Voices from the field

1. Voices from the field How laws and policies affect HIV responses SARA SIMON 26 July 2012 Legal Barriers, Legal Access IAS, Washington, DC

2. Introduction

3. I. Global report: Context and methodology • Experience of civil society with legal issues and HIV responses • 27 focus groups from all regions • 248 persons from affected and at risk communities • Qualitative discussions around 10 key questions: • knowledge and experience with the legal environment; • personal experiences in the use and enforcement of laws; • and coping mechanisms

4. Global consultation respondents

5. Global consultation respondents

6. Findings: 1. HIV-related stigma createsan environment forpunitivelaws • Misinformation in the general population fuels stigma and fear • Legal systems are not well-versed in HIV • Media often exacerbates stigma; reports often violate privacy and impartiality • Insensitive or unprofessional treatment by health care providers discourages access

7. Findings: 2. Punitivelawsandpolicesundermine HIV responses • Many not accessing HIV-related services due to fear and stigma, especially respondents whose behavior has been criminalized • Repressive laws toward women and girls limit access to HIV services • Criminalization of HIV non-disclosure, perceived exposure or transmission discourages testing • Criminalization of sex work increases vulnerability to violence and inhibits access to health care • Criminalization of drug use and the lack of availability of harm reduction methods is impacting ability to access HIV-related services • Undocumented workers and immigrants are afraid to seek health care

8. Findings: 3. Legal protections are insufficient; experience of lawenforcement is negative • Anti-discrimination laws are being undermined by HIV-related stigma • Workplace discrimination and mandatory testing continue • Experiences with law enforcement were negative • Incarceration can lead to treatment disruption and inhumane conditions

9. Findings: 4. Individuals do notknowtheirrights • Legal aid is important and helpful but not widely available. Legal information not always clear, leaving service providers unclear as to how to interpret laws to their clients. • Cooperation between AIDS service organizations and legal aid needs to be increased.

10. II. Focus on North America: Consultation respondents

11. North America: Consultation respondents

12. North America: Key findings • Need to increase the availability of: insurance coverage, housing and mental health services • Legal aid services have helped and need to be more widepsread • Lack of protective laws specific to immigrants, MSM, transgender persons, sex workers and people who use drugs is limiting access to HIV-related services

13. Recommendations • Support anti-stigma and HIV education campaigns to increase and enforce protective laws. • Oppose and repeal laws that criminalize HIV non-disclosure, exposure or transmission, homosexuality, gender identity/expression, abortion, sex work and drug use. • Foster protective laws and knowledge of protective laws and human rights within the justice system. • Support and promote programs to know your rights/laws and access justice.

14. Reaction to the report • Difficulty in discussing key issues and bringing recommendations to the UNAIDS board • Not all governments willing or able to recognize human rights issues or key populations • Inability to hold substantive discussions on follow up or gain state commitments • Is this a board level issue?

15. III. Next steps • Advocacy by and with communities at global and national levels based on these and other findings; avoiding tokenistic representation • Continued work at country levels to address stigma and discrimination, especially with government leaders • More quantitative prevention research on how HIV criminal laws affect HIV testing rates • Research in NA as to how laws, including health insurance reform, are affecting health care outcomes

16. Thank you! • All participants in the surveys and focus groups that led to this information • Focus group facilitators: Kwaku Adomako, Tariq Alaoui, Akram Algawi, Marcela Alsina, Abdul Hafed Alward, Rola Baraket, Calum Bennachie, Catalina Castillo, Catherine Healy, Ian Mcknight, Karla Montalvo, Dasha Ocheret, Shiba Phurailatpam, Abdul Rahim Rejaey, Peter Richtig, Eunice Sinyemu, Mohan Sundararaj, Irina Teplinskaya, Olivier Vandecasteele, and Younes Yatine • Advisory Group and especially Edwin Bernard, Michaela Clayton, Laurel Sprague, Nina Sun, and Susan Timberlake. • UNAIDS Human Rights Reference Group, especially Ralf Jürgens • Video clip: Hungarian Civil Liberties Union and Istvan Gábor Takács • NGO Delegation 2011: George Ayala, Mabel Bianco, Jane Bruning, Amira Herdoiza, Felicita Hikuam, Ebony Johnson, Nadia Rafif, Rathi Ramanathan, Rhon Reynolds, Matthew Southwell • NGO Delegation 2012: George Ayala, Mabel Bianco, Jane Bruning, Ebony Johnson, Laura Kirkegaard, Joel Nana, Ed Ngoksin, Alessandra Nilo, Nadia Rafif, Matthew Southwell • Amy Coulterman of the Communications Facility for support in data review and layout • Translators: António Guarita, Oswaldo Rada, Jodat Turataliev, Heba Wanis and the Dongjen Center for Human Rights Education and Action in Beijing www.unaidspcbngo.org