ISSN 1819-0111
Vol 1. Issue No.3/2012
HIV AND HUMAN RIGHTS Reshaping the PANCAP agenda
Production Team J. Bynoe-Sutherland Anita Davis-Craig Volderine Hackett
ConTenTS
Andrea Halley S. Khan-Persaud This publication is supported by the Centers for Disease Control and Prevention (CDC) funded project (Programme on Coordination and Harmonisation of HIV & AIDS in the Caribbean) under the President’s Emergency Plan for AIDS Relief (PEPFAR). ©2012 PANCAP Coordinating Unit Turkeyen Greater Georgetown, Guyana Tel: (592) 222 0001 Fax: (592) 222 0203 Email: pancap@caricom.org Website: www.pancap.org www.facebook.com/pancapnetwork
3 EDITORIAL
4 GLOBAL COMMISSION ON HIV AND THE LAW: RISKS, RIGHTS & HEALTH
6 EQUALITY FOR ALL: BUILDING BRIDGES FOR AN END TO AIDS Juliette Bynoe-Sutherland
10 SOCIAL MOBILISATION AND BUILDING SOCIAL CAPITAL: AN EFFECTIVE AND JUST RESPONSE TO HIV Ken Morrison, Ayana Hypolite, Sandra McLeish
twitter.com/pancaporg
13
www.youtube.com/PANCAPuTube
BREAKING THE BARRIERS OF STIGMA AND DISCRIMINATION Dr. Edward Greene
16 HUMAN RIGHTS MUST BE AT THE CENTRE OF THE GLOBAL HIV EFFORT IN THE CARIBBEAN – REMEMBERING ROBERT CARR Technical Team of the PANCAP R9 Global Fund `Vulnerabilised’ Groups Project.
17 LETTERS TO THE EDITOR
The red ribbon is the universal symbol of AIDS and it encircles the globe to show that HIV & AIDS is a global problem. The blue colour on the globe is representative of the Caribbean Region which is also indicated in the map outline on the globe. The yellow glow on the globe speaks of hope for the future, in the same way as we regard the sun’s rays in a positive light. The white background shows that there are no restrictions on saving the future. Anything is possible, even a cure.
ISSN 1819-0111
Vol 1. Issue No.3/2012
HIV AND HUMAN RIGHTS Reshaping the PANCAP agenda
18 HEALTH AND FAMILY LIFE EDUCATION: EMPOWERING YOUTH Crystal Brizan 19 HIV AND HUMAN RIGHTS – RESHAPING THE PANCAP AGENDA Caleb Orozco 20 GENDER DIMENSIONS OF THE HIV AND AIDS EPIDEMIC Valerie Beach Horne 22 FULL PARTNERSHIP FOR SEX WORKERS Miriam Edwards 23 MOVEMENTS! ADVANCING THE FIGHT AGAINST HIV AND AIDS AMONG YOUTH IN THE CARIBBEAN Christa Solyen, Tamira Browne, Dwayne Gutzmer
24 ADDRESS THE HIV SITUATION IN MARGINALIZED GROUPS TO ACHIEVE UNIVERSAL ACCESS Interview with Michel de Groulard by Cedriann Martin
25 HIV AND GUYANA’S CHILDREN: A DISCOURSE IN LEGAL PROTECTION Dela Britton
28 Cover:
ADVANCING THE HUMAN RIGHTS AGENDA IN THE CARIBBEAN CARIBBEAN HIV&AIDS ALLIANCE’S CONTRIBUTION
Concept Volderine Hackett/Rawle Warde
30
Design CPT
ADVANCING THE HUMAN RIGHTS AGENDA THROUGH EDUCATION: UNESCO’S CONTRIBUTION
Production (Trinidad & Tobago):
Articles may be reproduced in part or wholly, with due credit given to the publication
E
Editorial
T
he clamour for human rights gets louder with each passing day. This is understandable; the epidemic is thirty years old and has left too many deaths as just one of its many
consequences. On the positive side, significant scientific advances have resulted in better understanding of the virus, facilitated more options for care and treatment and, more recently, hope for a cure. In addition, research has facilitated a better understanding of the social and behavioural factors that fan the flames of the epidemic. These factors require urgent attention. We are on the bank of a mighty river with all the tools with which to build a strong and durable bridge that could see the end of the epidemic for the next generation. We must confront the current situation of significant progress in treatment, care and support, but far less than optimal yield in our prevention efforts. Getting to zero also demands the latter. Stigma
that are required. In fact, the Report of the Global Commission on
against people living with HIV and those at higher risks persists.
HIV and the Law: Risks, Rights and Health, chaired by Dr. Fernando
There are still many rivers to cross, and this is reflected in the
Henrique Cardoso, the former President of Brazil, provide the building
collective contributions of this third issue of the PANCAP Perspective.
codes and specifications for universal rights. It emphasizes the need to eliminate punitive laws and gender based violence. It also highlights
The contributions in this issue also reflect the challenges and
the need to promote research to inform policy and mechanisms for
opportunities – crossing rivers and building bridges- that are available
sanctions against acts of stigma and discrimination. The summary of its
to the policy makers, scientists and practitioners. They represent the
recommendations is therefore reproduced for the benefit of our readers
clamour for action that gets louder from one bank of the river because
in the hope that they will be stimulated to read the report in its entirety.
in looking across, there is heightened consciousness that after thirty years there is hope for an AIDS free generation. There is consciousness
Other articles in this publication indicate the various strategies for
also that in getting to the other side, the water though still in some
sustaining the bridge. Among them are those which place emphasis
parts is turbulent in others. The nature of the crossing is well known.
on social mobilization to bond, build and link communities to achieve
Our contributors agree that truly confronting the issues of human
equality for all. They prescribe behavioural research to complement
rights though venturing into the turbulence is necessary to get to
biomedical research. They specifically highlight the role of youth and
the other bank. They agree also that this requires bold and decisive
faith based organizations as credible advocates. Contributions also
leadership, shared responsibility, and solidarity. It requires compassion,
point to the fact that missed opportunities could adversely affect the
compromise and commitment to the goals of “health for all” and
maintenance of the bridge in good order and these should also be
“equity in health”. The crossing is about people, their right to access, to
addressed. These issues are all ably ventilated under the theme HIV and
respect, and in this particular case, the right to prevention, treatment,
Human Rights: Reshaping the PANCAP Agenda. Together with the other
care and support, without fear of being stigmatized or discriminated
contributions they give the Perspective readership food for thought and
against. Should we not quickly build the bridge across these waters and
prescriptions for action in order to get to the other side of the river.
accelerate our pace in doing so? How do we ensure that all have access to the capacity to cross?
The PANCAP Coordinating Unit wishes reflective reading of its third issue of Perspective.
As a resilient Caribbean people, we know what is to be done and how to build that bridge. The articles in this publication fully identify the salient components equivalent to the mortar, steel and other materials
Volderine Hackett Editor
EDITORIAL PANCAP PERSPECTIVE 2012
PAGE 3
HIV&TH HIV&TH GLOBAL COMMISSION ON HIV AND THE LAW: RISKS, RIGHTS & HEALTH
Global Commission on HIV and the Law: Risks, Rights & Health Summary Recommendations
To ensure an effective, sustainable response to HIV that is consistent with human rights obligations: 1. DISCRIMINATION
2.2 Law enforcement authorities must not prosecute people in cases of
HIV non disclosure or exposure where no intentional or malicious HIV 1.1 Countries must ensure that their national HIV policies, strategies,
transmission has been proven to take place. Invoking criminal laws in
plans and programmes include effective, targeted action to support
cases of adult private consensual sexual activity is disproportionate
enabling legal environments, with attention to formal law, law
and counterproductive to enhancing public health.
enforcement and access to justice. Every country must repeal punitive laws and enact protective laws to protect and promote human rights,
2.3 Countries must amend or repeal any law that explicitly or effectively
improve delivery of and access to HIV prevention and treatment, and
criminalises vertical transmission of HIV. While the process of review
increase the cost-effectiveness of these efforts.
and repeal is under way, governments must place moratoria on enforcement of any such laws.
1.2 Where they have not already done so, countries must explicitly
prohibit discrimination on the basis of actual or perceived HIV
2.4 Countries may legitimately prosecute HIV transmission that was
status and ensure that existing human rights commitments and
both actual and intentional, using general criminal law, but such
constitutional guarantees are enforced. Countries must also ensure
prosecutions should be pursued with care and require a high standard
that laws and regulations prohibiting discrimination and ensuring
of evidence and proof.
participation and the provision of information and health services protect people living with HIV, other key populations and people at risk of HIV.
2.5 The convictions of those who have been successfully prosecuted for
HIV exposure, non-disclosure and transmission must be reviewed. Such convictions must be set aside or the accused immediately
1.3 Donors, civil society and private sector actors, and the UN should
hold governments accountable to their human rights commitments.
released from prison with pardons or similar actions to ensure that these charges do not remain on criminal or sex off ender records.
Groups outside government should develop and implement rightsbased HIV-related policies and practices and fund action on HIV-
3. KEY POPULATIONS
related law reform, law enforcement and access to justice. Such efforts should include educating people about their rights and the
To ensure an effective, sustainable response to HIV that is consistent with
law, as well as challenging stigma and discrimination within families,
human rights obligations, countries must prohibit police violence against
communities and workplaces.
key populations. Countries must also support programmes that reduce stigma and discrimination against key populations and protect their rights.
2. CRIMINALISATION OF HIV TRANSMISSION, EXPOSURE AND NON DISCLOSURE
PEOPLE WHO USE DRUGS 3.1 Countries must reform their approach towards drug use. Rather than
2.1 Countries must not enact laws that explicitly criminalise HIV
punishing people who use drugs who do no harm to others, they must
transmission, HIV exposure or failure to disclose HIV status. Where
offer them access to effective HIV and health services, including
such laws exist, they are counterproductive and must be repealed.
harm reduction and voluntary, evidence-based treatment for drug
The provisions of model codes that have been advanced to support
dependence. Countries must:
the enactment of such laws should be withdrawn and amended to conform to these
3.1.1 Shut down all compulsory drug detention centres for people
who use drugs and replace them with evidence-based, voluntary services for treating drug dependence.
PAGE 4
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
HE LAW HIV&THE LAW
Global Commission on HIV and the Law: Risks, Rights & Health
3.1.2 Abolish national registries of drug users, mandatory and
3.2.3 Prohibit the mandatory HIV and STI testing of sex workers.
compulsory HIV testing and forced treatment for people who use drugs.
3.2.4 Ensure that the enforcement of anti-human-trafficking laws is
carefully targeted to punish those who use force, dishonesty 3.1.3 Repeal punitive conditions such as the United States
or coercion to procure people into commercial sex, or who
government’s federal ban on funding of needle and syringe
abuse migrant sex workers through debt bondage, violence
exchange programmes that inhibit access to HIV services for
or by deprivation of liberty. Anti-human-trafficking laws must
people who use drugs.
be used to prohibit sexual exploitation and they must not be used against adults involved in consensual sex work.
3.1.4 Decriminalise the possession of drugs for personal use, in
recognition that the net impact of such sanctions is often
3.2.5 Enforce laws against all forms of child sexual abuse and
harmful for society.
sexual exploitation, clearly differentiating such crimes from consensual adult sex work
3.1.5 Take decisive action, in partnership with the UN, to review
and reform relevant international laws and bodies in line with
3.2.6 Ensure that existing civil and administrative offences
the principles outlined above, including the UN international
such as “loitering without purpose”, “public nuisance”, and
drug control conventions: the Single Convention on Narcotic
“public morality” are not used to penalise sex workers and
Drugs (1961); Convention on Psychotropic Substances (1971);
administrative laws such as “move on” powers are not used
the Convention against the Illicit Traffic in Narcotic Drugs
to harass sex workers.
and Psychotropic Substances (1988) and the International Narcotics Control Board.
3.2.7 Shut down all compulsory detention or “rehabilitation”
centers for people involved in sex work or for children who SEX WORKERS
have been sexually exploited. Instead, provide sex workers
3.2 Countries must reform their approach towards sex work. Rather than
with evidence-based, voluntary, community empowerment
punishing consenting adults involved in sex work, countries must
services. Provide sexually exploited children with protection
ensure safe working conditions and offer sex workers and their
in safe and empowering family settings, selected based on the
clients access to effective HIV and health services and commodities.
best interests of the child.
Countries must: 3.2.8 Repeal punitive conditions in official development assistance 3.2.1 Repeal laws that prohibit consenting adults to buy or sell sex,
– such as the United States government’s PEPFAR anti-
as well as laws that otherwise prohibit commercial sex, such
prostitution pledge and its current anti-trafficking regulations
as laws against “immoral” earnings, “living off the earnings”
– that inhibit sex workers’ access to HIV services or their
of prostitution and brothel-keeping. Complementary legal
ability to form organisations in their own interests.
measures must be taken to ensure safe working conditions to sex workers.
3.2.9 Take decisive action to review and reform relevant international
law in line with the principles outlined above, including the UN Protocol to Prevent, Suppress and Punish Trafficking In
3.2.2 Take all measures to stop police harassment and violence
Persons, Especially Women And Children (2000).
against sex workers.
CONTINUED ON PAGE 32
PANCAP PERSPECTIVE 2012
PAGE 5
BUILDING BRIDGES FOR AN END TO AIDS
EQUALITY FOR ALL:
Is it fine for some of our citizens, because they are different, to be less entitled to the full realization of citizenship? How do each of us from our various perspectives approach the issue of equality? What value added can we bring to this discourse?
Building Bridges for an end to AIDS
Human Rights & Faith: Twin pillars of nation building It has become either unpopular or hackneyed to “harken back” to the 19th century colonial era, but at times our historical context is important to remind us of the continual cycles of history. Modern historians: Dr Eric Williams, former Prime Minister of Trinidad and Tobago; Professors Woodville Marshall and Hillary Beckles of Barbados and the Late Professor Gordon K Lewis of the University of Puerto Rico, among others, have carefully documented these cycles. In so doing, they have, inter alia, provided the evidence that during the 19th century, our struggle for human rights and the ending of slavery was a partnership between enslaved people, abolitionists and other faith based leaders. Faith leaders locally and in the metropole raised awareness of the inhumanity of slavery and asserted the fact of “humanhood” and “personhood” of black people, when it was unpopular and even dangerous to do so.
Juliette Bynoe-Sutherland
(Extract from Speech delivered to the Forum for government, civil society and faith-based leaders to launch the St. Kitts and Nevis Human Rights Campaign Making St. Kitts and Nevis Better: Equality for or All)
The role of constitutions There is a tendency today to view human rights and equality issues in one of two ways. First, as something from outside of the region – “something being pushed by American and Europeans”, seeking to undermine the fabric of Caribbean society. Second, and perhaps more problematic, there are some of us who are of the belief that there are no real substantive human rights issues impacting our society. Human rights and equality are just not seen as priority issues. We reason to ourselves: ‘Women and girls are fine and are often doing better than men and boys in school; the disabled are fine (we have ramps - don’t we?) With respect to sexual minorities – I was recently told
“
St Kitts and Nevis (?) - we hardly have any of those people here! Those we know are fine – they are friends with everyone and no one does them anything. They are not a priority for us; other issues are much more important.
