Right to Health in the Context of HIV/AIDS Human Rights and Traditional Values: Obstracting or Facilitating Human Rights Chaminuka Lodge, LUSAKA

Why Right to Health is a topic for discussion? Every person has the Right to the highest attainable standard of health. (ICESCR article 12) ‘fundamental human right’ and ‘a most important world- wide social goal’ requiring action by many actors other than just the health sector (non-binding Ama Ata Declaration).

HIV/AIDS Context WHO (2015) indicates that: Since the beginning of the epidemic, almost 78 million people have been infected with the HIV virus about 39 million people have died of HIV. Globally, 35.0 million [approx. 33.2–37.2 million] people were living with HIV at the end of 2013, out of a global population of approx. 7 billion people. Increasingly, demographic trends indicate that poor people and poor regions of the of the world are disproportionately affected by HIV/AIDS, and least able to deal with it.

Historically, aggressive treatment focussed strategies were used to fight communicable diseases incl HIV/AIDS. These measures have included:  identifying infected individuals;  tracking,  notifying and testing people who may have been exposed;  and isolating and quarantining individuals who may pose a risk of infecting others. These strategies have human rights implications such as the rights to privacy and personal autonomy, the right to non- discriminatory treatment, and the freedom of movement and association. Human Rights and HIV/AIDS

Examples: criminalisation of willful transmission, while it may have had good motivations, led to victimisation and suffering of women in failed PMTCT processes, as a result, women started avoiding HTC. Mandatory testing led to discrimination in recruitment and other opportunities and cause people to suffer and experience emotional and social deaths. Human Rights violations that resulted

It became increasingly important to address HIV/AIDS from a rights-based approach to protect PLH. Today, Human rights must be applied in addressing:  HIV Prevention: with increased discrimination, HIV infection flourishes  Support care and treatment (PLWH)  Mitigation of the impact (people directly affected) – orphans, widows, poor communities

Normative Definition of Right to Health the ‘highest attainable standard of health’ contains both freedoms and entitlements. UN General Comment no. 14: the right to health must include both entitlements and the freedoms. Freedoms include: Right to control one’s body and health, including sexual and reproductive freedom. Right to be free from interference such as free from torture, non-consensual medical treatment and experimentation.

Examples of violation (Windhoek, Namibia, Nov. 3, 2014) – Today the Namibian Supreme Court affirmed that HIV- positive women have been forcibly sterilised in public hospitals in Namibia. The case of Kapiri men suspected of being homosexual – forced to consent medical examination under threats of torture. Gender relations – women can not decide, husbands decide for them

Entitlements include: Right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health. Elements include;

Availability This entails a functioning public health and health-care facilities, goods, and services as well as programmes. Currently situation is discriminatory, in adequate, characterised by: 1. Lack of services for people of different sexual orientations and gender identity – Panos study 2. In some case, discriminatory to single women (male involvement) 3. Marginalisation of poor people in far-flung areas 4. Poor management, drug stock outs, limited personnel, etc chadiza case of IpTp.

Accessibility Ensuring that health facilities, goods and services are accessible to everyone, without discrimination. Accessibility has four overlapping dimensions:  Non-discrimination: LGBTI people  Physical accessibility: challenges esp with remote areas, maternity cases.  Economic accessibility: free services but not adequate  Information accessibility: the right to seek, receive and impart ideas – recent victory with Kasonkomona’s case, still stigmatised.

Continued… Acceptability: respectful of medical ethics, and culturally appropriate, respectful of confidentiality:  Blackmail by health service providers – Panos study  Sexual favours, sexual abuse – BLM case in Malawi Quality: scientifically, medically of good quality.

submissions Need to strengthen mechanisms to increase state accountability on international human rights obligations Need for increased awareness/popularisation of the broad concept on the right to health – even some human right activists don’t understand it fully. Need for increased rights-based approach to HIV prevention, moving away from moralistic approaches Addressing women’s socioeconomic vulnerabilities.

Thank You!!! NORAD Evaluation