hiv / aids and development rights base approach. hiv/aids and development objectives: what is the...

HIV/ AIDS and DevelopmentRights base approach

HIV/AIDS and development

Objectives:• What is the biology of HIV/AIDS?• How is Right to sustainable Livelihood affected by

HIV/AIDS?• How does Right to Identity affect the spread of

HIV/AIDS? • How is Right to Social Services affected by HIV/AIDS• How is Right to be heard and Right to security

affected by HIV/AIDS?• What are some projects Oxfam has in the field to

address these issues?

What is HIV/AIDS?

Acquired Immunodeficiency Syndrome

is cause by the infection of the

Human Immunodeficiency Virus

Biology 101

Fact about HIV• There are no known cure for the disease

• The virus is transmitted through blood and bodily secretion (semen or breast milk)

• This disease has a long latency period (infection with no symptoms, being HIV positive)

• Once a person develops full-blown AIDS (CD4 count of 200 or less) their immune systems is completely compromised and they become extremely susceptible to all kinds of infections and diseases with eventually leads to death

HIV/AIDS Treatment

• Antiretroviral drugs (ARV)

• The best method of treatment is known as HAART ( highly active retrovirus treatment). – Drug cocktail– Combining different types of drugs defers

immunity to treatment.

How does ARV work?There are currently four major classes of antiretroviral drugs in general use:

•nucleoside analogue reverse transcriptase inhibitors (NRTIs)

•nonnucleoside reverse transcriptase inhibitors (NNRTIs) •protease inhibitors (PIs)

• fusion inhibitors

This is the global picture and it grows by the day.

• People living with HIV/AIDS---40 Million (34-46 Million)

• New HIV infections in 2003---5 Million (4.2-5.8 Million)

• Death due to HIV/AIDS in 2003---3 Million (2.5-3.5 Million)

HIV/AIDS Global picture

•Approximately 60% of people infected with HIV are in Africa

HIV/AIDS in Africa

• In 2003, an estimated 26.6 million people were living with HIV

• 3.2 million were infected in the past year

• 2.3 million people died because of AIDS 2003

• Women are 1.2 times more likely to be infected with HIV than men

• The HIV prevalence rate ranges from1%in Mauritania to almost 40% in Botswana Swaziland

What is the relationship between HIV and poverty?

• HIV/AIDS and poverty is “bi-directional,” – Poverty is a factor in HIV

transmission and exacerbates the impact of HIV/AIDS

– Poverty is factor in activities and behaviours that increases the risk of contracting HIV.

Young women crushing millet. Village of Iskita (Tahoua area) Niger.

How does HIV Affect the Income of People?

• Household income– Death or illness of income provider means lost

of income. – Increase in household expenditures to meet

medical bills and funeral expenses

• Community income – Human capital is lost– Social capital in a community can have major

impacts on mitigating the effects of HIV/AIDS

Community income

• Shortage of an experienced labour force in all sectors of the economy. – This can lead to an increase in the price of labour.

• Increase in the number of female-, elderly- and child-headed households

• Increase in the number and rate of orphaned children• Change in out-migration of young adults• Change in age-sex composition• Increase in school dropout rate• Loss of knowledgeable and experienced community

leaders

Community impact

• Decrease in aggregate community income

• Reduction in expenditures in community businesses

• Reduction in aggregate community savings

• Increase in demand for loans and credit from formal and informal sources

• Decrease in demand for productive credit

• Increase in default rate in credit markets

How does HIV/AIDS Influence National Productivity?

• The disease’s first assault is on human resources. – The most productive people in a society.

• Increase in death among labour force decreases in productivity.

• HIV/AIDS also decreases business investment and prospective revenues.

• Foreign exchange of domestic commodities and resources face a decline, as productivity in industrial sectors falls.

What is the impact of HIV/AIDS on Food Security?

• HIV/AIDS jeopardizes freedom from hunger for millions of people in the developing world.

• HIV/AIDS diminishes people’s ability to both to produce and to purchase their food.

HIV/AIDS and Food Security

• FAO estimates that AIDS has killed 7 million agricultural workers in Africa since 1985.

• Potential to kill 16 million more within the next 20 years.

