2008 pan american health organization a human rights law based approach to hiv/aids in the context...

2008

Pan AmericanHealthOrganization

A HUMAN RIGHTS LAW BASED APPROACH TO

HIV/AIDS IN THE CONTEXT OF PAHO STRATEGIC PLAN

A HUMAN RIGHTS LAW BASED APPROACH TO

HIV/AIDS IN THE CONTEXT OF PAHO STRATEGIC PLAN

2008


“The use of international human rights principles, treaties and standards is seen in PAHO and WHO not as an optional tool to promote and protect public health, but as an essential strategy to improve the health of the people around the world”

Dr. Mirta RosesGeorgetown Law Center, October 2006Director Pan American Health Organization/Regional Office of

the World Health Organziation (PAHO/WHO)

“The use of international human rights principles, treaties and standards is seen in PAHO and WHO not as an optional tool to promote and protect public health, but as an essential strategy to improve the health of the people around the world”

Dr. Mirta RosesGeorgetown Law Center, October 2006Director Pan American Health Organization/Regional Office of

the World Health Organziation (PAHO/WHO)

2008


A HUMAN RIGHTS BASED APPROACH IN STRATEGIC PLAN 2008-2017

A HUMAN RIGHTS BASED APPROACH IN STRATEGIC PLAN 2008-2017

• “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition…”Constitution of WHO

• Strategic Objective 7: “…Human rights law as enshrined in international and regional human rights conventions and standards offer a unifying conceptual and legal framework for these strategies by which to evaluate success and clarify the accountability and responsibilities of the different stakeholders involved…”

• Region Wide Expected Result 7.4: “Ethics and rights based approaches to health promoted within PAHO/WHO and at national, regional and global levels”

• “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition…”Constitution of WHO

• Strategic Objective 7: “…Human rights law as enshrined in international and regional human rights conventions and standards offer a unifying conceptual and legal framework for these strategies by which to evaluate success and clarify the accountability and responsibilities of the different stakeholders involved…”

• Region Wide Expected Result 7.4: “Ethics and rights based approaches to health promoted within PAHO/WHO and at national, regional and global levels”

2008


• Indicator 7.4.1: “Number of countries using 1) international and regional human rights norms and standards; and 2) tools and technical guidance documents produced by PAHO/WHO to review and/or formulate national laws, policies and/or plans that advance health and reduce gaps in health equity and discrimination.”

Strategic Objective 2• Indicator 2.1.1 and 2.1.2: Number of countries that

provide prophylactic antiretroviral treatments• Indicator 2.2.1:Number of countries with health

sector policies and medium term plans in response to HIV

• Indicator 7.4.1: “Number of countries using 1) international and regional human rights norms and standards; and 2) tools and technical guidance documents produced by PAHO/WHO to review and/or formulate national laws, policies and/or plans that advance health and reduce gaps in health equity and discrimination.”

Strategic Objective 2• Indicator 2.1.1 and 2.1.2: Number of countries that

provide prophylactic antiretroviral treatments• Indicator 2.2.1:Number of countries with health

sector policies and medium term plans in response to HIV

2008


• Indicator 2.5.4 Maintain the number of countries involving communities, persons affected by the disease, civil-society organizations and the private sector in planning, design, implementation and evaluation of programs against HIV/AIDS

• Directing Council Resolution CD 45R10 (2004): Sustain and reinforce prevention activities and the reduction of stigma within health services and reduction of discrimination according to national laws (Right to equal protection of the law in a manner consistent with UN/OAS treaties)

• Indicator 2.5.4 Maintain the number of countries involving communities, persons affected by the disease, civil-society organizations and the private sector in planning, design, implementation and evaluation of programs against HIV/AIDS

• Directing Council Resolution CD 45R10 (2004): Sustain and reinforce prevention activities and the reduction of stigma within health services and reduction of discrimination according to national laws (Right to equal protection of the law in a manner consistent with UN/OAS treaties)

2008


Products and ServicesProducts and Services

• 1) Enactment of 6 national plans, policies and laws with reference to human rights norms; and

• 2) Dissemination of human rights norms and standards in 10 countries

• 3) Collaboration with the OAS/UN treaty bodies

• 1) Enactment of 6 national plans, policies and laws with reference to human rights norms; and

• 2) Dissemination of human rights norms and standards in 10 countries

• 3) Collaboration with the OAS/UN treaty bodies

2008


MilestonesMilestones

• 1) 5 countries will have received an introduction to the human rights norms/standards applicable to persons with disabilities, mental disorders, older persons, persons with HIV, indigenous peoples and adolescent health (emphasis on women and children)

