"Guaranteeing the exercise of the rights of women who live with or are affected by HIV requires an effective response to HIV across sectors from a human rights and gender equality perspective, supported by decision-makers at all levels, with...significant social participation."
This report is designed to inform discussions among Organization of American States (OAS) member states and their allies of the challenges that gender inequalities represent for the response to HIV in Latin American and Caribbean (LAC) countries, and of the actions that must be implemented at scale in order to enable HIV-positive women to exercise their rights to decent work, education, housing, healthcare, social protection, information, and social and political participation, as well as to live free from stigma, discrimination, and violence. It was developed by the Inter-American Commission of Women (CIM), OAS, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), with the collaboration of the International Community of Women Living with HIV/AIDS (ICW Latina). The report includes information from the following sources: questionnaires completed by 14 countries, studies on stigma and discrimination from 11 countries with 7,822 interviewees, the UNAIDS global database (AIDSINFO), and a literature review. For this report, special emphasis was placed on the collection of information on women in all their diversity.
The report examines public policies: the legal framework and programmatic responses. According to the 2011 Global AIDS Response Progress Reporting (GARPR) reports, the regulatory frameworks in 20 LAC countries include national strategies on gender equality: Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominica, Ecuador, El Salvador, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela. These countries affirmed in their reports that the "women's" sector, as well as equality and gender empowerment, are included in the national HIV strategies, while the other countries, except for El Salvador and Honduras, confirmed that women and girls were included in their strategies. Not all of the aforementioned countries explicitly spell out actions specifically focused on the various categories of women in their national plans. Although most countries in the region do have HIV-related laws, strategic plans and programs, regulations, and protocols, the approaches and scopes are varied. Furthermore, although a significant number of countries have laws in place to protect and promote the rights of women overall, very few have made progress towards recognising the specific rights of women living with HIV. At the time of this report, there was very little documentation of the differential impact of gender equality policies on women in all of their diversity.
The 14 countries that completed the questionnaire sent by the CIM/OAS and provided information on the barriers to the full exercise of the human rights of women living with HIV tend to agree that the main obstacles are the stigma and discrimination associated with HIV status, gender-based violence, the lack of empowerment of women living with HIV, their inadequate knowledge of their human rights, and their limited access to employment, and that these obstacles are closely associated with the disparities caused by gender inequalities themselves.
The bulk of the report examines the status of the rights of women living with HIV: progress and challenges, with discussion in these areas:
- Right to life - The States guarantee this right to the extent that they respond to the needs of all of the diverse women living with HIV, eliminate discrimination, and create an atmosphere favourable to the exercise of rights. This right also entails access to the services and resources necessary for prolonging an active, healthy life, as well as respect for the dignity and integrity of the bodies of women living with HIV.
- Right to non-discrimination and equality before the law - The guarantee of this right entails the prevention of discriminatory acts, the protection of persons living with HIV, and their integration into public policies on development.
- Right to the highest attainable standard of health - Access to sufficient, quality healthcare and to living conditions that ensure physical and mental well-being are key aspects for guaranteeing the right to health.
- Right to a life free of violence - Measures targeted at the following are required in order to guarantee this right in the context of HIV: preventing and responding to the many forms of violence against women, ensuring access to justice, and creating a policy environment to protect the rights of women with HIV in all their diversity and eliminate institutional violence, including violence exercised or tolerated by the State.
- Right to not be subjected to cruel, inhuman, or degrading treatment - In LAC, many key populations face barriers to accessing information, prevention, and treatment resources, are refused services, and suffer hostility and other forms of discrimination in various spheres of their lives.
- Right to education - Guaranteeing the exercise of this right entails eliminating economic, cultural, geographical, and social barriers to education, including the barriers associated with HIV status. HIV is also a consequence of inadequate education in women, since a lack of information about transmission and about their sexual rights limits their ability to protect themselves from the virus.
- Right to work - Guaranteeing this right entails eliminating barriers to access associated with HIV status, job security, social security, and fair pay. The percentage of women with HIV who were unemployed was double or more than the percentage of men in four of the countries analysed: the Dominican Republic, Guatemala, Mexico, and Paraguay.
- Right to social protection and an adequate standard of living - Given the high levels of social exclusion they experience, women living with HIV do not necessarily benefit from the initiatives aimed at increasing social protection coverage, namely: retirement benefits, pensions, and other income transfers to older adults, monetary transfers to families with children, access to health insurance and services, and finally, worker protection (insurance against illness and unemployment, together with labour rights policies like severance pay, overtime, leave periods, etc.).
- Right to form a family - With the progress that has been made in access to treatment, more HIV-positive women are deciding to get pregnant and have children; however, many of them do not receive information about their reproductive options. Some health service providers do not believe that people with HIV can or should have children.