”
Both positions, in my view, are extremely challenging. Why? Human rights, that is, rights to which you are entitled just on the basis of being a human being, are not external ideas being pushed on us. Human rights are rights that our ancestors fought for. They are deeply rooted in our collective psyche as black, brown and Creole peoples. We all deeply relate to the right to be treated with humanity and dignity as a people, whether we were brought here to the region as slaves or indentured servants. We fought for freedom from oppression, yet there continues to be segments of our community who have not felt that full realization of human rights such as women, the mentally and physically disabled and sexual minorities. There is still work to be done. There are still priorities to be tackled to make our Caribbean societies better places for ALL people. I wish to examine the structural approaches to human rights. I then wish to engage in a brief discussion on the role and potential limitations of our constitutional and legislative processes; the major human rights issues impacting our Caribbean societies and our proposed responses. I start by posing some questions that are central to this discussion:
PAGE 6
The constitutional history of many Caribbean countries demonstrates this dual relationship between faith and governance. For example, in 1983 The Federation of St Christopher and Nevis became an independent Commonwealth State. The Constitution of Saint Christopher and Nevis states: WHereAS the people of Saint Christopher and nevisa) declare that the nation is established on the belief in Almighty God and the inherent dignity of each individual; b) assert that they are entitled to the protection of fundamental rights and freedoms; c) believe in the concept of true democracy with free and fair elections; d) desire the creation of a climate of economic well-being in the context of respect for law and order; and e) are committed to achieve their national objectives with a unity of purpose: noW THereFore, the following provisions shall have effect as the Constitution of Saint Christopher and nevis:-
These phrases taken from the Preamble to the St. Kitts and Nevis constitution, stress — the belief in Almighty God is central to the foundation of this nation — the inherent dignity of each and every individual — ALL are entitled to protection of fundamental rights and freedoms — respect for law and order — Unity
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
BUILDING BRIDGES FOR AN END TO AIDS
This is also the case for constitutions across the English-speaking Caribbean and these constitutions have been pivotal in consolidating the institutions of the newly independent states – Parliament, Police, Defence and Security and Judiciary. In so doing they guarantee, at least in principle, our right as citizens to be protected against the powerful force of the state. However, these most remarkable instruments, our constitutions, have confounded us on the issue of economic, social and cultural rights despite the language in the constitutions themselves. The question is why? Simply put, in the pre-independence era in which our constitutions were being created, we were preoccupied with negotiating new states and we were desperate to change and emerge from our colonial past. Yet for continuity, we were cautious and careful to preserve our colonial heritage, as much as possible. Hence our prevailing cultural and religious norms, language and education shaped and formed our new governments. We created what we knew, what we could contextually negotiate and what our people and nation builders were comfortable with. So our constitutional focus has been on national development, preserving stability, continuity and securing our place in the world. In this respect, our constitutions rely on parliamentary legislators and an independent judiciary as the guardian of our human rights. Citizens freely elect their government and rely on the fairness of the judicial system at the national level, and through final courts of appeal such as the Privy Council and the Caribbean Court of Justice. Reflecting on our development across the region, despite the constitutional primacy given to faith, the role of the Church in the human rights agenda has not been fully articulated in our national discourse, and this is deserving of exploration. Despite current efforts to re-colonize the Church’s agenda, in Latin America and in Africa, the Church has historically been a powerful force for change with “liberation theologies” being an example. The Church here in the Caribbean has historically seen itself as contributing to nation building through schools, hospitals and other social welfare and spiritual support to individuals. The work of the parliamentarians, judiciary and legal profession in partnership with civil society activists has largely carried the human rights issues we have made progress on. Unfortunately, our constitutional jurisprudence has been extremely slow to respond to the promise inherent in our constitutions. Across the region, the words identified in the preamble of the constitution have been found by the Courts to be superfluous. Some legal minds have reasoned that these words (which affirm the very essence of our society: affirming faith, human dignity and protection) are unjusticiable. Some judgements suggest preambles are of no effect;. in other words, you cannot use them; you cannot sue and seek redress for violations of your economic, social and cultural rights contained in the preamble to constitutions because they are legally unrecognised by our judiciary. Yet these are rights, including the right to health, the right to education and the right to work that must be protected. This narrow interpretation of constitutions combined with the seemingly insurmountable role of savings law clauses in constitutions which preserve previous colonial laws around buggery, vagrancy and loitering, for example, provide for continuity and have seemingly made a mockery of constitutional jurisprudence. Therefore interest among the legal profession in pursuing public interest and social justice cases has been slow. Male and female commercial sex workers who are street based are still held for loitering or vagrancy under provisions of the law, dating back to colonial times and the desire to regulate where people operate.
contradictory and have implored the judiciary to move beyond them. It is only a matter of time before an interesting case emerges that provides the opportunity to move on some of these issues. In other Commonwealth jurisdictions such as India, preamble statements have been used to ensure that the interpretation of its constitution is more relevant and meaningful in addressing contemporary issues. The engagement of the judiciary in the human rights agenda is an important element in the movement towards achieving equality for all. This is a call to action for the legal profession to identify deserving social justice/public interest cases and for the judiciary to realize the full potential of the constitution as a living instrument of social change.
The role of legislation As an eternal optimist, I am completely unflappable in my belief in the potential of our judiciary and legal advocates. In contrast, for others, this shared optimism is tempered with pragmatism and a philosophy that constitutional jurisprudence is an unreliable basis for achieving social justice in a timely and efficient manner. In other words – you have to get the right cases, have the time and resources to pursue them, as often deserving claimants have no resources. You then have to play the judicial lottery. - Will you find a judge or Court prepared to move the law along so you hit the jackpot? Pragmatists (or optimists with insurance) suggest that alternate approach to addressing human rights issues beyond litigation is to rely on the Government to bring pieces of ordinary legislation and policies to advance human rights and equality. In recent times, laws across the region in many countries have ended bastardy for children out of wedlock thus asserting the equality of all children. The Equal Pay Act was recently passed in St. Kitts and Nevis, making advances for women. These are examples of legislation that Governments have brought to advance the human rights and equality agenda of women and children. The process of developing legislation is usually more engaging of and responsive to community stakeholders. In advancing legislation, Governments can provide collaborative leadership in protecting and promoting the rights of citizens. Ministers, together with unheralded leaders – our bureaucrats and technocrats – could move an agenda forward through legislation. Human rights and equality issues are legitimate concerns for which the Church, Judiciary, Government and key stakeholders must take action.
Social Consciousness and Moral responses Working in the HIV arena, we need to recognize that other groups in society also have a common interest in human rights. For example it is recognized that women and the disabled have been struggling for equality. Recently knighted Dame Suzette Moses-Burton of St. Maarten declared, in 2010 at a PANCAP/UNAIDS/UWI Symposium on HIV and Human Rights, that as a PLHIV she had come to the recognition that the human rights needs of HIV positive persons are the same human rights needs of all persons. Human rights are rights of all persons regardless of race, gender, sexual orientation, and disability.
Academics such as Simeon Macintosh and others have found these “saving law” clauses which keep old laws in new constitutions, as inherently
PANCAP PERSPECTIVE 2012
PAGE 7
BUILDING BRIDGES FOR AN END TO AIDS
Within PANCAP we have been calling for an end to HIV exceptionalism – where our concerns rest only with the human rights needs of People Living with HIV and other vulnerable communities denied access to prevention, treatment care and support. There is increasing recognition of a broad human rights and equality agenda that must be pursued across the region. Making our societies more tolerant and making equality for all the focus of our efforts, will provide an enabling environment and promote access. In relation to the needs of women, I am aware that St. Kitts and Nevis is committed to implementing the Convention on the Elimination of All forms of Discrimination against Women (CEDAW) and has recently passed supportive legislation. This country and its Minister of Health the Hon. Marcella Liburd is to be commended for the recent passing of the Equal Pay Act. This legislative intervention is a major stroke for advancing the rights of women. In an effort to accelerate the region’s approach to human rights through legislation, PANCAP has developed model antidiscrimination legislation which is designed to provide guidelines that countries may wish to adopt. The legislation focuses on regulations designed to eliminate discriminatory acts such as abuse, vilification, isolation against persons on the basis of HIV status, gender disability and sexual orientation and other grounds. It provides approaches to guarantee access to health and educational institutions, clubs and societies and other private spheres. It establishes that responsibility to eliminate discrimination is not only that of governments but also of private entities, NGOs and individuals. This model legislation also calls on countries to identify redress for a broad range of discriminatory issues.
The need for dialogue In developing the model legislation, it was recognized that countries in looking at their legislative agendas had to factor whether they were prepared to lead or follow public opinion. There is a role for both approaches.
In some instances, policy makers may wish to reflect national consensus for social cohesion. In other instances, depending on the social good being promoted, policy makers may wish to lead and shape consensus. Tobacco legislation and civil rights legislation are good examples or where government has had to lead to promote change. Sometimes national consensus could be wrong and history is replete with examples where national leadership has been required to move deeply rooted position, for example ending the “bastard” child.
Parliamentarians to remove certain issues from partisan discord. This, it is hoped, will give Government the flexibility to engage with the political Opposition on the development of key legislation. Building political partnership is not idealistic – it is already occurring in some countries in this region such as Barbados and I am very hopeful about St. Kitts and Nevis from my discussions here with various actors. Neither is it idealistic to believe that the faith-based community could provide key leadership on issues. Asking the Church to change its position on the morality of homosexuality is deeply problematic. But what if you asked the church to examine the facts and craft its own response grounded in biblical principles. Like the Abolitionists of old – the Bible can be a force for societal change. The facts are – sexual minorities in some countries face violence, abuse and vilification. Some economically marginalized women engage in sex work (on the street or in clubs) or transactional sex. They do this as a means of feeding their families, but are outcasts because of their lifestyle. What if the church was to be made aware that at-risk communities such as MSM are not accessing HIV care and treatment because of the expressed attitudes of health care providers many of whom sit in their pews? What if they were told that because these vulnerable persons feel so scorned by society they do not present for HIV services until it is too late?. The Church will respond and has responded. For example, the Caribbean Conference of Churches has produced Guidelines for faith leaders on HIV and Codrington College in Barbados for the Anglican Diocese has included HIV awareness as part of its pastoral care programme. Many persons of faith are beginning to stand up in places like Jamaica as being against violence, abuse and discrimination against all persons.
Tolerance does not have to mean acceptance. It means, however, provision of a space for doing the “Jesus walk” – engaging with the marginalized down trodden and alienated – for winning souls and transforming lives not through judgement but through love. Doing nothing is simply not an option. The St. Kitts and Nevis constitutional development embraced belief in Almighty God as central to development. The faith communality has to be part of the process of creating solutions which realize the promise of our constitutions.
In many cases a social dialogue is essential to ensure that ideas contend to form part of the evolving policy framework.
The willingness of a society to engage in dialogue represents a phase of maturing and deepening of democracy and recognizes that in today’s environment there are high levels of social literacy. By this I mean the the ability of persons to navigate their world and the issues around them. In some countries, local and international civil society has led efforts to enhance legal and social literacy, raise awareness of existing rights and redress and promote law reform or new legislation where necessary. PANCAP and its partners, UNDP and UNAIDS, have worked with
PAGE 8
HIV and Human Rights Reshaping the PANCAP agenda
Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses
Building consensus at community level PANCAP, the organization I represent, is intricately linked with St. Kitts and Nevis. PM Douglas was one its first architects and has remained its Chair. PANCAP has worked steadily over the past 11 years to support the St. Kitts and Nevis national HIV programme at the Community level. Through the pooled procurement system (PPS), ARVs were provided to the OECS as a result of PANCAP’s negotiation with Brazil which was led by PM Douglas for the entire OECS. More recently, PANCAP has bought life saving medications through Trinity Global and our CARICOM based Global Fund Round Grant. We are doing outreach and capacity building with women and girls through UN Women, the Caribbean HIV and AIDS Alliance (CHAA)(SISTA project, and the Regional Stigma and Discrimination Unit. The special consultation planned in St. Kitts and Nevis and other regional territories on World AIDS Day in December, is intended to bring together social partners, including representatives of FBOs, youth and media, to discuss the accelerated agenda for human rights with a view to eliminating stigma and discrimination. This event in St. Kitts and Nevis is supported by both government and opposition. It is also happening throughout the Region and augurs well for the proposed solutions that have emerged from the community consultations. It is important for the region to see the leadership of the people of St. Kitts and Nevis on issues of social justice which our forefathers struggled to attain.
Monitoring and reforming laws, regulations and policies relating to HIV
Conclusion In this discussion, I have sought to place human rights within the context of our social development and to demonstrate its basis in the Constitution. Though not being a theologian – I have sought to incorporate an appreciation on how the Bible and people of Faith can contribute to the discourse. It is self evident that the sustainability of our society must be supported by a collective will to stamp out discrimination and to enhance our dialogue on human rights. There are groups within the society who need to feel the promise of equality captured by the constitution of SKN. I look forward to hearing more on your discussions and see the bridges that you will be building to the future.
Laws, regulations and policies relating to HIV can negatively or positively impact a national HIV epidemic, as well as the lives and human rights of those living with and affected by HIV. It is thus essential to monitor and reform laws, regulations and policies so they support, and not hinder, access to HIV and health services. Examples of programmes to monitor and reform laws, regulations and policies in the context of HIV include:
Juliette Bynoe-Sutherland is the Director of the PANCAP Coordinating Unit
•
Review of laws and law enforcement practices to see whether they impact the response to HIV positively or negatively;
•
Assessment of access to justice for people living with or vulnerable to HIV;
•
Advocacy and lobbying for law reform;
•
Engagement of Parliamentarians and Ministers of Justice, Interior, Corrections, Finance, Industry, Labour, Women’s Affairs, Education, Immigration, Housing, Defence, Health and Trade, religious and traditional leaders, among others; and
•
Promotion of the enactment and implementation of laws, regulations and guidelines that prohibit discrimination and support access to HIV prevention, treatment, care and support. Source: (UNAIDS 2012)
PANCAP PERSPECTIVE 2012
PAGE 9
AN EFFECTIVE AND JUST RESPONSE TO HIV
Social Mobilisation and Building Social Capital: An Effective and Just Response to HIV Ken Morrison Ayana Hypolite Sandra McLeish
Stigma, Discrimination and Internalized Stigma (Self Stigma)
“
Situational assessments and epidemiology throughout the Caribbean show us that while epidemics in the region have all sorts of faces, there are subpopulations that are key to the dynamics of the epidemic. Among these are men who have sex with men (MSM), persons engaging in sex for exchange who may be poor, youth, single mothers, or migrants with few opportunities and, in some cases, users of drugs. None of these groupings are really structured entities, even though we tend to think of them as groups. These sub-populations, however, do hold a common thread in terms of being stigmatized – they are populations who are marginalized, even criminalized, in most former English colonies across the Caribbean. They are sub-populations isolated in silence and marginalized by the community. The ‘love that dare not speak its name’ shows its face throughout the Caribbean not only in higher than average HIV prevalence rates among MSM, and social taboos related to talking about sex, especially between MSM and same-sex couples. There is an absence of legal or social liberty to fully exercise individual human rights such as the right to equity in services, to equity in justice, to equity in input into social policy, and freedom of association. These are people who are shamed in public, shunned from households, extorted in private and public, and forced into hiding and subterfuge. As a result they resort to escape mechanisms and behaviours that sometimes exacerbate the social exclusion and reinforce a self-perpetuating cycle that drives the epidemic. The recent international AIDS conference in Washington gives us a look at the present and future. A key theme of the Washington conference, and where we now have our global sights set, was a generation without AIDS. Through combination prevention (concurrent strategic biomedical, behavioural, and structural responses) and treatment as prevention (ensuring that people infected with a virus are on treatment that brings their viral level so low that they will be much less likely to transmit it to others) we can see profound change on the horizon. Advances in science mean that we should expect to tackle and achieve almost immediate results such as eliminating vertical (mother to child) transmission. Technology and bio-medical advances have given us this opportunity. But unless women get tested, unless everyone has access to judgmentfree services and marginalized groups are participating actively in this comprehensive response, that goal may remain outside our grasp. Another crucial lesson from AIDS 2012 was the central role that human rights play as the cornerstone of a comprehensive response. At the conference, the report Global Commission on HIV and the Law: Risks, Rights & Health, was released. As two veteran politicians put it:
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It may be difficult, even uncomfortable, to reverse discriminatory laws, but laws – just like language and culture – must evolve with the times. Local and national leaders need to ensure that legal systems move us forward, not set us back… The truth is if we can rally support for a multibillion-dollar global effort to end AIDS, we can all muster the courage to put laws in place that make those dollars work. For the first time in the history of the epidemic, we have the tools to slow down the rate of new infections radically and keep virtually everyone living with HIV alive… We must aggressively deal with the wasteful, damaging laws that are standing in our way. There has never been so much to lose– or to gain.
