HIV and the World of Work: a prevention and social protection perspective HIV Stigma and Discrimination - evidence from workplaces and rights based

Transcription

1 HIV and the World of Work: a prevention and social protection perspective HIV Stigma and Discrimination - evidence from workplaces and rights based approaches Monday 18 November

2 Stigma and Discrimination Julian Hows Global Network of People Living with HIV

3 About me Involved in the HIV response since 1983 Worked in Mexico to Moldova, Philippines to Poland, as well as in UK My role at GNP+ is to enable facilitate support the voices of others Living with HIV for more that 20 years

4 Issues we will cover

5 Overview of presentation Brief introduction to GNP+ Stigma and Discrimination - anecdote to evidence in the context of the workplace what we we know what we think we know and how we might move forward 5

6 Overview of GNP+ Advocacy for improvement in quality of life of PLHIV Programmes on SRHR, Human Rights, Empowerment Evidence-informed advocacy Consultative processes All within an overarching context of a Positive Health, Dignity and Prevention to inform a Global Advocacy Agenda that can be utilized by (and is informed by) the local context 6

7 Why involve PLHIV? The involvement of people living with HIV in all aspects of prevention, care, and treatment including design, implementation, and monitoring is critical to ensuring the success of these programs.

8 In other words

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10 Some of what we know.. The research by PLHIV

11 Barriers to access of services Stigma and Discrimination: Stigma and discrimination are associated with lower uptake of preventive services, testing and counselling; reduced and delayed disclosure..postponing or rejecting care, and seeking healthcare services outside one s community for fear of breach of confidentiality (Ogden and Nyblade, 2005; UNAIDS, 2007). Examples Main problems and challenges identified as arising from stigma and discrimination is the fear of disclosing HIV status: discourages people to access health facilities and services. (Final report on PLHIV Stigma Index finding Fiji Islands) TUBS03 - Successful AIDS Sensitive Social Protection 11

12 Barriers to access of services continued Stigma and Discrimination: Example it can be as devastating as the illness itself:.., social ostracism, denial of medical services, lack of care and support, and violence. These consequences, or fear of them, mean that people are less likely to come in for HIV testing,..or access treatment, care and support (UNAIDS, 2007). From the 854 people interviewed for the PLHIV stigma index in Zambia, 80.9% reported experiencing external stigma and discrimination. TUBS03 - Successful AIDS Sensitive Social Protection 12

13 Barriers to access of services continued In Swaziland (270 violations reported over a 3 week period): 31 % of violations reported were related to the right to health; 51 % of all people who reported violations were unemployed; 11 people were dismissed from work upon disclosing their HIV+ status; 49% did not know of government policies that offer protection; In Namibia (120 violations reported in rural centres over 3 weeks) : 62% were unemployed and 52% only had up to primary school education; Violations to the rights to privacy (23%) Work (13%) and Health (10%) were the most violated rights 70% of the people did not report the violation to the authorities; (Human Rights Count!- Implementation report ARASA 2010) TUBS03 - Successful AIDS Sensitive Social Protection 13

14 Barriers to access of services human rights violations Kenya, Nigeria and Zambia: Kenya: out of 53 reports, 41 related to denial of access to housing, education or work on the basis of real or perceived HIV status; Zambia: next to psychological impact, human rights violations had an adverse economic impact on individuals resulting, mainly from loss of employment. From all three countries, the most common violation related to the right to work, with work being terminated or denied owing to HIV positive status; In all three countries, more than 60% of the people whose rights were violated did not report the violations to the authorities; (Human Rights Count!- study reports Kenya, Nigeria, Zambia) 14

15 Needs Vs. Provision: Zambia household considerations PLHIV Stigma Index: 854 (527 from Lusaka urban and 327 from Mkushi rural districts) About a third (31.4% in urban areas, and 37.9% in rural areas) of the participants stated that they had 1 orphan in their household, About a quarter (24.3% in urban areas, and 25.0% in rural areas) reported that they had 2 orphans in their household. More than a third (39.8%) of participants in urban areas reported not having enough food for their households to eat for 5 days or more in a month A third (33.3%) of the participants in rural areas reported not having enough food for their households to eat for 2 days in a month. 18 November 2013 TUBS03 - Successful AIDS Sensitive Social Protection 15

16 Needs Vs. Provision: Kenya PLHIV Stigma Index: 1086 PLHIV interviews Almost two thirds of the respondents reported living with an orphan. 39 % (424) respondents reported having orphans (affected by AIDS?) in their households, of these: 61% of the households had between two to four orphans; 11% of the households had more than 5 orphans, while Nearly 28% had one orphan in their household.

