The global context of HIV and Human Rights in 2010 Susan Timberlake

1. 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

2. 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

3. 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

4. Accountability –flawed, but growing (?) • UNGASS commitments • UNGASS reporting • Universal access • UA national targets • Epidemiology and surveillance • Disaggregation by sex and sometimes by age • 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

5. 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 andempower PLHIV • “Treatment equals prevention” – break down barriers • “Treatment 2.0” – push into new forms of accessibility, availability, affordability

6. A Rights-Based Approach to HIV IS about human rights obligations • 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 accountabilitymechanisms • 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.

7. 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

8. 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.

9. New focus on People living with HIVPositive Health, Dignity and Prevention • Linking together the social, legal, health and prevention needs of the individual living with HIV within a human rights frameworkto 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 decision-making 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.

10. 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

11. But need to be strategic with three elements of the legal environment • Law: reforming law or legislating – very difficult, labour intensive and risky AND may not have much impact • Law enforcement – improving italso difficult, but can have practical and immediate impact • Access to justice– strengthening it difficult, but can have immediate impact, as well as lead to social change

12. New focus on programming for human rightsUNAIDS promotes 7 key programmes to improve legal and social environment • Programmes to reform and monitor laws • Programmes to train police on non-discrimination, space for outreach, non-harassment, etc • Programmes to train health care workers on non-discrimination, informed consent, confidentiality, duty to treat, infection control • Provision of legal services • Programmes to build legal literacy (know your rights and laws) • Programmes to realize gender equality and reduce violence against women • Programmes to reduce HIV-related stigma

13. 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

14. 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.

15. 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