This commentary, published by the Canadian HIV/AIDS Legal Network and endorsed by more than 40 organizations around the world, including the Center for HIV Law and Policy, is a comprehensive, excellent critique the the April 2007 UNAIDS Guidane Note on HIV and Sex Work. Noting the Guidance Note's inconsistency with prior UN statements on the importance of protecting of sex workers' basic rights, the commentary addresses UNAIDS' failure "to consider seriously the precarious human rights situation of sex workers, and the way abusive and violent poicing and ill-conceived national laws undermine sex workers' rights. It also fails to discuss the human rights of sex workers as workers, including their right to work, their right to a livelihood of their choosing, and their right to workplace safety."
The Kaiser Family Foundation commissioned a racially diverse group study of lower-income women with HIV/AIDS in Philadelphia, Los Angeles, Miami and Savannah to hear directly from them about their lives and the challenges they face in obtaining a full-range of health care services. The specific issues addressed were barriers to receiving care, interactions with the health care system, relationships with providers, challenges unique to women, knowledge level about their illness, effects of HIV/AIDS on other aspects of their lives and the information they need and sources they trust. Ideas for improving access to quality health care were distilled from the womens insights. First, time of diagnosis is a critical moment to inform, support and connect women with HIV/AIDS services. How women were told about their status affected when and if they sought treatment. Second, gender specific services should be available to women such as mental health support, child care assistance, transportation and access to female providers. Third, women who were connected to local AIDS services organizations, services and networks of information had better health care experiences. Fourth, making Medicaid available to more women with HIV/AIDS and continuing to support ADAP. Fifth, use providers, peers, internet, TV/radio to inform women about HIV/AIDS and especially to reach out to Latinas with HIV/AIDS. Although not mentioned in the conclusions, a persistent problem for women with HIV is the stigma and prejudice they face from health care professionals who are not HIV specialists. Women still experience denial of services from dentists, gynecologists and general practitioners after disclosing their status. Stigma, and perception of social risk, affects when and whether women disclose their status or pursue and receive care for a multitude of health issues. This study highlights the imperative that all health care professionals be trained and educated about HIV/AIDS issues.
This report summarizes discussion from two international electronic fora in which advocates, service providers, and HIV-positive women discussed services and policies related to the sexual and reproductive health of HIV-positive women. While the discussions spanned numerous countries and cultures, common threads appeared regardless of the geographical or cultural context. These threads provide lessons for all advocates seeking to promote the well-being of HIV-positive women. Issues such as confidentiality, domestic abuse, and reproductive rights were discussed, with the overarching issue being the high degree of stigma and discrimination experienced by HIV-positive women. Most strikingly, the discussions revealed widespread violations of the human rights of HIV-positive women as a result of the stigma and discrimination that they faced. These violations provided a backdrop to virtually all other topics discussed, creating major obstacles to the attainment of appropriate care and services by HIV-positive women. Another major theme was the lack of the most basic services responsive to the needs of HIV-positive women. Women described significant barriers at the domestic, community, regional and national level in realizing their rights and sexual and reproductive health. Among those mentioned included: inaccessibility of health centers; lack of respect for female patients' rights and judgmental attitudes among health care workers. The report is published by EngenderHealth, Harvard University, International Community of Women Living with HIV/AIDS, Ipas, and the United Nations Population Fund.
This report prepared by the Center for Health and Gender Equity focuses on the role that female condoms can play in HIV prevention, and how the U.S. needs to be the leader in global distribution of, and education about, female condom use. The document’s executive summary explains that, “as international donors and country governments move forward with plans to make male circumcision more accessible and invest millions of dollars into developing microbicides and vaccines, they cannot afford to overlook the only available HIV prevention intervention that was designed to allow women to initiate protection: female condoms.”
This guide aims to provide sexual and reproductive health program planners, managers, and providers with the information necessary to integrate voluntary counseling and testing (VCT) for HIV within their services. VCT is not merely the simple assent to testing, but rather "the process by which an individual undergoes confidential counselling to enable the individual to make an informed choice about learning his or her HIV status and to take appropriate action." Counseling for VCT consists of pre-test, post-test, and follow-up counseling. VCT is a human-rights based approach to HIV testing and treatment that enables patients to make informed decisions; it has been shown to be an effective strategy to facilitate behavior change for HIV prevention, as well as to reduce the stigma and discrimination associated with HIV. The guide discusses the benefits of VCT and the barriers to implementation, and provides specific steps for each stage of implementing VCT, including the initial assessment of community need, planning, implementation, monitoring, and evaluation. The guide was produced by the United Nations Population Fund and the International Planned Parenthood Foundation.
