We all have the right to health, including the right to be able to prevent and treat HIV. Our right to health, entrenched almost 70 years ago in Article 25 of the 1948 Universal Declaration of Human Rights, forms the basis of Goal 3 of the 2030 Agenda for Sustainable Development which aims to ensure healthy lives and promote well-being for all people at all ages. But we also need all our other rights – like the right to education, the right to nutrition and the right to non-discrimination – to make these health rights real. Achieving the Sustainable Development Goals and reaching its target to end AIDS by 2030 requires protecting all human rights for each and every one of us, to ensure no-one – including the most marginalized in our society – is left behind.
The right to health means that we all have the right to accessible, available, acceptable and quality health care services for HIV. We have the right to be treated with respect and dignity, to know that our health information is treated confidentiality and to make our own decisions about our health.#myrighttohealth
Across the world, there are still people - particularly vulnerable and key populations – who struggle to realise their health rights, placing them at increased risk of HIV. Those who are most vulnerable to HIV – such as sex workers, gay and bisexual men and other men who have sex with men, transgender people, people who inject drugs, women and girls, young people, prisoners – are often also those most marginalized in our society. Those who are discriminated against or live in fear of violence or abuse, those who don’t know their rights and how to enforce them, those who live in societies that deny their rights or criminalize their conduct, are least able to get and use health care services to prevent and treat HIV.
For women and young girls between 15 to 49 years, for example, AIDS is the leading cause of death worldwide. Many young women live in societies where laws and norms deny them the right to make their own health care decisions without the help of a parent or spouse. Unequal relationships, sexual violence and harmful practices like child marriage rob many young women of their rights to grow and flourish, and increase their vulnerability to HIV and other health problems. Once HIV-positive, women report experiences of stigma and discrimination in their homes, communities, workplaces and health care settings. When using health services, they report receiving sub-standard care, being treated in an undignified manner, receiving conditional access to treatment and being forced to test or take treatment.
Research conducted by the Southern African Litigation Centre (SALC) in selected countries found a wide range of violations of the rights of women living with HIV, sex workers, gay men and men who have sex with men and people with disabilities when accessing health care, and their limited ability to seek remedies for rights violations.
“They test you for HIV before providing family planning to you. Anyone who wants to receive family planning services has to test for HIV” (Women living with HIV)
“I was refused to be given [ART] at [the clinic] when I went there to get more drugs when I had only a few pills left. The nurse there told me that they will not assist me because I sleep with their husbands.” (Sex worker)
“They are discriminated against as if they should not have children and they should not fall pregnant. A lot of them do not even go to antenatal for fear of how the nurses will speak to them.” (Women with disability)
Stigma and discrimination impacted on the willingness of these populations to test for HIV, seek out care and support, disclose vital information and to return for treatment. With funding from the Global Fund Africa Regional Grant, SALC is implementing follow-up work with health complaints mechanisms, to increase access to health care and access to justice for key populations in the region.
Research shows that these punitive and discriminatory laws and practices drive populations away from HIV services, increasing HIV infections and hampering our efforts to end AIDS. Conversely, evidence shows that programmes to combat stigma and discrimination and remove human rights barriers, leads to increased access to HIV prevention, testing and treatment. In 2016, countries across the world adopted the 2016 Political Declaration on HIV and AIDS, recommitting to reviewing and reforming laws, policies and practices that reinforce stigma and discrimination and create barriers to health care.
UNDP works in partnership with country stakeholders, including government and civil society organisations, to strengthen laws and remove human rights and gender-related barriers, to ensure that everyone, everywhere – including key populations - can realize their right to health. The updated Critical Enablers section of UNDP’s Capacity Development Toolkit aims to support country stakeholders to understand why protective laws, human rights and gender equality are critical enablers for promoting access to HIV prevention, testing and treatment services, and how best to do so.
The Toolkit sets out the key programmes promoted by UNAIDS and UNDP to strengthen laws and policies and remove human rights and gender-related barriers to HIV health care services. It provides information, examples and case studies of how country stakeholders can use programmes like those to review discriminatory laws, reduce stigma and discrimination or train health care workers, can support all people, including key populations, to protect themselves from HIV or get treatment and care.
In South Sudan, in its role as Global Fund Principal Recipient, UNDP supports a programme to train health care workers to respond to gender-based violence, and refer survivors to a range of appropriate services. By providing integrated psycho-social services as well as legal referral services for women, the programme helps to address critical enablers around gender equality and responding to gender-based violence, to reduce the spread of HIV.
In addition, the program supports a number of behavioural change communication initiatives aimed at preventing gender-based violence and supporting the use of relevant services, using the popular medium of radio. These messages are translated into multiple languages, including those spoken by internally displaced populations. They are aimed at removing the stigma and gender inequality that drives the HIV epidemic and often prevents survivors of gender-based violence from accessing key HIV-related prevention services.
See the Critical Enablers section of UNDP’s Capacity Development Toolkit for more practical guidance on addressing human rights, gender equality and key populations in national HIV, TB and malaria strategies, policies and programmes, in alignment with UNDP’s HIV, Health and Development Strategy, the UNAIDS_2016 – 2021 Strategy and the Global Fund Strategy 2017-2022.