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–Fernando Henrique Cardoso (former President of Brazil) and Helen Clark (Administrator of UNDP and the former Prime Minister of New Zealand)1
States assume obligations and duties under international law when they sign onto treaties to respect, protect, and fulfil human rights. The obligation to respect is to refrain from hindering the enjoyment of human rights. The obligation to protect safeguards individuals and groups from violations of human rights. The obligation to fulfil, however, means that states must take positive action to facilitate the enjoyment of basic human rights2. According to the Universal Declaration on Human Rights “All human beings are born free and equal in dignity and rights.” But in reality there are populations who are not able to exercise their rights. The question then remains how communities that are marginalized and isolated come together to participate in the response. GIPA (the greater involvement of persons living with HIV and AIDS) gives us some key lessons. Once it was thought that it was enough to have a person living with HIV (PLHIV) at the policy table. Then MIPA (meaningful involvement of PLHIV) was born and PLHIV were empowered and connected to a base of persons whom they represented as equal partners in policy dialogue and decision-making.
1
http://hivlawcommission.org/index.php/media-center/updates/125-bad-laws-hamperglobal-aids-fight 2 Adapted from http://www.ohchr.org/en/issues/Pages/WhatareHumanRights.aspx
HIV and Human Rights Reshaping the PANCAP agenda
AN EFFECTIVE AND JUST RESPONSE TO HIV
Social mobilisation, a broad-based movement to engage people in achieving a specific development objective through independent efforts, offers a promising direction. Social mobilisation techniques use participatory methodology in a decentralized process to facilitate change. It counts on interrelated and complementary efforts that seek to empower groups for action. It is a process that attempts to mobilize all relevant segments of society – including decision-makers, service providers, and communities. One of the relevant aspects of social mobilisation for the Caribbean is building social capital. Ayana Hypolite is the Caribbean Regional Programme Manager for Health Policy Project.
Social Capital Social capital, loosely speaking, is the capacity of a person or for a group to have social influence. It includes having sway in social policy, or being able to count on a support system in times of need. For many, building social capital – empowerment through the development of linkages – represents a vital portion of a comprehensive HIV response. It is not a panacea, but an accompaniment to biological, behavioural and other advances. People come together to create and strengthen bonds of common cause, feelings of belonging, and mutual support in order to influence any number of outcomes, including those related to health. Measurement proxies are often in terms of civic participation and trust in community institutions. We often think of building social capital as a three-step process: bonding, bridging and linking. It is a process of networking and coalition building in which one leads to another and where what one chooses to focus on depends on the particular community and context. In order to help communities develop their voice you need to foster a process of bonding:
Bonding is building social cohesion – bringing people together around a common issue in a safe environment where sharing stories and open communication can flourish. This group works to identify its challenges and possible solutions, to improve capacity to analyse and communicate needs. This component is especially important for the disempowered.
Social capital is a logical extension of the value of human contact that focuses on human linkages but with multiple definitions, interpretations, and uses. Some argue that social capital is a necessary precondition to strong development and that a strong legal and institutional base is necessary for the building of social capital. Others argue that strong social capital is necessary for a thriving democracy and vibrant economic growth. However, there is agreement that social capital is best characterized by trust of others, faith in social structures, robust cooperation, and the identification that an individual has within a community or network – formal or informal. Helping populations that are affected by HIV find a voice and strengthen the ability to analyse and communicate needs is a critical piece of the work we undertake in creating a supportive environment. This process of creating a collective voice and identifying representatives that can participate effectively in policy dialogue leads to improved collective action through advocacy, strategic alliances and programming based on real community needs. A coherent process of building social capital should lend itself to improved accountability in keeping policymakers on track toward meeting stated goals and commitments.
Social capital in action
There are many examples of community development that use principles of building social capital without necessarily calling it such. But how can we undertake this process in a coherent manner – one that fits with the other local biological, structural and behavioural factors? The second step, bridging, is about the creation One approach is to examine a current project or strengthening of strategic alliances for Ken Morrison is the Technical Team Leader for in the Caribbean for examples that illustrate accomplishing strategic action. The groups Health Policy Project for the Caribbean region. building social capital. These are activities in that have bonded in different ways work which the Health Policy Project (HPP) is working across groups in innovative responses. closely with local country counterparts and Finally, the third step in this process is linking. In order to foster building on and supporting the work of PANCAP implementing partners, accountability, one needs to link a community with other levels of power. including the Caribbean HIV and AIDS Alliance (CHAA), the Caribbean The affected groups who have formed bridges between themselves interact HIV and AIDS Regional Training (CHART) network, the University of the with the influential. In the case of HIV, the marginalized and vulnerable West Indies (UWI), the Regional Stigma and Discrimination Unit (RSDU), along with the service providers sit at the table with the policy makers to the Caribbean Vulnerable Communities (CVC) Coalition, United Nations improve policy outcomes, health outcomes, and strengthen health systems. agencies, and the Caribbean Regional Network of PLHIV (CRN+).
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AN EFFECTIVE AND JUST RESPONSE TO HIV
In St. Kitts Nevis, for example, HPP trained a cohort of 20 persons working So what? in different aspects of the AIDS response on stigma and discrimination as Social capital has its doubters, and there is indeed a need to conduct well as on facilitation of discussions on sensitive issues and participatory rigorous measurement to highlight the benefits of social capital training techniques. Under the guidance of the National AIDS Programme, interventions. Many measurements of social capital in the Caribbean approximately 25 public consultations around the theme of “Equality give us telling insights. A recent 2011 survey that looked at different for All” took place across the two-island state. Training for all health dimension of social cohesion around the globe, including social capital, personnel on health services and stigma, as well as facility-specific policy shows us that, while the Caribbean region showed development on equality in services will relatively average scoring for civic participation, it follow. This is part of a broader program scored extremely low in the area of trust – only 4% but gives us an example of bonding – in reported that most people could be trusted3. Similar this case in health delivery facilities. patterns emerge for the region in other studies In the workplace, colleagues come showing moderate levels of social engagement and together to monitor, analyze, discuss, 4 . low levels of social trust and deal with difficult issues in small communities on sensitive issues such as The question remains: How can we turn untrusting sexuality, gender, and violence. Bonding, communities into resilient communities? How do we of course, can happen in different help in reducing stigma and discrimination? Prejudice sectors and in different situations. The and exclusion? If we truly want a generation free most obvious example of bonding in of AIDS, where people are tested and treated as the world of HIV is with marginalized regular daily practice, we need to help the most populations: the coming together of the vulnerable and least protected towards being able to isolated and dispossessed so that united make healthy choices. This process includes having they can find common ground and work Sandra McLeish is Programme Manager Health access to those choices, being able to make choices, with others for common good. Policy Project (HPP), Jamaica and making choices – all of which are reinforced by having options to live productively with protection In Dominica, working with different and support in society... and prevention. partners, we can find another example of linkages to build social capital in the participatory development of a national HIV policy. Again, HPP trained a cohort of 20 persons on facilitating discussions, sharing information and learning about health, stigma, discrimination and HIV. The project convened public consultations and discussion groups with members of communities around the island. Working closely with affected populations of PLHIV and MSM, partners, led by the National AIDS Programme, put together a process to help bridge the communication and collaboration between health service delivery and service users – especially those with fear of rejection and negative treatment. This illustrates the process of “bridging” for collective action. In Jamaica, the Health Policy Project is working with different sectors, including health services, academia, and affected communities, including faith communities, to bring together evidence and collectively analyse and discuss implications. These different sectors are teasing out policy implications and developing recommendations to bring to policymakers, not only at the national level but at facility and parish levels. This represents an example of “linking”– how the service providers, service users and community leaders come together to feed into policy dialogue.
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Prevention is not just about the individual, it is about the person in his or her environment and the trust that he or she has in that environment. There is no single right answer for any situation or country. But there are processes for building social capital that we can undertake and promote to provide for a just answer.
PANCAP partners need to continue to invest in coalition building and commit to means of responding to HIV that build social capital. This is how we can ensure that there remains a legacy of strength and resilience for dealing with HIV as well as emerging health and social issues.
3
Christopher Garroway de Coninck, Johannes Jütting, OECD Development Centre Measuring cross-country differences in social cohesion, International Conference on Social Cohesion and Development 20.01.2011 http://www.oecd.org/dev/ perspectivesonglobaldevelopment/46984733.pdf
4
See Stephen B. Young and Josiah Lindstrom, 2009 Social Capital Achievement Country Rankings, http://www.cauxroundtable.org/index.cfm?&menuid=126&parentid=52 See also: 2011 Legatum Prosperity Index, http://www.prosperity.com/default.aspx
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
BREAKING THE BARRIERS OF STIGMA AND DISCRIMINATION
Breaking the Barriers of Stigma and Discrimination
Dr. Edward Greene
Defining Human Rights The UN High Level Political Declaration on HIV and AIDS (2011) embodies a number of human rights principles. It recognises the importance of eliminating stigma and discrimination against people living with, and affected by HIV. It aims to eliminate inequality and violence against women and girls and denial of sexual and reproductive rights. It calls for a review of laws that impede an effective HIV response. It supports actions leading to the repeal of punitive laws and the abandonment of approaches that affect key populations. These are all consistent with the principles embodied in the UN Universal Declaration for Human Rights (1948) to which all countries of the Caribbean subscribe.
PANCAP’s Human Rights Initiatives Human Rights have been high on the PANCAP agenda for some time. It was, for example, recognized as an element of the accelerated HIV response in the very first Caribbean Regional Strategic Framework 2002-2006. The CIDA-funded programme on Ethics, Law and Human Rights formed an integral part of the work programme of the PANCAP Coordinating Unit (PCU) and initiated the discussions on model legislation for adoption at country level. Human Rights featured again in the sub-regional consultations in Sint Maarten and Saint Lucia and a regional consultation in Jamaica, and led to the PANCAP publication on Universal Access to HIV Prevention, Care and Treatment (2006). The recommendations in this document informed the positions taken by the CARICOM/PANCAP delegates to the United Nations General Assembly Special Session (UNGASS) on HIV, in June 2006. Issues on Human Rights were further highlighted in the Caribbean Regional Strategic Framework 2008-2012. The PANCAP Coordinating Unit spearheaded the production of this Framework, from which the model anti-legislation to promote the rights of the people with HIV and key populations was developed. A landmark however is the PANCAP Conference on eliminating stigma and discrimination through the novel initiative of Champions for Change. The conference held in St Kitts and Nevis in November 2004, brought together parliamentarians, representatives of the private sector, regional and international institutions, faith based organizations, media, sports and cultural icons and people living with HIV and AIDS.
PANCAP PERSPECTIVE 2012
Its outcomes, included a number of concrete recommendations including “targeted” conferences for the media, faith based organizations and the judiciary, as well as the development of criteria for Champions. In this last regard, over the course of its “evolution” designated champions included: Prime Ministers, such as Owen Arthur, then Prime Minister of Barbados, cricket greats, such as Courtney Walsh and Clive Lloyd, calypsonian, The Mighty Gabby, media personality Barbara Gloudon, among others. In September 2010, a symposium jointly coordinated by UNAIDS, PANCAP/CARICOM and the University of the West Indies (UWI) under the leadership of Sir George Alleyne, then UN Special Envoy for HIV in the Caribbean, explored the varying components of human rights. Among its conclusions was that anchoring stigma and discrimination within the broader concept of Universal Human Rights, provided an expedient framework for achieving positive results.
What is briefly illustrated here, are the serious attempts by regional scholars, professionals, practitioners, activists, among others, to come to terms with the principles and practices of human rights. The issue however is: to what extent has there been effective implementation of the policies highlighted in the various conversations, publications and declarations?
Missed opportunities The 2004 PANCAP-initiated Champions for Change initiative underpinned a vision for broadening the base of advocacy against stigma and discrimination. By incorporating a cross section of stakeholders as crucial allies to champion and spread the appropriate messages, it was anticipated that national and regional consciousness and responses to end HIV stigma and discrimination would be stimulated. In other words, champions would act as catalysts for change. This is fully illustrated by the regional private sector pledge to the 2004 conference which matured in 2005 with the launching of the Pan Caribbean Business Coalition for HIV and AIDS, at the Fifth Annual General Meeting of PANCAP. It is also illustrated by the pledge of a development partner at that same conference, which was realized by a grant for the establishment of a Research Unit on Stigma and Discrimination in the Caribbean.
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BREAKING THE BARRIERS OF STIGMA AND DISCRIMINATION
On this last issue, it would be remiss of me if I did not share my view that this Unit located in an “untested “NGO was misplaced. Aligned to a more accredited socio-economic research Unit in UWI as was intended, it would have provided an appropriate environment for this new genre of policy research. It would also have complemented training and capacity building for students, policy makers and other key practitioners including from Civil Society across the region. There are other instances which, in my opinion, may be classified as missed opportunities to advance the human rights agenda. These include a failure to consolidate the mainstreaming of youth and media into the frontline of PANCAP’s strategic implementation. With respect to youth, one avenue for doing this was through the continuation and expansion of the CARICOM Youth Ambassador-led Mini Grants project aimed at building leadership capacity and response in youth-led NGOs. The other more recent example was failing to fully capitalize on the opportunities provided by a cohesive partnership with media and in particular to use existing robust structures such as the CBMP to do so. This organisation’s sustained network of broadcasting partners (106 stations in 24 countries), with a daily commitment for broadcasting dedicated messages to reach diverse populations and its LIVE UP Brand is a significant mechanism for enhancing information education and communication that is far reaching. Its accelerated programmes with the social media and collaboration with key populations, in particular, the Caribbean Vulnerable Communities Coalition in its planning and delivery of such programmes is on the right track. As I said before at the Fifth AGM of this body; “including the voice of the marginalized vulnerable and creating openness and innovation in the discussion on eliminating stigma and discrimination, may yet prove to be the biggest area where there is the greatest success. And it must continue.”
Taking Corrective Action: Confronting the hard issues I anticipate that as UN Secretary-General Special Envoy I could build on the work being undertaken by the PANCAP umbrella with the support of UNAIDS. My work programme for 2012-2013, for example, places emphasis on an accelerated human rights agenda. Based on visits to Antigua and Barbuda, Barbados, Jamaica, St Kitts and Nevis and Saint Lucia, there has been support for the holding of national consultations on human rights with a view to eliminating stigma and discrimination. These consultations to be spearheaded by the National HIV Councils in collaboration with faith based organizations and youth groups will draw on the body of work carried out by the PANCAP Coordinating Unit and UNAIDS. The immediate intention is to open up the debate on general issues such as mechanisms for removing the barriers to reducing stigma and discrimination and more specific ones such as laws criminalizing same sex sexual conduct. This is a most appropriate time to confront the hard issues that must be resolved rather than “[swept]… under the carpet”. Most Heads of
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Governments, Ministers of Health and leaders of faith based organizations with whom I have spoken, welcomed this type of open discussion that could provide the basis for action and, where possible, legal reforms and practices of tolerance. In the final analysis, attitudes towards men who have sex with men tend to have a multiplier effect by creating a cultural crisis faced by other communities such as women, injecting drug users and sex workers. And this must be urgently addressed.
