National health, HIV, TB and malaria strategies, plans and proposals, including Global Fund funding proposals, should include interventions aimed at achieving a strengthened legal and policy environment to protect human rights and gender equality.
An enabling legal and policy framework to address critical enablers for health requires several mutually reinforcing interventions that include:
Monitoring and reviewing laws, regulations and policies to protect human rights and promote gender equality for all populations at risk of poor health, including vulnerable and key populations at risk of HIV, TB and malaria;
Stigma and discrimination reduction programmes to reduce stigma and discrimination against vulnerable and key populations;
Legal literacy to educate communities about human rights, gender equality and protections in law and policy for their rights in the context of health;
Legal support services to support communities to get legal advice, access legal support, challenge violations and seek redress through litigation and other means;
Training for health care workers to prevent stigma, discrimination and human rights violations during the delivery of HIV, TB and malaria and other health services, including sexual and reproductive health services;
Sensitization of law-makers and law enforcers to strengthen the awareness and understanding of how vulnerable and key populations experience human rights and gender-related barriers to access to health care, and access to justice and the need for rights-based responses and appropriate law enforcement;
Addressing gender inequality, harmful gender norms and gender-based violence that impact on the health rights of vulnerable and key populations.
In addition, an effective response requires:
Capacity strengthening and mobilization of civil society and key populations to participate in and advocate for rights-based health responses; and
Research and monitoring of ongoing human rights issues and violations and progress towards creating protective, enabling frameworks and advocacy to address law, human rights and gender equality issues through strategies such as law review and reform, strategic litigation and integration of rights-based responses in national health responses.
The following pages provide details on several types of interventions for human rights, including those related to law reform, training health care workers, judges, lawmakers and other stakeholders, and health programme interventions to reduce stigma and promote gender-transformative responses to HIV, TB and malaria.
UNAIDS key programmes to reduce stigma & discrimination and promote access to justice in national responses
Since 2012, UNAIDS has advocated seven key programmes to reduce stigma and discrimination and create enabling legal and policy environments for access to HIV-related health care services. These programmes also serve to strengthen health and community systems and can also be applied to addressing human rights within TB and malaria responses. They are:
1) stigma and discrimination reduction 2) training for health care workers on human rights and medical ethics 3) sensitization of law-makers and law enforcement agents 4) legal literacy (“know your rights”) 5) HIV-related legal support services 6) monitoring and reforming laws, regulations and policies 7) reducing gender inequality, harmful gender norms and gender-based violence
Global Fund programmes to remove human rights-related barriers to HIV, TB and malaria services
The Global Fund recognises the UNAIDS 7 key programmes as essential to remove barriers to access to services for HIV & TB. In addition, for TB, it recommends programmes to:
Ensure confidentiality and privacy;
Mobilise and empower patients and community groups;
Address policies regarding involuntary isolation and detention for failure to address.
For malaria, it recommends programmes to:
Undertake human rights and gender assessments of malaria-related risks and access to services;
Support community systems strengthening;
Ensure the meaningful participation of affected populations;
Review laws, regulations and policies to enable malaria responses;
Improve access to services for underserved populations.
Key interventions to protect the health rights of key populations, adolescent girls and young women
Vulnerable and key populations, including young key populations, may be at increased risk of stigma, discrimination and human rights violations and should be targeted with specific efforts to reduce inequalities and social exclusion that drive HIV and poor health and that create enabling legal, regulatory and policy environments to strengthen their access to HIV-related and other health care services.
An effective health response for adolescent girls and young women (AGYW) in particular should include programmes to address all human rights and gender equality-related barriers that increase AGYW’s vulnerability to ill health or limit their access to sexual and reproductive health services. These may include initiatives to review and reform laws and strengthen access to justice to protect AGYW from:
Stigma and discrimination from health care providers, partners, families and communities
Breaches of the confidentiality and privacy rights of AGYW
Age of consent laws that make it difficult for AGYW to access sexual and reproductive health services independently of a parent or guardian
School policies that require pregnant girls to drop out of schools
Laws that criminalize consensual sexual activity amongst older adolescents
Laws that criminalize consensual same-sex sex
Laws that criminalize adult sex work
Laws that provide for punitive approaches to drug use
Laws that allow for child marriage
Laws and law enforcement that provides inadequate protection against gender-based violence