Regional Videoconference Addressing Stigma and Discrimination of HIV/AIDS in Africa Thursday, April 2, 2009 UNAIDS Perspective Susan Timberlake, Senior Human Rights and Law Advisor

In 2009, we have tools to measure stigma and discrimination and programmes to address them TOOLS TO MEASURE People Living with HIV Stigma Index (ICW, GNP+, IPPF, UNAIDS); Understanding and Challenging HIV Stigma (ICRW); PLHIV-Friendly Achievement Checklist (Population Council); New tool: Modes of transmission studies: incidence modelling and prevention response synthesis reviews (UNAIDS) PROGRAMMES TO ADDRESS Combination of empowerment of people living with HIV (i.e. led by positive people, or with their active involvement in the project design); updated education about HIV (i.e. how HIV is and isn’t transmitted) and activities that foster direct or indirect interaction between people living with HIV and key audiences (i.e. contact strategies, participatory education) Combination of social mobilization, human rights and legal activism

Addressing stigma and discrimination in HIV-responses Why do it…. Are obstacles to universal access to HIV prevention, treatment, care and support UNAIDS “mapping” data*: 86% of countries identify s&d as obstacle to universal access and/or to effective national HIV response. Countries that have laws prohibiting discrimination against key populations achieve higher prevention coverage Report on the Global AIDS Epidemic Discrimination is a human rights violation Countries have committed to eliminating all forms of discrimination, including against people living with HIV and members of vulnerable groups. * Based on an analysis of Universal Access Country consultation reports 2006, 2008 UNGASS Progress Reports, National Strategic Plans and related documents of 56 countries

Is it happening through law and law enforcement? UNGASS 2008, NCPI*: A large majority of countries (67%) report that laws and regulations are in place to protect people living with HIV from discrimination. BUT The degree to which these laws are enforced is unclear. Very few have access to justice systems. One third (33%) of countries still do not report having such laws. 62% of countries report having laws that present obstacles to effective HIV prevention, treatment, care and support for vulnerable populations. *Total number of countries responding to NCPI 136 (out of 192 reporting in UNGASS 2008)

Law and enforcement in focus countries* Ethiopia:  laws protect PLHIV, women, youth; effort made to enforce  no laws that present obstacles Kenya:  laws protect PLHIV; enforcement weak, policies unclear  obstacles to MSM, SWs and IDU Nigeria:  No apparent protective laws  Obstacles to IDU, MSM, SWs *Based on countries reporting in NCPI (UNGASS 2008)

Law and enforcement in focus countries* (continued) South Africa:  laws protect PLHIV, women, youth, MSM, prisoners, migrants; efforts to implement but gaps remain  obstacles to youth, IDU, MSM, SWs, prisoners, migrants Tanzania:  Laws protect PLHIV, women, youth, migrants  Obstacles to women, youth, IDU, MSM, SWs, prisoners Zambia:  No laws on PLHIV; weak mechanisms for implementation  Obstacles to IDU, MSM, SWs, prisoners Liberia: no data available

Is it happening through programming? UNGASS 2008, NCPI*: 90% of countries claimed to have programmes designed to change societal attitudes of and stigmatization associated with HIV and AIDS to understanding and acceptance. UNAIDS “mapping” data (based on 56 countries): 89% of countries include programmes to reduce S&D in NSPs 86% of countries include these programmes in Global Fund round 6 or 7 proposals 100% of countries include them in either Global Fund proposal or in NSP *Total number of countries responding to NCPI 136 (out of 192 reporting in UNGASS 2008) GOOD NEWS BUT WHAT DOES IT MEAN?

S&D programming in focus countries* Ethiopia:  in GF R7 proposal, but no budget or indicator  no such programme in NSP. Kenya:  in NSP and M&E plan, but no budget info available. South Africa:  in NSP, no budget or indicator info available.  in GF R6, including in budget, but no indicators. Tanzania:  in NSP, costing, and M&E (!) Nigeria:  in NSP and M&E plan, no budget info available Liberia and Zambia:  not covered in UNAIDS mapping * Based on an analysis of Universal Access Country consultation reports 2006, 2008 UNGASS Progress Reports, National Strategic Plans and related documents of 56 countries

Implications Recognition to sufficient action: Most countries recognise S and D as issue – BUT still long way to go to quality programmes at sufficient scale and coverage and to sufficient law enforcement and access to justice: Must become essential part of every national plan and taken through planning, to costing, budgeting, implementation, monitoring and evaluation Must be targeted to key aspects of particular epidemic: s and d for people living with HIV, for pregnant women living with HIV, for men who have sex with men, people who use drugs: e.g. among police if law enforcement is a problem; among health care workers for discrimination in the workplace Must be evaluated to get more evidence of what works

Promoting programmes to address stigma and discrimination as integral part of national responses to HIV From ‘Reducing Stigma and Discrimination: A Critical Part of national AIDS Programmes’ (UNAIDS, 2007):  The most promising approaches to stigma- and discrimination- reduction feature a combination of:  Empowerment of people living with HIV (i.e. led by positive people, or with their active involvement in the project design)  Updated education about HIV (i.e. how HIV is and isn’t transmitted)  Activities that foster direct or indirect interaction between people living with HIV and key audiences (i.e. contact strategies, participatory education)  Programmes promoting a combination of social mobilization, human rights and legal activism turn “victims” of stigma and discrimination into empowered groups engaged in self-determination and social change

Conclusions Stigma and discrimination remain key barriers to achieving universal access to HIV prevention, treatment, care and support Have measurement tools and programmatic approaches Have many countries claiming that they are implementing such programmes

Conclusions (continued) Need to know their content, scale and design, how and if they are working, whether they are being evaluated, what sort of evidence is building up? Need to be able to provide technical assistance to and political pressure on country level partners to support them to put these into proposals for funding and take them to scale Need to support civil society with other types of access to justice programmes