How to Integrate Human Rights into Treatment for Prevention Programs

How to Integrate Human Rights into Treatment for Prevention Programs Georgina Caswell, South Africa Kevin Fisher, USA Christian Fung, Hong Kong 2012 International HIV/AIDS Conference Amy Hsieh, USA Washington, DC, USA Moono Nyambe, Netherlands

Case Studies

Case Study #1 Sarah is 25 years old and living in an East African country. She is HIV-positive. She found out 6 months ago when she was feeling very sick and went to the hospital. She couldn’t break the news to her husband for fear of the consequences. The nurse told Sarah to come back with her husband and they will re-do the test together like it’s the first time. Sarah came back with her husband. They were counseled together and took the test together. They received the news separately. Sarah was HIV-positive and her husband was HIV-negative. In Sarah’s country, couples are encouraged to test together. If one person is HIV-positive and the other is HIV-negative, the one who is HIV-positive will be put on treatment as soon as they test HIV-positive. This is part of a plan to boost national HIV prevention and treatment efforts. In Sarah’s country, HIV testing is low, especially among couples. However, the coverage of treatment is quite high. More than 90% of people who need treatment with a CD4 count of 350 or below have access to free ARVs.

Questions to Consider • What are the human rights questions that come to mind? • Which human rights are potentially being violated? • How could these potential human rights violations be avoided?

Case Study #2 Molly is 32 years old and pregnant. She goes to an antenatal clinic to take the tests she needs to take. One of them is an HIV-test. Molly takes the HIV test and finds out she is HIV-positive. She did not think it could ever happen to her. She is shocked and afraid of passing it to her child. The doctor tells Molly that the best thing to do is to start taking treatment. By taking treatment, it would prevent Molly from transmitting HIV to her child and will also keep her strong and healthy. In Molly’s country, the government has decided to test all pregnant women . If a woman is HIV-positive, she will be put on treatment and kept on treatment for life. The country’s goal is to reduce the number of children born with HIV, to keep mothers healthy and alive and also to prevent HIV-positive women in discordant couples from passing on HIV to their partners.

Case Study #3 Michael is 37 years old and lives in city in the US. He is an HIV-positive gay man living with HIV. Michael tested HIV-positive 2 years ago. He has always been conscious of his health and was taking HIV tests about every six months. When he tested 2 years ago, he was surprised, though not shocked to learn he was HIV positive. He was told that the Department of Public Health policy was to treat everyone who tests HIV positive regardless of their CD4 count (in the rest of the country, the advice was to start treatment at a CD4 count of 500 or below). Michael started treatment immediately and has been doing his best to take his treatment properly and at the right time everyday. He later found out that his CD4 count was 550. He takes an interest in his health and goes online to read about his ARVs, side effects and how to maintain a healthy lifestyle.

Case Study #4 John is 18 year’s old and living in Southeast Asia . He is a male sex worker. In his country, the government would like certain groups at high risk of contracting HIV, like sex workers, to be tested for HIV often. If someone finds out they are HIV-positive, they will be referred to a hospital and given a certain package of services, including medication. An NGO comes and tests John and all the others who work with John every 6 months. Each time they come, they bring a lot of free condoms. Sometimes they bring free tshirts and caps too. John does not know too much about HIV. The two people he knows who tested HIV-positive have disappeared. He does not know exactly why they got HIV. He cannot imagine he would ever get it or would he would do if he became HIV-positive.

Step-wise approach to protect Human Rights Violations

HIV testing • Do individuals have access to full information about HIV, HIV testing and what it means if you test HIV-positive? • Do individuals have the opportunity to choose whether or not they would like to take an HIV test? • Do individuals have the support they need to decide whether or not they are ready to take an HIV test? • Does testing link people in need to treatment? • For those who test HIV-negative, are they offered a package of services as well?

HIV treatment • Do individuals have access to full information about HIV, HIV treatment and what it means to be living with HIV? • Is this information in an accessible format and language? • Do individuals have the support they need to learn about their HIV treatment options and what may or may not work for them? • Do individuals have the opportunity to ask questions and/or refuse HIV treatment?

Support and care • Is the information of clients being kept confidential (from other healthcare providers and others working in the clinic setting)? • Have sufficient programs to reduce stigma and discrimination been implemented in the country? • Are there protective laws for PLHIV and key populations?

Support and care, cont. • Are there laws that criminalize HIV transmission? Criminalize or forcibly ‘treat’ people who use drugs? Criminalize same sex behavior? Prevent sexual education? • Do police take protective, appropriate action in cases of domestic violence and violence against women? • Have there been programs to train health care workers in informed consent, confidentiality and non-discrimination?

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How to Integrate Human Rights into Treatment for Prevention Programs