Advocating for the rights of people living with HIV in Mozambique

Supporting community action on AIDS in developing countries

Advocating for the rights of people living with HIV in Mozambique A case study in national advocacy

Introduction This briefing describes how Alliance linking organisation MONASO – The Mozambican Network of AIDS Services Organisations – campaigned for the introduction of legislation to protect the rights and duties of people living with HIV/AIDS in Mozambique and the impact that the new legislation is having on the lives of people living with HIV/AIDS in communities across the country.

1. The HIV epidemic in Mozambique HIV prevalence in Mozambique is among the highest in the world. It reached 11.5% in 2009 and continued to rise in the Southern provinces. Nearly 1.5 million people are living with HIV in the country. The vast majority of Mozambicans are unaware of their HIV status, with only 12% of men and 15% of women reporting they knew their HIV status.

At present, an estimated 32% of the adults living with HIV in Mozambique in need of antiretroviral treatment have access to it. This figure drops to an estimated 14% in the case of children.1

2. The daily realities of living with HIV in Mozambique The fight against stigma and discrimination caused by an epidemic that affects so many Mozambicans should be a nationwide struggle involving all social, political and economic actors, from those who are affected by HIV and their families, to the State, civil society organisations, and community and religious leaders.

However, people who are living with HIV in Mozambique suffer from inequality and injustice. Many people living with HIV are expelled from their family and their community and excluded from any other type of social integration. Orphans and vulnerable children are often kept away from other children and marginalised. Between one quarter and one third of new HIV infections in Mozambique occur among people who inject drugs, men who have sex with men, and sex workers and their clients.2 The authorities acknowledge that stigma and discrimination towards sex workers and sexual minorities, and the criminalisation of homosexuality are barriers to their accessing health services, HIV testing, and HIV treatment.3

Notes: 1

UNAIDS, Global Report 2010 UNAIDS, Global Report 2010 3 Mozambique UNGASS Country Report 2010 2

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This stigma is however reflected in the HIV response. Mozambique’s total AIDS spending directed to HIV prevention among these three key populations is 0.25%. Spending directed specifically to support these populations in their response to HIV is only one hundredth of their share of the national epidemic.4

3. Campaigning for the legal protection of people living with HIV MONASO and its member organisations have been working to counter the impact of social stigma and discrimination on people living with HIV at the community level for nearly 20 years. In MONASO’s experience, the lack of protective legislation and public sector attention to people living with HIV and AIDS and those most at risk of HIV constitute a formidable barrier for the empowerment of these communities.

In the early 2000s, MONASO joined a civil society campaign to promote the labour rights of people living with HIV, which led to the introduction of a new Law (05/2002). However, it only protected the rights of people living with HIV in formal workplace settings, so further protection was needed.

In 2008, MONASO started a much more ambitious campaign for the introduction of legislation that would provide comprehensive protection for people living with HIV. The network drafted a bill which was presented to key members of the newly constituted HIV Commission in the Mozambican Parliament. The text, with few amendments, was passed in Parliament in March 2009, becoming the Law for the Defence of the Rights of and Against stigma and discrimination against people living with HIV and AIDS (12/2009 Law).

The 12/2009 Law represents a significant step forward in the protection of the rights of people living with HIV and AIDS in Mozambique. It outlines the rights and responsibilities of people living with HIV and AIDS and establishes the responsibilities of the State in the provision of antiretroviral treatment, in the promotion of HIV prevention, care and support programmes and services; and in the respect, protection and promotion of the human rights of people living with HIV and AIDS. With the passing of the new law, MONASO’s advocacy campaign turned into social campaigning to create awareness among communities about the rights of people living with HIV that were now enshrined in the Law. The campaign was facilitated by the nationwide presence of MONASO; implemented by the grass roots work of community based organisations that are members of MONASO, and supported by funders and partners, including UNAIDS, UK DFID, and Swedish SIDA. In less than two years, MONASO’s campaign had reached approximately 74 out of 144 districts in Mozambique, making this campaign one of the most successful and furthest reaching campaigns for the protection of the rights of people living with HIV at the community level in Mozambique.

