JUSTICE FOR ALL IN THE CARIBBEAN’S MARCH TOWARDS ZERO: : PANCAP JUSTICE FOR ALL PROGRAMME Taking Action to Eliminate Stigma and Discrimination in the HIV Response in the Caribbean by 2015 Paloma Mohamed, PhD Consultant Our Fight Against HIV Related Stigma and Discrimination Caribbean Regional Consultation Jamaica Pegasus, Kingston, Jamaica April 11-12, 2014

“….Social attitudes run deep and take time to change. But cultural considerations should not stand in the way of basic human rights….” Ban Ki Moon

KEY DEFINITIONS RESPONSES FROM THE GROUND : PROCESS AND SYNTHESIS OF CONSULTATIONS HELD SO FAR SITUATIONAL ANALYSIS OF THE REGION THE WAY FORWARD : AN EVOLVING ROADMAP AND DECLARATION SECTION 1 SECTION 2 SECTION 3 SECTION 4 SECTION 5 PRESENTATION MAP AIMS OF THE PRESENTATION

AIMS:AIM 1 AIM 2 AIM 3 Establish the main issues and challenges regarding the elimination of HIV related stigma and discrimination. Identify prospects for eliminating stigma and discrimination. Provide recommendations for a JFA roadmap and declaration.

KEY DEFINITIONSSTIGMA DISCRIMINATION HUMAN RIGHTS APPROACH STIGMA DISCRIMINATION HUMAN RIGHTS APPROACH A social process that exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur in a power situation that allows them (Link & Phelan) Discrimination in the context of HIV refers to unfair or unjust treatment (an act or omission) of an individual based on his or her real or perceived HIV status. (UNAIDS) Guided by the needs and rights of the community while simultaneously empowering those same communities to broaden their participation and strengthen their relationships with law, policy makers and partner organizations (HIV/AIDS & Human Rights in a Nutshell- ICASO, 2004)

ENACTED STIGMA PERCIEVED OR FELT STIGMA SELF OR INTERNALIZED PRIMARY, SECONDARY, MULTIPLE Actual experiences of discrimination. The devaluation, shame, secrecy and withdrawal triggered by applying negative stereotypes to oneself The fear of being discriminated against Experiences of stigma in different contexts, for different reasons and by association FORMS OF STIGMA

AIM 1 MAIN ISSUES AND CHALLENGES : THE SITUATION IN THE CARIBBEAN “ …The refused to buy from the shop anymore …just because they heard their son was HIV positive …. their own neighbors and friends …people they were good to. How can that ever be right ? ” Informant, St. Kitts and Nevis Gov. of Jamaica/ UNDP? UNAIDS Jamaica “Justice for All” Poster displayed at Jamaica parliamentarian forum

THE CARIBBEAN: HIV SITUATION Significant best practices acknowledged globally. But Caribbean most HIV-affected region of the Americas and the second most affected region in the world; Mosaic epidemic - number of different epidemics within countries and across the region; Leading cause of premature death among year-olds with 38 deaths daily; Prevalence in Caribbean countries 0.2 to 3.1% of adult population; Disproportionately affects the most vulnerable population groups; Gradually affecting men and women almost equally; Approximately 20,000 new HIV infections in Caribbean annually ; 1% of the total new global HIV infections (Ramsammy, 2013, Justice for All Creating a Facilitating Environment to Reduce HIV-Related Stigma and Discrimination in the Caribbean)