• 2) 5 countries…• 3) 6 countries will have submitted for PAHO’s

review drafts of their national plans, policies and/or laws on disability, menatl health, ageing, HIV, indigenous peoples health and adolescent health consistent with h. rights norms/standards

• 1) 5 countries will have received an introduction to the human rights norms/standards applicable to persons with disabilities, mental disorders, older persons, persons with HIV, indigenous peoples and adolescent health (emphasis on women and children)

• 2) 5 countries…• 3) 6 countries will have submitted for PAHO’s

review drafts of their national plans, policies and/or laws on disability, menatl health, ageing, HIV, indigenous peoples health and adolescent health consistent with h. rights norms/standards

2008


• 4) 11 countries will have incorporated the UN/OAS international human rights norms and standards in national plans, laws and/or policies.

• 4) 11 countries will have incorporated the UN/OAS international human rights norms and standards in national plans, laws and/or policies.

2008


LINKS AMONG HEALTH, HUMAN RIGHTS LAW AND HIV (Jonathan Mann/Larry

Gostin)

LINKS AMONG HEALTH, HUMAN RIGHTS LAW AND HIV (Jonathan Mann/Larry

Gostin)

• Violations of human rights can affect negatively the physical and mental health of individuals living with HIV;

• HIV policies, laws, programs and plans can affect positively or negatively the exercise of the basic human rights and freedoms of persons living with HIV (in special vulnerable groups); and

• Enjoyment of health and the exercise of human rights are both essential requirements to reach well-being and a healthy life

• Violations of human rights can affect negatively the physical and mental health of individuals living with HIV;

• HIV policies, laws, programs and plans can affect positively or negatively the exercise of the basic human rights and freedoms of persons living with HIV (in special vulnerable groups); and

• Enjoyment of health and the exercise of human rights are both essential requirements to reach well-being and a healthy life

2008


FUNDAMENTAL FLAWS WITH REGARD TO POLICIES/PLANS/LAWS/PRACTICES BASED ON VISITS TO COUNTRIES AND REPORTS

OF IACHR

FUNDAMENTAL FLAWS WITH REGARD TO POLICIES/PLANS/LAWS/PRACTICES BASED ON VISITS TO COUNTRIES AND REPORTS

OF IACHR

• Visits/interventions/trainings: Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Panama and Suriname

• Violations of basic human rights related with health of persons living with HIV;

• Limited awareness of the international and regional human rights instruments applicable to the pandemic among governmental officials and PAHO personnel;

• Visits/interventions/trainings: Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Panama and Suriname

• Violations of basic human rights related with health of persons living with HIV;

• Limited awareness of the international and regional human rights instruments applicable to the pandemic among governmental officials and PAHO personnel;

2008


• HIV policies, programs and laws are not being formulated consistent with international and regional human rights obligations (UN and OAS);

• Limited participation of organizations of persons living with HIV;

• Lack of national mechanisms at the level of Ombudspersons’ offices and other national agencies to monitor the right to health and other related human rights

• HIV policies, programs and laws are not being formulated consistent with international and regional human rights obligations (UN and OAS);

• Limited participation of organizations of persons living with HIV;

• Lack of national mechanisms at the level of Ombudspersons’ offices and other national agencies to monitor the right to health and other related human rights

2008


HUMAN RIGHTS INSTRUMENTS (UN and OAS SYSTEMS OF HUMAN RIGHTS)

HUMAN RIGHTS INSTRUMENTS (UN and OAS SYSTEMS OF HUMAN RIGHTS)

• Charter of the United Nations• WHO Constitution• National Constitutions;• Universal Declaration of Human Rights;• International Covenant on Civil and Political Rights;• International Covenant on Economic, Social and Cultural

Rights;• Convention on the Rights of Persons with Disabilities;• Convention on the Rights of the Child; • Convention on Elimination of Discrimination against Women;• American Convention on Human Rights and Protocol of San

Salvador;• Inter-American Convention on the prevention, punishment

and eradication of violence against women;

• Charter of the United Nations• WHO Constitution• National Constitutions;• Universal Declaration of Human Rights;• International Covenant on Civil and Political Rights;• International Covenant on Economic, Social and Cultural

Rights;• Convention on the Rights of Persons with Disabilities;• Convention on the Rights of the Child; • Convention on Elimination of Discrimination against Women;• American Convention on Human Rights and Protocol of San

