Africa Regional HIV Grant - Removing Legal Barriers
The Africa Regional Grant on HIV aims to address human rights barriers faced by vulnerable communities in Africa, and facilitate access to lifesaving health care. The Global Fund grant is the first of its kind and covers 10 countries, namely Botswana, Côte d’Ivoire, Kenya, Malawi, Nigeria, Senegal, the Seychelles, Tanzania, Uganda and Zambia. The programme also works at the continental and regional levels with the African Union Commission and key Regional Economic Communities to promote alignment of national laws and policy with regional and international human rights commitments.
The Africa Regional Grant on HIV aims to address human rights barriers faced by vulnerable communities in Africa, and facilitate access to lifesaving health care. The Global Fund grant is the first of its kind and covers 10 countries, namely Botswana, Côte d’Ivoire, Kenya, Malawi, Nigeria, Senegal, the Seychelles, Tanzania, Uganda and Zambia. The programme also works at the continental and regional levels with the African Union Commission and key Regional Economic Communities to promote alignment of national laws and policy with regional and international human rights commitments. In Kenya, Nigeria and Zambia, ‘transgender’ populations are being integrated into national strategic plans.
Fighting HIV and injustice
“When I visited her in prison, she thought she was in the wrong. When I explained she wasn’t, she burst into tears. She couldn’t believe it. She didn’t know her rights.”
Wesley Mwafulirwa, a human rights lawyer, was at home in Malawi when he read the news. El (name changed to protect her indentity), a young woman living with HIV and on antiretroviral treatment, had been arrested for breastfeeding another person’s child. She was unrepresented at her trial and sentenced to nine months imprisonment with hard labour.
“This was a woman who had no means of hiring a lawyer to defend herself. I’d just come back from a training on HIV criminalization and thought, I can do something about this. I took the case pro-bono,”
Read the full story of how Wesley and the Southern Africa Litigation Centre fought an appeal against El's sentence in a landmark case.
Human rights barriers to accessing HIV and TB services
Any law, policy or practice that inhibits access to needed health services violates human rights and is likely to result in poor health outcomes. Conversely, a strong legal and policy framework that protects marginalised groups can have the opposite effect. As just one example, the provision of sexual health services and information to female sex workers has been shown to lead to increased condom use and reduction in HIV and STI prevalence. International law is clear that discrimination on the basis age, sex, disability, marital and family status, sexual orientation, gender identity and health status (a non-exhaustive list) is prohibited.
Despite the Global Fund making a commitment to the scaling up of programmes to address human rights barriers in its 2012-2016 strategy, the level of investment in such programmes has remained low (0.5% of all programme spend). The Africa Regional Grant helps to address this programme imbalance.
Barriers faced by key populations in the Africa region
The examples below serve to demonstrate some of the particular programme challenges that the grant is looking to address.
- Botswana: the proportion of people expressing accepting attitudes towards people living with HIV decreased from 65% in 2008 to 24% in 2013. 14% of LGBT respondents were denied health care services in some areas of the county.
- Seychelles: Given the small size of the islands, many key informants cited embarrassment due to stigma as a barrier to accessing HIV-related services, particularly in their local districts.
- Côte D’Ivoire: 36% of sex workers interviewed reported being forced to have sexual intercourse against their will, and 48% reported having been physically assaulted. Close to 20% of sex workers reported being either intimidated or harassed by the police, and 23% were afraid to access health services.
- Botswana: Prisoners also face challenges in the context of Botswana’s legal environment; Botswana Prison's HIV/AIDS Policy of 2003 prohibits availing condoms for inmates as this would conflict with the government’s laws against homosexuality, contributing to the spread of HIV infections in prisons.
Regional activity highlights
- Training for parliamentarians on HIV, human rights and the law: The training run by Enda Santé in August 2016, and again in 2017, focused on the role and impact of parliamentarians on changing policy and reforming legislation to improve access to justice, health care and ensure human dignity for all. The participants, including civil society and key population reps, were exposed to challenges faced by vulnerable groups and trained on specific tools to support revision of laws, policies and strategies.
- Policy brief on law enforcement and key populations: A policy brief focusing on the key role of law enforcement in the context of key populations.
- Capacity strengthening: ARASA and ENDA are working to build capacity of NGO sub-recipients. Work already undertaken with Enda Santé will ensure that by the end of 2018 they will meet or exceed the minimum requirements to become a Global Fund PR.
- Advocacy and strategy meeting on transgender people: In October 2016, SALC and the Southern Africa Trans Forum (SATF) organised a regional meeting in Johannesburg, South Africa to examine the legal and policy frameworks that affect transgender people across the Southern African Development Community countries.
- Regional training: Training was delivered across the region with 36 people attending training on health litigation and 37 being trained on prison health and rights.
Programme activity by country 2016-17
(select country on map to see details)
ARASA is a regional partnership of non-governmental organisations working together to promote a human rights approach to HIV/AIDS and TB in Southern Africa through capacity building and advocacy. The organisation was established as a project of the Legal Assistance Centre in 2002 as an initial partnership of five NGOs working to promote a human rights based response to HIV in the Southern African Development Community. In 2006, ARASA was registered as an independent organization in the form of a trust in Windhoek, Namibia. It currently has 106 partner organisations representing diverse stakeholders, including networks of PLHIV, key populations groups, women’s groups, youth groups, and religious leaders. ARASA conducts its work under two programme areas: (i) Training and Capacity Strengthening (including an online training facility); and (ii) Advocacy. Both programme areas have international, regional and national components.
The Organization’s main mission is to support populations, in particular vulnerable groups or key populations, in exercising their right to access information and adequate health services. It commits itself to ethics and gender related aspects as the areas in which Enda Santé will direct its focus for the coming years.
ENDA operates as a community-based civil society organization, which contributes to the response to HIV and malaria, and invests in reproductive health, equity, gender and human rights. Staff strength is 98, and is composed of professionals of diverse nationalities, roughly 25% of whom are women. Oversight is provided by a board of directors, an executive body, and a directorate.
The Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN) was formed in 1994 and registered as a Non-Governmental Organisation (NGO) in 2001. It was established following a workshop in Accra, Ghana which focused on creating country-based networks that intersect law, ethics, human rights, and HIV. Their goal is to advocate for a holistic and rights-based system of service delivery in health and for the full enjoyment of the right to health by all, including the vulnerable, marginalized, and excluded populations in these four thematic areas. While originally created to protect and promote HIV-related human rights, their scope has expanded to also include:
- Sexual and reproductive health and rights,
- Key populations, and
- Women, land and property rights.
The Southern African Litigation Centre (SALC) was established in 2005 as a joint initiative between the International Bar Association and the Open Society Initiative for Southern Africa. Headquartered in Johannesburg and operated in the form of a trust, SALC has a board of trustees that provide strategic direction for the organization, and a current staff of ten. SALC currently has 11 programmatic areas, that include: disability rights, LGBT/sex worker rights, health rights, international criminal justice, freedom of expression, prisoners’ rights, regional advocacy, sexual and reproductive rights, xenophobia, regional migration, and child rights.