“… Still shooting blanks …”

1. “…Still shooting blanks…” Human Rights at the Core of the HIV & TB Response Lynette Mabote Advocacy Team Leader, AIDS & Rights Alliance for Southern Africa 23 July 2014

2. “the epidemic of stigma, discrimination, and denial…[is] as central to the global AIDS challenge as the disease itself”. -Jonathan Mann, former WHO head of HIV, 1987

3. At this point in time… We know our co-epidemics… We know whereto target interventions… We know who we need to invested in Science has shown us when these interventions should be implemented We have knowledge of howwe can reduce incidence rates and prevent deaths We now have the why… BUT THEN WHY not?

4. Trying to rationalise what seems irrational • Sluggishness progress on evidence based approaches – e.g. TB/HIV - in stark contrast to “progressive biomedical strides” – e.g. mass procurement of GeneXpert machines, but lack of infrastructure / To initiate Isoniazid Preventative Therapy (IPT) or not to initiate IPT • Stumbling blocks posed by “morally-centered laws and policies” which aim to navigate public health by controlling people – e.g. people who do not adhere to treatment being arrested for non-adherence • The real issue: While maximising on biomedical potential is essential…BUT has become a self-defeating prophecy, if we do not address the fundamental shortcomings in our response: socio-economic challenges

5. Intensifying attempts to “Control” HIV/TB • Criminalisation: • Ostensibly meant to encourage disclosure & protect people, often has opposite • effect: • Reinforcing stigma; bypasses more critical and fundamental interventions • Women and key populations are particularly affected due to challenges with disclosure and sex workers negotiating safe sex • Condones hysterical prejudice • Proliferation of HIV Prevention and Control Laws • Tendency towards coercion, particularly with regards to prevention of transmission • Effects: • Reproductive rights violations…essentially criminalization of peoples’ autonomy • Discourage uptake of services and encourage denial: additional access barriers • Restricts progressive thinking that is needed for HIV interventions to evolve in response to • evidence

6. Matter of Fact Current assertions… • Human rights responses are driven by enabling policy and legal environments • The strategic combination of social mobilization, science and use of the courts • Efforts need to mobilise communities in need and most at risk in order to catalyze on their right to health • These go a long way…BUT the frameworks cannot exist in a silo…with no implementation and effective monitoring of the ones who are most in need… Pay less now, pay more later syndrome

7. Advocacy to entrench human rights law in the HIV response • Requires sustained engagement at the community level (including outreach to social, cultural, religious leaders) • To drive change at policy making level • To be opinion leaders for rights-based approach in order to connect policy to practice • In order for laws and policies to be meaningful, need measures to enforce them and avenues for recourse in case of violations • Problem: SADC and East Africa regions where there is little access to justice

8. ARASA’s work on creating enabling environment • Annual training of trainers’ course • Work on criminalisation of HIV (e.g. submissions to parliaments/ govts / working with partners to understand the importance of undertaking in-country level advocacy for legal review/ reform • Support of strategic litigation by partners (e.g. SALC) • Work with SADC Secretariat, SADC Parliamentary Forum/ African Commission to promote the right to health mandate under various mandates and through special committtees • Sustained country programmes and ad hoc support to in-country partners • Production of Reports: ARASA HIV and human rights SADC/ EAC report • Advocacy on access to information on upcoming regional and international policies

9. Bottom Line • Problems may present with socio-economic indicators, but the fundamental issues are political • Advocacy framed within the context of broader political commitment to long-term socio-eonomic development • Remaining question dictating our Advocacy: How do we shift priorities and power dynamics?