Developing rights-based national policy on HIV/AIDS


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Developing rights-based national policy on HIV/AIDS

  1. 1. Country A or Country B? Developing rights-based national policy on HIV/AIDS Joanne Csete Canadian HIV/AIDS Legal Network February 2007 Third National Indonesian AIDS Conference, Surabaya
  2. 2. About the Canadian HIV/AIDS Legal Network The Canadian HIV/AIDS Legal Network ( promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is one of the world’s leading organizations working on the legal and human rights issues raised HIV/AIDS.
  3. 3. Presenting Country A <ul><li>HIV/AIDS thought of as a disease of drug users, sex workers, and promiscuous women. </li></ul><ul><li>People believe that HIV can be caught from public toilets or sharing fork with an HIV-positive person. </li></ul><ul><li>Law guarantees equal right to health care, but people living with HIV are often rejected at hospitals, and drug users with HIV do not receive ARVs because they are “too irresponsible”. </li></ul><ul><li>The National AIDS Program does not include any resources to combat violence against women. </li></ul>
  4. 4. Presenting Country A (2) <ul><li>Politicians know that people like policies that are “tough on crime”, especially tough on drugs. </li></ul><ul><li>Carrying a clean syringe is cause for arrest. </li></ul><ul><li>People who are convicted for even minor drug offenses go to jail, sometimes for a long period. </li></ul><ul><li>In jails, people inject drugs with “home-made” contaminated syringes; prisoners living with HIV are housed separately. </li></ul><ul><li>Sex work is legal, but sex workers are arrested and jailed often for minor offenses. </li></ul><ul><li>Many employers require HIV tests of their workers or potential recruits. </li></ul>
  5. 5. Presenting Country B <ul><li>Long-running education campaign explains that anyone can get HIV, but no one can get it from casual contact. </li></ul><ul><li>People with HIV and people who use drugs serve on the National AIDS Commission and on every provincial AIDS commission. </li></ul><ul><li>Drug law was modified so that no one can be arrested for having a sterile syringe. </li></ul><ul><li>Prison authorities admit that in spite of many efforts they can’t keep drugs out of the prison; sterile syringes are made available to prisoners. </li></ul>
  6. 6. Presenting Country B (2) <ul><li>The government has small grants for AIDS programs run by drug users and sex workers for their peers. </li></ul><ul><li>The National Human Rights Commission was given extra staff to hear cases about discrimination related to HIV status. </li></ul><ul><li>Major national training program on respectful treatment of people with HIV for doctors and nurses and in medical and nursing schools. </li></ul><ul><li>A program to combat domestic violence and rape is part of the national AIDS program. </li></ul>
  7. 7. Which country is likely to have the better national AIDS response? <ul><li>Country B has learned some lessons…. </li></ul>
  8. 8. Six human rights lessons for national AIDS policy <ul><li>1) Impossible to achieve universal access to services without respecting human rights : People who are afraid, criminalized, socially excluded, stigmatized are hard to reach with services. </li></ul><ul><li>2) Women are at particular risk of HIV; programs must address root causes of their risk : How can women demand condom use if they face violence in the home? </li></ul>
  9. 9. Six human rights lessons for national AIDS policy (cont.) <ul><li>3) NGOs of people living with HIV, people who use drugs, and sex workers – when they are supported and can work without interference – can and should play a crucial role in national and provincial AIDS responses. </li></ul>
  10. 10. Six human rights lessons for national AIDS policy (cont.) <ul><li>4) Legal frameworks are important : Laws should support non-discrimination, voluntary and confidential nature of HIV testing, legality of needle exchange and other services for drug users, protection from sexual violence, alternatives to incarceration for minor drug offenses, etc. Without good laws, even well-funded AIDS programs may fail. (See model laws, </li></ul>
  11. 11. Six human rights lessons for national AIDS policy (cont.) <ul><li>5) Many countries are losing the battle against AIDS by ignoring or denying HIV transmission in prison. </li></ul><ul><li>6) In many ways, AIDS is not like other diseases : Always been seen as linked to “deviance” or “immorality” – need to counter this with enforceable human rights protections and by working respectfully with people affected by HIV. </li></ul>