- Right to information - This involves: (i) access to comprehensive sex education for adolescents and young people: Inadequate access to comprehensive sex education negatively impacts efforts to protect girls, adolescents, and young women from HIV and other sexually transmitted infections (STIs); (ii) access to information in health services; and (iii) knowledge of HIV, forms of transmission, and condom use in young and adult women.
- Right to participation - Elements of guaranteeing this right for all of the diverse women living with HIV include furthering their capacities: to freely assemble without facing discrimination; to participate in decision-making mechanisms with regard to HIV, gender equality, and development; and to participate in all social and political bodies, while providing resources to ensure that they are adequately involved therein. Barriers to participation for young LAC women living with HIV include: their limited knowledge of their rights; their burden of unpaid domestic labour; the high levels of stigma and discrimination against young women in general and HIV-positive women in particular; the lack of opportunities for them to develop leadership abilities; social norms and laws that restrict their autonomy in the public and private spheres; the limited opportunities for addressing the varied situations faced by young HIV-positive women in all of their diversity; the violence to which they are subjected in their communities, families, and various public spaces; and the prevailing perceptions in the development of public policies and programmes that tend to see young women as objects of intervention rather than protagonists of change.
According to the report, making progress on the respect, protection, and fulfillment of the human rights of all of the diverse women living with HIV depends on several factors, including political commitment, leadership, changes in public policy processes and contents, and the financial resources to address the current gaps in the HIV response associated with these rights.
The 14 countries that completed the CIM/OAS questionnaires indicated that they did have some type of inter-sectoral agency in charge of coordinating actions in order to further the national response to HIV and AIDS, with representatives of all vulnerable populations and sectors, including organisations of women in general and women with HIV. However, as reported here, in practice, this participation is not always effective. For example, in Honduras, participation is limited to self-help groups and the national association of persons living with HIV; Belize reports that there is participation in planning and evaluation processes but not in the implementation and monitoring of actions.
With regard to information and knowledge-management systems, the information gleaned from the 14 participating countries indicates that only Chile and the Dominican Republic have performed studies on the human rights of women living with HIV. In terms of strategic information on HIV, all countries except for Argentina and the Dominican Republic have reported that they disaggregate their data by sex and age, and Chile, El Salvador, and Guatemala additionally have data that has been disaggregated by gender identity and sexual orientation. In Mexico, CENSIDA has information disaggregated by sex. However, the data disaggregated by sex are not available to the public in all countries, nor are all the data disaggregated in line with UNAIDS and World Health Organization (WHO) recommendations.
Communication-related highlights from the conclusions and recommendations section include:
- Some progress has been made on including key issues for women living with HIV in some national HIV strategic plans as well as in sector programmes and other public policy instruments. However, there is scarce documentation to show that the results of this progress are formally used in important indicators like education, work, health, and access to social protection for women living with HIV, among others.
- Women living with HIV face challenges to the exercise of their human rights. In particular, the right to health is restricted by factors like coverage and insurance plans, access to the voluntary HIV test, the lack of confidentiality, stigma and discrimination in services, and the prevailing approaches that confine the health and development of women living with HIV to the use of medication and the prevention of HIV transmission to their babies and sexual partners.
- Adolescents' and young people's limited access to comprehensive sex education; the low level of knowledge about HIV, how it is transmitted, and condom use; and the lack of strategies for providing condoms to teenage and young women, as well as the lack of information specifically geared toward women living with HIV in services and other spaces, all endanger the progress made on HIV and increase women's vulnerability to the virus.
- The lack of meaningful participation by women living with HIV in decision-making processes - not just for HIV-related policies and budgetary allocations, but for all human development policies - calls into question the capacity of these policies to respond to their needs and to produce sustainable changes in the structural factors that lead to violations of their rights.
- Crafting a regional agenda led by women's groups and by diverse women living with or affected by HIV on their human rights will make it possible to establish inter-institutional actions with key sectors like justice, education, employment, health, social protection, security, among others, with an eye to addressing the existing discrepancies in the exercise of rights.
- Continually strengthening the capacities of women living with HIV to advocate for their rights and access justice locally, nationally, and regionally involves reinforcing the strategic alliances between regional networks, local organisations, and the sectors with links to the HIV response at the domestic and international levels.
- Generating information that makes it possible to sustain evidence-based actions and that informs the funding of the interventions aimed at protecting and fulfilling the rights of women living with HIV is recommended.
UN Women Gender Equality And HIV/AIDS Portal, October 6 2017. Image caption/credit: Challenges on the Protection of Human Rights of Persons Living with HIV/AIDS in Latin America and the Caribbean: Human Rights, Non-Discrimination and HIV in the Americas - An Independent Affiliated Event of the XIX International AIDS Conference, held on Monday, July 23, 2012, at the Art Museum of the America. Photo courtesy of OAS - Inter-American Commission on Human Rights (IACHR)