Breaking down the cultural barriers on human sexuality The Lancet issue (July 2012) carried several articles which appropriately identified the optimism on the possibility of achieving an AIDS free generation. This view is supported by the results of a study which showed that early initiation of antiretroviral therapy reduced the risk of HIV transmission to unaffected partners by 96%. Findings like these are at the heart of the thrust of treatment as prevention. While this is good news, the countervailing views caution that basing policies solely on the results of science may yet prove to be the “Achilles heel” of prevention and control. The high cost of the new drugs for example is one consideration. It excludes the poor and vulnerable groups from access, especially in developing countries. Another is stigma and discrimination that fuels the spread of AIDS which is largely based on cultural and moral factors. Hence, there is need to couple biomedical with behavioural research to achieve the most favorable results. By this I mean that elimination of stigma and discrimination can be achieved mainly by understanding and accepting diverse sexual behaviour among men and women. To achieve this goal requires breaking down the cultural barriers through information, education and communication about human sexuality. Unfortunately, these are matters that people often wish to avoid. The passing of the UN Resolution to protect the rights of lesbians, gays, bisexuals and transgenders (LGBT) in June 2011 provides some impetus to breaking down the cultural barriers. It was accompanied by an instruction to the High Commissioner for Human Rights to document discriminatory laws around the world against people based on sexual orientation and gender identity. This is important in view of the fact that homosexuality is criminalized in seventy countries, five of which can impose the death penalty for this “offence” against the law.
Replacing Laws against sodomy with creative use of traditional law and legislative initiatives The laws against sodomy violate international law. Most Caribbean countries, however, have retained criminalization of consensual sex between adult men in its statutes, a legacy of British colonialism, dating back to the late 19th early 20th century. Britain has abolished these laws approximately 20 years ago. Many studies show the negative effects of
HIV and Human Rights Reshaping the PANCAP agenda
BREAKING THE BARRIERS OF STIGMA AND DISCRIMINATION
sustaining such laws including the fact that they are impediments to access to HIV prevention and treatment. This, combined by the persistence of anti-gay rhetoric, has helped to sustain homophobia and stigma leveled in particular against men who have sex with men. As late as 2004, the US President’s Emergency AIDS Relief (PEPFAR), imposed the conditionality of “abstinence” to qualify for its awards. A legitimate response comes from the recently released Report of the Global Commission on HIV and the Law, chaired by Dr. Fernando Cardoso, former President of Brazil. This report called for the repeal of punitive laws against sodomy and for the enactment of laws that facilitate and enable effective responses to HIV prevention, care and treatment services. In this regard, the Commission recommended that advocates can creatively use traditional laws to promote such priorities as women’s rights and health and gender sensitive sexual assault law. It also proposed that legislative initiatives and court actions should be informed by fairness and pragmatism. In so doing, the Commission argues that nations can shrug off “the yoke of misconceived criminalization”.
PANCAP at the Centre of the Strategy to Eliminate Stigma and Discrimination PANCAP is no doubt preparing for the 3rd iteration of its Caribbean Regional Strategic Framework (CRSF). The circumstances surrounding its development are vastly different from those that accompanied the versions of 2002 and 2008. In 2002, the emphasis was placed on projects to support institutional strenghtening of core Partners including: the Caribbean Epidemiological Centre (CAREC) the Caribbean Health Research Council ( CHRC), the Caribbean Network of PLWA (CRN+), and UWI, among others. In 2008, the shifts from projects to programmes and to regional public goods with impact at country level were prominent. This time, the emphasis will perhaps be on shared responsibility given the context of financial constraints, the need to sustain treatment and prevention programmes and the changing structure of the Partnership. This may well mean that PANCAP will need to revamp its strategic directions to attract and then maximise the responses of development partners.
hub. The importance of research and strategic information must also become hallmarks of the new CRSF. It is in this context that PANCAP must take the initative to reverse the missed opportunities. This should include placing human rights as one of the major priorities of the CRSF (2013-2018), actively engage with countries in their national consultations on human rights, placing greater emphasis on partnership with faith based organisations, establishing a mechanism for monitoring and sanctioning discriminatory activities, and expanding the range of stakeholders as Champions for Change. At the recently concluded retreat of UN Special Envoys for HIV held in Geneva, it was agreed that the Envoys from the Regions of Africa, Asia, the Caribbean, Eastern European and Central Asia would work jointly and in collaoboration with the Executive Director of UNAIDS to create synergies that cut across regional interests and established linkages between regional and global priorites. This new construction of solidarity was seen as a most expedient way of contributing towards an AIDS Free Generation. It was agreed that the Caribbean would take the lead in the accelerated agenda for human rights with special reference to the the goal of eliminating stigma and discrimination. This is no “low hanging fruit’‘ but a “big ticket” item. It cannot be achieved without the fullest cooperation based on factual information, concliatory diagolue and engagement of national, regional and international stakeholders within the PANCAP movement. This can be an historic moment. Indeed, new challenges and new directions beckon PANCAP.
Edward Greene is the UN Secretary-General Special Envoy for HIV and AIDS in the Caribbean Editor’s Note: This article is based on Part 2 of an interview with Dr. Edward Greene. The first Part was carried in the PANCAP ENews July 2012. This article maintains the sequence of the interview and the subtitles adequately describe the nature of the questions posed to Dr. Greene
The PANCAP Coordinating Unit must continue to function as the hub of the network in collaoboration with agencies such as the Caribbean Volunerable Communities Coalition (CVC), Caribbean Broadcasting Media Partnership against HIV (CBMP) and the Caribbean Business Coalition; complementary agencies such as UNAIDS, PAHO and CARPHA, and supporting agencies, mainly governments of the Caribbean and development partners. This model revolves around the notion of collective leadership and is also committed to the revival of CRN+ as a critical component of the PANCAP
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HUMAN RIGHTS MUST BE AT THE CENTRE OF THE GLOBAL HIV EFFORT IN THE CARIBBEAN
Human rights must be at the centre of the global HIV effort in the Caribbean - Remembering Robert Carr Technical Team of the PANCAP R9 Global Fund ‘Vulnerabilised’ Groups Project.
The renowned Caribbean activist Robert Carr passed away just over a year ago at the age of 48. He became known in the Caribbean and later internationally for his advocacy work by giving a voice to people who have been silenced and made invisible through systematic social exclusion. These include sex workers, gay and other men who have sex with men, marginalized youth, drug users, and prisoners.
Robert Carr firmly believed that HIV is a by-product of social inequalities. Robert spent his life calling for institutional and structural change that would turn the global rhetoric about human rights into rights realised at the grass roots. He was not afraid of calling out poor utilisation of AIDS resources and rampant and institutionalised homophobia, and he inspired activists the world over to demand change. It is near impossible to continue Robert Carr’s advocacy work with the same style and flair he embodied, but he has left the Caribbean with a rich advocacy legacy to guide our attempt to continue without him. Robert’s tireless talks about ensuring human rights were more than rhetoric and banal lines in a speech, but embodied the approach taken to address the needs of the marginalised people of the Caribbean and the wider world. For him, the HIV epidemic was exacerbated by social inequalities. Robert saw clearly that rights violations towards sex workers, men who have sex with men, drug users, women, and youth in difficult situations, were a key driver that fuelled the concentrated and generalised epidemics within our society. Robert consistently highlighted the interconnection between social exclusion and people’s inability to access HIV services. He was key in orchestrating Human Rights Watch’s now well-known 2004 report, ‘Hated to Death’, which highlighted how homophobia and violence were driving the HIV epidemic in Jamaica and the Caribbean. Robert repeatedly made the point that homophobia and discrimination perpetrated against marginalized communities in the Caribbean was at odds with the Caribbean’s rich history of resistance, anticolonialism and anti-racism struggles. As he said to a roomful of activists at the International AIDS Conference, held in Vienna in 2010:
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Many of us are coming from countries where as part of our independence movements there was all kinds of rhetoric about ‘power to the people’, about inclusion, about a new way of working… but somehow when it comes to our populations all of that gets parked to the side. Somehow on those populations the kind of brutality that police, for example, meet out to subjugated populations is appropriate when it comes to us ... That has to stop.
Robert Carr helped the HIV Collaborative Fund/ITPC and the amfAR MSM Initiative and other international grant-makers develop processes that were not only responsive to community needs but under community control, counter to the overt medicalisation of HIV that was then the model of the AIDS response.
Robert Carr’s life and work in the Caribbean proves to us that the tradition of rights-claiming and activism that took our nations to independence is still very much alive. His view on the importance of the centrality of rights in the HIV discourse is in line with a growing body of international evidence which demonstrates that rights protection results in improved public health. In a panel discussion in which Robert Carr participated at the last International AIDS Conference entitled “Is AIDS Activism Dead?”, he said:
“
There is a lot of money…if you really look concretely at what the HIV response is funding, what you see is a lot of workshops, for example, and a lot of documents being produced. Very often what is really needed is a kind of different strategy, a different kind of response. The ability to confront, the ability to be confrontational but to be supported in your confrontation, financially for example, so (we need) more human rights based activism…
”
During his life, Robert Carr advanced an integrated approach to working with key populations, building solidarity among vulnerabilised populations by mobilising around common concerns or causes. The Caribbean Vulnerable Communities Coalition is testament to this belief that a gay man or sex work can come together in solidarity to respond to HIV and AIDS because they both suffer marginalisation and stigma and discrimination and understand best the drivers of the epidemic in their communities. As Robert Carr said:
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We are all connected. We may believe we have nothing to do with a gay person, nothing to do with a sex worker, nothing to do with a drug-user, nothing to do with a prisoner, but it’s not true! We are part of a fabric of society, and as part of that fabric, what is happening in one part of that fabric/society affects the rest of it
“
”
Robert Carr believed fundamentally that HIV and AIDS responses should be community-led and controlled and must respond to community needs. He was the main architect of the Vulnerabilised Groups Project; it is a legacy to his drive and determination. Robert Carr worked hard to ensure that donors and national responses focused RIGHT, on vulnerabilised populations most in need of funding and struggling to combat a concentrated epidemic.
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HIV and Human Rights Reshaping the PANCAP agenda
LETTERS TO THE EDITOR
LETTERS TO THE EDITOR
Health and Family Life Education: Empowering Youth Crystal Brizan Is Health and Family Life Education (HFLE) necessary for our youth? The resounding answer is yes! Yet, notwithstanding the importance of HFLE, the implementation of various measures by the respective CARICOM member states and the efforts of Civil Society; HFLE is still lacking from the primary and secondary school sector. Despite the fact that there is a HFLE curriculum for primary and secondary schools in Trinidad and Tobago, it is not taught in a systematic and consistent manner. Exacerbating this situation is the reluctance and inability of parents and guardians to educate their children on key issues relating to puberty, anatomy, sexual relationships, sexually transmitted infections (STIs), and mental health.
Crystal Brizan is an Attorney at Law by profession with a passion for gender equity, gender justice and the advancement and preservation of human rights, particularly sexual and reproductive health and rights (SRHR). In 2010, she was selected as one of 100 global young leaders in Maternal Health.
One aspect of HFLE that creates controversy and discomfort amongst some in our society is the component of comprehensive sexuality education (CSE) for youth. The fear is that if you are educating young people about these issues then surely you are encouraging them to engage in sexual relationships and activities. This is certainly not the case. Evidence from an increasing number of studies clearly demonstrates that CSE does not lead to an increase in sexual activity and in fact can even delay sexual initiation and lead to a reduction in risky sexual behaviours.1 Denying youth the correct and factual information on sex and sexuality places them at a great disadvantage as they are ill prepared to navigate their sexual lives without risk. Age appropriate CSE not only explains the mechanics of sexual intercourse but also teaches young people about the emotional, social and cultural norms which shape our perception of sex and sexuality.
The need for CSE has reverberated at all levels of advocacy, including the United Nations. As recently as April 2012, member states at the 45th session of the United Nations Commission on Population and Development adopted a forward thinking and landmark resolution on the theme “Adolescents and Youth”. This resolution will go a long way towards the preservation of young people’s sexual and reproductive health and human rights.2 For the first time, governments have agreed to: Recognize that human rights include the right to have control over and decide freely and responsibly on matters related to sexuality, including sexual and reproductive health, free of coercion, discrimination, and violence (PP 15). Provide young people with evidence-based and comprehensive education on human sexuality, on sexual and reproductive health, human rights, and gender equality (OP 26).3 Policies, programmes and initiatives for young people should focus not so much on age, but rather on the specific developmental needs and rights of individuals as they transition from childhood to adulthood. For young people, sex and sexuality presents a dichotomous reality. On one hand they are advised that these dalliances should be avoided, however as a result of the media and peers these ‘vices’ are glorified. They are pressured from all fronts and this pressure is made worse by the lack of HFLE that is glaringly apparent in Trinidad and Tobago. Sexual taboos are largely as a result of culture and religion. These taboos are not insurmountable, but significant work must be done to ensure that the rights of young people are preserved and that their emotional, social and health needs are met. Civil society organisations have always been at the forefront of change. One such organization is Advocates for Safe Parenthood: Improving Reproductive Equity (ASPIRE), a non-governmental organisation which advocates for sexual and reproductive health and rights and is based in Trinidad and Tobago. Recognising the gaps which needed to be bridged, ASPIRE in 2008 embarked on a bold step; they hosted a HFLE Quiz for 12-15 year olds, the first of its kind in the country. It is a fun and innovative method of learning; a strategy which facilitates an environment to not only gain knowledge of vital life skills, but also inculcates dedication, focus, camaraderie and a sense of team spirit in the participants.This annual event has garnered the support of local UN agencies, youth advocates and organizations as well as the Government. This intervention has been so successful that this year, the Ministry of Education agreed to implement the Quiz in the secondary school system as a pilot project. The Quiz is just one of the many catalysts which will transform our country from being ruled by our sexual taboos and conservatism, to a society where open discussion is welcomed even on controversial and topical issues. Young people may feel that they lack a voice in a debate which is about them. Consequently, HFLE is a measure used to uphold several youth and adolescent rights, namely the right to health, education, access to information and protection from discrimination. Trinidad and Tobago’s young people represent one of the country’s most vulnerable and marginalized populations, but simultaneously they are a dynamic group with innovative ideas, passion and a desire to change the future. We should seek to empower our youth, thereby harnessing this limitless passion and channeling it towards effecting positive change whilst promoting responsibility. Health and Family Life Education is a proven means of accomplishing this all important goal.
1 IPPF, From Evidence to Action: Advocating for Comprehensive Sexuality Education, 2006 2 This year’s meeting (April 23-27) adopted a landmark resolution on Adolescents and Youth, its first ever on this subject matter. The resolution provides a groundbreaking framework for action on the health and human rights of adolescents and youth. 3 http://www.un.org/esa/population/cpd/cpd2012/Agenda%20item%208/Chairs%20Text%20_27April-19h10.pdf 18
LETTERS TO THE EDITOR
HIV and Human Rights – reshaping the PANCAP agenda Caleb Orozco The use of litigation to address the creation of an enabling environment is the only effective tool in challenging political leaders to uphold constitutional rights; the status quo and society’s perception of rights violation and discrimination. It must be led by marginalized populations and must be sustained with a clear communication plan to engage imported Christian right wing thinking that operates in the region under the guise of protecting national sovereignty and Christian values. Litigation, however, must be complemented with a communication plan addressing cultural attitudes that perpetuate political leaders justification for rights exclusion.