Salvador;• Inter-American Convention on the prevention, punishment

and eradication of violence against women;

2008


MOST RELEVANT HUMAN RIGHTS AND FUNDAMENTAL FREEDOMS IN THE

CONTEXT OF HIV POLICIES/PLANS/LAWS

MOST RELEVANT HUMAN RIGHTS AND FUNDAMENTAL FREEDOMS IN THE

CONTEXT OF HIV POLICIES/PLANS/LAWS

• Right to not to be discriminated against (Lack of access to voluntary and confidential testing without discrimination)

• Right to equal protection of the law (Lack of access to preventive measures, treatment, antiretroviral medicines, facilities and goods of good quality);

• Right to personal liberty and security of person (detention and solitary confinement/quarantine solely on the basis of an HIV infection and STI’s and access to counseling, treatment, medical tests, goods, services and essential medicines in prisons and public health facilities);

• Right to privacy (mandatory testing, dissemination of private information on health status by health personnel or tribunals. Example: armed forces, police, etc.);

• Right to life (national criminal laws on adultery, sex between consenting adult men and commercial sex encounters in the context of men who have sex with men, injecting drug users, sex workers and their clients);

• Right to not to be discriminated against (Lack of access to voluntary and confidential testing without discrimination)

• Right to equal protection of the law (Lack of access to preventive measures, treatment, antiretroviral medicines, facilities and goods of good quality);

• Right to personal liberty and security of person (detention and solitary confinement/quarantine solely on the basis of an HIV infection and STI’s and access to counseling, treatment, medical tests, goods, services and essential medicines in prisons and public health facilities);

• Right to privacy (mandatory testing, dissemination of private information on health status by health personnel or tribunals. Example: armed forces, police, etc.);

• Right to life (national criminal laws on adultery, sex between consenting adult men and commercial sex encounters in the context of men who have sex with men, injecting drug users, sex workers and their clients);

2008


• Right to personal integrity (national criminal, labor and public health laws in the context of prevention, treatment care and support related with prohibitions on consensual adult sexual conduct –criminalization-);

• Freedom of movement and residency (physical search, denial of travel and unnecessary interrogation);

• Freedom of thought and expression (lack of a wide dissemination of creative education training, media programs and information designed to change attitudes of discrimination associated with right to personal integrity, right to life, health and the sexual orientation of the person ; and

• Right to the highest attainable standard of health

• Right to personal integrity (national criminal, labor and public health laws in the context of prevention, treatment care and support related with prohibitions on consensual adult sexual conduct –criminalization-);

• Freedom of movement and residency (physical search, denial of travel and unnecessary interrogation);

• Freedom of thought and expression (lack of a wide dissemination of creative education training, media programs and information designed to change attitudes of discrimination associated with right to personal integrity, right to life, health and the sexual orientation of the person ; and

• Right to the highest attainable standard of health

2008


THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH (UN guidelines on HIV and Human Rights/General Comment

14)

THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH (UN guidelines on HIV and Human Rights/General Comment

14)• Establishment of public health

services/centers/facilities dedicated to HIV prevention/treatment and other STI’s in a national plan;

• Access without discrimination to equal treatment and essential medicines for prolonging the right to life;

• Access to condoms and sterile injection equipments; and

• Voluntary and confidential testing

• Establishment of public health services/centers/facilities dedicated to HIV prevention/treatment and other STI’s in a national plan;

• Access without discrimination to equal treatment and essential medicines for prolonging the right to life;

• Access to condoms and sterile injection equipments; and

• Voluntary and confidential testing

2008


THE FIRST HUMAN RIGHTS INTERVENTIONS (2001-02, THR and FCH):

ACCESS TO PROPHYLACTIC ANTIRETROVIRAL TREATMENT

THE FIRST HUMAN RIGHTS INTERVENTIONS (2001-02, THR and FCH):

ACCESS TO PROPHYLACTIC ANTIRETROVIRAL TREATMENT

• PAHO (THR and FCH) and IACHR: Technical opinions/meetings with human rights specialists on the analysis if medical history, STD screening, physical examination, routine hematological and biochemical tests, CD4 count, pregnancy tests, etc.

• Precautionary measures (Rules of the IACHR): Protect the right to live and personal integrity of persons living with HIV

• Countries benefited: Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Perú, R. Dominicana,

• PAHO (THR and FCH) and IACHR: Technical opinions/meetings with human rights specialists on the analysis if medical history, STD screening, physical examination, routine hematological and biochemical tests, CD4 count, pregnancy tests, etc.