• Quantity and quality of food available to a household will decline as productive family members fall ill or die.

• In urban areas, HIV contributes to high absenteeism, low productivity, increased health care costs, loss of skilled staff, and increased recruitment & retraining costs—resulting in substantial business losses.

HIV/AIDS in an Urban Context

• HIV/AIDS, poverty, and overcrowding are fuelling a resurgence of the infectious diseases. – Tuberculosis (TB)

• Often men who migrate to the city to find employment, leaving their spouse and children behind in the rural areas

• Transient nature of urban lifestyles means a lack of safety net at the community level

How does HIV/AIDS Impact the Agricultural Sector?

• Reducing the labour force and disrupting traditional social security mechanisms.

• Forced disposal of productive assets.

• Loss of indigenous farming methods.

• May necessitate a switch to less labour-intensive crop production. – Often leading to declining levels of

nutrition

How does HIV/AIDS Impact the Agricultural Sector?

• HIV/AIDS affects crop production→ reduction in land use → a decline in crop yields→ a decline in the range of crops grown.

• impact of the HIV/AIDS epidemic on livestock-raising practices has been felt in several ways:→ cattle are frequently sold to pay

medical bills and funeral expenses → decreases in labour availability result

in lower levels of care of livestock→ if the person in charge of the livestock

dies, family members are often unable to manage the livestock, due to the loss of skills and relevant experience

HIV/AIDS and Environmental Sustainability

• Natural capital assets that can decline in the presence of HIV/AIDS include:

Reductions in soil fertilityDeclines in on-farm conservation and/or irrigation practicesDecreased biodiversity due to asset stripping, selling of firewood, increased harvesting of wild food, game, etc.Decline in genetic resourcesDecline in quality of permanent cropsRenting or leasing out portions of the household's landholdingsAppropriation of land by relatives (taken from widows, orphans)Sale of livestockSale of land

Why Should AIDS Be Considered a Workplace Issue?

• 26 million of those infected with HIV/AIDS are workers aged 15 to 49 years.

• AIDS weakens economic activity by squeezing productivity.– Adding costs, diverting productive

resources, and depleting skills.

• HIV/AIDS decrease productively:– increased absenteeism– organisational disruption– loss of skills and organisational

‘memory’.

Young boy working in a cinder block factory. Senegal.

Essential Responses

• View of the disease as essentially a “resource issue”

• Policies and international responses must address deep-rooted structural problems.

• Need for both governments and international organizations to recognize the underlying economic and social (structural) conditions

• Adopting a “multisectoral” approach– commitment from across society, from political and

religious leaders, NGO’s, and the private sector

Essential Responses

• Development of human resources in rural areas through education, training and health support

• Encouraging the participation of women decision making process and the development of social and cultural activities

Development of programmes aimed at food self-sufficiency and security and improving the standards, lifestyles and conditions in the rural areas

Providing access to STD screening and treatment as well as other health services and reducing low-income groups’ barriers to these services

The agriculture sector should revise the content and delivery of its services, as well as the process of transferring agricultural knowledge

International Responses to AIDS

• In Bangkok, the insurance firm, American International Assurance, gives discounts on insurance premiums if company policy holders run effective prevention, non-discriminatory practices on HIV/AIDS in the workplace

Giant mining firm, PT Freeport in Indonesia Indonesia's Irian Jaya province, conducts a campaign against HIV/AIDS among its employees

Tata Tea Ltd in South India, has invested in a programme to train, educate, and counsel employees on sexually transmitted diseases and HIV/AIDS

Implement effective workplace programmes, companies can cope and prevent an increase in absenteeism, healthcare costs and labour turnover, a decrease in productivity, and loss of experienced personnel

Right to Identity

UN General Assembly Special Session (UNGASS) on HIV/AIDS in June 2001-where 189 countries signed Declaration of Commitment acknowledging that "gender equality and the empowerment of women are fundamental elements in the reduction of the vulnerability of women and girls to HIV/AIDS.

What is Gender?

• According to PAHO: “Gender is the sum of cultural values, attitudes, roles, practices and characteristics based on sex.”

• Gender impacts the spread of HIV/AIDS and affects men and women with HIV differently.

