Laws, policies and practices that reinforce inequality, marginalize and even criminalize key populations make it difficult for these populations to access appropriate treatment, prevention, care and support and to protect themselves from HIV infection.
Sex work, or aspects of sex work, is criminalized in many countries across the world. Sex workers report experiences of stigma, discrimination and violence from clients, health care workers and law enforcement officers. They experience denial of health care, discrimination and humiliation, as well as violence, rape, harassment, extortion and detention by police. This deters them from accessing and being able to use HIV prevention services effectively, further increasing their vulnerability to HIV.
Rights-based health programmes that seek to, for example a) strengthen the protection of sex workers’ rights in law and policy b) train health care workers to treat sex workers with dignity and respect, and c) sensitize law enforcement officials to the human rights and health rights of sex workers, will support access and adherence to HIV-related health care for sex workers.
Due to the stigma and prejudice surrounding HIV, people living with HIV and key populations also experience discrimination and violations of their rights on the basis of their actual or perceived HIV status. For instance, they may be socially marginalised, denied work, evicted from homes and discriminated against in health care. These human rights challenges are exacerbated when people living with and affected by HIV become ill, lose their jobs and are impoverished by the costs of health care. They become increasingly vulnerable, with less agency to protect their rights and limited ability to cope with the impact of HIV.
Some entry points and existing initiatives to protect the rights of people living with HIV are described below.
The Global Commission on HIV and the Law examined the impact of law on HIV responses for key and vulnerable populations. Its findings and recommendations called on countries to outlaw discrimination, repeal punitive laws and enact protective laws to promote public health and human rights for effective HIV responses. Since that time, UNDP and its partners have supported countries across the world to advance the Commission’s recommendations. The The GCHL Fact Sheet and UNDP’s Issue Brief: Advancing Human Rights, Equality and Inclusive Governance to End AIDS provide information and examples of across the globe of UNDP’s work with country stakeholders.
The People Living with HIV Stigma Index studies document stigma and discrimination and how it impacts on people living with HIV across the globe, including verbal and physical harassment and abuse within households and communities, discrimination and denial of sexual and reproductive health care services, discrimination within working environments and in access to justice, amongst others. An updated Stigma Index research tool has been developed that includes a strong focus on vulnerable and key populations and the impact of discrimination on access and adherence to treatment and care.
According to the WHO, there are an estimated 1 billion migrants in the world, of whom 258 million are international migrants and 763 million internal migrants – one in seven of the world’s population. The rapid increase of population movement has important public health implications and must be addressed in order to achieve the vision of the 2030 Agenda for Sustainable Development.
Migrants enjoy the same rights as all people to the highest attainable standard of physical and mental health. International human rights standards, such as the 1951 Refugee Convention protect the rights of migrants to health equivalent to that of others.
Nevertheless, many refugees and migrants often lack access to health services, including services for HIV. Migration data indicates that migrants and mobile populations face various health risks and barriers to accessing essential health-care services due to, for example:
See the International Organisation for Migration’s Migration Health Evidence Portal for COVID-19 for information on the barriers faced by vulnerability of migrants and mobile populations in the context COVID-19.
The GCHL (2018) Supplementary Report noted the adoption of discriminatory and restrictive laws and policies by some countries, such as visa denials, screenings, and deportation based on health status, including HIV and TB status. It recommended that governments review and reform all discriminatory and punitive laws, policies and requirements that create barriers to entry or access to health care for migrants. They should provide migrants with access to the full range of health services, including for HIV, TB and viral hepatitis
See the ‘Interventions to strengthen human rights’ section [link to the section in this website] for more information on creating an inclusive and effective environment for access to health care for all key and vulnerable populations.
The UNAIDS Reference Group on HIV and Human Rights, which is co-managed by UNDP, advises UNAIDS on matters relating to HIV and human rights.
The Reference Group has discussed and examined critical human rights and gender equality issues and produced leading guidance on protecting human rights in various aspects of effective responses to HIV.
The Reference Group also provides advice on the implementation of the human rights elements of the UNAIDS 2016-2021 Strategy. The Strategy highlights structural interventions required to address human rights and gender-related barriers for key populations with specific targets linked to the Sustainable Development Goals. The strategy has a specific focus on prevention, treatment and support services, social protection programmes and gender equality. The strategy also has a specific result area focused on ensuring that punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV are removed.