HIV Policy for Key Populations:
Why does it matter?
National Policy Priorities
Urban Policy Priorities
Jeffrey O’Malley
Director, HIV/AIDS Practice, UNDP
Secretariat, Global Commission on HIV & the Law
Modes of transmission in sub-Saharan
African countries, 2008-2009
Other
Percent new infections
100%
Sex Work
80%
IDU
60%
Prison population
(measured only in
Kenya)
MSM
40%
20%
Multiple partners
0%
Lesotho Kenya Swaziland Uganda Zambia
Benin Burkina Cote Ghana Nigeria Senegal
Faso d'Ivoire
Southern and East Africa
West Africa
Distribution of new infections by sources of risk
Heterosexual
couples
Median percentage of population reached
with HIV prevention services within specified
legal environment
100
Countries
reporting having
nondiscrimination
laws/regulations
with protection
for this
population
80
Median percentage
of population
reached with
HIV prevention
services
(UNGASS indicator 9)
60
Countries
reporting NOT
having nondiscrimination
laws/regulations
with protection
for this
population
40
20
0
Sex workers Injecting drugMen having
(N=42) users (N=17)sex with men
(N=28)
Source: UNGASS Country Progress Reports 2008
Key Populations
FINDINGS
1.
2.
3.
4.
Essential for key populations to have access to HIV prevention, treatment,
health services, commodities and information
Yet, there is underinvestment by donors and governments in inexpensive
commodities that can stop infection or programmes to promote and distribute
them
Some governments criminalise possession of commodities, and
behaviours and practices
Governments also stand by as the police administer society’s
disapprobation — beatings, extortion, torture, arbitrary arrest, and
mistreatment rather than protection in cases of violence
RECOMMENDATIONS
Calls countries to:
• Prohibit police violence against key populations
•
Support programmes that reduce stigma and discrimination against key
populations and protect their rights
5
6
People who use Drugs
FINDINGS
1.
Punitive laws against people who use drugs fuel the spread of HIV and
keep users from accessing services for HIV and health care
2.
Much evidence has shown that jurisdictions which have legalised
comprehensive harm reduction services have significantly reduced HIV
infections among people who use drugs, as against where such services are
restricted or blocked by law
3.
Although UN conventions, which aim to curb drug trafficking, allow for
treatment, rehabilitation and social reintegration, the approach to people
who use drugs has been predominantly repressive
4.
Some laws mandate compulsory treatment for drug dependence, testing for
suspected drug use and registration of drug users. But experiences show that
repressive drug control laws and policies fail to achieve their purported
goals, whether fighting crime or reducing drug use or drug-related harm.
5.
“Wars on drugs” are wars on people who use drugs
7
People who use Drugs
RECOMMENDATIONS
Calls for countries to:
•
Reform their approach towards drug use from a purely punitive one to one that promotes health
and treatment of users
•
Immediately close compulsory drug detention centres, replaced by evidence-based voluntary
services for treating drug dependence
•
Abolish national registries and mandatory testing and forced treatment of people who use drugs
•
Repeal punitive conditions such as the US government’s federal ban on funding of NSEPs that
inhibit access to HIV services for people who use drugs
•
Decriminalise the possession of drugs for personal use, in recognition that the net impact of such
sanctions is often harmful to society
•
Review and reform, in partnership with the UN, relevant portions of the international narcotics
conventions in line with aforementioned approaches
•
IN PRISONS – ensure that necessary evidence-based, voluntary health care is available, including
HIV prevention and care services (comprehensive harm reduction services, treatment for drug
dependence and ART), regardless of laws criminalising drug use, and satisfying international
standards of quality of care in detention settings.
8
9
Men who have sex with men
FINDINGS
1.
International law protects the universal right to privacy, which
guards people’s sexual practices from interference by the state.
2.
Criminalisation of same-sex relations is widespread. But even in
jurisdictions where same-sex relations are not criminalised, the
state extends no legal protection from discrimination on the
grounds of sexual orientation.
3.
Punitive laws against homosexual behaviour are impeding and
undermining HIV prevention efforts for MSM
4.
Decriminalisation is necessary, but insufficient – efforts are
also required to reduce associated stigma, violence, and improve
access to health and HIV services, commodities and information
11
Men who have sex with men
RECOMMENDATIONS
Calls countries to:
•
Reform their approach towards sexual diversity - from punishing consenting adults involved in
same-sex activity, offer access to effective HIV and health services and commodities
•
Repeal all laws that criminalise consensual sex between adults of the same sex and/or laws
that punish homosexual identity
•
Respect existing civil and religious laws and guarantees relating to privacy
•
Remove legal, regulatory and administrative barriers to the formation of community
organisations by or for LGBT people
•
Amend anti-discrimination laws expressly to prohibit discrimination based on sexual
orientation
•
Promote effective measures to prevent violence against men who have sex with men
•
IN PRISONS – ensure that necessary evidence-based, voluntary health care is available,
including HIV prevention and care services (condoms, ART), regardless of laws criminalising
same-sex acts, and satisfying international standards of quality of care in detention settings.
