Uasin Gishu County Dialogue Forum on HIV, Human Rights and the Law

HELD IN UASIN GISHU COUNTY 15 AUGUST, 2014

www.kelinkenya.org

CONTENTS

List of Abbreviations and Acronym 4

1.0 Executive Summary 5

2.0 Introduction and Participants Expectations 6

3.0 Objectives of the Forum 6

4.0 Methodology 6

5.0 Introduction of KELIN and climate setting 7

6.0 Setting the Scene 7

7.0 Discussions on issues – 8

Melba Katindi, KELIN i) TB and Stigma Caused by Incarceration of Defaulters - ii) Criminalization of Deliberate HIV Transmission iii) HIV and Disability iv) Uptake of HIV services in the County v) Profiling the Legal and Human Rights Issues Affecting the HIV Response- 9

Ted Wandera, KELIN

8.0 Comments by Duty Bearers 10

Closing Remarks 11

Conclusion and Recommendations

Annexes 12

Annexure 1 Program

Annexure 2 List of Participants 13

TRAINING OF LAWYERS FROM AND UASHIN GISHHU COUNTIESON HIV, HUMAN RIGHTS AND THE LAW 3 ABBREVIATIONS Executive Summary

ADr alternative Dispute Resolution

AIDS Acquired Immuno-deficiency Syndrome

ARV anti Retro Viral

CBO Community Based Organizations

HAPCa hiV and AIDS Prevention and Control Act, 2006

HIV Human Immuno-¬deficiency virus

KANCO AIDS NGO Consortium

LACE Legal Aid Centre

NASCOP National

NEPHAK National Empowerment Network of People Living with HIV and AIDS in Kenya

NGO Non-Governmental Organization

PLHIV Persons Living with HIV

TB Tuberculosis

4 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY Executive Summary

KELIN has been conducting training workshops on HIV, 1. Exploring a suitable community model for TB human rights and the law with lawyers, health care workers management that looks at the underlying factors of and persons living with HIV. It has carried out awareness treatment default as opposed to imprisonment, in the initiatives in collaboration with media in various counties absence of a proper isolation facility. around the country. As a follow up on recommendations from these activities, KELIN, with the support of AIDS Fonds 2. Need for dialogue with national policy makers and law and working closely with NEPHAK and AMPATH (LACE), enforcement agencies to ensure laws are not enforced in organized half day county dialogue forums, whose objectives a way that negatively impacts the rights of TB patients, were to bring together county officials and key stakeholders PLHIV and key populations. working on HIV, to discuss key issues around HIV, human 3. Need for civic education that will include awareness rights and the law affecting the county’s HIV response. The aim was to explore opportunities available for collaborative on basic health issues, human rights and sensitization action. of county policies, laws and opportunities for public participation, The Uasin Gishu County Dialogue Forum was held on 4. Involvement of stakeholders in setting out county 15 August 2014 at the Horizon Hotel, in town. It priorities and the development of county budgets and brought together 34 participants, including members of relevant legislation. the county assembly committee on health, judicial officers, law enforcement officers, the prison department, health It was agreed that the stakeholders would work closely with care workers, pro-bono lawyers, people living with HIV and one another to create interventions to avert new infections, members of key populations. The forum provided a unique in addition to policies ensuring the best care is available for opportunity for stakeholders to participate in an open and those living with and affected by HIV and TB. In particular, free discussion on HIV, human rights and the law. Among the awareness campaigns and the development of the county issues discussed were challenges, opportunities and the way Health Bill were identified as milestones in addressing health forward in regard to effective HIV responses, in the context of matters within the county. Members of the County Assembly the current legal environment. applauded the timeliness, in light of the on-going budgeting process. They undertook to put into consideration the key This dialogue was necessitated by the fact that the full issues identified in allocating resources, and welcomed enjoyment of human rights is necessary to enable individuals submissions to facilitate informed debate and decision and communities to effectively respond to HIV, to reduce making by the assembly. vulnerability to HIV infection and to lessen the adverse impact of HIV on those affected. The dialogue offered a unique The meeting ended with stakeholders calling for KELIN’s opportunity for the county government to interact with other support in ensuring follow-up on the commitments made by stakeholders to identify critical areas that require immediate the various stakeholders. attention, due to the recent devolution of the provision of health services. Areas identified as in immediate need were:

LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY 5 Introduction and Participants Expectations

A brief introduction by the participants established representation by the following stakeholders: policy makers, law enforcement officers, representatives from the judiciary, NGOs, health care workers and representatives of PLHIV.