This paper, drafted in 2002 for UNAIDS by Richard Elliott of the Canadian HIV/AIDS Legal Network, is a well organized and useful document that describes the various policy considerations involved in legislating criminalization of HIV, and includes multiple policy options that advocates can use to argue against criminal exposure and transmission laws, or at least for mitigation of the effects of such laws. It incorporates a human rights discussion throughout and offers some guiding principles that legislators ought to keep in mind when considering legislation designed to punish HIV-positive individuals.
HIV-positive women need access not only to appropriate health care and antiretroviral medications, but also to HIV treatment support. This paper discusses the unique barriers women face to Access to Care, Treatment, and Support (ACTS). Issues include the limitations of health centers as points of access, the lack of research on the effects of antiretrovirals that is specific to women, and the stigma and discrimination that keep women from obtaining the care and support they need. The paper argues that HIV-positive women are in the best position to understand these issues, and that they therefore should be involved in attempts to identify and address these barriers. The paper could be useful for HIV-positive women and their advocates, as well as health-care providers, who seek to understand and reduce gender inequalities and obstacles to HIV treatment. Produced by the International Community of Women Living With HIV/AIDS.
This document summarizes the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and describes the status of CEDAW in the United States, and describes CEDAW’s impact on several issues, including HIV/AIDS. It provides excellent insight into how CEDAW has been received by the federal government, and state and local government declarations with regard to CEDAW. It also specifically discusses the issues unique to women and HIV/AIDS and how CEDAW addresses these problems.
The Convention on the Elimination of All Forms of Discrimination Against Women (“CEDAW”), addresses women’s rights within the political, social, economic, cultural, and family life. It calls for state parties to overcome barriers of discrimination against women in areas of legal rights, education, employment, health care, politics, and finance, and sets benchmarks. Particularly relevant to HIV/AIDS issues are: the definition of discrimination against women (Article 1); a mandate that states condemn discrimination in all its forms and ensure a legal framework that provides protection and embodies the principle of equality (Article 2); mandate of the end of discrimination in employment, including the right to work, employment opportunities, equal renumeration, free choice of profession and employment, social security, and protection of health, including maternal health (Article 11); requirement of steps to eliminate discrimination in health care, including family planning access (Article 12); a focus on the unique problems that rural woman face in access to health care and adequate living conditions (Article 14); requirment of steps to ensure equality in marriage and family relations, including the right to freely determine the number and spacing of children (Article 16). Article 18 requires parties to submit reports periodically to the Committee on the Elimination of Discrimination Against Women on measures they have taken to give effect to the Convention.
As a treaty, CEDAW is binding on all parties that ratify it; those who sign but do not ratify it are obligated not to act contrary to the purpose of the convention under Article 18 of the Vienna Convention. CEDAW also has an optional protocol that allows individuals to submit complaints to the Committee arguing that their rights have been violated by the state party, and which allows the Committee to investigate grave or systematic violations of CEDAW. Although the United States has signed CEDAW, it has failed to ratify it, placing it among a small minority of countries including Iran, Sudan, and Somalia.
This chart, updated in August 2008, includes information on criminal laws related to exposure and/or transmission of HIV for all 50 states and the District of Columbia. Information includes statutory and regulatory citations, crime classification, summaries of laws, and additional notes.
