fear, discrimination, stigma
• Know how to use a condom and have access to them
• Stay on treatment and reduce infectiousness.
New focus on legal and social environments:
UNAIDS Outcome Framework (2009): “We can
remove punitive laws, policies, programmes, stigma
and discrimination that block effective responses to
HIV.”
• Clear evidence that stigma and discrimination
block individual uptake of prevention, treatment
and disclosure
• Strong anecdotal evidence that punitive laws
and policies block uptake and adherence
• Strong evidence that stigma and discrimination
block funding and programming for particular
groups
• Creation of Global Commission on HIV and the
Law to bring together evidence, dialogue,
recommendations
But need to be strategic with three
elements of the legal environment
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Law: reforming law or legislating – very
difficult, labour intensive and risky AND may
not have much impact
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Law enforcement – improving it also difficult,
but can have practical and immediate impact
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Access to justice – strengthening it difficult,
but can have immediate impact, as well as
lead to social change
New focus on programming for human rights
UNAIDS promotes 7 key programmes to improve
legal and social environment
1. Programmes to reform and monitor laws
2. Programmes to train police on non-discrimination, space
for outreach, non-harassment, etc
3. Programmes to train health care workers on nondiscrimination, informed consent, confidentiality, duty to
treat, infection control
4. Provision of legal services
5. Programmes to build legal literacy (know your rights and
laws)
6. Programmes to realize gender equality and reduce
violence against women
7. Programmes to reduce HIV-related stigma
New focus on reducing stigma and
discrimination
• Have many tools to measure, including Stigma
Index for and by PLHIV
• Know actionable causes (fear of HIV, ignorance of
harm of stigma, moral judgement)
• Know how to address through various
programmes: social change communication,
mass media, engagement of PLHIV, workplace
programmes, community dialogue, community
mobilisation around rights, support/advocacy
groups, strategic litigation
• May get UNGASS indicator
Towards a new type of response
• Identify vulnerability and respond: who, why, how
• Shift coverage – follow programmatic expenditure and coverage
and move it to cover those really vulnerable
• Shift content – to programmes that empower, address legal and
social vulnerabilities and other structural issues
• Shift partners – to Ministries of Interior, Gender, Justice;
Parliaments, Judiciary, Prisons, human rights groups, justice
reform groups, migrant groups, labour unions
• Take HIV out of isolation, e.g. human rights defenders networks
• Work in feedback loops
• Go to scale
• Through national/regional working groups on human rights and
law, identify and work to overcome the worst legal and social
blocks to effective responses.
Some suggested priorities for
investment and expansion
• Reducing HIV-related stigma and discrimination
 In communities (addressing stereotypes, layered stigma)
 In health care settings
• Building human rights and legal capacity of people living with HIV
 Human rights and legal literacy
 Legal support (integrated into existing legal aid/redress
mechanisms)
• Working with police to open space/get protection for
 Women in domestic violence and sex workers
 Sexual minorities
 People who use drugs
• Use Inter-American system and public litigation strategically