• Gender affects prognosis and treatment for HIV/AIDS • Gender gap that was evident in the beginning of the

epidemic is narrowing. – In some regions of Latin America and the Caribbean, women

infected with HIV outnumber men infected with HIV

• Women tend to be vulnerable while men to tend be at risk

Gender Roles

• WHO June 2000 – 14.8 million out of 33.6 million infected are women.2.3 million out

of 5 million newly infected in 1999 are women

• Contrast Canada : – 25% diagnosed are women compared with 44.4%men(figure

from ACT)

• Between 20%-48% of adolescent girls aged 10-25 report their first sexual encounter was forced

• In South Africa 33% of young women are afraid to say no to sex– 55% have sex when they do not want to because their

partners insists• Many women are unable to negotiate safer sex

HIV/AIDS women and girls

• Women’s risk of exposure is two to five times greater than men’s

• Presence of STI increases vulnerability to HIV and since many infected women are asymptomatic, many STIs go untreated

• Widow inheritance practices and cleansing rituals increase women’s vulnerability

• Female circumcision increases vulnerability • Internally displaced populations, including women, men

and children, are more vulnerable • Women infected with HIV are diagnosed later, have less

access to therapy and have a shorter life expectancy

Rights to Identity

• Often women and girls are the target of abuses due to unequal power relations

• Women and girls are made vulnerable by:– Poverty– Societal beliefs and values

• Women and girls are second class citizens; • seen to be a commodity to be bought, sold

– bride price– sexual slavery

– Often cannot negotiate the conditions under which they engage in sexual relations

• forced marriage (girls)• sexual slavery & sex trade

– Lack of access to education, land, means of earning income • Unequal property and inheritance rights

Men and Risk

• Concept of masculinity traditionally linked to a culture of risk (sexual activity, drug-injecting behaviour)

• Men at risk: migrants, military personnel, men who have sex with men, men in prisons, young men

• Men are less likely to seek information about their sexual health

• Because sexual services are integrated in reproductive health services, those men who do seek sexual health services might not always get the information they seek or need

Why are children vulnerable?

• Young women are more than six times likely than young men to contract HIV

• Sexual abuse increases risk of infection• Intergenerational sex increases risk of infection (“sugar

daddies” and young girls)• Young girls vulnerable to infection because of belief that

sex with a virgin will cure men of HIV• Young girls are often expected to leave school or to take

on more work to take care of sick family members• Many children orphaned by AIDS turn to prostitution to

contribute to their siblings’ needs

Why are children vulnerable?

Solutions

• More physical and material independence for women

• Empowerment of women so that they can take control of their own lives

• Increased educational and employment opportunities for women

• More public education on harmful effects of gender inequality

• Use of microbicides which are not also spermicides (more research needed into microbicides)

Solutions

• Need to challenge gender norms and stereotypes

• Need to improve men's access to information, counselling, and support

• Need to strengthen women’s legal rights

Right to Social Services

Education

• How is the Education Sector Affected by HIV/AIDS?

• To What Extent does HIV/AIDS Reduce the Supply for Education?

• To What Extent does HIV/AIDS Reduce the Demand for Education?

• Implications of Both…

Education and School assistance for children living in poor conditions. Philippines

Health• What is the Impact of

HIV/AIDS on Health Services?

• Where do Potential Opportunities Exist?

• Voluntary counselling and testing

• Community home based care

• Access to treatment, necessary support

Can you believe that this little plastic sack can save human lives? Utilize a condom for all your sexual encounters. Guinea

What are the Next Steps

• In the Education Sector?

• In the Health Services Sector?

Patent Basics

• What is a Patent?

• A Contract

• Protection Provided

• When it can be Obtained

• National Jurisdiction

The TRIPS Agreement

• Who Does it Effect?

• What Does it Mean?

• Is There Any Flexibility?

Canada…Moving Forward

• The Doha Declaration (2001)

• Canadian Act Amendments

– The Patent Act

– The Food and Drug Act

• Restrictions

• What This Means

Right to Life and Security and Right to be Heard

HIV affecting Life and Security

• Topics:- HIV and stigmatization (basic life support)- HIV and security situations- HIV, rape and the effect on children

• Stigma - powerful means of social control.• Early large-scale media campaigns have

contributed directly to increasing the stigma associated with those infected with HIV

Why is HIV/AIDS so stigmatized?