• Precautionary measures (Rules of the IACHR): Protect the right to live and personal integrity of persons living with HIV

• Countries benefited: Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Perú, R. Dominicana,

2008


• Chile and El Salvador• First formal hearing at IACHR (2004). THR and

FCH Objective: explain the links among human rights, HIV and criminalization of sexual conducts as a barrier for prevention/ access to treatment

• The training workshops approach (2006): Jamaica, Belize and Suriname

• Empowerment of organizations of persons living with HIV to end stigma and discrimination using human rights legal instruments ratified by PAHO Member States

• Chile and El Salvador• First formal hearing at IACHR (2004). THR and

FCH Objective: explain the links among human rights, HIV and criminalization of sexual conducts as a barrier for prevention/ access to treatment

• The training workshops approach (2006): Jamaica, Belize and Suriname

• Empowerment of organizations of persons living with HIV to end stigma and discrimination using human rights legal instruments ratified by PAHO Member States

2008


EXAMPLE OF A HUMAN RIGHTS INTERVENTION ON HIV: GUATEMALA

EXAMPLE OF A HUMAN RIGHTS INTERVENTION ON HIV: GUATEMALA

• Request of the Ministry of Health/PWR (2007)• National training workshop on the human rights of

persons living with HIV• Organizations of persons living with HIV (including

LGTB groups, Ombudsperson “Defensoría”, Criminal system, police, judges, public health personnel, National AIDS Program, Congressmen, USAID, UNAIDS and UN Office of the High Commissioner for Human Rights)

• Clarification of obligations of Guatemala under regional/international law; working groups; case studies and recommendations to be implemented based on

• Request of the Ministry of Health/PWR (2007)• National training workshop on the human rights of

persons living with HIV• Organizations of persons living with HIV (including

LGTB groups, Ombudsperson “Defensoría”, Criminal system, police, judges, public health personnel, National AIDS Program, Congressmen, USAID, UNAIDS and UN Office of the High Commissioner for Human Rights)

• Clarification of obligations of Guatemala under regional/international law; working groups; case studies and recommendations to be implemented based on

2008


• PAHO’s report on Central America and conclusions of working groups;

• Final Recommendations of working groups: urgent review of national HIV law with regard to mandatory testing for pregnant women, mandatory testing for victims of sexual violence and rape, mandatory and written consent of parents for HIV testing (all persons under 18 years old), mandatory notification of HIV infection to the partner and treatment/care to persons in psychiatric hospitals (not only prisons).

• PAHO’s report on Central America and conclusions of working groups;

• Final Recommendations of working groups: urgent review of national HIV law with regard to mandatory testing for pregnant women, mandatory testing for victims of sexual violence and rape, mandatory and written consent of parents for HIV testing (all persons under 18 years old), mandatory notification of HIV infection to the partner and treatment/care to persons in psychiatric hospitals (not only prisons).

2008


• Request of Congress and Ministry of Health: international human rights norms (American Convention and CRC) and HIV standards (UN guidelines) for amending national HIV law (Presented by THR and FCH, 2009)

• Request of Judiciary: capacity building for judges who make decisions on the rights of persons living with HIV (November, 2009)

• Request of LGTB groups: Capacity building activities based on the use of human rights instruments applicable to HIV

• Request of Congress and Ministry of Health: international human rights norms (American Convention and CRC) and HIV standards (UN guidelines) for amending national HIV law (Presented by THR and FCH, 2009)

• Request of Judiciary: capacity building for judges who make decisions on the rights of persons living with HIV (November, 2009)

• Request of LGTB groups: Capacity building activities based on the use of human rights instruments applicable to HIV

2008


Mechanisms of ProtectionMechanisms of Protection

• Country reports (UN treaty bodies);• Individual cases (IACHR, under the American

Declaration and the Inter-American Convention on violence against women and Domestic Tribunals/Ombudspersons);

• On site observations (IACHR and UN Special Rapporteur on the Right to Health);

• Precautionary measures (IACHR, under the American Declaration);

• Hearings (NGO’s and speciliazed agencies); and• Formulation of specific standards (mental health)

• Country reports (UN treaty bodies);• Individual cases (IACHR, under the American

Declaration and the Inter-American Convention on violence against women and Domestic Tribunals/Ombudspersons);

