Human rights in the response to HIV


In accordance with Human Rights Council resolution 38/8, a consultation on human rights in the response to HIV was held in Geneva on 12 and 13 February 2019. Participants discussed issues and challenges pertaining to the respect for and the promotion of human rights in the response to HIV, with a focus on regional and subregional strategies and best practices. The present report contains a summary of the discussions held and the recommendations made at the consultation.

I. Introduction

In its resolution 38/8, the Human Rights Council requested the United Nations High Commissioner for Human Rights to organize a consultation, in coordination with the Joint United Nations Programme on HIV/AIDS (UNAIDS), to discuss all relevant issues and challenges pertaining to respect for and the protection and fulfilment of human rights in the context of the response to HIV, with a focus on regional and subregional strategies and best practices. The consultation was held, pursuant to that request, on 12 and 13 February 2019. It was attended by a wide range of stakeholders, including representatives of Member States and of United Nations agencies, funds and programmes, special procedure mandate holders, experts and members of civil society, including persons living with, presumed to be living with, at risk of or affected by HIV. During the consultation, participants examined best practices, evidence, lessons learned and the challenges faced when removing human rights barriers and the promotion of human rights in the response to HIV in regional and subregional strategies. They also considered regional human rights mechanisms in monitoring, accountability and empowerment in the field of human rights and health, and addressed current challenges to ending AIDS by 2030, including stigma, discrimination, violence and abuse.

II. High-level opening

The United Nations Deputy High Commissioner for Human Rights, Kate Gilmore, opened proceedings by welcoming Human Rights Council resolution 38/8 as a milestone that recognized – conceptually, legally and practically – the added value brought by the human rights framework to an effective and sustained response to the HIV epidemic. The Deputy High Commissioner invited participants to identify affordable, practical, doable and transformative solutions to the HIV epidemic. She commended the core group, comprising Brazil, Colombia, Mozambique, Portugal and Thailand, for its leadership during negotiations, which resulted in the adoption by the Council of resolution 38/8 by consensus. She also expressed her gratitude to civil society and human rights defenders, without whom little would have happened in the response to HIV. She described HIV as an epidemic of human rights loss, denial, derailment, abuse and violence. She noted with concern that HIV and AIDS attracted the deepest and worst kinds of discrimination and life-threatening exclusion. In particular, she expressed concern that women, young people and key populations continued to be directly and the most affected by the epidemic. She hoped participants in the consultation would consider the situation faced by key populations, children and young people, and develop concrete measures to eliminate stigma, discrimination, violence and abuse. Recalling the Universal Declaration of Human Rights, she stressed that there was no justification for the bigotry, homophobia, discrimination and exclusion affecting people living with HIV. According to the Deputy High Commissioner, human rights should be upheld in order to promote an inclusive and deliberate programme of dismantling toxic attitude and behaviour by governments and non-government actors alike to those living with the cost of the epidemic. Failure to do so would imply risking not meeting the UNAIDS 90-90-90 treatment target for 2020, or Sustainable Development Goal target 3.3. She stressed that monitoring, empowerment and accountability played a critical role in promoting human rights-based solutions.

The Executive Director of the Global Network of People Living with HIV (GNP+), Rico Gustav, commended civil society for its crucial work in the response to HIV. He recalled article 12 of the International Covenant on Economic, Social and Cultural Rights, and reminded States parties about their obligations to protect and promote the right to health, for all. He also referred to general comment No. 14 (2000) of the Committee on Economic, Social and Cultural Rights on the right to the highest attainable standard of health, in which the Committee called upon States to work together, through international cooperation and assistance, on the realization of the right to health. Mr. Gustav noted the decline in global health aid, including funding reductions to middle-income countries, which had an impact on the well-being of people living with HIV, particularly since many States criminalized and excluded key populations, and refused to fund programmes to promote and respect their human rights. This decline had also contributed to the shrinking of civil society space. He called upon the Human Rights Council, the Office of the United Nations High Commissioner for Human Rights (OHCHR) and UNAIDS, in consultation with communities and key populations and global health funding agencies, to develop a set of human rights-based guiding principles for health donors. After describing the violations of human rights, stigma and discrimination faced by key population groups, he urged United Nations agencies and Member States to join efforts to address this situation, and identified the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination as a best practice in the response to HIV.

The Permanent Representative of Brazil to the United Nations Office at Geneva, Maria Nazareth Farani Azevêdo, spoke on behalf of the core group, which comprised Brazil, Colombia, Mozambique, Portugal and Thailand. She highlighted the centrality of human rights and of leaving no one behind in the response to HIV. She encouraged all stakeholders to join forces to address the challenge posed by HIV. Ms. Azevêdo recalled that, since 1990, the Commission on Human Rights, then the Human Rights Council, had consistently sought to address human rights challenges in the response to HIV. The relevant resolutions, initially proposed by Brazil and subsequently adopted by consensus, pioneered the adoption of a human rights-based approach in the response to HIV, until then promoted exclusively from a health perspective. Ms. Azevêdo recalled the importance of the International Guidelines on HIV/AIDS and Human Rights as a reference for HIV policies worldwide. Council resolution 38/8 affirmed the need to achieve universal health coverage for all in the context of HIV. Noting that different regions of the world faced different challenges, she encouraged stakeholders to work together to identify solutions to local realities, thus epitomizing the spirit of the consultation.

