HIV, Human and Sexual Health Rights
posted: 15/04/2010
A groundbreaking guide Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV has been produced by UNAIDS. Now, policy makers, programme managers, health professionals, donors and advocates have an important tool to better support the sexual and reproductive health and rights of people living with HIV.
Networks of people with HIV worldwide contributed to this guide, which explains what people involved in advocacy, health systems, policy making and law can do to support and advance the sexual and reproductive health of people living with HIV, and why these issues matter.
12 recommendations
- HIV testing should never be mandatory and always be based on the ‘three Cs’: confidential, based on informed consent, and conducted with counselling. This applies equally to marginalised groups, including sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, and transgender and intersex communities.
- Systems for HIV prevention, treatment, care, and support must be strengthened to deal with increased demand at the same time that HIV testing is scaled up, to ensure that HIV testing results in referral to HIV prevention, treatment, care and support programmes. In particular, pregnant women should not be tested only to prevent transmission from parent to child; they must also be offered prevention, treatment and care services.
- National laws should be reformed and enforced to ensure that:
¤ Laws explicitly ban discrimination based on sexual orientation, gender identity, and HIV status; ¤ Anal sex, sex work, same-sex relationships, and transgender relationships are decriminalized; ¤ Disclosure of HIV status is not required by law if a person is practicing safer sex, their HIV status is oherwise known, or there is a well founded fear of harm by the other person; ¤ HIV transmission is not considered a crime except for rare cases where there is evidence beyond a reasonable doubt that one person deliberately tried to infect another and indeed did so; ¤ HIV status alone does not affect a person’s right to marry or found a family, is not grounds for divorce, and is not relevant in child custody decisions; ¤ Young people have the right to confidentiality and do not need parental permission for age-appropriate information and sexual and reproductive health care, even if they are below the age of majority; ¤ Women’s property rights are ensured and protected, particularly following divorce, abandonment or a spouse’s death; ¤ Sexual violence, including incest, forced or early marriage, sexual assault or rape (including in the context of sex work or in marriage) is recognised and prosecuted as a crime; ¤ Injecting drug users are provided with treatment, including opioid substitution therapy, and harm reduction programmes as an alternative to incarceration; and ¤ Transgender people are legally recognised and clear procedures are in place for changing name and sex on official documents.
- All people living with HIV – including members of marginalised groups, such as sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, transgender and intersex communities – should have access to a full range of sexual and reproductive health services, including:
¤ All available contraceptive options and help with dual protection, without coercion toward any method; ¤ Counselling and support for positive prevention and voluntary disclosure ¤ Access to safe abortion (where legal) and post-abortion care; ¤ Counselling and support for safe ways to become pregnant; ¤ Counselling and practical support for infant feeding, whether breastfeeding or replacement feeding; ¤ Diagnosis and treatment of STIs; ¤ Cancer prevention and care; ¤ Counselling related to violence; ¤ Sexual dysfunction treatment; and ¤ Male circumcision for men living with HIV if, when fully informed, they want the procedure.
- Health workers should receive training in human rights and universal precautions, as well as specific training in sexual and reproductive health care for people living with HIV, including technical skills and stigma reduction. People living with HIV should participate in these programmes as trainers.
- Health service providers and advocates should support closer linkages between HIV prevention, care, and treatment; comprehensive sexual and reproductive health services; drug substitution therapy; mental health and psychosocial services; and anti-discrimination and antiviolence initiatives.
- Advocates should ensure that special centres and programmes are developed to deliver information and services to hard-to-reach populations.
- Governments, international agencies, and NGOs, in collaboration with organizations of young people living with HIV, should develop specific guidelines for counselling, support and care for people born with HIV as they move into adolescence and adulthood.
- Governments, international agencies, and NGOs should better research and monitor the sexual and reproductive health of people living with HIV, including data disaggregated by gender, age, marital status, geographic location and sexual orientation. This research should be conducted with the input and supervision of people living with HIV.
- Governments, international agencies, and NGOs should set and monitor concrete targets for involving people living with HIV in all relevant activities, including positive prevention programmes.
- Governments, international agencies, and NGOs should support income-generating programmes. This includes directly employing people living with HIV, and paying them for their work.
- Advocates should ensure that programmes to bolster participation of people living with HIV also help build needed skills. In particular, women and young people should be provided with ‘know your rights / laws’ education and advocacy training.
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