12
Sex Workers
FINDINGS
1.
Criminalisation in one form or other is the dominant legislative approach
to sex work.
2.
Laws against consensual adult sex work and associated activities have
undermined HIV prevention, allowed excessive police harassment and
violence and weakened sex workers ability to negotiate safer sex with
clients
3.
Sex workers who have collectivised have been able to protect their health,
bodily integrity and control HIV within their communities and beyond
4.
Criminal law should be used to curb trafficking, but distinguish with
consensual adult sex work
5.
Decriminalisation is the first step toward better working conditions for sex
workers
14
Sex Workers
RECOMMENDATIONS
Calls for countries to:
• Repeal laws that prohibit consenting adults to buy or sell sex, & laws that otherwise
prohibit commercial sex, Complementary legal measures must be taken to ensure safe
working conditions to sex workers.
•
Take all measures to stop police harassment and violence against sex workers.
•
Prohibit the mandatory HIV and STI testing of sex workers.
•
Ensure that the enforcement of anti-human-trafficking laws is carefully targeted against
those who use force to procure people into commercial sex, but not against those involved
in consensual adult sex work
•
Enforce laws against all forms of child sexual abuse and sexual exploitation, clearly
differentiating such crimes from consensual adult sex work.
•
Ensure that existing civil and administrative offences for “loitering” or “public nuisance/
morality” are not used to penalise sex workers
•
Shut down all compulsory detention or “rehabilitation” centres for people involved in sex
work
•
Repeal punitive conditions in official development assistance (e.g. PEPFAR antiprostitution pledge)
15
Transgender people
FINDINGS
1. In many countries, by law or by practice, transgender persons are denied
acknowledgment as legal persons. A basic part of their identity - their
gender - is unrecognised.
2.
Many jurisdictions also prohibit the basic daily expression of self, where
cross-dressing is an offence.
3.
Violence (by the police and citizenry) against transgender people is
often condoned by the State.
4.
Such marginalisation contributes to increased marginalisation,
exposure to HIV and disproportionately rare use of HIV prevention,
treatment, care and support services in support of transgender people.
5.
There has been some progress – legislation that recognises transgender
persons and their rights - legal sex change, registration of
identification documents in accordance with lived gender, recognition
of alternative/ third genders and prohibition of discrimination against
people of non-conforming gender.
16
Transgender people
RECOMMENDATIONS
Calls countries to:
•
Offer transgender people access to effective HIV and health services and
commodities
•
Repeal all laws that criminalise transgender identity or associated behaviours,
including cross-dressing
•
•
•
•
Respect existing civil and religious laws and guarantees related to the right to
privacy.
Remove legal, regulatory or administrative barriers to the formation of
community organisations by or for transgender people.
•
Explicitly prohibit discrimination based on gender identity
•
Allow for affirmation of transgender identity in identification documents, without
the need for prior medical procedures such as sterilisation, sex reassignment surgery
or hormonal therapy.
17
The special role of cities
UNDP African urban policy scan
 Urban issues not understood and addressed sufficiently
 HIV and AIDS not a priority of municipalities and city officials
 Policy makers not providing guidance or strategies and donors not
providing focused resources.
 Major donors and implementing agencies follow national strategy,
but local level leaders and AIDS Councils often not consulted.
 A lot of monitoring but not enough co-ordinating.
 Coordination capacity limitations in municipalities – human,
technical, financial
 Challenges in addressing the needs of key populations in
improving access to justice, protection from sexual and genderbased violence and access to services.
 Civil society vs. government capacity – how can we develop
implementation and co-ordination capacity of different sectors?
19
Way forward – what do we expect from cities?
All cities could take action to:
• Integrate HIV in local development plans - own the response, identify targets
and establish accountability mechanisms.
• Know the epidemic and the response – produce evidence on size, prevalence,
behaviour and mapping of relevant population groups and high
transmission areas to mobilise and target prevention resources
• Develop evidence on specific urban dynamics - major drivers of epidemic such
as MCP, sex work and transactional sex, sero-discordancy , mobility,
migration routes, urban poverty, informal settlement, etc
• Advocate for enhanced urban responses (including for rural populations) – an important
and cost effective way to reach rural residents. Urban responses need investment to cater
for migrants and satellite communities.
• Provide leadership on rights based approaches -reduce harassment and increase
protection from law enforcement agencies.
• Support national resource mobilization efforts – generate “city” and extra resources e.g.
through partnership between public – private – community.
• Ensure accountability– monitor progress, evaluate, and provide political leadership.
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Thank You!
Report of the Global Commission on HIV and
the Law
“Risks, Rights & Health”
available at: www.hivlawcommission.org
Twitter: twitter.com/HIVLawCom
Facebook: facebook.com/HIVLawCommission