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Let’s not fall behind on ending HIV, TB
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|Let’s not fall behind on ending HIV, TB by Kenyans247(1): Tue 17, March, 2020 01:55pm|
A healthcare worker accused of encouraging sex workers ‘deviant behaviour’. A gay man lectured on sin. A transgender woman taken into police custody after visiting a health facility.
These testimonies, documented in UNDP’s assessments of healthcare barriers in Africa, do not exist in isolation; they are fuelled by an increasingly hostile legal environment. For example, since 2005, 14 countries in West and Central Africa passed new laws criminalising HIV transmission.
But the dawn of 2020 means we are only a decade from the UN target for ending the HIV and tuberculosis (TB) epidemics.
Despite progress, this goal is far from achieved. Inequities in access to health services, often experienced by the most vulnerable, are more pronounced than ever.
People are fighting to uphold the fundamental right to health. Punitive laws are being challenged, lights shone on discriminatory practices and socially marginalised groups demanding to be heard and their health needs met.
These are valiant efforts. Yet the magnitude of the task — ending two of the deadliest epidemics ever — far outweighs the political commitment and investment. UNAIDS says just 0.13 per cent of Aids spending by low- and middle-income countries is allocated to human rights programming.
Since 2016, UNDP and its civil society partners have worked with governments to address legal barriers to health services through a regional grant supported by the Global Fund to Fight Aids, Tuberculosis and Malaria.
Conducted in 10 African countries, this has transformed attitudes, increased access to justice, resulted in law and policy reform and used regional approaches to address the issues which may have been too sensitive to address at the country level.
But clearly, the ambition must match the goal. Achieving universal health coverage requires expanding programmes to reach the most at risk, scaling up innovative approaches and sharing good practices.
And strong networks of civil society organisations are essential to achieving this. For their invaluable local knowledge, they are uniquely placed to meet the needs of the most vulnerable.
Given this, the shrinking of civil society space, as highlighted by the Global Commission on HIV and the Law, is not only unjustifiable; it will, ultimately, cost lives.
Prisoners are five times more likely to be living with HIV. But effecting change in a prison system requires collaboration with law enforcement officials, coupled with evidence of successful approaches in similar contexts.
Which is why human rights training on law enforcement and healthcare is so effective.
Gathering and sharing evidence is also imperative. In Côte d'Ivoire, a recently established observatoire supported by Enda Santé documented 19 cases of human rights violations between October and December 2019.
But this is only the first step. Using the evidence to advocate political change is vital but often fraught with political sensitivities.
Uniting civil society to advocate collectively has helped to overcome some of the most contentious and divisive issues.
Legal challenges to discrimination also reverberate far beyond any one individual case.
When a Nigerian man was sacked based on his HIV status, he got legal support from Lawyers Alert and the Southern Africa Litigation Centre (SALC).
The National Industrial Court found dismissing employees based on their perceived or actual HIV status unlawful, awarding over five years’ of salary in damages. This ruling sets an important precedent.
Similarly, peer-learning helps countries to navigate common pitfalls.
When the Kenya National Commission on Human Rights presented their experience of a national inquiry on human rights violations against LGBTI persons, they highlighted the security risks of public hearings, particularly for marginalised groups.
Following the workshop, organised by the Aids and Rights Alliance for Southern Africa (Arasa), the Malawi National Commission on Human Rights cancelled their planned inquiry, which civil society feared could put LGBTI lives in danger, and instead focused on a national study which could protect peoples’ anonymity.
Efforts to uphold the right to health are making a tangible difference and should be lauded. But they are fragmented. Regional approaches together with civil society organisations, supporting the most at risk, are one of the best defences against the epidemics.
With only 10 years to fulfil our commitment to end HIV and TB, the world cannot afford to fall further behind.
Mr Saha is the team leader of the UNDP HIV, Health and Development Team for Africa. @amitrajitsaha
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