In!Sri!Lanka!

[NAME] [FIRM] [ADDRESS] [TELEPHONE NUMBER] [FAX NUMBER]

UNITED STATES DEPARTMENT OF JUSTICE EXECUTIVE OFFICE FOR IMMIGRATION REVIEW IMMIGRATION COURT [CITY, STATE]

______) In the Matter of: ) ) File No.: A ______) ) In removal proceedings ) ______)

INDEX TO DOCUMENTATION OF COUNTRY CONDITIONS REGARDING PERSECUTION OF HIV-POSITIVE INDIVIDUALS IN SRI LANKA

TAB SUMMARY

GOVERNMENTAL SOURCES

1 U.S. Dep’t. of State, Sri Lanka 2019 Human Rights Report (2020), available at: https://www.state.gov/wp-content/uploads/2020/03/SRI-LANKA-2019-HUMAN- RIGHTS-REPORT.pdf

• “Persons who provided HIV prevention services and groups at high risk of infection reportedly suffered discrimination. In addition, hospital officials reportedly publicized the HIV-positive status of their patients and occasionally refused to provide health care to HIV-positive persons.” (p. 25)

• “The constitution prohibits discrimination, including with respect to employment and occupation, on the basis of race, religion, language, caste, sex, political opinion, or place of birth. The law does not prohibit employment or occupational discrimination on the basis of color, sexual orientation or gender identity, age, HIV-positive status, or status with regard to other communicable diseases.” (p. 28)

2 U.S. Dep’t. of State, Sri Lanka 2018 Human Rights Report (2019), available at: https://www.state.gov/wp-content/uploads/2019/03/SRI-LANKA-2018.pdf TAB SUMMARY

• “Persons who provided HIV prevention services and groups at high risk of infection reportedly suffered discrimination.” (p. 21)

• “[H]ospital officials reportedly publicized the HIV-positive status of their clients and occasionally refused to provide health care to HIV-positive persons.” (p. 21)

• “The constitution prohibits discrimination, including with respect to employment and occupation, on the basis of race, religion, language, caste, sex, political opinion, or place of birth. The law did not prohibit employment or occupational discrimination on the basis of . . . sexual orientation and/or gender identity, . . . , [or] HIV-positive status . . . .” (pp. 24-25)

3 Ministry of Health, Nutrition & Indigenous Medicine, National STD/AIDS Control Programme - Sri Lanka, Excerpts of Integrated Biological and Behavioral Surveillance (IBBS) Survey Among Key Populations at Higher Risk of HIV in Sri Lanka, (March 2015), available at: https://www.aidscontrol.gov.lk/images/pdfs/publications/research_documents/ibbs_surve y_in_sri_lanka_report_print_version.pdf

• “High levels of HIV related stigma are present across all [most-at-risk populations (“MARP”)] and districts. While most respondents would be willing to care for an HIV positive family member, many do not believe an HIV positive student should be allowed to go to school, and would not buy food from an HIV positive food seller.” (p. 3)

• “Punitive policies, including both legal and policy frameworks, result in high levels of stigma and discrimination in Sri Lanka, for people living with HIV and AIDS. Both sex work and sex between men are prohibited by national laws and evidence implies that many populations at higher risk of infection delay testing and treatment because they are concerned about identification as part of a most-at-risk population (MARP), testing positive, and related confidentiality issues.” (p. 6)

INTER-GOVERNMENTAL SOURCES

4 Independent Advisory Group on Country Information, Excerpts of Country Policy and Information Note: Sri Lanka: Sexual orientation and gender identity and expression, (October 2018), available at: https://www.justice.gov/eoir/page/file/1101906/download

• “The high visibility of LGBT persons in HIV prevention intervention programmes is considered to pose a barrier to recognizing their need for services for general and reproductive health problems as for the general population.” (p. 33)

• “Transmen (female to male) are often left out of HIV awareness programmes since often only transwomen are categorised as men having sex with men by HIV service providers.” (p. 33) TAB SUMMARY

5 Law and Society Trust et al., Excerpts of The State of Economic, Social and Cultural Rights in Sri Lanka: A Joint Civil Society Shadow Report to the United Nations Committee on Economic Social and Cultural Rights (April 2017), available at: https://www.ecoi.net/en/file/local/1402110/1930_1498129564_int-cescr-css-lka-27228- e.pdf

• “LGBTIQ persons risk public humiliation, harassment and threats to their right to privacy at the hands of medical officers in public hospitals upon revealing their sexual orientation and gender identity. The lack of public data on healthcare availability, the inability and/or unwillingness to provide adequate healthcare services to LGBTIQ individuals and the prejudiced discourse that links LGBTIQ persons to HIV carriers further perpetuates the lack of access to healthcare and homophobia and transphobia amongst healthcare providers.” (pp. 47-48)

6 UNAIDS, Family Planning Association Sri Lanka and Partners, People Living with HIV Stigma Index Sri Lanka (November 2010), available at: https://www.aidsdatahub.org/sites/default/files/documents/UNAIDS,_Family_Planning_ Association_Sri_Lanka_and_Partners_(2010)_People_Living_with_HIV_Stigma_Index_ Sri_Lanka.pdf

• “In terms of experiencing stigma and discrimination . . ., it is clear that respondents were not comfortable with friends, neighbours, co-workers, employers, and children finding out their status. In fact even spouses and other adult family members have not been the priority when disclosing HIV status.” (p. 17)

• “People are afraid of us. This fear is based on ignorance. People do not have accurate and comprehensive knowledge of HIV transmission. People are ashamed to be associated with me. I look sick.” (p. 20)

• “The majority of Stigma Index respondents were tested [for HIV] without their knowledge. This includes 78% of those tested for employment, which emerged as the most common reason for testing. The report on HIV Vulnerabilities of Migrant Women gives us further insight: ‘Blood and urine tests (for HIV and pregnancy, respectively) are mandatory for legally migrating women prior to their departure. The test results are provided directly to the agents, and many of the interviewed women admitted to being in the dark about the nature of these tests.’” (p. 21)

• “Furthermore, anecdotal evidence was offered by the research team and respondents on how their status was communicated by hospital workers to their village or community resulting in ostracization, physical assault and damage to property. It is no surprise therefore that the Stigma Index results indicate that HIV positive people in Sri Lanka do not absolutely trust that their confidentiality is maintained by healthcare workers with 42% indicating they are not sure whether healthcare workers have disclosed their status, and 23% claiming they have actual knowledge of healthcare workers disclosing their status without consent.” (p. 23)

• “44% [of HIV+ individuals] reported that healthcare professionals have advised them NOT to have child after being diagnosed HIV positive. 9% speak of being coerced into TAB SUMMARY

not having children; and 8% reported that obtaining ART was conditionally based on the use of some form of contraception and 4% (women) indicated that they were coerced into terminating their pregnancy. These results suggest violations of HIV positive people’s human rights as outlined above by IPPF.” (pp. 24-26)

NON-GOVERNMENTAL SOURCES

7 Family Planning Association of Sri Lanka, Assessment of the Legal and Policy Environment for HIV in Sri Lanka, ([undated]), available at: http://www.fpasrilanka.org/sites/default/files/fpa_srilanka_advocacy_brief.pdf

• “In addition, stigma and discrimination on the basis of sexual orientation or on the basis of being a sex worker or as a person who injects drugs was also found and was reported to hinder access by members of these groups to HIV prevention and treatment services.” (p. 2)

• “HIV is not specifically listed as a protected grounds for non-discrimination in the Constitution, nor is there specific HIV legislation in Sri Lanka. . . . Additionally there are a number of punitive or coercive provisions in the law, which create barriers to the response to HIV. For example, the penal code provisions that criminalize same-sex relations and the Vagrants and Brothel Ordinances are used to criminalize aspects of sex work and result in making access to services for key populations more difficult.” (p. 2)

• “[A]ccess to law enforcement and justice for human rights violations is limited. Despite certain legal provisions for access to justice and redress in Sri Lanka, punitive laws and policies further entrench the feelings of inequality, stigma and discrimination resulting in a lack of trust in authorities due to actual or perceived stigma and discrimination being attached to identification as part of a key population, the criminal laws targeting key populations, and inaction or violence from state actors, including police. Moreover these laws and policies can contribute to an increase in the acceptability and prevalence in harassment and violence against key populations, in addition to reinforcing self-stigma, which reduces access to key programs and services.” (p. 2)

8 Human Rights Watch, Excerpts of All Five Fingers Are Not the Same: Discrimination on Grounds of Gender Identity and Sexual Orientation in Sri Lanka, (August 15, 2016), available at: https://www.hrw.org/report/2016/08/15/all-five-fingers- are-not-same/discrimination-grounds-gender-identity-and-sexual

• “Criminalization of same-sex conduct and gender non-conformity, which gives police wide powers to arrest and harass LGBTI people, creates barriers to HIV prevention.” (p. 44)

• “Sri Lankan health agencies have identified transgender people and MSM [men having sex with men] as key populations in addressing the HIV epidemic. . . .” (p. 4)

• “For example, one 2011 editorial titled ‘MSM to lead HIV/AIDS in Sri Lanka by 2015,’ used the high HIV prevalence among men who have sex with men in Sri Lanka to argue against equal rights for gays and lesbians: ‘[I]t is pathetic to see that most of [the TAB SUMMARY

homosexuals and lesbians and their organisations] are busy fighting for their ‘rights’ and promoting their sexual preference. First of all it is right to safety and health they should fight for.’” (pp. 12-13)

• “[S]ome transgender people and MSM told Human Rights Watch that the experience or fear of stigma and discrimination remained a barrier to them getting tested for HIV and sexually transmitted infections (STIs).” (p. 44)

• “[P]eople getting HIV and STI tests in government clinics . . . felt judged for getting tested and discriminated against for being homosexual or gender non-conforming.” (p. 44)

9 Sexually Transmitted Infections, BMJ Publishing Group, Abstract of Discriminatory Attitudes Towards People Living with HIV/AIDS, A Population Based Study in Sri Lanka, (June 2016), available at: https://sti.bmj.com/content/92/Suppl_1/A45.1

• “People living with HIV/AIDS (PLWHA) are vulnerable to discrimination because of the stigma associated with the disease.”

• “Around 92% (120/130) of the respondents [to a telephone survey] reported discriminatory attitudes in at least five out of the 20 relevant items, about 98% would avoid making physical contact with PLWHA, hesitating to sit next in the public transport (98%), divorcing the infected spouse (85%) and dismissing a HIV positive maid (100%).”

• “A sizeable proportion of the respondents exhibit negative perceptions; PLWHA are merely receiving the punishment they deserve (92%) and believe that they are purposefully infect others (94%). Also 89% concluded that the majority of PLWHA are promiscuous.”

• “About 90% would give PLWHA the lowest priority in resource allocation among five groups of chronic diseases.”

10 Institute for Participatory Interaction in Development (IPID), Excerpts of Rapid Situation Assessment of Transgender Persons in Sri Lanka, (December 2016), available at: https://aidsdatahub.org/sites/default/files/publication/Sri_Lanka_Rapid_Situational_Asse ssment_of_TGs_2017.pdf

• “Stigma, violence, discrimination and marginalization are everyday life features for [Transgender] populations Discrimination against transgender people may stem from multiple forms of stigma relating to gender identity, gender expression and perceived sexual orientation. Research by the International Centre for Research on Women (ICRW) found the possible consequences of HIV-related stigma to be: (i) loss of income and livelihood; (ii) loss of marriage and childbearing options; (iii) poor care within the health TAB SUMMARY

sector; (iv) withdrawal of care giving in the home; (v) loss of hope and feelings of worthlessness; (vi) loss of reputation.” (p. 3)

11 American Public Health Association, Opposition to Immigration Policies Requiring HIV Tests as a Condition of Employment for Foreign Nationals, (2016), available at: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy- database/2017/01/23/opposition-to-immigration-policies-requiring-hiv-tests

• “Some of the most restrictive policies subject immigrants to mandatory HIV testing when they apply for residency or for an employment visa, which is frequently required by states for legal residency. Countries that currently require proof of migrants’ HIV- negative status for employment include . . . Sri Lanka . . . .”

12 Centre for Policy Alternatives, Policy Brief: A Critique: HIV/AIDS and the Legal and Policy Framework in Sri Lanka, (August 2013), available at: https://www.cpalanka.org/a-critique-hivaids-and-the-legal-and-policy-framework-in-sri- lanka/

• “A key objective of the National HIV/ AIDS Policy is stated to be to improve the quality of life of [People living with HIV/AIDS (“PLWHA”)] through minimising stigma and discrimination and providing quality care and support. Article 3.11 of the policy stipulates that the Government will ensure that the human rights of PLWHA are promoted, protected and respected and measures taken to eliminate discrimination and combat stigma which in turn will provide an enabling environment to seek relevant services. Unfortunately the existing legal framework is far from the standard provided in the policy. Public Health laws in Sri Lanka . . . provide discriminatory and out dated quarantine rules for PLWHA as for any infectious disease and hence require substantial amendments. One of the main problems encountered by the individuals interviewed with regard to the current legislation relevant to HIV/AIDS in Sri Lanka, is the lack of clarity and understanding by a cross section of people including medical providers, police officers and others regarding the real status and nature of HIV/AIDS, how its transmitted and its impact.” (p. 16)

• “All interviewed by CPA indicated that the current laws do not recognise the rights of PLWHA and do not protect against stigma and discrimination. A community leader interviewed by CPA stated the following: ‘In this area there are 32 PLWHA. Three committed suicide and this was because their identity had been compromised and the wider society found out they were HIV positive. People said they should be locked into a room because they do not know how HIV is contracted . . . .’” (p. 16)

• “[T]he stigma and discrimination resulting from the legal provisions creates a barrier to approach the homosexual community in the HIV/AIDS response.” (p. 24)

• “Although the official number of cases of Sri Lankans living with HIV was at 4,200 in 2011, the actual number is thought to be much higher as many do not come forward for testing as a result of the stigma and discrimination related to HIV/AIDS.” (p. 8) TAB SUMMARY

MEDIA SOURCES 13 Daily News, HIV risk in Sri Lanka, (November 29, 2018), available at: https://www.dailynews.lk/2018/11/29/features/169766/hiv-risk-sri-lanka

• “On November 13, 2011, consultant venereologists and health professionals in Sri Lanka predicted that in future (by 2015 and beyond), MSM (men having sex with men) will be the main cause for the spread of HIV in Sri Lanka. The highest number of HIV infections in the Sri Lankan history was reported last year (2017) and the number is 285.”

• “MSM will be the main cause of the spread of HIV.”

14 “Trans Woman and HIV Advocate Murdered in Sri Lanka” Gay Star News (Sept. 6, 2017), available at: https://www.gaystarnews.com/article/trans-woman-hiv-advocated- murdered-sri-lanka/

• “A trans woman who was a tireless community advocate was killed in a violent attack in Sri Lanka. Sanath Kumara, 34, received head injuries after she was beaten over the head with a club on Tuesday. Police said they had found multiple wooden clubs at the scene . . . Kumara was a trans woman who had not yet come out. She worked as a HIV peer educator and helped to raise HIV awarenes among trans communities.”

Dated: [DATE] Respectfully submitted, [CITY, STATE]

[FIRM] Pro Bono Counsel for Respondent______

By: ______[NAME] [FIRM] [ADDRESS] [PHONE NUMBER] [FAX NUMBER]

TAB 1

SRI LANKA 2019 HUMAN RIGHTS REPORT

EXECUTIVE SUMMARY

Sri Lanka is a constitutional, multiparty democratic republic with a freely elected government. Gotabaya Rajapaksa was elected president on November 16. Accredited domestic and international observers described the election as peaceful and technically well managed but noted that unregulated campaign spending, abuse of state resources, and media bias affected the level playing field. Following the results of the presidential election, the prime minister and cabinet peacefully resigned, and a new cabinet was sworn in on November 22. The timeline for parliamentary elections in 2020 was pending at year’s end.

The Sri Lanka Police are responsible for maintaining internal security and are under the Ministry of Defense. The military, also under the Ministry of Defense, may be called upon to handle specifically delineated domestic security responsibilities, but generally without arrest authority. The nearly 11,000-member paramilitary Special Task Force, a police entity that reports to the Inspector General of Police, coordinates internal security operations with the military. Civilian authorities generally maintained control over the security forces.

On April 21, suicide bombs killed 258 individuals. The attacks were the responsibility of the National Thowheed Jamath (NTJ), members of which had sworn allegiance to the Islamic State. The following day the government declared an emergency under the Public Security Ordinance, deployed the armed forces domestically, and gave them arrest authority. During the emergency the government banned three Islamist organizations: the NTJ, Jamathe Millathe Ibrahim, and Vilayath As Seylani. The three Islamist groups remained banned after the emergency expired on August 22. President Maithripala Sirisena subsequently ordered the military to remain deployed across the country after the expiration of the emergency, although no longer with arrest authority. President Rajapaksa in turn extended the order on November 22.

Significant human rights issues included: unlawful killings by the government; torture by government agents; sexual abuse; arbitrary detention by government entities; restrictions on freedom of expression, including unjustified arrests of journalists and authors, and limited social media blocking; widespread corruption; violence against lesbian, gay, bisexual, transgender, and intersex (LGBTI) persons, and the criminalization of same-sex sexual conduct.

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Often police reportedly harassed civilians, often with impunity, although the government took steps to investigate and prosecute some officials who committed human rights abuses. The government did not implement a mechanism to hold accountable military and security personnel accused of atrocities during the 1983 to 2009 civil war as called for in 2015 by UN Human Rights Council (UNHRC) Resolution 30/1.

Section 1. Respect for the Integrity of the Person, Including Freedom from: a. Arbitrary Deprivation of Life and Other Unlawful or Politically Motivated Killings

There were reports that the government or its agents committed arbitrary or unlawful killings.

Lack of accountability for conflict-era abuses persisted, including with regards to military, paramilitary, police, and other security-sector officials implicated in cases involving the alleged targeted killing of parliamentarians and abductions and suspected killings of journalists and private citizens. Civil society organizations asserted the government and the courts were reluctant to act against security forces for conflict-era offenses. Although the government took steps to investigate and prosecute some officials who had allegedly committed human rights abuses, it failed to secure any convictions.

In February authorities indicted 17 individuals, including 15 police officers from the Southern Province Special Crimes Unit for the alleged abduction and killing in January of two Sinhalese businessmen in Rathnaudanagama in Galle. Those arrested remained remanded, and the case was pending at year’s end.

On August 18, then president Sirisena appointed Shavendra Silva as army commander. Silva faced credible allegations of serious human rights violations during the final phases of the civil war. A 2015 OHCHR report alleged Silva was responsible for extrajudicial killings in 2009.

On November 22, just six days after the presidential election, the government transferred key police personnel leading investigations into alleged abductions and suspected killings of journalists and private citizens. The officers conducting the investigations were transferred to administrative roles outside the capital. One senior investigator who reportedly received threats from senior government officials fled the country.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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On July 3, the Trincomalee chief magistrate acquitted 12 Special Task Force members and a senior police officer accused of executing five Tamil youths in 2006 (known as the “Trinco 5” case). The suspects were released due to lack of evidence. The attorney general instructed Acting Inspector General of Police C. D. Wickramaratne to locate the witnesses in the case so that the prosecution could proceed. b. Disappearance

During the year there were no disappearance cases registered with police.

Disappearances during the war and its aftermath remained unresolved. The Office on Missing Persons (OMP) opened three regional offices in Mannar, Matara, and Jaffna and continued outreach to families of the missing and disappeared. Based on the recommendation of the OMP, the cabinet approved interim financial relief of approximately 5,700 rupees (Rs) ($33) per month in recognition of the dire economic situation of the families of the missing.

In the case of Prageeth Eknaligoda, a journalist and cartoonist for Lanka eNews who disappeared in 2010, the attorney general fielded indictments against seven army intelligence officers in November. In May then president Sirisena pardoned and released Galagoda Aththe Gnanasara, general secretary of Bodu Bala Sena, a Buddhist extremist organization, from jail. Gnanasara was serving a five-year sentence for contempt of court for interrupting an August 2018 hearing on the abduction of Eknaligoda and for intimidating Eknaligoda’s wife, Sandya Eknaligoda, in 2016. The Supreme Court will take up the appeal by Sandya Eknaligoda against the presidential pardon in February 2020.

On October 31, the Court of Appeal reaffirmed a stay order issued on September 24 upholding a petition filed by then presidential candidate Gotabaya Rajapaksa in connection with a habeas corpus inquiry into the 2011 disappearance of two human rights activists, Lalith Kumar Weeraraj and Kugan Muruganandan, who went missing during his tenure as defense secretary. Rajapaksa had filed the petition to postpone appearing as a witness in Jaffna Magistrate Court until after the November presidential election, citing threats to his personal security. Rajapaksa was elected on November 16 and cannot be prosecuted for any crime while serving his presidential term. c. Torture and Other Cruel, Inhuman, or Degrading Treatment or

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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Punishment

Interviews by human rights organizations found that torture and excessive use of force by police, particularly to extract confessions, remained endemic. The Human Rights Commission of Sri Lanka (HRCSL), for example, noted that many reports of torture referred to police officers allegedly “roughing up” suspects to extract a confession or otherwise elicit evidence to use against the accused. As in previous years, arrestees reported torture and mistreatment, forced confessions, and denial of basic rights such as access to lawyers or family members.

In October the Court of Appeal acquitted four military personal who were convicted and sentenced in 2015 to 30 years for the 2010 gang rape in Vishvamadhu. While the rape happened in 2010, the men remained free on bail and were not convicted and sentenced until 2015. The basis for the acquittal was that the accused were not properly identified by witnesses. The victim’s lawyers appealed the decision on November 20.

In November a Sri Lankan employee of the Swiss embassy in Colombo alleged that she was detained and questioned about her official duties by persons claiming to be police officers. Senior Sri Lankan government officials publicly denigrated the employee and questioned her credibility. She was subsequently arrested and accused of making false statements. She was out on bail while the matter was under investigation.

In its report to the March session of UNHRC, the Office of the High Commissioner for Human Rights (OHCHR) noted it “has continued to receive credible information about cases of abduction, unlawful detention, torture and sexual violence by security forces, which allegedly took place between 2016 and 2018.”

Prison and Detention Center Conditions

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Prison conditions were poor due to old infrastructure, overcrowding, and a shortage of sanitary facilities.

Physical Conditions: Overcrowding was a problem. The commissioner of prisons indicated that the prison population significantly exceeded the system’s capacity. Authorities sometimes held juveniles and adults together. Authorities often held pretrial detainees and convicted prisoners together. In many prisons inmates reportedly slept on concrete floors, and prisons often lacked natural light or ventilation.

A few of the larger prisons had their own hospitals, but the majority were staffed only by a medical unit. Authorities transferred prisoners requiring medical care in smaller prisons to the closest local hospital for treatment.

In January the Committee to Protect Prisoners’ Rights released videos revealing assaults by prison authorities against prisoners who protested the Angunakolapelessa Prison superintendent’s conduct in November 2018. In response the prison reforms and justice minister appointed a three-member committee to investigate, but no information had been released by year’s end by the committee.

Administration: The HRCSL investigates complaints received and refers them to the relevant authorities when warranted. The HRCSL reported it received some credible allegations of mistreatment from prisoners, but the Ministry of Prison Reforms reported it did not receive any complaints.

Independent Monitoring: The Board of Prison Visitors is the primary domestic organization conducting visits to prisoners and accepting complaints; it also has the legal mandate to examine overall conditions of detention. The Board of Prison Visitors functions as an internal governmental watchdog and was established under the Prisons Ordinance. The members are representatives of civil society otherwise unaffiliated with the government or other state institutions. The International Committee of the Red Cross (ICRC) and the HRCSL also have a mandate to monitor prison conditions, the recommendations of which police have largely respected. During the year the HRCSL undertook a National Study on Prisons and visited 20 prisons across the country. No report was available at year’s end.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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Program, which sends prisoners to rehabilitation camps in lieu of long-term confinement. d. Arbitrary Arrest or Detention

The law prohibits arbitrary arrest and detention and provides for the right of any person to challenge the lawfulness of his or her arrest or detention in court, but there were reports arbitrary arrest and detention occurred.

Arrest Procedures and Treatment of Detainees

The criminal procedure code allows police to make an arrest without a warrant for offenses such as homicide, theft, robbery, and rape. Alternatively, police may make arrests pursuant to arrest warrants that judges and magistrates issue based on evidence. The law requires authorities to inform an arrested person of the reason for the arrest and arraign that person before a magistrate within 24 hours for minor crimes, 48 hours for some grave crimes, and 72 hours for crimes covered by the PTA. More time reportedly elapsed before some detainees appeared before a magistrate, particularly in PTA cases. For bailable offenses as characterized under the Bail Act, instead of arraignment in court, police can release suspects within 24 hours of detention on a written undertaking and require them to report to court on a specified date for pretrial hearings. Suspects accused of committing bailable offenses are entitled to bail, administered by police before seeing a magistrate, but for suspects accused of nonbailable offenses, bail is awarded only after appearing before a magistrate and at the magistrate’s discretion.

Judges require approval from the Attorney General’s Department to authorize bail for persons detained under the PTA, which the office normally did not grant. In homicide cases regulations require the magistrate to remand the suspect, and only the High Court may grant bail. In all cases suspects have the right to legal representation, although no provision specifically provides the right of a suspect to legal representation during interrogations in police stations and detention centers. The government provided counsel for indigent defendants in criminal cases before the High Court and courts of appeal but not in other cases; the law requires the provision of counsel only for cases heard at the High Court and courts of appeal.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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According to police, 2,299 individuals were arrested, primarily under the PTA, in the aftermath of the Easter Sunday attacks. As of September, 293 suspects remained in custody. Nongovernmental organizations (NGOs) reported that in the aftermath of the Easter Sunday terrorist attacks, more than 1,000 citizens were arrested under the PTA and detained without access to family or counsel or an explanation of charges they faced. As of September, NGOs with access to prisoners detained under these ordinances reported that to the best of their knowledge, the vast majority of arrestees had been released. International NGOs continued to have access to the remaining April 21 attack suspects.

In a July letter to the acting inspector general of police, the HRCSL noted it had received an increased number of complaints for arbitrary arrests in the wake of the April 21 attacks, alleging detention occurred for possessing Arabic language literature or as a result of unsubstantiated rumors. The commission observed that in nearly all complaints the investigations occurred after arrest, leaving suspects detained for indefinite periods. A July review by Human Rights Watch of information provided by defense lawyers for 105 individuals detained under the PTA summarized what Human Rights Watch judged as spurious justifications given by the authorities for arrests, including: “Keeping money at home”; “Talking in playground (Breaking emergency law)”; “A post [he] had shared on social media 5 years back”; “Having English lecturer docs”; “Arabic song in Laptop”; “Traveling to Jaffna for job”; and “no reason.”

Arbitrary Arrest: As of August the National Police Commission reported 17 complaints of unlawful arrest or detention.

The HRCSL received numerous complaints of arbitrary arrest and detention through November. Police sometimes held detainees incommunicado, and lawyers had to apply for permission to meet clients, with police frequently present at such meetings. In some cases unlawful detentions reportedly included interrogations involving mistreatment or torture.

On May 17, a Muslim woman was arrested, remanded, and released on bail three weeks later by the Hasalaka Police for wearing a kurta decorated with the logo of a ship’s helm wheel, which was alleged to be a Buddhist dharma chakra. She was charged under the International Covenant on Civil and Political Rights (ICCPR) Act. Legal experts and civil society groups pointed out that the ICCPR Act has never been used to prosecute those who allegedly sought to incite hatred and communal tensions.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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Seigu Siyabdeen Mohammed Shafi, a Muslim doctor attached to the Kurunegala Teaching Hospital’s gynecology and obstetrics section who had contested the 2015 parliamentary election as a United National Party candidate, was arrested on May 24 for suspicious accumulation of wealth. Separately, the doctor came under investigation after complaints and a substantial social media campaign emerged accusing him of trying to sterilize Sinhala women during caesarian operations. During his two-month detention, he was never charged with a crime. Shafi was released on bail on July 25, after police found no evidence to substantiate any of the accusations. The hospital director, the magistrate, and the area deputy inspector of police were all under scrutiny for being involved in a possible attempt to frame the doctor, but six days after the presidential election, on November 22, key investigators in the case were transferred. Police have reopened the investigation, arguing in a December 12 hearing that the previous investigation should be invalidated due to political interference. The Kurunegela magistrate ordered an expert medical panel to review available evidence related to the sterilization claims and issue a report for the court by January 16, 2020.

Pretrial Detention: Pretrial detainees composed approximately one-half of the detainee population. The average length of time in pretrial detention was 24 hours, but inability to post bail, lengthy legal procedures, judicial inefficiency, and corruption often caused trial delays. Legal advocacy groups asserted that for those cases in which pretrial detention exceeded 24 hours, it was common for the length of pretrial detention to equal or exceed the sentence for the alleged crime.

In July Tamil prisoners across the country, including former Liberation Tigers of Tamil Elam (LTTE) fighters, and civil society groups undertook hunger strikes, demanding immediate resolution to the prisoners’ protracted detention. Many of the prisoners were held under the PTA without charge. They asked the government either to indict them or provide a pathway for their eventual release.

Detainee’s Ability to Challenge Lawfulness of Detention before a Court: Under the law a person may challenge an arrest or detention and obtain prompt release through the courts. The legal process takes years, however, and the Center for Human Rights Development indicated the perceived lack of judicial independence and minimal compensation discouraged individuals from seeking legal remedies. Under the PTA the ability to challenge detentions is particularly limited. e. Denial of Fair Public Trial

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

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The law provides for an independent judiciary, and the government generally respected judicial independence and impartiality.

Trial Procedures

The constitution and law provide for the right to a fair and public trial, and an independent judiciary generally enforced this right. The law presumes defendants are innocent until proven guilty. All criminal trials are public. Authorities inform defendants of the charges against them, and they have the right to counsel and the right to appeal. The government provided counsel for indigent persons tried on criminal charges in the High Court and the courts of appeal but not in cases before lower courts. Defendants have the right to confront witnesses against them and to present witnesses and evidence.

The law requires court proceedings and other legislation to be available in English, Sinhala, and Tamil. Most courts outside the northern and eastern parts of the country conducted business in English or Sinhala. Trials and hearings in the North and East were in Tamil and English. A shortage of court-appointed interpreters limited the right of Tamil-speaking defendants to free interpretation as necessary. In several instances, courts tried criminal cases originating in the Tamil-speaking north and east in Sinhala-speaking areas, which exacerbated the language difference and increased the difficulty in presenting witnesses who needed to travel. Few legal textbooks were available in Tamil. Defendants have the right to be present in court during trial and have the right to adequate time and facilities to prepare a defense. Defendants also have the right not to testify or admit guilt.

Political Prisoners and Detainees

Some Tamil politicians and local human rights activists referred to alleged former LTTE combatants accused of terrorism-related violent crimes as “political prisoners.” NGOs reported that more than 130 such prisoners remained in detention. The government did not acknowledge any political prisoners and claimed the prisoners in question remained detained for violent criminal acts. The government permitted access to prisoners on a regular basis by the HRCSL, magistrates, and the Board of Prison Visits, and it allowed the ICRC access to monitor prison conditions. Authorities granted irregular access to those providing local legal counsel.

Civil Judicial Procedures and Remedies

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Citizens may seek civil remedies for alleged human rights violations through domestic courts up to the Supreme Court.

Property Restitution

Land ownership disputes continued between private individuals in former war zones, and between citizens and the government.

The military seized significant amounts of land during the war to create security buffer zones around military bases and other high-value targets, known as high security zones (HSZs). According to the 1950 Land Acquisition Act, the government may acquire private property for a “public purpose,” but the law requires posting acquisition notices publicly and providing proper compensation to owners. The former government frequently posted acquisition notices for HSZ land that were inaccessible to property owners, many of whom initiated court cases, including fundamental rights cases before the Supreme Court, to challenge these acquisitions. Throughout the year lawsuits, including a 2016 Supreme Court fundamental rights case and numerous writ applications filed with high courts, remained stalled. Although HSZs had no legal framework following the lapse of emergency regulations in 2011, they still existed and remained off limits to civilians. During the year the government returned 1,308 acres of land. Since 2009 the government reported it had released more than 89,273 acres of land, representing more than 85 percent of all land occupied during the war.

With the amount of remaining land in dispute, many of those affected by the HSZs complained that the pace at which the government demilitarized land was too slow, that the military held lands it viewed as economically valuable for military benefit, and that military possession of land denied livelihood to the local population. According to the acquisition notices, while most of the land acquired was for use as army camps and bases, among the purposes listed on certain notices were the establishment of a hotel, a factory, and a farm. Some Hindu and Muslim groups reported they had difficulty officially claiming land they had long inhabited after Buddhist monks placed a statue of Buddha or a bodhi tree on their property, and described these acts as part of a ‘colonialization’ plan to dilute the concentration of minorities in the North. f. Arbitrary or Unlawful Interference with Privacy, Family, Home, or Correspondence

The PTA permits government authorities to enter homes and monitor

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SRI LANKA 11 communications without judicial or other authorization. Government authorities reportedly monitored private movements without appropriate authorization.

Security forces and police, armed with a court order, attempted to search the residence of Tamil National Alliance member of parliament S. Shritharan on August 21, a day after he criticized the appointment of Shavendra Silva as army commander. Earlier, on May 18, four soldiers and a police officer searched Shritharan’s residence in Jaffna, while he was taking part in the commemoration of war victims in Kilinochchi.

Section 2. Respect for Civil Liberties, Including: a. Freedom of Expression, Including for the Press

The constitution provides for freedom of expression, including for the press, and the government generally respected this right. An independent press, an effective judiciary, and a functioning democratic political system combined to promote freedom of expression, including for the press. According to UN and civil society reports, intelligence operatives conducted domestic surveillance operations and harassed or intimidated members of civil society. During the emergency, following the April 21 attacks, the government banned face coverings such as the burqa, niqab, and full-face helmets, citing national security and public safety concerns. The ban on face coverings was briefly lifted when the emergency regulation lapsed; however, in late August, the cabinet passed legislation permanently banning the burqa, the niqab, and similar face coverings, after consultation with the Muslim community.

Freedom of Expression: Authorities restricted hate speech, including insult to religion or religious beliefs through the police ordinance and penal code. The government requested media stations and outlets to refrain from featuring hate speech in their news items and segments.

In April Kurunegala police arrested Shakthika Sathkumara, a 33-year-old novelist, under the ICCPR law. His short story, “Ardha,” which reportedly dealt with homosexuality and child sexual abuse in a Buddhist monastery, angered members of the country’s Buddhist clergy. He was released on bail in August after being remanded for four months. On July 29, Amnesty International declared Sathkumara a prisoner of conscience. At his criminal hearing on December 10, the court granted the government’s request for a continuance in the case until May 2020. His fundamental rights petition challenging the constitutionality of his arrest

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SRI LANKA 12 was continued until June 2020.

Press and Media, Including Online Media: Independent media were active and expressed a wide variety of views. Journalists in the Tamil-majority North and East, however, reported harassment, intimidation, and interference from the security sector when reporting on sensitive issues related to the civil war or its aftermath. They reported the military contacted them to request copies of photographs, lists of attendees at events, and names of sources from articles. They also reported the military directly requested that journalists refrain from reporting on sensitive events, such as Tamil war memorials or land occupation protests, and that they feared repercussions if they did not cooperate.

In May, after communal violence following the Easter Sunday attacks of April 21, the HRCSL issued guidelines that called for all electronic media institutions to exercise sensitivity when broadcasting news due to concerns over the Muslim community being unreasonably subject to unsubstantiated suspicion and disrespect.

On September 9, then president Sirisena brought the state television Sri Lanka Rupavahini Corporation under the purview of the Ministry of Defense. The Working Journalists Association of Sri Lanka and the Free Media Movement strongly condemned the decision. Two fundamental rights petitions, one filed by a civil society activist and one filed by a member of parliament, were pending before the Supreme Court.

Violence and Harassment: There were reports of harassment and intimidation of journalists when covering sensitive issues.

On April 20, police arrested and released on bail Shanmugam Thavaseelan, a correspondent of the English-language online newspaper the Tamil Guardian, following a complaint filed by the navy stating the journalist, who was covering a disappearances protest, assaulted and caused injury to a navy officer attached to the ‘Gotabaya’ Camp in Mullaitivu. Charges reportedly were that he had threatened and photographed protesters at an earlier disappearances rally.

Reporters Without Borders (RSF), in a June statement, expressed alarm over a resurgence in police attacks on Tamil journalists and urged authorities to ensure that police cease the harassment of reporters. On May 27, Tamil daily Virakesari journalist Kanapathipillai Kumanan, who was covering a dispute between Hindu and Buddhist temples, was physically assaulted and verbally abused by the officer in charge of the Kokkilai police station. According to RSF, the May 27 violence

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SRI LANKA 13 against the reporter was the third reported attack on a journalist of Tamil origin during the year.

Internet Freedom

There were no credible reports that the government monitored private online communications without appropriate legal authority. The government placed limited restrictions on websites it deemed pornographic. In the aftermath of the Easter Sunday attacks, the government imposed a temporary ban on several social media platforms, including Facebook, WhatsApp, and Instagram. The nine-day ban on social media was briefly reimposed May 13 after anti-Muslim riots.

Academic Freedom and Cultural Events

State university officials allegedly attempted to prevent professors and university students from criticizing government officials. The government interfered with university appointments and credentialing of individuals based on legal activities and political expression.

On November 9, the Jaffna University leadership endorsed the September 27 decision of the University Grants Commission of Sri Lanka (UGC) to debar K. Guruparan, the head of the Department of Law, from legal practice. Leaked letters from the Ministry of Defense to the UGC showed that Guruparan was debarred for pursuing habeas corpus cases filed in 2017 by three families regarding the disappearance of 26 youths in Jaffna allegedly involving the military. Plainclothes military intelligence personnel travelling with Attorney General Department representatives threatened the lawyers and families outside of the court.

In May the UGC removed the university’s vice chancellor, Jaffna Ratnam Wigneswaran, without cause or an inquiry. An affidavit in response to a fundamental rights petition filed by the chairman of the UGC at the Supreme Court showed that the removal was due to a complaint from the Directorate of Military Intelligence of the Army regarding Wigneswaran’s participation in an event called Thamil Amutham, where a reconstructed memorial monument carrying Tamil

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SRI LANKA 14 nationalist proclamations was unveiled within the university premises. b. Freedoms of Peaceful Assembly and Association

The law provides for the freedoms of peaceful assembly and association. The government restricted these rights in a limited number of cases.

At the conclusion of his visit to the country in July, UN Special Rapporteur on the Rights of Freedom of Association and Peaceful Assembly Clement Nyaletsossi Voule observed that authorities applied laws in discriminatory ways, with Tamil protests and gatherings in the North and East disproportionately facing crackdowns. Although he noted that the country had a comprehensive legal framework governing the right to freedom of peaceful assembly, it was “scattered in different sets of laws and regulations which seem to be interchangeably enforced.”

Freedom of Peaceful Assembly

The law provides for freedom of peaceful assembly, and the government generally respected this right. The constitution stipulates that the freedom of assembly may be restricted in the interest of religious harmony, national security, public order, or the protection of public health or morality. It also may be restricted in the interest of securing due recognition and respect for the rights and freedoms of others, or in the interest of meeting the just requirements of the general welfare of a democratic society. Under Police Ordinance Article 77(1), protesters must seek permission from the local police before holding a protest. The emergency regulations in force from April 22 to August 23, following the Easter Sunday attacks, granted the security services extensive powers to detain and question suspects without court orders for up to 90 days. Under the emergency, the government instituted nighttime curfews and curtailed freedom of movement, and it permitted the president to ban public assembly.

