This presentation highlights linkages between law, human rights & high impact programming for HIV and TB

1. Risks, Rights & Health
Global Fund Secretariat
25 September 2013
Dr Mandeep Dhaliwal & Tenu Avafia
HIV, Health And Development Practice
United Nations Development Programme

2. Outline
• Introduction to the Global Commission on HIV and
the Law
• Linkages between law, human rights and high impact
programming
• Synergies between Commission follow up and the
Global Fund

3. 1. Introduction to The Global Commission on
HIV & the Law

4. The Role of the Law in the AIDS
Response

5. Introduction to The Global
Commission on HIV & the Law
• UNAIDS target: by 2015, halve the number of countries
with punitive laws and practices around HIV
transmission, sex work, drug use or homosexuality.
Create legal environments that advance and safeguard
dignity, health and justice in the context of HIV
• To develop actionable, evidence based
recommendations for effective AIDS responses that
mitigate the impact of HIV and promote and protect the
human rights of people living with and most vulnerable
to HIV

6. The Global Commission on HIV & the Law
(1) Laws and Practices that
Effectively Criminalise People Living
With and Vulnerable to HIV
(2) Laws and Practices that Mitigate
or Sustain Violence and
Discrimination as Lived by Women
(3) Issues of Law and HIV pertaining
to children
(4) Laws and Practices that Facilitate
or Impede HIV-related Treatment
Access

8. 2. Linkages between law, human rights & high impact
programming for HIV and TB

9. Commission’s Key Messages
1.
Epidemic of bad laws is fueling the spread of HIV, resulting in
human rights violations and costing lives.
2.
Epidemic of bad laws is wasting money & limiting effectiveness
and efficiency of HIV and health investments.
3.
Good laws and practices that protect human rights and build on
public health evidence already exist - they strengthen the global
AIDS response, and they must be replicated.
4.
Scientific tools alone are not sufficient to halt and reverse AIDS.
Enabling legal environments are essential to a successful AIDS
responses

10. An epidemic of bad laws is fueling the spread
of HIV and is costing lives
1. In over 60 countries, it is a
crime to expose another
person to HIV or to transmit it,
especially through sex.
2. Worldwide, countries and
jurisdictions have promulgated
HIV-specific criminal laws:
 34 States & territories in the
USA
 27 countries in Africa following
the N'Djamena Model Law
(2005)
 13 countries in Asia-Pacific
 11 countries in Latin America
 9 countries in Europe

11. An epidemic of bad laws is fueling the
spread of HIV and is costing lives
• Laws criminalizing HIV transmission, exposure & non-disclosure are
often:


Over-broad and vaguely worded; disproportionately applied against people
at greater risk (migrants, sex workers, transgender people, injecting drug
users, men who have sex with men);and
Applied regardless of age, level of education, personal circumstances &
relevant factors
• Criminalization of HIV transmission reinforces stigma and
discrimination against people living with HIV:
 People are discouraged from getting tested or treated, in fear of being
prosecuted for passing HIV to lovers or children
 Undermines the trust between health professionals, service providers and
their patients

12. Bad laws limit the effectiveness and efficiency
of HIV and health investments
•
Criminalisation of same-sex relations is
widespread
•
Punitive laws against homosexual
behavior are impeding and
undermining HIV prevention efforts for
MSM
•
Decriminalization is necessary, but not
sufficient on its own – efforts are also
required to reduce associated stigma,
discrimination and violence
•
Resources spent on prosecutions could
be better spent providing access to
health services

13. Bad laws limit the effectiveness and
efficiency of HIV and health investments
•
Evidence has shown that Governments
which have provided comprehensive
harm reduction services have
significantly reduced HIV infections in
people who use drugs
•
Although UN conventions, which aim to
curb drug trafficking, allow for
treatment, rehabilitation and social
reintegration, the approach to people
who use drugs has been predominantly
repressive
•
“War on drugs” actually a war on
people who use drugs and has
negative consequences for HIV

14. Bad laws limit the effectiveness and
efficiency of HIV and health investments
• Well intentioned “anti-counterfeit” legislation that aims to
outlaw substandard medicines can have the unintended
consequence of threatening the supply of generic medicines
– Definition of ‘counterfeit’ conflates substandard medicines with generic
medicines
– Example of proposed legislation in East African Community, in which 4
of 5 member countries are classified as LDCs
• Customary laws which disempower women increase their
vulnerability to HIV
– Early marriage
– Inheritance
– Legal definitions of sex crimes may preclude prosecuting some coerced
acts (i.e. marital rape).

15. Bad laws limit the effectiveness and
efficiency of HIV and health investments

16. Bad laws limit the effectiveness and
efficiency of HIV and health investments
•
Some countries, completely prohibit ageappropriate sexual health education in schools
while in others, laws impose ‘abstinence-only’
education
•
Some countries have established different legal
ages for consent to sex and for autonomous
access to sexual and reproductive health
services
•
Enact laws which ensure that the right of every
child, to have access to age appropriate
comprehensive sexual health education to
enable them to protect themselves and others
from HIV and to live positively with HIV.
•
Reform laws to ensure that the age of consent
for autonomous access to HIV and sexual and
reproductive health services is equal to or
lower than the age of consent for sexual
relations

17. Good laws and practices that protect human
rights strengthen the AIDS response
.
• Laws against consensual adult sex work undermined HIV
prevention, allowed excessive police harassment and violence
and weakened sex workers ability to negotiate safer sex with
clients – where punitive approaches have not been used, HIV
outcomes for sex workers improved
• Sensitization of law enforcement on HIV and the law increases
access to services for key populations, impacts on HIV prevalence
• Provision of legal aid for marginalised populations also
contributes to improving health outcomes
• Health care workers should be trained on informed consent,
confidentiality and non-discrimination

