Enhancing HIV responses - the role of Human Rights Protections

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  • Leadership of the HK Government. Work of the ACA. Acknowledge UNAIDS’s support in the development of the new Strategy Role of Civil Society Organisations to make sure HIV policy and programming are relevant and effective. UNDP’s mandate around laws and human rights, UNAIDS division of labour re MSM
  • At the launch of the Global Commission on HIV and the Law in 2010, Helen Clarke made a remarkable statement: she stated that it is “increasingly clear that success in responding to HIV can ONLY reach the required scale (or reach the necessary population groups) if they are underpinned by legal, regulatory and social environments which advance human rights, gender equality, and social justice goals .” It is now 2012, and we have some preliminary findings from the Global Commission, and this statement is more pertinent than ever as we find ourselves in an environment where resources are diminishing, but the need for HIV prevention, treatment, care and support programs to reach the key affected populations are crucial in the Asia-Pacific region to prevent worsening trends. We are fortunate to be able to enhance HIV programmes by creating enabling environments that protects human rights, human rights thus offer us an opportunity to intensify our efforts to make our HIV programmes more effective.
  • This graph represents the likely impacts of different approaches on the number of new HIV infections per year. If investment further increases , targeted to the populations that drive HIV epidemics, we could see even more rapid decreases in new infections over the next few years, as shown in the green and red lines on this graph. Over time, however, even more spending won’t further decrease HIV infections, unless the policy environment is improved as well. That is why the green and red lines go flat after 2015. If funding levels are maintained at current levels, with current programmes and policies – new infections should continue to drop for a year or two but they will likely then start to slowly rise again, as shown in the light blue line at the top of this graph. However, even if current spending levels are only maintained at current levels rather than increased, it is possible to keep reducing new HIV infections. The purple line on this graph shows the potential impact of maintaining current spending levels while improving the legal and policy environment. You will notice that changes to policy alone – without also increasing spending – will drive down new infections, but not as quickly as seen through a scale-up of programming. That isn’t surprising – it takes some time for law and the legal environment to have an impact on behaviour. Of course, the best response of all is to increase overall spending, to target the spending more effectively on key affected populations, and to combine those investments with improvements to the policy and legal environment. Such a combination would give us both rapid improvements and sustainable improvements.
  • As you may know, the Board of UNAIDS called in 2010 for the establishment of an independent Global Commission on HIV and the Law, which is being supported by a Secretariat based at my office, in UNDP New York The Commission is chaired by Fernando Henrique Cardoso, the former President of Brazil, and includes 15 eminent leaders from around the world, including current and former senior politicians, judges and public health experts. Over the past 18 months, the Commission has commissioned research, examined the existing evidence base and consulted widely to understand how the law and legal environments can help or hinder HIV responses and protect and fulfill human rights. The Commission has received 680 written submissions from 133 countries as well as convening seven “Regional Dialogues”. The first of the Regional Dialogues was held here in the Asia-Pacific region in Bangkok. The Commission’s final report is now being drafted and will be launched in the coming months, but many findings and recommendations are already clear and I am pleased that many countries – including countries in Asia Pacific – have already begun to address some of the key issues
  • It is clear that attention law and the legal environment is essential for effective, affordable and sustainable responses to HIV, even if the right laws cannot by themselves stop the epidemic. Countries must also pay attention to law enforcement – that is, the law on the streets as experienced by affected populations – and to whether or not key affected populations have access to justice and protection against discrimination and human rights abuses. It is essential for people at heightened risk of acquiring HIV to have access to HIV prevention, treatment, health services, commodities and information – for their own health and broader society. That is why anti-discrimiantion laws have a particular role to play in changing realities on the ground in terms of universal access of health services and access to justice.
  • It is essential for people at heightened risk of acquiring HIV to have access to HIV prevention, treatment, health services, commodities and information – for their own health and broader society. That requires focused investment and programming but also an enabling legal environment . Some of the best laws - and some of the worst - have been agreed specifically to respond to HIV. As you know, some countries have travel restrictions on people with HIV, and others specifically criminalize HIV transmission or exposure. Those laws may have been well-intentioned in the first place but they have proven to be misguided and counter-productive. They actually undermine prevention instead of helping. Other HIV-specific laws are much more useful. For example, we heard from UNAIDS this morning that many countries in this region have passed laws to prohibit discrimination on the basis of HIV status. The Commission also examined many relevant laws that were not passed with HIV in mind. Trade agreements can facilitate or undermine access to treatment. Law and law enforcement related to gender based violence is essential to protect and empower vulnerable women. Old, colonial anti-sodomy statutes undermine participation and services for men who have sex with men.
  • Fortunately, there are many examples of good practice in Asia Pacific. We heard this morning about Fiji’s success in improving its HIV-related laws – allow me to congratulate the President for his leadership. For key affected populations, it is particularly important to look for progress in all three areas identified by the Commission – law reform, law enforcement and access to justice. We heard some great examples at lunch today about opportunities to strengthen HIV prevention and treatment access amongst sex workers through partnerships with the police – even in the absence of law reform. There are multiple States in India that have seen success through this approach. In many countries, the most promising way forward on law enforcement and access to justice issues is through partnerships with municipal governments, rather than through national or state action alone. China piloted such work in Cheng Du is now scaling up such an approach to ten further cities, while the ACHIEVE project in Quezon City is pioneering such municipal-level sensitization of the police about sex work in the Philippines. Of course, law reform is also important. Each country must find its own legal solutions, and decriminalization is not the same as legalization. That said, sex work related law reform is possible, and it makes a dramatic difference, as we have seen in New Zealand.
  • Many countries in this region moved earlier on improving laws or legal environments for sex work, without yet addressing issues for men who have sex with men or transgender populations. That lack of policy attention to MSM and trans people - coupled with wide-spread discrimination – helps to explain why HIV continues to spread in these populations in most countries of Asia Pacific. Fortunately, for both MSM and transgender people, we are beginning to see a rapid policy change and increasing attention to their needs and rights in this region. For MSM, we have seen partial or full repeal of anti-sodomy laws in countries such as India, Nepal and Fiji. In these countries as well as some others, we are also seeing stronger community organizing, more societal acceptance, and less harassment from police. The needs of transgender people sometimes overlap with MSM and sometimes are distinct. Pakistan and Nepal should be congratulated for their recent progress in legal recognition of transgender people – including the right to be officially recognized as trans on passports and other official identification papers. Much more needs to be done on law reform, law enforcement and access to justice for people with HIV, for sex workers, for transgender people and for MSM. The same is true for people who use drugs, as you will hear in a moment. Nevertheless, Asia-Pacific continues to be a leader in shaping strong HIV responses – and this region has the potential to continue its leadership in these challenging areas. Let me now hand over to Gary to conclude the presentation.
  • Enhancing HIV responses - the role of Human Rights Protections