Freedom of Association

The law provides for freedom of association but criminalizes association with or membership in banned organizations. Christian groups and churches reported that some authorities classified worship activities as “unauthorized gatherings” and pressured them to end these activities. According to the groups, authorities sometimes justified their actions, stating the groups were not registered with the government, although no law or regulation specifically requires such registration.

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c. Freedom of Religion

See the Department of State’s International Religious Freedom Report at https://www.state.gov/religiousfreedomreport/. d. Freedom of Movement

The law provides for freedom of internal movement, foreign travel, emigration, and repatriation, and the government generally respected these rights. The government cooperated with the Office of the UN High Commissioner for Refugees (UNHCR) and other humanitarian organizations in providing protection and assistance to internally displaced persons (IDPs), refugees, returning refugees, stateless persons, or other persons of concern. e. Internally Displaced Persons

The country’s civil war, which ended in 2009, caused widespread, prolonged displacement, including forced displacement by the government and the LTTE, particularly of Tamil civilians. According to the Ministry of National Policies, Economic Affairs, Resettlement and Rehabilitation, Northern Province Development and Youth Affairs, 25,889 citizens remained IDPs as of August 31. The large majority resided in Jaffna, Kilinochchi, Mannar, and Batticaloa Districts in the North and East. While all IDPs had full freedom of movement, most were unable to return home due to: land mines; restrictions designating their home areas as part of HSZs; lack of work opportunities; inability to access basic public services, including acquiring documents verifying land ownership; and lack of government resolution of competing land ownership claims; and other war-related reasons. The government did not provide protection and assistance to these IDPs in welfare camps.

The government promoted the return and resettlement of IDPs by returning approximately 8,000 acres of military-seized land since 2015 and making additional state land available for landless IDPs. The military and other government agencies supported the resettlement of IDPs by constructing houses, schools, toilets, and providing other social services on newly released lands. f. Protection of Refugees

Abuse of Migrants, Refugees, and Stateless Persons: The government cooperated

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SRI LANKA 16 with UNHCR and other humanitarian organizations in providing protection and assistance to IDPs, refugees, returning refugees, and asylum seekers.

After the April 21 attacks, more than 1,600 Muslim and Christian refugees were forced to leave their homes in the wake of retaliatory attacks and seek protection in three welfare centers in Negombo and Pasyala. Local community members threatened to destroy the houses of Pakistani, Afghan, and Iranian refugees. The government, police, and security forces assisted UNHCR to ensure the protection of refugees. In the months following the April 21 attacks, most refugees who were not resettled outside of the country had returned to their rented residences.

Access to Asylum: The law does not provide for the granting of asylum or refugee status. A 2005 Memorandum of Understanding allows UNHCR to operate in the country to conduct refugee registration and status determinations. UNHCR also facilitates durable solutions for refugees, in the form of resettlement to third countries. The government relied on UNHCR to provide food, housing, and education for refugees in the country and to pursue third-country resettlement for them. Asylum seekers, on the other hand, had to rely on the support of NGOs for basic needs.

Access to Basic Services: The law does not permit refugees and asylum seekers to work or enroll in the government school system, but many worked informally. Refugees and asylum seekers registered with UNHCR have access to free health care in state hospitals. g. Stateless Persons

Not applicable.

Section 3. Freedom to Participate in the Political Process

The constitution provides citizens the ability to choose their government in free and fair periodic elections held by secret ballot and based on universal and equal suffrage.

Elections and Political Participation

Recent Elections: Domestic and international observers concurred that the 2019 presidential election was technically well managed, with few reports of violence. Observers pointed out, however, that unregulated campaign spending, abuse of

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SRI LANKA 17 state resources, and media bias affected the level playing field. Commonwealth observers commended the country on a largely peaceful, credible, and orderly election, but they expressed concern that some groups experienced fear and intimidation. Both local and international observers reported several dozen incidents of postelection violence, particularly targeting minority groups.

Political Parties and Political Participation: According to foreign election observers, although the election was free and fair, media institutions were biased towards the two leading candidates, and political parties used social media platforms to spread disinformation and hate speech. The EU election observation mission’s preliminary findings stated: “The presidential election was largely free of violence and technically well-managed, but unregulated campaign spending, abuse of state resources and media bias affected the level playing field.” According to the Asian Network for Free Elections (ANFREL), more than 1.2 million migrant workers were not able to exercise their franchise due to the requirement that they return to their home voting districts to vote. ANFREL reported accessibility challenges to 1.3 million persons with disability, especially wheelchair-bound and elderly voters at polling centers.

Participation of Women and Minorities: No laws limit participation of women or members of minorities in the political process, and they did participate. The HRCSL wrote to the election commission on November 8 raising concerns over the disenfranchisement of 8,000 bhikkhunis (female Buddhist priests) due to procedural issues preventing the issuance of national identity cards to them. The HRCSL noted that the Department of Registration of Persons does not recognize bhikkhuni as a profession for the purpose of national identity cards.

Section 4. Corruption and Lack of Transparency in Government

The law provides criminal penalties for corruption by officials, but the government did not implement the law effectively, and officials often engaged in corrupt practices with impunity. There were numerous reports of government corruption during the year.

Corruption: Corruption remained a significant and continuing problem. International companies frequently reported requests for bribes on issues ranging from customs clearances to government procurement. As of November the Commission to Investigate Allegations of Bribery or Corruption arrested 42 individuals on suspicion of providing and accepting bribes during the course of the year.

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Financial Disclosure: The law requires all candidates for parliamentary, local government, provincial, and presidential elections to declare their assets and liabilities to the speaker of parliament. Some but not all candidates in parliamentary elections submitted their financial reports to the speaker, but authorities did not enforce compliance. By law members of the public may access records relating to the assets and liabilities of elected officials by paying a fee.

Section 5. Governmental Attitude Regarding International and Nongovernmental Investigation of Alleged Abuses of Human Rights

A number of domestic and international human rights groups generally operated without government restriction, investigating and publishing their findings on human rights cases. Government officials somewhat were cooperative and responsive to their views.

The United Nations and Other International Bodies: UNHRC continued to have a country-specific resolution related to addressing justice, accountability, and reconciliation in the country. In March UNHRC adopted a resolution granting two additional years to the country to fulfil its commitments to reconciliation and transitional justice.

At the 42nd session of UNHRC in September, the core group expressed concern that the country had made “slow” progress on accountability, calling on UNHRC and the international community “to give the necessary attention and support to Sri Lanka.” Despite the country’s cosponsorship of the 2015, 2017, and 2019 resolutions, senior government officials continued to make public statements attacking the UN process and asserting they would not take any steps to hold “war heroes” accountable, despite their commitment to initiate a criminal justice process, with international participation, to address war-time abuses.

On September 25, the UN Department of Peace Operations banned deployment of nonessential Sri Lankan army troops in UN peacekeeping missions in response to the appointment of Shavendra Silva as army commander. The United Nations also decided to repatriate Sri Lankan Army units and individual officers serving with peacekeeping missions beginning in October. It suspended future Sri Lankan army deployments except where suspension would expose UN operations to serious operational risk. Nonetheless, on November 13, a new contingent of 243 army personnel of the Combat Convoy Company were deployed to Mali to serve in the UN Multidimensional Integrated Stabilization Mission.

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Government Human Rights Bodies: The HRCSL has jurisdiction to investigate human rights violations. The HRCSL consists of five commissioners and has divisions for investigations, education, monitoring and review, and administration and finance. There are 10 regional offices across the country. The HRCSL accepts complaints from the public and may also self-initiate investigations. After an allegation is proven to the satisfaction of the commission, the HRCSL may recommend financial compensation for victims, refer the case for administrative disciplinary action or to the attorney general for prosecution, or both. If the government does not follow an HRCSL request for evidence, the HRCSL may summon witnesses from the government to explain its action. If the HRCSL finds the government has not complied with its request, the HRCSL may refer the case to the High Court for prosecution for contempt by the Attorney General’s Department, an offense punishable by imprisonment or fine. By statute the HRCSL has wide powers and resources and may not be called as a witness in any court of law or be sued for matters relating to its official duties. The HRCSL generally operated independent of and with lack of interference from the government.

The HRCSL was also responsible for vetting of the country’s peacekeepers. The memorandum of understanding between the United Nations, HRCSL, Ministry of Defense, and Ministry of Law and Order for the vetting of military and police participants in peacekeeping operations was finalized in December 2018. As of August 2019, the vetting process was carried out by the HRCSL.

In April the government appointed five commissioners to the Office for Reparations, an independent authority created by the Office for Reparations Act passed in October 2018. The office is mandated to identify aggrieved victims qualified for reparations and provide appropriate compensation individually or collectively.

Section 6. Discrimination, Societal Abuses, and Trafficking in Persons

Women

Rape and Domestic Violence: The law prohibits rape and domestic violence, but enforcement of the law was inconsistent. Section 363 of the penal code does not explicitly criminalize rape of men. Section 365 B (1), which is gender neutral, criminalizes “grave sexual abuse.” The prescribed penalties for rape are seven to 20 years’ imprisonment and a fine of at least 200,000 Rs ($1,160). For domestic

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SRI LANKA 20 violence, a victim can obtain a protection order for one year and request a maintenance allowance. The law prohibits spousal rape only if the spouses are legally separated.

Women’s organizations reported police and judiciary responses to rape and domestic violence incidents and cases were inadequate. The police Bureau for the Prevention of Abuse of Women and Children conducted awareness programs in schools and at the grassroots level to encourage women to file complaints. Police continued to establish women’s units in police stations. Services to assist survivors of rape and domestic violence, such as crisis centers, legal aid, and counseling, were generally scarce nationwide due to a lack of funding.

Female Genital Mutilation/Cutting (FGM/C): Some of the country’s Muslims historically practiced FGM/C, but it was not a part of public discourse until recent years when media articles drew attention to the practice. There were no statistics on the current prevalence of FGM/C in the country, which does not have laws against FGM/C. In May 2018 the director general of health services from the Ministry of Health issued a circular prohibiting medical practitioners from carrying out FGM, but FGM/C itself is not criminalized. Several civil society groups led mostly by Muslim women continued to campaign against FGM/C.

Sexual Harassment: Sexual harassment is a criminal offense carrying a maximum sentence of five years in prison. Sexual harassment was common and was a particularly widespread problem in public transport.

Coercion in Population Control: There were no credible reports of coerced abortion or involuntary sterilization.

Discrimination: Women have equal rights to men under civil and criminal law. Adjudication of questions related to family law, including marriage, divorce, child custody, and inheritance, varied according to the customary law of each ethnic or religious group, resulting in discrimination.

Children

Birth Registration: Children obtain citizenship from their parents.

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SRI LANKA 21 schools. There was also growing public concern about the high incidence of violence, including sexual violence, against children in the family and community. Despite successful efforts to reform the penal code, the basic criminal law, and other laws on child abuse, cruelty to children and their exploitation in trafficking, and child labor persisted. Penalties vary based on the type and degree of child abuse, but trials tended to drag on for years.

Most child abuse complaints received by the National Child Protection Authority (NCPA), usually via a toll free 24-hour hotline, related to violence inflicted on children, and the rest of the complaints addressed related issues such as cruelty to children, deprivation of a child’s right to education, sexual abuse, and child labor. Teachers, school principals, and religious instructors reportedly sexually abused children. In a number of child rape cases, government officials were the suspected perpetrators. Civil society organizations working on children’s issues asserted children had insufficient mechanisms to report domestic violence or abuse safely. Although police stations are supposed to have an officer dedicated to handling abuse complaints from women and children, the government did not consistently implement this practice nationwide. Although the police Children and Women Bureau plays a major role in investigating abuse cases, depending on the severity of the case, some fall under the jurisdiction of the magistrates’ courts as outlined in the criminal procedure code. In these instances police file a formal complaint sheet and begin a judicial medical process. The attorney general files indictments for child abuse cases exclusively in high courts.

The NCPA’s founding chairman, Harendra de Silva, said the organization failed at its core mandate due to increasing politicization in recent years. He stated the thousands of child abuse cases that were pending in courts and other state institutions, including the NCPA, signaled a “trend of corruption.” According to the NCPA, at least 9,000 complaints are filed annually on various forms of abuse, including cruelty to children, sexual harassment, rape, grave sexual abuse, child labor and trafficking. The NCPA began awareness programs during the year, such as Jana Paura or “people’s shield”, to educate the public on child protection and children’s rights. The Attorney General’s Department reported that, from January to July 31, some 3,113 child abuse cases were concluded where 1,881 indictments were served in high courts; advice was sought on 399 cases; and 833 cases were discharged.

On June 12, the Supreme Court ruled that Chief Inspector Waruni Bogahawatta of the Matara police station, an award-winning female police officer, was responsible for a minor girl’s unlawful arrest and deprivation of her liberty. The officer

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SRI LANKA 22 allegedly detained her without justification and subjected her to degrading treatment while she questioned the child in a bid to frame a local politician for rape. The Supreme Court also ordered Bogahawatta to pay approximately 98,600 Rs ($570), and the state to pay approximately 49,300 Rs ($285), as compensation to the victim.

Early and Forced Marriage: Civil law sets the minimum legal age for marriage at 18 for both men and women, although girls may marry at age 16 with parental consent. According to the penal code, sexual intercourse with a girl younger than 16 years, with or without her consent, amounts to statutory rape. The provision, however, does not apply to married Muslim girls older than 12. The Muslim Marriage and Divorce Act, which applies only to Muslims, permits the marriage of girls as young as 12 at the consent of the bride’s father, other male relative, or a quazi (a judge who interprets and administers Islamic law).

Sexual Exploitation of Children: The law prohibits the commercial sexual exploitation of children, the sale of children, offering or procuring a child for child prostitution, and practices related to child pornography, but authorities did not always enforce the law. The minimum age of consensual sex is 16.

In June UN-appointed independent rights experts said the scale of the country’s child sex tourism industry has reached such worrying proportions that the authorities should act immediately. The UN Committee on the Rights of the Child said that the scourge was “very widespread,” particularly in the North of the country.

Displaced Children: IDP welfare centers and relocation sites exposed children to the same difficult conditions as adult IDPs and returnees in these areas.

International Child Abductions: The country is a party to the 1980 Hague Convention on the Civil Aspects of International Child Abduction. See the Department of State’s Annual Report on Parental Child Abduction at https://travel.state.gov/content/travel/en/International-Parental-Child- Abduction/for-providers/legal-reports-and-data/reported-cases.html.

Anti-Semitism

The Jewish population is very small. There were no reports of anti-Semitic acts.

Trafficking in Persons

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See the Department of State’s Trafficking in Persons Report at https://www.state.gov/trafficking-in-persons-report/.

Persons with Disabilities

Various laws forbid discrimination against any person with physical, sensory, intellectual, or mental disabilities in employment, education, air travel, other public transportation, and access to health care. In practice, however, discrimination occurred in employment, education, and provision of state services, including public transportation. Children with disabilities attended school at a lower rate than other persons. There were regulations on accessibility, but accommodation for access to buildings and public transportation for persons with disabilities was rare. Observers of the November presidential election noted process improvements were needed to ensure participation of persons with disabilities in future elections.

National/Racial/Ethnic Minorities

Both local and Indian-origin Tamils maintained that they suffered longstanding, systematic discrimination in university education, government employment, housing, health services, language laws, and procedures for naturalization of noncitizens. Throughout the country, but especially in the North and East, Tamils reported security forces regularly monitored and harassed members of their community, especially activists, journalists, and former or suspected former LTTE members.

The government had a variety of ministries and presidentially appointed bodies designed to address the social and development needs of the Tamil minority. The government implemented a number of confidence-building measures to address grievances of the Tamil community. The Office of National Unity and Reconciliation, established in 2016, continued to coordinate the government’s reconciliation efforts. The office focuses on promoting social integration to build an inclusive society, securing language rights for all citizens, supporting a healing process within war-affected communities via the government’s proposed Commission for Truth, Justice, Reconciliation, and nonrecurrence of the violence. The Tamil National Alliance and Defense Ministry continued to meet in accordance with a formal dialogue on returning military-held lands in the Northern and Eastern Provinces inaugurated in 2017.

On August 29, then president Sirisena, in his capacity as minister of defense,

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SRI LANKA 24 directed officials to estimate the extent of lands under occupation and release them appropriately with the consultation of the security forces and to submit a report before October 1 to the governor of the Northern Province. The submission was pending at year’s end.

On November 16, three buses carrying Muslim voters from Puttalam to Mannar were reportedly stopped in Thanthirimale by Sri Lanka Podujana Peramuna (SLPP) supporters. The SLPP supporters burned tires and threw rocks, eventually hitting one of the buses and breaking a window. At least one shot was reportedly fired, but no one was injured.

In May extremist groups led by Buddhist monks and politicians attacked and vandalized mosques, Muslim-owned businesses and homes in Kurunegala, Gampaha, and the Puttalam Districts, resulting in one death and extensive property damage. In Negombo and Chilaw, police initially were slow to respond or stop perpetrators from damaging Muslim buildings and assaulting Muslim individuals resulting in the death of a Muslim citizen and damage to Muslim-owned businesses. Buddhist monks also used hate speech on social media in the aftermath of the Easter Sunday attacks; a chief prelate of the Asgiriya chapter stated, “Don’t eat or drink from Muslim shops. Traitors who have destroyed this country shouldn’t be allowed to live in peace”.

Indigenous People

The country’s indigenous people, known as Veddas, reportedly numbered fewer than 1,000. Some preferred to maintain their traditional way of life, and the law generally protected them. They freely participated in political and economic life without legal restrictions, but some did not have legal documents.

Acts of Violence, Discrimination, and Other Abuses Based on Sexual Orientation and Gender Identity

The law criminalizes consensual same-sex sexual conduct between adults. Those convicted of engaging in same-sex sexual activity in private or in public face 10 years’ imprisonment. Although prosecutions were rare, human rights organizations reported police used the threat of arrest to assault, harass, and sexually and monetarily extort LGBTI individuals. Antidiscrimination laws do not prohibit discrimination based on sexual orientation and gender identity.

Transgender persons continued to face societal discrimination, including arbitrary

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SRI LANKA 25 detention, mistreatment, and discrimination accessing employment, housing, and health care.

HIV and AIDS Social Stigma

Persons who provided HIV prevention services and groups at high risk of infection reportedly suffered discrimination. In addition, hospital officials reportedly publicized the HIV-positive status of their patients and occasionally refused to provide health care to HIV-positive persons.

Section 7. Worker Rights a. Freedom of Association and the Right to Collective Bargaining

The law provides for the right of workers to form and join unions of their choice. Exceptions include members of the armed forces, police officers, judicial officers, and prison officers. Workers in nonessential services industries, except for workers in public-service unions, have the legal right to bargain collectively. The law does not explicitly recognize the right to strike, but courts have recognized an implied right to strike based on the Trade Unions Ordinance and the Industrial Disputes Act. Nonunion worker councils tended to represent labor in export processing zone (EPZ) enterprises, although several unions operated in the zones. According to the Board of Investment, which operates the EPZs, if both a recognized trade union with bargaining power and a nonunion worker council exist in an enterprise, the trade union would have the power to represent the employees in collective bargaining.

Under Emergency Regulations of the Public Security Ordinance, the president has broad discretion to declare sectors “essential” to national security, the life of the community, or the preservation of public order and to revoke those workers’ rights to conduct legal strikes. In addition to the Public Security Ordinance, the Essential Public Services Act of 1979 allows the president to declare services provided by government agencies as “essential” public services. In 2018 and also during the year, the government used the essential public-services act to declare the Sri Lankan Railway and petroleum sector as essential sectors in attempts to force striking union members back to work.

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SRI LANKA 26 before the law obligates the employer to bargain with the union. The law does not permit public-sector unions to form federations or represent workers from more than one branch or department of government. The Labor Ministry may cancel a union’s registration if it fails to submit an annual report for three years.

The law prohibits antiunion discrimination. Labor laws do not cover domestic workers employed in the homes of others or informal-sector workers.

The law allows unions to conduct their activities without interference, but the government enforced the law unevenly. Violations for antiunion discrimination may result in a fine of 100,000 Rs ($578). The law requires an employer found guilty of antiunion discrimination to reinstate workers fired for union activities, but it may transfer them to different locations. In general these penalties were insufficient to deter violations. Only the Labor Ministry has legal standing to pursue an unfair labor practice case, including for antiunion discrimination.

Since 1999 the Labor Ministry has filed 14 cases against companies for unfair labor practices under the Industrial Disputes Act. The ministry did not file any new unfair labor practices cases during the year. The courts issued rulings on four cases and continued to try the other five; three cases have not been filed due to inadequate evidence. Citing routine government inaction on alleged violations of labor rights, some unions pressed for standing to sue, while some smaller unions did not want that ability because of the cost of filing cases. Workers brought some labor violations to court under the Termination of Employment and Workmen Act and the Payment of Gratuity Act. Lengthy delays hindered judicial procedures. The Industrial Dispute Act does not apply to the public sector, and public-sector unions had no formal dispute resolution mechanism.

The government generally respected the freedom of association and the right to bargain collectively. Public-sector unions staged numerous work stoppages on a number of issues, ranging from government moves to privatize state-owned enterprises to wage issues.

While some unions in the public sector were politically independent, most large unions affiliated with political parties and played a prominent role in the political process.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

SRI LANKA 27

Labor requires labor commissioners to hold union certification elections within 30 working days of an application for registration if there was no objection or within 45 working days if there was an objection. The commissioner general of labor held five union certification elections in 2017. No union certification elections were held in 2018 and from January to September 2019. b. Prohibition of Forced or Compulsory Labor

The law prohibits all forms of forced and compulsory labor, but penalties were insufficient to deter violations. The government did not effectively enforce the laws due to inadequate resources, inspections, and remediation efforts, as well as a lack of identification of forced labor cases. Labor Ministry inspections did not extend to domestic workers. The government sporadically prosecuted labor agents who fraudulently recruited migrant workers yet appeared to sustain its monthly meetings to improve interministerial coordination.

Children between the ages of 14 and 18 and women working as live-in domestic workers in some homes were vulnerable to forced labor (see section 7.c.).

Also see the Department of State’s Trafficking in Persons Report at https://www.state.gov/trafficking-in-persons-report/. c. Prohibition of Child Labor and Minimum Age for Employment

The minimum age for employment is 14, although the law permits the employment of younger children by their parents or guardians in limited family agricultural work or technical training. The government increased the compulsory age of education from 14 years to 16 years in 2016. The law prohibits hazardous work for persons younger than 18. The law limits the working hours of children ages 14 and 15 to nine hours per day and of ages 16 and 17 to 10 hours per day. The government estimated less than 1 percent of children--approximately 40,000--were working, although employment was often in hazardous occupations. The government currently classifies 51 activities as hazardous.

The government did not effectively enforce all laws, and existing penalties were not sufficient to deter violations.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

SRI LANKA 28 guidelines for district officials. The Department of Labor continued its efforts to monitor workplaces on the list of hazardous work for children.

According to the Child Activity Survey of 2016 published in February, children worked in the construction, manufacturing, mining, and fishing industries and as cleaners and helpers, domestic workers, and street vendors. Children also worked in agriculture during harvest periods. Children displaced by the war were especially vulnerable to employment in hazardous labor.

The list of hazardous work prohibited for children younger than 18 does not include domestic labor. This left children employed as child domestic workers vulnerable to physical, sexual, and emotional abuse. Family enterprises, such as family farms, crafts, small trade establishments, restaurants, and repair shops, commonly employed children. Criminals reportedly exploited children, especially boys, for prostitution in coastal areas catering to sex tourists (see section 6, Children).

Also see the Department of Labor’s Findings on the Worst Forms of Child Labor at https://www.dol.gov/agencies/ilab/resources/reports/child-labor/findings. d. Discrimination with Respect to Employment and Occupation

The constitution prohibits discrimination, including with respect to employment and occupation, on the basis of race, religion, language, caste, sex, political opinion, or place of birth. The law does not prohibit employment or occupational discrimination on the basis of color, sexual orientation or gender identity, age, HIV-positive status, or status with regard to other communicable diseases. The government has proposed reforms to existing labor legislation that would more explicitly prohibit discrimination based on gender and other categories. Women have a wide range of workforce restrictions, including caps on overtime work and limits on nighttime shifts.

The government did not always effectively enforce these laws, and discrimination based on the above categories occurred with respect to employment and occupation. For example, some employers specified particular positions as requiring male or female applicants, and women often earned less than men for equal work. e. Acceptable Conditions of Work

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SRI LANKA 29

The parliament passed its first-ever national minimum wage law in 2015 and the government issued a Gazette notice on October 18, increasing the minimum monthly wage for private-sector workers by 25 percent. The changes increase the minimum wage increase from Rs 10,000 ($54.90 per month or $1.83 per day) to Rs 12,500 ($68.30 per month or $2.27 per day). The Department of Labor’s 44 wage boards continued to set minimum wages and working conditions by sector and industry in consultation with unions and employers. On September 24, the Cabinet of Ministers approved salary increases for all government employees effective January 1, 2020. The minimum private-sector and public-sector wages are well above the government’s official poverty line, which was Rs 4,166 ($22.98) in 2016.

The law prohibits most full-time workers from regularly working more than 45 hours per week (a five-and-a-half-day workweek). In addition, the law stipulates a rest period of one hour per day. Regulations limit the maximum overtime hours to 15 per week. Overtime pay is 1.5 times the basic wage and is paid for work beyond 45 hours per week and work on Sundays or holidays. The provision limiting basic work hours is not applicable to managers and executives in public institutions. The law provides for paid annual holidays.

The government sets occupational health and safety standards. Workers have the right to remove themselves from dangerous situations, but many workers had no knowledge of such rights or feared that they would lose their jobs if they did so.

Authorities did not effectively enforce minimum wage, hours of work, and occupational safety and health standards in all sectors. The Labor Ministry’s resources, inspections, and remediation efforts were insufficient. The number of labor inspectors was insufficient for the size of the country’s workforce. Occupational health and safety standards in the rapidly growing construction sector, including on infrastructure development projects, such as port, airport, and road construction, as well as high-rise buildings, were insufficient. Employers, particularly those in the construction industry, increasingly used contract employment for work of a regular nature, and contract workers had fewer safeguards.

Labor Ministry inspectors verified whether employers fully paid employees and contributed to pension funds as required by law. Unions questioned, however, whether the ministry’s inspections were effective. The Labor Department used a computerized Labor Information System Application designed to improve the efficiency and effectiveness of inspections, but officials and trade unions noted

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

SRI LANKA 30 concerns that the system was not well maintained.

Enforcement of labor laws and basic work conditions was also insufficient. Under the Shop and Office Act, the penalties for violating hours of work laws are a fine of 500 Rs ($2.89), six months’ imprisonment, or both. The law charges a fine of 50 Rs ($0.29) per day if the offense continues after conviction. These penalties were insufficient to deter violations. Labor inspectors did not monitor wages or working conditions or provide programs or social protections for informal sector workers. In September amendments to the factories ordinance and the wages board ordinance increased fines for nonpayment of salaries to workers under the purview of the wages board between Rs.5,000 ($27) to Rs.10,000 ($55), along with an imprisonment not exceeding one year.

Country Reports on Human Rights Practices for 2019 United States Department of State • Bureau of Democracy, Human Rights and Labor

TAB 2

SRI LANKA 2018 HUMAN RIGHTS REPORT

EXECUTIVE SUMMARY

Sri Lanka is a constitutional, multiparty democratic republic with a freely elected government. In January 2015 voters elected President Maithripala Sirisena to a five-year term. The parliament shares power with the president. August 2015 parliamentary elections resulted in a coalition government between the two major political parties with Ranil Wickremesinghe as the prime minister. Both elections were free and fair.

Civilian authorities generally maintained control over the security forces.

On October 26, President Sirisena announced the removal of Prime Minister Wickremesinghe and the appointment of former president Mahinda Rajapaksa as prime minister and subsequently announced the dissolution of parliament. Prime Minister Wickremesinghe and others challenged both actions as unconstitutional. On December 13, the Supreme Court ruled that Sirisena's decision to dissolve parliament was unconstitutional. Following the ruling, Rajapaksa resigned and Sirisena reinstated Wickremesinghe as prime minister on December 16.

Human rights issues included unlawful killings; torture, notably sexual abuse; arbitrary detention by government forces; website blocking; violence against lesbian, gay bisexual, transgender, and intersex (LGBTI) persons and criminalization of same-sex sexual activity; and corruption. Although same-sex sexual conduct was prohibited by law, it was rarely prosecuted.

Police reportedly harassed civilians with impunity, and the government had yet to implement a mechanism to hold accountable government security personnel accused of crimes during the civil war. During the year, however, the government took steps to investigate, prosecute, and punish some officials who committed human rights abuses.

Section 1. Respect for the Integrity of the Person, Including Freedom from: a. Arbitrary Deprivation of Life and Other Unlawful or Politically Motivated Killings

There were reports that the government or its agents committed arbitrary or unlawful killings. 2

On January 20, police reportedly shot and killed a motorcyclist who disobeyed orders to stop his motorcycle at the Wedihiti Kanda checkpoint in Kataragama.

The Criminal Investigation Division (CID) continued to investigate an October 2017 case in which two plainclothes members of the Police Special Task Force shot and killed a man on a motorcycle in Ariyalai in the Jaffna District. In November 2017 the CID arrested the two officers, who remained incarcerated pending a hearing scheduled for February 2019.

Police continued to investigate an October 2016 case in which police shot and killed two Jaffna University students after they failed to obey orders to stop their motorbike at a checkpoint. The following day authorities arrested five police officers in connection with the shooting. In March, after 11 months of detention, all five officers were reinstated into police service, pending the outcome of their trial. In October the Jaffna Magistrate Court exonerated three of the accused officers and filed new indictments against two others.

The investigation into the 2009 killing of prominent journalist and politician Lasantha Wickrematunge, chief editor of the newspaper Sunday Leader, continued. In February police arrested five high-ranking former security officers from the Mt. Lavinia police station, including the deputy inspector general and the officer in charge, after charging them with obstruction related to the investigation. The officers were detained until July 17, when they were released on bail pending the outcome of the investigation.

The Attorney General’s Department appealed the acquittal of five suspects accused of killing former Tamil National Alliance parliamentarian Nadarjah Raviraj; the Court of Appeal was scheduled to hear the appeal in January 2019. b. Disappearance

Disappearances during the war and its aftermath remained unresolved. The July 2017 report of the UN Working Group on Enforced or Involuntary Disappearances noted the number of outstanding cases of enforced or involuntary disappearances at 5,859. On February 28, the government appointed seven commissioners to the Office on Missing Persons. The office met members of the public and family members of missing persons in Mannar, Jaffna, Kilinochchi, Trincomalee, Matara, and Colombo. In August it issued an interim report that provided a series of interim relief proposals and justice-related recommendations for families and

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 3 victims of disappearances. At year’s end the office was finalizing a list of approximately 20,000 names of missing persons dating from 1983.

In the case of Prageeth Eknaligoda, a journalist and cartoonist for Lanka eNews who disappeared in 2010, authorities had not charged any suspects as of year’s end. c. Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment

The constitution and law prohibit such practices, but authorities reportedly employed them. The law makes torture a punishable offense and mandates a sentence of not less than seven years’ and not more than 10 years’ imprisonment. The government maintained a Committee on the Prevention of Torture to visit sites of allegations, examine evidence, and take preventive measures on allegations of torture. Police reportedly tortured and sexually abused citizens, often to extract confessions for alleged crimes. The Prevention of Terrorism Act (PTA) allows courts to admit as evidence any statements made by the accused at any time and provides no exception for confessions extracted by torture. In February 2017 the government announced it suspended making arrests under the PTA due to widespread concerns about several of its provisions; however, the government made at least four arrests under the PTA during the year. An estimated 70 to 130 individuals remained in detention from prior PTA arrests.

The Human Rights Commission of Sri Lanka (HRCSL) reported that torture committed by police forces was routine and continued throughout the country, and that it received 193 allegations of physical and mental torture by state actors as of June. It stated that many reports of torture referred to police officers allegedly “roughing up” suspects to extract a confession or otherwise elicit evidence to use against the accused.

Interviews by human rights organizations found that torture by police remained endemic throughout the country. As in previous years, suspects arrested under the PTA since the civil war ended in 2009 gave accounts of torture and mistreatment, forced confessions, and denial of basic rights such as access to lawyers or family members. Some released former combatants reported torture or mistreatment, including sexual abuse by state officials while in rehabilitation centers and after their release. Excessive use of force against civilians by police and security officials also remained a concern.

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There were also reports of sexual abuse committed by government and security sector officials against wives who came forward seeking information about their missing husbands or against war widows who attempted to claim government benefits based on their deceased husbands’ military service.

Prison and Detention Center Conditions

Prison conditions were poor due to old infrastructure, overcrowding, and a shortage of sanitary facilities.

Physical Conditions: Overcrowding was a problem. The commissioner of prisons estimated that the prison population exceeded the system’s capacity by nearly 64 percent. Authorities sometimes held juveniles and adults together. Authorities often held pretrial detainees and convicted prisoners together. In many prisons inmates reportedly slept on concrete floors, and prisons often lacked natural light or ventilation.

The commissioner of prisons reported 52 total deaths of prisoners in custody as of July. The majority of deaths were due to natural causes. There were also three suicides.

A few of the larger prisons had their own hospitals, but only a medical unit staffed the majority. Authorities transferred prisoners requiring medical care in smaller prisons to the closest local hospital for treatment.

On August 13, approximately 20 prisoners in the Women’s Wing of the Welikada Prison protested prison conditions by climbing onto the roof of the facility to demand faster trials and an end to restrictions on food brought by family members for prisoners. The protest was in response to prison officials’ decision to limit outside food deliveries in an effort to stop drug smuggling into the facility. The protest ended peacefully on August 14 after Ministry of Prison Reform officials promised to discuss the raised issues.

Administration: The HRCSL investigates complaints received and refers them to the relevant authorities when warranted. The HRCSL reported it received some credible allegations of mistreatment reported by prisoners, but the Ministry of Prison Reforms reported it did not receive any complaints.

Independent Monitoring: The Board of Prison Visitors is the primary domestic organization conducting visits to prisoners and accepts complaints; it also has the

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 5 legal mandate to examine overall conditions of detention. The Board of Prison Visitors functions as an internal governmental watchdog and was established under the Prisons Ordinance. The members are representatives of civil society otherwise unaffiliated with the government or other state institutions. The International Committee of the Red Cross (ICRC) and the HRCSL also have a mandate to monitor prison conditions. During the year the HRCSL undertook a National Study on Prisons and visited 20 prisons across the country. The report was not available at year’s end.

Improvements: The Prison Department sought to address overcrowding by moving several prisons out of urban areas into more spacious, rural locations. During the year the government implemented the Community Correctional Program, which sends prisoners to rehabilitation camps in lieu of long-term confinement. d. Arbitrary Arrest or Detention

The law prohibits arbitrary arrest and detention and provides for the right of any person to challenge the lawfulness of his/her arrest or detention in court, but there were reports that arbitrary arrest and detention occurred, although at a decreased rate compared with 2017, according to civil society and the HRCSL; under the PTA the ability to challenge detentions was particularly limited.

Role of the Police and Security Apparatus

The Police Service is responsible for maintaining internal security and in November was moved from the Ministry of Law and Order to the Ministry of Defense. The military falls under the Ministry of Defense and is responsible for external security. According to the criminal procedure code, the military may be called upon to handle specifically delineated domestic security responsibilities. President Sirisena served as the minister of defense, but the civilian secretary of defense had daily operational responsibility over the military and, as of November, the police. The nearly 11,000-member paramilitary Special Task Force is a police entity that reports to the Inspector General of Police, which falls under the Ministry of Law and Order. It coordinates internal security operations with the military.

Civilian authorities generally maintained control over the security forces. Reports indicated that during anti-Muslim violence in March, the police initially were slow to respond or stop perpetrators from damaging Muslim buildings and assaulting Muslim individuals. The Ministry of Law and Order is responsible for determining

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 6 whether security force killings were justifiable. According to civil society, intelligence operatives conducted domestic surveillance operations and harassed or intimidated members of civil society (see section 2.a., Freedom of Expression, Including for the Press).

Impunity for conflict-era abuses also persisted, including military, paramilitary, police, and other security-sector officials implicated in cases involving the alleged targeted killing of parliamentarians, abductions, and suspected killings of journalists and private citizens. Civil society organizations asserted the government and the courts were largely reluctant to take action against security forces. Prosecutions for abuses committed by the security forces and police were rare but increasing, as were prosecutions for government corruption and malfeasance.

Security forces had limited internal mechanisms to investigate abuses, but victims may bring cases directly to the Supreme Court. The HRCSL and criminal courts may also investigate such abuses, and the government pursued prosecutions and secured convictions in multiple high-profile cases against members of the security services. On August 9, the Jaffna High Court sentenced two senior military intelligence officers to death for the killing of a Liberation Tigers of Tamil Eelam (LTTE) militant while in custody in 1998. On July 18, the Supreme Court upheld and reimposed the suspended sentence of imprisonment of former Welikada police chief inspector Kamal Amarasinghe, who was convicted for assault. On July 5, the Supreme Court ruled against the police, ordering payment of compensation to a commercial sex worker and holding that her fundamental rights had been violated when she was harassed in 2014. On June 7, two police officers were sentenced to 20 years and six months of imprisonment with hard labor by the Colombo High Court after they were convicted of rape in Bambalapitiya in 2003. In October the United Nations sent the commander of the Sri Lankan peacekeeping contingent in Mali back to Sri Lanka after reportedly having discovered information that claimed to link him to a unit implicated in atrocities during Sri Lanka’s civil war.

In March widespread anti-Muslim violence erupted in the central Buddhist region of Kandy District, resulting in hundreds of Muslim homes, business, and mosques being destroyed or damaged, in addition to the deaths of four individuals and the injury of 28 others. Observers and victims of the violence reported some members of the police and Special Task Force either took no action to quell the violence or actively participated.

Arrest Procedures and Treatment of Detainees

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The criminal procedure code allows police to make an arrest without a warrant for offenses such as homicide, theft, robbery, and rape. Alternatively, police may make arrests pursuant to arrest warrants that judges and magistrates issued based on evidence. The law requires authorities to inform an arrested person of the reason for the arrest and arraign that person before a magistrate within 24 hours for minor crimes, 48 hours for some grave crimes, and 72 hours for crimes covered by the PTA. More time reportedly elapsed before some detainees appeared before a magistrate, particularly in PTA cases. For bailable offenses as characterized under the Bail Act, instead of arraignment in court, the police can release suspects within 24 hours of detention on a written undertaking and require them to report to court on a specified date for pretrial hearings. Suspects accused of committing bailable offenses are entitled to bail, administered by the police before seeing a magistrate, but for suspects accused of nonbailable offenses, bail is awarded only at a magistrate’s discretion, i.e., after appearing before a magistrate.