• Metaphors commonly associated with HIV/AIDS: – HIV/AIDS as death, fighting

HIV/AIDS as a war, HIV/AIDS as a crime, provided a powerful basis for stigma and discrimination.

• Stigma and discrimination cause a kind of social death.

Why is HIV/AIDS so stigmatized?

• HIV/AIDS as it is associated with behaviours that are considered deviant, particularly homosexual sex and drug injection

• People with HIV/AIDS are often thought to be responsible for having contracted the disease

• Religious or moral beliefs:– HIV/AIDS is the result of a

moral fault, such as promiscuous or deviant sex, that deserves punishment.

HIV and the marginalized groups

• Spread of HIV/AIDS is significantly higher marginalized groups:– women, children,

people living in poverty, minorities, indigenous peoples, migrants, people with disabilities, sex workers, homosexuals, injecting drug users and prisoners.

HIV and the marginalized groups

• Marginalized groups have less access to education, information and health care mandatory or compulsory testing.– According to the World Health Organization,

such programs should be considered, but only within the context of a comprehensive HIV/AIDS prevention and control program

HIV creating insecurity

• Divisions among ethnic and social groups may be exacerbated

• Economic migration and refugee seekers increase

• 15 million orphans, the majority live in sub-Saharan Africa, many in areas struck by food crisis and violent conflict or political disturbances

• Engaging in risky activities for survival, such as transacting sex in exchange of food, shelter and protection AIDS orphans

HIV creating insecurity

• AIDS is a communal security issue.• Affects police capability and community stability

more generally.• In Africa, many military forces have infection

rates as much as five times that of the civilian population.

• Weaknesses cause by AIDS in militaries, as well as in the pillars of economic growth and institutional endurance can make nations more vulnerable to both internal and external conflict.

HIV creating insecurity

• Regions hit by famine, repression or violent conflict and war, populations are more at risk of HIV infection.

• Rape has become one of the most brutal weapons of war to the extent that such sexual abuses (declared a war crime under the ICC)– Rwanda

• Emergencies increase susceptibility to infection with HIV and vulnerability to the impacts of the HIV/AIDS epidemic.

HIV and Human Rights

• Growing recognition that without impacting upon human rights– Programmes cannot successfully impact upon the

prevention of HIV and care of people living with HIV/AIDS.

• Human rights approach to HIV/AIDS. – Takes the principle of non-discrimination as a point of

departure. – Outlined in the International Guidelines on HIV/AIDS

and Human Rights, is the most effective approach both in terms of human rights and public health

Solutions

• Good governance– Rule of law, transparency, responsiveness to the

community, consensus building, equity, effectiveness, accountability and vision apply at all levels

– Beyond adoption of laws, bills and regulations but also in ensuring that constituents are fully aware of their rights and how they can improve their lives within existing legal frameworks and policies

– Political commitment to mitigating the impact of HIV/AIDS

– Building effective alliances with civil society

Solution

• Greater Involvement of People living with HIV/AIDS (GIPA) Principle was set out in the 1994 Paris Declaration

• The Objectives of GIPA are to:• promote and advocate for the GIPA Principle as an

HIV/AIDS prevention and management strategy; and• involve people living with HIV/AIDS in the development and

implementation of work-based policies and programmes• increase the understanding of the HIV/AIDS epidemic within

organizations, thereby normalizing HIV infection and contributing towards reducing stigma and discrimination.

• establish networks and support structures for people living with HIV/AIDS within organizations and companies

Oxfam projects

• Mainstreaming in Malawi

• JOHAP Joint Oxfam HIV/AIDS Programme in South Africa

Oxfam in Malawi

• Oxfam has been working in the Shire Highlands since the 1990s.

• Working through government extension staff, the core business of the programme is to diversify and increase agricultural production, improve soil fertility through crop selection and manure production, agro-forestry and gaining access to markets.