Caleb Orozco is an LGBT/Human Rights activist who has worked to advance Human Rights, Sexual Orientation and Gender Identity Resolutions within the LGBTTI Latin America and Caribbean Coalition
The United Belize Advocacy Movement (UniBAM) acknowledged synergies of access to legal advocacy, support from the University of The West Indies Rights Advocacy Project (URAP). Litigation preparations were a three and half year process that translated into filed action in 2010 in the Belizean Supreme Court. When UniBAM and I sought to challenge the constitutionality of section 53 of the Belize criminal code, we knew we were breaking new ground in the region. While Belize is the only place that has an active in-country legal challenge in the region, it is not the only country in the region seeking to amend a discriminatory law. Jamaican Attorney Maurice Tomlinson from the organization AIDS Free World announced in October 2011, his organization was seeking to lodge a case with the Inter-American Commission for Human Rights on behalf of two gay men. In 2010, while in Guyana, a legal challenge was filed on behalf of four transwomen arrested in February 2009. The transwomen were stripped, denied phone calls, medical attention and detained over a weekend based on an old British colonial era anti-cross dressing statute that is still in effect. Compounding the experience of stigma and discrimination is the refusal of the state to acknowledge that laws help to perpetuate cultural justification of discrimination in education, the workplace and home. This was best reflected by CR McIntosh, Former Dean & Prof of Jurisprudence Faculty of Law, UWI, Cave Hill who said:
…while we readily recognise the majoritarian principle as one of the defining principles of constitutional, democratic rule, we are yet mindful of the fact that, for this form of governance to have great normative value and any claim to moral distinction, there are certain issues of principle which cannot simply be determined on the grounds of whatever happens to be the desire or the preference of the overwhelming majority of persons in the society. For if that were the case, then minorities in a society would forever be at the mercy of the majority. They would hold their fundamental rights and freedoms at the sufferance of the majority….
Majority thinking has been reflective in regional political statements in quotes from Bruce Golding of Jamaica who in, 2006, said “homosexuals will find no solace in a cabinet formed by me”. Former Dominica, Prime Minister, Roosevelt Skerritt was recorded in December 2008 as saying that buggery would not be made legal under his administration. While in Belize, a former Minister of Public Works said on June 7th, 2011 in response to his position to section 53 challenge. … Why you think God made a man and a woman, man has what woman wants, and woman has what man wants it’s as simple as that. I didn’t make me for no..., I’ll fight tooth and nail to keep that law. I don’t see how that can be right.
On the other hand, credit must be given to those politicians who have made positive public statements on the issues of addressing discriminatory laws such as the former chair for PANCAP and Prime Minister of St. Kitts and Nevis Prime Minister Denzil Douglas. Belize has made progressive statements in the Universal Periodic Review addendum of 2009 in response to recommendation 9, 12 and 28, but in 28 the government responded as follows: While there is no political mandate at this time to amend the relevant legislation, the Government is nonetheless committed to protecting all members of society from discrimination. Indeed protection from discrimination is protected by the Belize Constitution.
Despite constitutions operating in most member states in the Caribbean the words “No political mandate” remains a telling response to the seriousness of representatives of state to address the structural issues of discrimination. It makes the point that because state representatives govern based on perceived majority position and votes, there is little motivation to truly look at the sodomy laws in the region or the broader issues of anti-discrimination legislation. There is model legislation, but without civil society push, it may languish for the next ten years. Litigation is important, as it supports the dignity and rights of a group often ignored in legislative processes and demonized in the society by the Christian Right. Fundamental rights and freedoms have a history of being advanced by persons affected, but eroded on grounds of religious fears. The challenge in the region is ensuring that there is equity in the distribution of legislative justice in member states. We are challenged by the idea, though ill-defined by opponents, that Christian values rather than constitutional rights must prevail.
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LETTERS TO THE EDITOR
Gender Dimensions of the HIV and AIDS Epidemic Valerie Beach Horne
Thirty years into the AIDS epidemic, three years before the time set for achievement of the Millennium Development Goals (MDGs) and despite the many advances in care and treatment, available evidence shows that more females than males are affected by the disease. Women account for nearly half of the estimated 34 million people living with HIV worldwide1. In sub-Saharan Africa, over seventy per cent of the young people (aged 15-24 years) living with HIV are female, while in 2011 in the Caribbean, fifty three percent of people living with AIDS were women. If the spread of HIV is to be reversed, the critical role that gender relations plays in an individual’s sexual and reproductive life, and how it affects HIV prevention must be addressed. The changing face of the epidemic brings into sharp focus the need for a Human Rights approach to care and treatment. Only by so doing can we reduce the gender and social inequalities that shape people’s behaviours and limit their choices. Let us examine some of the contributing factors 1 Many HIV prevention strategies and approaches tend to assume that we live in an ideal world where everyone is equal, free and empowered. They do not take into consideration that varying circumstances can prevent even the well intentioned from opting to abstain from sex, stay faithful to one partner or using condoms consistently. Expecting consistent use of condoms becomes irrelevant and not the first priority, if a woman is being beaten and raped.
Valerie Beach Horne is Strategic Information and Communication, PANCAP Coordinating Unit
2 In reality, in some societies and based on economic circumstances, many women and girls in particular, face a range of HIV-related risk social factors and vulnerabilities that men and boys are exempt from. Many women are in danger of being beaten, abandoned or thrown out of their homes if their HIV-positive status is known, regardless of the source of their infection. 3 Gender is a factor in health-seeking behaviour. Stigma associated with HIV and AIDS is a major factor preventing many women and men from accessing services. This fact is exacerbated by societal status, norms and values, e.g. for sex workers and different sexual orientations.
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Male identity is very much linked to sexual performance. In many societies including ours, men feel pressured to have several sexual partners and experiences to ‘prove’ their masculinity. Safer sex, which entails a reduction in the number of possible partners, avoiding “one night stands” and greater selectivity in sexual partnership may therefore be seen as a threat to masculinity. Young men, in particular, may feel pressured to take unnecessary risks to assert their male identity.
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The other side of the coin is very different. In some societies, if a woman for her own safety seeks information about safe sex, she may be considered promiscuous or adulterous. In cultures where high value is placed on virginity, some young unmarried women and young girls may engage in high-risk behaviors such as anal sex to preserve their virginity. In addition, a woman’s risk for HIV is further exacerbated because she is physiologically two to four times more susceptible to infection than a man. Women have a larger mucosal surface where micro-lesions can occur. Young girls and adolescents, due to their under developed reproductive tracts, are even more susceptible to STIs and HIV.
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Vertical STI and HIV and AIDS services may deter vulnerable women and transgender persons from accessing care. In addition, health providers need to be aware of and sensitive to the possibility of gender violence in the home which can impact negatively not only on accessing care, but on disclosure of HIV + status
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Changes in the family structure due to economic vulnerability of women and men resulting in economically motivated migration and homes headed by grandparents or older siblings. Men also become vulnerable due to migration and occupation, for example, long haul drivers, soldiers or policemen and miners
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UNAIDS 2010 Press Release
LETTERS TO THE EDITOR
Much sexual risk-taking by girls and young women is marked by unequal gender relations, and unequal access to resources, assets, income opportunities and social power. We must take into consideration the role of sexual exploitation at work and at home, transactional and intergenerational sex. In this regard, more must be done to ensure sustainable livelihoods for women and girls, particularly those living in femaleheaded households. Doing so will equip them to protect themselves against HIV infection and deal with its impact. Creating economic opportunities and social power for women should be seen as an integral component of potentially successful and sustainable AIDS strategies. In addition we must accept the fact that the vulnerability of same-sex practicing, and gender non-conforming men and women drives an interlocking set of human rights violations and social inequalities. These factors which result from their sexual and gendered behavior and identity, heighten HIV risk and produce disproportionate HIV prevalence. Gender issues Need Revisiting in the Caribbean HIV affects women and girls and is disproportionately affecting transgender persons as well. Therefore gender issues can no longer be limited to or defined by conventional male or female socially accepted roles. The issue of gender must be ventilated at all levels of society so that we can achieve a clear understanding of how many genders exist in the region and what role sexual orientation plays in the redefinition of gender. Issues confronting gay, transgender or transsexuals should be taken into consideration in this debate.2 We also need to consider the following: 1. A Rights Based approach to HIV and AIDS and other reproductive health services must become the norm and not the exception. Far more
must be done to ensure sustainable livelihoods for women and girls. 2. If HIV-prevention activities are to succeed, they need to occur alongside other efforts which address and reduce violence against women and
girls; particularly those living in female-headed households. 3. Development of gender sensitive strategies designed to raise awareness among women, men, boys and girls about the ways in which gender
differences affect them. 4. Review of the present definitions of masculinity and femininity and identify ways in which the specific needs of all gender can be met. 5. Creation of a truly enabling environment which would promote awareness of the dire impact of AIDS on the entire community, encourage
improved dialogue between the sexes at an early age, and enhance the sensitivity of men and women to the changing nature of societal roles, including sexual roles.
References Women and AIDS� Chapter of the AIDS Epidemic Update 2004 (UNAIDS WHO) UNAIDS KS111 (2011)
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UNAIDS keeping the Score3 – Recommendation 6 21
LETTERS TO THE EDITOR
Full Partnership for Sex Workers Miriam Edwards We all know that the constitution entitles all citizens to be treated equally and to be entitled to earn a living free from fear and to be protected by the law to carry out one’s duties. It is quite clear that these rights are not enjoyed by Sex Workers (SW) in this region. Although my experience is largely in Guyana, my discussions with other SW groups across the Caribbean leads me to believe that with few exceptions, possibly in Suriname, life for SW is a continuous hassle. Persistence of Stigma and discrimination
Miriam Edwards is Executive Director & Project Coordinator, Guyana Sex Work Coalition and President of the Caribbean Sex Work Coalition
There is much talk about reducing stigma and discrimination but from the view point of SW, there is no real evidence that much is taking place. SW continue to feel vulnerable mainly because of a continued lack of protection from law enforcement authorities. From experience, the police –men and women-- are among those who perpetuate stigma and discrimination. There are so many concrete examples to support this view For example, earlier this year a SW was raped. She gave a report at the police station, the police response was: “nothing can be done you are a whore, you’re a madwoman, and you sell your body to these men. Look how you dress” In another case, one transgender sex worker was stabbed at a bar. The Police kept him for nine hours with a fractured jaw that became infected because of lack of immediate medical attention. The Health service is no better. It is clear from the attitudes of the health workers that the rights of SW are abused. Overcoming the challenges
SW have attempted to organize and to collectively make their case to the authorities including Parliamentarians. We have formed a commercial sex workers coalition with a view to setting standards of operation, healthy practices, prevention strategies including use of condoms and regular testing for HIV and other sexually transmitted diseases. We have undertaken public awareness activities with various segments of the population like the police, army, health care workers nurses, hospitality workers and patrons of bars, barbershops and salons on issues of human rights, particularly the SW. We have many partners and have received their support. From the United Nations Population Fund (UNFPA), support has been mainly for sensitizing, counseling and testing and from the National AIDS Programme (NAP), we have received condoms and testing kits. The NAP has also engaged us in decision making fora that deal with solving practical problems. We have also been involved in sessions on the trafficking of persons coordinated by the United States Embassy. These sessions are important for identifying legal boundaries of our actions and ways to protect ourselves from exploitation. While we attend meetings at times and try to use these events to promote our cause, we are left with the feeling that there is no assistance provided for meaningful follow up. Vulnerable communities need to be reclassified because often the sex workers interests are not properly served under the broad umbrella which presently exists. We need both technical and financial support to sustain the gains that we have made and the gaps that we have seen in our work. As a specific grouping we have achieved much. For example, we have helped persons to build on their strengths so that they could start their own in-country organisations. Additionally, because of the Sex Workers Coalition, sex workers are provided with a platform to get their voice heard and we provide safe spaces when these are necessary. Our future plans include expanding our work with women and girls in the riverain areas of Guyana. Based on our observations too many young girls are engaging in sex work. We would like to conduct a survey of why so many girls are getting into sex work and what we need to do to give them alternatives to keep them in school longer. But we need both technical and financial assistance to do so. We face a major challenge of funding. Finally, it is our view that we may need to rethink the organisation of SW as part of a wider umbrella group of vulnerable communities. It is good to work with others, but we feel our issues are not given sufficient focus. We should also be part of the PANCAP partnership in our own right. We need both technical and financial support to sustain the gains that we have made.
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LETTERS TO THE EDITOR
MOVEMENTS! Advancing the fight against HIV and AIDS among youth in the Caribbean Christa Solyen - CARICOM Youth Ambassador, Barbados Tamira Browne - Vice Dean, CARICOM Youth Ambassadors Programme Dwayne Gutzmer - Dean, CARICOM Youth Ambassador Programme In an environment where HIV and AIDS continue to affect the lives of the citizens of the Caribbean, two things are evident: first, young people are in the middle of this battle and second, our educational and advocacy tools must be revamped. The CARICOM Commission on Youth Development (CCYD) ably puts this issue into perspective as it highlights the study conducted by the Pan-American Health Organization (PAHO), which cited HIV and AIDS as the leading cause of death among Caribbean youth. Through research, statistics, peer interaction and experience there is a common understanding that many of the programmes in place are simply not sufficient or effective. Richard Carter’s study in Barbados1 provides qualitative and quantitative information which illustrates that knowledge about HIV and AIDS in most cases does not translate into behavioral change. Caribbean youth can no longer sit back and wait for adults to educate and create policies that propagate the necessary change for them. Young people must be compelled to stand up, act and educate themselves and their peers to effect change. An important element of the HIV and AIDS message is eliminating stigma and discrimination. The negative attitudes of young people that cause stigma and discrimination are constantly reinforced through their environments which make education an important but difficult task. If we recognize that HIV and AIDS messages have to compete with the enticement of negative activity which affect them, then it is evident that we need to “step up” our approach to education. In other words, we need to use creative means and lively discussions to spread positive messages. Our “branding” must be exciting and engaging so that young people will want to learn more and take charge of their lives in a way that promotes good decision making. HIV and AIDS messaging should be empowering! The answer to effective HIV and AIDS advocacy and education cannot be found in a board room or a technical working group without youth input or participation. Rather, solutions to this problem will be found by consultation with a special type of expert. This expert can be found in classrooms, popular “hang out spots” or in youth organizations. The first step in education on stigma and discrimination involves consulting with young people and hearing their views on strategies that work and strategies that do not work. Partnerships should be forged with youth groupsinvolved in HIV and AIDS advocacy, whether they are international like the Youth Advocacy Movement by the Family Planning Association, regional like the CARICOM Youth Ambassadors Programme or national like the United Youth Leaders of Barbados. The National Youth Councils across the region has an important role to play in this regard. The second step is to involve all types of young people - those who like social media, sports, academics, socializing or fashion. There is a place for all young people in HIV and AIDS education and advocacy. When we give young people the opportunity to state their ideas and proposals, they become empowered to be advocates for a cause. Caribbean young people have a way of thinking outside the box, even with the most unorthodox ideas but that is exactly what is needed! The desired effect in any campaign is a chain effect which starts with youth consultation and the creation of campaign strategies. This is followed by educational sessions using the strategies highlighted by young people which should then lead to empowered youth advocates who are involved in peer education. The first two phases are the most important because they require specialists in the relevant area to immerse themselves in the world of a young person. This is a world of hashtags and facebook, these free resources are waiting to be explored. Many campaigns have recognized their importance in recent times and have been benefitting from this type of coverage. The UNWOMEN’s Unite Campaign heavily relies on social media and has involved young people in the creation of campaign strategies which are best practices. Creating a catchy Facebook wall photo can become something viral just by clicking “Share”. This is a powerful tool and if used correctly, could have lasting results. A best practice can be found in the use of regional celebrities as seen in the “Live Up” campaign. This type of campaigning paves the way for local educators to reinforce the message using a hands-on and creative approach. We can never discount the power of testimonies, rap sessions and real life stories in the education process. A safe space must be created where youth are allowed to freely express how they feel and exchange their opinions. Although it has been a point of contention for some persons, sex negotiation and condom demonstrations are important elements of protection and must be used as part of sex education for young adults. They need to be armed with the skills and information needed to lead healthy lives. In any activity aimed at educating young people there are important factors that must be considered. If you can GRAB their attention, SHARE a message and EMPOWER them to be part of a movement, then you have educated their families and friends. Training peer educators the correct way is an important tool in any campaign or strategy targeting young people. Using these tools allow the HIV and AIDS message of protection and ending stigma and discrimination to spread faster (than traditional means) and more effectively. The creation of youth advocates encourages young people to take care of themselves and instills genuine concern for the interests and well-being of their peers. We can no longer use the “sugar coated” and “watered down” approach used previously. There are too many myths about sex and in order to protect our youth, we need to be “straight up” and be honest with them. Young people need to be involved; they need to be seen as key partners. The solution is at our finger tips, our messaging has to be more than a project, it must be a movement!