• On site observations (IACHR and UN Special Rapporteur on the Right to Health);

• Precautionary measures (IACHR, under the American Declaration);

• Hearings (NGO’s and speciliazed agencies); and• Formulation of specific standards (mental health)

2008


DE-CRIMINALIZATION IN THE AMERICAS: A HUMAN RIGHTS LAW CHALLENGE

DE-CRIMINALIZATION IN THE AMERICAS: A HUMAN RIGHTS LAW CHALLENGE

• Right to live, Right to personal integrity, equal protection of the law and right to health (national criminal, labor and public health laws in the context of prevention, treatment care and support related with prohibitions on consensual adult sexual conduct –criminalization-)

• Example (Jamaica):“Offences against the Person Act” (criminalizing sex

between consenting adult men and women)“Towns and Communities Act” (targeting MSM and sex

workers, employment termination after mandatory testing,

• Right to live, Right to personal integrity, equal protection of the law and right to health (national criminal, labor and public health laws in the context of prevention, treatment care and support related with prohibitions on consensual adult sexual conduct –criminalization-)

• Example (Jamaica):“Offences against the Person Act” (criminalizing sex

between consenting adult men and women)“Towns and Communities Act” (targeting MSM and sex

workers, employment termination after mandatory testing,

2008


Health insurance procedures, mortgage procedures, school attendance and visas procedures (travelling);

Role of PAHO (HQ) in collaboration with PWR’s, sub-regional advisors, teams and IACHR:

- Train of key stakeholders (congress, persons living with HIV and judges) on international human rights norms and issues related with sexuality, sexual orientation and HIV prevention; and

- Organize consultations with organizations of persons living with HIV (campaigns, written information and litigation at national and regional level –IACHR-)

Health insurance procedures, mortgage procedures, school attendance and visas procedures (travelling);

Role of PAHO (HQ) in collaboration with PWR’s, sub-regional advisors, teams and IACHR:

- Train of key stakeholders (congress, persons living with HIV and judges) on international human rights norms and issues related with sexuality, sexual orientation and HIV prevention; and

- Organize consultations with organizations of persons living with HIV (campaigns, written information and litigation at national and regional level –IACHR-)

2008


Intervention on HIV and sexual health: Honduras

Intervention on HIV and sexual health: Honduras

• Request of the Ministry of Health/PWR (2009)• National training workshop on HIV and

sexual/reproductive health of LGTB groups• National training workshop on the human rights of

vulnerable groups (including persons living with HIV, young people, LGTB groups, Ombudspersons, criminal system, police, judges, health care providers, National AIDS Program and UNAIDS)

• Clarification of obligations of Honduras under regional/international law; working groups; case studies and recommendations to be implemented (CRC-CEDAW)

• Request of the Ministry of Health/PWR (2009)• National training workshop on HIV and

sexual/reproductive health of LGTB groups• National training workshop on the human rights of

vulnerable groups (including persons living with HIV, young people, LGTB groups, Ombudspersons, criminal system, police, judges, health care providers, National AIDS Program and UNAIDS)

• Clarification of obligations of Honduras under regional/international law; working groups; case studies and recommendations to be implemented (CRC-CEDAW)

2008


• Final recommendations of working groups: Urgent review of a draft national law that would ban the selling and administration of “emergency contraception” (AOE) and urgent collaboration with the Ministry of Health using a human rights based approach

• Consultation with civil society organizations that protect the human rights of young girls and women

• Request of the Ministry of Health: PAHO technical opinion on the access to emergency contraception in the context of CEDAW and CRC human rights norms and standards

• Final recommendations of working groups: Urgent review of a draft national law that would ban the selling and administration of “emergency contraception” (AOE) and urgent collaboration with the Ministry of Health using a human rights based approach

• Consultation with civil society organizations that protect the human rights of young girls and women

• Request of the Ministry of Health: PAHO technical opinion on the access to emergency contraception in the context of CEDAW and CRC human rights norms and standards

2008


• Request of the Supreme Court of Honduras: PAHO technical opinion on the access to emergency contraception in the context of CEDAW and CRC human rights norms and standards

• Request of the Supreme Court of Honduras: PAHO technical opinion on the access to emergency contraception in the context of CEDAW and CRC human rights norms and standards

2008


The human right to the highest attainable standard of health of persons living with

HIV

The human right to the highest attainable standard of health of persons living with

HIV

2008 pan american health organization a human rights law based approach to hiv/aids in the context...

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