The Bail Act states no person should be held in custody for more than 12 months prior to conviction and sentencing without a special exemption. Under the PTA detainees may be held for up to 18 months without charge, but in practice authorities often held PTA detainees for longer periods. After a July 2017 visit by a UN special rapporteur on the protection of detainees accused of terrorism, the UN report noted that of 81 prisoners in pretrial detention awaiting the police investigation to be completed and the Attorney General’s Department filing of charges for offenses under the PTA, 70 had been in detention without trial for more than five years and 12 had been in detention without trial for more than 10 years. There was no known action on these cases during the year.

The minister of justice acknowledged the suspension of the PTA in February 2017; however, the government made at least four arrests under the PTA during the year.

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Arbitrary Arrest: The HRCSL received 101 complaints of arbitrary arrest and detention through June. Police sometimes held detainees incommunicado, and lawyers had to apply for permission to meet clients, with police frequently present at such meetings. In some cases unlawful detentions reportedly included interrogations involving mistreatment or torture.

In October dozens of Tamil prisoners across the country, including former LTTE fighters, undertook a hunger strike, demanding an immediate resolution to their protracted detention. Many of the prisoners were held under the PTA without charge. They asked the government either to indict them or provide a pathway for their eventual release.

Detainee’s Ability to Challenge Lawfulness of Detention before a Court: Under the law a person may challenge an arrest or detention and obtain prompt release through the courts. The legal process takes years, however, and the Center for Human Rights Development (CHRD) indicated the perceived lack of judicial independence and minimal compensation discouraged individuals from seeking legal remedies. Under the PTA the ability to challenge detentions is particularly limited. e. Denial of Fair Public Trial

The law provides for an independent judiciary, and the government generally respected judicial independence and impartiality.

Trial Procedures

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 9 lower courts. Defendants have the right to confront witnesses against them and to present witnesses and evidence.

The law requires court proceedings and other legislation to be available in English, Sinhala, and Tamil. Most courts outside the northern and eastern parts of the country conducted business in English or Sinhala. Trials and hearings in the north and east were in Tamil and English. A shortage of court-appointed interpreters limited the right of Tamil-speaking defendants to free interpretation as necessary. In several instances courts tried criminal cases originating in the Tamil-speaking north and east in Sinhala-speaking areas, which exacerbated the language difference and increased the difficulty in presenting witnesses who needed to travel. Few legal textbooks were available in Tamil. Defendants have the right to be present in court during trial and have the right to adequate time and facilities to prepare a defense. Defendants also have the right not to testify or admit guilt.

Political Prisoners and Detainees

Some Tamil politicians and local human rights activists referred to alleged former LTTE combatants accused of terrorism-related violent crimes as “political prisoners,” and the CHRD reported that more than 130 such prisoners remained in detention. The government did not acknowledge any political prisoners and claimed the prisoners in question were detained for violent criminal acts. The government permitted access to prisoners on a regular basis by the HRCSL, magistrates, and the Board of Prison Visits, and it allowed the ICRC access to monitor prison conditions. Authorities granted irregular access to those providing local legal counsel.

Civil Judicial Procedures and Remedies

Citizens may seek civil remedies for alleged human rights violations through domestic courts up to the Supreme Court.

Property Restitution

Land ownership disputes continued between private individuals in former war zones, and between citizens and the government.

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 10 government may acquire private property for a “public purpose,” but the law requires posting acquisition notices publicly and providing proper compensation to owners. The former government frequently posted acquisition notices for HSZ land that were inaccessible to property owners, many of whom initiated court cases, including fundamental rights cases before the Supreme Court, to challenge these acquisitions. According to the acquisition notices, most of the land acquired was for use as army camps and bases, but among the purposes listed on certain notices were the establishment of a hotel, a factory, and a farm. Throughout the year lawsuits, including a 2016 Supreme Court fundamental rights case and numerous writ applications filed with High Courts, remained stalled. Although HSZs had no legal framework following the lapse of emergency regulations in 2011, they still existed and remained off limits to civilians. During the year the government returned approximately 2,300 acres of land. Since 2009 the government reported that it had released more than 83,000 acres of land, representing more than 80 percent of all land occupied during the war.

With the amount of remaining land in dispute, many of those affected by the HSZs complained that the pace at which the government demilitarized land was too slow and that the military held lands it viewed as economically valuable. Some Hindu and Muslim groups reported they had difficulty officially claiming land they had long inhabited after Buddhist monks placed a statue of Buddha or a bodhi tree on their property. f. Arbitrary or Unlawful Interference with Privacy, Family, Home, or Correspondence

The PTA permits government authorities to enter homes and monitor communications without judicial or other authorization. Government authorities reportedly monitored private movements without appropriate authorization.

Section 2. Respect for Civil Liberties, Including: a. Freedom of Expression, Including for the Press

Freedom of Expression: Authorities restricted “hate speech,” including insult to

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 11 religion or religious beliefs through the police ordinance and penal code. The government requested media stations and outlets to refrain from featuring hate speech in their news items and segments.

Press and Media Freedom: Independent media were active and expressed a wide variety of views. Journalists in the Tamil-majority north, however, reported harassment, intimidation, and interference from the security sector when reporting on sensitive issues related to the civil war or its aftermath. They reported the military contacted them to request copies of photographs, lists of attendees at events, and names of sources from articles. They also reported the military directly requested that journalists refrain from reporting on sensitive events, such as Tamil war memorials or land occupation protests, and that they feared repercussions if they did not cooperate.

In October, after former President Mahinda Rajapaksa was appointed prime minister in a move challenged in court as unconstitutional, some of Rajapaksa’s supporters took control of state media outlets. The International Federation of Journalists reported serious concern about harassment of journalists at state media institutions, and in some cases mobs loyal to Rajapaksa entered facilities and threatened employees and forced them to leave the premises. In another case the bodyguard of a minister loyal to ousted Prime Minister Ranil Wickremesinghe opened fire into a crowd of protesters outside a state media outlet, killing a Rajapaksa supporter.

Violence and Harassment: There were reports of harassment and intimidation of journalists when covering sensitive issues. Reporters Without Borders reported authorities intimidated Tamil Guardian journalist Uthayarasa Shalin in August following his coverage of a festival at a Hindu temple, but there were conflicting reports whether Shalin was targeted due to his work as a journalist.

Censorship or Content Restrictions: On several occasions print and electronic media journalists noted they self-censored stories that criticized the president or his family. These journalists said they had received direct calls from private individuals or supporters of the government asking them to refrain from reporting anything that tainted the first family. On June 5, the Telecommunications Regulatory Authority (TRA) closed Telshan Network, a private television station. TRA accused the network of defaulting on its license fees. The network denied the allegations and claimed the closure was politically motivated. In November 2017 TRA blocked access of London-based website Lanka eNews after it published an expose into alleged corruption in President Sirisena’s office; the site remained

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 12 blocked at year’s end.

Internet Freedom

There were no credible reports that the government monitored private online communications without appropriate legal authority. The government placed limited restrictions on websites it deemed pornographic. In March the government imposed a weeklong ban on several social media platforms, including Facebook, Whatsapp, and Instagram, during a state of emergency imposed following an eruption of anti-Muslim violence in the Central Province.

According to International Telecommunication Union data, approximately 34 percent of the population used the internet in 2017.

Academic Freedom and Cultural Events

State university officials allegedly prevented professors and university students from criticizing government officials. There were no other reported government restrictions on academic freedom or cultural events. b. Freedoms of Peaceful Assembly and Association

The law provides for the freedoms of peaceful assembly and association, but the government restricted these rights in a limited number of cases.

Freedom of Peaceful Assembly

Freedom of Association

The law provides for freedom of association but limits the right, for example, by criminalizing association with or membership in banned organizations. Christian

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 13 groups and churches reported some authorities classified worship activities as “unauthorized gatherings” and pressured them to end these activities. According to the groups, authorities sometimes justified their actions stating the groups were not registered with the government, although no law or regulation specifically requires such registration. c. Freedom of Religion

See the Department of State’s International Religious Freedom Report at www.state.gov/religiousfreedomreport/. d. Freedom of Movement

The law provides for freedom of internal movement, foreign travel, emigration, and repatriation, and the government generally respected these rights. The government cooperated with the Office of the UN High Commissioner for Refugees (UNHCR) and other humanitarian organizations in providing protection and assistance to internally displaced persons, refugees, returning refugees, stateless persons, or other persons of concern.

Internally Displaced Persons (IDPs)

The country’s civil war that ended in 2009 caused widespread, prolonged displacement, including forced displacement by the government and the LTTE, particularly of Tamils. According to the Ministry of Resettlement, Rehabilitation, Northern Development, and Hindu Religious Affairs, 37,815 citizens remained IDPs as of June 30. The large majority resided in Jaffna, Kilinochchi, Mannar, and Batticaloa Districts in the north and east. While all IDPs had full freedom of movement, most were unable to return home due to land mines; restrictions designating their home areas as part of HSZs; lack of work opportunities; inability to access basic public services, including acquiring documents verifying land ownership; and lack of government resolution of competing land ownership claims and other war-related reasons. The government did not provide protection and assistance to IDPs in welfare camps.

The government promoted the return and resettlement of IDPs by returning approximately 840 acres of military-seized land and making state land available for landless IDPs. The military and other government agencies supported the resettlement of IDPs by constructing houses, schools, toilets, and providing other social services on newly released lands.

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Protection of Refugees

Access to Asylum: The law does not provide for the granting of asylum or refugee status. The government relied on UNHCR to provide food, housing, and education for refugees in the country and to pursue third-country resettlement for them. The law does not permit refugees and asylum seekers to work or enroll in the government school system, but many worked informally.

Section 3. Freedom to Participate in the Political Process

The constitution provides citizens the ability to choose their government in free and fair periodic elections held by secret ballot and based on universal and equal suffrage.

Elections and Political Participation

Recent Elections: The Commonwealth Observer Group reported that in the 2015 presidential election, voters exercised their franchise freely and that vote counting was transparent with the results swiftly revealed to the public. Observers reported widespread abuse of state resources used for campaigning, consistent bias in state media toward the former government, and denial of access to venues for the opposition candidate.

Domestic and international observers concurred that local authorities conducted the 2015 parliamentary elections in a fair and free manner with few reports of violence. The EU election observation mission’s preliminary findings stated the elections were “well administered and offered voters a genuine choice from among a broad range of political alternatives, although campaign rules were restrictive.” The mission noted the government respected freedoms of assembly and movement. It added that party activists and candidates campaigned vigorously despite restrictive campaign rules, such as not allowing candidates to engage in door-to- door campaigning, canvass in person, or distribute leaflets.

Participation of Women and Minorities: No laws limit participation of women or members of minorities in the political process, and they did participate. Voters elected 13 women to the 225member parliament in 2015. The local government elections held during the year included for the first time a quota for women’s participation, requiring that 25 percent of all local and municipal council seats be held by women. Parties struggled to reach this new quota, but the final results

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 15 came close to the required total, reaching 22.8 percent of all local government elected positions.

Section 4. Corruption and Lack of Transparency in Government

Corruption: Corruption remained a continuing problem. For example, in December 2017 a presidential commission investigating irregularities in a Central Bank bond sale recommended legal action against a former finance minister and a former central bank governor. Corruption investigations against current or former government officials were often stalled.

After President Sirisena’s announcement on October 26 removing Prime Minister Wickremesinghe and appointing former president Rajapaksa as prime minister, Sirisena prorogued parliament until November 16, during which time there were numerous reports of attempted vote buying to secure support for the move when parliament reconvened. In one case a member of parliament alleged he was offered 500 million rupees (Rs) ($2.89 million) to switch sides and support Rajapaksa as prime minister.

Section 5. Governmental Attitude Regarding International and Nongovernmental Investigation of Alleged Abuses of Human Rights

United Nations and Other International Bodies: The UN Human Rights Council

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 16 continued to have a country-specific resolution related to addressing justice, accountability, and reconciliation in Sri Lanka. The current resolution, cosponsored by Sri Lanka and passed in 2017, maintains UN monitoring of the commitments Sri Lanka made in 2015 to address these issues until March 2019. Despite Sri Lanka’s cosponsorship of the 2015 and 2017 resolutions, senior government officials continued to make public statements attacking the UN process and asserting they would not take any steps to hold “war heroes” accountable, despite their commitment to initiate a criminal justice process, with international participation, to address war-time abuses.

Government Human Rights Bodies: The HRCSL has jurisdiction to investigate human rights violations. The HRCSL is composed of five commissioners and has divisions for investigations, education, monitoring and review, and administration and finance. There are 10 regional offices across the country. The HRCSL accepts complaints from the public and may also self-initiate investigations. After an allegation is proven to the satisfaction of the commission, the HRCSL may recommend financial compensation for victims, refer the case for administrative disciplinary action or to the attorney general for prosecution, or both. If the government does not follow an HRCSL request for evidence, the HRCSL may summon witnesses from the government to explain its action. If the HRCSL finds the government has not complied with its request, the HRCSL may refer the case to the High Court for prosecution for contempt by the Attorney General’s Department, an offense punishable by imprisonment or fine. By statute the HRCSL has wide powers and resources and may not be called as a witness in any court of law or be sued for matters relating to its official duties. The HRCSL generally operated independent of and with lack of interference from the government.

The HRCSL was also responsible for vetting Sri Lankan peacekeepers, although the memorandum of understanding between the United Nations, HRCSL, Ministry of Defense, and Ministry of Law and Order for the vetting of all Sri Lankan military and police participants in peacekeeping operations was not finalized by year’s end.

Section 6. Discrimination, Societal Abuses, and Trafficking in Persons

Women

Rape and Domestic Violence: The law prohibits rape and domestic violence, but enforcement of the law was inconsistent. Section 363 of the penal code does not

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 17 explicitly criminalize rape of men. Section 365 B (1), which is gender neutral, criminalizes “grave sexual abuse.” The prescribed penalties for rape are seven to 20 years’ imprisonment and a fine of at least 200,000 Rs ($1,160). For domestic violence, a victim can obtain a protection order for one year and request a maintenance allowance. The law prohibits spousal rape only if the spouses are legally separated.

In February two men reportedly raped a nurse at a private hospital in Narahenpita. Police in Narahenpita arrested the suspects five days after receiving the report, and their trial was underway at year’s end.

Female Genital Mutilation/Cutting (FGM/C): The country’s Muslims historically practiced FGM/C, but it was not a part of public discourse until recent years when media articles drew attention to the practice. There were no statistics on the current prevalence of FGM/C in the country, which does not have laws against FGM/C. In May the director general of health services from the Ministry of Health issued a circular prohibiting medical practitioners from carrying out FGM, but FGM/C itself is not criminalized.

Coercion in Population Control: There were no reports of coerced abortion or involuntary sterilization.

Children

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 18

Birth Registration: Children obtain citizenship from their parents.

Child Abuse: According to reports and evidence from fundamental rights applications and complaints filed with police during the year, school authorities frequently violate government regulations on banning corporal punishment in schools. There was also growing public concern about the high incidence of violence, including sexual violence, against children in the family and community despite successful efforts to reform the penal code, the basic criminal law, and other laws on child abuse, cruelty to children and their exploitation in trafficking, and child labor. Penalties vary based on the type and degree of child abuse, but trials tended to drag on for years.

Most child abuse complaints received by the National Child Protection Authority related to violence inflicted on children, and the rest of the complaints addressed related issues such as cruelty to children, deprivation of a child’s right to education, sexual abuse, and child labor. Teachers, school principals, and religious instructors reportedly sexually abused children. In a number of child rape cases, government officials were the suspected perpetrators. Civil society organizations working on children’s issues asserted children had insufficient mechanisms to report domestic violence or abuse safely. Although police stations are supposed to have an officer dedicated to handling abuse complaints from women and children, the government did not consistently implement this practice nationwide.

Early and Forced Marriage: Civil law sets the minimum legal age for marriage at 18 for both men and women, although girls may marry at age 16 with parental consent. According to the penal code, sexual intercourse with a girl younger than 16 years, with or without her consent, amounts to statutory rape. The provision, however, does not apply to married Muslim girls older than 12. The Muslim Marriage and Divorce Act, which applies only to Muslims, permits the marriage of girls as young as 12 at the consent of the bride’s father or other male relative. The bride’s consent is not required.

Child sex tourism remained a problem.

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 19

Displaced Children: IDP welfare centers and relocation sites exposed children to the same difficult conditions as adult IDPs and returnees in these areas.

Anti-Semitism

The Jewish population remained very small. There were no reports of anti-Semitic acts.

Trafficking in Persons

See the Department of State’s Trafficking in Persons Report at www.state.gov/j/tip/rls/tiprpt/.

Persons with Disabilities

National/Racial/Ethnic Minorities

Both local and Indian-origin Tamils maintained they suffered longstanding, systematic discrimination in university education, government employment, housing, health services, language laws, and procedures for naturalization of noncitizens. Throughout the country, but especially in the north and east, Tamils reported security forces regularly monitored and harassed members of their community, especially activists and former or suspected former LTTE members.

The government had a variety of ministries and presidentially appointed bodies

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 20 designed to address the social and development needs of the Tamil minority. The government implemented a number of confidence-building measures to address grievances of the Tamil community. It also replaced military governors of the Northern and Eastern Provinces with civilians. The Office of National Unity and Reconciliation, established by the president in 2016, continued to coordinate the government’s reconciliation efforts. The office focuses on promoting social integration to build an inclusive society, securing language rights for all citizens, supporting a healing process within war-affected communities via the government’s proposed Commission for Truth, Justice, Reconciliation, and nonrecurrence of the violence. The Tamil National Alliance and Defense Ministry continued to meet in accordance with a formal dialogue on returning military-held lands in the Northern and Eastern Provinces inaugurated in 2017. On October 4, President Maithripala Sirisena, in his capacity as minister of defense, publicly ordered the security forces to release all remaining private land in their possession by December 31. Observers noted that implementation by the deadline was logistically improbable.

Extremist Buddhist monks instigated violent attacks on Muslims and their property. In March Sinhalese mobs led by Buddhist monks attacked Muslim civilians, shops, homes, and mosques that resulted in two confirmed deaths, 28 injured, and extensive property damage. Observers blamed local government and law enforcement officials for failing to stop the riots, with some claiming police personnel took part in the anti-Muslim rioting. The central government responded by declaring a 10-day state of emergency, sending in the army to restore order, restricting social media, and arresting more than 150 alleged perpetrators.

Indigenous People

Acts of Violence, Discrimination, and Other Abuses Based on Sexual Orientation and Gender Identity

The law criminalizes consensual same-sex sexual conduct between adults. Although prosecutions were rare, human rights organizations reported police used the threat of arrest to assault, harass, and sexually and monetarily extort LGBTI individuals. Those convicted of engaging in same-sex sexual activity in private or

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 21 in public face 10 years’ imprisonment. Antidiscrimination laws do not prohibit discrimination based on sexual orientation and gender identity.

Transgender persons continued to face societal discrimination, including arbitrary detention, mistreatment, and discrimination accessing employment, housing, and health care.

HIV and AIDS Social Stigma

Persons who provided HIV prevention services and groups at high risk of infection reportedly suffered discrimination. In addition hospital officials reportedly publicized the HIV-positive status of their clients and occasionally refused to provide health care to HIV-positive persons.

Other Societal Violence or Discrimination

Sources stated some Buddhist monks regularly tried to close down Christian and Muslim places of worship on the grounds they lacked the Ministry of Buddha Sasana’s approval. The National Christian Evangelical Alliance of Sri Lanka documented 65 cases of attacks on churches, intimidation and violence against pastors and their congregations, and obstruction of worship services as of September.

Section 7. Worker Rights a. Freedom of Association and the Right to Collective Bargaining

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 22

Under Emergency Regulations of the Public Security Ordinance, the president has broad discretion to declare sectors “essential” to national security, the life of the community, or the preservation of public order, and to revoke those workers’ rights to conduct legal strikes. In addition to the Public Security Ordinance, the Essential Public Services Act of 1979 allows the president to declare services provided by government agencies as “essential” public services. In 2017 the government began using the essential public-services act to declare the Sri Lankan Railway and petroleum sector as essential sectors, thus deterring the workers from striking.

The law prohibits retribution against striking workers in nonessential sectors. Seven workers may form a union, adopt a charter, elect leaders, and publicize their views, but a union must represent 40 percent of workers at a given enterprise before the law obligates the employer to bargain with the union. The law does not permit public-sector unions to form federations or represent workers from more than one branch or department of government. The Labor Ministry may cancel a union’s registration if it fails to submit an annual report for three years.

The law prohibits antiunion discrimination. Labor laws do not cover domestic workers employed in the homes of others or informal-sector workers.

Since 1999 the Labor Ministry had filed only 10 cases against companies for unfair labor practices under the Industrial Disputes Act. The ministry did not file any new unfair labor practices cases during the year. The courts issued rulings on two cases and continued to try the other eight. Citing routine government inaction on alleged violations of labor rights, some unions pressed for standing to sue, while some smaller unions did not want that ability because of the cost of filing cases. Workers brought some labor violations to court under the Termination of Employment and Workmen Act and the Payment of Gratuity Act. Lengthy delays hindered judicial procedures. The Industrial Dispute Act does not apply to the public sector, and public-sector unions had no formal dispute resolution mechanism.

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 23

While some unions in the public sector were politically independent, most large unions affiliated with political parties and played a prominent role in the political process.

Unions alleged that employers often indefinitely delayed recognition of unions to avoid collective bargaining, decrease support for unionization, or identify, terminate, and sometimes assault or threaten union activists. The Ministry of Labor requires labor commissioners to hold union certification elections within 30 working days of an application for registration if there was no objection or within 45 working days if there was an objection. The commissioner general of labor held five union certification elections in 2017. No union certification elections were held from January to September. b. Prohibition of Forced or Compulsory Labor

The law prohibits all forms of forced and compulsory labor, but penalties were insufficient to deter violations. The government generally enforced the laws, but resources, inspections, and remediation efforts were not always adequate. Labor Ministry inspections did not extend to domestic workers. The government sporadically prosecuted labor agents who fraudulently recruited migrant workers yet appeared to sustain its monthly meetings to improve interministerial coordination.

Children between the ages of 14 and 18 and women working as live-in domestic workers in some homes were vulnerable to forced labor (see section 7.c.).

Also see the Department of State’s Trafficking in Persons Report at www.state.gov/j/tip/rls/tiprpt/. c. Prohibition of Child Labor and Minimum Age for Employment

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 24 for persons younger than 18. The law limits the working hours of children ages 14 and 15 to nine hours per day and of ages 16 and 17 to 10 hours per day. The government estimated less than 1 percent of children--approximately 40,000--were working, although employment was often in hazardous occupations.

The government did not effectively enforce all laws, and existing penalties were not sufficient to deter violations.

The Labor Ministry made some progress in implementing its plan to eliminate the worst forms of child labor. The government appointed district coordinators with responsibility of reducing child labor in all 25 districts and provided new guidelines for district officials. The Department of Labor continued its efforts to monitor workplaces on the list of hazardous work for children.

According to the Child Activity Survey of 2016 published in February, industries and services were the largest sectors employing child labor. Within these sectors children worked in the construction, manufacturing, mining, and fishing industries, and as cleaners and helpers, domestic workers, and street vendors. Children also worked in agriculture during harvest periods. Children displaced by the war were especially vulnerable to employment in hazardous labor.

Also see the Department of Labor’s Findings on the Worst Forms of Child Labor at www.dol.gov/ilab/reports/child-labor/findings/. d. Discrimination with Respect to Employment and Occupation

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 25

The government did not always effectively enforce these laws, and discrimination based on the above categories occurred with respect to employment and occupation. For example, some employers specified particular positions as requiring male or female applicants, and women sometimes earned less than men for equal work. e. Acceptable Conditions of Work

The parliament passed its first-ever national minimum wage law in 2016, mandating a wage of 10,000 Rs ($58) per month and 400 Rs ($2.31) per day. In addition the Department of Labor’s 44 wage boards continued to set minimum wages and working conditions by sector and industry in consultation with unions and employers. The minimum wage in the public sector remained unchanged at 32,040 Rs ($185) between 2016 and 2018. The official estimate of the threshold poverty level was 4,659 Rs ($26.90) per person per month.

The law prohibits most full-time workers from regularly working more than 45 hours per week (a five and one-half-day workweek). In addition the law stipulates a rest period of one hour per day. Regulations limit the maximum overtime hours to 15 per week. Overtime pay is 1.5 times the basic wage and is paid for work beyond 45 hours per week and work on Sundays or holidays. The provision limiting basic work hours is not applicable to managers and executives in public institutions. The law provides for paid annual holidays.

Authorities did not effectively enforce minimum wage, hours of work, and occupational safety and health standards in all sectors. The Labor Ministry’s resources, inspections, and remediation efforts were sometimes inadequate. Occupational health and safety standards in the rapidly growing construction sector, including on infrastructure development projects, such as port, airport, and road construction, as well as high-rise buildings, were insufficient. Employers, particularly those in the construction industry, increasingly used contract employment for work of a regular nature, and contract workers had fewer safeguards.

Labor Ministry inspectors verified whether employers fully paid employees and contributed to pension funds as required by law. Unions questioned, however,

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor 26 whether the ministry’s inspections were effective. The Labor Department used a computerized Labor Information System Application designed to improve the efficiency and effectiveness of inspections. The financial punishment for nonpayment of wages is negligible, with fines ranging from 100 Rs ($0.58) to 250 Rs ($1.44) for the first offense, 250 Rs ($1.44) to 500 Rs ($2.89) for the second offense, to 1,000 Rs ($5.78) or incarceration for a term not exceeding six months, or both, for the third offense. Under the Shop and Office Act, the penalties for violating hours of work laws are a fine of 500 Rs ($2.89), six months’ imprisonment, or both. The law charges a fine of 50 Rs ($0.29) per day if the offense continues after conviction. These penalties were insufficient to deter violations. Labor inspectors did not monitor wages or working conditions or provide programs or social protections for informal sector workers.

No reliable sources of data covered the informal sector.

Country Reports on Human Rights Practices for 2018 United States Department of State • Bureau of Democracy, Human Rights and Labor

TAB 3

This report was written by Kelsi A. Kriitmaa with input from Prasantha Abeykoon, Liezel Wolmarans, Dr. Nimal Kasturiaratchi, Dr. Shamini Prathapan, Prof. Neluka Fernando, Anke van der Kwaak and Pam Baatsen. This publication was made possible through financial support from the Global Fund to fight AIDS, TB and Malaria (GFATM) grant for Sri Lanka.

This publication may be freely reproduced or distributed with appropriate acknowledgement. This report contains the analysis of data collected by the IBBS Survey conducted in 2014 and does not necessarily represent the decisions or stated policies of the National STD/AIDS Control Programme of Sri Lanka, the Global Fund and other organisations that have provided support to the IBBS Survey.

Copies of this publication can be obtained from: Director, National STD / AIDS Control Programme (NSACP) No. 29, De Sarams Place, Colombo 10, Sri Lanka +94 11 533 6873, +94 11 268 2859 [email protected] www.aidscontrol.gov.lk

Management Frontiers (Pvt) Ltd. (MF) No. 20/74 – 1/1, Fairfield Gardens, Colombo 8, Sri Lanka +94 11 2674667/8 [email protected] http://www.managementfrontiers.com

Published by National STD / AIDS Control Programme (NSACP) No. 29, De Sarams Place, Colombo 10, Sri Lanka

Printed by Printel (Pvt) Ltd. No. 21/11, Araliya Uyana, Depanama, Pannipitiya, Sri Lanka +94 11 2850280

Suggested citation Integrated Biological and Behavioural Surveillance (IBBS) Survey among Key Populations at Higher Risk of HIV in Sri Lanka, 2014 – Report, Colombo, National STD/AIDS Control Programme, Management Frontiers (Pvt) Ltd and KIT, 2015

ISBN : 978-955-0505-71-5

II  IBBS Survey, Sri Lanka 2014 phones usage is high, providing the potential for m-health projects, as many of the key populations indicated they would be interested in receiving HIV and heath related text messages. Alcohol and drug usage: Alcohol and drug consumption amongst FSW, MSM and BB is not particularly high; however, amongst those few who have injected, most shared injecting equipment. Stigma: High levels of HIV related stigma are present across all MARP and districts. While most respondents would be willing to care for an HIV positive family member, many do not believe an HIV positive student should be allowed to go to school, and would not buy food from an HIV positive food seller. High levels of stigmatization in society, lead to a non-conducive environment for safer sexual practices and access to health services. STI care seeking behaviour: Most respondents go to Government STD clinics for HIV testing, but not when they have symptoms of an STI, the first point of call is typically a private pharmacy or chemist, illustrating that sentinel surveillance for STIs may be underestimated. Additional MARP specific conclusions are specified below.

FSW While HIV prevalence is low and condom usage at last sex with clients is high, all other GARPR indicators are low (testing, knowledge, and reached with prevention programmes). Reasons for first entry into sex work are typically due to financial reasons (not having money or a job) and abandonment by husband, thereby showing potential for interventions with separated or divorced high-risk women, including skills training and livelihoods programmes. The average amount of money earned per last sex act is between 1,276 Rupees (Colombo) and 1,822 (Kandy), which when compared with the typical salary for a plantation worker is approximately four times higher, clearly illustrating a financial incentive for entry and maintenance in sex work. Three wheeler and truck stops are a commonly reported place where FSW meet clients, showing possibility for implementing interventions in three wheeler and truck stops and other areas of mobility, such as mobile clinics, IEC, etc. The most common location where sex is being exchanged is hotels, providing an opportunity for engaging with the private sector in a condom distribution strategy. A high number of FSW have been paid more for sex with no condom, and as such interventions targeting clients to raise awareness are needed, and condom negotiation skills building for FSW. Most condoms are currently obtained from private pharmacies, justifying engagement with the private sector, and potential for a public/private partnership for condom distribution.

MSM While HIV prevalence is low, overall MSM show poor performance on all GARPR indicators, including condom usage, testing, knowledge and reach of prevention programmes. Anal sex is high amongst MSM across all districts, alongside poor condom usage, clearly providing a pathway for the increased spread of HIV. Presence of sex with women is present, illustrating the potential for cross-spread between MARP and general populations. Many MSM have both sold and paid for sex, and the qualitative component further confirmed that identities and boundaries are sometimes blurred between MSM and sex work. These blurred sexual boundaries may be creating potential for multiple environments of risk, which are not well understood by service providers and should be taken into account for successful prevention and treatment and care programmes.

PWID While HIV prevalence amongst PWID is zero, high risk behaviour is present showing a conducive environment for the spread of HIV. For example, poor performance on all GARPR indicators, including

IBBS Survey, Sri Lanka 2014  3 1. Introduction

1.1 Globally

More people than ever are currently living with HIV due to fewer AIDS-related deaths and the continued large number of new infections, with 2.5 million people newly infected persons every year. Millennium Development Goal (MDG) 6 of combating HIV/AIDS, malaria and other diseases remains a priority even though new HIV infections continue to decline in most regions globally. Despite the fact that the target to reach universal access to treatment for HIV/AIDS for all those who need it was missed in 2010, access to treatment for people living with HIV has increased globally, across all regions. At the end of 2011, 8 million people were receiving antiretroviral therapy for HIV1. In 2011, to make a difference, the UN pressed Governments in concentrated epidemic countries to put in place strategies that focused on the needs of populations at higher risk of HIV, including sex workers (SW), men who have sex with men (MSM) and people who inject drugs (PWID)2. Commitment to ending the HIV epidemic, pledging to focus on populations at higher risk and to build shared responsibility for achieving targets was outlined in the 2011 Political Declaration.

1.2 Sri Lanka

Sri Lanka is a Democratic Socialist Republic and an island situated in the Indian Ocean, southwest of the Bay of Bengal. Sri Lanka is separated from the Indian subcontinent by the Gulf of Mannar and the Palk Strait, with a population of 20.5 million3. Sri Lanka has been classified by UNAIDS as a country with a low-level HIV epidemic, with a national HIV prevalence of less than 0.1% that is non-generalized across the population. According to the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO), an estimated 4,100 adults (15 years and above) were living with HIV/AIDS in Sri Lanka at the end of 2011, of which 1,400 are women The male to female ratio amongst HIV positive persons in Sri Lanka is nearly 3:1 and the proportion of eligible people receiving antiretroviral therapy at the end of 2011 was between 20 to 39%4.

HIV is mainly transmitted through heterosexual sex, accounting for 82.5% of total cases; followed by homosexual and bisexual modes (11.3%), peri-natal (5.3%), blood transfusion (0.3%) and use of injecting drugs (0.6%). Sri Lanka is one of 9 countries worldwide (and one of four in the Asia Pacific region) where the number of people newly infected in 2011 was at least 25% higher than in 20015. Risk behaviours are believed to be more concentrated among key populations such as FSW, MSM, beach boys (BB), prison inmates and narcotic drug users6. The first round of behavioural surveillance survey (BSS) results of 2006/7 also focused on drivers of three-wheeler taxis and factory workers from the Free Trade Zone7. In 2006/07 BSS, factory workers were included as a low risk group for HIV. Results confirmed that their HIV risk is as same as the general population.

Punitive policies, including both legal and policy frameworks, result in high levels of stigma and discrimination in Sri Lanka, for people living with HIV and AIDS. Both sex work and sex between men are prohibited by national laws and evidence implies that many populations at higher risk of infection delay testing and treatment because they are concerned about identification as part of a most-at-risk population (MARP), testing positive, and related confidentiality issues8.

1.3 Female sex workers

FSW are females who are selling sex in exchange for money or goods, in an array of contexts or venues including the streets, lodges/hotels, brothels, massage parlours, karaoke bars/nightclubs,

6  IBBS Survey, Sri Lanka 2014

TAB 4

Country Policy and Information Note Sri Lanka: Sexual orientation and gender identity and expression

Version 3.0 October 2018

8.2.2 The Women and Media Collective Shadow Report, Discrimination of Lesbians, Bisexual Women and Transgender Persons in Sri Lanka, Presented to the 66th Session of CEDAW 13 February – 03 March 2017: observed: ‘While the basic health needs of LGBT people and the general population are the same, their sexual orientation and gender identity and expression is a barrier to LGBT individuals accessing health related entitlements. LBT women in Sri Lanka continue to face challenges in exercising their basic right of access to health care, including reproductive health and avoid or delay receiving health care or receive inappropriate or inferior care in general and health care settings. The high visibility of LGBT persons in HIV prevention intervention programmes is considered to pose a barrier to recognizing their need for services for general and reproductive health problems as for the general population.’84 8.2.3 Further adding: ‘Members of the transgender community report complete disregard and lack of concern for protecting the confidential details of their medical histories by State run healthcare facilities. Information has been shared with non-medical hospital personnel such as cleaners and security staff. Some transgender persons report intimidation and harassment by hospital staff. In one case, a doctor sexually harassed a transwoman seeking medical assistance at a government hospital. In another incident a transgender man reported having his genitals examined when he was under sedation for surgery not related to his sexual organs. There are also reports indicating that transwomen who go to government healthcare facilities have faced discrimination, such as their cases being delayed and their appointments being pushed to the back of the queue. Transmen (female to male) are often left out of HIV awareness programmes since often only transwomen are categorised as men having sex with men by HIV service providers.’85 8.2.4 DFAT noted however, in their 2018 report: ‘Local sources have identified the Kalubowila government hospital near Colombo as a transgender-friendly hospital; it conducted the first sex reassignment surgery in Sri Lanka in 2017.’86 Back to Contents 8.3 Employment 8.3.1 A 2014 report by Kaleidoscope, noted: ‘Discrimination, among other things, limits access to employment, housing and health services. There have been reports of LGBTI individuals being fired from jobs, refused accommodation or forced to leave, because of their real or perceived sexual orientation or gender identity.’87 8.3.2 At an European Union sponsored business roundtable on the ‘challenges and benefits of the diversity in the workplace’ at the Taj Samudra on 14 June

84 Women and Media Collective, ‘Report’, 13 February – 03 March 2017, (p9), url. 85 Women and Media Collective, ‘Report’, 13 February – 03 March 2017, (p10), url. 86 DFAT, ‘country report’ (para 3.102), 23 May 2018, url. 87 Kaleidoscope, ‘Report’ (p. 4), September 2014, url.

Page 33 of 43

TAB 5

The State of Economic, Social and Cultural Rights in Sri Lanka: A Joint Civil Society Shadow Report to the United Nations Committee on Economic Social and Cultural Rights

April 2017

2012.212 Some of the major causes identified for overall food insecurity and malnutrition include: High reliance on the market and physical and financial barriers; rising food prices; income inequality; poor infrastructure; high informal sector labour force; gender inequality; land degradation; urbanization; population aging, and climate change.213

State interventions for eradicating the Dengue epidemic are inadequate

11. In 2016, Sri Lanka was named one of the most Dengue affected countries in Asia with 54,945 cases reported in the same year—25,168 more than in 2015.214 Fifty-nine deaths were reported due to Dengue in 2016.215 At the time of writing this report a major Dengue epidemic was sweeping Batticaloa in the east with over 1500 cases being reported from the district in the first three months of 2017.216 Whilst central, provincial and local authorities are engaged in preventive measures, it is clear that there is an urgent need to significantly step up preventive and curative responses to the disease.

Right to health, gender and sexual orientation

12. Women’s rights organisations have noted that enhancing women’s right to health in Sri Lanka calls for urgent attention to redressing serious regional disparities in maternal, child care and family planning services, increasing women’s access to information on health and health care services, and taking measures to counter prejudices and misconceptions regarding sexual and reproductive rights.217 Women’s sexual and reproductive health continues to be severely compromised because current law holds that abortion is illegal, except when a mother’s life is in danger.218

13. LGBTIQ persons risk public humiliation, harassment and threats to their right to privacy at the hands of medical officers in public hospitals upon revealing their sexual orientation and gender identity.219 The lack of public data on healthcare availability, the inability and/or

212 Sanguhan, Y. and Gunasekara, V. (2017), Researching livelihoods and services affected by conflict: SLRC panel survey Sri Lanka wave II report, London: Overseas Development Institute. 213 See Sri Lanka: Food Security Atlas 2015, p. v. World Food Programme (2017), National Strategic Review of Food Security and Nutrition: Towards Zero Hunger, Colombo: WFP. Retrieved from: https://www.wfp.org/sites/default/files/NSRFSNZH_FINAL.pdf 214 Epidemiology Unit, Ministry of Health, Sri Lanka. http://www.epid.gov.lk/web/index.php?option=com_casesanddeaths&Itemid=448&lang=en# 215 Robert, H. (2016), Sri Lanka Dengue Update: 38,000 cases and 59 deaths. Retrieved from: http://outbreaknewstoday.com/sri-lanka-dengue-update-38000-cases-and-59-deaths-26991/ 216 See The Sunday Times (2017, April 02nd), Dengue epidemic overwhelms Batticaloa: 1,500 cases in three months. Retrieved from: http://www.sundaytimes.lk/170402/news/dengue-epidemic-overwhelms-batticaloa-1500-cases-in-three- months-234980.html 217 Sri Lanka Shadow Report to the Committee on the Elimination of All Forms of Discrimination against Women (CEDAW), submitted for the 66th Session of the CEDAW Committee (2017) 218 Ibid. 219 EQUAL GROUND. (2016) at p.11 in its submission before the Committee records the story of a Transgender man whose garments were forcibly removed to convince the patients of a female ward that he was indeed female and should be admitted to the female ward; of the request by the nursing staff to allow the staff to examine his body of ‘learning purposes’ and of the harassment thereafter with unsolicited calls, and public identification of him in a local market exposing his transgender status publicly. Other similar accounts of coercive examination of transgender persons whilst they were unconscious, refusal to provide pain medication possibly due to gender identity and sexual orientation, further these accounts.

unwillingness to provide adequate healthcare services to LGBTIQ individuals and the prejudiced discourse that links LGBTIQ persons to HIV carriers further perpetuates the lack of access to healthcare and homophobia and transphobia amongst healthcare providers. 220

Questions

1. What concrete policy measures are envisaged in relation to eradicating pockets of high food insecurity and malnutrition, especially with respect to children and pregnant or lactating mothers? 2. What steps have been or will be taken by the Government to implement the 2013-2020 Mental Health Action Plan, which was unanimously approved at the 66th World Health Assembly? 3. What measures have been or will be taken by the Government to ensure there is no discrimination in the provision of health services against any group owing to their social identity or status?