The Deputy Executive Director a.i. of UNAIDS, Tim Martineau, pointed out that, globally, 37 million people lived with HIV; there were 1.8 million new HIV infections every year; some 22 million people were on treatment; there had been a drop in deaths of 34 per cent since 2010; and that 75 per cent of people living with HIV knew their status. There had been, however, decrease of only 18 per cent in new HIV infections since 2010. He expressed concern that people were being left behind: two thirds of all new infections were in sub-Saharan Africa, and one in four new infections among adolescent girls and young women. In Eastern Europe and Central Asia, new infections had doubled since 2000, and outside of sub-Saharan Africa, approximately 47 per cent of all new infections were among key populations and their sexual partners. Insufficient investment in HIV treatment, an uncertain funding environment and the shrinking of space available for civil society had resulted in slow or even no progress in efforts to address the human rights barriers in the response to HIV. Respecting, promoting and fulfilling human rights in the response to HIV was vital to ensuring that no one was left behind. He stressed that addressing laws, particularly criminal laws, policies, gender inequality and discrimination in all its forms was essential to ending HIV. All laws criminalizing HIV transmission, exposure and non- disclosure, same-sex sexual conduct, drug use and sex work had an effect on the response to HIV. Law reform was a key element in the response to HIV, particularly in order to ensure that criminalized populations had equal and quality access to universal health coverage. Decriminalizing sex work could prevent more than 33 per cent of new infections among sex workers and their clients. The decriminalization of drug use could significantly decrease HIV infections among people who inject drugs. Lowering the age of consent to testing and treatment was correlated with the higher uptake of testing by adolescents. Despite the existence of human rights norms, frameworks and commitments, their translation into real action was lagging. He called for effective partnerships among governments, civil society, accountability mechanisms, human rights groups and health professionals to initiate programmes to end human rights abuses and to remove stigma and discrimination.

The Assistant Director-General for Communicable Diseases at the World Health Organization (WHO), Dr. Ren Minghui, stated that the right to health could be realized by strengthening capacity-building in public health. He stressed that the right to health was essential to the identity and mandate of WHO, permeating all its strategies and actions, including its new five-year strategy, adopted by Member States in May 2018. A core mandate of WHO was to ensure people-centred health care for everyone, including marginalized and overlooked groups of people. He reported that people living with HIV continued to face discrimination, including within the health sector, which prevented them from having access to HIV health services. According to Dr. Ren, “put simply, discrimination kills”. WHO supported the Global Partnership and would lead in addressing discrimination in the health sector, since universal health coverage would not be achieved while people were still marginalized, criminalized, stigmatized or denied access to health services for any reason. The Sustainable Development Goals offered a platform on which to improve health outcomes and to transform the health systems on which billions of people depended. He also highlighted Human Rights Council resolution 38/8, in which the Council urged States to bring their laws, policies and practices, including HIV strategies and other health-related Sustainable Development Goals, fully into compliance with their obligations under international human rights law. WHO was currently coordinating the development of a global action plan for healthy lives and well-being for all, with human rights and the right to health at its heart, to promote collaboration and accelerate progress in health determinants.

During the general debate, representatives of the European Union, Brazil, Portugal, the Gambia, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Nations Development Programme (UNDP), the Elizabeth Glaser Pediatric AIDS Foundation, the International Network of People Who Use Drugs and Aidsfonds took the floor. All speakers pointed out that HIV was not only a health issue, but also a human rights issue, and highlighted the centrality of human rights in the response to HIV.

The representative of Brazil expressed its commitment to fighting stigma, discrimination and prejudice, and highlighted its focus on key populations. The representative of Portugal stressed that HIV would not be eliminated by 2030 if human rights were not the cornerstone of universal health coverage and the Sustainable Development Goals. The representative of the Gambia called upon the international community to step up its advocacy, and invited pharmaceutical companies to support the response to HIV through corporate social responsibility. The European Union affirmed its commitment to the promotion of human rights in the response to HIV, including through its global investment on non-discriminatory HIV initiatives and programmes, and also through its continued support for the Global Fund.

The representative of the Global Fund explained that its commitment to human rights was one of its objectives in its strategy for the period 2017–2022. Over the past two years, the Global Fund had provided support to 20 countries, having dedicated a total of $77.3 million to addressing human rights-related barriers to HIV, tuberculosis and malaria, which represented a tenfold increase over the period 2014–2016. The representative of UNDP stressed that the response to HIV would not be effective or efficient without an environment that respected, promoted and fulfilled human rights for all, and recalled the recommendations made by the Global Commission on HIV and the Law.

The representative of the Elizabeth Glaser Pediatric AIDS Foundation called for prevention measures and for lowering new infections among adolescent girls by granting full access to testing and treatment services, reviewing laws on the age of consent that prevented access, and encouraging longer schooling for girls. The International Network of People Who Use Drugs called for decriminalizing sex work and drug use. Aidsfonds highlighted the strong linkages between health and human rights, and the essential role of local communities.

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