Human Rights: The Role of Health Professionals and The Challenge of HIV/AIDS

1. Human Rights:The Role of Health Professionals and The Challenge of HIV/AIDS A Project of Physicians for Human Rights www.healthactionaids.org Dennis Lukaaya BA International Relations MA Candidate Human Rights Department of Philosophy Makerere University Co-Founder of Action Group for Health, Human Rights and HIV/AIDS (AGHA) Sarah Kalloch Africa Workshop Coordinator Physicians for Human Rights Health Rights Action Group (HAG) AGHA LOGO?!?!? Action Group for Health, Human Rights and HIV/AIDS (AGHA)

2. Physicians for Human Rights A Project of Physicians for Human Rights www.healthactionaids.org • A U.S.-based NGO • Use medical skills to document violations • Collaborate with health professionals and activists to use their knowledge and strong voices to promote human rights around the world. • Help amplify the voices of health professionals in advocacy for human rights as part of their commitment to health.

3. Right to health under international human rights law A Project of Physicians for Human Rights www.healthactionaids.org The Right to Health a fundamental human right indispensable for the exercise of other human rights. The right to health embraces a wide range of social economic factors that promote conditions in which people can lead a healthy life, and extends to underlying determinants of health such as food and nutrition, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment.

4. Right to health under international human rights law A Project of Physicians for Human Rights www.healthactionaids.org Universal Declaration of Human Rights Article 25 Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

5. Right to health under international human rights law A Project of Physicians for Human Rights www.healthactionaids.org International Covenant on Economic, Social and Cultural Rights Article 12 1. States recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. Steps to be taken to achieve the full realization of this right shall include those necessary for: (a) provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) improvement of all aspects of environmental and industrial hygiene; (c) prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) creation of conditions which would assure to all medical service and medical attention in the event of sickness.

6. Right to health under international human rights law A Project of Physicians for Human Rights www.healthactionaids.org Convention on Elimination of all forms of discrimination Against Women Article 12  1. States take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning. 3. Statesshall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. Convention on the Rights of the Child Article 24 "States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health...."

7. Interrelatedness of the Right to Health A Project of Physicians for Human Rights www.healthactionaids.org The right to health is closely related to and dependent upon the realization of other human rights: The rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information, and the freedoms of association, assembly and movement. These and other rights and freedoms address integral components of the right to health and are needed for the right to health to be fully realized.

8. What the Right to Health Encompasses A Project of Physicians for Human Rights www.healthactionaids.org The right to health is not the right to be HEALTHY. The right to health contains both freedoms and entitlements: • Freedoms include the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free of torture, non-consensual medical treatment, and experimentation. • Entitlements include the right to a system of health protection which provides equality of opportunity for people to enjoy the “highest attainable level of health”.

9. Right to Health: Entitlements A Project of Physicians for Human Rights www.healthactionaids.org Availability: Functioning public health and health care facilities, good services and programs, including safe drinking water, adequate sanitation facilities, hospitals, clinics and other health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs, as defined by WHO.

10. Right to Health: Entitlements A Project of Physicians for Human Rights www.healthactionaids.org Accessibility: Health facilities, good and services must be accessible to everyone, economically, physically and in terms of access to information, without discrimination.

11. Right to Health: Entitlements A Project of Physicians for Human Rights www.healthactionaids.org Acceptability: All health services must be culturally appropriate and respectful of medical ethics such as confidentiality Quality: Health services must be scientifically and medically appropriate and of good quality. This means skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe water and adequate sanitation.

12. Connections: Human rights and health practice A Project of Physicians for Human Rights www.healthactionaids.org You cannot separate health service provision and observing human rights. • Medical ethics, like human rights, based on value of life, and dignity of patients • Ethical Obligation of beneficence • Ethical requirement of non-discrimination • Promoting right to health consistent with idea of ethical responsibility to community as a whole • Implies solidarity with patients and activists in system where human rights violations cause harm

13. What health professionals offer to human rights A Project of Physicians for Human Rights www.healthactionaids.org • Commitment to health • Knowledge of what is needed to protect health of individuals • In public health, what is needed to protect health of community • Power of your voice

14. Health professionals on the front lines of human rights A Project of Physicians for Human Rights www.healthactionaids.org Evaluation of conditions of detention Care for refugees

15. Health professionals on the front lines of human rights A Project of Physicians for Human Rights www.healthactionaids.org Seek protection of public health Promote health of displaced people

16. Health professionals on the front lines of human rights A Project of Physicians for Human Rights www.healthactionaids.org Ending discrimination Assess landmine injuries and advocate for ban

17. Rights and Responsibilities of Health Professionals and Patients A Project of Physicians for Human Rights www.healthactionaids.org

18. Rights of Health workers A Project of Physicians for Human Rights www.healthactionaids.org Conducive, safe professional environmentFacilitiesSpaceProper Training (Medical & Dental Practitioners statute -1996, part II pg 8)

19. Responsibilities of Health workers A Project of Physicians for Human Rights www.healthactionaids.org Reduce morbidity and mortality Social rehab./counseling Appropriate referral Comprehensive report writing (Kasolo & Owor, 2001) Provide information (UNHCO 2003, HSC Act 2001, Part IV code of conduct-pg13)

20. Rights Information Choice Participation in decision making Respect and nondiscrimination Confidentiality Responsibilities Ask about your health Be considerate to staff and other patients Let health workers know if you are not going to follow treatment Keep appointments Rights and Responsibilities of consumers of health services A Project of Physicians for Human Rights www.healthactionaids.org