Recommendations

1. Recognising that many mental health and psychosocial problems have their roots in social, political and economic determinants, the Government must integrate measures to protect and promote mental health and psychosocial wellbeing within its economic, welfare, education, health and other activities. 2. Take definitive and time-bound measures to strengthen the public health system by ensuring adequate budgetary and human resources as well as infrastructure, and ensuring public health facilities are more equitably distributed across the country. 3. Take all possible steps to ensure that the right to health and the right to food are recognised as fundamental rights in the new constitution.

220 Interview with LGBTIQ Activists, Colombo, February 17, 2017;

TAB 6

People Living with HIV Stigma Index Sri Lanka

November 2010

All rights are reserved. The document may, however, be freely reviewed, quoted, reproduced or translated, in part or in full, provided the source is acknowledged. The views expressed in the document are solely the responsibility of the authors and do not necessarily represent the partnership.

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PREFACE Preface...... 3 PREFACE Foreword...... 4 It is our pleasure as networks of people living with HIV to partner with the Acknowledgements ...... 5 Stigma Index research. This important research, for the first time, analyzes Acronyms ...... 5 levels of stigma and discrimination from the perspective of people living with Executive Summary ...... 6 HIV in Sri Lanka. We conducted this research for our own people. They were Background ...... 7 comfortable discussing their experiences with us, because they knew that we HIV and Stigma in Sri Lanka ...... 7 understood. What is the People Living with HIV Stigma Index?...... 7 Methodology ...... 9 A number of incidents of both physical and psychological harassment due to Who is HIV positive in Sri Lanka?...... 10 HIV status have been reported in the recent past. We are pleased that there Experiences of Stigma & Discrimination ...... 16 have been timely interventions to reduce such incidents in the future, but General Experiences ...... 17 more needs to be done if people living with HIV are to live positive and Harassment & Assault...... 18 dignified lives. Employment & Education ...... 19 Stigma in Healthcare Settings ...... 21 The strategic information generated by this report lays the foundation and Testing & Diagnosis ...... 21 outlines the need for policy and practice that ensures our legal and human Confidentiality and Disclosure ...... 22 rights. We, as representatives of people living with HIV in Sri Lanka expect that Care and Support (including reproductive options) ...... 24 the recommendations of this report be seriously considered and also Stigma Internalized: feelings and decisions of HIV positive people ...... 27 integrated into future national strategic plans that deal with HIV & AIDS in Sri Rights, Laws, and Policies ...... 30 Lanka. Effecting Change...... 31 Recommendations ...... 32 Need for Rights, Law and Policy ...... 33 Government of Sri Lanka...... 33 Development Partners...... 33 Shereen Rodrigo Princey Mangalika Sunanda Jayarathne Civil Society Organizations ...... 33 President, Director, General Secretary, Reflections on Health Sector Best Practices...... 33 Lanka+ Positive Women’s Network Positive Hopes Alliance Government of Sri Lanka...... 33 Development Partners...... 33 Civil Society Organizations ...... 33 HIV Prevention Programming ...... 33 Government of Sri Lanka...... 33 Development Partners...... 34 Civil Society Organizations ...... 34 Greater Involvement of People Living with HIV ...... 34 Government of Sri Lanka...... 34 Development Partners...... 34 Civil Society Organizations ...... 34 People Living with HIV ...... 34

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FOREWORD Finally we commend the work of the community of people living with HIV in Sri FOREWORD Lanka, who have tirelessly researched and compiled this report. We are It gives us great pleasure to share with you the results of the Stigma Index honoured to be involved in delivering its findings. Report and findings.

At the heart of human rights is human dignity. And central to human di gnity is a life free from stigma, discrimination and a commitment to upholding everyone’s human rights. This means honouring the Declaration of Commitment on HIV/AIDS promulgated by the General Assembly of the United Nations and to which Sri Lanka is a signatory. Dr Nimal Edirisinghe Mr Gamini Wanasekara Director, Executive Director, The Stigma Index Report provides, for the first time, an important insight into National STI & AIDS Control Programme Family Planning Association the manner of injustice found against people who are HIV positive in Sri Lanka. Sri Lanka Sri Lanka It not only reveals that direct and visible injustice occurs, such as verbal harassment, domestic abuse, intimate partner violence as well as lost employment opportunities, but also finds significant levels of invisible or structural injustice exists.

The many types of injustice found to be perpetrated against people infected Mr David Bridger with the virus or against people from communities most vulnerable to HIV and UNAIDS Country Coordinator AIDS means that their human rights and the opportunities afforded them by Sri Lanka and Maldives such rights are gravely diminished. It means that opportunities for people with HIV and AIDS to confidently live the same full and rewarding lives as those less affected people are unfairly curtailed. Key amongst the many findings of the Sri Lankan Stigma Index Report are the high levels of “internalised stigma” experienced by people who are infected or affected by HIV and the “corresponding decisions” they make in the face of the many structural or invisible societal barriers in Sri Lankan society. Unfair stereotyping of people with HIV is linked to prejudicial attitudes and there is a need to strengthen avenues through which remedies can be sought by those who have been discriminated against.

As the report asserts, “If the Stigma Index points to anything, it points to the need for positive living – how to live positive, productive and full lives with HIV – in Sri Lanka.”

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ACKNOWLEDGEMENTS ACRONYMS The successful implementation of the People Living with HIV Stigma Index in AIDS Acquired Immune Deficiency Syndrome Sri Lanka would not have been possible without the support of Lanka+ and ANC Antenatal Care Positive Hopes Alliance (two networks of people living with HIV in Sri Lanka), ARV (ART) Antiretroviral (Therapy) UNAIDS in Colombo, and the Family Planning Association of Sri Lanka. BCC Behaviour Change Communication CBO Community Based Organisation We would also like to thank the National STD & AIDS Control Programme for FGD Focus Group Discussion technical support with the translation of the questionnaire, and International FPASL Family Planning Association, Sri Lanka Planned Parenthood Federation UK and India, for technical support and FSW Female Sex Worker advice during the implementation and analysis phases. GNP+ Global Network of People Living with HIV/AIDS HIV Human Immunodeficiency Virus We are especially grateful for the research team of people living with HIV that ICW International Community of Women Living with HIV/AIDS diligently performed the interviews, sometimes under arduous conditions, and IEC Information, Education, Communication similarly our gratitude extends to all those people living with HIV who IDU Injecting Drug User participated in the Stigma Index study. INGO International Non-Governmental Organization IPPF International Planned Parenthood Federation Finally we would like to thank the team from Grassroots Development MARP Most-At-Risk Population Consultants for help with facilitating the training programme of the Stigma MSM Men who have Sex with Men Index interview team, analysis of the gathered data, and for producing this NGO Non-Governmental Organization report. NSACP National STD & AIDS Control Programme OI Opportunistic Infection PLHIV Person/people living with HIV RSA Rapid Situation Assessment Hans Billimoria STI Sexually Transmitted Infection National Research Consultant UNAIDS Joint United Nations Programme on HIV & AIDS People Living with HIV Stigma Index Sri Lanka UNHCR United Nations High Commission for Refugees VCT Voluntary Counseling and Testing

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EXECUTIVE SUMMARY The Stigma Index also clearly points to a complete lack of knowledge and EXECUTIVE SUMMARY understanding of rights. Sri Lanka currently has no policy or law pertaining This People Living with HIV Stigma Index report is a result of a series of specifically to the rights of HIV positive people, however even the knowledge consultations with key stakeholders including membership of three networks of basic human rights is poor, as is knowledge of available provisions under of HIV positive people, and the National Partnership comprising of UN joint existing laws and policies. The Stigma Index can be used as a tool therefore to team on AIDS, the National STD & AIDS Control Programme and the Family inform law and policy makers, encourage legal professionals to become Planning Association of Sri Lanka. During these consultations we reviewed the potential advocates for rights of HIV positive people, and educate HIV positive findings of the Stigma Index and formulated strategies on how best to use this people on their rights and available legal options. document as a tool for advocacy, education, and prevention in Sri Lanka. Both the National Partnership and the positive network membership agreed on the The demographic data gathered though the Stigma Index suggests that HIV need for a focused approach, rather than general dissemination of the results. positive people largely belonged to low socio-economic strata (annual household income levels below USD 3000 for 74%, with only 1% earning more For example, results around access to treatment; including ART, OI medication than USD 5000) with low levels if education (almost 60% only achieved a and reproductive health options and issues of disclosure and confidentiality maximum of primary education and >30% received secondary education) and related to medical settings, should be discussed primarily with the health a largely provincial or rural locus (80% approx). This information is validated sector and used to assist the health sector and practitioners further develop by the Positive Networks, from whose membership the respondents were skills on dealing with HIV positive people in Sri Lanka. This is especially randomly selected. This also helps us understand the perception of infallibility important in a setting where HIV positive people are reluctant to disclose their with regard to healthcare professionals. Anecdotal evidence indicates that HIV status to family and friends, and often receive no support or advice outside of positive people from middle class, affluent backgrounds do exist but largely their visits to the clinic. Furthermore, given that medical practitioners, ignore the positive network membership and also do not depend on the Sri especially doctors are largely considered above reproach (god-like) by patients Lankan health sector for treatment. and are the primary source of knowledge and information for HIV positive people in Sri Lanka, the issue of possible stigma and discrimination in In a nutshell, the respondents to the Stigma Index have poor knowledge of healthcare settings need to be addressed. rights; they are reluctant to disclose their status to family and friends and therefore lack crucial social support; and they are totally dependent on the While the high levels of internalized stigma and corresponding decisions – not government health sector for treatment. get married (>45%), not have sex (>35%), not have children (>75%) – may have their root in interaction with healthcare professionals, the results on This report makes specific recommendations to address the needs of people internalized stigma – feelings of shame (>50%), self-blame (>50%) and guilt living with HIV in Sri Lanka, as identified through the Stigma Index, focusing (>40%) – also show a clear need for positive networks in Sri Lanka to primarily on Health Care Settings, Law and Rights and Positive Living. This introduce and/or strengthen positive living components. Positive living report recognizes that while external conditions of stigma and discrimination components, even as we assist the health sector to revisit their practices, can need to be addressed, HIV positive people in Sri Lanka require the capacity and help a Positive Network membership gain the knowledge and skills to live full skills to educate each other on life after HIV, and how they can live positive and productive lives. The results on internalized stigma or how HIV positive and productive lives free from fear, and be conscious of their rights; rights they people view themselves is also a clear indication of how much more requires may have to fight for; a fight that they must believe they can win. to be done by all stakeholders in Sri Lanka to normalize living with HIV.

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BACKGROUND extrapolated from research on HIV Knowledge, Attitudes and Behaviour BACKGROUND studies. For example, in a HIV & AIDS Rapid Situation Assessment (RSA) of the HIIV and Stiigma iin Srii Lanka Maritime Sector in Sri Lanka, conducted in January 2010, students from across three maritime schools in the country (Colombo, Panadura, Galle) showed that “Currently Sri Lanka is experiencing a low level HIV epidemic. The estimated knowledge of HIV transmission and transmission myths does not necessarily number of people living with HIV as at end 2009 was 3000 and the estimated reduce stigmatizing attitudes towards people living with HIV. Over 90% of HIV prevalence among adults (15-49 years) is less than 0.1%. Survey data students identified the modes of transmission correctly, and over 80% observes that even among individuals considered at higher risk of infection on identified existing myths of transmission correctly (including use of the same the basis of their occupation, behaviors and practices, the HIV prevalence is toilet facilities, speaking with and touching people living with HIV, and being below 1% up to end of 2009. As at end December 2009, a cumulative total of sneezed on by people living with HIV) but when asked if they would work 1196 HIV persons were reported to the NSACP. The main mode of alongside people living with HIV (49%), share tools and equipment (37%) or transmission is due to unprotected sex between men and women (82.8%). share a room (35%) these numbers dropped dramatically.3 Men who have sex with men have accounted for 11.2% of the transmission while mother to child transmission was 5.4%. Transmission through blood and The strength of the Stigma Index is that distinctive voices of HIV positive blood products was 0.4%. Injecting drug use in Sri Lanka is not a common people in Sri Lanka will be heard for the first time discussing their perceptions phenomenon. However, certain socioeconomic and behavioral factors which and experiences of stigma and discrimination, and what it means to them to are present in the country may ignite an epidemic in the future. The presence be HIV positive. This is neither an anecdotal fragmented account nor is it of a large youth population, internal and external migration, clandestine but dependent on extrapolations from HIV related behavioural research with non- flourishing sex industry, low level of condom use, concurrent sexual HIV positive target groups. And with 2011 approaching the Stigma Index relationships among most-at-risk-populations (MARP) are some such factors. conducted two years into the strategic plan is a good indicator to measure the Low level of sexually transmitted infections (STI), availability and accessibility successes and challenges of the National Strategic Plan (2007-2011). to free of charge health services from the state sector, high literacy rate, low 1 level of drug injectors, are factors considered to be protective.” What iis the Peoplle Liiviing wiith HIIV Stiigma IIndex?

The UNGASS Report currently provides the most detailed information available The People Living with HIV Stigma Index is a joint initiative that has been on HIV in Sri Lanka and provides the necessary backdrop for the discussion of developed and implemented by and for people living with HIV. Those involved HIV related stigma and discrimination in Sri Lanka. The UNGASS Report also in design and development of this survey tool (since 2005) include the Global refers to the National Strategic Plan (2007-2011) that guides the national Network of People Living with HIV/AIDS (GNP+); the International Community response, which includes “mitigating stigma and discrimination to improve the of Women Living with HIV/AIDS (ICW); the International Planned parenthood quality of life of people infected with or affected by HIV” 2 Federation (IPPF); and the Joint United Nations Programme on HIV/AIDS (UNAIDS). How stigma and discrimination has been mitigated and the increase in the quality of life of HIV positive people is difficult to measure. Information on The Stigma Index aims to a) Document various experiences of people living experiences of stigma and discrimination are largely anecdotal and with HIV within a particular community or country regarding HIV related fragmented. Interaction and discussion with Positive Networks suggests that stigma and discrimination; b) Compare situations of people living with HIV in stigmatizing attitudes and behaviour exist among family, colleagues, friends, one country or across different countries with respect to a particular issue; c) healthcare sector, employers, and even religious leaders, but no documented Measure changes over a period of time to ascertain if conditions for people evidence exists. Often information on stigma and discrimination has to be living with HIV have improved or worsened with regard to stigma and discrimination; d) Provide an evidence base for policy change and

1 UNGASS Country Progress Report Sri Lanka 2010, p.4 2 Ibid, p.15 3 HIV & AIDS Rapid Situation Assessment Maritime Workers 2010

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PEOPLE LIVING WITH HIV STIGMA INDEX

programmatic interventions; and e) Use the Stigma Index as a local, national The People Living with HIV Stigma Index also recommended the establishing of and global advocacy tool to fight for improved rights for peopl e living with a National Partnership that will be responsible for implementing the index. The HIV.4 National Partnership in Sri Lanka includes UNAIDS, FPA Sri Lanka (representing IPPF), Lanka+ and Positive Hopes Alliance who represent GNP+ and ICW. The The Stigma Index tool is designed to gather detailed information on: National STD & AIDS Control Programme (NSACP) have also been involved with the implementation process and have thus far provided technical assistance . Personal information - relationship status, education, employment and during the translation process of the Stigma Index questionnaire. household income levels . Experience of stigma and discrimination from others More information on the People Living with HIV Stigma Index, including the . Access to work, health and education services latest news, results and challenges faced during global implementation is . Internal Stigma available on www.stigmaindex.org. . Knowledge of rights, laws and policies . Experiences of effecting change - including efforts to challenge, confront or educate someone with stigmatizing behaviour . Experiences around testing and diagnosis; h) Issues of disclosure and confidentiality . Knowledge and experiences around treatment . Knowledge and experiences around having children . General problems and challenges

“The process of implementing the index is intended to be an empowering one for people living with HIV, their networks, and local communities.”5 This is the most significant feature of the Stigma Index; the full and complete participation of people living with HIV in the (design and) implementation of the Stigma Index. The User Guide clearly states: The People Living with HIV Stigma Index is not intended to be an abstract academic exercise that is done ‘to’ our community… People living with HIV will be at the centre of the process as interviewers and interviewees and as drivers of how the information is collected, analysed and used.”6 It was designed to be a part of a process of empowerment for the interviewees and the interviewer in discussing the experiences of stigma and discrimination faced by them. The Sri Lanka research team reported how emotional and empowering certain interviews were, with both interviewee and interviewer breaking down over particularly difficult accounts of stigma. The empowerment came through the feeling that they were not alone, and that they had been given an opportunity to s peak of what had happened to them.

4 People Living with HIV Stigma Index – User Guide 2008, p.4 5 Ibid, p.9 6 Ibid

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METHODOLOGY questionnaire, and the associated forms and agreements that are METHODOLOGY administered as part of the interview process; the skills to conduct and record Following the 2008 regional consultation in Katmandu, the People Living with interviews with people living with HIV in their community using appropriate HIV Stigma Index methodology was introduced to South East Asia. Three methods; and guidance as to how one would reflect on the data that have representatives from Sri Lankan networks of people living with HIV attended been gathered during the interview process and be able to access the 9 this consultation and following their return, a National Partnership was formed necessary support from the team leader. The translated questionnaire was to coordinate implementationwhich included NSACP, UNAIDS, FPA, and further refined during this training programme along with the key related representatives of the networks. The National Research Consultant was then concepts. recruited for implementation under the guidance of the National Partnership. Respondents were randomly selected from the network memberships, and The Sri Lanka People Living with HIV Stigma Index was implemented in three also included those non-members who were in contact with the networks. phases. Phase I (June – September 2009) included selection and training of the Phase I included respondents from urban, provincial and rural communities Stigma Index research team, and completion of 60% of the interviews. Phase II with interviewers traveling as north as Anuradhapura, as south as Matara, and (November 2009 – March 2010) included completion of the remaining 40% of as east as Batticoloa. Phase II focused mainly on respondents from the interviews, data entry, analysis and reporting. Phase III (April to June 2010) Colombo and Kandy districts. included consultation with principle stakeholders on key findings and strategies moving forward in-country. Stigma Index guidelines ensured that interviewees were clear on the nature and scope of the interview, and provided verbal or written consent before 10 The People Living with HIV Stigma Index has clear guidelines as to the commencement. Interviewers also ensured that they worked together with 11 processes and procedures of the index. It was requested that the the interviewee (side-by-side-interviewing) to complete the questionnaire. questionnaire should not be changed or adapted in any way. This was Completed questionnaires were returned to the Team Leader for quality adhered to in Sri Lanka, and while there was provision to add sections, the review. This was followed by a debriefing to discuss interviewer experiences research team after consultation with people living with HIV decided it was during implementation. This proved significant in gathering qualitative data on adequate for Sri Lankan contexts, and pains were taken to accurately translate the overall Stigma Index process. it into both Sinhalese and Tamil. All interviewers were people living with HIV 7; the Sri Lankan interviewer team consisted of seven people living with HIV, Four Data entry and analysis was carried out using the recommended program Epi- women and three men. This included two native Tamil speakers (one man and Info developed by the Centre for Disease Control and Prevention (CDC). one woman). Interviewers were drawn from existing networks8 which Questionnaires are currently archived as per unique identifying codes and included Lanka+ (5 members) and Positive Hopes Alliance (2 members). We stored under lock and key by the Team Leader. Post data analysis a draft conducted a three-day training programme for interviewers at FPA Colombo report was prepared, discussed with the research team and then shared with to provide participants with an understanding of the history, rationale and the the National Partnership. Presentations on key findings in both English and partners involved in the People Living with HIV Stigma Index; an opportunity to Sinhalese were used for the respective consultations with the National consolidate their own understanding of the key concepts associated with HIV Partnership and positive network membership to discuss and plan future related stigma and discrimination, and to reflect on some of their own strategies using the Stigma Index as an advocacy tool. experiences of these; a thorough understanding of the content of the 9 Ibid, p. 59 10 “Get informed consent before the interview starts and make certain that the interviewee would 7 “Being interviewed by another person living with HIV does make a difference as you feel they genuinely like to be part of the process and is not just saying ‘yes’ because s/he feels pressurised really would understand more about how you feel about things related to being HIV positive.” – to do so.” – Researcher, Pilot Workshop, South Africa, Ibid, p.11 Researcher, Pilot Workshop, South Africa, Ibid 11 “Try to reduce the power imbalance between yourself and the interviewee by sitting alongside 8 “The process of implementing the index is intended to be an empowering one for people living the interviewee, and sharing information about some of the more difficult concepts with the with HIV, their networks, and local communities.” Ibid, inside front cover interviewee” – Researcher, Pilot Workshop, South Africa, Ibid, p.9

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WHO IS HIV POSITIVE IN SRI LANKA?

Who is HIV positive in Sri Lanka?

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The majority of the Stigma Index respondents were over the age of 35 with Respondent age (all) near equal distribution of sexes. They have been living with HIV for various periods, with only one respondent indicating living with HIV for more than 15 years.

The Stigma Index respondents were predominantly from low socio-economic strata with 63% of households earning below 1500 USD annually and another 8% indicating that they have no means of income. Only 1% of households earned more than 5000USD. Education levels are also low with 14% receiving no formal education; the bulk 46.5% managed only primary education and 34% attended secondary school. Only 5% of respondents received a technical college or university degree. This suggests that the low socio-economic levels of HIV positive people in Sri Lanka are linked with low education levels.

The research team confirms that low levels of education and economic status Respondent age (women) is common amongst network membership. It is also not clear if material or emotional support is the primary impetus to join a network, however the Stigma Index does provide evidence of dependence on the state for treatment. When asked to describe their problems and challenges with ART, over 70% of respondents spoke of their concerns of the government continuing with FREE ART, they discussed how they perceive it as their lifeline and, some spoke of the economic difficulties they faced in order to access these free services.

“I hope the government will continue with free ART, otherwise I will have no chance to live.”

“It is the duty of the government to continue Respondent age (men) with free ART for all of us.”

“Will the government provide free ART forever? I doubt, and then we will be the ones in trouble.”

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How long living with HIV (all) Respondent location

How long living with HIV (women) Annual household income

How long living with HIV (men) Education level

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Current employment status (all) “Thank God that the government provides free ART,

but it costs me a lot to travel to get it. But what to do?

If I don’t take it then I will die.”

What emerges from the Stigma Index is a group of HIV positive people that struggle economically and are dependent on the state and other actors for treatment, support and in some instances food and livelihood support.

“I hope the government will continue with free ART,

otherwise I will have no chance to live.” Current employment status (women)

“The Salvation Army used to give us food packets,

and now they have stopped that. It is very difficult for us to find food.”

“I make a little money selling cards, and now I am learning to make candles. This will help me find money to buy other medication I need.” Current employment status (men)

Evidence of dependence includes 13% who went hungry for up to 10 days in the month before they answered the questionnaire and their current employment status. The majority are unemployed, with only 8% who have retained fulltime employment.

Only 8% of respondents are in full-time employment

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Loss of employment has little association with HIV status (and this is indicative Do you belong to, or have you in the past belonged to, any of the following categories? of the secrecy and general non-disclosure of HIV status) and therefore poor levels of education, socio-economic status and also a largely provincial/rural locus may have roles to play in contributing to HIV status.

There emerges a stereotypical profile of HIV positive people in Sri Lanka. They are poor. They are uneducated. They are ignorant of the ways of the world.

Vulnerable key populations that are HIV positive include migrant workers (33%) with near equal distribution between men and women. The UNDP report ‘HIV Vulnerabilities of Migrant Women: from Asia to the Arab States’ states that “various reports assert that of all women living with HIV in Sri Lanka, 20 – 48 percent are returning migrants.”12 This report also discusses that none of the 15 HIV positive participants in the Sri Lankan study “had heard of the virus prior to contracting it, and nearly half were uncertain about how they could spread it.”13 During the dissemination of key findings to approximately 30 HIV positive people from three networks in Sri Lanka, every single member spoke of a link to migrant work. They were either migrant workers themselves, or had a spouse or partner who was a migrant worker.

The other vulnerable or key populations that emerged from the Stigma Index were men who have sex with men (10%); prisoners (8%); sex workers (6%) and injecting drug users (1%). This list is indicative of the negative HIV stereotype, also called most at risk populations from HIV. The public health perspective would argue that their increased risk is not due only to their potential to engage in risky behaviour but due to the stigma and discrimination that prevents them from accessing information and services that can help reduce the proclivity for risky behaviour.

12 HIV Vulnerabilities of Migrant Women: from Asia to the Arab States, p. 85 13 Ibid, p.86

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WHO IS HIV POSITIVE IN SRI LANKA?

Stigma and discrimination as a barrier to accessing HIV prevention information Relationship status (all) and services also includes those respondents who are married or have been in married relationships. 48.5% of respondents were either married or cohabiting with their partner.14 10% were divorced or separated, and 16% were widowed.

Still, even though the majority of HIV positive people have been within culturally normative relationships, the stereotypes that face stigma and discrimination in Sri Lanka remain. Once again, they are poor. They are uneducated. They are either ignorant of the ways of the world, or belong to communities that put themselves at risk; this includes married people that have “extramarital affairs” or “sex with prostitutes”. The Stigma Index will show that it is this approach of stereotypes and HIV in Sri Lanka that lends to the experiences of stigma and discrimination.

Do HIV positive people who belong to higher socio-economic groups exist? People who do not qualify as the stereotype? The research team speaks of how these individuals have avoided interaction with the networks, and also accessing free medication. This more affluent group accesses their medication from the private health sector either locally or regionally (India and Singapore) to ensure confidentiality of status. This information however is purely anecdotal. The Stigma Index records the experiences of only those who have had the courage to share.

Women Men

14 Given Sri Lanka’s cultural norms and mores, this statistic is more suggestive of individuals who are married rather than those cohabiting with unmarried partners. Only one instance of non- married partners cohabiting was reported during debriefing sessions.

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EXPERIENCES OF STIGMA & DISCRIMINATION

Experiences of Stigma & Discrimination

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This section is broken down into discussions around general experiences of of other HIV positive people. What is clear is that these patterns of non- stigma (including stigma in the workplace and educational settings) and stigma disclosure are the primary reason for recording low levels of experienced in healthcare settings. To set the context for discussing HIV positive people’s stigma through the Stigma Index. experience of stigma and discrimination in Sri Lanka, we have to first discuss their patterns on disclosure. Generall Experiiences

As indicated above due to non-disclosure of HIV status recorded levels of Descriptions of how (and if) I told Someone Someone They Not stigma and discrimination remain low. For example, exclusion from social and family and community learnt them else told else told don’t applicable religious gatherings, and family activities due to HIV status was as low as 10%, of respondents’ HIV status. them, them, know 3%, and 5% respectively. And only 5% were forced to change their place of WITH my WITHOUT my HIV consent my consent status residence due to HIV status. % % % % %

Your husband/wife/partner 39.4 12.1 4 9.1 40.4 In the last 12 months, how often have you been excluded from social Other adult family members 30.3 9.1 14.1 43.4 7.1 gatherings or activities? Children in your family 14.1 3 4 54.5 25.3 (Total number people who been excluded = 12) Your friends / neighbours 1 1 15.2 72.7 12.1 Other people living with HIV 75.8 8.1 5.1 10.1 6.1 People who you work with 2 0 5.1 57.6 36.4 Your employer(s) 0 0 2 37.4 62.6 Your clients 0 0 1 36.4 63.6 Injecting drug partners 0 0 0 1 99 Religious leaders 5.1 01 3 39.4 51.5 Community leaders 3 2 3 34.3 57.6 Health care workers 56.6 11.1 18.2 5.1 13.1 Social workers 8.1 7.1 4 26.3 54.5 Teachers 0 0 3 31.1 65.7 Government officials 4 0 7.1 29.3 59.6 The media 1 0 5.1 28.3 65.7

HIV positive people have found it easiest to share their status with other people living with HIV. This is indicative of the majority of respondents “If people in the village learn of my status belonging to networks in Sri Lanka. In terms of experiencing stigma and discrimination however, it is clear that respondents were not comfortable with I won't be able to walk on the road. friends, neighbours, co-workers, employers, and children finding out their Only my children know in the village.” status. In fact even spouses and other adult family members have not been the priority when disclosing HIV status. The research team reported that respondents requested interviews not at their homes or even the general vicinity, but at public places including bus stands, parks, tea shops, often after dark, to ensure that their families remained unaware of what was taking place. It is not clear whether disclosure has been difficult due to stigma and discrimination experienced directly or vicariously through anecdotal accounts

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Harrassmentt & Assaulltt 12% of respondents Notably, 12% felt they were verbally harassed and threatened in circumstances specifically related to their HIV status. And 5% were physically reported verbal harassment related to their HIV status assaulted based on their HIV status. Domestic abuse is under-reported in Sri Lanka15, and Sri Lankan culture shares the region’s traditional apathy towards domestic abuse and intimate partner violence. Four women and a man who live with HIV being assaulted by husbands or family members would not be 5% of respondents deemed unusual. In fact, the research team through discussion suggests that people would attempt to justify it based on punitive grounds, especially if the reported physical assault related to their HIV status individual is perceived to bring shame on the family due to their HIV status.

In the last 12 months, how often have you been verbally insulted, harassed and/or threatened? In the last 12 months, how often have you been physically harassed and/or threatened?

( Total number people who had some form of verbal harassment = 20) (Total number people who had some form of physical harassment = 7)

If so, was this…? If so, was this…?

15 “Most acts and consequences of violence remain hidden and unreported” - Dr. Lakshman Senanayke, co-author, National Report on Violence and Heath in Sri Lanka. http://www.sundayobserver.lk/2008/04/20/imp01.asp

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Emplloymentt & Educattiion In the last 12 months, how often have you lost your job (if employed) or another source Of the 11% that indicated they lost their job, the most significant reason that of income (if self-employed or an informal/casual worker)? emerged was poor health. Only 4% of respondents indicate they were refused a work opportunity due to their HIV status. (Total number people who had some form of income = 85)

No respondents reported being dismissed, suspended or prevented from attending educational institutions. This could be more reflective of the ages and educational levels of the respondents than it is of the lack of stigma and discrimination towards people living with HIV by educational institutions. Nevertheless, 3% of respondents indicated that due to their HIV status, their children had been dismissed, suspended or prevented from attending educational institutions.

Low levels of stigma and

discrimination in the Stigma Index If so, was this…?

are due to non-disclosure (Total number of people who lost their jobs or income = 24)

of HIV status

The bottom line remains: the reported low levels of stigma and discrimination in the Stigma Index are due to non-disclosure of HIV status.

However, if HIV positive people are reluctant or afraid to disclose their status, this is still an indicator of the high levels of stigma and discrimination they perceive or anticipate. To measure this perceived or anticipated stigma and discrimination by HIV positive people is difficult, yet the Stigma Index does include a section that asks respondents who have experienced stigma and discrimination on why they think people stigmatized or discriminated against them. Their answers indicate the need for a less deterrent approach to HIV prevention programming in Sri Lanka to which a pre-HAART 1980s, early 1990s ‘AIDS is a Death Sentence’ scare strategy is still central. It is a strategy that failed. It is a strategy that has proved to be an obstacle to HIV prevention, and a definite obstacle to HIV positive people accessing services.

Page 19 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

People are afraid of us. This fear is based on ignorance. People do not have accurate and comprehensive knowledge of HIV transmission. People are ashamed to be associated with me. I look sick. This insight into public perception is accurate and supported by personal accounts of research team members who have endured stigma and discrimination (related to casual transmission) even from non-HIV positive co-workers and colleagues working with them on HIV prevention education and support programmes.

These results are also indicative of how HIV positive people view themselves. “I look sick” is readily translated from “I am sick”, which in turn comes from the diagnosis “you are sick.” In a time when bug chasing16 – aberrant to most – remains a practice in environments where HIV is chronic and manageable, in a time when HIV, even in the developing world, if identified and treated, is a chronic and manageable condition, this focus on sickness needs revisiting. If the Stigma Index points to anything, it points to the need for positive living – how to live positive, productive and full lives with HIV – in Sri Lanka. Positive living that requires assistance and support from healthcare workers.

I f you have experienced some form of HIV-related sigma and/or discrimination i n the last 12 months, why do you think this is?

16 http://en.wikipedia.org/wiki/Bugchasing

Page 20 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

Stiigma iin Heallthcare Settiings Why were you tested for HIV?

This section is divided into 3 key areas: Testing & Diagnosis; Confidentiality & Disclosure; and Care & Support (including Reproductive Options).

Testtiing & Diiagnosiis The majority of Stigma Index respondents were tested without their knowledge. This includes 78% of those tested for employment, which emerged as the most common reason for testing. The report on HIV Vulnerabilities of Migrant Women gives us further insight: “Blood and urine tests (for HIV and pregnancy, respectively) are mandatory for legally migrating women prior to their departure. The test results are provided directly to the agents, and many of the interviewed women admitted to being in the dark about the nature of these tests.”17

Was the decision to get tested for HIV up to you?

The UNDP report on Migrant Workers together with 79% of Stigma Index respondents who reported that they received only post test counseling, indicates poor implementation of NSACP guiding principles. Section 3.2 of the National Strategic Plan 2007-2011 Respect for Human Rights clearly states: “HIV testing without prior informed consent is never acceptable (unless anonymous unlinked for screening purposes) and each HIV test result has to be confidential.”

“HIV testing without prior informed consent is never

acceptable (unless anonymous unlinked for screening purposes) and each HIV test result

has to be confidential.”

Section 3.2 of the National Strategic Plan 2007-2011

Respect for Human Rights

17 HIV Vulnerabilities of Migrant Women: from Asia to the Arab States, p. 86

Page 21 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

Did you receive counseling when you were tested for HIV? Conffiidenttiialliitty and Diiscllosurre

When Stigma Index respondents were asked to discuss problems and

challenges related to HIV testing and diagnosis, their main issues were around

confidentiality and disclosure. One respondent recorded:

“I am afraid that people will get to know about my status because hospital workers gossip.”

More than 65% of respondents echoed similar feelings through their written comments at the end of the questionnaire. This fear of being gossiped about is the primary fear HIV positive respondents had, and obviously will intensify when associated with healthcare workers who have accurate knowledge of their HIV status.

In the last 12 months, have you been fearful of any of the following things happening to you? 8% of Stigma Index respondents received no counseling either before or after testing positive. These are people who had to cope with their result based on their limited understanding of HIV, which they equated with a death sentence, given the prevalent strategies of prevention in Sri Lanka. They had to wait until their appointment with a healthcare professional for treatment to learn of life options after HIV.

Pre-test counseling prepares an individual for the HIV test. It allows for discussion of fears and doubts related to the test, and also mitigates the fear of receiving a death sentence. If correctly administered with discussions on lifestyle changes (regardless of the result) it can be an effective prevention tool and an opportunity for the test candidate to receive accurate and comprehensive information on living with HIV. Pre and post test counseling are the first steps in the continuum of care for a person living with HIV. Ignoring these first steps are a violation of human rights and a lost opportunity for both prevention and positive living.

8% of respondents received

no counseling whatsoever

Page 22 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

Furthermore, anecdotal evidence was offered by the research team and respondents on how their status was communicated by hospital workers to 64% of respondents their village or community resulting in ostracization, physical assault and damage to property. It is no surprise therefore that the Stigma Index results are not sure that their medical records will be kept confidential indicate that HIV positive people in Sri Lanka do not absolutely trust that their confidentiality is maintained by healthcare workers with 42% indicating they are not sure whether healthcare workers have disclosed their status, and 23% claiming they have actual knowledge of healthcare workers disclosing their 3% of respondents status without consent. Are certain that their records are definitely not confidential

Disclosure of HIV status by Healthcare Worker WITHOUT consent

In addition, 64% are not sure as to how confidential their medical records related to HIV status remain. With both these results the majority of respondents are ‘not sure’, a response that is indicative of the need for an improved relationship between healthcare workers and HIV positive people. If the healthcare sector is willing to listen to the concerns of the Stigma Index respondents and take steps to build trust and confidence, in the event the Stigma Index is conducted again these results of confidentiality and disclosure will improve.

“I am doubtful to the extent that my confidentiality is protected. I also don't think disclosure is an option. As soon as you disclose you are persecuted.”

Page 23 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

Carre and Supporrtt ((iinclludiing rreprroducttiive opttiions)) Access to Opportunistic Infection (OI) medication

The Stigma Index results show that there is a need for more comprehensive care and support in Sri Lanka. Almost 50% of respondents reported that they have had no discussions with healthcare professionals on HIV related treatment options. This is despite respondents reporting ready access to antiretroviral therapy.

Access to antiretroviral therapy (ART)

Care and support does not end with ART or treatment of opportunistic

infections. Positive living is about living full and productive lives as a HIV

positive person. Normalizing living with HIV medically includes discussing the

sexual and reproductive options of HIV positive people. ‘Healthy, Happy and

Hot: A young person’s guide to their Rights, Sexuality, and Living wi th HIV’ a

2010 publication by the International Planned Parenthood Federation states:

“Sexual and reproductive rights are recognized around the world as human

rights. Every person living with HIV is entitled to these rights and they are

necessary for the development and well-being of all people and societies in

which they live.”

To enjoy these rights HIV positive people need the support of the healthcare

sector. The Stigma Index results show that this support is still lacking and that

healthcare professionals will have to take steps in improving their interaction Access to ART and discussion around ART regimens including adherence with HIV positive people around their sexual and reproductive needs. For counseling is only part of the continuum of care, and treatment includes example, 56% of respondents have not discussed issues of sexual and medication for opportunistic infections. The research team reported that some reproductive health, sexual relationships and emotional well-being with respondents had verbally indicated that they didn’t understand what kind of appropriate healthcare professionals. medication they were taking for opportunistic infections (OI). The pills were described by colour not by name, and in the event they misplace or lose their 64% of respondents have however received specific counseling from medication they do not know what to buy at a pharmacy to continue with the Healthcare professionals on their reproductive options. The main objective of course of treatment. Furthermore, the contrast between access to ART and OI these counseling sessions appears to focus on dissuadi ng HIV positive people medication could also point the economic status of HIV positive people in Sri from having children. 44% reported that healthcare professionals have advised Lanka outlined above, given that OI medication is not always made available them NOT to have child after being diagnosed HIV positive. 9% speak of being by the state. coerced into not having children; and 8% reported that obtaining ART was

conditionally based on the use of some form of contraception and 4%

(women) indicated that they were coerced into terminating their pregnancy.