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18 Recommendations Involve people living with HIV networks Use existing structures Evidence informed! Treatment, Prevention, Care and Support all, not some! Acknowledge social, cultural, economic and policy context in which PEOPLE live People centred approaches are not opposing public health priorities -It s not human rights OR public health, but AND Protection of rights, not criminalisation Link with broader education and other responses Key populations are often ignored, with disastrous consequences for the HIV response - 18

19 Workplace Policies and Recommendations Some of the work PLHIV networks have been doing with ILO Within the context of identifying the issues and barriers in scaling up access to treatment care and support 1 9

20 What we know about Treatment as prevention Opportunity to scale up treatment access Opportunity to explore preventative effect at individual level Major changes in policy and social conditions required to protect human rights Substantial and sustained scale-up of infrastructure and resources required 20

21 Why do people test later than is useful? Why do people access HIV care later than is useful, or not at all? People test later because People Access treatment later or are unable to do so even though they clinically need it Exclusion from testing It is not available Services are unfriendly There is no confidentiality A HIV+ positive test may result in loss of income, loss of home, physical violence Often when it is to late to They are denied treatment because of who they are It is not in place The results More infections Greater costs to all concerned

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23 County Data Analysis through the world of work lens Country Respondents Local Lead Partner Organisation (s) Argentina 1198 Red de Personas con vih/sida- Mar del Plata Fundación Huésped Estonia 300 Estonian Network of People Living With HIV (ENPLWH) Kenya 1086 National Network for Empowerment of People Living with HIV in Kenya (NEPHAK) Malaysia 421 MTAAG + (Positive Malaysian Treatment Access and Advocacy Group) Mexico 931 Red Mexicana de Personas que Viven Con VIH/SIDA, A.C. & Fundación Mexicana para la Planificación Familiar, A.C. (MEXFAM) Nigeria 706 Network of People Living with HIV and AIDS in Nigeria (NEPWHAN) Philippines 80 Pinoy Plus Philippines, Babae Plus, Pinoy Young Positives Poland 502 SIEĆ PLUS Polish Network of People Living with HIV/AIDS Association Zambia 854 Network of Zambian People Living with HIV (NZP+)

24 Employment loss resulting from HIV stigma and discrimination HIV effected individual s job security both through its impact on respondents health and as a result of discrimination against people living with HIV. Discrimination related employment loss confirms the limitations of HIV antiretroviral treatment as a remedy against HIV-positive persons employment/income source insecurity.

25 Conclusions There are millions of people of workforce age who are living with HIV. Most are able and willing to work. Denying their right to work delivers no advantage. Instead it undermines states social capital, while causing individuals untold harm and destabilising families, communities, business and national economies. The PLHIV Stigma Index provides clear evidence that HIV-related stigma and discrimination is causing individuals to be: refused entry to the labour market forced to change the kind of work they perform denied promotion fired from their jobs refused access to adult education and training. Accompanying each unit of PLHIV Stigma Index data is an individual s story of personal frustration, and frequently individual and familial disaster. At macro level, local and national economies are weakened or underperform. The consequences of HIV-related stigma and discrimination in the workplace remain economically and socially profound.

26 5 million women and men workers undergo Voluntary and Confidential HIV Counselling and Testing (VCT) by 2015 Launched by the ILO and UNAIDS on 6 th June 2013 RATIONALE Nearly 10 people living with HIV are accessing antiretroviral treatment However estimated 26 million people are now eligible for treatment but the majority are not accessing it. Around half of all people living with HIV globally, do not know their status, thus preventing them from accessing treatment Workplaces can places a key role in this effort. By knowing their status early, workers can access the available treatment and care,and can live a long productive life. PRINCIPLES Countries are encouraged to implement the VCT@WORK Initiative based on the following principles: Consent Confidentiality, Counselling, Convenience, Connection to Care Addressing the issues of equity and fender Meaningful engagement of people living with HIV associations/networks

27 Importance of the care continuum VCT needs to be VCTT?

28 A last thought We are in a state of emergency! If we don t act now new infections will rise; we will never achieve universal access, get to zero or end AIDS. Over three decades into this epidemic: we are angry that still 4500 of us are dying of AIDS-related illnesses every day. People without access to treatment die!

29 Thank you

30 For more information about GNP+ please visit 30