  12. 12. Will Indonesia be more like Country A or Country B? The world is watching! <ul><li>“ The HIV/AIDS harm reduction program at Hasan Sadikin Hospital in Bandung, West Java, has been operating now for more than two years. Unfortunately, many drug addicts are still reluctant to undertake the treatments, thanks to repeated police raids and arrests.” </li></ul><ul><li>-- The Jakarta Post , 2 Feb 2007 </li></ul>
  13. 13. Drug users often face human rights abuse <ul><li>Police harassment, extortion, unlawful arrest; first targets to fill arrest quotas </li></ul><ul><li>Harsh penalties, including long prison sentences for minor offences, small amounts </li></ul><ul><li>Forced detoxification, forced testing </li></ul><ul><li>Long detention without trial, without being charged, without access to counsel </li></ul><ul><li>Torture: addiction used against them </li></ul><ul><li>Extra-legal crackdowns and “street sweeps”; extrajudicial killing </li></ul>
  14. 14. <ul><li>“ A lot of users just think it’s better to use old needles than to run into the police. Police can hang out near the needle exchange or near the drug stores where you buy syringes. If they catch you with syringes, even if you have no heroin, you can be arrested or have to pay $500.” </li></ul><ul><li>Vladimir A., Russia, 2004 </li></ul>
  15. 15. <ul><li>I didn’t have heroin on me, I only had a syringe. There was nothing in the syringe. The police officer couldn’t find any drugs on me, so he put some in my pocket and then took it out and said “Does this belong to you?” </li></ul><ul><li>He could tell I was a drug user, so it was easy for him to pin charges on me. </li></ul><ul><li>--Samut, Bangkok, 2004 </li></ul>
  16. 16. Human rights concerns of women who use drugs <ul><li>Women who use drugs often avoid health services for fear of losing custody of children or being rejected by family and community. </li></ul><ul><li>Addiction treatment services designed for women are rare; some centres do not allow children on the premises. </li></ul><ul><li>In many places, women are more likely to need help injecting – may make them dependent on an injecting partner or make them “second on the needle”. </li></ul>
  17. 17. Thailand’s partial success: HIV prevalence in vulnerable populations
  18. 18. Feasible actions/strategies <ul><li>Ensure real resources to enable people who use drugs to be at the policy table </li></ul><ul><li>Fix the legal framework </li></ul><ul><ul><li>methadone and syringe programs must be clearly backed by law </li></ul></ul><ul><ul><li>carrying a sterile syringe should not be illegal </li></ul></ul><ul><ul><li>due process: access to counsel, right to prompt trial and charges, humane conditions of interrogation </li></ul></ul>
  19. 19. Feasible actions/strategies (cont’d) <ul><li>Law enforcement practices </li></ul><ul><ul><li>Don’t confiscate or destroy injection equipment </li></ul></ul><ul><ul><li>Don’t arrest while injection is occurring </li></ul></ul><ul><ul><li>Interrogation of someone in withdrawal is unethical </li></ul></ul><ul><ul><li>ALSO: resources to ensure adequate police salaries, training on harm reduction </li></ul></ul><ul><li>Methadone is on WHO List of Essential Drugs – all countries must treat it as ESSENTIAL </li></ul>
  20. 20. Feasible actions/strategies (cont’d) <ul><li>5. Humane treatment for addiction as a rallying issue: </li></ul><ul><ul><li>international standards? </li></ul></ul><ul><ul><li>promote understanding of the human right to humane addiction treatment </li></ul></ul><ul><li>6. Methadone and sterile syringes in prison: be courageous to evaluate the evidence! </li></ul>
  21. 21. Human rights as a benchmark for AIDS policies <ul><li>“ The success of various HIV/AIDS interventions has been shown to be directly proportional to the degree to which human rights are promoted and protected in the context of these interventions.” </li></ul><ul><li>— UNAIDS, 1997 </li></ul>
  22. 22. Simple respect <ul><li>“ The police just grab me, and go through my pockets, and say “What have you got?” The cop said “Well, you’re too clean to be an addict,” which means I must be a dealer. What did I do wrong other than living in the poorest neighbourhood in Canada?” </li></ul><ul><li>--Jack R., 23, Vancouver (2003) </li></ul><ul><li>“ They treat us [drug users] like dirt. I just want to be treated like a normal human being.” </li></ul><ul><li>--Yevgeny B., Russia (2004) </li></ul>
  23. 23. Contact Joanne Csete Canadian HIV/AIDS Legal Network 1240 Bay Street, Suite 600 Toronto, Ontario Canada M5R 2A7 Telephone: +1 416 595-1666 ext. 232 Fax: +1 416 595-0094 E-mail: Website: