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In Kenya, networks of key populations and people living with HIV decided to focus on human rights violations among female sex workers living with HIV. Interviews with 30 sex workers living with HIV in six counties – Nairobi, Mombasa, Kiambu, Machakos, Kisumu and Busia – brought to the surface the many human rights violations female sex workers living with HIV face while accessing healthcare services, and violations by law enforcement officers.

Based on real life examples of violations, the Kenyan networks defined recommendations to promote the right to healthcare and access to justice, and to reform laws and policies.

The AIDS and Rights Alliance for Southern Africa (ARASA), Prévention Information Lutte contre le Sida (PILS) and the undersigned civil society organisations call on the Prime Minister of Mauritius to stop the deportation of a young woman from Cameroon solely on the basis of her HIV status. We urge policy makers in Mauritius to review and amend the Immigration Act which specifies that persons afflicted with any infectious disease are prohibited from entering the country.

As part of her study permit application, the female student was tested for HIV upon arrival in Mauritius. After testing positive for HIV, she received a notification letter from the Passport and Immigration Office informing her that the application for her study visa had been denied and that she would be deported from the country.
The determination that the student be deported on the basis that her HIV status is a contagious infection, as provided for in the Immigration Act, is discriminatory. Scientific and medical developments in the last three decades have proven that effective HIV treatment has significantly reduced AIDS-related deaths and has transformed HIV infection from a condition that inevitably resulted in early death to a chronic manageable condition.

It is well accepted that states may not discriminate against people living with HIV or members of groups perceived to be at higher risk of HIV infection on the basis of their actual or presumed HIV status. International human rights law guarantees the rights to equal protection before the law and freedom from discrimination on any ground. The rights to equality and non-discrimination in the context of HIV has in addition been interpreted as imposing an obligation on states to review and repeal any laws, policies and practices to exclude treatment based on arbitrary HIV-related measures. The provisions of the Immigration Act which permit deportation on the basis of HIV status are discriminatory and there is no evidence that laws of this nature protect public health.

The deportation of this student on the basis of her HIV status only is not only contrary to fundamental international human rights, but will undoubtedly fuel the already high rates of stigma and discrimination against people living with HIV in Mauritius. All persons have the right to education and this right extends to people living with HIV. States should ensure that people living with HIV are not discriminatorily denied access to education, including access to schools, universities, scholarships and international education or subject to restrictions solely based on their HIV status.

We appeal to the Mauritian government to make progressive efforts to increase awareness and education on HIV, law and human rights for the general public, government agencies, services providers within key sectors and law enforcement officials. Comprehensive anti-discrimination law that protects people against discrimination on the basis of real or perceived HIV status should be adopted.

Findings and recommendations from studies led by people living with HIV

This report presents the findings of the PHDP survey in Malawi. It describes the experiences of PLHIV in the context of the national scale up of HIV testing, care and treatment with highlights of the important linkages between prevention, treatment, care, support and human rights. This can be used to inform evidence based PHDP programming. The findings of the study were analyzed in relation to the following PHDP components: empowerment, gender equality, health promotion and access, human rights, prevention of new infections, sexual and reproductive health and rights, and social and economic support.

The research was carried out by the Malawi Network of People Living with HIV (MANET+), with support from the Global Network of People Living with HIV (GNP+), conducted a cross-sectional survey among PLHIV to document their experiences in relation to Positive Health, Dignity and Prevention (PHDP) which promotes holistic health and wellness, including human rights, legal protections, policy environment free of stigma and discrimination for PLHIV as well as access to HIV treatment, care and support services and by doing so contributes to the health and wellbeing of their partners, families and communities.

 

 

A new report released by the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW), and other local network partners, calls for dignity and rights in family planning programmes for women living with HIV in Cameroon, Nigeria and Zambia. that calls for discrimination-free family planning services for women living with HIV. The study examined the experiences of women living with HIV in accessing family planning services.

Positive Health, Dignity and Prevention. Findings and recommendations from a study led by and among people living with HIV in Swaziland 2012

At 26% Swaziland’s HIV prevalence is the highest among adults in the world (UNAIDS, 2010). An estimated 210,000 people of all ages are living with HIV in Swaziland. The increasing availability of HIV treatment has enabled people living with HIV (PLHIV) to live longer, healthier lives, and to engage in issues that directly impact on their lives and those of their partners, families and communities. In 2011, the Dutch Postcode Lottery funded a proposal submitted by STOP AIDS NOW! and the MaxART consortium, whose primary objective was to maximize access to antiretroviral treatment (ART) in Swaziland. The scale up in access to, and uptake of, HIV testing and treatment has set the stage for an implementation study to put into practice the exciting new evidence that HIV treatment can also serve as a means of prevention. One of the components of the project was the documentation of the needs and realities of PLHIV in Swaziland, in the context of the national scale-up of access to ART. This helped to continuously improve and develop evidence informed activities.

To this end, MaxART partner organization Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA), with support from the Global Network of People Living with HIV (GNP+), conducted a cross-sectional survey among PLHIV to document their experiences in relation to Positive Health, Dignity and Prevention (PHDP) which promotes holistic health and wellness, including human rights, legal protections, policy environment free of stigma and discrimination for PLHIV as well as access to HIV treatment, care and support services and by doing so contributes to the health and wellbeing of their partners, families and communities. A total of 919 people were reached from the four regions of Swaziland with the support of expert clients who are also people living with HIV.

This report presents the findings of the PHDP survey and it describes the experiences of PLHIV in the context of the national scale up of HIV testing, care and treatment with highlights of the important linkages between prevention, treatment, care, support and human rights. This will go a long way to inform evidence based PHDP programming. The findings of the study were analyzed in relation to the following PHDP components: empowerment, gender equality, health promotion and access, human rights, prevention of new infections, sexual and reproductive health and rights, and social and economic support.

Zambia is one of the more urbanised countries of sub-Saharan Africa with a high rate of population growth. The country has ten provinces that are subdivided into ninety-five districts. Within the districts, the administrative units are Chiefdoms and Constituencies and the latter is made up of Wards.

  • Almost 40 percent live in urban areas .
  • Average household size is 5.2 .
  • Life expectancy is 51.2 years .
  • 45.4 percent of the population below the age of 15 years .
  • 60% live below the national poverty line (2006).

The epidemic

The HIV prevalence among adults 15-49 years was 14.3% in 2007. Prevalence varies across regions, ranging from 7% in North-Western province to 22% in Lusaka province. The prevalence was about twice as high in urban (20%) than in rural areas (10%). In Zambia, HIV disproportionately affects more women than men, with women constituting 57% of the 1.2 million adults est mated to be living with HIV (UNAIDS, 2008). Women aged 20-24 are 2.3 times more likely to be HIV-positive than men of the same age group (Central Statistical Office, CSO, 2008).

Progress Since 2005, with support of development partners, the Government has provided free anti retroviral therapy (ART) in all public health insƟ tuƟ ons. The proportion of people who are both eligible for and able to access ART has increased from 38.9% in 2007 to 68% in 2009 (NAC, 2010). Over the years, the number of public and private facilitates providing ART related services such as CD4 counts has increased, resulting in improved services in both rural and urban areas. According to the 2009 Zambia Sexual Behaviour Survey,2 levels of HIV-related stigma and discrimination have in general been declining since 2005. Modest positive changes have been observed in proxy indicators to measure the level of stigma and discrimination (CSO, 2010).

The 2012 Zambia Country Report,3 listed several indications of the HIV epidemic being reversed including: a slight reduction in the percentage of the adult population living with HIV from 15.6 in 2001-2002 to 14.3 percent in 2007; a significant reduction in the percentage of young women 20-24 years living with HIV from 16.3 in 2001-2002 to 11.8 percent in 2007; in the antenatal sentinel surveillance the percentage of pregnant HIV-positive women in this age group dropped from 34.3 percent in 1994 to 28.1 percent in 2008-2009.

Among children born to mothers living with HIV, the percentage of infants contracting HIV reduced from about a peak of 7.72 per cent in 1997 to about 1.99 per cent in 2011 because of the reduction of HIV infection among pregnant women and the prophylaxes administered to women living with HIV in the prevention of vertical transmission. National coverage for this programme in 2011 at about 80 per cent was approaching near universal levels.

Challenges

The report also summarised challenges remaining: There are still sub-optimal numbers of children accessing ART, due to challenges in relation to the availability of infant diagnostic tests. Although the percentage living with HIV reduced among all the groups by sex and area of residence, it increased among men 15-49 years in rural areas from 8.9 per cent in 2001-2001 to 11.0 per cent in 2007. In fact, the gains in rural areas where the level of the epidemic can be said to be about half of that in urban areas were modest. Although the level of the epidemic in rural areas is much lower than in urban areas, the population affected is quite high since about 65 percent of the population lives there.

South African society continues to be seriously affected by HIV, together with its related diseases, especially tuberculosis. South Africa currently ranks the third highest in the world in terms of the TB burden, and the incidence has increased at alarming rates in the past decade. There have been signs of a steady decline in the HIV infection rate but South Africa continues to have the highest number of people who are living with HIV in the world, with an estimated 5.7 million people living with HIV.

The Positive Health, Dignity and Prevention report review the results of the different GNP+ evidence gathering tools that were applied in South Africa in recent years to assess whether the HIV response works within a human rights framework respectful of people living with HIV.

Ethiopia is the second most populous country in Africa. The country has nine Regional States and two City Administrations. These are subdivided into over 800 administrative woredas (districts), which are further divided into kebeles, the smallest administrative unit. Ethiopia is one of the countries with the lowest per capita income, estimated at 390 USD per annum and over a third of the population live below the absolute poverty line. Nevertheless, it has one of fastest growing economies among non- oil producing countries in sub-Saharan Africa. In recent years, the country has seen rapid progress in economic growth, expansion of social infrastructure, and in improving healthcare.

