Needs and rights of key affected women and girls in HIV programmes: Report by Bobby Ramakant

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In the lead up to the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP), an issue-focussed and time-limited online consultation was facilitated on the issue: key affected women and girls, on SEA-AIDS by the Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA) and Citizen News Service (CNS) during 1-20 August 2011 [The summary report of this online consultation is online here. It will be released at the Women Community Forum of 10th ICAAP too on 25th August 2011].
This summary report makes the following recommendations:
* Key affected women and girls should include those women and girls living with HIV, female sex workers, female drug users, transgender women (‘hijras’ and other gender variants), wives/female partners of drug users, wives of men-who-have-sex-with-men (MSMs) among others who are at heightened risk of HIV in local/ specific settings
* Zero tolerance for gender based violence, stigma, discrimination and criminalisation of key affected women and girls
* Increase awareness about safe sex and sexually transmitted infections (STIs) including HIV/AIDS among key affected women and girls by ensuring access to comprehensive sexuality education to them.
* Endorsing policies and funding that raise awareness of and access to more protection options for women and girls and building the knowledge and skills of women and girls so that they can use these technologies effectively.
* Increase investment to reach and provide services for key affected women and girls such as female partners of MSM, female IDUs, female partners of IDUs, transgender populations among others.
* National HIV programmes should address gender inequality that makes it harder for women and girls to insist on and negotiate safer sex or using STI/HIV prevention options. It also should accelerate research, development and eventual introduction of safe and effective new STI/HIV prevention options including vaginal, rectal microbicides and vaccines.
* More government and donor support is warranted to increase availability, affordability and accessibility of female condoms and other safe and effective STI/HIV prevention and/or contraceptive methods, particularly for key affected women and girls to initiate and use
* Countries need to de-criminalize drug use and sex work and provide a friendly, safe and supportive healthcare service facility, including reproductive and sexual health services, for female injecting drug users (IDUs) and sex workers. Legal reforms must happen for supportive public health policies that do not criminalize sex work or drug use.
* Scaling up of gender sensitive harm reduction services for female IDUs and female partners of IDUs needs to be taken up.
* It is very important to address mental health needs of transgender population, especially sex workers through proper counselling. This is largely a neglected area. The drop-in centres and other AIDS-related healthcare service centres should provide counselling to transgender populations to deal with mental health issues and not just for issues related to STI or HIV/AIDS.
* HIV investments made on affected population should be quantised and tracked. A new report produced by the Global Forum on MSM & HIV (MSMGF), indicates that most major bilateral, multilateral and private philanthropic funders that focus on HIV do not consistently track their investments targeting transgender people. Even domestic government funding does not do it at all. So very often the funds do not reach the affected populations for whom they were intended.
* HIV prevention programmes should take a community and health system strengthening approach. Community Systems Strengthening can be done by building capacity of key affected women and girls, to make them competent enough to contribute effectively in programmes addressing their community by being involved in making decisions on developing, designing, implementing, monitoring and evaluating HIV policies and programmes. Also just coming from the affected community does not mean that the person is automatically equipped to be a peer counsel –they will have to be equipped for this.
* Strengthen the linkages between HIV and Sexual Reproductive Health (SRH), and their inter-relationships within broader issues of public health, development and human rights. It is imperative to respect the basic rights of drug users and sex workers. Coercion and forced detention will always have a detrimental effect, and so will the wilful use of anti-trafficking laws to arrest sex workers or demolish sex work establishments, thereby increasing vulnerability.
* Easy access to basic legal services is essential to helping women living with HIV obtain what the law provides for them (in most countries) but what society denies them: property ownership, employment opportunities and social protection coverage for basics like health care, food, water and shelter. If they are given free legal aid and helped to get what is rightfully theirs, it will go a long way in helping them lead a dignified life.
* Address HIV, Hepatitis B and C vulnerabilities of key affected women and girls
* Key affected women and girls must be engaged in making decisions on developing, designing, implementing, monitoring and evaluating HIV policies and programmes. Stigma, discrimination and the criminalisation of key affected populations prevent women from reporting acts of violence against them and seeking redress. Appropriate systems needs to be established to investigate and document violence and the link between HIV and different forms of violence against all women and girls, including key affected populations.
* Members of affected communities of women and girls need capacity building and must be competent enough to contribute effectively in programmes addressing their community, so that there is ‘Nothing About Us Without Us’. (CNS)
(The author serves as CNS Policy Adviser and is a World Health Organization (WHO) Director-General’s WNTD Awardee 2008. He writes extensively for Citizen News Service (CNS) on health and development. Email: bobby@citizen-news.org, website: www.citizen-news.org)

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