1 Paper presented at SALISES 7th Annual Conference, Sherbourne Conference Centre, Barbados. “Youth, KAPB and HIV-AIDS: The Challenges for Social Policy”, 29 – 31 March, 2006. http://www.cavehill.uwi.edu/salises/conferences/2006/Youth%20KAPB%20and%20HIV-AIDS%20-%20Carter.pdf
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ADDRESS THE HIV SITUATION IN MARGINALIZED GROUPS TO ACHIEVE UNIVERSAL ACCESS
Address the HIV situation in marginalized groups to achieve universal access Interview with Michel de Groulard by Cedriann Martin Michel de Groulard worked for just a short time in his native France. As a physician, he spent almost a decade providing healthcare services ranging from surgery to obstetrics in African countries. The healthcare access challenges and human interactions that he experienced during that stint prepared him for an eventual career shift to public health, epidemiology and HIV programme support in the Caribbean. Now the Regional Programme Adviser at the Joint United Nations Programme on HIV/AIDS(UNAIDS), de Groulard brings to bear more than 15 years’ expertise in prevention, surveillance and programme development, implementation and monitoring in the regional context. “Over my years with the Caribbean Epidemiology Centre (CAREC) and at UNAIDS, my major contribution was bringing evidence of a generalised epidemic that also has large pockets of concentrated epidemics with vulnerable groups,” he notes. “If we do not address the HIV situation in men who have sex with men and sex workers in particular, we would not achieve universal access in prevention, in treatment or in care”. We asked this unlikely Caribbean voice about the strides and challenges of the region’s HIV response. Q: Reflect on your early years in the Caribbean. What were the main challenges that had to be overcome and how has the region progressed since then? A: At first what was surprising and a bit shocking was that—particularly in the smaller islands—there was a lack of confidentiality and a lack of understanding of the basic human rights of people living with HIV. This means that there was also a lack of appropriate capacity to deal with HIV beyond the health sector response. Also, there was no real focus at the time on most at risk populations. HIV was seen as a generalised epidemic and therefore the response was to the general population with no specific attention to particular groups. This was probably linked to an important data gap as there was no real data on the epidemic apart from the number of reported cases. I would say that a number of countries have built a multi-sectoral response since then. This has helped to move the response beyond the health sector and take into consideration social and development issues that are both affecting the HIV epidemic and resulting from the HIV epidemic. I also think we can say that we have made progress toward eliminating stigma and discrimination, certainly in terms of dealing with people living with HIV. We are still challenged by how the society deals with groups of people that are, or are perceived to be, more at risk for HIV because they belong to marginalised groups. Some of these populations are not socially accepted or even recognised because of the legal environment.
Q: You are recognised as one of the experts in the area of prevention. Where is the region with prevention as a strategy for effectively reducing the spread of HIV? A: We can say that we have achieved a lot on HIV prevention in the sense that the epidemic has been contained to relatively low levels when compared to sub-Saharan Africa. That in itself is evidence that some of the work done in prevention has been effective. Yet today we see that the number of new infections is still high which means that what has been done is not enough and we need to address the most difficult issues by going beyond public education, beyond condom promotion and beyond other strategies like promoting abstinence and faithfulness. We need to address sex and sexuality education and issues of sexualities and all that is related to that. What we do should not only be in terms of bio-medical interventions but also in terms of structural interventions, that is, how the society deals with marginalised populations and how those populations deal with the stigma and discrimination that they are facing. Q: You have witnessed the evolution of PANCAP. What are your thoughts on the partnership’s future? A: PANCAP has achieved a lot in terms of coordination and the mobilisation of resources. It is essential that we keep the regional dimension to the response given the political, population and economic context of the Caribbean. There has to be more regional and national investment at this time of dwindling external support because the need for coordination is still there. The future of PANCAP must be addressed in the context of this reduction in international donor funding as well as in the context of an evolving approach to public health in the region which will include the Caribbean Public Health Agency (CARPHA) coming on board next year. Q: What is the agenda of UNAIDS and its added value for the region? A: UNAIDS prioritises political advocacy for universal access to prevention, treatment and care in accordance with targets from the 2011 Political Declaration on HIV/AIDS. That advocacy includes dimensions related to financial sustainability which means better efficiency, resource allocation and country commitments. We are also committed to the United Nations agenda on human rights, human dignity and gender equality.
One of the top priorities for us in the Caribbean HIV response is social justice which includes the removal of punitive laws that hinder the HIV response. Cedriann Martin is Communications Officer, UNAIDS Regional Support Team, Caribbean
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HIV and Human Rights Reshaping the PANCAP agenda
HIV AND GUYANA’S CHILDREN
HIV AND GUYANA’s CHILDREN: A Discourse in Legal Protection Dela Britton
“…let it be that human rights are women’s rights and women’s rights are human rights once and for all” Hillary Clinton (UN 4th World Conference on Women Beijing, September 1995
Picture this scenario: Felicia who we assume to be aged 10 has the HIV virus and she is abandoned by her natural parents. She resided on the streets of Georgetown until recently. Both the Children’s Home and the Government are in a quandary as to what to do with Felicia.
Children’s rights are also human rights. In Guyana, any person under the age of 18 years of age is defined as a child. Guyana is signatory to a large number of international conventions on the rights of women and children. It has, in accordance with the mandate from the various UN committees, ratified some of these conventions into local law.
The Legal Environment in Guyana Human Rights are those rights which are enjoyed by citizens of any democratic society. They include inter alia the right to life; right to personal liberty; protection from deprivation of property and, for the purposes of this article, right to protection from inhuman treatment and protection from discrimination. No attempt is made here to engage in a scientific discussion on the causes or effects of HIV and AIDS. Rather, the discussion centers on the lacuna, enforcement, interpretation and accountability of various pieces of legislation affecting children and HIV infection. In this regard, the provisions of the Guyana Constitution, the Convention on the Rights of the Child (CRC) and a cursory glance at local laws made as a result of the CRC will be briefly discussed. The Guyana Constitution (with Amendments to 12th August 2003) is the supreme law of the land. This means that any other laws created in Guyana which are inconsistent with the spirit and intent of the Constitution will be unlawful and indeed unconstitutional. In 2003, when various amendments were adopted to this document, the scourge of HIV and AIDS amongst children was already rampant. An extensive portion of the Constitution is dedicated to protection against discrimination. The Constitution further makes it mandatory that the best interests of the child is the primary consideration in all judicial proceedings and decisions. Article 24 of the Constitution expressly provides that ‘every citizen has the right to free medical attention’. It further provides for the establishment through the Women and Gender Commission for the promotion of and research on women’s health, especially reproductive health.
PANCAP PERSPECTIVE 2012
The Constitution defines discrimination (Article 149) as
‘affording different treatment to different people attributable wholly or mainly to their parents or guardians’ respective descriptions of …. Birth, pregnancy… whereby persons of one such description are subjected to disabilities or restrictions to which other persons of the same or another such description are not subject or are accorded privileges or advantages which are not afforded to other persons of the same or another such description’. The Constitution, however, fails to adequately address the issue of diseases such as HIV and AIDS in women and children. Expressed protection should be afforded to such children and indeed their mothers from the highest legislative body in the land and such provision should have been contemplated by the framers of this document. Such broad provisions, therefore, are now left to the interpretation of judges who, by virtue of being human, could bring their own biases and prejudices to bear when deliberating on how to protect children affected with HIV. In 1991, Guyana became a signatory to the CRC. The CRC is a dynamic document which seeks to preserve and safeguard the human rights of children against all forms of discrimination and punishment. Like the Guyana Constitution, the common golden thread in the CRC is to ensure that all measures are implemented and executed with ‘the best interests of the child’ at the forefront of all deliberations. Article 2 of the CRC urges all State Parties to ‘respect and ensure the rights…to each child within their jurisdiction without discrimination of any kind, irrespective of the child’s, or his or her parent’s … disability, birth or other status’. Further, the aforementioned Article mandates that State Parties ‘take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of status…’ Status here means whether child is born in or out of wedlock. Guyana has removed such labels as ‘bastard’, therefore by law Felicia will not, and should not be stigmatized even though she has been abandoned. Felicia’s guardians may face additional challenges including: determining her date of birth and the identity of the natural parents, if she is unable to properly provide such information. There appears to be no proper database of children who are abandoned and, as such, the relevant Ministry officials might be forced to engage the services of a doctor in order to pronounce on Felicia’s age. The article pertaining to Health (Article 23) under the CRC focuses on the disabled child and not on the child affected with the AIDS virus. Article 24 deals with other issues relating to children’s health but therein lies another lacuna as Article 24(2)(c) and 24(2) (d) merely makes provision to ‘combat disease..’. and ‘to ensure appropriate pre and post natal health care for mothers. Nowhere is there provision for mothers or children affected with the virus.
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HIV AND GUYANA’S CHILDREN
No mention in the CRC is made directly or indirectly for the treatment of HIV positive children as it relates to the areas of Adoption (Article 21); Education (Articles 28 & 29) and Juvenile Justice (Article 37). In 2009, executing its mandate under the CRC, the Guyana Parliament passed three important pieces of legislation as it relates to children, namely: the Childcare and Protection Agency (Act No. 2 of 2009), Protection of Children Act (Act No. 17 of 2009) and the Adoption of Children Act 2009). The purpose of the Childcare and Protection Agency Act was to establish the namesake Agency and to enumerate its various functions. It is to be read in conjunction with the Protection of Children Act. Principal amongst the duties of the Agency is to ‘… have responsibility for the implementation of the policy and decisions as it relates to the laws governing children’. More importantly, the Agency is clothed with wide ranging functions as it relates to Guyana’s children. Interestingly at section 5(1) (k) of the Act, provision is made for the following:
‘to provide care and protection for children under special vulnerability including orphans, children infected with or affected by HIV and AIDS …’ It is important to note that only the children who are in need of protection fall under the auspices of this Act, not children who are leading balanced ‘non- abused’ lives. The Childcare and Protection Agency Act makes provision for the protection of the privacy of the child as it relates to disclosure of information regarding the child in proceedings before the court or any other authority established by or under any law (emphasis applied). However, there is no such umbrella privacy protection of the medical records of the child affected with HIV in day to day situations. Like its sister Act, Section 5 of the Protection of Children Act 2009, makes the following provision: ‘All relevant factors shall be considered in determining a child’s best interest including (1) Any issue to be considered where a child is HIV positive or has special needs’. The Act has many innovative provisions. These include making it mandatory for persons who have direct information on a child, in need of protection (which may include children who are HIV positive and in need of the relevant care) to report such abuse to the Director of the Child Care Agency, Police Officer or Probation Officer (Section 7). Upon receipt of the report of abuse or lack of care, Section 8 makes it mandatory that the Director of the Agency or a social worker assess whether the child is in need of protective intervention. The Act also makes provision for the Director or social worker to interview the child. If access is denied to the child, the Director may apply to the court for either such access or for an order to prohibit contact between the negligent parent or guardian with the child. It also provides for application to the court for an order of removal of the child from the environment if other forms of intervention have proved futile. The Act provides that such decision of the Court to so remove the child shall be in writing within 90 days after the filing of the application - this is an inordinate amount of time for a child who is HIV positive and whose survival may depend on a swift decision. Given the tremendous backlog of general cases in Guyana- this provision does not adequately adhere to the ‘best interests of the child’s ‘principle. According to the Director of the Agency, the Agency does not discriminate against children like Felicia. Upon detection of the virus, the Health Care
PAGE 26
system would refer children and their parents/guardians to the Agency which in turn would ensure that they receive adequate and appropriate health care. The Director further stated that the Agency maintains a database of the care-plan and history of all children who are HIV positive. She had high praise for the Health Science Unit which is responsible for the training of the Agency’s caregivers, especially as it related to sensitizing and providing information on the virus and dietary needs of the child. The Adoption of Children Act 2009 makes reference to the aforementioned Childcare and Protection Agency Act in that it states that any matters not covered by the Adoption Act shall be in accordance with section 4 of Childcare Act as it relates to the implementation of policy and decisions governing children. The Adoption Act makes provision for the dispensation with the consent of a parent who ‘has persistently failed without reasonable cause to dispense the parental duties in relation to the child’ or ‘has abandoned, neglected or persistently ill-treated the child’ (Section 20(1)(iii) and(iv) respectively. Such neglect or dereliction of parental duties in this regard could include failure to seek or provide adequate medical care for a child suffering with HIV. ‘Orphans’ such as Felicia become wards of the State. The Childcare and Protection Agency therefore becomes responsible for her care, custody and control until she is either placed in foster care, or is adopted by a couple or a single person as per the provisions of the Adoption Act. Similarly, the Act makes provision contained in Section 40(2)(a) and (b) for the revocation of adoption order, if the Court is of the opinion that the adoptive parents ‘evade the fulfillment of their parental duties; neglect, fail or refuse to perform parental duties and responsibilities …’ When retained to make application for adoption of a HIV positive child in 1999, it was appalling then to witness firsthand the opposition and discrimination meted out to the adoptive parents at the hands of the Social Worker. This was mainly because the Social Worker attached to the Children’s home did not demonstrate the tact necessary to deal with children affected with HIV. The writer cannot vouch for the confidentiality and or the professionalism of the personnel who deal with children affected by HIV since the advent of the Childcare and Protection Agency Act 2009 and the other pieces of legislation discussed. However, thanks to the establishment of the Childcare and Protection Agency it is anticipated that any prospective adoptive parents would fare better in their process. Guyana is to be commended for the passage of the pieces of legislation. It is useful to note, however, an approach by this writer to a US government funded Agency committed to dealing with persons affected by HIV and AIDS, regarding this article, revealed that while every pre natal clinic is required to urge the expectant mother to take an HIV test, there was no legal protection for mothers or children affected with HIV.
Recommendations This brings to the fore, the fact that more could be done to bolster the legislative framework pertaining to children living with HIV. In this regard, the following recommendations are submitted for immediate consideration: • Establish a technical working group which will include Government Agencies of Health, Youth, Education and Social Services, NGOs, Legal Personnel and Civil society to develop and oversee the: -
implementation of a separate non-discrimination law;
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
HIV AND GUYANA’S CHILDREN
-
implementation of a Patients’ Bill of Rights for all hospitals and clinics
-
development of a National Database of persons affected with the HIV virus
-
reform of relevant Acts including Ministry of Health Act; Education and Juvenile Justice
-
wider development of awareness programmes on the promotion and protection of human rights and education regarding children who are HIV positive;
-
training programmes to include wider personnel such as educators in the specified area of persons living with HIV;
-
development and maintenance of a cadre of social workers who will be engaged at the Family Court;
-
creation and maintenance of a Register with information on the birth of all children affected by HIV and a system of regular checks with home and school on their progress.
Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses
Sensitization of lawmakers and law enforcement agents
Conclusion This short discourse merely scratches the surface of enhancements which can be made to bolster the legal environment, and it is hoped that it will generate action to address the rights of children living with HIV. The old adage that ‘children are our future’ immediately comes to mind in light of Felicia’s plight. HIV protection should be a high priority on the Government of Guyana’s agenda as it relates to such issues of education, health and the status of children affected with HIV. Without question, if the disease is allowed to spread unchecked especially in developing countries, this will threaten the reversal of other vital achievements in human, social and economic development.
These programmes seek to inform and sensitize those who make the laws (parliamentarians) and those who enforce them (Ministers of Interior and Justice, police, prosecutors, judges, lawyers, traditional and religious leaders) about the important role of the law in the response to HIV, e.g. to protect those affected by HIV against discrimination and violence and to support access to HIV prevention, treatment, care and support. Sensitization programmes aim to help ensure that individuals living with and vulnerable to HIV can access HIV services and lead full and dignified lives, free from discrimination, violence, extortion, harassment and arbitrary arrest and detention. Such programmes may include:
If the future plans of Guyana (and other developing countries) are to be realized, then adequate legal protection must be guaranteed to persons and children who are HIV positive. We must all work together to ensure that this becomes a reality for this generation and the next.
•
Sensitization of police regarding HIV and how it is and is not transmitted; the importance of reaching out to and accessing populations at risk; the importance of appropriately addressing domestic and sexual violence cases in the context of HIV; and the negative consequences of illegal police activity on justice and on the HIV response;
•
Facilitated discussions and negotiations among HIV service providers, those who access services and police to address law enforcement practices that impede HIV prevention, treatment, care and support efforts;
•
Information and sensitization sessions for Parliamentarians, personnel of Ministries of Justice and Interior, judges, prosecutors, lawyers, and traditional and religious leaders on the legal, health and human rights aspects of HIV and on relevant national laws and the implications for enforcement, investigations and court proceedings;
•
Training for prison personnel regarding the prevention, health care needs and human rights of detainees living with or at risk of HIV infection; and
•
HIV in the Workplace programmes for law makers and enforcers.
Attorney at Law, Ms. A. Dela Britton has been in practice for over 15 years. She is currently the Managing Partner of Britton, Hamilton and Adams Law firm in Georgetown, Guyana
REFERENCES The Guyana Constitution Laws of Guyana UNICEF Draft Report: Legislative Analysis for 2010 Situation Assessment and Analysis of Women and Children. Dela A Britton UN Declaration on Human Rights The Convention on the Rights of the Child Materials from the Internet Director of Childcare and Protection Agency- Ms Ann Greene
Source : UNAIDS (2012)
Executive Director for Artistes in Direct Support- Ms Desiree Edghill
PANCAP PERSPECTIVE 2012
PAGE 27
CARIBBEAN HIV AND AIDS ALLIANCE’S CONTRIBUTION
Advancing the Human Rights Agenda in the Caribbean: Caribbean HIV and AIDS Alliance’s contribution Dr. Denise Chevannes-Vogel
Since its inception, the Caribbean HIV and AIDS Alliance (CHAA) has developed successful human rights based models to mitigate the impact of HIV and AIDS in the region. CHAA works specifically to empower and mobilise communities to carry out HIV prevention, care and support activities in three key populations at higher risk of infection: men who have sex with men (MSM), sex workers (SW) and people living with HIV (PLHIV). The portfolio of CHAA consists of five main elements: (1) prevention (2) health services and empowering PLHIV (3) care and support of people living with HIV (PLHIV) (4) peer support and (5) acceleration of the private sector response to HIV&AIDS. Headquartered in Trinidad and Tobago, CHAA also has country offices in Jamaica, Antigua and Barbuda, Barbados, Dominica, Grenada, St Kitts and Nevis, St. Lucia, and St. Vincent and the Grenadines. In its rights-based programme, CHAA is guided by the priorities of the PANCAP Caribbean Regional Strategic Framework (2008-2012) as well as the National Strategic Plans of the countries in which it works. Cognisant of the varied human rights conventions and declarations to which many countries in the region are signatory, CHAA’s engagement in HIV and human rights is further under-girded by the United Nation’s Universal Declaration of Human Rights in which the rights, values and opinions of people are respected regardless of their socio-economic and/or HIV status.
Ensuring the meaningful involvement of key populations at higher risk of infection One of the most successful models in our integrated human rights approach is the meaningful involvement of peer outreach workers or Community Animators. These Animators are from key populations at higher risk of infection. They have been trained and mobilised to deliver prevention and education services in a manner that protects, promotes and fulfils the rights of all persons to universal access to HIV prevention, care, support and treatment. At this time, CHAA engages 40 Community Animators across 7 countries in its work.
CHAA’s programming and advocacy work acknowledges that the protection of human rights yields optimal results in health care access and service delivery. It has built capacity for human rights based responses and supported civil society partners to advocate for programming, policies and laws that protect people living with HIV and support those most vulnerable to HIV infection. In this context, CHAA has partnered with critical stakeholders such as National AIDS Programmes, civil society organisations, the police, policy makers and faith based leaders to help sensitise them to the needs of key populations and the public health imperatives of supporting prevention and care. CHAA’s multi-sectoral approach has also extended to the private sector with its work in the tourism industry in Jamaica and Barbados to reduce stigma and discrimination against tourism workers. Using a rights-based education and training approach, CHAA mobilised tourism workers to actively engage in HIV communication programmes and to better articulate their health needs and rights. It has also produced two publications, “A compendium of Best Practice Case Studies” and a “Toolkit of HIV&AIDS and Responsible Tourism Models in the Caribbean”. The CHAA S&D approach operates at individual, community and structural levels. At the community level, the intent is to mobilise community groups to work with stigmatised groups not only to challenge S&D, but to actively participate in the response to HIV at the research, policy and operational levels. One such initiative recently took place in St Kitts and Nevis with the implementation of over 20 community level consultations. It is hoped that the consultations contribute to a reduction in the incidence of HIV and related S&D, and increase freedom of sexual expression. The consultations sought to assess participants’ understanding of S&D and Human Rights. Information was also obtained on persons and groups whose rights had been infringed or violated, and suggestions were made on how those violations could be addressed. “The consultations were at times heated and controversial but they resulted in rich sources of information, and served as a platform for educating the participants about their human rights as well as the rights of other persons in the community.” Teddy Leon, CHAA Senior Programme Officer, Barbados
Addressing the structural determinants of stigma and discrimination (S&D) CHAA addresses stigma and discrimination (S&D) by supporting advocacy efforts for political change to create the right environment for key populations to take control of their sexual and reproductive health rights and to access health care in a manner that is appropriate to their needs. This right-based approach was evident in the development of anti-stigma and discrimination toolkits which CHAA completed on behalf of PANCAP for use by a variety of audiences. These include, persons living with HIV, health care workers, private sector, tourism sector, and educators.
PAGE 28
HIV and Human Rights Reshaping the PANCAP agenda
CARIBBEAN HIV AND AIDS ALLIANCE’S CONTRIBUTION
CHAA has actively engaged faith-based organisations (FBOs) which have the potential to serve as a cornerstone in the HIV response. Recently, CHAA facilitated workshops on S&D for faith leaders, including 125 leaders from the Southern Caribbean Methodist conference, and 40 leaders from the Evangelical churches in St Kitts and Nevis. The workshop examined specific activities that the Church could undertake such as the development of key messages. Participation by Animators proved to be very powerful as they spoke frankly about how the Church could improve so that their clients would feel welcome. It also allowed the Faith partners to better understand the daily challenges many persons from key population groups feel and that they wish to feel included and not stigmatised against. As an Animator said: “As Caribbean people most of us are raised in the Church – so we want to feel we can come back to the Church in our times of need regardless of the paths that we may take along the way – please don’t judge us for being sex workers or MSM – please look at us as the same as you are – we are still capable of doing good things”
condom use, sexual behaviour, sexual communication, and sexual assertiveness skills and that their partners will be more likely to adopt and support consistent condom use.
Empowering men who have sex with men In seeking to promote health seeking behaviours and access to services of MSM, CHAA is collaborating on Mpowerment, a CDC evidence-based intervention that focuses on the specific needs of MSM. Consultation on the adaptation of Mpowerment for Barbados took place following a feasibility study and is the basis of a proposal for an adapted version of Mpowerment that is currently being further explored for possible implementation. The potential of Mpowerment lies in its ability to help: •
Empower gay men to protect themselves, encouraging safer sex norms and behaviours within the social networks of peers.
•
Recognising the importance of gender and human rights
Shift the cultural and social norms within the gay community regarding safer sex.
•
Create further awareness among gay men regarding their rights and how to better challenge or respond to instances of stigma.
CHAA works to address harmful gender norms and stereotypes by continuing to broaden its programming to include issues of gender-based violence, sexual decision-making, and sexual and reproductive health and rights. Gender and social equity are cross cutting in all our programmes and are at the forefront of our programme design.
In conclusion, CHAA remains committed to continuing to partner with PANCAP and other critical stakeholders to advance the HIV and human rights agenda in the region. We are impassioned by the work that we do and the positive difference that we make to the lives of persons from key populations. As one of our Animators succinctly remarked:
In carrying out a body of seminal work on gender and human rights, CHAA has collaborated on a Centers for Disease Control (CDC) evidencebased intervention, Sisters Informing Sisters about Topics on AIDS (SISTA), to adapt the intervention to the Caribbean context. Targeting vulnerable women, SISTA is a group-level training intervention designed for heterosexual women (ages 18-29) who engage in sexual behaviours that increase their vulnerability for HIV infection. The goal of SISTA is to reduce women’s risk of contracting HIV infection by encouraging consistent condom use with male partners. SISTA focuses on building self-esteem; providing information on HIV risk reduction, communication, and proper condom use; and developing partner norms supportive of consistent condom use. To date, more than 200 women in St. Kitts and Nevis and St. Lucia have been trained. It is anticipated that participants in the social-skills intervention will demonstrate increased consistent
Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses PANCAP PERSPECTIVE 2012
‘If you have never been in sex work, it’s hard for you to understand information that is shared with you. If you’ve been there you can understand social issues that impact sex workers, and you can make plans to address these issues. You have sex workers that experience gang rape, domestic violence, and financial difficulty. I work with sex workers and if they say to me, ‘A condom broke last night’, or ‘somebody hit me’, I am not gonna say, ‘Well, I understand’. I understand because I really do understand, I’m not saying that just to comfort them, which I think really means a lot. Having been there also lets you have the passion for doing what you are doing. It gives me the strength to want to advocate on their behalf.’
Althea, CHAA Community Animator Dr. Denise Chevannes-Vogel is Chief of Party
Legal Literacy (“know your rights”) Legal literacy programmes teach those living with or affected by HIV about human rights and the national and local laws relevant to HIV. This knowledge enables them to organize around these rights and laws and to advocate for concrete needs within the context of HIV. Thus, these programmes focus on both legal and rights knowledge and on strategies regarding how to use this knowledge to improve health and justice. The programmes may also provide information on different legal or human rights fora in which one can advocate or seek redress, such as patients’ rights groups, ombudsmen offices and national human rights institutions. Legal literacy programmes can form part of other HIV services (e.g. health care provision, prevention outreach, peer education, support groups, in prisons) or can be stand-alone programmes involving such activities as: •
Awareness-raising campaigns that provide information about rights and laws related to HIV through media (e.g. TV, radio, print, Internet);
•
Community mobilization and education;
•
Peer outreach; and
•
Telephone hotlines.
Source: UNAIDS (2012)
PAGE 29
UNESCO’S CONTRIBUTION
Advancing the Human Rights Agenda through Education: UNESCO’s contribution
As outlined in our Organization’s current Strategy for HIV and AIDS, UNESCO’s response to the epidemic is structured around three strategic priorities – Building country capacity for effective and sustainable education responses to HIV; Strengthening comprehensive HIV and sexuality education; and Advancing gender equality and protecting human rights. Drawing on the Organization’s unique mandate in education, the sciences, culture, and communication and information, these priorities guide our contribution to UNAIDS Strategy and Outcome Framework 2011-2015. The UNESCO Kingston Cluster Office for the Caribbean covers 17 countries in the region. In keeping with UNESCO’s convening role within the revised UNAIDS Division of Labour to ensure good quality education for a more effective HIV response, it continues to give the highest priority to strengthening the capacity of the education sector in these countries to respond effectively to the AIDS epidemic. Since 2002, it has been supporting Ministries of Education to develop, strengthen and implement education sector policies on HIV and AIDS, enabling a policy and regulatory environment that advocates for the rights of education staff and learners alike. Through global initiatives such as EDUCAIDS, UNESCO has supported schools to provide safe, supportive learning environments that incorporate measures to eliminate discrimination, abuse, sexual harassment and violence, including gender-based violence. It has also promoted universal access to HIV prevention, treatment and care and support services. UNESCO supports the rights of HIV-positive learners and educators and the enforcement of laws and policies against stigma and discrimination in educational settings. In 2009 the Kingston Office supported the
PAGE 30
Caribbean Child Development Centre at the University of the West Indies to carry out research on the effects of HIV and AIDS related stigma and discrimination on children’s school experience and educational outcomes in Guyana and Saint. Lucia. The findings of that research were widely disseminated among education stakeholders in both countries and used to inform communication and other strategies to raise national awareness of education sector policies on the issue. UNESCO promotes the principles and the right for the Greater Involvement of Persons Living with AIDS (GIPA) in the education sector’s response to HIV and AIDS. In this context, it has partnered with the Education Development Centre Inc. (EDC) in 2010 to develop a toolkit to assist education sector staff, networks of PLHIV, and others to apply the GIPA principles as a comprehensive approach to the education sector’s response to HIV and AIDS. The process used to develop the Toolkit was in itself an application of GIPA principles. People living with HIV participated in the decision-making and implementation of activities. They served as co-writers of the Toolkit and in its piloting in The Bahamas and Jamaica, served as facilitators and provided feedback. Through the combined efforts of its education, culture, communication and information programmes, the Kingston office supports innovative and cultural approaches to inclusive education in formal and non-formal education settings, targeting socially vulnerable and at-risk populations, including people living with HIV, persons with disabilities and young people. To illustrate, in 2009, the Office partnered with the youth organization, PANDEMOVE, the Health, Hope and HIV Network (HHHN), the Ministry of Education and the National AIDS Secretariat in Antigua and Barbuda, to compile, print and disseminate a collection of testimonials of persons living with and affected by HIV in that country. Because many young people still lack access to the information, skills and
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
HIV-related legal services
UNESCO’S CONTRIBUTION
HIV-related legal services can facilitate access to justice and redress in cases of HIV-related discrimination or other legal matters. These might include: estate planning; breaches of privacy and confidentiality; illegal action by the police; discrimination in employment, education, housing or social services; and denial of property and inheritance rights. Specifically, these services may include: •
Legal information and referrals;
•
Legal advice and representation;
•
Alternative/community forms of dispute resolution;
•
Engaging religious or traditional leaders and traditional legal systems (e.g. village courts) with a view to resolving disputes and changing harmful traditional norms; and
•
Strategic litigation.
Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses
(Source: UNAIDS 2012)
The 2010 report of the UN Special Rapporteur on the right to education focused on the human right to comprehensive sexuality education as a means to realizing other human rights. It emphasized that the right to sexuality education is grounded in human dignity and in international human rights law, and highlighted the importance of comprehensive sexuality education in view of the threat of HIV.
bullying in educational institutions. On May 17, 2012, the day on which IDAHO is observed globally, the Kingston Office partnered with UNICEF, the British High Commission and other members of the diplomatic corps and civil society in Jamaica to support the Jamaica Forum for Lesbians, Gays and All-Sexuals (JFLAG) in a public forum to commemorate IDAHO in Jamaica. More than 80 participants attended the forum which was held in Kingston under the theme, “Right the Wrong: Encouraging Respect for Safer Schools and Better Learning Environments.”
UNESCO seeks to strengthen the capacity of the education sector in the Caribbean to deliver culturally appropriate, scientifically accurate, age and gender sensitive sexuality education. The Kingston Office is partnering with UNICEF and the University of the West Indies Open Campus, along with other members of the CARICOM Regional Working Group on Health and Family Life Education (HFLE), to enhance teacher training to deliver life-skills based HFLE. This will be done through the development of a professional diploma in HFLE Instruction, to be offered on-line in 2013.
The Kingston office continues to implement its multi-disciplinary programme actions in the Caribbean region for the 2012-2013 biennium and beyond. This is being done in partnership with UN Country Teams and national UN Joint Teams on HIV. The UNESCO office will continue to adopt a human rights-based approach that emphasizes equality, non-discrimination, participation and accountability, and will work to reduce stigma and discrimination, promote tolerance and uphold the rights of people affected by HIV and of those who are particularly vulnerable to HIV.
services required to prevent HIV, UNESCO champions comprehensive sexuality education within the context of wider health promotion.
UNESCO promotes the human right to a quality education, reflected in its commitment to the principles and goals of Education for All (EFA). Reflecting on these principles and building on its engagement to stop violence in schools, its work to address all forms of discrimination and gender-based violence, and its expertise in HIV and sexuality education, UNESCO convened the first-ever United Nations’ international consultation on homophobic bullying in educational institutions in December 2011 in Rio de Janeiro, Brazil. This event brought together experts from UN agencies, NGOs, ministries of education and academia from more than 25 countries around the world. Early in 2012, UNESCO commemorated the International Day Against Homophobia/Transphobia (IDAHO) in partnership with the IDAHO Committee, under the theme, “Combating Homo/Transphobia In Education and Through Education” by organising a meeting, broadcast live via web streaming, at its Headquarters in Paris. Speakers and participants included Mr. Louis-George Tin, the Founder of IDAHO and President of the IDAHO Committee as well representatives of the United Nations Office of the High Commissioner for Human Rights (OHCHR). In May, 2012, UNESCO launched the resource, Education Sector Responses to Homophobic Bullying, the eighth publication in its series on Good Policy and Practice in HIV and Health Education. The publication contains practical guidance for developing and implementing policies, interventions and practical tools to prevent and address homophobic
PANCAP PERSPECTIVE 2012
(Left to Right) Minister of Education, Jamaica, Hon. Ronald Thwaites, Canadian High Commissioner to Jamaica, Stephen Hallihan, UNESCO Director and Representative, Kwame Boafo, British High Commissioner, Howard Drake and UNICEF Representative, Robert Fuderich, at the IDAHO event in Kingston Jamaica on 17 May, 2012 source: British High Commission Kingston http://ukinjamaica.fco.gov.uk
PAGE 31
HIV&TH HIV&TH GLOBAL COMMISSION ON HIV AND THE LAW: RISKS, RIGHTS & HEALTH
Global Commission on HIV and the Law: Risks, Rights & Health CONTINUED FROM PAGE 9
3.4.4 Amend national anti-discrimination laws to explicitly prohibit
MEN WHO HAVE SEX WITH MEN
discrimination based on gender identity (as well as sexual orientation).
3.3 Countries must reform their approach towards sexual diversity.
Rather than punishing consenting adults involved in same sex
3.4.5 Ensure transgender people are able to have their affirmed
activity, countries must offer such people access to effective HIV and
gender recognised in identification documents, without the
health services and commodities. Countries must:
need for prior medical procedures such as sterilisation, sex reassignment surgery or hormonal therapy.
3.3.1 Repeal all laws that criminalise consensual sex between
adults of the same sex and/or laws that punish homosexual
PRISONERS
identity. 3.5.1 Necessary health care is available, including HIV prevention 3.3.2 Respect existing civil and religious laws and guarantees
relating to privacy.
and care services, regardless of laws criminalising samesex acts or harm reduction. Such care includes provision of condoms, comprehensive harm reduction services, voluntary
3.3.3 Remove legal, regulatory and administrative barriers to the
and evidence-based treatment for drug dependence and ART.
formation of community organisations by or for gay men, lesbians and/or bisexual people.
3.5.2 Any treatment offered must satisfy international standards
of quality of care in detention settings. Health care services, 3.3.4 Amend anti-discrimination laws expressly to prohibit
including those specifically related to drug use and HIV,
discrimination based on sexual orientation (as well as gender
must be evidence-based, voluntary and offered only where
identity).
clinically indicated.
3.3.5 Promote effective measures to prevent violence against men
MIGRANTS
who have sex with men. 3.6.1 In matters relating to HIV and the law, countries should offer
TRANSGENDER PERSONS 3.4 Countries must reform their approach towards transgender people.
the same standard of protection to migrants, visitors and residents who are not citizens as they do to their own citizens.
Rather than punishing transgender people, countries must offer transgender people access to effective HIV and health services and commodities as well as
3.6.1 Countries must repeal travel and other restrictions that
prohibit people living with HIV from entering a country and/ or regulations that mandate HIV tests for foreigners within
3.4.1 Respect existing civil and religious laws and guarantees
a country.
related to the right to privacy. 3.6.1 Countries must implement regulatory reform to allow for legal 3.4.2 Repeal all laws that punish cross-dressing.
registration of migrants with health services and to ensure that migrants can access the same quality of HIV prevention,
3.4.3 Remove legal, regulatory or administrative barriers to formation
treatment and care services and commodities that are available
of community organisations by or for transgender people.
to citizens. All HIV testing and STI screening for migrants must be informed and voluntary, and all treatment and prophylaxis for migrants must be ethical and medically indicated.
PAGE 32
HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
HE LAW HIV&THE LAW
Global Commission on HIV and the Law: Risks, Rights & Health
4. WOMEN
4.1 Countries must act to end all forms of violence against women and girls,
4.3.2 Health care workers are trained on informed consent,
including in conflict situations and post-conflict settings. They must: 4.1.1 Enact and enforce specific laws that prohibit domestic
confidentiality and non-discrimination. 4.3.3 Accessible complaints and redress mechanisms are available
violence, rape and other forms of sexual assault, including marital rape and rape related to conflict, whether perpetrated against females, males or transgender persons.
in health care settings. 4.4 Countries must reform property and inheritance laws to mandate that
women and men have equal access to property and other economic resources, including credit. They must take measures to ensure that
4.1.2 Take judicial or legislative steps to remove any immunity–or
in practice property is divided without gender discrimination upon
interpreted immunity–from prosecution for rape when the
separation, divorce or death and establish a presumption of spousal
perpetrator is a married or unmarried partner.
co-ownership of family property. Where property and inheritance practices are influenced or determined by religious or customary
4.1.3 Fully enforce existing laws meant to protect women and girls
from violence, and prosecute perpetrators of violence against
legal systems, the leaders of these systems must make reforms to protect women, including widows and orphans.
women and girls to the full extent of the law. 4.5 Countries must ensure that social protection measures recognise 4.1.4 Formulate and implement comprehensive, fully resourced
and respond to the needs of HIV-positive women and women whose
national strategies to eliminate violence against women
husbands have died of AIDS and that labour laws, social protection
and girls, which include robust mechanisms to prevent,
and health services respond to the needs of women who take on
investigate and punish violence. Provision of health services,
caregiving roles in HIV-affected households.
including post-exposure prophylaxis, legal services and social protection for survivors of violence, must be guaranteed. 4.2 Countries must prohibit and governments must take measures
4.6 Countries must ensure that laws prohibiting early marriage are
enacted and enforced.
to stop the practice of forced abortion and coerced sterilisation of HIV-positive women and girls, as well as all other forms of violence against women and girls in health care settings.
4.7 The enforcers of religious and customary laws must prohibit practices
that increase HIV risk, such as widow inheritance, “widow cleansing” and female genital mutilation.
4.3 Countries must remove legal barriers that impede women’s access
to sexual and reproductive health services. They must ensure that: 4.3.1 Health care workers provide women with full information
5. CHILDREN AND YOUTH 5.1 Countries must enact and enforce laws that:
on sexual and reproductive options and ensure that women can provide informed consent in all matters relating to their
5.1.1 Ensure that the birth of every child is registered. This is
health. The law must ensure access to safe contraception and
crucial for supporting children’s access to essential services.
support women in deciding freely whether and when to have
Ensure that their rights are protected and promoted, as per
children, including the number, spacing and methods of their
the Convention on the Rights of the Child.
children’s births.
PANCAP PERSPECTIVE 2012
PAGE 33
HIV&TH HIV&TH GLOBAL COMMISSION ON HIV AND THE LAW: RISKS, RIGHTS & HEALTH
Global Commission on HIV and the Law: Risks, Rights & Health 5.1.2 Ensure that every orphaned child is appointed an appropriate
health services is equal to or lower than the age of consent for sexual
adult guardian. This includes provisions for transfer of
relations. Young people who use drugs must also have legal and safe
guardianship of AIDS orphans from deceased parents to
access to HIV and health services.
adults or older siblings who can ensure their well-being. In selecting a guardian, preference should be given to adults from the biological or extended families. HIV-positive adults
6. INTELLECTUAL PROPERTY LAW AND THE GLOBAL FIGHT FOR TREATMENT
who are otherwise in good health should not be prohibited from adopting children.
6.1 The UN Secretary General must convene a neutral, high-level body
to review and assess proposals and recommend a new intellectual 5.1.3 Support community-based foster care for children orphaned
property regime for pharmaceutical products. Such a regime should
by AIDS as an alternative to institutionalization, when formal
be consistent with international human rights law and public
adoption is not possible or appropriate.
health requirements, while safeguarding the justifiable rights of inventors. Such a body should include representation from the High
5.1.4 Ensure HIV-sensitive social protections as required, such as
Commissioner on Human Rights, WHO, WTO, UNDP, UNAIDS and
direct cash transfers for affected children and their guardians.
WIPO, as well as the Special Rapporteur on the Right to Health, key technical agencies and experts, and private sector and civil society
5.1.5 Prohibit discrimination against children living with or
representatives, including people living with HIV. This re-evaluation,
affected by HIV, especially in the context of adoption, health
based on human rights, should take into account and build on efforts
and education. Take strict measures to ensure that schools
underway at WHO, such as its Global Strategy and Plan of Action
do not bar or expel HIV-positive children or children from
on Public Health, Innovation, and Intellectual Property and the work
families affected by AIDS.
of its Consultative Expert Working Group. Pending this review, the
5.2 Countries must enact and enforce laws to ensure that children
orphaned by AIDS inherit parental property. Children orphaned by
WTO must suspend TRIPS as it relates to essential pharmaceutical products for low- and middle-income countries.
AIDS should inherit regardless of their sex, HIV status or the HIV status of family members. Such enforcement
6.2 High-income countries, including donors such as the United States,
European Union, the European Free Trade Association countries 5.2.1 Collaboration with the enforcers of religious and customary
(Iceland, Liechtenstein, Norway and Switzerland) and Japan must
laws to ensure justice for children orphaned by AIDS.
immediately stop pressuring low- and middle-income countries to adopt or implement TRIPS-plus measures in trade agreements that
5.2.2 Reconciliation of conflicts between discriminatory customary
impede access to life-saving treatment.
laws and traditional practices and international human rights standards to ensure compliance with international law.
6.2.1 All countries must immediately adopt and observe a global
5.3 Countries must enact and enforce laws ensuring the right of every
moratorium on the inclusion of any intellectual property
child, in or out of school, to comprehensive sexual health education,
provisions in any international treaty that would limit the
so that they may protect themselves and others from HIV infection or
ability of countries to retain policy options to reduce the
live positively with HIV.
cost of HIV-related treatment. Agreements such as the AntiCounterfeiting Trade Agreement (ACTA) must be reformed; if
5.4 Sexually active young people must have confidential and independent
ACTA is not reformed to exclude such intellectual property
access to health services so as to protect themselves from HIV.
provisions, countries should not sign it. All countries must
Therefore, countries must reform laws to ensure that the age of
cease unilateral practices to this same, access-limiting end.
consent for autonomous access to HIV and sexual and reproductive
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HiV AnD HUMAn riGHTS RESHAPING THE PANCAP AGENDA
HE LAW HIV&THE LAW
Global Commission on HIV and the Law: Risks, Rights & Health
6.2.2 High-income countries must stop seeking to impose more
from the application of TRIPS provisions in the case of pharmaceutical
stringent, TRIPS-plus intellectual property obligations on
products. The UN and its member states must mobilise adequate
developing country governments. High-income countries
resources to support LDCs to retain this policy latitude.
must also desist from retaliating against countries that resist adopting such TRIPS-plus measures so that they may achieve better access to treatment.
6.5 The August 30, 2003 Decision of the WTO General Council has
not proved to be a viable solution for countries with insufficient pharmaceutical manufacturing capacity. It is essential that the system established by that decision be revised or supplemented
6.3 While the Commission recommends that WTO Members must urgently
with a new mechanism, to allow the easier import of pharmaceutical
suspend TRIPS as it relates to essential pharmaceutical products for low
products produced under compulsory licence. WTO Members should
and middle income countries, we recognise that such change will not
desist from ratifying the adoption of the August 30, 2003 Decision as
happen overnight. In the interim, even though individual countries may
a new Article 31 bis of the TRIPS Agreement, and they must pursue
find it difficult to act in the face of political pressure, they should, to the
efforts to reform or replace the system.
extent possible, incorporate and use TRIPS flexibilities, consistent with safeguards in their own national laws.
6.6 TRIPS has failed to encourage and reward the kind of innovation that
makes more effective pharmaceutical products available to the poor, 6.3.1 Low- and middle-income countries must not be subject to
including for neglected diseases. Countries must therefore develop, agree
political and legal pressure aimed at preventing them from
and invest in new systems that genuinely serve this purpose, prioritising
using TRIPS flexibilities to ensure that infants, children
the most promising approaches including a new pharmaceutical R&D
and adolescents living with HIV have equal access to HIV
treaty and the promotion of open source discovery.
diagnosis and age-appropriate treatment as adults. 6.3.2 It is critical that both countries with significant manufacturing
capacity and those reliant on the importation of pharmaceutical products retain the policy space to use TRIPS flexibilities as broadly and simply as they can. Low- and middle-income countries must facilitate collaboration and sharing of technical expertise in pursuing the full use of TRIPS exceptions (for instance, by issuing compulsory licences for ARVs and medicines for co-infections such as hepatitis C). Both importer and exporter countries must adopt straightforward, easy-to-use domestic provisions to facilitate the use of TRIPS flexibilities. 6.3.3 Developing countries should desist from adopting TRIPS-
plus provisions including anti-counterfeiting legislation
The full commission report is available at:
that inaccurately conflates the problem of counterfeit or
www.hivlawcommission.org
substandard medicines with generics and thus impedes access to affordable HIV-related treatment.
Follow the Commission on Facebook: www.facebook.com/HIVLawCommission
6.3.4 Countries must proactively use other areas of law and policy
and on Twitter: www.twitter.com/HIVLawCom
such as competition law, price control policy and procurement law which can help increase access to pharmaceutical products. 6.4 The WTO Members must indefinitely extend the exemption for LDCs
PANCAP PERSPECTIVE 2012
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