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: Key populations
Although most countries in SADC have generalised HIV epidemics, certain groups of people such as sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people, have been identified as key populations whose needs and vulnerabilities are insufficiently addressed.
Although HIV risks are much higher amongst these groups than in the general population, access to services is often far lower due to inadequate political will, widespread stigma, discrimination and other human rights abuses, under-resourced community capacity, and punitive laws that deter service uptake.
UNAIDS states that ending the AIDS epidemic in Southern and East Africa will require the HIV transmission among the four populations to be dramatically lowered. In particular, lowering rates of HIV among female sex workers and their clients will have the greatest impact on the regional epidemic as they have the highest HIV prevalence of any population.
Key populations by the numbers78
- HIV prevalence among men who have sex with men ranges from 3.8% to 36% in Southern and East Africa, and transmission within this population accounts for 6% of new HIV infections.
- In seven countries (Botswana, Lesotho, Malawi, Namibia, Rwanda, South Africa and Zimbabwe), more than 50% of sex workers are living with HIV.
- Little information is available regarding the HIV burden among transgender people in the region, although globally transgender women are 49 times more likely to be living with HIV than the general population.
Useful definitions
Gender identity: refers to a person’s persistent and consistent sense of being male, female or androgynous (in between). An internalised representation of gender roles and an awareness from infancy which is reinforced during adolescence.
Homophobia: an irrational fear of homosexual feelings, thoughts, behaviours or people and an undervaluing of homosexual identities, resulting in prejudice, discrimination and bias against homosexual individuals.
Key populations in the context of HIV: groups that experience a high epidemiological impact
combined with reduced access to services and/or being criminalised or otherwise marginalised.
Key populations in the HIV response include gay, bisexual and other men who have sex with men; people who inject drugs, and/or who are sex workers; as well as all transgender people who are socially marginalised, often criminalised and face a range of human rights abuses that increase their vulnerability to HIV.
Sex work: sex workers include female, male and transgender adults and young people (aged 18 – 24) who receive money or goods in exchange for sexual services, either regularly or occasionally. Sexual orientation: the attraction between two people on various levels (emotionally, physically, intellectually, spiritually and sexually).
International and regional human rights obligations
Key populations, like all other people, are entitled to the full protection of all their rights under international and regional human rights laws, including their right to the highest attainable standard of health, privacy, liberty and security, freedom of expression and assembly, freedom from violence and arbitrary arrest and equality and non-discrimination.
Equality and non-discrimination are key provisions in international and regional human rights treaties, including the African Charter on Human and Peoples’ Rights, the International Covenant on Civil and Political Rights (ICCPR), the CEDAW, the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (the Maputo Protocol) and the CRC.
The African Commission on Human and Peoples’ Rights, in interpreting member states’ obligations, ruled that discrimination on the basis of sexual orientation is a violation of the Charter.
The UN Committee on Economic, Social and Cultural Rights has also clarified that discrimination on the grounds of sexual orientation and gender identity is prohibited. The same committee has also directed states to take all steps necessary for the prevention, treatment and control of the HIV epidemic and this includes ensuring access to condoms and other HIV prevention services and commodities and information.
In addition to their legal obligations under international 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 focusses and good health and wellbeing and sets several important targets for 2030, including ensuring universal access to sexual and reproductive health care services, ending the HIV epidemic and strengthening prevention and treatment for substance abuse.
Target 10 focusses on reducing inequalities within and amongst countries and by 2030, countries should empower and promote social, economic and political inclusion for everyone and eliminate discriminatory laws, policies and practices.
The 2016 Political Declaration for Ending AIDS includes a pledge to eliminate stigma and discrimination and to create enabling legal, social and policy frameworks to support the elimination of stigma and discrimination and end HIV-related information.
In October 2017, SADC developed a regional strategy to advance prevention, treatment, care and support and SRHR for key populations. The regional strategy will guide the adoption and institutionalisation of a “standard, comprehensive package that addresses the unique challenges of providing equitable and effective HIV and SRH rights and services to key populations.”
Human rights barriers to comprehensive HIV and Sexual and Reproductive Health (SRH) for key populations
Examples of human rights violations against LGBTI people80 LGBTI people experience violations of their human rights, such as the right to equality and non-discrimination and the rights to life and health. The table opposite sets out key rights available to all persons and looks at how human rights violations impact on access to SRHR for LGBTI people in the
context of HIV.
Criminalisation and lack of an enabling legal environment
Laws that criminalise consensual sex between adults make it harder for gay men and other men who have sex with men, transgender people and sex workers to protect themselves from HIV and STIs and undermines their access to HIV-related services and sexual and reproductive health care. Laws that inappropriately criminalise non-disclosure, exposure and transmission of HIV also undermine the ability of key populations from seeking information and services related to HIV and their SRH. These laws create particular barriers to HIV prevention and testing.
Stigma and discrimination
Key populations experience double stigma and discrimination: they are discriminated against on the grounds of their HIV or perceived HIV status and because they are part of a key population that is associated with sex, drug use and other controversial issues.
Stigma and discrimination not only increase vulnerability to HIV, they also deter key populations from seeking out services and many choose to hide their sexual orientation, gender identity or the fact that they are sex workers, from health care workers, further undermining their access to appropriate health care. Transgender people experience particularly high levels of stigma and discrimination in multiple settings, including their homes, schools, the workplace and health facilities.
Violence
Key populations are at high risk of violence, including sexual violence. Criminalisation of their behaviours and stigma and discrimination increase their risk of violence and leave them without access to remedies for abuses and crimes committed against them.
Sex workers are at risk of violence from clients, sexual partners, police officers and other officials from the criminal justice system. Because sex work is criminalised, few sex workers report abuse to the police and this impunity may fuel further violence against them. Their criminalised status may deter them from seeking post rape care, including PEP to reduce the risk of HIV transmission.
Lack of access to health services and other programmes
Key populations have complex health needs, but frequently struggle to get access to appropriate and essential HIV and sexual and reproductive health care and most key populations in Africa use services tailored for the general population. Transgender people are particularly neglected in national AIDS responses and health care workers lack training and information about the health needs of transgender people.
There are few programmes in SADC countries that place key populations at the centre of the AIDS response. The 2017 UNAIDS report on key populations in Southern and East Africa indicates that at least four key populations, men who have sex with men, sex workers, people who use drugs and transgender people, “largely lack access” to essential prevention and treatment services. The WHO recommends the provision of comprehensive HIV services, including access to condom and lubricant, harm reduction interventions for substance use, behavioural interventions, routine HIV testing services, HIV treatment and care (including management of co-morbidities), PrEP and SRH interventions
Next, we discuss: Stigma and discrimination in health care settings