As part of the main drivers of the BAM Group of Companies, this being the umbrella company within which Informative Newspaper operates, alongside sister brands Finite Magazine, Finite Lifestyle Club, Bam Promotions and Twin Talk, Informative Newspaper takes particular interest in social issues and causes created to advance the development of young girls and women and their participation in the global space.
To advance and cement the organization’s support for women and young girls, the Sexual and Reproductive Health and Rights is today, through this issue introduced. Its purpose is to advance knowledge and create further awareness on developments surrounding the said community sector and to help audiences stay updated on such, further guiding means of both action and reaction to these developments.
This week we discuss Prevention
The scale-up of ART is one of the most significant achievements in the struggle against HIV, but it has not been matched by similar progress in HIV prevention. No country was able to meet the target of reducing sexual and drug-related transmission by 50% in 2015, as set out in the 2011 UN Political Declaration on HIV/AIDS. In October 2017, UNAIDS released its HIV Prevention 2020 Road Map. 92 The Road Map is intended to guide the scale-up of national prevention programmes and assist countries to meet the 2030 HIV targets.
Although a 29% decline in new HIV infections has been reported in Southern and East Africa between 2010 and 2016, this decline is uneven between countries and population groups.93 One third of all new infections in the region in 2016 were in South Africa and an additional 50% occurred in Kenya, Malawi, Mozambique, Uganda, Tanzania, Zambia and Zimbabwe.94 Key populations, including sex workers, gay men and men who have sex with men, transgender persons, and people who use drugs, also continue to have disproportionately high rates of HIV infection and access to services does not meet the demand.95 The 2017 SADC Regional Strategy for HIV and AIDS Prevention, Treatment and Care and Sexual and Reproductive Health and Rights amongst Key Populations confirms the high levels of both HIV prevalence and risk for key populations and the urgent need to address their access to HIV prevention.
Various groups are being left behind:
• The HIV epidemic in Southern and East Africa continues to disproportionately affect women and girls, with young women (aged 15–24 years) accounting for 26% of new and GBV block access to HIV prevention services and young women and girls do not have access to CSE to allow them to make informed decisions about how to protect themselves from HIV, nor can they always decide when or whether to have sex. Laws and policies that require parental consent to HIV testing and access to SRH care may further undermine prevention efforts.
- Gender inequality and GBV increase women’s vulnerability to HIV and undermine their access to HIV prevention services and commodities, including HIV testing and counselling. Women in abusive relationships cannot make decisions about protecting themselves from HIV and they are often afraid to undergo HIV testing, access ART or disclose their HIV status to a sexual partner. Adolescent girls and young women are especially vulnerable to domestic violence and in Africa, many girls report that their first sexual experience was coercive.
- Stigma and discrimination, including criminalisation of consensual adult sex, help to block access to HIV prevention information, services and commodities for key populations and high levels of sexual violence contribute to their increased vulnerability to HIV.
What is combination prevention? Combination prevention programmes are rights-based, evidence- informed and community-led and they seek the best ways to reduce new infections amongst individuals and communities. They combine biomedical, structural and behaviour interventions into a single integrated response tailored to the local context.98 The 2016 Prevention Gap Report states that too few countries are applying a combination prevention approach to HIV.
International and regional human rights obligations
International human rights law has been interpreted to obligate states to ensure access to condoms and other HIV prevention services, as part of the right to the highest attainable standard of health. ICESCR directs governments to take steps necessary for the prevention, treatment and control of epidemics. This would include HIV. Laws and policies that undermine access to HIV prevention services and commodities, including needle and syringe exchange programmes and harm reduction information, including through criminalisation, may infringe on the right to health.
The UN Human Rights Council adopted its sixth resolution on the protection of human rights in the context of HIV and AIDS in 2011. The resolution confirmed that prevention should be at the core of national, regional and international responses to HIV and include:
• Reducing risk taking behaviours and encouraging responsible sexual behaviour;
• Expanding access to male and female condoms and sterile injecting equipment; and
• Providing age appropriate sexuality education to children and young people.
The CSW adopted a 2016 resolution on women, girls and HIV that recognises the impact of gender inequality, harmful practices and violence on women and girls’ vulnerability to HIV. The resolution calls on government to intensify their efforts to achieve gender equality and eliminate violence against women and girls and to reduce barriers to their participation in HIV prevention. The resolution also calls on governments to enable young women and men to protect themselves from HIV infection by enabling their use of male and female condoms, PEP and PrEP.
In addition to their legal obligations under international and regional human rights laws, SADC countries have also committed to achieve the SDGs, also known as the Global Goals. These goals aim to end extreme poverty, eliminate inequality and injustice and address climate change by 2030. Goal 3 deals with health and well-being and one of the targets for measuring this goal is the eradication of the AIDS epidemic by 2030.
The 2016 UN General Assembly Political Declaration on Ending AIDS recognises the gaps in prevention and obliges states to provide comprehensive prevention services for all women, girls and key populations, including by:
• Providing non-discriminatory HIV-prevention efforts by “taking all measures to implement comprehensive, evidence-based prevention approaches to reduce new infections”;
• Scaling up “scientifically accurate age appropriate comprehensive education, relevant to cultural contexts” to adolescent girls and boys, young women and men and in and out of school youth about SRH, HIV prevention, gender equality, women’s empowerment, human rights, physical, psychological and pubertal development and power in relationships between women and men; and
• Providing tailored prevention interventions, including male and female condoms, voluntary medical male circumcision and efforts to minimise the public health and social consequences of drug abuse.
Human rights barriers to key prevention services
Lack of access to male and female condoms
Condoms are central to HIV prevention efforts and an estimated 45 million HIV infections have been prevented since 1990 through condom usage.100 However, the demand for condoms far outweighs supply, and several groups struggle even more than the general public to gain access to condoms:
• There is a dearth of female condoms available in sub-Saharan Africa and few women and girls have consistent access to them.
• In many African countries, laws, regulations and/or policies prevent the distribution of condoms in prisons. Even where condoms are available in prisons, lubricant is rarely provided.
• Criminalisation of consensual adult sex hampers condom distribution to gay men and other men who have sex with men and sex workers, especially when possession of condoms may be used as evidence of unlawful sexual activity by the police and expose key populations to prosecution, fines and/or imprisonment. In some countries, governments also refuse to supply lubricant for men who have sex with men and accuse organisations who supply lubricants to men who have sex with men of promoting homosexuality.
Harm reduction for people who use drugs
People using drugs are extremely vulnerable to HIV infection – the 2016 Gap report suggests they are 24 times more likely to be infected with HIV than members of the general population. The package of harm-reduction services for injecting drug use is well known and includes needle and syringe exchange programmes (to reduce not only the spread of HIV, but also hepatitis C and other blood borne diseases) and opioid substitution therapy. Few SADC countries are providing these services consistently, if at all.
Criminalisation, stigma and discrimination prevent people who use drugs from accessing HIV prevention information, services and commodities that are tailored to their needs, and in some countries, possession of needles and syringes may be seen as evidence of drug use, further undermining efforts by people who use drugs to protect themselves from HIV.
Suppression of viral load
People with undetectable viral loads are far less likely to transmit HIV to their sexual partners. Treatment adherence is crucial to viral load suppression. While the scale up of ART is one of the successes of the international AIDS response, there are inequalities to access, especially for key populations and access to viral load testing is limited in resource poor settings.
Next we discuss What can parliamentarians do to advance HIV prevention?
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