Laws, Regulations and Policies YES (Countries) NO (Countries) Comment Against HIV Discrimination 5 (Bahamas, Dominica, Grenada, St. Lucia, and Suriname) 9 (Antigua and Barbuda, Barbados, Belize, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Vincent and the grenadines, Trinidad and Tobago) Where anti-discrimination laws specifically mention HIV usually is in regards employment Protect Vulnerable Sub- Populations 4 (The Bahamas, Belize, St. Lucia, Trinidad and Tobago) 10 (Antigua and Barbuda, Barbados, Dominica, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname) Protection is mainly for employment That Present Obstacles to Access Prevention, Treatment and Care Services 11(The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, St. Lucia, St. Kitts and Nevis, Suriname, Trinidad and Tobago) 3 (Antigua and Barbuda, Haiti and St. Vincent and the Grenadines) HIV-Specific Restriction on Entry, Stay or residence 11 (Other than Belize, none of the CARICOM countries have laws restricting entry, stay and residence) 1 (Belize) That Criminalize HIV Transmission and Exposure 3 The Bahamas, Barbados and Belize) Outside of the Bahamas, Belize and Barbados, no country has laws criminalizing HIV transmission or exposure That Criminalize same-Sex Sexual Activities 12 (All countries, except Haiti and Suriname) 2 (Haiti and Suriname Barbados and Guyana allows for life imprisonment for same-sex relations, although this law is not enforced. In most countries, penalties could be imprisonment for up to 10 years. Deeming Sex Work as Illegal 13 (All countries except Belize) 1 (Belize) That Impose Compulsory Treatment for Drug Users 0 (No country makes provision for compulsory treatment of drug users 15 (All countries provides for penalties for drug users Source: RAMSAMMY, 2013 THE CARIBBEAN: LEGAL SITUATION

CARIBBEAN: GENERAL LEGAL ENVIRONMENT Gains in other areas solid and globally recognized but : High levels of stigma and discrimination related to sero-status Disconnect between Constitution and Ordinary Laws, Policies and enforcements. Including Savings Clause, right to health, status as basis of discrimination Copyright - TRIPPS Sexual orientation - absent as a ground for non – discrimination / HIV status Gender violence Homophobia Criminalization - MSM, sex work Inequality Migration and migrant populations/ permits/ landing /visas Confidentiality and Privacy

….Legal Environment Criminalization of HIV – contagious classification Employment (access, dismissal, benefits, insurance, confidentiality) Low Knowledge of Rights Redress Mechanisms Weak Health Care response to Public Health – allocation of resources Research and Documentation Uptake of various instruments for measuring, monitoring, and regulation slow ( PANCAP MODEL Legislation and Policy) General punitive and not regulatory nature of legislation Implementation of programmes and plans weak (Alleyne and Antoine, 2013)

Stigma in The Caribbean Royes et al, 2008 Figueroa, 2013

MAIN PERPRETRATORS THIRD HIGHEST FOURTH SECOND HIGHEST HIGHEST HEALTH CARE WORKERS, SCHOOLS, WORKPLACES Family, Community, Close friends, including workmates YOUTH General Public

EXPERIENCES OF STIGMA & DISCRIMINATION IN THE CARIBBEAN Dismissal from employment; Discrimination within the workplace; High levels of discrimination within the health sector – breaches of confidentiality, refusal of services, death resulting from refusal to treat, ill treatment and abuse; Denial of housing; Ostracism from family, community by threats, physical abuse, burning of residence; Stoning of children; Denial of entry into school; Denial of insurance coverage, even in cases of perceived HIV status; Denial of transportation; Refusal of work permits; Denial of entry /registration as a Citizenship even in cases of descent; Victimization and harassment, inter alia. (Regional Policy and Model Legislation to address HIV and AIDS Related Discrimination, Desk Review and Change Report Cenac, 2010)

THE ECONOMIC EQUATION “…In light of new global evidence that shows the pernicious economic effects of exclusion, it is clear there is a continued need for the mobilization of national, regional and international communities to protect the most vulnerable in society from being excluded, and from development and health. Evidence also indicates that an estimated 1.7% of GDP could be lost in a single year due to exclusion of sexual minorities and marginalization of vulnerable groups ….” Right Honorable Dr. Denzil Douglas, Prime Minister of St. Kitts and Nevis

AIM 2: PROSPECTS FOR ELIMINATION- PANCAP’S RESPONSE “We cannot afford for Government and the Churches to be at odds. The filigreed chain that links the two is a proud part of the national ornamentation, and it cannot be allowed to break. Government will therefore fully respect the right of the churches to propagate their understanding of the morality, or immorality, of homosexuality. But what Government cannot do is to shirk its duty to ensure that all citizens, without exception, enjoy the full protection of the law. After all, the Belize Constitution that affirms the supremacy of God also affirms fundamental rights and the dignity of the individual human being. That same Constitution further declares that all persons are equal before the law and entitled to non-discrimination; to freedom from interference with their privacy; and to freedom from unlawful attacks on their honour and reputation.” ( Hon. Dean Barrow, Prime Minister of Belize )