21. Dennis: Help! More on this slide?!?!?!Significance of Human Rights in health service provision A Project of Physicians for Human Rights www.healthactionaids.org Current adverse health consequences are due to HR neglect in the past decades. Practice of “apartheid medicine” in SA HIV/AIDS in disadvantaged groups Communication (Takatsuno. J, Urban refugees)

22. Human Rights and AIDS: Making the Connection, Meeting the Challenge A Project of Physicians for Human Rights www.healthactionaids.org

23. AIDS and Human Rights How Violations of Human Rights Fuels the Disease A Project of Physicians for Human Rights www.healthactionaids.org • Discrimination against people who are HIV+ , combined with lack of access to treatment, impedes people from getting tested • Discrimination and stigma against people who are HIV+ leads to job discrimination, loss of housing, loss of inheritance rights. • Lack of information leads people not to take necessary precautions. • Lack of universal precautions leads to transmission of HIV/AIDS to health workers and patients in medical settings. • Poverty and economic vulnerability can prevent people from both accessing care and treatment and taking proper prevention steps

24. Domestic violence and forced sex without condoms Poverty and deprivation lacks to relationships that leads to HIV/AIDS Discrimination in community life – inheritance, marital obligations after husband’s death Added Stigma if HIV+ ; fear to reveal Results in higher prevalence in young women How Discrimination Against Women Drives Disease A Project of Physicians for Human Rights www.healthactionaids.org

25. Access to Treatment as a Human Right A Project of Physicians for Human Rights www.healthactionaids.org

26. A Project of Physicians for Human Rights www.healthactionaids.org

27. A Project of Physicians for Human Rights www.healthactionaids.org

28. If people are treated for AIDS, and they live longer, more productive lives, the repercussions for other human rights are enormous: A Project of Physicians for Human Rights www.healthactionaids.org Right to Education (Article 26, UDHR) • Children no longer have to quit school to care for their orphaned siblings Right to be protected from Economic Exploitation (Article 32, CRC) • Young women who go to school and have more skills are les likely to have to resort to prostitution or transactional sex, which contributes to HIV risk

29. If people are treated for AIDS, and they live longer, more productive lives, the repercussions for other human rights are enormous: A Project of Physicians for Human Rights www.healthactionaids.org Right to non-discrimination (???) “I can’t even go to the market with my skin this way!” Given Rx one would not hear such statement(s). Right to life (Article 3 UDHR) Effective treatment enables persons with AIDS to manage their illness as a chronic condition and renders the symptoms invisible.

30. What a Human Rights Approach to HIV/AIDS Requires – Obligations of government A Project of Physicians for Human Rights www.healthactionaids.org • Protection against discrimination • Protection against gender-based violence. • Access to information about the disease and its prevention • Access to treatment , including ARV medications and well supplied clinics, if infected. • Assurance of a well trained health work force. • Protection against spread of the disease in clinics

31. Health professionals on the front lines of human rights and HIV/AIDS A Project of Physicians for Human Rights www.healthactionaids.org 1. Health Professionals are themselves subject to human rights violations • Subjected to discrimination if HIV+ • Often lack access to treatment themselves • Placed at risk of infection in clinics from lack of supplies and equipment.

32. Health professionals on the front lines of human rights and HIV/AIDS A Project of Physicians for Human Rights www.healthactionaids.org • Health Professionals required to practice in an environment that violates the right to health of their patients • Cannot provide the voluntary testing needed to identify HIV for lack of kits. • Are not provided measures to prevent transmission in medical setting. • Lack resources for ARVs and drugs for opportunistic infections that are needed. • Do not receive compensation adequate to the work they perform • In many places do not have access to sufficient other staff to do needed jobs

33. A Human Rights Response A Project of Physicians for Human Rights www.healthactionaids.org • Recognize that a human rights framework helps understanding the implications of health policies and understand where inequity in health systems violates human rights • Points to reforms needed to resolve human rights violations • Empowering to all in stimulating action by health professionals to end violations • Helps ends feeling of demoralization and powerlessness.

34. Health Professionals as Advocates A Project of Physicians for Human Rights www.healthactionaids.org Nurses, Physicians, Students Advocating for Resources for HIV/AIDS

35. Challenges to Engagement A Project of Physicians for Human Rights www.healthactionaids.org • Day to day responsibilities can be overwhelming. • Differences and conflicts among professions that need to be bridged • Traditional healers and Western-trained doctors and nurses • Roles of nurse/midwives, lab technicians, pharmacists needed to be recognized, and strong alliances formed. • Need to become informed on health and public policy issues and the decision-makers, with organization focused on this • Traditions do not emphasize solidarity with patients or people living with HIV on patients’ rights • Focus outwardly on patients and community not just inwardly on profession

36. Meeting the Challenges --responses of health professionals acting to protect human rights -- HIV/AIDS A Project of Physicians for Human Rights www.healthactionaids.org • Acknowledging HIV+ status and speaking out. • Taking collective action to analyze the problem of HIV/AIDS in human rights terms and speaking out on needs. • Speaking out to protect women. • Developing alliances with people with HIV/AIDS on discrimination, treatment, confidentiality. • Advocacy for treatment, care and prevention resources

37. Way forward A Project of Physicians for Human Rights www.healthactionaids.org Constantly remind yourself, your clients and your colleagues about their rights and responsibilities so that they can deliver health services within a strong human rights framework. If any of us knew what our position in life would be (rich or poor, male or female, sick or well) any rational person would insist on society that respects universal norms such as human rights. ( John Rawls - Harvard Philosopher)