27 August 2014

Africa: Human Rights Must Be Central to HIV Prevention Efforts

Last month, Australia hosted the 20th International AIDS Conference in Melbourne, putting HIV and human rights high on the agenda in discussions on the new post 2015 development goals.

As an HIV activist and leader it was a pleasure to be at AIDS 2014 advocating on behalf of people living with HIV as well as young lesbian, gay, bisexual and transgender people.

The conference (20-26 July), attended by more than 12,000 people from across the globe, highlighted barriers to tackling HIV among young people and lesbian, gay, bisexual and transgender communities. These include difficulties in accessing HIV services for people under the age of consent, the criminalisation of homosexuality in many countries, a lack of sex education, and stigma and discrimination.

Age of consent

The age of consent, when a person is legally old enough to have sex, can create barriers for adolescents in accessing HIV services and support. In countries like India, Pakistan, Sri Lanka, Nepal and Bangladesh, young people under 18 years old cannot go for HIV testing without parental consent.

Another issue for adolescents who are confused about their sexuality is that community-based organisations will not always support them, because they are afraid the police will take action against the organisation. As a result, adolescents are difficult to reach because they will not go to their parents or community organisations to talk about HIV or their sexuality, because they are too afraid.

In a session on scaling up approaches to reach young key populations of the HIV epidemic I gave my own example from India, where being gay and HIV positive, I feel like I would just die if I was under 18 because I would not have access to services.

Legal barriers

In countries such as India, Pakistan and Sri Lanka, it is anti-homosexuality laws which create barriers to people seeking HIV testing and treatment.

In India under article 377, lesbian, gay, bisexual and transgender people can face violence from police as having sex with the same sex is a criminal offense. Article 377 states: "Whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal, shall be punished with imprisonment for life, or with imprisonment of either description for term which may extend to ten years, and shall also be liable to fine."

Men who have sex with men, transgender and bisexual people are considered more at risk of HIV infection. However, the reality is that people who are criminalised for their sexuality will not want to visit government hospitals, because doctors and counselors will not treat them correctly.

Sex education

The Indian health minister, Dr Harshwardhan, recently stated that sex education should be banned in schools.

Such attitudes still prevail in a number of countries, and people don't talk about sex much as it is a taboo subject - but this is simply turning a blind eye to the fact that adolescents often start having sex at an early age.

But in many contexts young people think that if they go for HIV testing, and share the details of their sexual behaviour with a doctor or counsellor, then they will be seen as a criminal and treated badly. Unfortunately this can sometimes be true and this fear prevents many young people from going for HIV testing.

Stigma and discrimination

People who are living with HIV and who belong to the lesbian, gay, bisexual and transgender community (LGBT) face dual stigma and discrimination: firstly for their sexual orientation and secondly for being HIV positive. They face such attitudes from family, friends, neighbours and sometimes their own doctors.

I know this from my own experience as when I disclosed my sexual orientation and my HIV status to healthcare staff, they told me not to have sex.

Educating people to end discrimination towards people living with HIV and the LGBT community is one of the biggest challenges ahead. As debates on the post 2015 development framework intensify, we need to ensure a human-rights based approach is embedded into the new sustainable development goals (SDGs). And this will only happen if we, as citizens, ensure our voices are heard.

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