INTERNATIONAL REPONSES THROUGH GLOBAL COMMITMENT AND TARGETS UN Universal Declaration of Human Rights – 1948 International Covenant on Civil and Political Rights Covenant on Economic, Social and Cultural Rights Convention on the Elimination of All Forms of Racial Discrimination Convention on the Elimination of All Forms of Discrimination Against Women Convention on the Rights of the Child PAHO/WHO Resolution CD/50/12 – 2010: Health and Human Rights UN Declaration of Commitment on HIV and AIDS (2001) UN Political Declaration on HIV and AIDS (2006) UN Political Declaration on HIV and AIDS: Intensifying our efforts to eliminate HIV/AIDS (2011) The Human Rights Council of the UN Resolution on LGBTI PAHO Resolution CD52.R6 MDG’s by 2015

REGIONAL RESPONSE THROUGH FUNCTIONAL CO-OPERATION Caribbean Regional Strategic Framework (CRSF) – Priority area 1 of the CRSF is “advocacy, policy development, and legislation.” This priority area was retained in the 2 nd CRSF ( ). It is further developed in the 3 rd CRSF as a priority area. PANCAP, in collaboration with CIDA, developed the HIV/AIDS Law, Ethics and Human Rights (LEHR) Project. Establishment of the PANCAP Regional Stigma and Discrimination Unit in Barbados. Establishment of Human Rights Desks in six countries in PANCAP Study - reported on the Initial Assessment of HIV and AIDS Stigma and Recourse Mechanisms in Six Countries of the Caribbean. Establishment of the Caribbean Rights Defenders Network. Development of the PANCAP Anti-discrimination Policy ( 2010) and Model Anti-Discrimination Bill (2012). UNAIDS (March 2010), Assessment of Human Rights Desk in Selected OECS Countries.

REGIONAL RESPONSE THROUGH FUNCTIONAL CO-OPERATION Establishment of UWIHARP by the University of the West Indies at its three campuses in 2001 Establishment of the Caribbean HIV and AIDS Alliance (CHAA) Establishment of the Champion for Change Initiative in 2004 Completion of study and publication of a report on Prostitution, Sex Work and Transactional Sex in the Caribbean (2009) Assessment of Human Rights Desk in Selected OECS countries – commissioned by UNAIDS, Barbados and the OECS Mapping of Punitive Laws which Impede Universal Access to HIV Prevention, Treatment, Care and Support in OECS and Barbados Justice For All Desk Review and Consultations (2013 to present)

Regional Policy and Legal Instruments 1. PANCAP’s Regional Policy on HIV Related Stigma and Discrimination (2010) and Model Anti-Discrimination Bill (2012) a) CARICOM Regional Policy on HIV-Related Stigma and Discrimination was finalized in Policy Statement,recommendations on how to confront the issue of stigma and discrimination; recommended actions for governments, PLWHA, vulnerable populations and other important stakeholders. b) PANCAP the model legislation as part of the Human Rights Approach to HIV in CARICOM countries. Comprehensively addresses among other things Prevention of Discrimination in Employment and Other Areas; Harassment, Victimization and Vilification Prevention and Care The Anti-Discrimination Commission Complaints, Investigation and Conciliation; The Anti-Discrimination tribunal

Justice for All The Justice for All Programme: PANCAP initiative spearheaded in 2013 at the request of the Honorable Prime Minister of St Kitts and Nevis, Dr Denzil Douglas. Recognizes dire need to reduce the epidemic of stigma and discrimination. Seeks to even out the response in the Caribbean region so that progress towards eliminating stigma and discrimination matches the success in reducing new infections and AIDS deaths. Embraces the notion that eradicating stigma and discrimination is imperative in ending AIDS in the Caribbean. (Professor Edward Greene, UN Secretary-General’s Special Envoy for AIDS in the Caribbean )

JUSTICE FOR ALL Specific issues addressed by JFA as indicated in the desk reviews are: Increasing access to treatment including affordable medicines for all those in need; Reducing gender inequality, including violence against women; Promoting sexual and reproductive health and rights; Achieving legislative reforms for modifying and repealing punitive laws. Project Outputs Are : Providing targets and indicators for tracking progress; Agreeing on a Pan Caribbean Roadmap; and Submitting a Declaration for approval by Caribbean Heads of Government. In tandem with UNAIDS 7 Point Agenda and Guidance from Global Commission on HIV, Ethics and Law:

INTERNATIONAL MODEL POLICIES UNAIDS – 7 PRONGED ATTACK 1. Stigma and discrimination reduction; 2.HIV-related legal services; 3. Monitoring and reforming laws, regulations and policies relating to HIV ; 4. Legal Literacy (“know your rights”); 5. Sensitization of law-makers and law enforcement agents ; 6. Training for health care providers on human rights and medical ethics related to HIV ; 7. Reducing discrimination against women in the context of HIV. ( UNAIDS guidance note | KEY PROGRAMMES TO REDUCE STIGMA AND DISCRIMINATION AND INCREASE ACCESS TO JUSTICE IN NATIONAL HIV RESPONSES)

INTERNATIONAL MODEL POLICIES The Global Commission on HIV and the Law Established in July 2010 by UNDP and UNAIDS. The commission met three times, held regional dialogues in seven regions, and has received and reviewed hundreds of submissions from countries on the impact of the law on national HIV responses and key populations. Key Areas of Focus: Discrimination Criminalization of transmission, exposure and non-disclosure; Key populations: women, children and youth; Intellectual Property Law and the global fight for treatment

AIM 3 Recommendations For Roadmap Through The JFA Process

JUSTICE FOR ALL – THE PROCESS PANCAP JFA AT A GLANCE Countries: 4 done; 4 to go. Number participants: 359 Number adoptions: 77% Emerging Unanimous Adoptions: Anti-discrimination legislation and Policy Emerging Sensitive Areas: Minors, same sex, prisoners rights

JUSTICE FOR ALL – THE RESPONSE FROM THE GROUND Priority Areas Mapped Unto UNAIDS and Global Commission Recommendations

JUSTICE FOR ALL: 6 PRIORITY AREAS FROM CONSULTATIONS 1. Education and Training:. Parenting, protective services, PLWHA’s, Health workers 2.Legal and Policy Framework: Adopt/ Adapt PANCAP Anti Discrimination Policy and Model Legislation; Faith Based Organizations; Issues Regarding Minors Workplace Rights ; TRIPS. 3.Social Inclusion: community integration; create support spaces; Special Populations 4.Wellness: Counseling, Care and Treatment: Establish wellness programs and holistic care 5.Governance: Transparency: strengthening local governments; Integration and coordination; accountability. 6.Research and Communication: Dialogue; Sensitization and Communication; research.

OUTCOME DOCUMENTS JUSTICE FOR ALL ROAD MAP 1.Acceptable - Consensus, minor modifications; 2.Different but Necessary - Sensitive but just; 3.Achievable – Time ( 2015, , 2018+), resources (human and material); 4.Priorities – low hanging, necessary. 5.Tracking and Evaluation - Targets, output, deliverables, indicators; 6.What’s already in place - Strengthening, replication, lessons learned; 7.Share - Add, comment, constructively.

OUTCOME DOCUMENTS DECLARATION Might include -- Actions and ideals to which we commit ( elimination of HIV related stigma and discrimination, amendments existing legislation; revisions of HFLE, universal equal rights, access, justice ) Actions to be supported : ( e.g. Programmes for differently -abled, PANCAP and partners, and Justice for All Roadmap ; an overarching anti-discrimination Act utilizing the Model Policy Legislation; institutions of higher learning ) Actions and efforts to be encouraged : (the efforts to ensure that the Caribbean is the first region in the world to achieve the elimination of mother to child transmission of HIV) Actions and Items to be endorsed : (enactment of laws to ensure universal coverage for treatment by ; equal rights and treatments)

We will get to zero We can, We Must, We know we will. I Thank You! Questions? APPRECIATION: PROF. EDDIE GREENE, DERECK SPRINGER AND STAFF AT PANCAP, VOLDERINE HACKETT, ANITA DAVIS, ANDREA HALLEY, KAREN HARLEQUIN WHO SUPPORTED THE CONSULTATIONS. IN COUNTRY COORDINTATING TEAMS FROM SUIRNAME, GUYANA, ST. KITTS AND NEVIS, GRENADA AND JAMAICA. UNAIDS, UNDP JAMAICA, GLOBAL FUND. ALL OTHERS WHO ASSISTED IN THIS WORK. THANK YOU!