1. HIV and Women’s Rights

2. Session Goal
To discuss why women are disproportionately affected by the HIV epidemic globally, and how public health programs and human rights doctrines address (or aim to address) this inequality.

3. Learning Objectives
Understand the drivers of inequality that cause women and girls to be more vulnerable to HIV infection
Understand how human rights relates to the prevention, treatment, and care of HIV
Analyze the specific conditions in countries with high rates of HIV transmission among women
Differentiate between a public health and human rights approach to addressing women’s HIV vulnerability and burden

4. Understanding the Epidemic
What is HIV
Current epidemiology
Prevalence
36.7 million people living with HIV in 2016 (UNAIDS)
Incidence
In 2015 there were 0.3 new HIV infections per 1,000 uninfected people (people at risk)
1.8 million new infections in 2016 (UNAIDS)
Source:

5. Women and HIV 51% of people living with HIV (PLHIV) are women
Women account for 60% of PLHIV in western and central Africa and 56% of new infections among adults in Sub-Saharan Africa. (UNAIDS, 2017)
HIV is the leading cause of death among women aged 30-49

6. Young Women and HIV
Young women are 2x as likely to acquire HIV as their male counterparts (UNAIDS, 2016)
Sex workers are 10x more likely to acquire HIV than adults in the general pop. (Amin, 2015)
Transgender women are 49x more likely to be living with HIV as compared to all adults of reproductive age groups (Amin, 2015)
Intimate partner violence against women is associated with a 1.5-fold increase in risk of STIs or HIV in some regions (Amin, 2015)

7. Girls and HIV
Source: When Women Lead Change Happens, UNAIDS 2017

8. This epidemic unfortunately remains an epidemic of women.
Michel Sidibé, Executive Director of UNAIDS

9. Fishbone Diagram Activity
How does gender inequality lead to increased risk for HIV?
Causes/Drivers
Socio-cultural
Political Inequality
Legal Protection
Economic inequality
Violence
Biology

10. Human Rights and HIV Right to Health
HIV is often framed within the context of the human right to health
Noted in International Covenant on Economic, Social, and Cultural Rights and constitution of the World Health Organization (WHO)
Sexual and Reproductive Health and Rights (SRHR)
Women’s SRH is related to multiple human rights including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination.
The OHCHR and CEDAW have both indicated that women’s right to health includes their SRH

11. Human Rights and HIV
UN International Guidelines on HIV/AIDS and Human Rights, 1998 and 2006
UN Declaration of Commitment on HIV/AIDS, 2001
UN Political Declaration on HIV/AIDS, 2006 and 2011
Expressed concern for feminization of HIV, recognizing that gender inequalities and all forms of violence against women and girls increase their vulnerability to HIV
Affirmed that full realization of all human rights is an essential element in the global response to HIV, including in the areas of prevention, treatment, care and support, and recognize that addressing stigma and discrimination is also a critical element in combating the pandemic

12. Human Rights and HIV
UNAIDS has adopted a rights-based approach in its policies, programs and activities
UNAIDS 2016–2021 Strategy is one of the first in the UN system to be aligned to the Sustainable Development Goals:
SDG3: Good Health and Well-being
SDG 10: Reduced Inequalities
SDG 5: Gender Equality
SDG 16: Peace Justice and Strong Institutions
Source:

13. Human Rights Violations
Criminalization
Sex workers
HIV Transmission, exposure, and nondisclosure
Discrimination
In healthcare
In the workplace
HIV related travel and immigration restrictions
Other Violations
HIV testing without consent
SRHR of WLHIV

14. The Global Commission on HIV and the Law Recommendations
TED Talk: How to Fight An Epidemic of Bad Laws, Shereen El-Feki
What recommendations address women’s HIV vulnerability and burden? (El-Feki pp )

15. The Global Commission on HIV and the Law Recommendations
TED Talk: How to Fight An Epidemic of Bad Laws, Shereen El-Feki
What recommendations address women’s HIV vulnerability and burden? (El-Feki pp )
Decriminalize sex work
Address issues of violence: domestic violence, rape, sexual assault, forced abortion and coerced sterilization of HIV positive women
Address legal environment around early marriage, widow inheritance, widow cleansing
Improve access SRH information and options
Improve access to age-appropriate comprehensive sex education

16. Human Rights vs Public Health Framework
Human Rights Approach
Laws, treaties, political declarations and commitments that protect and promote fundamental rights such as health
Guidelines may be vague as well as not legally binding or enforced
How it can be applied:
Influencing law and policy reform
Monitoring and enforcement
Addressing violations
Implement harm reduction policies

17. Human Rights vs Public Health Framework
Public Health Approach
Surveillance and research on prevention, treatment and care of population health challenges
Evidence-based interventions that promote and protect health including information, education, and services.
Time bound and dependent upon funding
How it can be applied:
Effective delivery of prevention, treatment and care services to those at risk or affected addresses their right to health
Public health programs can promote or violate human rights depending on how they are designed or implemented
Can prioritize vulnerable populations

18. Integrated Framework
Translating international human rights principles and legal obligations into practical public health programming at the country level.
Incorporating human rights principles into HIV programs creates an environment where the most vulnerable have their rights fulfilled and and access the services they need.
Key Principles
Equality and non-discrimination
Equal and full participation of all stakeholders
Putting communities at the center of programs
Capacity-building of rights holders and decision makers
Accountability (AVERT, 2017)
Source:

19. Integrated Framework Examples of human rights-related HIV programs:
Stigma and discrimination reduction
Legal services
Monitoring and reforming laws, regulations and policies relating to HIV
Rights education for people living with HIV and key populations
Sensitization of lawmakers and law enforcement officials
Human rights training for healthcare workers
Reducing gender-related discrimination
Community responses to HIV and human rights.
Source:

20. Integrated Framework Examples:
RCTs show male circumcision can prevent HIV transmission, but raises human rights concerns. In 2007 UNAIDS published a guidance for decision makers on human rights and legal considerations surrounding it.
Treatment Action Campaign (TAC), a South African organization sued the government to provide ensuring mother-to-child-transmission (MTCT) prevention programs and access to antiretroviral therapy (ART) in public clinics
US President's Emergency Plan for AIDS Relief (PEPFAR) used to exclude family planning in HIV/AIDS activities but now supports integration of SRH. In addition to gender mainstreaming in HIV programs, it supports human rights integration.

21. Discussion Questions
1. Pick a country from AVERT HIV Around the world page at
2. Why are women more vulnerable or disproportionately affected by HIV there?
3. What would be a more effective approach for addressing women’s HIV burden in the country? A Public Health or Human Rights approach?

22. Learning Objectives Recap
Understand the structural drivers of inequality that cause women and girls to be more vulnerable to HIV infection
Fishbone Diagram using UNAIDS, Amin, El-Feki readings
Understand how human rights relates to the prevention, treatment and care of HIV
Discussion of current human rights doctrine
Discussion of El-Feki Recommendations
Analyze the specific conditions in countries with high rates of HIV transmission among women
AVERT research activity
Differentiate between a public health and human rights approach to addressing women’s HIV vulnerability and burden
AVERT research activity discussion question
3:10-3:20

23. -Michel Sidibé, Executive Director of UNAIDS
“It’s incredible to see the progress that some countries have made over the past five years. They’ve taken important strides to protect the rights of women and people living with and vulnerable to HIV. But now is also the time to think of the way forward in addressing the persistent and new challenges that are leading to people being left behind in the response to HIV”.
-Michel Sidibé, Executive Director of UNAIDS