In a case brought by the Brennan Center for Justice at NYU School of Law, two organizations (AOSI and Pathfinder International) that received funding under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (the Leadership Act) sued the U.S. Agency for International Development (USAID), among others, seeking to enjoin their narrow reading of the Leadership Act’s provision requiring funded organizations to have a policy expressly opposing prostitution and sex trafficking. In May, 2006, the U.S. District Court for the Southern District of New York had ruled that this requirement violated the organizational plaintiff’s First Amendment rights, restricting their privately-funded speech and forcing them to adopt the U.S. government’s views in order to be eligible for funding. The Court of Appeals remanded in view of proposed new HHS and UNAIDS guidelines to determine whether a preliminary injunction is appropriate. In February 2008, the plaintiffs filed an amended complaint to add Global Health Council and InterAction (international development and public health groups) as plaintiffs; Global Health Council and InterAction then moved for a preliminary injunction on behalf of their members. HHS represented to the court that its July 2007 guidelines will go through a notice and comment process by April 2008, after which the court will assess the constitutionality of the revised guidelines. For copies of pleadings and other information, go to http://www.brennancenter.org/content/resource/aosi_v_usaid/
In a case brought by the Brennan Center for Justice at NYU School of Law, two organizations (AOSI and Pathfinder International) that received funding under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (the Leadership Act) sued the U.S. Agency for International Development (USAID), among others, seeking to enjoin their narrow reading of the Leadership Act’s provision requiring funded organizations to have a policy expressly opposing prostitution and sex trafficking. In May, 2006, the U.S. District Court for the Southern District of New York ruled that this requirement violated the organizational plaintiff’s First Amendment rights, restricting their privately-funded speech and forcing them to adopt the U.S. government’s views in order to be eligible for funding. The opinion may also be useful to those looking for a source in which to discuss HIV among marginalized groups. The opinion discusses the larger context in which the debate takes place, citing the high rates of HIV among some populations sex workers and the difficulties in reaching this marginalized community. The Court of Appeals for the Second Circuit remanded in view of proposed new HHS and UNAIDS guidelines to determine whether a preliminary injunction is appropriate. In February 2008, the plaintiffs filed an amended complaint to add Global Health Council and InterAction (international development and public health groups) as plaintiffs; Global Health Council and InterAction then moved for a preliminary injunction on behalf of their members. HHS represented to the court that its July 2007 guidelines will go through a notice and comment process by April 2008, after which the court will assess the constitutionality of the revised guidelines. For copies of pleadings and other information, go to http://www.brennancenter.org/content/resource/aosi_v_usaid/
According to the introduction, the purpose of the study described in this paper was to “obtain information on criminal prosecutions for HIV exposure in the United States, including: state and year, mode of exposure, type of law under which prosecution occurred, defendant and victim characteristics, and outcome.” Identifying 316 prosecutions in 39 states over a 15-year period, the authors found that outcomes varied significantly depending on the factors noted above. Ultimately, the authors concluded that, as a public health intervention and a deterrent to future activity, criminal prosecution of HIV exposure is ineffective.
This issue, published in English and Spanish, focuses on the rights of sex workers. It addresses: 1) police raids and “rescue” services that are often counterproductive to securing sex workers’ rights and ensuring no underage involvement in sex work; 2) how criminalization of sex work further stigmatizes the people it is meant to help and encourages violence against them; 3) participation of sex-workers in approaches to HIV treatment and prevention; 4) targeting trafficking and the entry into sex work as separate from targeting those living as sex workers; 5) a case study in how the United States PEPFAR “anti-prostitution pledge” has influenced the response to female sex workers’ HIV/AIDS needs in Nigeria; 6) sex worker organizing in Madagascar; unfriendly encounters with police among Manhattan sex workers; 7) an analysis of the rhetoric used in newspaper articles about sex work and how that influences attitudes and responses; and 8) peer-led HIV/AIDS responses in New South Wales, Australia.Additional issues of Research for Sex Work are available here.
Esta edición, publicado en ingles y español, enfoca en los derechos de trabajadores sexuales. Se dirigió 1) las ataques de incursiones por la policía y los grupos reformadores que son contraproducentes a las metas de asegurar los derechos de los trabajadores y de asegurar que los minores no entrañan en el trabajo sexual; 2) la manera en que la criminalización del trabajo sexual estigmatiza más los persones que se trata de ayudar y se promota la violencia contra ellos; 3) la participación de los trabajadores sexuales en las maneras de prevención y tratamiento de VIH; 4) distinguir el tráfico humano y la entrada al trabajo sexual como diferente que los trabajadores sexuales en sí mismas; 5) un estudio de caso en como el “Compromiso Anti-Prostitución” del E.E.U.U. ha influido la reacción a los necesidades de VIH/SIDA de las trabajadores sexuales en Nigeria; 6) organizando a los trabajores sexuales en Madagascar; encuentros no amistosos con la policía entre los trabajadores sexuales en Manhattan; 7) un análisis de la rétorica usada en los artículos de diarios que discuten el trabajo sexual y como este influye los actitudes y las repuestas; 8) las repuestas de un grupo de persons que viven con VIH/SIDA sobre este sujeto en New South Wales, Australia.Ediciónes adicionales de Investigación para el Trabajo Sexual son disponible aquí.