Page 24 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

49% of respondents

have not had a constructive discussion with a healthcare professional about

HIV-related treatment options

and only 56%

have had a constructive discussion with a healthcare professional about

sexual and reproductive health

Page 25 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA EXPERIENCES OF STIGMA & DISCRIMINATION

These results suggest violations of HIV positive people’s human rights as Only one respondent spoke vaguely of people’s rights to have children: outlined above by IPPF. The research team offered the following rationale for the reluctance of healthcare professionals in Sri Lanka to encourage HIV positive people to have children. “Everyone would like to have a child. It is children that help us live for the future. So there should be advice 1) People living with HIV are not economically in a position to support their and medication given to those who want to have treatment and have a child. 2) Limited access to required medical facilities including regular viral load children, even if they are HIV positive.” and CD4 testing.

The research team gleaned this information through discussion with If healthcare professionals do not support positive living in Sri Lanka, positive healthcare professionals in Sri Lanka. They were unwilling to accept that living interventions will fail. The positive networks and other civil society healthcare professionals could have been unaware of reproductive options organisations that work with HIV positive people need to garner the support of available to people living with HIV. “How could they not know? They are the healthcare sector. Talk of rights and policies and laws is futile if healthcare doctors.” They did admit however that there is rarely a discussion with the HIV professionals, who are perceived as the source of knowledge on life after HIV positive client on reproductive options. If the subject is broached the response are not in agreement that HIV positive people can clinically live productive and of the healthcare professional is often imperative: It is not suitable for HIV full lives. The next section demonstrates that the decisions that HIV positive positive people to have children! people make are based on their experiences of stigma and discrimination, and on information that is available to them on life after HIV. Healthcare professionals approach to reproductive options of people living with HIV has had its desired effect. In the written responses by respondents on the problems and challenges with regard to having children, over 77% have indicated that it is NOT SUITABLE for HIV positive people to have children. In 64% of the responses no additional reasons were proffered. The rest spoke of difficulties associated with costs of treatment, mortality of infants, longevity of parents who live with HIV, and passing on the ‘sin.’

“It is not suitable to have children in my view because we don’t know how long our health will remain like this and after that who will look after our children.”

“Why do we want to pass this sin on to our children? It is better that we don’t have children.”

Page 26 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA

STIGMA INTERNALIZED: FEELINGS AND DECISIONS OF HIV POSITIVE PEOPLE Stigma Internalised:

feelings & decisions of HIV positive people

Page 27 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA STIGMA INTERNALISED: FEELINGS & DECISIONS

Internalized stigma appears closely associated with stereotypical behaviour immediately position people already living with HIV outside of these cultural that can result in HIV infection (“extramarital affairs” or “sex with values. This again can lend to feelings of shame, guilt and self-blame, despite prostitutes”); the fear of disclosure linked to being gossiped about and so being housewives who remained faithful to their husbands and still became excluded by family, friends, and community, not to mention the loss of HIV positive. The results of ‘blaming others’ is an indicator of how some employment; the information available on living with HIV and the dependence women feel they have remained faithful to their partners, with no record of on the government healthcare system. any men blaming anyone but themselves for getting infected.

F EELINGS: In the last 12 months, have you experienced any of the following Furthermore, 32% of respondents who have reported suicidal feelings show f eelings because of your HIV status? that Sri Lanka cannot afford to ignore people already living with HIV.

32% of respondents experienced

suicidal feelings

because of their HIV status

As suggested, feelings of internal stigma also have a clear impact on life decisions. These results however also appear to be influenced by information they have received from healthcare professionals, and stigma and discrimination that they have experienced.

Stigma Index results show that shame (54%) and guilt (51%) are the most prevalent feelings of both male and female respondents. This is closely followed by self-blame (43%). It is possible, as discussed above that these feelings are exacerbated by the stereotypical behaviours associated with HIV which include unprotected extra-marital sex with female and/or male partner(s); unprotected sex before marriage with female and/or male partner(s); unprotected sex with female and/or male sex worker(s); and injecting drug use. Also media reports, typically around World AIDS Day, where Sri Lanka’s low prevalence is often associated with strong cultural values18

18 Former Minister of Healthcare and Nutrition, Nimal Siripala de Silva’s rationale for Sri Lanka’s low HIV prevalence rate: high literacy rate and strong cultural roots. http://www.dailynews.lk/2009/12/01/news23.asp

Page 28 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA STIGMA INTERNALISED: FEELINGS & DECISIONS

Decisions around sexual and reproductive health are the most pronounced with 77% deciding against having children; 45% not intending to get married; 77% of respondents decided and 37% deciding not to have sex again. While there could be multiple drivers as outlined for these decisions around sexual and reproductive health, the decision not to attend clinics or hospitals even when in need points to experiences of stigma and discrimination within healthcare settings. not to have children

The findings of feelings and decisions in Sri Lanka call once again for a because of their HIV status comprehensive positive living intervention that equips HIV positive people in Sri Lanka with the skills they require to live after being diagnosed with HIV.

The continuum of care is incomplete, and at best reserved only to ART and treatment of OIs. Sri Lanka needs a more holistic approach if HIV positive people are to live with the dignity and rights they deserve, and are to be advocates for prevention.

D ECISIONS: In the last 12 months, have you done any of the following things % of respondents because of your HIV status? 37

are intending not to have sex again

56% of respondents are intending not to get married

Page 29 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA STIGMA INTERNALISED: FEELINGS & DECISIONS

Riights,, Laws,, and Polliiciies HIV positive people can find legal recourse. And given that violations continue to occur, as we wait for national policies to be reviewed and adopted, existing Knowledge of laws and policies was poor, and this was predictable. The Stigma laws and policies along with legal teams willing to represent HIV positive Index guidelines suggested we insert the best known national law/policy or set people need to be identified, and this information needs to be disseminated of guidelines, but Sri Lanka has no laws or policies specifically related to HIV. across the positive networks. The best we could manage was the National Strategic Plan 2007-2011 produced by NSACP, that discusses the need for a policy. 87% of respondents had never heard of it, and only 5% claim to have ever read or discussed it. None of the respondents had ever heard of the Declaration of Commitment on HIV/AIDS made by the General Assembly of the United Nati ons.

87% of respondents

have never heard of the National Strategic Plan 2007-2011 prepared by NSACP

Only 5% of respondents

have ever read it or discussed it

13% of respondents claimed that they had their rights abused, but only 38% of these (5 respondents) attempted to get legal redress, of which 3 respondents indicated that nothing happened and 2 claimed that the matter was still being dealt with. The research team in discussing issues around laws and policies spoke of how HIV positive people have had poor experiences with HIV and law. They also underlined that people had no confidence in the system and were afraid of being subject to further stigma and discrimination in seeking legal redress for violation of their rights.

If the Stigma Index is to be implemented in the future, we need to consider including knowledge of basic rights, and existing laws and policies under which

Page 30 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA STIGMA INTERNALISED: FEELINGS & DECISIONS

Effectiing Change Recommendations for action This section in the Stigma Index discusses how HIV positive people can participate in effecting change in their communities. In Sri Lanka the main obstacle to effecting change is the fear of disclosure and related fears of stigma and discrimination. People are not willing to come forward and be identified as HIV positive. Only certain leaders of the networks do. And while the HIV positive community does feel that they have a stake in effecting change either through policy (5%) or through working on HIV prevention programmes (17%), 47% feel they have no power to influence any decision related to the community, and prefer to remain silent.

Still, the community, as represented by the Stigma Index respondents, does have recommendations for the HIV industry (Government, Multilaterals, Bi - laterals, INGOs, HIV Business Coalitions, NGOs, and CBOs). Their need assessment is as follows (as discussed with the research team):

. Advocate for our rights, include the rights of marginalized (key) populations. . We want support, give us skills, jobs, dignity; we don’t want handouts. . Conduct HIV awareness for the public, giving accurate and comprehensive knowledge so that people are no longer scared of us and stop stigmatizing and discriminating against us. . Teach us how to live with HIV; we don’t want to be scared of it any longer.

“An HIV test is very important. Although I got infected, I now know how to protect my wife when we have sex.”

“Treatment is available free and this is a good thing. But we need to ensure that we know to take it without breaking the regime.”

Page 31 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA

RECOMMENDATIONS

Recommendations

Page 32 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA RECOMMENDATIONS

RECOMMENDATIONS

. Ensure the rights and confidentiality of potential migrant workers in Need for Riights,, Law and Polliicy relation to voluntary counseling and testing (Ministry of External Affairs). . Strengthen & increase healthcare professionals’ knowledge on the sexual Goverrnmentt off Srrii Lanka and reproductive rights of people living with HIV (NSACP) . Document the legal and rights violations of people living with HIV in Sri Lanka (Human Rights Commission). Devellopmentt Parrttnerrs . Consider the need for specific law to protect the rights of people living . Advocate for consistent Voluntary Confidential Counseling and Testing with HIV (Ministry of Justice & Law Reform). practices across both government and private sector health care fa cilities; . Establish legal aid services for people living with HIV that include expertise including private health care facilities for migrant workers (UN System). on inheritance property rights, discrimination within healthcare settings . Advocate for consistent approaches across the HIV continuum of care19 and wrongful dismissal under existing laws and policies. (UN System).

Devellopmentt Parrttnerrs Ciiviill Sociietty Orrganiizattiions . Advocate with the Government of Sri Lanka for law and policy reform . Develop strategies to increase knowledge on rights and practices in related to the rights of people living with HIV (UN System). relation to voluntary confidential counseling and testing services. . Convene joint government and civil society forums to highlight and share . Develop strategies to increase knowledge on sexual and reproductive experiences of good practices globally and regionally in relation to the rights of people living with HIV. rights, laws and policies around HIV (UN System). . Strengthen partnerships and referral systems with government and private sector healthcare service providers to encourage a more holistic Ciiviill Sociietty Orrganiizattiions approach to care and support of people living with HIV. . Document experiences of people living with HIV and advocate with the Government of Sri Lanka for their rights. HIIV Preventiion Programmiing . Strengthen partnerships and referral systems with government and civil Goverrnmentt off Srrii Lanka society agencies that provide legal aid services to people living with HIV. . Develop more effective information, education and communication . Ensure immediate cessation of ‘fear-based’ HIV prevention approaches approaches around existing laws, policies and services so that people and ensure that future prevention messaging does not contribute to living with HIV know and understand their rights and seek legal redress in stigma and discrimination of people living with HIV (NSACP). the event their rights are violated. . Develop guidelines for HIV prevention programming, including IEC/BCC in partnership with people living with HIV to ensure sensitive approaches to Refllectiions on Heallth Sector Best Practiices HIV prevention programming (NSACP). . Ensure that a regulatory mechanism is put in place in partnership with Goverrnmentt off Srrii Lanka Civil Society Organisations to monitor and evaluate HIV prevention . Convene an extraordinary meeting of the National AIDS Committee to programming (NSACP). share the results of the Stigma Index and provide a forum for discussion on recommendations (NSACP). . Establish a consultative mechanism to regularly review the continuum of care for people living with HIV (NSACP). 19 Development of relevant IEC/BCC methodology; provision of condoms; STI management; . Strengthen capacity of healthcare professionals in policy and practice voluntary confidential counselling and testing; prevention of parent to child transmission; relating to rights, confidentiality and testing (NSACP). psychosocial support and counselling; treatment and management of opportunistic infections; provision of ART incl. adherence counselling; and palliative care or HIV end stage management.

Page 33 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA RECOMMENDATIONS

Devellopmentt Parrttnerrs Ciiviill Sociietty Orrganiizattiions . Advocate for minimum standards in relation to HIV prevention . Improve the outreach and services in meeting the needs of people living programming (UN System). with HIV and integrating HIV with sexual and reproductive health services. . Convene government and Civil Society forums to share good practices in . Involve people living with HIV in HIV prevention programming and HIV HIV prevention programming both regionally and globally (UN System). related services.

Ciiviill Sociietty Orrganiizattiions Peoplle Liiviing wiitth HIIV . Ensure immediate cessation of ‘fear-based’ HIV prevention approaches . Strengthen the partnerships between different networks of people living and ensure that future prevention messaging does not contribute to with HIV to advocate as ONE VOICE for the rights and needs of ALL people stigma and discrimination of people living with HIV. living with HIV. . Advocate with the government for minimum standards in relation to HIV . Engage in self-evaluation of strategies and programmes thus far prevention programming. conducted by the networks of people living with HIV to identify good . Develop HIV prevention strategies, including IEC/BCC in consultation with practices that can be replicated and areas where further capacity building people living with HIV to ensure sensitive approaches to HIV prevention is required. programming.

Greater IInvollvement of Peoplle Liiviing wiith HIIV “Due to the fear of HIV people are unwilling to come Goverrnmentt off Srrii Lanka forward to get tested. We need awareness . Ensure that people living with HIV are actively engaged in the all over Sri Lanka to dispel this ignorance.” development of the next National Strategy on HIV and AIDS (NSACP). . Develop specific psychosocial counseling and support programmes for people living with HIV (NSACP). . Develop a partner/family HIV counseling and testing programme (NSACP). . Implement the Stigma Index every 2-3 years as a national monitoring tool in terms of measuring country progress in order to reduce stigma and discrimination (NSACP).

Devellopmentt Parrttnerrs . Advocate for the greater involvement of people living with HIV in development of strategic plans and policies related to HIV (UN System). . Support people living with HIV to gain the skills in order to more fully participate in NAC working groups and other planning forums (UN System). . Support training of people living with HIV in the development of a framework for positive health, dignity and prevention (UN System).

Page 34 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA

TAB 7

People Living With HIV Stigma Index – Sri Lanka November 2010 www.stigmaindex.org Design and layout by Grassroots Development Consultants www.grassrooted.net Page 35 of 35 PEOPLE LIVING WITH HIV STIGMA INDEX – SRI LANKA Original photo by z6p6tist6 5. Improve support and care for key populations and people living with HIV 2. Service provision including Screening, Testing and Counselling • Reactivate and strengthen the Legal and Ethics Subcommittee of the National AIDS • Adapt the “Time Has Come” training package to the local context for local and national Committee to examine the rights and welfare of people living with HIV and other key level health training curriculum to reduce stigma in healthcare settings. populations in order to effectively respond to rights violations experienced. • Introduce a process of quality assurance and certification of HIV testing in the private • Strengthen the Comprehensive Guideline on Management of HIV/AIDS through the sectors and Gulf Cooperation Council Approved Medical Centers Association clinics introduction of elements of psycho-social counselling to reduce the impact of psy by the National STD/AIDS Control Programme. chosocial distress among key populations.

3. Furthering Recognition of Human Rights of People Living with HIV 6. Further strengthen efforts concerning transmission of HIV through blood and Other Key Populations and Legal Reform: and blood products ASSESSMENT OF • Take advantage of the current opportunities for constitutional and legal reform and • Secure the Government of Sri Lanka’s commitment through the approval of the ensure the Supremacy of the Constitution and broaden the Bill of Rights to include National Blood Transfusion Act, which would include guidelines for testing of blood at THE LEGAL AND POLICY the rights to life, health, privacy, non-discrimination on the grounds of HIV status and blood banks. sexual orientation and gender identity, and right of patients; • Require all private hospitals to register with the National Blood Transfusion Services • Repeal and/or amend existing legislation, including section 365, 365A and 399 of the and be monitored by the Blood Transfusion Monitoring Committee. ENVIRONMENT FOR HIV Penal Code, the Vagrants Ordinance and Brothel Ordinance, to ensure that the existing legislation is not used discriminatorily and arbitrarily against key populations IN SRI LANKA including sexual orientation and gender minorities and develop corresponding SOPs PRELIMINARY FINDINGS for implementation to guarantee the equitable application of laws; • Provide gender appropriate citizenship documents reflecting the preferred gender of the requesting person without any prior judicial or medical approval, in addition to the development of a clear, simple and uniformly applied supporting legal framework 1 The Government of Sri Lanka outlined its commitments to the HIV response in the National HIV/AIDS Policy. Specifically Section 3.11 on human rights states that “[t]he Government of Sri Lanka will ensure that the human rights of people living with HIV are promoted, necessary to implement this law in accordance with international laws and standards. protected and respected and measures taken to eliminate discrimination and combat stigma which will provide an enabling • Further develop training modules through a consultative process to effectively combat environment to seek relevant services.” This commitment was made prior to the August 2015 parliamentary elections. To date 28 ESCAP members and associate member States within the Asia and the Pacific region have “initiated the review and/or stigma, discrimination and other rights-based violations from law enforcement consultation on legal and policy barriers to HIV responses.” UNESCAP, “National Reviews and Multisectoral Consultations on Policy personnel and healthcare workers on 1) law and human rights, 2) ethical professional and Legal Barriers to Effective HIV Responses,” 19 June 2015. Available from http://www.unescap.org/resources/national-re views-and-multisectoral-consultations-policy-and-legal-barriers-effective-hiv. DRIVERS AND MANIFESTATIONS/ practice, 3) public health issues and key populations, and 4) sexual orientation and 2 IMPACTS OF To date 28 ESCAP members and associate member States within the Asia and the Pacific region have “initiated the review and/or FACILITATORS OF OUTCOMES OF gender. consultation on legal and policy barriers to HIV responses.” UNESCAP, “National Reviews and Multisectoral Consultations on Policy HIV-RELATED HIV-RELATED HIV-RELATED • Enact internal non-discrimination and non-harassment policies for law enforcement and Legal Barriers to Effective HIV Responses,” 19 June 2015. Available from http://www.unescap.org/resources/national-re DISCRIMINATION views-and-multisectoral-consultations-policy-and-legal-barriers-effective-hiv. DISCRIMINATION DISCRIMINATION and health departments that protect key populations, specifically people living with HIV 3 The review included Key Informant Interviews and Focus Group Discussions to ensure that the opinions and views of the and sexual orientation and gender minorities. These policies should be created in line communities, government ministries, civil society organizations and national AIDS Programmes were heard and included. 4 Strategic Information Management Unit NSACP 2015. with community and individual feedback. 5 Ibid 11. • Create and implement Standard Operating Procedures (SOPs) for law enforcement 6 Ibid 14. 7 Report on the Technical Committee on Reversing the HIV Epidemic, NSACP February 2014. agencies to address issues that arise when interacting with key populations. These 8 Annual Report of the NSACP 2014/2015. SOPs should be informed by community input and individuals directly impacted by 9 National Dangerous Drugs Control Board. 2014. Stigma and prejudice, Denial of health care Poor uptake of 10 National STD/AIDS Control Programme (2015) Annual Report 2015, Ministry of Health Sri Lanka & National STD/AIDS Control Programme. social and cultural beliefs HIV testing discriminatory policing. 11 International guidelines and standards recognize prisoners, transgender people and all sex workers as key populations. • Support efforts to assist community organizations to unite in establishing a common 12 Report of the External Review of the response to HIV and STI in Sri Lanka 2011. 13 advocacy platform. IBBS 2015, IBBS 2014, the People Living with HIV Stigma Index 2010, Exploratory study on the impact of HIV positivity on psychosocial aspects of people living with HIV) and their family members in Sri Lanka (2011), SAARC Situation Assessment of Women and Fear and lack of access to Poor quality of care Losses to follow-up at Children infected and affected by HIV/AIDS in Sri Lanka. means of protection all stages of treatment 14 For example despite Chapter III of the Constitution of Sri Lanka providing for fundamental human rights, it is not the supreme law of 4. Reducing sexual transmission of HIV the land. Unlike many constitutions, the Sri Lankan constitution does not contain a supremacy clause. Instead, Article 16(1) of the cascades • Ensure greater coverage of adolescents through implementing the Healthy Sexuality current Constitution provides, “[a]ll existing written law and unwritten law shall be valid and operative notwithstanding any component of the Essential Sexual and Reproductive Health Package. inconsistency with the preceding provisions of this Chapter. The failure to enshrine the supremacy of the Constitution results in the Legal, regulatory and Forced sterilization inability to legally challenge legislation that is incompatible or inconsistent with the fundamental rights provisions of the Constitution, policy barriers • Access to HIV testing should be provided for adolescents (recognizing the age of including the sections 365, 365A and 399 of the Penal Code, the Vagrants Ordinance and the Brothels Ordinance, in addition to Poor health outcomes discretion, 16 years of age). other of legislation either facially or as applied. The current Constitution does not include the right to privacy, the right to dignity, the • right to security of the person, the right to work, the right to education, among others. The Constitution of Sri Lanka provides for the Continued advocacy work with the Ministry of Education and related institutions to freedom of thought, conscience and religion; freedom from torture; right to equality; freedom from arrest, detention and punishment; Impunity and lack of Disrespect and abuse implement age appropriate and culturally sensitive, comprehensive sexuality freedom of speech, assembly, association, occupation and movement; right of access to information; and the remedy for the mechanisms of redress infringement of fundamental rights by executive or administrative action (only). education in secondary schools to address sexual health risks for adolescents and 15 See generally sections 365, 365A and 399 of the Penal Code, the Vagrants Ordinance and the Brothels Ordinance. young people. Healthy Policy Project, Asia Pacific Transgender Network, United Nations Development Programme. 2015. Blueprint for the Provision • Increase awareness of STIs among all sexually active populations and publicize the of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific. Washington, DC: Futures Group, Health Policy Project. availability of high quality services in the state health sector through mass media. 16 Healthy Policy Project, Asia Pacific Transgender Network, United Nations Development Programme. 2015. Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific. Washington, DC: Futures Group, Health Source: UNAIDS, Agenda for Zero Discrimination in Health Care Policy Project.

1. Strengthening the National HIV/AIDS Policy • Strengthen the National AIDS Committee to general political commitment to support and direct the national HIV prevention responses; • Ensure greater commitment and facilitate policy coherence of all sectoral partners, including clarification of the roles and responsibilities; • Enhance gender responsiveness by including a dedicated strategy for women to enable a response to the unique HIV-related risks for women and complement the relief measures provided through the Prevention of Domestic Violence Act, in addition to ensuring the representation of the Ministry of Women and Child Development in the National AIDS Committee; • Engage in further epidemiological studies to determine whether the definition of key populations as currently used the National STD/AIDS Control Programme (NSACP) and NSP should be amended to include additional populations that may currently be hidden or under-reported. 5. Improve support and care for key populations and people living with HIV 2. Service provision including Screening, Testing and Counselling • Reactivate and strengthen the Legal and Ethics Subcommittee of the National AIDS • Adapt the “Time Has Come” training package to the local context for local and national Committee to examine the rights and welfare of people living with HIV and other key level health training curriculum to reduce stigma in healthcare settings. populations in order to effectively respond to rights violations experienced. • Introduce a process of quality assurance and certification of HIV testing in the private • Strengthen the Comprehensive Guideline on Management of HIV/AIDS through the sectors and Gulf Cooperation Council Approved Medical Centers Association clinics introduction of elements of psycho-social counselling to reduce the impact of psy by the National STD/AIDS Control Programme. chosocial distress among key populations.

4. Reducing sexual transmission of HIV • Ensure greater coverage of adolescents through implementing the Healthy Sexuality component of the Essential Sexual and Reproductive Health Package. • Access to HIV testing should be provided for adolescents (recognizing the age of discretion, 16 years of age). • Continued advocacy work with the Ministry of Education and related institutions to implement age appropriate and culturally sensitive, comprehensive sexuality education in secondary schools to address sexual health risks for adolescents and young people. • Increase awareness of STIs among all sexually active populations and publicize the availability of high quality services in the state health sector through mass media.

INTRODUCTION KEY FINDINGS IN SRI LANKA KEY RECOMMENDATIONS

In the 2011 Political Declaration: Intensifying our Efforts to Eliminate HIV/AIDS, governments, Strong and effective health sector leadership a sex worker or as a person who injects including Sri Lanka, committed to review laws and policies that directly and indirectly has enabled the maintenance of the prevailing drugs was also found and was reported to 1. Strengthening the National HIV/AIDS Policy • Strengthen the National AIDS Committee to general political commitment to support affect access of people living with and affected by HIV to health and HIV services. This low epidemic status for almost three decades. hinder access by members of these groups and direct the national HIV prevention responses; was further reinforced in ESCAP Resolutions 66/10 and 67/9 and the agreed Regional The adoption of integrated service delivery to HIV prevention and treatment services. • Ensure greater commitment and facilitate policy coherence of all sectoral partners, Framework for Implementation of the Political Declaration, which pledged to conduct 1) led to HIV being integrated with on-going Third, the scan revealed a weak legal including clarification of the roles and responsibilities; national reviews on policy and legal barriers and 2) national multi-sectoral consultations STI services and more recently, Sexual and environment for the full realization of human • Enhance gender responsiveness by including a dedicated strategy for women to to assess progress in meeting the commitments in the Political Declaration and ESCAP Reproductive Health components namely rights and fundamental freedoms for all, enable a response to the unique HIV-related risks for women and complement the Resolutions 66/10 and 67/9.1,2 During 2015, Family Planning Association of Sri Lanka family planning counseling and commodities which is an essential element in the HIV relief measures provided through the Prevention of Domestic Violence Act, in addition organized a team of legal and public health experts to review laws, regulations and being incorporated into STI/HIV services. response. Part of this included identified to ensuring the representation of the Ministry of Women and Child Development in the policies impacting the HIV response in Sri Lanka towards creating a more enabling legal STI/HIV clinics provide a comprehensive gaps in the current provisions in the National AIDS Committee; environments for people living with HIV and key populations at higher risk.3 The review range of services including free of cost Constitution.14 HIV is not specifically listed • Engage in further epidemiological studies to determine whether the definition of key provides a set of concrete recommendations to assist individuals and organizations in Sri including aetiologic management of STIs, as a protected grounds for non-discrimination populations as currently used the National STD/AIDS Control Programme (NSACP) Lanka to work together on advocacy priorities for removing the legal and policy barriers HIV testing, antiretroviral treatment and in the Constitution, nor is there specific HIV and NSP should be amended to include additional populations that may currently that prevent key populations from the full realization and enjoyment of their fundamental related investigations, condoms, cervical legislation in Sri Lanka. Due to the continued be hidden or under-reported. rights, including the right to the highest attainable standard of physical and mental health cancer screening and referral or other low HIV prevalence status of the country, in relation to access to HIV prevention, treatment and care. services as required. Moreover Sri Lanka the need for a HIV specific legislation has adopted the Joint Strategy for the Elimination not been viewed as a pressing concern for of Mother to Child Transmission and the government. Additionally there are a Congenital Syphilis (2014-2017) and is number of punitive or coercive provisions in aiming to achieve the elimination of mother the law, which create barriers to the response to child transmission in 2017. to HIV. For example, the penal code provisions EPIDEMIOLOGICAL BACKGROUND that criminalize same-sex relations and the However despite the progress, this scan Vagrants and Brothel Ordinances are used 9 Currently Sri Lanka is categorized as a low remain low (1 percent) at present. identified a number of on-going challenges to criminalize aspects of sex work and level HIV epidemic country based on an Between 2009 and 2013, the number of relating to HIV, law, policy and human result in making access to services for key Judiciary estimated HIV prevalence among adults people reported to be HIV positive in each 15 rights in Sri Lanka. First, there are a number populations more difficult. Development Media (15 to 49 years of age) of less than 0.1 quarter doubled with a gradually increasing of key populations who have been shown to partners 4 percent. At the end of December 2014, a trend in male to male transmission, including be at higher risk of HIV exposure and/or to Fourth, access to law enforcement and cumulative total of 2,074 HIV cases and a among male bisexuals, has emerged with experience the impact of HIV more severely. justice for human rights violations is limited. cumulative total of 548 AIDS cases was a concomitant decline in heterosexual The National HIV/AIDS Policy recognizes Despite certain legal provisions for access 10 reported based on confirmed serological transmission. the following as key population groups: to justice and redress in Sri Lanka, punitive testing of samples received from state and female sex workers, men who have sex with laws and policies further entrench the 5 Civil society Policy makers private health sector institution. Among men, people who use drugs, people who feelings of inequality, stigma and HIV cases reported in 2014, 76 percent inject drugs and beach boys.11 Other discrimination resulting in a lack of trust in were 25 to 49 years of age, and 6.3 populations that were identified to be more authorities due to actual or perceived 6 percent were 15 to 49 years of age. The vulnerable to HIV include women, children, stigma and discrimination being attached HIV prevalence rate in the 15 to 49 age youth, migrant workers, armed forces to identification as part of a key population, Academia Healthcare group was less than 0.1 percent. Between personnel, prisoners and police personnel. the criminal laws targeting key populations, 2009 and 2013, new infections among Prisons and correctional facilities are and inaction or violence from state actors, Key populations youth between 15 to 24 years of age, recognized as high risk environments including police.16 Moreover these laws and (considered as proxy for HIV incidence) where drugs, and unsafe sex is common.12 policies can contribute to an increase in the 7 increased by 92 percent. The cumulative acceptability and prevalence in harassment proportion of prenatally acquired infections Second, HIV-related stigma and discrimination and violence against key populations, in (children less than 15 years of age) is 3 was found and was reported to exacerbate addition to reinforcing self-stigma, which 8 percent. No HIV cases have been reported the negative impact of HIV.13 In addition, reduces access to key programs and In order for the recommendations to be implemented and contribute to creation of an due to blood transfusion since 2000, and stigma and discrimination on the basis of services.17 enabling legal and policy environment, there is a need for a holistic approach involving HIV among injecting drug users appear to sexual orientation or on the basis of being multiple interdependent actors and stakeholders.

TAB 8

HUMAN “All Five Fingers Are Not the Same” RIGHTS Discrimination on Grounds of Gender Identity WATCH and Sexual Orientation in Sri Lanka

This in turn can have serious social and health implications, including inhibiting access to HIV prevention and treatment: Sri Lankan health agencies have identified transgender people and MSM as key populations in addressing the HIV epidemic.3

Social standing plays a significant role in the discrimination that LGBTI people face: those who are poor, who engage in sex work, or who obviously do not adhere to rigid gender norms are most vulnerable to abuse, including physical assault or arrest.

***

Sri Lanka has been in the midst of constitutional reform since a new government took office following the electoral defeat of Mahinda Rajapaksa in 2015. This presents an opportunity to expressly incorporate gender identity and sexual orientation into the constitution’s equal protection clause, and other fundamental rights protected under international law that are currently absent from constitutional text, including the rights to life, health, and privacy.

Sri Lanka’s parliament should urgently repeal criminal law provisions that criminalize same-sex sexual relations. Police need sensitivity training and clear guidance on their duty to respect the rights of all people regardless of their gender expression, gender identity, or sexual orientation, and they should be held accountable when they fail to uphold these rights. Doctors, nurses, other medical practitioners, and support staff in the health system need better training, guidelines, and accountability systems to uphold the right to the highest attainable standard of health for LGBTI people in Sri Lanka.

It is the government’s responsibility to ensure the safety of all people within its borders, including by more effectively addressing the violence and insecurity that lesbian, gay, bisexual, transgender, and intersex people face. Authorities need to send an unambiguous message to law enforcement officials as well as ordinary citizens that all Sri Lankans,

3 National STD/AIDS Control Programme, “National Response to HIV/AIDS and Sexually Transmitted Infections in Sri Lanka: Mid Term Review 2013-2017 National Strategic Plan,” January/February 2015, http://www.aidscontrol.gov.lk/web/images/web_uploads/Guidelines_Reports_Publications/2015%20Mid%20Term%20Rev iew%20Report%20of%20the%20Sri%20Lankan%20National%20Strategic%20Plan%20for%202013-2017.pdf (noting the “gradual development of prevention services for key populations” and that “[p]rogrammes addressing sex workers, men who have sex with men and transgendered people, and drug users are now in place.”) (accessed July 20, 2016).

“ALL FIVE FINGERS ARE NOT THE SAME” 4

Transgender people are particularly vulnerable to abuse when they begin to adopt a gender expression that aligns with their preferred gender—a time when they are likely to behave and appear in ways that do not conform to social expectations based on their assigned sex. Fathima, a 25-year-old transgender woman in Colombo, said that after she started growing her hair, her family and people in her village told her she needed to behave like a man if she wanted to live there.11 Eshan, a 37-year-old transgender man in Colombo, said his manager at work pressured him to resign after he began to transition from female to male.12

Other LGBTI people also said they were singled out for not conforming to norms related to appearance. Maneesha, a 26-year-old lesbian in Colombo, said: “Whenever people see someone like us, they get uncomfortable.”13 She said that people in public places openly debate whether she and her gender non-conforming lesbian friends are men or women.14 Maneesha said that when she had short hair, using public washrooms was a “nightmare” because other women, mistaking her for a man, would stop her entering or ask her to leave15—a scenario echoed by other lesbians.16

Social and cultural prejudice against homosexuality and gender non-conformity is underpinned by inadequate sexual education in schools, and routinely finds expression in mainstream and social media, as the UN Development Program and others have documented.17 Dr. Kapila Ranasinghe, a psychiatrist who has worked with transgender people as well as with gay, lesbian, bisexual and intersex people since 2007, said: “Media stigmatize horribly through articles and editorials about sexual minority groups, demonizing these individuals, and misinforming society about medical issues.”18

11 Human Rights Watch interview with Fathima (pseudonym), Colombo, November 3, 2015. 12 Human Rights Watch interview with Eshan (pseudonym), Colombo, October 26, 2015. 13 Human Rights Watch interview with Maneesha (pseudonym), Colombo, January 23, 2016. 14 Ibid. 15 Ibid. 16 Human Rights Watch interview with Vindya (pseudonym), Colombo, January 23, 2016. 17 A 2013 UN Development Program (UNDP) study on coverage of HIV in Sri Lankan media found that media “perpetuates and promotes” a number of homophobic and transphobic “grand narratives,” including that: “[H]omosexuality and transsexuality are dangerous; they threaten the long-standing Buddhist culture of Sri Lanka; and they represent a ‘pariah’ western culture that is perverted. Homosexuality is a mask for paedophilia, involves older Caucasian men ‘preying’ on young innocent boys and is an illness that can be treated with bizarre cures.” See UNDP, Stigma, Discrimination and Key Affected Populations: Strengthening the Role of Media Advocacy in Sri Lanka through a Critical Analysis of News Media Coverage, 2013, http://www.snap-undp.org/elibrary/Publications/HIV-2013-stigma-discrimination-and-kaps.pdf (accessed April 9, 2016). 18 Human Rights Watch interview with Dr. Kapila Ranasinghe, Colombo, November 16, 2015.

“ALL FIVE FINGERS ARE NOT THE SAME” 12

For example, one 2011 editorial titled “MSM to lead HIV/AIDS in Sri Lanka by 2015,” used the high HIV prevalence among men who have sex with men in Sri Lanka to argue against equal rights for gays and lesbians:

[I]t is pathetic to see that most of [the homosexuals and lesbians and their organisations] are busy fighting for their “rights” and promoting their sexual preference. First of all it is right to safety and health they should fight for.19

While there is a school reproductive health curriculum as part of a biology course, interviewees said that teachers sometimes do not teach it and instead ask students to “just read it at home.”20 One person said the reproductive health chapter was so focused on anatomy and written in such scientific language that “even after reading the chapter, we didn’t know what sex was.”21 Another recalled being taught about sex by a teacher who was so bashful that she said: “You know what happened to the plant? It also happens to humans.”22

19 “MSM to lead HIV/AIDS in Sri Lanka by 2015,” Sunday Observer, November 27, 2011, http://www.sundayobserver.lk/2011/11/27/fea06.asp (accessed April 5, 2016). 20 Human Rights Watch interview with Nithura (pseudonym), Colombo, November 4, 2015. 21 Ibid. 22 Human Rights Watch interview with Amitha (pseudonym), Colombo, January 24, 2016. Human Rights Watch located a publically available textbook chapter entitled “Reproduction in Organisms,” included within the Grade 11 Science curriculum on the Ministry of Education’s website, http://www.e- thaksalawa.moe.gov.lk/moodle/pluginfile.php/22458/mod_resource/content/1/chapter%202%20Biology.pdf (accessed April 9, 2016). In line with Amitha’s statement, reproduction in plants and human beings are included within a single chapter, of which 13 pages focus on “Reproduction in plants” and 8 pages focus on “Human Reproduction.” Under “Human Reproduction,” the topics considered are: the male reproductive system; the female reproductive system; fertilization; development of the fetus; menstrual cycle in women; role of hormones in reproduction; and sexually transmitted diseases. Of the three exercises at the end of the chapter, the first focuses on potatoes, the second on flowers, and the third on the female reproductive system.

13 HUMAN RIGHTS WATCH | AUGUST 2016

government of Sri Lanka has committed itself to “reducing stigma and discrimination in relation to HIV/AIDS … in order to promote appropriate health care seeking behaviors.”147

However, some transgender people and MSM told Human Rights Watch that the experience or fear of stigma and discrimination remained a barrier to them getting tested for HIV and sexually transmitted infections (STIs).

Kavitha, a transgender woman, said that she and her friends do not trust clinics in Jaffna and instead travel to Colombo (about 400 kilometers away) to get tested for HIV. “We don’t like to be exposed—as transgender people and as people getting HIV tests,” she said.148 “We believe doctors and nurses would treat us badly, and since we have that fear, we are not going.”149

Human Rights Watch heard a range of experiences of people getting HIV and STI tests in government clinics. In positive experiences, people felt treated with respect. In negative experiences, people felt judged for getting tested and discriminated against for being homosexual or gender non-conforming.

Criminalization of same-sex conduct and gender non-conformity, which gives police wide powers to arrest and harass LGBTI people, creates barriers to HIV prevention. Sri Lanka’s National STD/AIDS Control Programme, in a mid-term review of its 2013-2017 strategic plan, notes that “continued criminalization of sexual activity between members of the same sex is likely to marginalize these individuals and promote stigma and discrimination,” and recommends decriminalization.150

Dr. Sisira Liyanage, director of the National STD/AIDS Control Programme, told Human Rights Watch that transgender people and MSM have reported being arrested for carrying condoms. Responding to these concerns, his team has developed a three-day training

147 National STD/AIDS Control Programme, “National HIV/AIDS Policy, Sri Lanka,” http://www.aidscontrol.gov.lk/web/images/web_uploads/Policy_or_Law/National%20HIVAIDS%20policy%20final%20Engl ish.pdf (accessed July 22, 2016). 148 Human Rights Watch interview with Kavitha (pseudonym), Jaffna, November 15, 2015. 149 Ibid. 150 National STD/AIDS Control Programme, “National HIV/AIDS Policy, Sri Lanka.”

“ALL FIVE FINGERS ARE NOT THE SAME” 44

TAB 9

Abstracts consult their partners before having an HIV test. Availability and Background/introduction Despite media guidance from the accessibility of PMTCT service facilities, associated stigma, shame National Aids Trust (NAT), there is evidence to suggest the UK and fear, confidentiality of reports and concerns over risk to the media are continuing to portray HIV infection in a negative foetus due to lack of knowledge are some of the potential bar- fashion. The “Charlie Sheen effect” has been described with a riers identified with future PMTCT programs. reported 400% increase in Google related HIV searches just Conclusion Lack of knowledge, stigma and fear and confidential- after Charlie Sheen’s diagnosis. ity issues need to be overcome with extensive universal aware- Aim(s)/objectives Our aim was to identify themes of discussion ness programs on HIV/AIDS and PMTCT. about HIV in the media following the publication of Charlie Sheen’s diagnosis, focussing specifically on language used. Methods Articles were selected using the term “Charlie Sheen HIV” in Google search engine. Fourteen articles dating from P075 DISCRIMINATORY ATTITUDES TOWARDS PEOPLE LIVING 17th November 2015 to 27th November 2015 were reviewed WITH HIV/AIDS, A POPULATION BASED STUDY IN SRI and common themes identified. We compared the language used LANKA to NAT guidelines.

1,2 3 3 3 Results 9/14 articles were negative in their overall discussion A.A.I.N Jayasekara*, D.A.C.L Dalugama, W.M.S.N.K Nawarathne, K.M.N.G.N Dias, about HIV and three contained factually incorrect information. 3S.D Dharmarathne. 1Brighton and Sussex University Hospitals, Brighton, UK; 2Faculty of 3 There were a large number of sensationalist headlines and quotes Medicine, University of Sydney, Sydney, Australia; Faculty of Medicine, University of “ ” Peradeniya, Peradeniya, Sri Lanka including HIV monster . 6/7 articles from 17th November referred to Sheen’s drug use, wealth and sexual preferences. 10.1136/sextrans-2016-052718.129 Three speculated about sexual contact with “prostitutes” and transgender men. Two articles commented on racism and domes- Background People living with HIV/AIDS(PLWHA) are vulner- tic violence despite no association with article content. able to discrimination because of the stigma associated with the Discussion/conclusion The media continue to associate HIV disease. infection with negative personality traits, which have no impact Aim(s)/objectives To examine the level of disease awareness, dis- on HIV transmission. The media has a key role in reducing criminatory attitudes towards PLWHA and factors in association stigma associated with HIV. With a quarter of people living with with such attitudes. HIV in the UK unaware of their status, it is imperative that bar- Methods A cross sectional survey was conducted by using a riers to testing and treatment (including pervasive stigma) are semi-structured validated telephone questionnaire of a random tackled urgently. sample from the Sri Lankan telephone directory. The questionnaire consisted questions regarding awareness of the modes of transmission and questions to assess the attitude toward PLWHA. P077 MANAGING AN OUTBREAK OF INFECTIOUS SYPHILIS Results Around 92% (120/130) of the respondents reported dis- AMONG UNIVERSITY STUDENTS criminatory attitudes in at least five out of the 20 relevant items, about 98% would avoid making physical contact with PLWHA, Gill Bell*, Helen Keegan, Sally Howlett. Sheffield teaching Hospitals NHS Foundation Trust, hesitating to sit next in the public transport (98%), divorcing the Sheffield, Yorkshire, UK infected spouse (85%) and dismissing a HIV positive maid 10.1136/sextrans-2016-052718.131 (100%). A sizeable proportion of the respondents exhibit negative perceptions; PLWHA are merely receiving the punishment Background/introduction In November 2015 we were surprised they deserve (92%) and believe that they are purposefully infect by 5 cases of infectious syphilis among university students, others (94%). Also 89% concluded that the majority of PLWHA including two bisexual males and one female. Mindful of the are promiscuous. Multiple regression analysis found that age, potential for onward transmission bridging both homosexual HIV related knowledge, above mentioned negative perceptions and heterosexual networks in this atypical group, we alerted about PLWHA and fear associated with AIDS are independent Public Health to a potential outbreak. predictors of discriminatory attitudes towards PLWHA. About Aim(s)/objectives To report on management of an outbreak. 90% would give PLWHA the lowest priority in resource alloca- Methods A pre-existing Outbreak Control Team (OCT) liaised tion among five groups of chronic diseases. by telephone to discuss preliminary control strategies. Student Conclusion Stigma among this study sample of general public Health services were alerted immediately by telephone and was mostly due to fear of contracting the HIV/AIDS. Therefore, email. Partner notification (PN) for syphilis cases was prioritised steps need to take increase public awareness and dissemination and intensified: additional information was collected (descrip- of information regarding HIV/AIDS to reduce the stigma associ- tions, where/how met, where studying); provider referral was ated with HIV. encouraged, and home visits undertaken to reach contacts before the Christmas vacation. Targeted screening and on-line health promotion via student bulletins and social network sites was introduced. P076 THE CHARLIE SHEEN AFFAIR: HIV NARRATIVES IN THE Results From November 2015 – January 2016, a linked network UK MEDIA IN 2015 – DOES REPORTING MEET THE of 37 individuals was identified, of whom 29 (78%) attended. NATIONAL AIDS TRUST STANDARDS? Most contacts attended following provider referral (25/29; 86%). Repeated efforts were required to secure the attendance 1Craig McEwan, 1Rosie Briggs, 1Fionnuala Finnerty*, 1,2Daniel Richardson. 1Brighton & Sussex University Hospitals NHS Trust, Sussex, UK; 2Brighton & Sussex Medical School, of several contacts. In all, 7 student cases of infectious syphilis Sussex, UK were identified (1 female; 2 heterosexual males, 2 bisexual males, 2 MSM). The last 2 cases, identified in January, had ini- 10.1136/sextrans-2016-052718.130 tially tested negative 2–3 weeks after exposure.

Sex Transm Infect 2016;92(Suppl 1):A1–A106 A45

TAB 10

Rapid Situation Assessment of Transgender Persons in Sri Lanka

Final Draft

Submitted by:

Institute for Participatory Interaction in Development (IPID) No. 23, P. Ruban Peiris Mawatha, Kalubowila, Dehiwala, Sri Lanka Telephone: 0112723833, 0117417587 / 0117417588, Fax: 0112723225

December 2016 This review reveals the stigma and prejudice that the HIV affected Trans persons are linked to- on a social, cultural, political and legal arena. Such discrimination is rooted in the cultural beliefs of communities and societies about sexuality and gender norms and non-conforming (ATPN & UNDP: 2012). There is a need to confront the social, sexual and gender norms that push vulnerable populations towards HIV.

Stigma, Violence, Discrimination and Marginalization Stigma, violence, discrimination and marginalization are everyday life features for TG populations Discrimination against transgender people may stem from multiple forms of stigma relating to gender identity, gender expression and perceived sexual orientation. Research by the International Centre for Research on Women (ICRW) found the possible consequences of HIV-related stigma to be: (i) loss of income and livelihood; (ii) loss of marriage and childbearing options; (iii) poor care within the health sector; (iv) withdrawal of care giving in the home; (v) loss of hope and feelings of worthlessness; (vi) loss of reputation.

Violence motivated by homophobia and transphobia is often particularly brutal, and in some instances characterized by levels of cruelty exceeding that of other hate crimes.” In every region in the world, the U.N. continues to receive reports of physical and psychological abuse perpetrated against individuals perceived to be LGBT. In addition, LGBT people are targets for religious extremists, paramilitary groups, and extreme nationalists, and also risk being ostracized by their families and communities. The Gender Based violence (GBV) is a fundamental human rights violation and a serious public health concern. The GBVs are often based on social norms that emphasize on dominant notions of masculinity, and are often seen as the root cause of transphobia and homophobia. Transmen in Asia are forced into marriage and sexual violence. Several countries, including Malaysia, Kuwait, and Nigeria, enforce laws that prohibit “posing” as the opposite sex—outlawing transgender people’s very existence. In scores of other countries, transgender people are arrested under laws that criminalize same-sex conduct.

Human Rights Watch documented rights violations against Malaysia’s transgender women including arbitrary arrests, sexual assault, torture, employment discrimination, stigmatizing treatment by health workers, and a ban on sex reassignment surgery. Across South Asia, the trans people are targeted for harassment, extortion, detention, assault and rape. In many cases transgender people have reported being detained for the purpose of extorting payments, but not prosecuted. These offences include prostitution, vagrancy and public nuisance offences, and indecent behavior in public, breach of the peace, obscenity, and soliciting (APCOM: 2010).

TAB 11

APHA > Policy Statements and Advocacy > Policy Statements > Policy Statement Database > Opposition to Immigration Policies Requiring HIV Tests Opposition to Immigration Policies Requiring HIV Tests as a Condition of Employment for Foreign Nationals

Date: Nov 01 2016 Policy Number: 20168 Key Words: Hiv Aids, Immigration, Global Health, International Health, Employment

Abstract

All people have the right to condential and voluntary HIV testing and counseling, and people living with HIV/AIDS have the right to privacy, to employment, and to appropriate medical care under long-standing established human rights principles. However, HIV- related restrictions against entry, stay, and residence remain common around the world. Various countries have policies that mandate HIV testing of all or certain groups of foreign nationals as a condition of obtaining a visa for employment. These policies have no basis in science and violate migrant workers’ human rights to condentiality and informed consent to testing, exposing them to exploitation by their employers. According to the Joint United Nations Programme on HIV/AIDS, 35 countries currently have ofcial HIV-related travel restrictions. In many cases, such policies directly affect US citizens living and working abroad. Furthermore, HIV-related travel restrictions against foreign nationals have been shown by international treaty bodies, international legal scholars, and human rights organizations to constitute discrimination based on race, ethnicity, and/or country of origin. APHA’s long-standing opposition to racism and commitment to equity and social justice make this resolution a logical and much-needed addition to the association’s policy base.

Relationship to Existing Policy Statements

• APHA Policy Statement LB-15-02 (Opposition to Policies Requiring a Negative HIV Test as a Condition of Employment for Foreign Nationals), adopted at the annual meeting in November 2015, reafrms APHA’s opposition to the use of HIV test results to discriminate against foreign nationals seeking employment outside their country of origin, and it calls on human rights groups to emphasize that all HIV testing is voluntary and that all people living with HIV/AIDS deserve access to counseling and medical care. The impetus for this late-breaker policy statement was the ruling of the UN Committee on the Elimination of Racial Discrimination that the Republic of Korea’s practice of requiring HIV tests for foreign English teachers constitutes racial discrimination; the policy urges the US government to pressure the Republic of Korea to eliminate its HIV testing requirement for employment visa applicants and encourages the Joint United Nations Programme on HIV/AIDS (UNAIDS) to revoke Korea’s status as a nation without HIV-related restrictions.

• Policy Statement 7632(PP) (Policy Statement on International Health) establishes APHA’s overall commitment to international health and specically outlines APHA’s intention to support initiatives that promote funding, research, workforce development, and scholarly collaboration in public health around the world. It states that “APHA should exert its inuence in helping to achieve for all countries the goals…in the Constitution of the World Health Organization” and that "APHA should do whatever it can to help the forces of democracy, humanity, and equity in all countries."

• Policy Statement 8223 (Avoiding the Public Health Consequences of Anti-Immigrant Racism) applies APHA’s long-standing opposition to racism to anti-immigrant sentiment in particular, and it recognizes that the economic and social pressures faced by immigrants and exacerbated by racism can have deleterious effects on outcomes related to both health and health care.

• Policy Statement 8701 (Irrational Response to the Fear of the Spread of the Virus that Causes AIDS) establishes APHA’s stance against HIV-related stigma and its commitment to the rights of people with HIV in the United States. In addition, it states APHA’s position that all public health measures to control HIV should be scientically based.

• Policy Statement 8927 (HIV Guidelines for the Workplace) urges US employers to provide accurate information about HIV to their employees, to not discriminate against individuals with HIV, and to ensure the condentiality of employees’ medical information. / • Policy Statement 9013 (Immigration Policies Related to Communicable Diseases) takes a rm stance against the US entry ban on HIV-positive individuals and supports the development of immigration policies based on science.

Problem Statement

According to UNAIDS, 35 countries currently have ofcial HIV-related travel restrictions openly acknowledged and enforced by the government.[1] These restrictions vary from outright entry bans, which bar people living with HIV/AIDS from entering the country, to restrictions on stays longer than a specied period of time.[2–4] Other countries have inconsistent policies and/or intentionally misrepresent their policies with respect to HIV- related restrictions[5]; for example, while UNAIDS noted 59 countries with HIV-related travel restrictions in 2008,[6] Human Rights Watch documented 66 countries with such restrictions the same year.[2] In addition, a survey of German embassies conducted by Deutsche AIDS-Hilfe around the same time showed that 97 countries had some form of HIV-related travel restrictions, including 31 that deported people living with HIV/AIDS.[7]

Such policies and practices, and the number of migrants affected by them, are difcult to track because of differing or ambiguous denitions[8] and a lack of data.[7,8] Some of the most restrictive policies subject immigrants to mandatory HIV testing when they apply for residency or for an employment visa, which is frequently required by states for legal residency.[3,7,9–11] Countries that currently require proof of migrants’ HIV-negative status for employment include (but are not limited to) all Gulf Cooperation Council nations (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates),[10] South Korea,[5,9,12] Cyprus, Russia,[3] Sri Lanka,[2] and Egypt.[13]

Restrictions on travel, immigration, or residence related to HIV status are a violation of the principles of nondiscrimination and equal treatment included in all international human rights laws, treaties, and agreements.[2,4,14] The International Covenant on Civil and Political Rights guarantees the right to equal protection under the law, free from discrimination based on race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status, and the UN Commission on Human Rights has determined that this includes discrimination based on health status, including HIV infection. According to the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, while international human rights law allows governments to restrict rights in cases of emergency or serious public concern, the restrictions must be the minimum necessary to effectively address the concern—and HIV-related travel restrictions have been overwhelmingly ruled as both overly intrusive and ineffective.[4] Within such restrictions, compulsory HIV testing is a serious violation of numerous human rights principles, including the right to bodily integrity and dignity.[15] The accompanying deportation and/or loss of employment and residency status of HIV-infected migrants that frequently accompany such testing violate the rights of people with HIV/AIDS to privacy, work, and appropriate medical care.[2,14] The International Labour Organization has specically stated that neither HIV tests nor private HIV-related personal information should be required of employees or job applicants.[15,16]

These policies also violate migrants’ human rights to condentiality and informed consent to testing and expose them to exploitation by their employers. For example, a 2007 study conducted by CARAM Asia (Coordination of Action Research on AIDS and Mobility) on mandatory HIV testing policies showed that migrants were routinely tested without informed consent, not provided with test counseling, deprived of condentiality with respect to test results, denied treatment and employment, and in some cases deported.[11]

HIV-related travel restrictions are often used as a means of reducing or slowing immigration, excluding foreign workers from jobs, addressing citizens’ concerns regarding foreign inuences and cultural infringement, and appeasing voters.[17] Policies restricting entry and residence among people with HIV/AIDS are typically rooted in social, economic, and/or political pressures; an overwhelming portion (89%) of World Health Organization member countries with high percentages of foreign nationals have HIV-related travel restrictions.[8] Furthermore, government policies requiring an HIV test (to prove HIV- negative status) in order to obtain a work visa and/or residency have been used to discriminate against migrants and asylum seekers[18] and may be direct manifestations of xenophobia or anti-immigrant sentiment.[9,19]

For example, in a recent case against the government of South Korea led with the United Nations Committee on the Elimination of Racial Discrimination, the country’s Ministry of Justice admitted that its policy requiring HIV tests for foreign English teachers (while there is no such requirement for Korean citizens or even noncitizens of Korean ethnicity[20]) was put in place to “ease the anxiety of [Korean] citizens.”[9] After nding that the policy “does not appear to be justied on public health grounds or any other ground, and is a breach of the right to work without distinction to race, colour, [or] national or ethnic origin,” the committee ruled that it constituted racial discrimination.[21] Ofcials in Greece have also used police-mandated HIV testing as a means of ofcially sanctioned discrimination against / migrants,[18,19] and British ofcials have suggested implementation of HIV testing for immigrants and asylum seekers to the United Kingdom[22,23] at a time of high anti- immigrant sentiment.[24–26]

Evidence-Based Strategies to Address the Problem

The clear strategy to address this issue is to repeal policies requiring HIV tests for visa issuance and employment and to ensure that agencies and businesses that employ foreign nationals do not use HIV tests as a means to discriminate against potential employees. [2,10,15,16,27] Human rights and HIV/AIDS advocacy organizations should continue to push for removal of mandatory HIV testing of migrants, along with all HIV-related travel and immigration restrictions. Also, they should call for all HIV testing to be voluntary and condential.[2] In addition, legal and government resources should be shifted from maintaining and enforcing HIV-related restrictions, which are time consuming and costly, to providing HIV prevention and treatment services that are equally accessible to citizens and foreign nationals.[2,4] Migrant workers should have access to culturally appropriate HIV prevention and care programs in languages they can understand.[27]

Increasing awareness of the discrimination, human rights violations, and harms related to mandatory testing and other HIV-related travel restrictions and accompanying pressure from multilateral institutions and human rights advocates have begun to prompt countries to lift travel bans and change their immigration policies.[4] UNAIDS, the United Nations body exclusively focused on eliminating HIV/AIDS worldwide, actively advocates for the elimination of HIV-related travel restrictions. In 2008, UNAIDS established the International Task Team on HIV-related Travel Restrictions to “bring together stakeholders concerned with the continued implementation of restrictions on the entry, stay and residence of HIV-positive people who cross borders; examine the current context and impact of such restrictions; and create new energy and action towards their elimination.”[6] The following year, the task team noted in its ndings that 59 countries, territories, or areas have laws and policies specifying HIV-related travel restrictions on entry, stay, or residence. Advocacy efforts using this information have resulted in several countries loosening these restrictions or, in some cases, dropping them entirely[4]; for example, the number decreased from 59 to 45 countries in 2011 and to 35 as of September 2015.[1]

These data, although they can serve as a useful advocacy tool, are not perfect. Many countries have inconsistent or conicting policies related to discrimination based on HIV status.[7,15] Some continue to require or justify HIV testing by citing vague laws or policies, and at least one (South Korea), through deliberate misrepresentation of its policies, received recognition from UNAIDS for lifting travel restrictions when it had not actually done so.[5,28]

Opposing Arguments

The two primary justications offered by governments for mandatory HIV testing of migrant workers and other HIV-related travel restrictions are to protect public health and to reduce the cost burden on the country’s health care system imposed by providing HIV care services to foreign nationals.[8,22,23,27,29] However, neither of these justications stand up to scrutiny. While countries have the right to employ measures to protect their populations from communicable diseases of public health concern, HIV is not transmitted by casual contact, and thus there is no scientic basis for attempting to control its spread via immigration policies[2,4,8,10,15,29]; indeed, this was the rationale provided by the US Department of Health and Human Services and the Centers for Disease Control and Prevention for the removal of the US HIV entry ban.[30] Countries that do not have HIV- related travel restrictions have not reported increased negative public health consequences relative to those that do.[29] Furthermore, recent analyses suggest that migration does not affect peak national HIV prevalence, implying that even migration from countries with generalized HIV epidemics does not pose a public health risk to destination countries.[31]

In fact, immigration policies banning or restricting entry or employment based on HIV status often have the opposite effect of their protective intention, causing direct harm to the health of both immigrants and citizens. They marginalize individuals living with HIV/AIDS, regularly discourage people from accessing HIV testing and treatment,[5,31] and reinforce stereotypes and discriminatory attitudes against people with HIV/AIDS in the general population.[32] Regulations requiring HIV tests of immigrants can promote the idea that foreigners are dangerous to the national population and a public health risk,[4,29] as well as creating a false sense of security by reinforcing the notion that only migrants are at risk for infection.[14,27] In addition, such attitudes can adversely affect the host country’s own HIV epidemic, as citizens who are unaware of their HIV-positive status, underestimating their HIV risk and avoiding testing due to stigmatization, are more likely to transmit the virus to others, driving up infection rates.[28,33]

/ State-enforced HIV screening of migrants costs far more than it saves in treatment expenditures. Since the beginning of the epidemic, numerous health and human rights organizations have made it clear that screening travelers and migrants for HIV is impractical and economically wasteful.[4,8,29] -Labor migrants (both regular and undocumented) bring signicant economic benets to their host countries, in addition to themselves, and this cost-benet balance remains even when migrants are HIV positive and rely on the host country’s health care system for treatment and support.[3,10,27]

Action Steps

APHA recommends that:

1. UNAIDS, the World Health Assembly, and other HIV and human rights organizations (e.g., Amnesty International, Human Rights Watch, International Labour Organization) continue to call on all countries that still maintain and/or enforce HIV-related restrictions on entry, stay, or residence to eliminate such restrictions, ensuring that all HIV testing is condential and voluntary and that counseling and medical care are available to all people living with HIV/AIDS within a country’s borders, including migrants and foreign nationals.

2. UNAIDS take steps to ensure that its protocols for researching and investigating countries’ HIV-related travel restrictions are sufciently thorough by monitoring and documenting any reported instances of HIV-related discrimination targeting immigrants, particularly when presented with evidence demonstrating that recognition of a country’s removal of travel restrictions is unwarranted, in order to ensure that governments are not able to misrepresent their policies to gain undeserved recognition for supporting human rights with regard to HIV/AIDS.

References 1. Joint United Nations Programme on HIV/AIDS. Lithuania conrms no restrictions on entry, stay and residence for people living with HIV. Available at: http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2015/september/20150917_Lithuania. Accessed January 11, 2017. 2. Human Rights Watch. Discrimination, denial, and deportation: human rights abuses affecting migrants living with HIV. Available at: https://www.hrw.org/sites/default/les/reports/health0609webwcover_0.pdf. Accessed January 11, 2017. 3. Committee on Migration, Refugees and Displaced Persons. Migrants and refugees and the ght against AIDS. Available at: http://www.integrazionemigranti.gov.it/Documenti-e- ricerche/Migrants%20and%20refugees%20and%20the%20ght%20against%20AIDS_Council%20of%20Europe_2014_EN.pdf. Accessed January 11, 2017. 4. Amon J, Todrys KW. Fear of foreigners: HIV-related restrictions on entry, stay, and residence. J Int AIDS Soc. 2008;11:8. 5. Amon J. Seoul’s broken promises on HIV testing. Available at: http://thediplomat.com/2013/06/seouls-broken-promises-on-hiv-testing/. Accessed January 11, 2017. 6. Joint United Nations Programme on HIV/AIDS. The impact of HIV-related restrictions on entry, stay and residence: an annotated bibliography. Available at: http://www.unaids.org/sites/default/les/media_asset/jc1729_bibliography_en_0.pdf. Accessed January 11, 2017. 7. Horn T. At least 31 countries deporting people living with HIV. Available at: https://www.poz.com/article/hiv-deportation-migrant-18781-6045. Accessed January 11, 2017. 8. Chang F, Prytherch H, Nesbitt RC, Wilder-Smith A. HIV-related travel restrictions: trends and country characteristics. Glob Health Action. 2013;6:20472. 9. Wagner BK, VanVolkenburg M. HIV/AIDS tests as a proxy for racial discrimination? A preliminary investigation of South Korea’s policy of mandatory in-country HIV/AIDS tests for its foreign English teachers. J Korean Law. 2012;11:179–245. 10. Joint United Nations Programme on HIV/AIDS. The gap report. Available at: http://www.unaids.org/sites/default/les/media_asset/UNAIDS_Gap_report_en.pdf. Accessed January 11, 2017. 11. State of Health of Migrants 2007: Mandatory Testing. Kuala Lumpur, Malaysia: CARAM Asia; 2007. 12. English Program in Korea. Contract for fall 2015 English Program in Korea. Available at: https://www.epik.go.kr/contents.do?contentsNo=54&menuNo=283. Accessed January 11, 2017. 13. Bahgat H. Egypt: protection of the rights of all migrant workers and members of their families. Available at: http://eipr.org/en/report/2007/04/01/635. Accessed January 11, 2017. 14. Global Commission on HIV and the Law. Risks, rights, and health. Available at: http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health- EN.pdf. Accessed January 11, 2017. 15. International Labour Organization, Subregional Ofce for East Asia, and International Organization for Migration. Mandatory HIV Testing for Employment of Migrant Workers in / Eight Countries of South-East Asia: From Discrimination to Social Dialogue. Bangkok, Thailand: International Labour Organization; 2009. 16. International Labour Organization. The ILO code of practice on HIV/AIDS and the world of work. Available at: http://www.ilo.org/global/publications/KD00015/lang--en/index.htm. Accessed January 11, 2017. 17. Lazarus JV, Curth N, Weait M, Matic S. HIV-related restrictions on entry, residence, and stay in the WHO European Union: a survey. J Int AIDS Soc. 2010;13:2. 18. Human Rights Watch. Greece: Human Rights Watch submission to the United Nations Committee against Torture. Available at: https://www.hrw.org/news/2014/03/24/greece- human-rights-watch-submission-united-nations-committee-against-torture. Accessed January 11, 2017. 19. Varoufakis Y. Sick predators: how a dying regime preyed upon women with HIV, invested in wholesale racism, and endangered public health. Available at: http://wdwreview.org/desks/sick-predators/. Accessed January 11, 2017. 20. Kang SW. Foreign teachers say visa-rule biased. Available at: http://www.koreatimes.co.kr/www/news/nation/2008/10/117_32169.html. Accessed January 11, 2017. 21. UN Ofce of the High Commissioner for Human Rights. Republic of Korea’s foreigners- only HIV tests violated New Zealand teacher’s rights—UN experts. Available at: http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx? NewsID=15981&LangID=E. Accessed January 11, 2017. 22. Withnall A. Nigel Farage defends his policy of banning immigrants with HIV from UK. Available at: http://www.independent.co.uk/news/uk/politics/eu-referendum-nigel-farage- andrew-marr-brexit-ukip-vote-leave-immigration-migrants-hiv-ban-from-uk- a7077716.html. Accessed January 11, 2017. 23. Watt N. Keep HIV-positive migrants out of Britain, says Ukip’s Nigel Farage. Available at: http://www.theguardian.com/politics/2014/oct/10/nigel-farage-keep-hiv-positive- migrants-out-britain. Accessed January 11, 2017. 24. Calamur K. Will Brexit actually curb immigration to the U.K.? Available at: http://www.theatlantic.com/news/archive/2016/06/brexit-migration/489014/. Accessed January 11, 2017. 25. Al Jazeera. UN urges UK to end xenophobic attacks after Brexit vote. Available at: http://www.aljazeera.com/news/2016/06/uk-xenophobic-attacks-brexit-vote- 160628171147062.html. Accessed January 11, 2017. 26. Grose TK. Anger fuels the U.K.’s Brexit campaign. Available at: http://www.usnews.com/news/best-countries/articles/2016-06-16/anger-at-immigration- fuels-the-uks-brexit-movement. Accessed January 11, 2017. 27. Joint United Nations Programme on HIV/AIDS, International Labour Organization, and International Organization for Migration. International labor migration: policy brief. Available at: http://www.hivlawandpolicy.org/resources/hiv-and-international-labour- migration-policy-brief-unaids-international-labour. Accessed January 11, 2017. 28. Keralis JM. South Korea still requires HIV test for some visas, as its own HIV rates climb. Available at: http://www.humanosphere.org/global-health/2015/12/south-korea-hiv/. Accessed January 11, 2017. 29. Klein A. HIV/AIDS and Immigration: Final Report. Montreal, Quebec, Canada: Canadian HIV/AIDS Legal Network; 2001. 30. Centers for Disease Control and Prevention. Removal of HIV entry ban from immigration medical screening. Available at: https://www.cdc.gov/immigrantrefugeehealth/pdf/nal-rule-hiv-removal-fact-sheet.pdf. Accessed January 11, 2017. 31. Kenyon C, Colebunders R, Voeten H, Lurie M. Migration intensity has no effect on peak HIV prevalence: an ecological study. BMC Infect Dis. 2014;4:350. 32. Kirby M. Human rights and the HIV paradox. Lancet. 1996;348:1217–1218. 33. Aponte-Rivera VR, Dunlop BW. Public health consequences of state immigration laws. South Med J. 2011;104:718–719.

TAB 12

A CRITIQUE

HIV/AIDS AND THE LEGAL AND POLICY FRAMEWORK IN SRI LANKA

AUGUST 2013

CENTRE FOR POLICY ALTERNATIVES ! ! ! ! POLICY!BRIEF! ! ! ! A!CRITIQUE:! HIV/AIDS!AND!THE!LEGAL!AND!POLICY! FRAMEWORK!IN!SRI!LANKA! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Centre!for!Policy!Alternatives! August!2013! ! A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

! ! ! ! ! ! ! ! ! ! " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " The"Centre"for"Policy"Alternatives"(CPA)"is"an"independent,"nonJpartisan"organization"that"focuses" primarily"on"issues"of"governance"and"conflict"resolution."Formed"in"1996"in"the"firm"belief"that"the" vital" contribution" of" civil" society" to" the" public" policy" debate" is" in" need" of" strengthening," CPA" is" committed" to" programmes" of" research" and" advocacy" through" which" public" policy" is" critiqued," alternatives"identified"and"disseminated."" " Address"" :" 24/2"28th"Lane,"off"Flower"Road,"Colombo"7,"Sri"Lanka" Telephone" :"" +94"(11)"2565304/5/6" Fax" " :" +94"(11)"4714460" " Web"" " :" www.cpalanka.org,"facebook.com/cpasl,"twitter.com/cpasl" Email" " :" [email protected]" !

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"2" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Acknowledgements!! ! Bhavani"Fonseka"and"Nicole"Kakantoussis,"the"authors"of"the"policy"brief"acknowledge"the" support"provided"by"Gareesha"Wirithamulla"on"initial"drafts"and"the"field"research"carried" out"by"Luwie"Ganeshathasan"and"Subhashini"Samaraarachchi.""They"also"acknowledge"the" editorial"comments"made"by"Dr."P."Saravanamuttu.! ! ! ! !

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"3" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

Table!of!contents! ! ! Section!1" 7" Introduction" 7" 1.1" HIV/"AIDS"situation"in"Sri"Lanka"and"the"need"for"reform" 8" 1.2" Methodology" 9" " Section!2" 10" Legislation"and"Policies"relevant"to"Health"Care"and"HIV"/"AIDS" 10" 2.1" The"Constitution"and"Public"Health" 10" 2.2" National"Health"Laws"and"HIV/AIDS"in"Sri"Lanka" 10" " Need"for"Reform" 12" 2.3" Care,"Treatment"and"Management"of"HIV/AIDS" 13" 2.3.1" Health"Ministry"Circulars" 13" " Best"Practices" 14" 2.4" Blood,"Tissue"and"Organ"Supply" 15" 2.5"" Stigma"and"Discrimination"of"PLWHA" 16" 2.6" Management"of"Information" 17" " Best"practices" 17" " Section!3" 19" Vulnerability"Factors"and"Vulnerable"Groups" 19" 3.1" Commercial"Sex"Workers" 20" 3.2" Men"who"have"Sex"with"Men" 23" " Best"Practices" 25" 3.3" Prison"Inmates" 28" 3.4" Employment" 30" " Section!4" 32" National"Policies" 32" 4.1" National"HIV/AIDS"Policy"of"Sri"Lanka" 32" 4.2" National"Policy"on"HIV/AIDS"in"the"World"of"Work" 32" " Best"Practices" 33" " 4.3"Migrant"workers" 34" " Section!7" 36" Conclusion" 36" " Section!8" 37" Recommendations" 37" National"HIV/AIDS"Policy" 37" HIV/AIDS"Legislation" 37"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"4" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

HIV/AIDS"Sensitisation"Programme" 37" Leadership"&"Coordination" 38" Treatment"and"Care" 38" ! ! ! ! ! ! ! ! !

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"5" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

! ! ! ! Acronyms! ! ! AIDS"""""""""""""""" Acquired"Immunodeficiency"Syndrome" ART""""""""""""""""""" Antiretroviral"Treatment" CPA" " Centre"for"Policy"Alternatives" CSW" " Commercial"Sex"Workers" HIV" " Human"Immunodeficiency"Virus" IDP" " Internally"Displaced"Person" ILO" " International"Labour"Organisation" I/NGO" " International/NonJGovernment"Organisation" IPC" " Indian"Penal"Code" IOM" " International"Organisation"for"Migration" LGBT/I"" Lesbian,"Gay,"Bisexual,"Transgender/Intersex" MDG" " Millennium"Development"Goals" MSM" " Men"who"have"Sex"with"Men" NSACP"" National"STD/AIDS"Control"Programme" PLWHA" People"Living"With"HIV/AIDS" STD" " Sexually"Transmitted"Disease"" TB"" " Tuberculosis" UN" " United"Nations" UNAIDS" Joint"United"Nations"Programme"on"HIV/AIDS" WHO" " World"Health"Organisation" ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"6" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka"

Section!1! ! Introduction! ! " Official" figures" indicate" Sri" Lanka" to" be" a" low" prevalence" country" but" numerous" factors" could"contribute!towards"the"possibility"of"an"outbreak"of"HIV"/"AIDS."These"factors"include" poverty," lack" of" awareness," low" condom" use" and" the" presence" of" numerous" vulnerable" groups."This"coupled"with"the"high"levels"of"stigma"and"discrimination"prevents"many"from" coming"forward"to"obtain"assistance"including"necessary"health"care."It"is"compounded"by"a" legal" and" policy" framework" that" criminalises" and" subjects" vulnerable" communities" to" further"harassment."This"paper"discusses"and"comments"on"the"legal"and"policy"dimension" and"the"obstacles"it"poses"to"a"sustainable"and"effective"response"to"HIV/AIDS"as"many"do" not"come"forward""to"obtain"medical"services"for"fear"of"violence,"stigma"and"discrimination." The"paper"highlights"that"low"prevalence"levels"are"underestimated"due"to"the"existing"legal" and" policy" framework" that" is" outJdated" and" in" need" of" reform" and" recommends" specific" steps"to"be"taken"to"address"the"situation."" " The" post" war" period" has" witnessed" escalated" development" and" rehabilitation" across" Sri" Lanka." Most" of" the" conflict" affected" areas" in" the" north" and" east" of" Sri" Lanka" have" been" demined"with"thousands"of"internally"displaced"persons"(IDPs)"returning"to"their"lands"and" rebuilding" their" lives" and" livelihoods." While" there" continue" to" be" IDPs" and" affected" communities,"there"has"been"development"in"the"areas"with"much"needed"infrastructure" rehabilitated" or" built" new" including" hospitals" in" the" areas.1"Although" development" in" Sri" Lanka"has"been"rapid,"poverty"still"persists.2"Sri"Lanka"prides"itself"on"a"high"literacy"rate" and"attributes"this"number"to"free"education."Yet,"conservative"values"are"interwoven"into" the"fabric"of"society"alongside"still"impoverished"rural"areas"of"the"country"–"a"key"reason" for" children"dropping"out"of"school."The"lack"of"resources"is"an"onJgoing" battle" for" those" living" below" the" poverty" line3," as" they" require" basic" services" such" as" health," education," water"and"sanitation."This"has"further"marginalised"vulnerable"groups"such"as"women"and" children."" " Health"care"provided"by"the"Government"is"free"and"accessible"to"all."There"is"also"health" care"financed"and"managed"by"the"private"sector."Due"to"various"factors"including"poverty," many" are" unable" to" afford" private" health" care," and" rely" on" public" health" care." Although" public"health"care"is"meant"to"be"accessible"to"all,"there"are"issues"such"as"lack"of"resources," staff"and"training."This"has"led"to"those"who"are"able"to"afford"it"to"seek"private"health"care." The" present" Government’s" shift" towards" economic" development," while" having" some" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 1"Central"Bank"of"Sri"Lanka"–Annual"Report"2009,"page""70,"available"at," http://www.cbsl.gov.lk/pics_n_docs/10_pub/_docs/efr/annual_report/ar2009e/PDF/7_chapter_03.pdf""last" accessed"on"23"May"2013" Central"Bank"of"Sri"Lanka"–Annual"Report"2012,"page""86","available"at," http://www.cbsl.gov.lk/pics_n_docs/10_pub/_docs/efr/annual_report/AR2012/English/7_Chapter_03.pdf","last" accessed"on"23"May"2013"" 2"Wimal"Nanayakkara,"“Eradicating"Poverty"in"Sri"Lanka:"Strong"progress"But"much"remains"to"be"done”" available"at""http://www.scribd.com/doc/96488153/TEJSpecialJReportJMPIJWNJJun2012,"last"accessed"on" 23May"2013" 3"Palitha"Abeykoon","“Case"Study"Sri"Lanka”"available"at," http://www.who.int/chp/knowledge/publications/case_study_srilanka.pdf,"last"accessed"on"23"May"2013"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"7" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" benefits" for" poverty" alleviation" and" the" provision" of" infrastructural" development," is" not" sufficient" in" addressing" basic" health" care" needs." It" is" therefore" important" to" examine" Government" policy" towards" key" sectors" including" health" to" understand" how" the" present" economic"development"model"will"contribute"towards"better"services."This"includes"People" Living"With"HIV/AIDS"(PLWHA)"being"able"to"access"and"enjoy"basic"services"such"as"health" care."" " !

1.1! HIV/!AIDS!situation!in!Sri!Lanka!and!the!need!for!reform! " Although"the"official"number"of"cases"of"Sri"Lankans"living"with"HIV"was"at"4,200"in"20114," the"actual"number"is"thought"to"be"much"higher"as"many"do"not"come"forward"for"testing"as" a"result"of"the"stigma"and"discrimination"related"to"HIV/AIDS."Many"others"may"not"come" forward"for"testing"as"they"are"unaware"of"being"infected."Thus,"according"to"UNAIDS,"the" number" of" people" actually" living" with" HIV/AIDS" is" estimated" to" be" somewhere" around" 11,000." Regardless," Sri" Lanka" has" been" classified" as" a" low" HIV" prevalence" country" in" the" South"Asian"region.5" " Within"Sri"Lanka,"the"Western"Province"which"is"the"most"densely"populated"area,"accounts" for" 60%" of" HIV" infection.6"This"could"be"interconnected"with"the"fact"that"most"cases"are" reported" and" tested" within" the" Western" Province," which" is" able" to" offer" better" testing" centres" along" with" having" better" infrastructure" thus" resulting" in" a" higher" percentage" of" infections" being" detected.7"The" majority" of" people" who" have" HIV/AIDS" are" heterosexual" couples" that" practice" unprotected" sex" amounting" to" 59.30%" and" Homosexuals" and" Bisexuals" which" constitute" 10.73%." Mother" to" child" transmission" amounts" to" 3.51%" and" transmission"through"blood"and"blood"products"and"transmission"through"injecting"drug" use"amounts"to"0.24"%"and"0.30"%"respectively.8"! " Despite"the"low"prevalence"rate,"Sri"Lanka"still"has"multiple"factors"which"put"the"country"at" risk"in"terms"of"the"increase"in"HIV/AIDS."There"is"an"increase"in"the"number"of"vulnerable" groups"such"as"a"flourishing"sex"industry,"a"large"number"of"Men"who"have"Sex"with"Men" (MSM)," Internally" Displaced" Persons" (IDPs)" and" migrant" workers." Such" risk" factors" may" hamper" efforts" at" rebuilding" and" rehabilitation" and" slow" down" sustainable" development." Therefore,"there"needs"to"be"change"including"reform"in"the"legal"and"policy"framework"and" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 4"UNAIDS"reports"that"as"of"2011."the"official"number"of"cases"of"Sri"Lankans"living"with"HIV/AIDS"is"4200," available"at","http://www.unaids.org/en/regionscountries/countries/srilanka/"","The"National"STD/AIDS"control" programme"reports"it"as"of"31st"March"2013"as"1693,"available"at"," http://www.aidscontrol.gov.lk/web/Web%20uploads/Surveillance/HIV%20Case%20Reporting/HIVquarterly data20131stQ.pdf" 5"Journal"of"Global"Infectious"Diseases"–"Current"status"of"HIV/AIDS"in"South"Asia",available"at"," http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840955/,"last"accessed"on"23"May"2013" 6"The"National"STD/AIDS"control"programme"‘Cumulative"HIV"cases"by"province"of"residence"by"end"2012’" available"at" http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=63&Itemid=85&lang=en," last"accessed"on"30"May"2013" 7"Although"the"Western"Province"had"high"numbers,"interviews"conducted"by"CPA"did"not"indicate"higher"levels" of"discrimination"in"the"area."Interviews"conducted"by"CPA"indicated"that"stigma"and"discrimination"was" prevalent"across"Sri"Lanka.""" 8"The"National"STD/AIDS"control"programme"‘Probable"mode"of"transmission"by"end"2012’"available"at," http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=63&Itemid=85&lang=en," last"accessed"on"30"May"2013"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"8" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" greater"awareness"raising."Such"measures"will"reduce"stigma"and"discrimination"and"create" an" environment" for" people" to" seek" health" care" services" and" not" be" penalised" and" discriminated" on" the" basis" of" their" gender," economic" background," class" or" ethnicity." This" includes"PLWHA"being"able"to"access"health"care"without" the" threat" of" physical" harm" or" harassment." Sri" Lankan" policies" should" be" reformed" in" order" to" meet" appropriate" health" care"standards"and"protect"the"human"rights"of"people."With"programs"such"as"the"Tackling) HIV) and) AIDS) Stigma) and) Discrimination,) the) South) Asia) Region) Development) Marketplace) (SARDM)9,)being"supported"by"the"World"Bank"and"partners"in"2008J2009,"this"provides"a" framework"for"change"and"steps"need"to"be"taken"towards"reform."This"document"highlights" areas"that"require"urgent"attention"in"the"legal"and"policy"sphere"to"ensure"reform"meets" with"both"national"and"international"standards.""" " This"policy"brief"highlights"the"limited"progress"in"Sri"Lanka"regarding"the"legal"and"policy" framework"in"relation"to"the"Right"to"Health,"especially"for"PLWHA"and"the"urgent"need"for" reform."The"policy"brief"highlights"key"laws"and"policies"that"are"in"need"of"urgent"attention," highlighting"specific"instances,"which"are"documented"where"PLWHA"and"other"vulnerable" groups"have"been"targeted."It"draws"a"comparative"analysis"of"other"countries"in"the"region" which" have" implemented" legislation" and" policies" specifically" addressing" the" needs" of" vulnerable" groups" living" with" HIV" /" AIDS." These" have" been" used" in" this" policy" brief" to" provide" modalities" for" consideration" in" the" reform" process," specific" examples" that" are" successful"in"other"countries"and"can"be"adopted"in"the"Sri"Lankan"context."The"policy"brief" also" uses" cases" from" across" Sri" Lanka," which" highlights" the" everyday" difficulties," threats," harassment," violence" and" other" obstacles" faced" by" PLWHA" and" vulnerable" communities" with"limited"recourse"available"due"to"fear"of"further"stigma,"discrimination"and"violence."" !

1.2! Methodology!! " The"production"of"this"policy"brief"entailed"both"field"and"desk"research."Interviews"were" conducted"across"Sri"Lanka"among"a"cross"section"of"actors"including"Government"officials," health"care"professionals,"UN,"I/NGOs,"community"groups,"PLWHA"and"other"groups."Due"to" security"concerns,"names"of"individuals"have"been"left"out"but"the"policy"brief"captures"the" key"issues"raised"by"PLWHA,"vulnerable"groups,"community"groups"and"service"providers." Interviews"raised"a"range"of"issues"related"to"HIV/AIDS."Although"the"interviews"were"rich" in"content"and"require"more"attention,"this"policy"brief"merely!captures"issues"pertaining"to" the" legal" and" policy" debate." This" by" no" means" discounts" other" issues" raised" during" the" research"period"and"CPA"will"continue"to"advocate"for"reform"as"done"in"the"past"through"a" rights"framework."The"present"policy"brief"is"the"most"recent"research"conducted"by"CPA," which"highlights"the"urgent"need"for"reform"in"the"legal"and"policy"sphere,"which"in"turn," can"address"many"other"issues"including"stigma"and"discrimination."" " !

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9"UNAIDS,"‘"26th""Meeting"of"UNAIDS"Programme"coordinating"Board,"Geneva,"22J24"June"2010,"page"18," available"at," http://www.unaids.org/en/media/unaids/contentassets/documents/priorities/20100526_non_discrimination _in_hiv_en.pdf,"last"accessed"on"30"May"2013" "

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Section!2!! ! ! Legislation!and!Policies!relevant!to!Health!Care!and!HIV!/!AIDS! ! !

2.1! The!Constitution!and!Public!Health! " The" Constitution" of" Sri" Lanka" does" not" provide" any" specific" laws" dealing" with" HIV/AIDS." According" to" Article" 15(7)" of" the" Constitution" of" Sri" Lanka" several" fundamental" rights" guaranteed"by"the"Constitution"can"be"restricted"in"the"interests"of"public"health.10"Hence" public"health"is"viewed"as"a"key"element"in"the"rights"framework"in"Sri"Lanka."The"Directive" Principles" of" State" policy" provided" by" Section" 27" of" the" Constitution" does" not" directly" provide"objectives"in"this"regard."It"includes"the"realisation"by"all"citizens"of"an"adequate" standard"of"living"for"themselves"and"their"families,"including"adequate"food,"clothing"and" housing,"the"continuous"improvement"of"living"conditions"and"the"full"enjoyment"of"leisure" and"social"and"cultural"opportunities."" " The"rationale"behind"the"rights"based"response"to"HIV"/"AIDS"is"that"public"health"interests" do"not"conflict"with"human"rights."Further,"it"has"been"observed"that"when"human"rights"are" protected"fewer"people"become"infected"and"PLWHA"and"their"families"can"better"cope"with" the"HIV/AIDS"and"its"social"consequences."This"provides"a"strong"justification"for"the"State" to" review" its" legal" and" human" rights" responses" to" HIV" /" AIDS" and" ensure" a" national" framework"that"conforms"to"international"norms"and"standards.11" " "

2.2! National!Health!Laws!and!HIV/AIDS!in!Sri!Lanka! " Public"health"laws"of"a"State"stipulate"rules"and"procedures"to"control"and"prevent"diseases" and"to"provide"guidance"on"public"health"issues"that"may"arise"from"time"to"time"with"the" appointment" of" a" competent" authority" to" manage" these" issues." Within" the" Sri" Lankan" context,"there"are"many"public"health"laws."The"research"documented"that"issues"related"to" HIV"/"AIDS"are"addressed"through"the"existing"framework" as" discussed" below." A" notable" feature"of"these"laws"is"that"they"have"been"enacted"over"a"century"ago,"way"before"the"HIV" /" AIDS" discourse" commenced." As" highlighted" in" this" policy" brief," the" present" legal" framework"is"outJdated"and"in"need"of"reform"in"conformity"with"national"and"international" commitments." " Two"laws"relevant"to"public"health"need"attention."They"are:"" • Contagious"Diseases"Ordinance"No.08"of"1866" • Quarantine"and"Prevention"of"Diseases"Ordinance"No.03"of"1897" " """""""""""""""""""""""""""""""""""""""""""""""""""""""" 10!Constitution"of"Sri"Lanka"1978",""" Articles"12,"13(1),"13(2)"and"14"which"include:"right"to"equality,"freedom"from"arbitrary"arrest,"freedom"of" speech,"expression,"religion"and"assembly." 11"Guidelines"were"adopted"at"the"second"International"Consultation"on"HIV"/"AIDS"and"Human"Rights"in"Geneva" in"1996"

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The! Contagious! Diseases! Ordinance" provides" that" every" case" of" smallpox," cholera" or" other"disease,"which"may"from"time"to"time"be"named"by"the"Minister,"should"be"notified"to" a"Police"officer"or"Grama"Niladari"by"the"householders,12"who"shall"report"the"same"to"the" Superintendent" of" Police" or" the" Magistrate" in" the" respective" districts." The" same" responsibility"is"vested"with"the"medical"attendants"who"handle"cases"of"such"contagious" diseases.13"Accordingly,"neglecting"to"report"such"a"disease"makes"the"householders"or"the" medical"attendants"liable"to"a"fine."" " Further,"the"Ordinance"empowers"the"Superintendent"of"Police"or"the"Magistrate"to"order" the"removal"of"persons"with"such"diseases.14" " It"is"important"to"note"that"although"HIV"/"AIDS"has"not"yet"been"gazetted,15"the"Minister" concerned"has"wide"powers"to"gazette"HIV"/"AIDS"under"the"ordinance"(under"the"‘other" disease’" category)" which" could" make" the" strict" provisions" discussed" applicable" to" HIV" /" AIDS."" " Quarantine! and! Prevention! of! Diseases! Ordinance" spells" out" the" powers" and" responsibilities" of" the" health" authorities" in" preventing," identifying," managing" and" controlling"contagious"diseases." " Section" 2" of" the" Ordinance" empowers" the" Minister" of" Health" to" make" regulations" for;" isolating" of" all" cases" of" diseases" and" diseased" persons," prescribing" modes" of" burial" or" cremation" of" the" diseased," regulating" the" removal" of" diseased" persons" until" they" can" be" discharged" with" safety" to" the" public," remove" the" infected" person" or" person" suspected" of" being"infected"to"a"public"hospital"or"other"place"and"for"prescribing"the"reporting"to"such" officer"/"officers"as"may"be"named"in"the"regulations"by"medical"practitioners"of"cases"of" diseases"treated"by"them."" " According" to" the" regulations16"made"under"the"ordinance"every"medical"practitioner"who" attends"to"any"person"suffering"from"AIDS"should"notify"the"proper"authority"with"the"name," race,"sex,"age"and"place"of"residence"within"twelve"hours"from"the"time"the"patient"was"first" treated."The"regulations"further"provide"for"the"medical"practitioner"to"take"action"based"on" a"doubtful"diagnosis,"(rather"than"a"positive"diagnosis)"and"gives"time"to"confirm"his"doubts" to"the"authorities.17" " According" to" Section" 5" of" the" Ordinance" if" a" person" is" guilty" of" an" offence" against" the" Ordinance," he" /" she" will" be" punished" either" by" imprisonment" for" a" period" less" than" six" months"or"a"fine"of"one"thousand"rupees"or"both."" "

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 12"Contagious"Diseases"Ordinance"No."08"of"1866,"Section"3" 13"Contagious"Diseases"Ordinance"No."08"of"1866","Section"5" 14"Contagious"Diseases"Ordinance"No."08"of"1866","Section"6" 15"According"to"the"Director"General"of"National"STD/AIDS"Control"Programme,"Dr.S.Liyanage,"HIV/AIDS"has"not" yet"been"gazetted"in"Sri"Lanka"as"a"Sexually"Transmitted"Disease." 16"“Surveillance"Case"Definitions"for"Notifiable"Diseases"in"Sri"Lanka’’"Epidemiology"Unit"–"Ministry"of"HealthJ" page"1,"2,"42"available"at"http://archive.dgroups.org/?s9t05pzc","last"accessed"on"30"May"2013" 17"Indunil"Abeysekera,"The"Legal"Framework"for"HIV"/"AIDS"in"Sri"Lanka,"Law,"Ethics"and"HIV,"Proceedings"of"the" UNDP"InterJcountry"Consultation,"1993"

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Need!for!Reform! " These"laws"were"enacted"over"a"century"ago"and"predate"the"discourse"on"HIV/AIDS"and"the" right"to"health."They"fail"to"grasp"changes"in"spheres"of"personal"autonomy"and"privacy"and" the"unique"nature"of"HIV"/"AIDS"transmission"visJàJvis"other"contagious"diseases"such"as" smallpox" and" cholera." Such" distinctions" are" important" in" addressing" the" misconceptions" surrounding"HIV/AIDS"and"thereby"reducing"the"fear"and"stigma"associated"with"it."" " Furthermore," these" laws" provide" public" health" authorities" wide" powers" that" can" discriminate"PLWHA"Jfor"instance"power"to"isolate"PLWHA"or"to"report"cases"without"being" subject"to"any"confidentiality"clause."On"the"other"hand,"given"the"stigma"and"discrimination" associated" with" HIV/AIDS," the" laws" significantly" fail" to" prevent" discrimination" of" those" affected." This" harmfully" impacts" not" only" PLWHA" and" their" families" but" also" makes" it" difficult"for"the"health"authorities"to"manage"the"issue"as"those"who"are"infected"fear"coming" forward.""" " A"key"problems"associated"with"the"health"laws"in"relation"to"HIV"/"AIDS"in"Sri"Lanka"is"the" provision" which" runs" counter" to" the" principles" of" confidentiality." There" are" no" requirements" of" confidentiality" of" information" in" the" present" framework" and" research" indicates"the"blatant"abuse"of"confidentiality."This"provides"ample"space"for"stigmatisation" and"discrimination"of"not"only"the"patients"but"also"their"families.18"Research"indicates"that" many"cases"of"discrimination"have"occurred"in"the"health"sector,"ranging"from"disclosure"of" a"person’s"HIV"status"by"health"facilities,"non"Jprovision"of"basic"facilities"to"the"patients"at" hospitals"and"unprofessional"and"unkind"treatment"by"the"staff"at"the"hospitals.19"" " Secondly," there" is" no" framework" that" provides" for" mandatory" pre! and! post! counselling" which" is" another" universally" accepted" principle" but" absent" in" the" Sri" Lankan" framework." Whilst,"commending"several"Ministry"of"Health"circulars," which"require"pre"and"post"test" counselling20,"this"needs"further"strengthening"to"ensure"actual"implementation"and"should" therefore"be"brought"within"the"legal"framework."" " Another"significant"lacuna"in"the"health"laws"is"that"they"have"not"been"amended"to"conform" to"international"standards"and"current"debates"around"HIV/AIDS."The"lack"of"change"means" there"is"no"official"recognition"of"the"established"fact"that"HIV/AIDS"cannot"be"transmitted" through"casual"contact"between"individuals,"which"is"the"case"of"contagious"diseases."This" has" directly" resulted" not" only" in" misconception" and" fear" surrounding" HIV/AIDS" but" exacerbated"the"stigma"and"discrimination"faced"by"PLWHA."" " " " !

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 18"Centre"for"Policy"Alternatives"(CPA)"for"The"Asia"Pacific"Leadership"Forum"(APLF),"A"Profile"of"the"Stigma"and" Discrimination"faced"by"People"Living"with"HIV/AIDS,"2005,"Page"4J10" 19"ibid" 20"Internal"CircularJ"Circular"issued"by"the"National"STD/AIDS"Control"Programme"for"its"guidance"and" management,"‘Protocol"for"HIV"testing"for"Central"STD"Clinic"patients"without"a"clinic"file"but"only"a"OPD"number" (People"who"come"for"an"voluntary"test)’"available" at",http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=72&Itemid=90&lang= en,"last"accessed"on"30"May"2013"

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2.3! Care,!Treatment!and!Management!of!HIV/AIDS!! ! Care"and"treatment"of"PLWHA"is"an"important"aspect"in"the"response"to"HIV/AIDS."In"the" absence"of"legislation"related"to"HIV/AIDS,"attention"has"been"placed"on"the"administrative" and" policy" framework" in" terms" of" Sri" Lanka’s" position" regarding" care" and" treatment" of" PLWHA." According" to" Article" 3.8" of" the" National" HIV/" AIDS" Policy" (discussed" in" greater" detail" in" Section" four)," the" Government" accepts" the" rights" of" PLWHA" to" have" access" to" treatment" without" stigma" and" discrimination." It" further" provides" that" antiretroviral" treatment"will"be"provided"for"PLWHA"by"the"State"sector"in"line"with"national"guidelines" and"prevailing"national"health"policy."Further,"Article"3.9"of"the"National"HIV"/"AIDS"Policy" provides" that" post" exposure" prophylaxis" should" be" provided" in" situations" of" accidental" exposures" according" to" the" national" guidelines." All" above" areas" are" managed" through" Ministry" of" Health" Circulars," Memos" and" the" National" HIV/AIDS" Policy." Some" of" the" important"Health"Ministry"Circulars"on"HIV"/"AIDS"are"discussed"below:"" " !

2.3.1! Health!Ministry!Circulars!! " The" Ministry" of" Health" Circular" of" Management" of" Persons" Infected" with" HIV21"directs" government" hospitals" to" manage" all" HIV" patients" in" the" general" hospital" wards" and" only" people"with"infections"or"complications"be"transferred"to"the"Infectious"Diseases"Hospital."It" further"provides"that"whenever"facilities"are"available,"such"patients"should"be"managed"in" the"general"wards"and"provides"that"chronically"ill"HIV"patients"should"be"encouraged"to"be" managed"at"home"in"the"community."" " Further," the" Internal" Circular" which" provides" instructions" on" how" to" inform" the" HIV" antibody"test"results"to"hospital"wards"/"clinics22,"provides"that"screening"tests"should"be" performed"as"early"as"possible"and"that"strict"confidentiality"should"be"maintained."With" regard"to"screening"tests"the"medical"officer"or"the"consultant"in"the"ward,"or"the"consultant" Venereologist"or"MO/STD"has"to"do"the"preJtest"counselling.23" " Although" there" are" salient" points," these" do" not" have" legal" force." Usually" the" policies" are" passed"on"to"the"heads"of"the"institutions"and"its"administration"and"implementation"is"not" monitored.24"Further,"no"disciplinary"measures"are"taken"against"the"health"workers"if"the" circulars"are"not"followed.25"Therefore,"it"is"important"that"steps"are"taken"to"explore"ways" of"enforcing"circulars"and"hold"to"account"those"who"are"in"breach"of"basic"standards."It"is" also"important"that"salient"points"of"such"circulars"feed"into"formulation"of"legislation"in"the" future."" !!! """""""""""""""""""""""""""""""""""""""""""""""""""""""" 21"General"Circular"Letter"No."02/125/98,"Ministry"of"HealthJ"‘Management"of"patients"infected"with"HIV’"," available" at,http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=72&Itemid=90&lang= en","last"accessed"on"30"May"2013" 22"Director"NSACP,"Internal"Circular"dated"26"August"2009,"‘Instructions"on"how"to"inform"the"HIV"antibody"test" results"to"hospital"wards/clinics"‘"available"at," http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=72&Itemid=90&lang=en," last"accessed"on"30"May"2013" 23"ibid" 24"Interview"with"UNAIDS,"Colombo,"17"July"2012" 25")ibid"

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Article" 3.6" of" the" National" HIV/AIDS" Policy" provides" that" the" Government" of" Sri" Lanka" promotes" voluntary" confidential" testing," recognising" that" mandatory" testing" would" drive" those"at"high"risk"of"HIV"infection"beyond"reach"and"prevent"their"access"to"public"health" preventive"activities"and"other"health"services."Despite"the"importance"of"including"these" provisions"in"the"legal"framework,"the"laws"have"been"silent"on"the"issue."" " There"are"no"express"laws"in"Sri"Lanka"that"recognise"the"principle"of"informed!consent"for" HIV"testing."The"law"on"consent"to"medical"treatment"is"interpreted"based"on"the"Roman" Dutch"law."Accordingly," it"is"established," that"valid"consent"must"be"obtained"by"a"legally" competent" person" who" consents" voluntarily" through" expressed" or" implied" consent. 26" However," in" Sri" Lanka," the" practice" has" been" that" compulsory" HIV/AIDS" testing" can" be" justified"on"grounds"of"public"health.27"" " There"have"been"many"instances"in"Sri"Lanka"where"compulsory"HIV/AIDS"testing"has"been" ordered" by" court." For" example," in" May" 2012," Additional" Magistrate" for" Colombo" P." Ranasinghe"ordered"compulsory"HIV"testing"of"212"male"inmates"at"the"Welikada"prison"in" Colombo" subsequent" to" the" death" of" a" prisoner" resulting" from" AIDS,"housed"in"the"same" prison"ward.28"In"many"instances"including"recruitment"for"employment,"many"public"and" private"sector"organisations"require"individuals"to"test"for"HIV"without"obtaining"voluntary" consent."In"some"of"the"cases"the"blood"samples"are"sent"for"HIV/AIDS"testing"without"the" knowledge"of"the"persons"being"subjected"to"the"tests.29"Further,"no"action"has"been"taken" by" the" health" authorities" against" organisations" or" individuals" who" conduct" involuntary" HIV/AIDS" testing" in" Sri" Lanka."CPA"has"documented" cases" where" involuntary" testing" has" resulted" in" stigma" and" discrimination" of" PLWHA" including" the" loss" of" employment" and" livelihoods.30"Therefore"it"is"important"that"steps"are"taken"to"address"this"issue"including" providing" for" a" stronger" framework" " that" recognises" the" importance" of" confidentiality." Without"the"implementation"of"legal"provisions"in"this"and"related"areas,"the"stigmatisation" of"PLWHA"will"continue."This"should"be"coupled"with"provisions"that"protect"a"patient"from" compulsory"testing."" " !

Best!Practices! " In"order"to"fully"understand"the"gaps"in"the"legal"system"in"Sri"Lanka"for"the"protection"of" PLWHA," it" is" important" to" look" at" countries," which" have" implemented" successful" policies" and"therefore"can"inform"reform."" " """""""""""""""""""""""""""""""""""""""""""""""""""""""" 26"Udapadie"S."Liyanage,"‘"Applicability"of"the"defence"of"informed"consent"against"medical"negligence"in"the" scope"of"a"patient’s"autonomy:"A"Sri"Lankan"Perspective’""available"at," http://webcache.googleusercontent.com/search?q=cache:ZyFdeDMCwfgJ:archive.cmb.ac.lk/research/bitstream /70130/248/1/article%25202J1st%2520editJ %2520informed%2520consent%255B1%255D.doc+&cd=1&hl=en&ct=clnk&gl=lk&client=firefoxJa,"last" accessed"on"30"May"2013" 27")ibid" 28"‘Sri"Lankan"court"orders"checking"prison"inmates"for"HIV/AIDS’"available"at," http://www.colombopage.com/archive_12/May29_1338298372JR.php,"last"accessed"on"31"May"2013" 29"The"launch"of"the"State"of"Health"2007"Report"in"the"ICAAP,"available"at," http://wwwcaramasia.org/enews/2007/Sept/SOHlaunch%20ICAAP.pdf,"last"accessed"on"23"May"2013" 30"The"Centre"For"Policy"Alternatives"(CPA),"‘A"Profile"of"the"Stigma"and"Discrimination"faced"by"the"People" Living"with"HIV/AIDS’"

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Cambodia! " • Article"20"of" The"Law)on)the)Prevention)and)Control)of)HIV/AIDS)specifically" prohibits" HIV/AIDS" testing" for" the" purposes" of" employment," education," travel," healthcare" and" 'freedom" of" abode'" (the" right" to" choose" where" to" live).31"This" clear" prohibition" of" compulsory" HIV/AIDS" testing" except" in" limited" defined" circumstances" sends" a" clear" message" to" employers," health" care" workers," and" others," regarding" the" importance" of" voluntary"testing."" " • Article"21"of"the"same"law"specifies"that"compulsory"testing"is"only"permissible"where"it" is" authorised" by" a" court" and" provides" that" sealed" medical" records" relating" to" the" HIV/AIDS"status"should"be"provided"to"courts.32" " " These"sections"demonstrate"the"importance"given"to"voluntary"consent"and"confidentiality" of" information" including" test" results." Sri" Lanka" should" examine" these" provisions" and" introduce" a" framework" that" respects" the" rights" of" those" getting" tested" including" their" privacy."While"the"existence"of"a"legal"framework"is"a"start,"attention"should"also"be"paid"to" the" enforcement" of" such" legislation" including" through" the" awareness" campaigns" and" the" education"of"service"providers"on"the"importance"of"such"issues."" " Article"3.7"of"the"National"HIV/AIDS"Policy"provides"that"counselling"be"recognised"as"an" integral" part" of" all" programs" related" to" HIV/AIDS" prevention," care" and" treatment" and" highlights"the"importance"of"these"services"being"provided"by"persons"who"are"adequately" trained" in" HIV/AIDS" counselling." Compulsory" counselling" is" an" important" aspect," which," should"be"included"in"legislation"related"to"HIV/AIDS."At"present"this"aspect"is"covered"in" the" Health" Ministry" circulars." (i.e." Protocol" for" HIV" testing" for" Central" STD" Clinic" Patients" provides" that" inJdepth" pre" and" post" test" counselling" be" carried" out" in" every" case.)" Counselling" has" become" a" universally" accepted" norm" and" should" be" made" available" for" PLWHA"to"ensure"they"are"able"to"better"cope"with"their"condition"and"handle"obstacles"as"a" result"of"stigma"and"discrimination."In"the"Sri"Lankan"context,"the"need"is"greater"due"to"the" high"levels"of"stigma"and"discrimination."" ! !

2.4! Blood,!Tissue!and!Organ!Supply! " Transmission"of"HIV/AIDS"due"to"blood"and"blood"products"has"been"extremely"low"in"Sri" Lanka" (0.4%)" with" only" 4" cases" of" transfusion" related" HIV/AIDS" infections" reported.33" Government" sector" blood" banks" carry" out" HIV/AIDS" tests" as" per" standard" operational" procedures"on"all"donated"blood"prior"to"transfusion.34" "

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 31"http://www.ilo.org/wcmsp5/groups/public/JJJed_protect/JJJprotrav/JJJ ilo_aids/documents/legaldocument/wcms_113128.pdf" 32"Article"34(c)"" 33"UNAIDS,"Country"Progress"Report"Sri"Lanka"2010J2011,"page"7,"available" at,http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_LK _Narrative_Report%5B1%5D.pdf",last"accessed"on"19"June"2013" 34"Ibid"

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The"National"Blood"Policy"of"Sri"Lanka35"recognises"the"importance"of"regular"voluntary"and" nonJremunerative" blood" donations," with" preJdonation" information" and" counselling," and" testing" of" all" donated" blood" to" ensure" a" safe" blood" supply.36"The" National" Blood" Policy" provides"a"framework"on"how"to"manage"an"infected"donor."It"provides"that"they"should"be" informed"in"a"confidential"manner"to"refrain"from"further"blood"donations,"counselled"with" information"provided"for"treatment,"care"and"support"services."" " The" National" Blood" Policy" is" a" good" starting" point" by" which" to" provide" for" a" rights" framework"in"blood"testing"and"related"issues."This"though,"as"already"highlighted,"is"merely" a"policy"and"steps"should"be"taken"to"fully"enforce"it."! ! !

2.5!Stigma!and!Discrimination!of!PLWHA!! " A"key"objective"of"the"National"HIV/"AIDS"Policy"is"stated"to"be"to"improve"the"quality"of"life" of" PLWHA" through" minimising" stigma" and" discrimination" and" providing" quality" care" and" support.37"Article" 3.11" of" the" policy" stipulates" that" the" Government" will" ensure" that" the" human" rights" of" PLWHA" are" promoted," protected" and" respected" and" measures" taken" to" eliminate" discrimination" and" combat" stigma" which" in" turn" will" provide" an" enabling" environment" to" seek" relevant" services." Unfortunately" the" existing" legal" framework" is" far" from" the" standard" provided" in" the" policy." Public" Health" laws" in" Sri" Lanka" (discussed" previously)"provide"discriminatory"and"outJdated"quarantine"rules"for"PLWHA"as"for"any" infectious" disease" and" hence" require" substantial" amendments." One" of" the" main" problems" encountered"by"the"individuals"interviewed"with"regard"to"the"current"legislation"relevant" to" HIV/AIDS" in" Sri" Lanka," is" the" lack" of" clarity" and" understanding" by" a" cross" section" of" people"including"medical"providers,"police"officers"and"others"regarding"the"real"status"and" nature"of"HIV/AIDS,"how"its"transmitted"and"its"impact."All"interviewed"by"CPA"indicated" that" the" current" laws" do" not" recognise" the" rights" of" PLWHA" and" do" not" protect" against" stigma"and"discrimination."A"community"leader"interviewed"by"CPA"stated"the"following:"“In) this)area)there)are)32)PLWHA.)Three)committed)suicide)and)this)was)because)their)identity) had)been)compromised)and)the)wider)society)found)out)they)were)HIV)positive.)People)said) they)should)be)locked)into)a)room)because)they)do)not)know)how)HIV)is)contracted.”38"Similar" sentiments"were"shared"by"other"community"groups"and"service"providers,"the"information" shared"with"CPA"capturing"the"practical"difficulties"and"vulnerabilities"faced"by"PLWHA"and" vulnerable" groups." Interviews" conducted" by" CPA" and" existing" studies" demonstrate" the" misconceptions"among"sections"of"society"that"result"in"stigma"and"discrimination."There"

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 35"As"per"the"information"received"from"National"Blood"Transfusion"Service,"Sri"Lanka,"The"National"Blood"Policy" was"passed"in"Parliament."The""National"Blood"Transfusion"Service"Bill"which"was"gazetted"on"21"September" 2007","as"a"bill"to"provide""for"the"regulation"and"monitoring"of"blood"transfusion"services";""to"ensure""an" effective"safe"blood"supply"throughout"the"country"in"order"to"give"effect""to"the"National"Blood"Policy"has"been" revert"back"to"Ministry"of"Health"for"amendments."For"More"information"is"available"at" http://203.94.76.60/Act/NBTSJBillJEnglish.pdf" 36"Under"the"National"Blood"Transfusion"Policy,"Sri"Lanka"committed"itself"to"the"promotion"of"voluntary"nonJ remunerative"blood"donation"by"diligently"recruiting"selecting"and"retaining"blood"donors"at"the"what"is" supposed"to"be"the"safest,"most"advanced"manner."This"policy"was"introduced"in"2005."For"more"information" available"at,"http://209.61.208.233/LinkFiles/Public_Information_&_Events_vol3J2_sriJlanka.pdf" " 37"Article"2.2" 38"Interview"with"community"groups,"11"April"2013"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"16" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" should"be"immediate"efforts"to"examine"the"present"framework,"taking"note"of"salient"points" in"the"existing"policy"which,"can"be"incorporated"into"legislation."" ! !

2.6! Management!of!Information! " Management"and"dissemination"of"information"related"to"any"health"condition"needs"to"be" underpinned" by" the" principle" of" confidentiality" and" an" individual’s" right" to" privacy." Information" related" to" the" HIV/AIDS" status" of" an" individual" must" be" protected" from" unauthorised"collection,"use"or"disclosure"in"the"healthcare"and"other"settings"and"the"use"of" sensitive" information" including" those" relevant" to" HIV/AIDS" status" requires" informed" consent." Sri" Lankan" laws" and" policies" are" silent" on" the" issue" of" information" disclosure" pertaining" to" HIV" status" of" an" individual." There" is" also" silence" on" this" issue" in" circulars" publicly"available.39"" " There"is"an"urgent"need"for"a"strong"legal"and"policy"framework"to"be"introduced"in"this" regard,"which"is"underpinned"by"the"rights"framework"including"the"right"to"privacy."Such"a" framework"must"be"strictly"implemented"with"disciplinary"action"taken"against"those"who" undermine"its"basis."CPA"has"documented"several"cases"of"breach"of"confidentiality"which" has"resulted"in"serious"repercussions"including"threats"and"intimidation.40" " !

Best!practices41! ! Some"of"the"best"practices"regarding"the"protection"of"PLWHA,"in"terms"of"legal"frameworks" can" be" found" in" Philippines" and" Cambodia." The" following" policies" should" provide" a" framework"for"Sri"Lanka."" " ! Philippines) ) Philippine)AIDS)Prevention)and)Control)Act,)1998:" " • Provides"formal"legal"recognition"that"all"people"with"HIV"are"entitled"to"full"protection" of"their"human"rights"and"civil"liberties" • Places" a" positive" obligation" on" the" government" to" promote" HIV" education" and" awareness" • Requires" basic" health" services" to" be" available" to" people" with" HIV" in" all" government" hospitals"

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 39"National"STD/AIDS"Control"Programme,"Circular"No."02"J"125."1998"‘Management"of"patients"infected"with" HIV’"available"at" http://www.aidscontrol.gov.lk/web/index.php?option=com_content&view=article&id=72&Itemid=90&lang=en," last"accessed"on"31"May"2013" 40"The"Centre"For"Policy"Alternatives"(CPA),"‘A"Profile"of"the"Stigma"and"Discrimination"faced"by"the"People" Living"with"HIV/AIDS’,"page"4,5." 41"UNDP,"Law,"Policies"and"Regulations"Concerning"HIV/AIDS"Prevention"and"Containment:"An"Assessment"and" Recommendations,"August"2003"

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• Outlaws"discrimination"against"people"with"HIV"in"the"workplace,"in"schools,"in"health" care,"and"in"the"provision"of"credit"and"loan"services" • Requires"medical"confidentiality"to"be"respected" • States"that"the"government"must"seek"to"eradicate"conditions"that"aggravate"the"spread" of"HIV,"including"poverty,"gender"inequality,"marginalisation"and"ignorance"

" Cambodia42) ) Law)on)Prevention)and)Combat)against)the)spread)of)HIV/AIDS)2002:" " • Prohibits"discrimination"against"people"with"HIV,"and"establishes"legal"confidentiality" protection"in"relation"to"a"person's"HIV"status" • Prohibits"HIV"testing"without"consent"in"the"absence"of"a"court"order" • Provides"PLWHA"freedom"of"movement"and"residence" • Prohibits"the"refusal"of"health"care"on"the"basis"of"HIV"infection" • Requires" the" government" to" encourage" the" involvement" of" people" with" HIV" in" public" HIV"awareness"campaigns" " " " " " " ! !

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 42"ibid"

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Section!3! ! ! Vulnerability!Factors!and!Vulnerable!Groups! ! ! According" to" the" available" statistics" the" main" mode" of" HIV/AIDS" transmission" is" through" unprotected"sex"between"men"and"women"(82.8%)"and"secondly"through" men"who"have" sex"with"men"(MSM)"(12.3%).43""The"same"data"indicate"that"mother"to"child"transmission" amounts" to" 4.4%," transmission" through" blood" and" blood" products" amounts" to" 0.4%" and" transmission" through" injecting" drug" use" amounts" to" 0.5%." Whilst" the" main" mode" of" HIV" transmission"is"unprotected"sex"between"men"and"women,"another"significant"portion"of" the"infected"are"men"who"engage"in"sexual"intercourse"with"men"indicating"the"vulnerability" of"these"two"groups." " Despite"the"fact"that"soliciting"sex"is"illegal"in"Sri"Lanka44,"it"is"reported"that"the"sex"industry" is" flourishing" in" Sri" Lanka" and" a" mapping" exercise" has" estimated" that" there" are" 35,000J 47,000"sex"workers"in"the"country.45"Further,"it"has"been"estimated"that"the"number"of"MSM" in"Sri"Lanka"are"between"24,000"J"37,00046"thus"indicating"that"a"significant"portion"of"the" population" are" among" the" vulnerable" groups" which" necessitates" the" engagement" and" involvement"of"these"groups"in"the"HIV/AIDS"response.""" " The"National"HIV/AIDS"Policy"provides"that"preventive"interventions"will"focus"on"highly" vulnerable" groups.47 "Further," Article" 3.6" provides" that" the" ‘Government" of" Sri" Lanka" promotes"voluntary"confidential"counselling"and"testing,"recognising"that"mandatory"testing" would"drive"those"at"high"risk"of"HIV/AIDS"infection"beyond"reach"and"prevent"their"access" to"public"health"preventive"activities"and"other"health"services’."Hence"it"is"paramount"that"a" conducive"environment"is"created"for"those"at"high"risk,"to"approach"the"health"authorities" for"services"without"being"subjected"to"stigma"and"discrimination"but"also"without"the"fear" of" arrest" or" detention" for" engaging" in" illegal" activity." Moreover," it" is" crucial" that" laws" to" protect"the"most"vulnerable"communities"are"implemented"in"order"to"prevent"the"further" transmission"of"the"HIV/AIDS."" " Article"3.11"of"the"policy"further"states"that"the"Government"of"Sri"Lanka"will"ensure"that"the" human"rights"of"PLWHA"are"promoted,"protected"and"respected,"and"that"measures"will"be" taken" to" eliminate" discrimination" and" combat" stigma" which" will" provide" an" enabling"

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 43"National"STD/AIDS"Control"Programme,"‘Laws"Concerning"Commercial"Sex"and"HIV/AIDS"Prevention’," available"at" http://www.aidsdatahub.org/dmdocuments/Laws_Concerning_Commercial_Sex_and_HIV_AIDS_Prevention.pdf," last"accessed"on"31"May"2013" 44"Brothels"Ordinance"No.43"of"1981,"Section"2" 45"UNAIDS,"‘Country"Progress"Report"Sri"Lanka"2010J"2011’"Page"7,"available"at:" http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_LK_N arrative_Report%5B1%5D.pdf"" 46"ibid"" 47"National"HIV/AIDS"Policy"in"Sri"Lanka,"Article"3.1,"available"at" http://www.aidscontrol.gov.lk/web/Web%20uploads/Policy%20or%20Law/National%20HIVAIDS%20policy %20final%20English.pdf,"last"accessed"on"31"May"2013"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"19" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" environment" to" seek" relevant" services 48 "thereby" requiring" State" action" including" introducing"amendments"to"legislation"deemed"discriminatory."" " Discussed" below" are" some" legislation" that" are" discriminatory" and" run" counter" to" the" National"HIV/AIDS"Policy." ! "

3.1! Commercial!Sex!Workers! " The"official"data"provided"in"the"previous"section"indicate"the"high"vulnerability"of"women" and"men"engaging"in"unprotected"sex"in"transmitting"HIV,"thus"requiring"special"responses" targeting" this" group." Commercial" sex" workers" and" their" partners" are" a" key" vulnerable" category."Issues"of"the"commercial"sex"workers"in"Sri"Lanka"are"manifold"which"makes"it" difficult" to" involve" them" effectively" in" the" HIV/AIDS" response." In" Sri" Lanka" sex" work" is" unlawful"and"the"sex"workers"often"suffer"harassment,"stigma"and"discrimination,"which"is"a" barrier"for"them"in"approaching"healthcare"and"awareness"raising"measures"to"reduce"their" vulnerability"to"infection.49"Interviews"conducted"by"CPA"with"civil"society"and"community" groups" who" work" with" sex" workers" highlighted" that" the" increased" stigma" and" discrimination" stems" mainly" from" those" who" have" lower" education" levels" including" low" ranking"police"officials."This"leads"to"violence"and"unlawful"arrests."" " “The)sex)workers)are)ostracised)from)their)families)thus)forcing)them)to)live)on)the)minimal) payments) they) earn.) They) are) forced) into) sexual) activities,) they) are) mentally) tortured) and) ridiculed)in)society”.50)) " The" hostile" social" and" legal" environment" prevents" sex" workers" from" taking" measures" to" protect" themselves" and" others" from" infection. 51 "Some" of" the" laws" which" deal" with" commercial"sex"workers"are"discussed"below"from"an"HIV"/"AIDS"perspective." " ! Vagrants!Ordinance!No.!04!of!1841! " Vagrants)Ordinance)is"commonly"used"by"police"to"arrest"sex"workers"in"Sri"Lanka."While" there" is" no" law" against" sex" work" in" private" in" Sri" Lanka," under" the" Vagrants" Ordinance," street"based"sex"work"and"the"operation"of"brothels"are"illegal."According"to"Section"3(1)"(b)" of" the" Ordinance," every" common" prostitute" wandering" in" the" street," highway" or" a" public" place"and"behaving"in"a"riotous"or"indecent"manner,"shall"be"deemed"an"idle"or"indecent" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 48"The"rights"stipulated"include"the"rights"of"everyone"to"life,"liberty"and"security"of"person,"freedom"from" inhuman"or"degrading"treatment"or"punishment,"equality"before"law,"absence"of"discrimination,"freedom"from" arbitrary"interference"with"privacy"or"family"life,"freedom"of"movement,"the"right"to"work"(rights"of"the"people" living"with"HIV"in"the"work"places)"and"to"a"standard"of"living"adequate"for"health"and"well"being"including" housing,"food"and"clothing,"the"right"to"the"highest"attainable"standard"of"physical"and"mental"health,"the"right"to" education,"the"right"to"information"which"includes"the"right"to"knowledge"about"HIV/AIDS/STI"related"issues" and"safer"sexual"practices,"the"right"to"capacity"building"of"the"individual"in"dealing"with"this"condition,"the"right" to"participate"in"the"cultural"life"of"the"community"and"to"share"in"scientific"advancement"and"it’s"benefit." 49UNDP,"“Law,"Ethics"and"HIV"/"AIDS"in"South"Asia"–"A"study"of"the"legal"and""social"environment"of"the"epidemic" in"Bangladesh,"India,"Nepal"and"Sri"Lanka”"page"19,"available"at"" http://www.hivpolicy.org/Library/HPP000261.pdf,"last"accessed"on"19"June"2013" 50"Interview"with"community"groups,"11"April"2013" 51)Ibid.)