Objectives of the Forum

The half-day dialogue forum sought to achieve the following objectives: 1. To provide a platform for open discussion between county officials and the relevant stakeholders working on HIV issues Setting the Scene affecting PLHIV, including women and children, as well as key and affected populations in Uasin Gishu County. 2. To provide a platform for partnership building among the different stakeholders for promotion of a rights-based multi- sectoral county response to HIV.

Methodology

The county forum took the form of a town hall discussion. Stakeholders had an opportunity to discuss stigma and discrimination, and its impact on HIV prevention and treatment services, punitive laws and policies that hinder access to HIV services for high- risk populations. The political commitment to condemning HIV-related stigma and the mobilization of resources to increase and sustain the county HIV response was also discussed.

6 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY Introduction of KELIN and climate setting

Ms. Katindi, Program Officer KELIN, officially introduced KELIN and highlighted the various programs and interventions that the organization has been engaged in over the years, with an emphasis on the various activities in Uasin Gishu County. KELIN had undertaken similar county forums in ……KELIN is a human rights NGO working to protect and promote HIV–related human rights in Kenya. KELIN provides legal services and support, undertakes capacity building for professionals and communities on human rights, advocates for policies promoting a rights-based approach and laws that are people-centered, conducts research for evidence-informed programming.

She explained that the interventions in Uasin Gishu County were informed by findings of a “Study on Human Rights Violations against People Living with HIV and AIDS in Kenya” , which revealed high levels of human rights violations against PLHIV, and concerns over their impact on the HIV response. She further explained that the identification of the stakeholders and the agenda was informed by recommendations from the activities undertaken, in the county and was largely undertaken by local partners based in the county.

Setting the Scene

Experiences of PLHIV in Uasin Gishu County;

Gladys Langat-NEPHAK

Gladys formally introduced NEPHAK and highlighted that the organization deals with PLHIV through support groups, CBO’s, NGO’s and other networks. She indicated that NEPHAK’s vision is to have a HIV and TB free society through meaningful empowerment of PLHIV in the national response to HIV. NEPHAK also works to improve the lives of PLHIV by addressing stigma and discrimination, protection of legal and human rights of PLHIV and TB patients, ensuring communities have access to HIV and TB prevention services, ensuring the rights of PLHIV to privacy and confidentiality are respected. The speaker concluded by stating that NEPHAK’s position is that TB patients who do not adhere to treatment should be educated and not imprisoned.

LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY 7 Discussions on issues

Melba Katindi, KELIN Criminalization of Deliberate HIV Transmission

TB and Stigma Caused by Incarceration of Defaulters - Melba shared the Uasin Gishu HIV profile by National AIDS control Council which indicates that only 14% of people Ms. Katindi initiated a discussion on TB and punishment in Uasin Gishu County had been tested as at 2011. She meted out on TB drug defaulters. A participant stated that added that it would therefore, be difficult for a person to TB drugs have serious side effects and many patients may come before a court and argue another has put him or her default because of this. It’s important to investigate reasons at risk. Of the 14% tested only 79% of them went back for for defaulting before recommending incarceration. Some treatment. Melba raised concern about measures put in patients who display TB symptoms refuse to get tested place to encourage voluntary testing, uptake of prevention and seek treatment because they are apprehensive of the and treatment interventions and the Uasin Gishu county’s provisions of the Public Health Act that provide for the commitment to put everyone who qualifies on treatment. incarceration of TB defaulters. He opined that to better Discussions were against mandatory testing and focused deal with the disease, it is important that first TB patients be on the need to encourage everyone to take personal provided with basic TB education such as cough etiquette. responsibility for their health emphasizing on the benefits. Incarcerating a TB patient who does not have a clue on Participants deliberated on the impact of legal provisions cough etiquette would risk the infection of a whole prison criminalizing HIV transmission in discouraging voluntary population with TB. testing. A participant emphasized that there is need to come up with a policy and strategy to encourage uptake of Another participant stated that it’s important to use PLHIV voluntary testing prevention and treatment services in the and TB patients to educate the defaulters instead of the county. police because they can explain that the side effects are only temporary and the long term benefits of adhering to HIV and Disability medication. Melba explained that people with disability are expected to A participant from Kenya prisons stated that he doesn’t access condoms and other health services the same way as support incarceration of TB defaulters because they lack able bodied people. These people must be considered when isolation cells for TB patients. He added that this increases the making health policies, especially related to HIV. risk of infection to other members of the prison population e.g. other prisoners, guards, officers, etc. A participant from She added that there is need to look at the problems people the judiciary stated that it is important to consider the rights with disability are facing and integrate their interventions of other members of society who get infected with TB by TB within programs funded by the Ministry of Health within the defaulters. County as this group is often forgotten.