The Convention on the Elimination of All Forms of Discrimination Against Women (“CEDAW”), addresses women’s rights within the political, social, economic, cultural, and family life. It calls for state parties to overcome barriers of discrimination against women in areas of legal rights, education, employment, health care, politics, and finance, and sets benchmarks. Particularly relevant to HIV/AIDS issues are: the definition of discrimination against women (Article 1); a mandate that states condemn discrimination in all its forms and ensure a legal framework that provides protection and embodies the principle of equality (Article 2); mandate of the end of discrimination in employment, including the right to work, employment opportunities, equal renumeration, free choice of profession and employment, social security, and protection of health, including maternal health (Article 11); requirement of steps to eliminate discrimination in health care, including family planning access (Article 12); a focus on the unique problems that rural woman face in access to health care and adequate living conditions (Article 14); requirment of steps to ensure equality in marriage and family relations, including the right to freely determine the number and spacing of children (Article 16).
A revised and consolidated version of the original guidelines published in 1996, the purpose of the Guidelines is “to assist States in creating a positive, rights-based response to HIV that is effective in reducing the transmission and impact of HIV and AIDS and is consistent with human rights and fundamental freedoms.” The Guidelines are a joint project of the United Nations Office of the High Commissioner for Human Rights and UNAIDS. The consolidated guidelines include the revised Guideline 6, which reflects the human rights dimensions of access to HIV prevention, treatment, care, and support. The document consists of three parts: 1) twelve guidelines for state action; 2) recommendations for dissemination and implementation of the Guidelines; and 3) a description of the human rights principles underlying a positive response to HIV. The primary users are intended to be states, but it is also meant to inform intergovernmental organizations, non-governmental organizations, networks of people living with HIV, community-based organizations, networks on ethics, law, human rights, and HIV, and AIDS service organizations. It is also useful for any person looking for interested in a rights-based approach to HIV/AIDS and specific steps needed to implement such an approach.
This Handbook is intended to guide a human-rights based response to HIV for national human rights institutions, civil society organizations, networks of people living with HIV, and national AIDS programs. Government institutions and other partners of national institutions may also find it useful. It provides a useful outline of international legal principles that underlie a rights-based approach to HIV/AIDS, as well as specific steps institutions can take to further these principles. Such steps are outlined in the context of: outreach and in-reach for assessing national institutions and their partnerships, workplans, and priorities; integrating HIV into existing activities and programs; education and raising awareness on HIV and human rights; working with national AIDS programs; and achieving universal access to HIV prevention, treatment, care, and support. The Handbook is intended to be read alongside the International Guidelines on HIV/AIDS and Human Rights. The annex includes the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS.
Public Law No. 110-293 is the reauthorizing legislation of the President’s Emergency Plan for AIDS Relief (PEPFAR), originally authorized in 2003.
The 2008 Act authorizes up to $48 billion for PEPFAR through 2013, an increase from the $15 billion originally authorized for the first five years in 2003. It also eliminates a statutory ban prohibiting HIV-positive foreigners from entering the United States, which made HIV the only disease for which there was a de facto statutory ban requiring a special waiver.
Regardless of this progress, some of the Act’s policies are subject to criticism for continuing certain policies of the 2003 Act. In particular, many organizations oppose the Act’s prohibition on funding for organizations that do not adopt organization-wide positions opposing commercial sex work, limiting the ability or organizations to work with the sex-worker community to prevent exploitation and promote safer practices. This provision has been the source of an ongoing legal challenge, Alliance for Open Society International v. United States Agency for International Development, 430 F.Supp.2d 222 (S.D.N.Y 2006), since its inclusion in the 2003 Act. Also, policies promulgated under PEPFAR, though not written into the law, also restrict the kinds of programs that may be funded, prohibiting the funding of safe needle exchange programs for intravenous drug users, despite the proven efficacy of such programs. Moreover, although the new Act no longer requires that one-third of the funds for prevention efforts be directed toward programs that promote abstinence-only programs, the Act requires a report to Congress if less than half of HIV prevention funds in a particular country be spent on abstinence and fidelity programs. Recent studies have demonstrated abstinence-only programs to be ineffective and, in many countries, marriage increases a woman’s risk of contracting HIV.