18. Good laws and practices that protect human
rights strengthen the AIDS response

19. 3. Synergies between Global Commission on HIV & the
Law and the Global Fund

20. Synergies between Global Commission on
HIV and the Law and the Global Fund: Why?
• Synergies between Commission follow up & Global Fund
supported programmes can contribute to delivering on UNDP’s
new Strategic Plan, the UNAIDS Strategy and the Global Fund’s
Strategy, Investing for Impact
– Strategic Objective 4 (GF Strategy):
• promote and protect human rights by integrating human rights
considerations throughout the grant cycle;
• increase investments in programs that address human rights-related
barriers to access; and
• ensure that the Global Fund does not support programs that infringe
human rights

21. Synergies between Global Commission on
HIV and the Law and the Global Fund: Why?
-Can also contribute to other strategic objectives
• Impact, value for money and risk
• Enhance efficiency and quality
• Increase sustainability
• Expand partnerships
-Support roll out of New Funding Model
• By helping to prioritize investments in the “right interventions
for the right people in the right place at the right time” in
national strategies and concept notes
• Encourage investment in high-impact programmes that
address human-rights related barriers to access including legal
environments*

22. Commission follow up
• Legal environment assessments to inform legislative reform in
51 countries
• Legislative reform – e.g.: laws related to key populations
• National dialogue & action planning on HIV and the Law in 20
countries
• Judicial sensitization
• Parliamentarian sensitization
• Access to justice – law enforcement, legal services &
legal/human rights literacy programs
• Knowledge/capacity building products

23. Kenya
Follow up stories – World Map on the Implementation of the
In October 2012, UNDP, in conjunction with the Ministry of of the Global Commission
Recommendations
Malawi
State for Special Programmes, UNAIDS, NEPHAK and KELIN
held the first national symposium on HIV, Law and Human
Rights. The2012, the first ever national conference on HIV and
In October symposium highlighted the findings and
recommendations of the Commission’s report andto discuss
law was held. This was a multi-stakeholder forum innovative
Philippines
good practice to increase access to justice such as the HIV
the report of a participatory national legal environment
Equity October 2012, Cebu, a city infindingsof a court andthe
assessment, which is based has the the southern part of can
On 17 Tribunal. The tribunal on the power and
receive evidence, historicCommission’s report. Thefull hearings
recommendations hear witness accounts, conduct meeting
Philippines, set a of the precedence in the fight for equal
Indonesia a communique read by the HIV, human rights
and pass judgments on matters relatingin the country with the
concluded with
rights among marginalized populations to Principal Secretary
and discrimination.commitment to act on evidence and deliver
affirming of the anti-discrimination ordinance which is closely
passage Malawi’s
On 3 September 2012, the government of Indonesia took an
on human rights commitments by reviewing discriminatory and
aligned with to expand access to medicines and help save
important step
Moldova the Commission’s recommendations. Showing
punitive laws and harmful practices as well as to focus on the
strong commitment to the principles of HIV/AIDS and hepatitis
and improve lives of people living with equality and human
protection City Council of Cebu unanimously approved a local
rights of people living with HIV. The
rights, the of humanIndonesia
B. July 2012, a few
decree authorizing
13 The President of days cited signed a thethe Commission.
launch basis of sexual
communique specifically after the work ofof the Global
legislation prohibiting discrimination on
government use of patents for seven Health convened a town
HIV/AIDS and hepatitis
Commission’s Report, the Ministry of status (i.e. HIV), among
orientation, This measure could health widespread generic
medicines. gender identity and lead to
hall meeting, together with UNDP,such as Davao City and
others. Other local governments, UNAIDS and other partners,
competition and generateinternationalsavings in the world's
major cost experts to
of leading Moldovan also now considering similar discuss how
Albay Province, are and
antifourth most its implementation promotes an effective one
the law and populous country. The decree representsAIDSof
discrimination legislation.
the most robust uses of public health related TRIPS flexibilities
response. The meeting adopted an action plan to ensure that
by law works for people affected by HIV. The country
thea country since the World Trade Organization 1995
Agreement on Trade-Related to implement the Commission’s
announced that it was the firstAspects of Intellectual Property
came into force.
recommendations. Moldova recently adopted legislative and
regulatory amendments for removing HIV as grounds for
restricting people’s right to entry and residence, as well as
other discriminatory provisions.

24. Key Synergies between Global Commission on
HIV and the Law and the Global Fund
• At the country level:
– Linking country level Commission follow up activities with concept note
development, national strategic plans and periodic reviews
• Investment Case
• Country Dialogue
• Concept Note development
• Engaging with CCMs during grant development process and periodic
reviews
– Technical support on enabling legal environments and critical enablers
(human rights, gender and key populations) for interim applicant
countries and periodic reviews
– ensuring that concept notes and grants include legal services, legal
literacy programmes, sensistisation of judiciary, Parliamentarians and
law enforcement officials
– Coordinated emergency response system to deal with human rights
violations – engaging key stakeholders involved in Commission follow up

25. Key Synergies between Global Commission on
HIV and the Law and the Global Fund
At the global level:
– Disseminating UNDP developed tool
to conduct:
• Reviews of specific laws
• Legal environment assessments aimed
at improving enabling legal
environments
– Documenting and sharing of good
practice on enabling legal
environments that support high
impact programmes
– Guidelines on how to use the law to
make financing the AIDS response
more sustainable – e.g.: enabling legal
frameworks, competition law

26. Thank You
www.hivlawcommission.org
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http://twitter.com/HIVLawCom
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https://undp.unteamworks.org/node/210039