Key Populations: Making Them Matter in the Global HIV Response Inextricable Links: HIV and Human Rights Robyn Dayton, LINKAGES Gender Advisor Friday March 4, 2016 USAID Global Health Mini-University
What are Human Rights? The freedoms and dignities derived inherently on account of being human - Right to life - Right to equality and non-discrimination - Right to the highest attainable standard of health - Right to liberty and security of person - Right to freedom from torture, and cruel, inhumane and degrading treatment - Right to work and to enjoy just and favorable conditions of work - Right to adequate standard of living, including adequate food, clothing and housing
How do Human Rights Violations Affect HIV Prevalence among Key Populations? HIV prevalence among key populations is much higher than among the general population 12 times higher for sex workers (SWs) 19 times higher for gay men and other men who have sex with men (MSM) 28 times higher among people who inject drugs (PWID) 49 times higher among transgender women Source: UNAIDS 2014 Gap Report
Sex Workers, Human Rights Abuses 116 countries have punitive laws against sex work Stigma and discrimination prevent service uptake and limit the quality of provision Violence against sex workers is common Sources: 1. Open Society Foundation. 2012. The Global Commission on HIV and the Law: Sex Workers 2. WHO, et al. 2013. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions.
Exploring the Pathways between Human Rights Violations and HIV for Sex Workers Violation Proportion affected Effect on HIV and safety Physical or sexual violence by police Arbitrary arrest and detention Police seizure of condoms or syringes Physical or sexual violence by non-state actors -Sexual violence 7-89% -Physical violence 5-100% -Police-perpetrated sexual violence is often unprotected -Police sexual violence significantly associated with accepting more money for unprotected sex, inconsistent condom use, STI/HIV infection -Undermines SW s ability to obtain protection from police - 4-75% -A content for police physical/sexual violence -Sexual abuse in detention and at time of arrest can confer immediate HIV risk -Fear of arrest is barrier to HIV testing, care and treatment -SWs move underground, increased risk of unprotected sex -7-80% condom confiscation -29-48% syringe confiscation -8-76% abuse by clients -2-64% abuse from non-paying partners -Can prompt unprotected sex and unsafe injection practices -Syringe confiscation associated with HIV -Client violence associated with STI/HIV -Client violence is often perpetrated when SWs refuse unprotected sex or certain types of sex -Barrier to accessing health services, barrier to adherence Source: Decker et al., 2015
Women in sex work are not coming from another planet. They are also human beings. We have now learnt that we are also citizens of this country and have a right to talk about this country. That s why we are able to offer effective solutions. Meenakshi Kamble, sex worker and VAMP, India
Gay Men and Other MSM, Human Rights Abuses 78 countries criminalize same-sex sexual acts Stigma and discrimination are barriers to accessing services and disclosing risk behaviors Violence against gay men and other MSM is widespread Source: UNAIDS 2014 Gap Report; MSMGF Service Under Seige
The extent to which healthcare providers continue to shame, humiliate, or chastise men who have sex with men is the degree to which MSM will avoid prevention, care, and treatment services. Access to HIV Prevention and Treatment for Men Who Have Sex with Men, The Global Forum on MSM and HIV
Transgender People, Human Rights Abuses
Trans people are not sick; we are not confused. We are poorly understood, negatively portrayed, and even invisible in some settings. We experience discrimination and violence, and suffer from a lack of access to justice, housing, education, employment and health care. HIV-related deaths among trans people, as a result of failure to seek medical services due to provider discrimination and stigma, require urgent intervention. We need genderaffirming HIV services that respect us, that acknowledge trans people as a unique population, and that treat us as partners. Lexy Ogeta, trans activist from Kenya
People Who Inject Drugs, Human Rights Abuses People who inject drugs are almost universally criminalized Punitive laws, including compulsory rehabilitation, limit access to services High levels of stigma and marginalization, including from health service providers Police harassment and violence Source: UNAIDS 2014 Gap Report; AIDS Alliance
We must listen to the voices of an increasingly empowered drug using community and chart a new course that can enable people who use drugs to live healthy and fulfilled lives, with the full realization of our human rights, free from the threat of incarceration, and in an atmosphere that respects our choices and gives us the tools to prevent us from contracting HIV, HCV, or dying needlessly from overdose. Eliot Albers, International Network of People Who Use Drugs
What is a Human Rights Approach to HIV Prevention, Care, and Treatment? 1) Expanded access to nondiscriminatory HIV prevention, treatment and care for all people, including LGBT persons 2) Increased civil society capacity to advocate for and create enabling environment 3) Increased gender equality in HIV services and decreased gender-based violence PEPFAR s Human Rights Action Agenda Source: PEPFAR 3.0 Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation
What Are Some Human Rights Activities? Agency Engagement of KPs Advocacy Rights and social justice education Policy and practice Reporting and prosecuting human rights violations Alliances Health care worker trainings to reduce stigma and discrimination Violence prevention and response, such as police and judicial trainings Working with media
Select LINKAGES Activities to Secure, Protect, and Promote Human Rights LINKAGES Advisory Board includes global representatives of the four key population networks Leadership from local and regional key population communities in research design and implementation Efforts to strengthen violence response services in almost every country where LINKAGES works, including direct support to community-based organizations Health care worker training development and roll out that emphasizes stigma and discrimination in health care settings and providers communities Activities to document human rights abuses against key populations Rights in Action focus
The Power of a Human Rights Approach We cannot solve our problems with the same thinking we used when we created them. Albert Einstein Source: MSMIT/SWIT
Thank You AIDS will not end until those at the very forefront of the epidemic those who all too frequently the most marginalized and socially excluded and those whose voices are not sufficiently heard in the hallways of political power and influence have access to the latest scientific and biomedical advancements that we know are so critical. And access to these will not be attained until the human rights considerations, and the inextricable links to HIV, are squarely addressed. - Kevin Osborne, LINKAGES Project Director