• The impact of the virus greater for women

HIV Mainstreaming in Malawi

• In last 4 years The Shire Highlands Sustainable Livelihoods Programme (SHSLP) in Mulanje District, was being negatively affected by HIV/AIDS

• Elderly widows or children were commonly seen as head of households

• SHSLP had to rethink how it functioned

Shelling coffee beans, Côte d'Ivoire

HIV Mainstreaming in MalawiSummary of lessons1. Effective leadership that can acknowledge and reflect the reality

of HIV/AIDS into all elements of policies.2. Staff must be given the opportunity to properly internalize the

impact of HIV/AIDS as individuals as well as professionals through training, appropriate policies and access to services

3. Participatory techniques must allow women and girls, housebound people, the elderly and child headed households to be involved at every stage of the programme

4. Capacity building of local structures, government extension and partners needs to be on-going, not simply one of workshops or trainings. This will mean spending additional resources

5. HIV/AIDS may change who is most vulnerable in the community, particularly young people

HIV Mainstreaming in Malawi

• Adapting its core business rather than become an HIV/AIDS specific organization.

Develop the capacity of SHSLP through mainstreaming HIV/AIDS internally

• SHSLP needed to increase levels of awareness and skills of their staff around HIV/AIDS.

• Institutional Vulnerability Audit to assess how HIV/AIDS could affect the organization

HIV Mainstreaming in Malawi

Research in the programme area on the impact of HIV/AIDS

• Limited testing facilities available, and stigma making it difficult for people to publicly state their serostatus

• Oxfam looked at the impact of HIV/AIDS, rather than who was infected.

• Knowledge about HIV/AIDS was quite high– stigma was still a huge problem

HIV Mainstreaming in Malawi

Adapting ways of working – local structures.

• SHSLP programme worked through government extension services and village development committees

• Developing new ways of working that can more directly reach affected households

HIV Mainstreaming in Malawi

Adapting ways of working – local structures.

• SHSLP programme worked through government extension services and village development committees

• Developing new ways of working that can more directly reach affected households

HIV Mainstreaming in Malawi

• Promising practices: adapting activities

• Promotion of small ruminants: – rabbits, guinea fowls, chickens and goats can

help affected households

• Intercropping promotes maximum use of land

• Treadle pumps -help irrigate land in a shorter space of time (reduced from 6-8 hours to 3-4 hours)

HIV Mainstreaming in Malawi

• Adapt some intervention criteria such as revolving schemes.

• Compost manure making such as pit, cube and less chemical

• Paying more attention to the nutritional value of food crops

Joint Oxfam HIV/AIDS Programme (South Africa )

• Joint Oxfam HIV/AIDS Programme in South Africa (JOHAP) was established by a group of Oxfam affiliates as a pilot programme in1998.

• The guiding principles of the framework specify that Oxfam agencies in the region should:

• Follow a rights-based approach;• Pursue a commitment to gender equity; and • Address HIV/AIDS as a development issue

Joint Oxfam HIV/AIDS Programme (South Africa )

• Priorities: Phase One (1998-2001)• Working through partners in KwaZulu-Natal and

Limpopo Province. – Capacity building– Service delivery– Advocacy

• Target group– Young women– Vulnerable children– Young men– Policy makers– CBOs/NGOs– People living with HIV/AIDS (PLWHA)

Joint Oxfam HIV/AIDS Programme (South Africa )

• Phase 2 (2002-2005) building achievements made in phase 1– Improving quality and

cohesion of civil society response. Supported by Ireland, Hon Kong, the Netherlands (Novib) and Germany

Joint Oxfam HIV/AIDS Programme (South Africa )

• Strategies• Linking and learning -within and across sectors• Documented lessons, models and tools relating to

good practice• Documenting and Sharing – supporting the

development of case studies of partners work,• Developing good practice guides of lesson learned

through experience• Improving Cohesion – building alliances and

participating in networks and seminars and other forums

Joint Oxfam HIV/AIDS Programme (South Africa )

• Objectives for Phase 2– Support approaches to HIV/STI prevention work that

effectively address gender and sexuality issues– Identify and support and link models of linking HIV

prevention and care– Contribute to more enabling environment for

HIV/AIDS programming. (Rights of PLWHA)– Ensure the management and governance of JOHAP

work toward its objectives effectively , efficiently and ethically