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UNAIDS, Global Report 2010

The International HIV/AIDS Alliance

4. Using the law to enable an effective HIV response MONASO’s campaign has generated a true understanding within communities about the impact of stigma and discrimination on the lives of people living with HIV. HIV activists and educators have started to train health care workers about the provisions of the law and ways of protecting the rights of people living with HIV in health care settings.

Hundreds of communities have distributed thousands of copies of the text and have started to document and report cases of violations of the rights of people living with HIV (see box below).

Maria’s story Maria1 is a 30 year old HIV activist who works for Irmãos Unidos (a member of MONASO in Mandimba district, south of the province of Niassa). João, who lives with HIV, suffered serious discrimination by a health worker at the largest hospital in the district and with the support of Irmãos Unidos, she decided to lodge a legal complaint with the State Attorney. Surprisingly, the Attorney claimed not to know of any legal provision to base a complaint on, until Maria produced a copy of the 12/2009 Law. The Attorney has agreed to represent her in court.

Maria had also lodged a complaint with the Mandiba District Director for Health Services, Women and Social Action, who summoned the health worker and apologised toMaria. This case prompted the District Office for Health Services to organise a series of seminars on HIV and AIDS for its health care professionals; and to establish a weekly system to monitor the status of patients undergoing antiretroviral treatment. The new system includes a new provision of home care for patients and their families with the participation of HIV activists based in health care facilities.

5. Future challenges for the enforcement of the 12/2009 Law  Training of officials in the judiciary and in the administration of justice remain a challenge because most of them have not received specific human rights training andmany have little knowledge of HIV and AIDS and how these two areas converge in specific human rights instruments such as the 12/2009 Law.  Raising awareness at within health care facilities where people living with HIV are often most vulnerable to discrimination. This needs the greater involvement of health professionals at every level in the delivery of services for people living with HIV, which constitutes a significant undertaking in terms of time and resources.

Useful links: Download a copy of the Law for the Defence of the Rights of and Against Stigma and Discrimination against people living with HIV and AIDS (12/2009 Law). http://www.monaso.org.mz/IMG/pdf/Brochura_da_Lei_12-09_de_Direitos_e_Deveres_PVHS.pdf

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Contact information:

About MONASO Established in 1993, MONASO is dedicated to advocacy and capacity building activities for its 1,400 member organisations, within 90 of Mozambique’s 128 districts. It’s members are all Mozambican indigenous NGOs and community-based organisations working on the HIV response.

MONASO’s overall objective: “Contributing to a decrease in the HIV/AIDS incidence rates, the improvement of quality of life, the respect and realisation of the rights of people living with HIV and the mitigation of the disease’s negative effects on people, families and communities without neglecting the dynamics of gender and vulnerability”.

MONASO has identified the following priority activities within its 2010-2014 Strategic Plan:  Networking/promotion of networks;  Coordination of Advocacy;  Research and capacity building;  Organisational development;  Institutional capacity development;  Onward granting of funds for programmes in the HIV/AIDS sector.

MONASO is a member of the International HIV/AIDS Alliance since 2010.

Bairro da Coop, Rua Tomás Ribeiro. No 4.

Tel : 00 258 21-414687 or 21-414687.

Fax: 21414688 Email: monasosede@monaso.co.mz www.monaso.org.mz/

About THE INTERNATIONAL HIV/AIDS ALLIANCE Established in 1993, the International HIV/AIDS Alliance is a global partnership of nationally-based linking organisations working in over 40 countries, to support community action on AIDS in developing countries.

The Alliance’s current strategic framework (2010-2012) has three aims: 1. Protect human rights 2. Increase access to health services 3. Support secure livelihoods.

91-101 Davigdor Road, Hove, East Sussex BN3 1RE United Kingdom Tel: +44 1273 718 900 Fax: +44 1273 718 901 Email: mail@aidsalliance.org Registered charity no. 1038860 www.aidsalliance.org

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The International HIV/AIDS Alliance