Ms. Katindi stated that the threat to the public is increased Another participant stated that there are no curriculums for when TB patients are imprisoned because of overcrowding in doctors or nurses on how to attend to persons with disabilities. prison. Moreover, Section 27 of the Public Health Act states These patients might have to be referred to another facility, the punishment is isolation, but does not specify isolation and more often than not they might not make it there. Ms. should be done in prison. Katindi added that this was a huge gap since health training and capacity building for health care workers on disability It was concluded that: was lacking. Thus there is need for the County government to work with the National government to find out how to help • There’s need for HCWs to offer sound advice on TB disabled children and educate others on disability. medication to TB patients so as not to scare them away but to encourage informed choices in favour of voluntary completion of medication. They should also find out Uptake of HIV services in the County the reason for default and ways of mitigating treatment default before recommending incarceration. Mr. Musundi stated that the county interventions and • The county should prioritize the availability of well- programs have evolved since the passing of the HIV Act in resourced isolation facilities within hospital facilities to 2006. He pointed out that the county had invested a lot in the manage treatment default and patients lost to treatment. HIV response and currently uses about 25 million to purchase Prison isolation facilities should be utilized for inmates ARVs in support of treatment for each quarter. The speaker who are diagnosed with TB in prisons or proven cases of proceeded to give the county profile statistics of Uasin Gishu. extreme threats to public health. He noted the issue of people not wanting to use condoms despite the availability of the same. He was also concerned about the poor follow up on treatment and the cases of delivery at home.

8 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY Presentation

Summary of Clients Demographics and Cases

Profiling the Legal and Human Rights Issues Affecting the Drug users are another key population that the facilitator HIV Response- spoke about. He stated that sharing contaminated needles is the most common way of spreading HIV among drug Ted Wandera, KELIN users. Next he mentioned sex workers as another stigmatized population. He stated that there is need to respect sex The speaker stated that lack of respect for human rights fuels workers because they are human beings and lack of respect the spread of HIV directly. He said that HIV often comes with for their rights leads to an increase in new infections.. stigmatization, which results in violation of PLHIV’s rights. The law can be used to help protect the rights of PLHIV but it can Men who have sex with men and the prison population are also do harm by isolation of those most vulnerable to HIV. By other groups at a higher risk of contracting HIV. Overcrowding enforcing punitive laws, those most vulnerable such as sex in prison propels the spread of infections and exposes HIV workers and injecting drug users are not able to seek health positive individuals to TB and other infections. care services besides the constitution guaranteeing all the highest attainable standard of health.

On culture, women and girls he stated, the HIV epidemic has aggravated discrimination against women and girls, because they are more vulnerable to HIV. Children and youth are also overly burdened by HIV, because they are stigmatized if they are infected. There is general stigmatization by communities and also by health care providers.

LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY 9 Comments by D uty Bearers Closing Remarks

Mr R.J Cheserak from NASCOP speaking about willful Hon Patrick Kiptoo a member of the County Assembly stated transmission inquired, how easy it is to determine who that there is a lot to be done in relation to HIV interventions in infected whom. He stated that if one is positive and the other the county. He encouraged participants to suggest and share is negative, then it is easier to ascertain. Melba stated that in action plans with the County assembly. He also said he will such a case, one may not be sure unless the positive person take information gathered from the forum to the community was the negative person’s only sexual partner which is not and to the assembly. He also took time to commend the easy to ascertain. The Representative added that one still police officer and prison officer saying it shows promise for needs to prove they are negative, which means they must the country when officers from the said departments are get tested. concerned about such human rights issues. From KELIN, he Mr Mathew Mutisia an officer representing the Kenya Prisons requested an upscale of such forums to other stakeholders. Service stated that unless changes in the law are brought to He invited KELIN to the county assembly to share such their attention it would be difficult to effectively implement. information with his colleagues. He advised the organizers to engage prisons officials on Conclusion and Recommendations the issue of condom provisions as they are legally unable Melba challenged the Members of the County Assembly and to provide this to inmates. The officer opined that it was the executives to; not morally acceptable to distribute condoms because this would be misconstrued as encouraging sex in prisons. • Budget and scale up similar public forums where the Melba reacted by suggesting a study to determine whether public and the stakeholders in the county can debate on availability of condoms would encourages sexual activities in issues before MCAs legislate on them. prison. She also added that condoms in prisons would be used by both staff and inmates. • Come up with sustainable measures to ensure that the commitments made during such dialogues are Mr Smollets N. Munyianzi an officer representing the police implemented. She underscored the fact that KELIN and stated that the police arrest sex workers and drug users. He local partners would actively request for information asked whether information on punitive laws could be shared on the County`s budgets, legislative processes, for the with other law enforcers to enlighten them on how to deal with these groups in a humane manner. He also asked that purpose of sharing with the relevant stakeholders and the the people who are more in touch with the community pay community for feedback and meaningful engagement. attention to these cases and follow through with them. She added that the right to health is progressive, which Melba stated that it is important for the police to work with means the budget and other resources for it should be sex workers because often sex workers can be helpful and increasing each year. have information that the police could use. She added that • The county leadership should be actively involved in in counties like there have been projects that have encouraged collaborative work between police and sex championing issues of improving HIV management and workers to address security. care.

