By Sophie Dilmitis
I recently re-watched the film called ‘And the Band Played On’. The film focuses on the early days when HIV, then called GRIDS, arrived in the gay community in San Francisco and it illustrates how politically charged the epidemic was back then. We see how today politics, denial, gender inequality, issues around ownership and health structures related to public health, continue to be some of the deciding factors that prevent people today from enjoying human rights.
Sadly today people continue to die and to face gross human rights violations in countries where the same governments promise to protect people. As a woman and a member of civil society I feel angry and frustrated with the status quo. Often communities survive and thrive, but only despite the very structures that are there to protect and serve us. In countries most affected by the epidemic human rights have not been meaningfully integrated into everyday life as a fundamental principle of social and political relations. In fact, human rights have often been characterised by governments as a great imposition, and therefore addressed more in the breach than in respect and accountability, most especially when it comes to those who are made vulnerable by the lack of human rights. These include women, who are also lesbian and transgendered women, young people, sex workers, people who use dugs, men who have sex with men and migrants who are blamed for everything under the sun.
Because most often it is the human rights of the vulnerable that governments fail to protect, most people in communities do not understand human rights. They do not know what their governments promised and they are so far down the development line that rights literacy becomes challenging. Sometimes it feels like this is a strategy that governments use to control the impact of human rights commitments on social change at the expense of the communities who most need the protection of the State.
A major challenge with Universal Access is the very language used in the document itself. Universal Access is a “global commitment to provide HIV prevention, treatment care and support to all those in need…” But, there is also language in the document such as “…based on national targets set by countries,” or “…towards a higher level of coverage.” This begs the question of what does “Universal Access” actually mean? This language is problematic and offers governments a way to deliver on their commitment without achieving Universal Access to all those in need.
The major problem with the health care system, which provides us with treatment, is that it is not built on the basis of respecting individual human rights. The health care system structure is set up to leverage systems to ensure the most impact. Moreover, healthcare systems are vulnerable to political agendas. This is why providing comprehensive reproductive services to women, or anal and oral STI care for men who have sex with men who are also having sex with women, becomes contentious. These important health concerns are so easily dropped from a public health agenda, despite the clear and urgent need for such services in communities, especially poor communities.
The ‘right to health’ is thus an important component of a human rights approach to HIV. The right to health includes the right to health care, which embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions and environment. This includes the right to sexual and reproductive health services, access to information, as well as the resources necessary to act on that information.
However, because the focus is on public health and community level outcomes, health care systems do not focus on achieving the highest attainable standard of health for every person. As a result, public health is pinned up against human rights and this is feet at the community level and through a number of global policies such as:
1. Provider initiated HIV testing – which is often not implemented in a way that respects human rights and often short changes or eliminates pre-test counseling, which is critical for people to understand the consequences of testing and life after a positive diagnosis. WeCareHIV, a network that was set up to unite positive women across Europe and Central Asia, did a study earlier this year with 165 women living with HIV and it revealed some shocking figures such as:
- Only 14% where living openly with HIV
- 54% received no counseling upon receiving their diagnosis
- One third of the women had experience some form of violence from their
- Partners – this we see is in line with what is happening globally.
- Only half of these women had chosen to disclose their status to their partners.
2. Criminalising the spread of HIV.
3. Travel restrictions for people living with HIV, as well as sex workers and people who use drugs who are active in the AIDS response.
4. Punitive laws and cultures that support these laws.
As a women’s organisation that has been addressing HIV since the early 1990’s, we struggle with the fact that whilst most UN data shows how women are vulnerable, we are often not thought of by the whole UN system as a most-at-risk population. We understand a very different reality. As an international NGO based in 125 countries working to secure the rights of all women – especially in the AIDS response, we see how global policy impacts women at the community level. As we sit on many committees that support the work of global HIV and AIDS policy, we see women addressed in only one of three ways and not fully supported through the different stages of their life.
Women are almost always addressed in either one of three ways in the AIDS response – Either in prevention of vertical transmission programmes, in the area of sex work, or in generic youth programs that too often blame young women as loose or immoral because they are sexually active. Therefore if you are a woman living with HIV who does not engage in sex work or you are a woman living with HIV who is not pregnant, there is very little out there for you. Although gender inequality is widely recognised as a driver of the epidemic, the budgets and the programming do not support this both at the global level and at almost every country level.
Last week civil society organisations from key populations in the AIDS response united, namely women, including lesbian and transgendered, men who have sex with men, people who use drugs and sex workers in order to secure political commitment to health for all. We have realized that we need to work together – to support each other as civil society and not to be divided and pitted against each other. Too often we are subject to divide and conquer strategies that in the end fail all of us.
In conclusion, communities are doing great work in raising the alarm on crucial gaps as well as providing services, but this needs to happen on a much larger scale. Sadly community responses are seriously lacking in resources to drastically shift the epidemic. We need money and other resources to do the work.
We also see that capacity building approaches need to be more dynamic – we need to move beyond one off workshops that can never address such entrenched challenges. We need to provide more powerfully, enabling opportunities for building capacity and the resourcing of communities to deliver.
There are three key points that we must meet if we are to achieve a health care system that supports human rights:
1. We must ensure that communities around the world understand their human rights. We have to support all people in being able to hold governments accountable. In order to achieve Universal Access we have to mobilise communities at the country level. This is where the governments need to feel the pressure.
2. We have to economically empower women, especially young women, so that they are in better positions to access their rights – often this only comes through economic security.
3. We must also provide comprehensive prevention that addresses sexual and reproductive health, HIV and violence against women. This prevention needs to be fully supported with comprehensive health services for all women irrespective of their socio-economic status, their sexual identity, their profession or their decision to use drugs.
For more information contact:
Sophie Dilmitis, SRHR and HIV Coordinator
16 Ancienne Route CH-1218 Grand Saconnex, Geneva, Switzerland
Telephone (+41) 22 929 60 33 | Telefax (+41) 22 929 6044
Email Sophie.email@example.com | Website www.worldywca.org
www.worldywcacouncil.org | July 10-16, 2011 | Women Creating a Safe World