People of Ethiopia:

  •  The majority (83.9%) reside in rural areas
  • The average household size is 4.7
  • The average life expectancy is 51 years for males and 53 years for females
  • Women in the reproductive age group constitute 24% of the population

The epidemic
With an estimated adult prevalence of 1.5%, Ethiopia has a large number of people living with HIV (approximately 800,000) and about 1 million children orphaned by AIDS  There is wide variation in HIV prevalence among administrative regions, and between urban and rural settings as confirmed by Demographic Health Survey (DHS) 2011: urban adult HIV prevalence was 4.2% (women 5.2%, men 2.9%) while rural adult HIV prevalence was 0.6% (women 0.8%, men 0.5%).

The 2012 Country Progress Report published by the Government of Ethiopia summarises the progress made and challenges remaining in its current response.

This report reviews the combined findings and recommendations of research conducted by NEPHAK using five GNP+ evidence gathering tools, trying to answer the questions how we can create a Positive Health, Dignity and Prevention (PHDP) Framework for Kenya. It explores whether the evidence contained within the five reports to describe the country’s progress towards achieving the values of PHDP and to document the existence and performance of the programmatic components (policies, services and initiatives) are ready to be integrated into a national PHDP framework, and then highlights recommendations most likely to improve the health and dignity of PLHIV in Kenya.

A thematic review was performed of the findings, conclusions and recommendations to search for any significant reference to the key PHDP themes and issues, as described by the PHDP Policy Framework. Observations were made on any topic which was not addressed in the LTA research.

The report summarises the key findings of the review, and describes the key barriers and opportunities to advance PHDP as suggested by the thematic analysis and the action steps for PHDP advocacy that can be drawn from the LTA research recommendations.

The Nigerian Network NEPWHAN used the data of the five evidence gathering tools that were implemented in the country to analyse in how far the country was working within the positive health, dignity and prevention framework. PHDP looks at people with HIV in a holistic way and within a human rights framework. You can read more about what this means here.

This study was conducted by the National Association of People living with with HIV & AIDS as part of the HIV leadership through accountability programme. The aim of the study was to map and document existing laws, and policies that impact on responses to HIV in South Africa.

The criminalisation scan documents protective as well as punitive laws and policies as they relate to people living with HIV and key populations at higher risk of HIV infection. The study found that while post apartheid South Africa has one of the most extensive bills of rights in the world, many of the protective laws and policies are not adequately promoted and enforced, with the result that many people suffer dicrimination and abuse.

This is a report on a study conducted with Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people to explore their Sexual and Reproductive Health and Rights experiences and needs. The research exercise involved HIV positive LGBTI people and LGBTI NGOs in Kwa-­Thema in Springs, Gauteng, South Africa. The main objective of the research was to collect data on sexual and reproductive health needs and experiences of LGBTI community, especially among people who are living with HIV.

This study was carried out by the National Network of Positive Women Ethiopia (NNPWE) in collaboration with GNP+ and NEP+. The study is an expansion of an earlier study focusing on the Adama and Addis Abeba regions. The study concludes that while policies are well defined, there are large gaps due to poor infrastructure and limited resources. Knowledge has increased but there remains large difference betwen urban and rural settings.

The National Association of People Living with HIV and AIDS (NAPWA) would also like to thank the Global Network of People Living with HIV (GNP+) and the United Kingdom’s Department for International Development (DFID) Governance and Transparency Fund (GTF). Their financial and technical support made this study possible.

The mission statements and goals of the participating organisations covered a wide range of activities aimed at addressing the HIV epidemic. These included, improving the lifestyles of people, monitoring and evaluating programmes, providing technical support to health service providers, supporting government, conducting testing campaigns, encouraging home based care and support, developing Integrated Development Programmes (IDPs) and LGBTI services, enhancing delivery and empowering sex workers. Some participants did not provide information about their mission statements.

This report was produced as part of  HIV Leadership through Accountability programme, which ran for five years, from 2009 to 2013

It was spearheaded Global Network of People Living with HIV (GNP+) and the World AIDS Campaign (WAC), and funded by the Department for International Development (DfID), to create evidence-based campaigning, advocacy and lobbying for and by people living with HIV. Research was carried out to inform and strengthen national, regional and international advocacy, and was implemented with a bottom-up approach, informed by community responses, and strengthened by South-South collaboration.

 The countries where the programme was implemented were: Cameroon, Ethiopia,  Kenya, Malawi, Moldova, Nigeria, Senegal, South Africa, Tanzania and Zambia.

 More information and background materials can be found  at http://www.hivleadership.org/ which is the archive site for the programme

The Alliance and GNP+ held a workshop from 6–9 December 2010 in Dakar, Senegal, to discuss how people living with HIV are involved in delivering HIV programmes in Africa. The workshop was based on the recently developed GIPA good practice guide. Although the principle of the greater involvement of people living with HIV (GIPA) is not new, it is important to revisit regularly how it is being applied in HIV programmes so that people living with HIV can play an effective role in how HIV work is shaped and run in their countries.

Available in English and French