    1. 1. Enhancing HIV Responses The role of human rights protections Presented by Li Zhou Technical Officer – Human Rights and Sexual Diversity HIV, Health and Development Practice UNDP Asia Pacific Regional Centre
    2. 2. Enabling HIV Responses It has also become increasingly clear that successes in responding to HIV can only reach the required scale if they are underpinned by legal, regulatory and social environments which advance human rights, gender equality, and social justice goals. - Helen Clarke, UNDP Administrator
    3. 3. Structural change/ enabling environment Source: Cost and Finance Working Group, aids2031 (across 139 countries)
    4. 4. Global Commission on HIV and the Law 1. Analyse existing evidence and generate new evidence 2. Develop human rights-based and evidence-informed recommendations 3. Increase awareness amongst key constituencies 4. Engage with civil society and strengthen their ability to campaign, advocate, lobby Objectives  Consolidated, coherent and compelling evidence base  Greater awareness among key stakeholders  Leadership of law and policy makers to create a positive legal environment  Public dialogue on social attitudes, human rights and legal issues relating to HIV  Civil society engagement Outcomes
    5. 5. Global Commission on HIV and the Law • The law alone cannot stop AIDS – nor can the law be blamed when HIV responses are inadequate. But the right laws and policies make HIV responses more effective, less expensive and more sustainable. • Countries must pay attention to: • Laws on the books • Law on the streets • Access to justice
    6. 6. Global Commission on HIV and the Law • It is obvious that people at risk of HIV and people living with HIV need information and services. The Commission has found powerful examples of good laws that facilitate such access as well as misguided laws that undermine access. • Need to examine HIV-specific law: e.g. include HIV in anti-discrimination provisions and repeal specific provisions criminalizing HIV transmission • Also need to examine broader laws that influence HIV: trade agreements, gender violence, drugs, sex work, homosexuality
    7. 7. Good Practices: Sex Work • Transition to supportive law enforcement as part of a peer-led, CSO-Government partnership in Sonagachi (India); condom use among sex workers increasing from 2% to 85%; ACHIEVE in Quezon City, Philippines • Decriminalization (2003) along with joint worker/government workplace health and safety standards for sex work (New Zealand); successful maintenance of very low HIV incidence
    8. 8. Good Practices: MSM and Transgender • Judicial repeal of sodomy laws (eg India 2009) • Police sensitization with MSM and transgender people (e.g. Thailand, Australia and Papua New Guinea). • Legal recognition of transgender people (China, Indonesia, Japan, Nepal, Pakistan, Republic of Korea, Singapore).
    9. 9. Good Practices: Gender & PWUD Gender •Making gender based violence support services more available through GBV and HIV service providers and more accessible to women and men (for example in PNG). People Who Use Drugs (PWUDs) •Malaysia has transformed drug rehabilitation centres into "Cure and Care 1 Malaysia Clinics" where people who use drugs can seek drug treatment, HIV, harm reduction and a range of other services on a voluntary basis rather than compulsorily, and this has resulted in a reduction in HIV transmissions amongst PWUDs.
    10. 10. Conclusion Human Rights protections as part of the HIV response are: • Key in preventing the spread of HIV • Cost-effective and sustainable • Crucial in achieving universal access, targets and commitments • Well grounded in research and experiences in the Asia-Pacific region • Consistent with progress being made already in countries across the Asia-Pacific

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