Ms Caroline Wattimah who was representing the Judiciary stated that individuals brought before them are treated as innocent until proven guilty. Often the issue is judicial officers are not made aware of peoples’ status immediately. These people are arrested and confined before they are charged. She further stated that the police should ensure these people are given adequate representation and are treated for medical issues as their trial continues. She gave an example of someone who is being held and can’t put up a bond and is not receiving the required medication for conditions such as TB and HIV. She was concerned that medical needs of accused persons are often brought to the attention of the court in a timely manner. She stated that there is need to create awareness among law enforcement staff and judicial officers on the need to inquire on and effectively address health concerns.

10 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY Closing Remarks

Dr. Phillip thanked KELIN and members of staff. He called everyone to action in an effort to have a multi sectoral approach to HIV response in the County. He further advised that having an open mind in approaching issues of HIV, particularly when dealing with members of key populations would complement other interventions in place. He suggested consideration of other factors before confining TB patients to prisons such as behavioral and social factors as an effective response to TB.

Conclusion and Recommendations

The County Dialogue Forum brought together the county officials and key stakeholders working on issues relating to PLHIV, including women, children and key and affected populations in Uasin Gishu County. It provided a platform which partnership building among the different stakeholders for the promotion of a rights-based multi-sectoral county response to HIV could take place. The discussions highlighted the challenges and opportunities available to creating an informed HIV response in the county. At the end of the discussions, the various stakeholders and the county government officials committed to implementing various recommendations of the participants, and also agreed to hold consultative meetings to ensure that the county benefits from these deliberations by way of lowering its HIV burden.

LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY 11 Annexes Annexes

Annexure 1 Program

COUNTY DIALOGUE FORUM ON HIV, HUMAN RIGHTS AND THE LAW FRIDAY, 16TH MAY 2014, HOTEL HORIZON, ELDORET - UASIN GISHU COUNTY PROGRAM

TIME SESSION 8.30 – 9.00 AM Arrival and Registration 9.00 - 9.30 AM Introduction, climate setting and welcome remarks - KELIN 9.30 AM – 9.45 AM Setting the scene:

• Uasin Gishu County’s HIV profile (10 min) • Experiences of PLHIV (5 min) • Experiences of populations at higher risk (5 min) • Experiences of Health care service providers (5 min) • Profiling the legal and human rights issues affecting the HIV response (5 min)

10.30 – 11.00 AM Tea Break 11.00 - 12.00 PM Plenary Discussions on the issues: • Stigma and discrimination and its impact on HIV prevention and treatment services for PLHIV especially women, children and key populations. • Cultural practices that increase vulnerability of women & girls and punitive laws that hinder equal access to services for populations at higher risk. • Community leadership in condemning stigma and Political commitment for increased & sustained investment for the HIV response in the County.

12.00 – 12.30 PM Way Forward and commitment by stakeholders • Representatives of Police, Prisons and Judiciary • Representatives County officials from the Executive and Assembly

12.30 – 1.00 PM Closing Remarks • County Assembly Representative – Speaker / Chair of Health Committee

1.00- 2.00 PM Lunch and Departure

12 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY Annexes

Annexure 1 Program

Name Gender Organization Alfred Oginda Male AMPATH Caren Wandati Female AMPATH Caroline Wattimah Female Judiciary Charles Onyango Male MSW Edda Kogo Female KESENGET Eunice Barbuch Female AMPATH George Ng’ety Male FHOK Gladys Atieno Female FSW Gladys Lagat Female KIMUSOR Hellen Chepchirchir Female Vision in Action Henry Kamau Male AMPATH Hon Patrick Kiptoo Male MCA Lawrence Atundo Female AMPATH Mary Goretti Boroswa Female Kipsomba FSG Mathew Mutisya Male Kenya Prisons Moses Yatich Male NACC Peter Sedo Male AMPATH Philip Owiti Male AMPATH Rael Jelimo Female Standard Media Group Rose Ambogo Female Interpreter Smollets N. Munyianzi Male Kenya Police Sophia Torotich Female Ministry of Health Tom Mboya Male County Healthcare Worker

LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY 13

www.kelinkenya.org

16 LEGAL AID CLINIC REPORT IN UASHIN GISHU COUNTY