Key Populations: Making Them Matter in the Global HIV Response

Inextricable Links: HIV and Human Rights

Kevin Osborne, LINKAGES Project Director 2 March 2015USAID Mini-University

Why Human Rights?

Human Rights

Public HealthHIV

Public Health Versus Human Rights

What is the Link between Key Populations and Human Rights?

HIV prevalence among key populations is much higher than among the general population:• 12 times higher for sex workers• 19 times higher for gay men and other men

who have sex with men (MSM)• 28 times higher among people who inject

drugs• 49 times higher among transgender women

Source: UNAIDS 2014 Gap Report

What is a Human Rights Approach to HIV Prevention, Care and Treatment?

PEPFAR’s Human Rights Action Agenda

1) Expanded access to non-discriminatory HIV prevention, treatment and care for all people, including LGBT persons

2) Increased civil society capacity to advocate for and create enabling environment

3) Increased gender equality in HIV services and decreased gender-based violence

Source: PEPFAR 3.0 Controlling the Epidemic: Delivering on the Promiseof an AIDS-free Generation

Human Rights Issues Across Key Populations

• Penalties for HIV non-disclosure, exposure or transmission are widespread

• Limited funding and attention to work with key populations

• Decreasing funding for civil society organizations’ human rights-related activities

Source: UNAIDS 2014 Gap Report

Sex Workers, Human Rights Abuses

• 116 countries have punitive laws against sex work

• Stigma and discrimination prevent service uptake and limit the quality of provision

• Violence against sex workers is common– Workplace violence– Intimate partner violence– Perpetrators at large– Organized non-state and state violence

Sources:1. Open Society Foundation. 2012. The Global Commission on HIV and the Law: Sex Workers2. WHO, et al. 2013. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions.

“Community empowerment and enabling sex workers to organize and work together for their

own benefit is a fundamental component of reducing their vulnerability to HIV.”

- Ruth Morgan Thomas, Global Coordinator of the Global Network of Sex Work Projects

Gay Men and Other MSM, Human Rights Abuses

• 78 countries criminalize same-sex sexual acts• Stigma and discrimination are barriers to

accessing services and disclosing risk behaviors• Violence against gay men and other MSM is

widespread

Percentage of gay men and other MSM who report physical, psychological or sexual violence in selected countries

Source: UNAIDS 2014 Gap Report

“There have been so many hate crimes, people get beaten up just for being them… you get

harassed, beaten, arrested just for being you.”

- Jamie Mburu, Kenya MSM, Empowerment Program

Transgender People, Human Rights Abuses

• Discrimination and social marginalization • Inability to obtain legal documents• Very limited access to transgender-friendly

health services• Widespread violence

Source: Transgender Europe’s Trans Murder Monitoring TDOR 2014 update

Source: Reisner, et al. 2013. Transgender Technical Report A Review to Inform the PEPFAR Programming

“The international community must take concrete steps to halt the needless pain and suffering among transwomen who, deprived of basic

human rights to health, work, and function in society, are then further marginalized by their

own governments. The time to act is now!”

- JoAnne Keatley, Director of the Center of Excellence for Transgender Health

People Who Inject Drugs, Human Rights Abuses

• People who inject drugs are almost universally criminalized

• Punitive laws, including compulsory rehabilitation, limit access to services

• High levels of stigma and marginalization, including from health service providers

• Police harassment and violence

Source: UNAIDS 2014 Gap Report

“The key to managing this epidemic in this community does not lie in judgment or prejudice — but rests on both strengthening community

empowerment and providing access to comprehensive harm reduction services including needle and syringe exchange programs within an

enabling legal environment.”

– Eliot Ross Albers, Executive Director of the International Network of People Who Use Drugs

What Are Some Human Rights Activities?

Agency• Engagement of KPs (GIPA for KPs)Advocacy• Rights and social justice education• Policy and practice • Reporting and prosecuting human rights violationsAlliances• Health care worker trainings to reduce stigma and

discrimination• Violence prevention and response, such as police

and judicial trainings • Working with media

Select LINKAGES Activities to Secure, Protect and Promote Human Rights

• M-watchers and M-friends social protection network to reduce stigma and discrimination in Ghana against MSM, female sex workers and KPs living with HIV

• Research on experiences of violence in Latin America and the Caribbean with transgender women and MSM

• Development and implementation of a health care worker training that addresses stigma against and the human rights of all KPs in Africa and Asia

• LINKAGES Advisory Board includes global representatives of the four key population networks

Thank You

“Those who advocate for expanding the circle of human rights were and are on the right side of history, and

history honors them… We are called once more to make real the words of the universal declaration.

Let us be on the right side of history.”

– Secretary of State, Hillary Clinton (2010)