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"20" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" person"and"on"conviction"liable"to"an"imprisonment"of"fourteen"days"or"to"a"fine."Further," Section"3(2)"the"Ordinance"permits"arrest"of"such"persons"without"a"warrant." Hence," the" Ordinance" deems" common" prostitutes" wandering" in" the" public" streets" or" highway" and" behaving"in"a"riotous"or"indecent"manner"‘idle"and"disorderly’,"and"enables"arrest"of"such" persons" without" a" warrant" and" on" conviction" imprisonment" of" fourteen" days" with" or" without"a"fine."Further,"according"to"Section"4(a)"of"the"Ordinance"an"individual"convicted"a" second" time" of" the" offence" of" ‘idle" and" disorderly’" person" is" deemed" to" be" a" ‘rogue" and" vagabond’"punishable"with"imprisonment"of"one"month." " It"is"important"to"note"that"the"law"not"only"uses"language"that"stigmatises,"but"also"makes"it" possible" to" arrest" any" person" who" is" suspected" of" prostitution" thus" resulting" in" stigma" which"makes"it"difficult"to"reach"out"to"them"in"the"HIV"response."Further,"it"is"argued"that" the"Vagrants"Ordinance"makes"explicit"the"unjustifiable"equation"of"sex"work"with"begging" and"vagrancy"and"that"sex"workers"are"automatically"included"in"the"categories"of"‘vagrant’" and" ‘rogue’" and" liable" to" punishment" despite" sex" work" having" nothing" in" common" with" begging"or"vagrancy." " " In"Saibo&v.&Chellam&et&al52&the"Court"in"interpreting"the"phrase"‘living"on"the"earnings"of" prostitution’"under"Section"9(1)"(a)"of"the"Vagrants"Ordinance,"in"the"context"of"sex"workers" /"prostitutes"being"charged"held"that"both"according"to"the"intention"of"the"Ordinance"and" the"words"used"Section"9(1)(a),"it"has"no"application"to"prostitutes"who"live"on"their"‘own’" earnings"or"prostitution."The"judgment"clearly"lays"down"that"sex"work/prostitution"is"not" an" offence" under" the" law" and" that" a" woman" earning" a" living" from" sex" work/prostitution" cannot"be"convicted"for"any"offence"under"the"Ordinance." ) " It" is" noteworthy" that" despite" the" above" judicial" pronouncement" CPA" was" informed" that" media"reports"the"arrest"of"sex"workers"in"a"derogatory"manner"that"leads"to"stigma"and" discrimination." Research" conducted" by" CPA" concluded" that" the" Vagrants" Ordinance" has" caused"numerous"unlawful"and"unnecessary"arrests"by"law"enforcement"officials"and"it"is" often"times"abused"as"a"means"to"promote"personal"benefits."" ! "“The)Vagrants)Ordinance)creates)a)major)barrier)in)society)for)the)mere)fact)that)if)police) undertake) a) certain) number) of) cases) they) receive) a) promotion) thus) the) cases) involving) sex) workers)are)easy)ones)to)take)on”.53)) & This"necessitates"reviewing"the"issue"of"not"only"of"legalising"sex"work"but"also"awareness" raising" and" sensitising" key" stakeholders." This" includes" training" law" enforcement" and" judicial"officials"on"sex"work"and"their"vulnerability"of"HIV/AIDS"transmission.""" ! & Brothels!Ordinance!No.!5!of!1859! " According"to"Section"2"of"the"Brothels"Ordinance,"any"person"who"keeps,"manages,"acts"or" assists"in"the"management"of"a"brothel,"a"tenant,"occupier"or"owner"of"any"premises"who" knowingly"permits"such"premises"to"be"used"as"a"brothel"or"for"habitual"prostitution,"the" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 52(1923))25)NLR)251)(27)July)1923)" 53"Anonymous"Interview,"Support"Group,"11"April"2013"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"21" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" lessor,"landlord"or"an"agent"who"knowingly"lets"premises"to"be"used"as"a"brothel"or"for" habitual"prostitution"is"guilty"under"the"ordinance"and"on"conviction"liable"to"a"penalty"or"in" the"discretion"of"the"court"to"simple"or"rigorous"imprisonment"not"exceeding"six"months." Further,"according"to"Section"3"of"the"Ordinance,"any"person"who"is"the"keeper,"manager," master"or"mistress"of"such"premises"could"also"be"held"liable"under"the"ordinance." " It"is"notable"that"although"the"law"enables"owners,"manages"or"occupiers"to"be"charged"for" managing"a"brothel,"the"act"of"prostitution"itself"or"the"commercial"sex"workers"cannot"be" charged"under"the"Ordinance."In"light"of"the"barriers"that"have"been"placed"on"sex"workers" through"these"laws"which"results"not"only"in"stigma"and"discrimination"but"also"legal"action," imprisonment" and" imposition" of" fines," the" rights" and" freedoms" such" as" the" freedom" to" choose"ones’"own"work"or"profession"and"the"right"to"equality"is"hampered."" "" It" is" often" argued" that" sex" workers" have" the" right" to" choose" the" work" they" do.54"Further," from"the"point"of"view"of"managing"HIV/AIDS,"it"is"submitted"that"stigma,"discrimination" and"fear"of"violence"and"arrest,"prevent"many"sex"workers"from"accessing"health"services" (i.e."voluntary"testing,"treatment)"as"well"as"awareness"programmes." " It" is" important" to" note" that" in" Sri" Lanka" the" court" has" never" considered" the" rights" of" sex" workers"in"the"light"of"the"fundamental"rights"guaranteed"under"the"Constitution."Progress" made"in"this"regard,"in"comparative"contexts,"are"discussed"below"to"provide"a"glimpse"of" the" situation" in" other" countries" and" possible" lessons" for" Sri" Lanka." Further," as" judicial" review" of" legislation" is" nonJexistent" in" Sri" Lanka," this" makes" it" difficult" for" the" court" to" declare"the"discriminatory"provisions"of"the"laws"null"and"void."Thus,"reform"in"this"area"is" urgently"needed,"ensuring"that"new"legislation"is"formulated"with"the"involvement"of"civil" society,"community"groups"and"communities."" " ! ! Nepal! " In"Nepal"No."7"of"the"Chapter"on"Rape"of"the"Country"Code"provide"that"in"cases"where"a"sex" worker"is"raped,"the"maximum"penalty"for"the"rapist"on"conviction"would"be"a"fine"of"up"to" Rs."500.55"It"was"argued"that"the"punishment"imposed"was"highly"discriminatory"against"the" sex"workers"as"the"penalty"imposed"in"a"case"where"the"woman"is"not"a"sex"worker"was"ten" years" imprisonment" and" a" half" share" of" the" culprit’s" property" to" the" raped" woman." The" provision"was"challenged"in"the"Supreme"Court"in"the"case"of"Sapana"P."Malla"for"FWLD"v." HMG/Nepal" demanding" that" the" existing" provision" be" declared" discriminatory" and" unconstitutional.56"In"a"remarkable"decision"the"Supreme"Court"held"that"sex"work"is"also" like"any"other"profession"and"no"discrimination"could"be"made"on"the"basis"of"sex"work."The" Court"took"the"opinion"that"prostitution"is"legalised"in"some"countries"and"held"that"it"is"a" profession"or"occupation"irrespective"of"its"legality"and"hence"the"existing"provision"is"null" and"void." ! """""""""""""""""""""""""""""""""""""""""""""""""""""""" 54"South"Asia"Roundtable"Dialogue","‘"Legal"and"Policy"Barriers"to"the"HIV"Kathmandu,"Nepal,""8J10"November" 2011"" 55"UNDP,"Law"Ethics"and"HIV"/"AIDS"in"South"Asia,"2002,"Writ)No.)56/2058,)Date)of)decision:)2059.1.19)B.S.)(May)2,) 2002),"Publication"of"Judgments"relating"to"Human"Rights"(Special"issue)"Supreme"Court"2059(2002)" 56"Supreme"Court"of"Nepal"in"Sapana"P."Malla"for"FWLD"v."HMG/Nepal,"Publication"of"Judgments"relating"to" Human"Rights:"Special"Issue"(Kathmandu:"Supreme"Court,"2002)"at"144J151."

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By" legalising" prostitution," the" government" is" automatically" removing" the" fear" of" discrimination,"stigmatisation"and"arrest"from"the"sex"workers"mind."Furthermore,"they"are" allowing"them"to"access"health"care"services"thus"preventing"the"spread"of"HIV/AIDS."" " ! New!Zealand57"" " Prostitution!Reform!Act!2003:! " • Permits"and"regulates"sex"work,"but"prohibits"sex"work"among"those"who"are"under"18" years"of"age."" • The" Act" requires" that" all" reasonable" steps" be" taken" to" use" an" appropriate" barrier" (condom)"if"the"act"engaged"in"is"likely"to"transmit"infection."" • Mandates" that" sex" workers" be" represented" in" nationalJlevel" policy" decisionJmaking" related"to"sex"work" • Department" of" Labour" published" information" useful" to" protecting" the" health" of" sex" workers:" i.e." A" Guide" to" Occupational" Health" and" Safety" in" the" New" Zealand" Sex" Industry.58""

3.2! Men!who!have!Sex!with!Men! " Sexual"intercourse"between"those"who"belong"to"the"same"sex"is"a"punishable"offence"under" the"Penal"Code"of"Sri"Lanka"including"MSM."This"has"not"only"resulted"in"creating"stigma" and"discrimination"of"those"engage"in"sexual"intercourse"with"those"belonging"to"the"same" sex"but"also"creates"a"barrier"in"engaging"this"group"in"HIV/AIDS"preventive"measures"due" to"the"stigma"attached.59"" " Article"12"of"the"Constitution"of"Sri"Lanka"provides"that"‘no"citizen"shall"be"discriminated" against"on"the"grounds"of"race,"religion,"language,"caste,"sex,"political"opinion,"birth"or"any" one"of"such"grounds.’"The"Penal"Code"provision"(as"discussed"fully"below)"remains"in"force" due"to"the"absence"of"not"only"post"enactment"judicial"review"of"legislation"in"Sri"Lanka"but" also" the" limited" judicial" activism" on" the" issue" and" inability" and" lack" of" interest" in" progressive"reform."The"relevant"legal"provisions"will"be"considered"below:" " Penal!Code!No.!02!of!1883!as!amended! " According"to"Section"365"of"the"Penal"Code,"‘whoever)who)has)voluntary)sexual)intercourse) against)the)order)of)the)nature)with)any)man,)woman)or)an)animal)shall)be)punished)with) imprisonment)up)to)ten)years)and)a)fine….’"" " Further,"Section"365A"of"the"Penal"Code"provides"that"any"person,"who"in"public"or"private," commits," or" is" party" to" the" commission" of," or" procures" or" attempts" to" procure" the" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 57"UNDP,"Law,"Policies"and"Regulations"concerning"HIV/AIDS"Prevention"and"Containment:"an"Assessment"and" Recommendations,"August"2003" 58"To"find"information"about"the"protection"of"sex"workers"from"the"Department"of"Labor"in"the"New"Zealand"Sex" Industry,"available"at,"http://www.osh.govt.nz/order/catalogue/pdf/sexindustry.pdf,"last"accessed"on31"May" 2013" 59"Interview"with"UNAIDS,"17"July"2012"

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"23" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" commission" by" any" person" of," any" act" of" gross" indecency" with" another" person," shall" be" guilty"of"an"offence,"and"shall"be"punished"with"imprisonment"up"to"two"years"or"a"fine,"or" both."It"further"stipulates"that"if"such"offence"is"committed"against"a"person"under"sixteen" years"of"age,"the"offender"shall"be"punished"with"rigorous"imprisonment"for"a"term"of"ten"to" twenty"years,"to"a"fine"and"compensation"payable"to"the"person"against"whom"such"offence" is"committed"for"the"injuries"caused." " Accordingly"the"Penal"Code"Sections"365"and"365A"imposes"grave"punishments"for"sexual" conduct"occurring"between"those"who"belong"to"the"same"sex"notwithstanding"the"fact"that" such"conduct"is"between"consenting"adults." " Until" 1995," (before" Section" 365" was" amended" to" include" Section" 365A)" the" offence" was" limited"to"sexual"acts"between"male"persons."Thus,"Section"365"stated"that"‘any)male)person,) who)in)public)or)private,)commits,)or)is)party)to)the)commission)of,)or)procures)or)attempts)to) procure)the)commission)by)any)male)person)of,)any)act)of)gross)indecency)with)another)male) person,) shall) be) guilty) of) an) offence,) and) shall) be) punished) with) imprisonment) of) either) description)for)a)term)which)may)extend)to)two)years)or)with)fine,)or)with)both,)and)shall)also) be)liable)to)be)punished)with)whipping.’) " The" 1995" amendment" to" the" Penal" Code" has" increased" the" penalty" to" rigorous" imprisonment"if"the"offence"was"committed"by"a"person"over"eighteen"years"on"someone" under"sixteen"years"of"age"(Section"365)"and"Section"365"A,"extended"the"offence"from"‘any" male"person’"to"a"‘person’,"thus"penalising"homosexual"conduct"not"just"between"men"but" also"between"women."With"the"amendment"of"1995,"Sri"Lanka"became"the"only"country"in" the"region"to"criminalise"sexual"acts"between"females.60" " Criminalisation" of" homosexual" conduct" involves" a" number" of" human" rights" challenges" as" well"as"challenges"to"the"HIV/AIDS"response."From"the"human"rights"perspective,"the"legal" provision"questions"the"equality"before"the"law"guaranteed"by"the"Constitution"of"Sri"Lanka," by" imposing" an" artificial" heterosexuality" norm" among" all" persons" irrespective" of" their" biological" difference" as" well" as" sexual" preference." From" the" HIV/AIDS" prevention" perspective," the" stigma" and" discrimination" resulting" from" the" legal" provisions" creates" a" barrier"to"approach"the"homosexual"community"in"the"HIV/AIDS"response."" " Although"the"Penal"Code"criminalises"homosexual" behaviour,"at"the"time"of"writing" there" have" not" been" any" prosecutions" under" this" provision." Regardless" of" the" absence" of" indictments" and" prosecutions," CPA" reiterates" that" the" mere" existence" of" the" law" in" the" statute"book"itself"leaves"ample"room"for"stigmatisation"and"human"rights"violations"based" on" sexual" orientation" and" gender" identity" of" a" person." It" also" leaves" scope" to" target" individuals" based" on" this" archaic" piece" of" legislation." It" is" reported" that" the" LGBT" community"in"Sri"Lanka"suffer"harassments"in"all"forms"on"a"daily"basis.61"On"the"other"hand" the" stigma" and" discrimination" prevents" these" vulnerable" groups" from" taking" part" of" awareness" programmes" and" approaching" the" health" systems" in" HIV/AIDS" prevention" response"thereby"leaving"much"wider"scope"for"HIV/AIDS"transmission"due"to"their"lack"of" awareness." """""""""""""""""""""""""""""""""""""""""""""""""""""""" 60"Naz"Foundation,"‘"Political"and"Legal"Framework"regarding"MSM"in"South"Asia’","available"at"," http://test.aidsportal.org/atomicDocuments/AIDSPortalDocuments/ResearchPapers_ArvindNarrain.pdf","last" accessed"on"31"May"2013" 61"‘Celebrating"Pride"in"Sri"Lanka’,"available"at,"http://groundviews.org/2010/07/09/celebratingJprideJinJsriJ lanka/,"last"accessed"on"31"May"2013"

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Further," although" the" Government" has" given" an" undertaking" in" the" National" HIV/AIDS" Policy"to"work"with"highly"vulnerable"groups"such"as"MSM,"this"is"proven"to"be"difficult"due" to"the"stigma"and"discrimination"resulting"from"the"social"norms"that"have"been"backed"by" legislation.62"Without"the"onJgoing"engagement"with"these"vulnerable"groups,"such"as"MSM," the" transmitting" of" HIV/AIDS" can" bring" Sri" Lanka" to" higher" risk" due" to" their" high" risk" behaviour"(i.e."lack"of"condom"usage)."" " "

Best!Practices! ! India! India"has"been"a"leader"in"terms"of"providing"for"the"protection"of"PLWHA"and"the"other" vulnerable"groups,"recognising"their"rights"within"the"Constitutional"and"legal"framework." This"has"also"been"possible"due"to"the"progressive"judicial"pronouncements"by"the"Indian" judiciary,"activism"by"civil"society"and"other"interest"groups"to"push"for"a"rights"framework" in" the" response" to" HIV/AIDS" and" reform" in" the" policy" sphere." The" policy" brief" briefly" discusses"a"recent"challenge"and"judicial"order"regarding"the"law"criminalising"sodomy."In" the" recent" case" of" Naz& Foundation& v& Government& of& NCT& of& Delhi& and& Others63"in" June" 2009," Delhi" High" Court" declared" Section" 377" of" the" Indian" Penal" code" (IPC)" (similar" to" Section"365"of"the"Sri"Lankan"Penal"Code)"to"be"unconstitutional."The"boxes"discusses"key" aspects"of"this"very"important"case."" " Naz&Foundation&v&Government&of&NCT&of&Delhi&and&Others& In"this"case,"Naz"Foundation,"an"NGO"working"with"PLWHA,"filed"a"petition"claiming"that" Section"377"of"the"Indian"Penal"Code"(IPC)"that"criminalised"consensual"sexual"acts"between" sameJsex"persons"was"unconstitutional."In"a"landmark"decision,"the"High"Court"of"Delhi"held" that" the" application" of" certain" parts" of" Section" 377" was" to" unfairly" discriminate" on" the" grounds"of"sexual"orientation"and"was"therefore"unconstitutional." The"Naz"Foundation"argued"that"Section"377"affected"the"rights"of"the"gay"and"transgender" community" and" violated" rights" guaranteed" under" the" Indian" Constitution," including" the" right"to"equality,"the"right"to"nonJdiscrimination,"the"right"to"privacy"(guaranteed"under"the" right"to"life"and"liberty),"and"the"right"to"health."" " Naz"Foundation"argued"that"the"application"of"Section"377"was"to"unfairly"discriminate"on" the" basis" of" sexual" orientation," in" contravention" of" Article" 15" of" the" Constitution." It" was" argued" that" the" right" to" nonJdiscrimination" on" the" ground" of" “sex”" in" Article" 15" of" the" Constitution"should"be"interpreted"widely"so"as"to"include"sexual"orientation." " In"particular,"in"relation"to"the"right"to"health,"it"was"argued"that"affected"individuals"were" reluctant" to" reveal" sameJsex"conduct"due"to"fear"of"law"enforcement"crackdown,"thereby" pushing" cases" of" HIV" infection" underground," and" making" it" difficult" for" public" health" workers" to" access" them" and" crippling" HIV" prevention" and" management" efforts." High" vulnerability" of" the" MSM" group" was" shown" in" a" comparison" of" National" Sentinel" Surveillance" Data" (2005)," which" showed" an" 8%" HIV" infection" rate" among" the" MSM" population"versus"1%"in"the"general"population."" " """""""""""""""""""""""""""""""""""""""""""""""""""""""" 62"Interview"with"UNAIDS,"17"July"2012" 63"Writ"Petition"No.7455/2001,"2"July"2009"

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The" High" Court" of" Delhi" held" that" “Section" 377" IPC," insofar" as" it" criminalises" consensual" sexual" acts" of" adults" in" private," violates" Articles" 21," 14" and" 15" of" the" Constitution”." The" Court" held" that" the" criminalisation" of" sameJsex" acts" in" the" absence" of" harm" was" both" arbitrary"and"unreasonable."The"court"noted"that"Section"377"makes"no"distinction"between" the"consensual"and"nonJconsensual"nature"of"acts"between"adults"(as"consensual"sexual"acts" between"adults"in"private"does"not"cause"harm"to"others)"and"further,"that"Section"377"does" not"take"into"account"relevant"factors"such"as"consent,"age"and"the"nature"of"the"act." " In" confirming" the" need" to" include" sexual" orientation" among" protected" grounds" of" discrimination,"and"build"indirect"discrimination"and"harassment"into"any"consideration"of" the" right" to" equality," the" Court" considered" Canadian," South" African" and" United" States" jurisprudence" as" well" as" the" international" position" contained" in" the" Equal" Rights" Trust’s" Declaration"of"Principles"on"Equality.""" " The" Court" held" that" even" though" Section" 377" appeared" neutral" on" the" face" of" it," the" operation" of" the" section" unfairly" targeted" the" MSM" community." In" determining" that" the" reference"to"“sex”"in"Article"15"of"the"Constitution"should"be"interpreted"as"including"sexual" orientation,"the"Court"referred"to"international"jurisprudence,"and"in"particular"the"Human" Rights"Committee’s"decision"in"Toonen)v.)Australia,64"in"which"“sex”"was"similarly"found"to" include"sexual"orientation,"and"the"criminalisation"of"sameJsex"acts"was"held"to"be"violation" of"Article"2"of"the"International"Covenant"on"Civil"and"Political"Rights." " The"crucial"theme"of"nonJdiscrimination"is"evident"in"the"Courts"conclusion:"" " “If) there) is) one) constitutional) tenet) that) can) be) said) to) be) underlying) theme) of) the) Indian) Constitution,)it)is)that)of)'inclusiveness'.)This)Court)believes)that)Indian)Constitution)reflects) this) value) deeply) ingrained) in) Indian) society,) nurtured) over) several) generations.) The) inclusiveness) that) Indian) society) traditionally) displayed,) literally) in) every) aspect) of) life,) is) manifest) in) recognising) a) role) in) society) for) everyone.) Those) perceived) by) the) majority) as) 'deviants')or)'different')are)not)on)that)score)excluded)or)ostracised.”65) ) " ! Nepal! " Pant&v.&Nepal66& & In"December"2007,"the"Supreme"Court"of"Nepal"ruled"that"transgender"people"and"men"who" have"sex"with"men"are"equal"under"the"Constitution."In"this"case"the"petitioners"argued"for" the"issuance"of"an"order"of"mandamus"in"order"to"provide"the"gender"identity"on"the"basis"of" their"gender"feelings"and"to"recognise"their"cohabitation"as"per"their"sexual"orientation." The"court"further"held"that"gender"identity"and"sexual"orientation"of"the"third"gender"and" homosexuals," cannot" be" ignored" by" treating" the" sexual" intercourse" among" them" as" unnatural."" " """""""""""""""""""""""""""""""""""""""""""""""""""""""" 64"(No.488/1992,"CCPR/C/50/D/488/1992,"March"31,"1994)." 65"Naz)Foundation)v)Government)of)NCT)of)Delhi)and)Others)(No.488/1992,"CCPR/C/50/D/488/1992,"March"31," 1994),"at"130,"per"Ajit"Prakash"Shah"CJ. 66"Writ"No."917"of"the"year"2064"BS"(2007"AD),"NJA)Law)Journal)2008"

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The"Supreme"Court"of"Nepal"called"upon"the"State"to"create"appropriate"environment"and" make" legal" provisions" to" enable" the" LGBT" people" enjoy" fundamental" rights." This" was" to" include" inserting" provisions" in" the" Constitution," guaranteeing" nonJdiscrimination" on" the" ground"of"‘gender"identity’"and"the"‘sexual"orientation’"besides"‘sex’"in"line"with"the"Bill"of" Rights"of"the"Constitution"of"South"Africa." " The"Court"issued"a"directive"order"to"the"Government"of"Nepal"to"form"a"committee"in"order" to"undertake"the"study"on"overall"issues"in"this"regard"and"make"the"legal"provisions"after" considering"recommendations"made"by"the"said"Committee." " The" Supreme" Court" of" Nepal" also" noted" based" on" evidence" given" by" the" World" Health" Organisation"(WHO),"that"the"existence"and"birth"of"LGBT"is"a"natural"phenomenon"and"not" a"disease."It"put"forward"that"despite"the"fact"that"the"LGBT"persons"are"born"naturally,"the" existing"society"mistrusts"their"existence"in"the"name"of"unnatural"phenomenon." " It" further" noted" that" many" countries" including" in" Europe," have" made" remarkable" legal" provisions"to"protect"the"rights"of"the"people"in"regard"to"the"sexual"orientation"and"gender" identity."The"latest"is"South"Africa,"which"has"made"constitutional"provision"to"ensure"nonJ discrimination"on"the"basis"of"sexual"orientation."The"Court"noted"that"in"India,"there"is"a" group"known"as"Hijaras)and"there"is"the"provision"specifying"their"own"sexual"identity"as" Hijara)in"their"passport"and"other"identity"cards." " ! ! ! South!African!Constitution! " The" South" African" Constitution" of" 1996" was" adopted" to" be" the" foundation" of" the" new" democratic"society."The"Constitution"expressly"commits"all"state"and"private"institutions"to" human" dignity," the" achievement" of" equality" and" the" advancement" of" human" rights" and" freedoms.67" " Article" 9" (3)" of" the" Constitution" provides" that" the" state" may" not" unfairly" discriminate" directly"or"indirectly"against"anyone"on"one"or"more"grounds,"including"race,"gender,"sex," pregnancy,"marital"status,"ethnic"or"social"origin,"colour,"sexual"orientation,"age,"disability," religion,"conscience,"belief,"culture,"language"and"birth."" " Article"10"of"the"Constitution"provides"that"everyone"has"inherent"dignity"and"the"right"to" have"their"dignity"respected"and"protected."The"state"is"required"to"respect"and"promote" this"right." " " " " " " """""""""""""""""""""""""""""""""""""""""""""""""""""""" 67"Open"Society"Foundation"for"South"Africa,"‘"A"best"practice"guide"to"HIV"disclosure’,"Page"12,"available"at"," http://osf.org.za/wp/wpJcontent/uploads/2012/09/AJbestJpracrticeJguideJtoJHIVJdisclosure1.pdf"","last" accessed"on"31"May"2013"

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3.3! Prison!Inmates! " In"most"countries"prisoners"are"regarded"as"having"a"higher"HIV"infection"prevalence"than" the"general"population"as"rates"of"HIV"infection"in"prison"settings"tend"to"be"higher"than"in" the"community"outside"prisons."68"The"high"risk"groups"are"including"sex"workers,"injecting" drug" users," the" poor" and" the" marginalised" are" highly" represented" among" the" prisoners" which" increases" the" risk" of" HIV" transmission" in" prisons." Further," CPA" was" informed" of" instances"of"drug"use"and"unsafe"sexual"behaviour"(forced"or"consensual)"among"prisoners" or" prison" staff" with" reduced" access" to" the" prevention" measures" (such" as" condoms" and" sterile" injecting" equipment)" and" health" education," although" limited," that" are" available" to" people"outside"prison." " The"prisoners"have"little"or"no"access"to"voluntary"HIV"testing"or"treatment,"HIV"prevention" information"and"tools,"condoms"and"sterile"needles"and"syringes"despite"strong"evidence"of" their"effectiveness"in"preventing"HIV.69"The"prisoners"living"with"HIV"/"AIDS"on"the"other" hand"have"several"of"their"rights"violated,"often"segregated"from"society"and"denied"vital" medical"care."" " Hence"it"is"paramount"that"the"State"authorities"carry"out"programmes"for"preventing"HIV" transmission"in"prisons."Further,"necessary"legislation,"prison"policies"and"prison"rules"need" to"promote"the"aforementioned"effective"responses"to"HIV"in"prisons."" " ! Practical!issues!! " A"clear"illustration"which"proves"that"HIV"responses"are"required"in"prisons"in"Sri"Lanka"is" the"recent"death"of"an"AIDS"infected"individual"in"the"prisons"and"subsequent"order"issued" by"a"Magistrate"to"carry"out"HIV"testing"of"220"inmates"who"shared"the"same"ward"with"the" deceased"prisoner.70"The"cause"of"death"of"the"34"year"old"prison"inmate"in"March"2012"was" not"known"to"the"prison"officials"till"the"postJmortem"examination"reports"were"released."It" was"further"reported"that"the"deceased"prisoner"was"diagnosed"as"HIV"positive"in"2006,"and" was"undergoing"treatment"at"the"National"STD/AIDS"Control"Programme"(NSACP)"until"his" imprisonment"in"May"2011."Upon"his"imprisonment"he"had"failed"to"receive"the"required" treatment"as"he"had"not"informed"his"status"to"the"prison"officials."This"case"highlights"that" due"to"the"stigma"and"the"discriminatory"laws"in"place,"the"inmate"was"unable"to"reveal"his" HIV"positive"status"which"would"have"potentially"saved"his"life."""" " The" incident" is" a" wakeJup" call" to" introduce" HIV" /" AIDS" responses" including" awareness," counselling," and" safe" sex" education" in" the" prisons" system" in" Sri" Lanka." Despite" this" need" neither"the"legislation"nor"policies"in"Sri"Lanka"acknowledge"the"need"for"any"measures"to" prevent" HIV" transmission" in" the" prison" system." Existing" policy" documents" including" the" National"HIV"/"AIDS"Policy"do"not"identify"prisoners"as"a"vulnerable"group"in"the"national" response"to"HIV/"AIDS"and"do"not"undertake"any"special"preventive"measures"in"the"prisons" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 68"IPU,"UNAIDS,"UNDP,"Taking"action"against"HIV:"A"Handbook"for"Parliamentarians,"N°15"J"2007" 69"ibid"" 70"‘220"prison"inmates"test"positive"for"HIV’,"Tuesday,"12"June"2012,"available"at," http://www.hirunews.lk/36430,"last"accessed"on"31"May"2013" See"also:"Hans"Billimoria,"‘A"man,"a"magistrate"and"220"intimates:"A"reflection"of"the"HIV"response"in"Sri"Lanka’," 12"June"2012,"available"at"http://groundviews.org/2012/06/15/aJmanJaJmagistrateJandJ220JintimatesJaJ reflectionJofJtheJhivJresponseJinJsriJlanka/,"last"accessed"on"30"May"2013""

Centre"for"Policy"Alternatives"|"www.cpalanka.org" Page"28" A"Critique:"HIV/AIDS"and"the"Legal"and"Policy"Framework"in"Sri"Lanka" system" in" Sri" Lanka." Further" the" Prisons" Ordinance" of" Sri" Lanka" does" not" undertake" any" positive"measures"on"the"issue"of"HIV"/"AIDS"control"as"highlighted"below:"" " Prisons!Ordinance!No!16!of!1877!! The"Prisons"Ordinance"contains"many"provisions"about"the"medical"treatment"of"prisoners" which"include"the"appointment"of"a"medical"officer.71"Accordingly"it"is"the"responsibility"of" the"Minister"in"charge"of"Health"to"make"rules"as"to"how"often"the"medical"officer"should" visit"the"prisons,"on"maintenance"of"records"on"sick"prisoners"and"other"related"issues.72"" " Further"according"to"section"19"and"20,"it"is"the"duty"of"the"medical"officer"to"report"to"the" superintendent" of" prisons" about" the" medical" status" of" the" prisoners." Section" 66" of" the" Ordinance"makes"provision"for"the"reporting"of"sick"prisoners"to"the"medical"officer."" " Section"69"(1)"of"the"Ordinance"provides"that"where"a"prisoner"is"found"to"be"suffering"from" any" disease" which" cannot" be" adequately" treated" in" a" prison," he" shall" be" transferred" to" a" public"hospital." " The"recent"death"of"a"prisoner"(discussed"above)"is"a"clear"illustration"for"the"inadequacy"of" the"medical"officer"to"report"cases"of"HIV."Hence"it"is"important"that"special"HIV"prevention" programmes" are" introduced" within" the" prison" system" and" that" legal" and" policy" interventions"are"made"to"that"effect."""""" " Best!Practices! " HIV/AIDS!Policy!in!Malawi! " The" government" of" Malawi" has" committed" its" efforts" to" providing" HIV" treatment" and" substantial" progress" has" been" made" in" recent" years." The" number" of" people" receiving" antiretroviral" therapy" has" risen" dramatically" over" the" last" few" years" and" this" has" had" a" positive"impact"on"thousands"of"PLWHA.73"The"HIV/AIDS"Policy"in"Malawi"provides"that"the" government"undertakes"the"following:" " • Ensure"that"prisoners"are"not"subjected"to"mandatory"testing,"quarantine,"segregation" or"isolation"on"the"basis"of"HIV"or"AIDS"status." • Ensure" that" prisoners" (and" prison" staff)" have" access" to" HIVJrelated" prevention," information," education," voluntary" counselling" and" testing," the" means" of" prevention" (including"condoms),"treatment"(including"ART),"care"and"support." • Ensure"that"prison"authorities"take"all"necessary"measures,"including"adequate"staffing," effective"surveillance,"and"appropriate"disciplinary"measures,"to"protect"prisoners"from" rape,"sexual"violence"and"coercion"by"fellow"prisoners"and"by"wardens."Juveniles"shall" be"segregated"from"adult"prisoners"to"protect"them"from"abuse." • Ensure"that"prisoners"who"have"been"victims"of"rape"or"sexual"violence"have"access"to" postJexposure"prophylaxis,"as"well"as"effective"complaint"mechanisms"and"procedures," and"the"option"to"request"separation"from"other"prisoners"for"their"own"protection."

" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 71"Prisons"Ordinance"No"16"of"1877,!Section"8! 72"Prisons"Ordinance"No"16"of"1877,!Section"18(1)" 73"“Averting"HIV"and"AIDS"in"Malawi”,"2012,"http://www.avert.org/aidsJmalawi.htm"

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3.4! Employment!! " HIV/AIDS"affects"largely"men"and"women"in"the"reproductive"age"group"most"of"who"belong" to"the"country’s"workforce.74"The"impacts"of"HIV"/"AIDS"include"absenteeism"at"work,"poor" work"performance"due"to"physical"and"psychological"morbidity"and"a"reduced,"productive" labour"force,"due"to"premature"deaths,"which"has"adversely"affected"enterprise"performance" and" threatened" national" economies.75"At" an" individual" level" workers" have" experienced" increasing"health"care"costs,"termination"of"employment,"slashed"incomes,"social"isolation" and" unwarranted" stigma" and" discrimination.76"It" has" been" highlighted" that" 11.1%" of" the" working"population"in"Sri"Lanka"are"dismissed"for"contracting"HIV/AIDS.77"" " Further,"research"indicates"that"the"majority"of"PLWHA"are"unemployed,"whilst"a"few"are" selfJemployed."It"was"reported"that"those"who"were"employed"and"whose"HIV/AIDS"status" was" made" known" to" their" employers" and" coJworkers" were" subject" to" discrimination" and" had"to"face"the"lack"of"regard"for"confidentiality"pertaining"to"their"HIV/AIDS"status.78"With" regards"to"PLWHA,"when"interviewed,"it"was"found"that"people"who"have"tested"positive"are" reluctant" to" apply" for" jobs" where"they"meet"the"qualifications."The"reasoning"behind"this" was"the"mandatory"blood"test"that"they"are"forced"to"take"which"will"reveal"their"HIV"status" thus" creating" an" even" greater" stigma." This" illustrates" the" need" for" laws" that" prohibit" discrimination" against" people" with" HIV" and" the" urgent" need" for" legal" establishment" of" confidentiality"protection"of"one’s"HIV"status."" ! Constitutional!and!legal!provisions!related!to!employment!issues! " Neither"the"Constitution"nor"any"employment"related"laws"in"Sri"Lanka"expressly"recognise" HIV"/"AIDS"related"workplace"issues." However," some" of" the" Constitutional"provisions"are" important"in"the"light"of"managing"HIV"/"AIDS"in"the"workplace."" " According"to"Article"14(1)(g)"of"the"Constitution"every"citizen"is"entitled"to"the"freedom"to" engage"by"himself"or"in"association"with"others"in"any"lawful"occupation,"profession,"trade," business"or"enterprise."Further,"the"limitations"to"this"provision"are"imposed"in"Article"15" (5)"of"the"Constitution"which"states"that"the"exercise"and"operation"of"this"right"is"subject"to" the"restrictions"in"the"interests,"of"national"economy"or"obtaining"the"professional,"technical," academic," financial" and" other" qualifications" necessary" for" practicing" any" profession" or" carrying"on"any"occupation,"trade,"business"or"enterprise,"and"the"licensing"and"disciplinary" control." Accordingly," it" is" possible" for" an" organisation" /" professional" body" to" impose" discriminatory" policies" /" standards" on" employment," recruitment" and" termination" of" employees."(i.e."compulsory"HIV"testing"etc.)"" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 74"National"Policy"on"HIV/AIDS"in"the"World"of"Work,"Prepared"by"International"Labour"Organisation,"Sri"Lanka" in"Consultation"with"National"stakeholders,"June"2010"" 75"National"Policy"on"HIV/AIDS"in"the"World"of"Work,"Prepared"by"International"Labour"Organisation,"Sri"Lanka" in"Consultation"with"National"stakeholders,"June"2010"" 76"ibid"" 77"Statement"made"by"ILO"East"and"SouthJEast"Asia"and"the"Pacific"Senior"Specialist"on"HIV"and"AIDS"Richard" Howard,"Sunimalee"Dias,"‘Sri"Lanka"committed"to"job"security"for"HIV/AIDS"victims’,"available"at," http://sundaytimes.lk/110724/BusinessTimes/bt36.html,"last"accessed"on"31"May"2013" " " 78"The"Centre"For"Policy"Alternatives"(CPA),"‘A"Profile"of"the"Stigma"and"Discrimination"faced"by"the"People" Living"with"HIV/AIDS’,"2005"

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" Further,"Article"15(7)"of"the"Constitution"restricts"the"rights"guaranteed"under"Article"14,"in" the"interests"of"public"health."Hence,"public"health"concerns"could"be"relied"upon"to"seek"to" justify"discrimination"/"unjustified"termination"and"similar"issues"in"the"workplace"due"to" HIV/"AIDS." " Major"employment"related"laws"in"Sri"Lanka"(i.e."Industrial"Disputes"Act,"Shop"and"Office" Act," Factories" Ordinance" and" the" Termination" of" Employment" of" Workmen" (Special" Provisions)" Act)" do" not" contain" any" provision" on" managing" HIV" /" AIDS" or" infectious" diseases"in"the"workplace."Unless"it"is"argued"otherwise"it"is"possible"for"employers"to"make" rules" on" compulsory" HIV" testing" for" employees" as" well" as" subsequent" termination" /" discrimination"on"being"found"positive.""" ! In"addition,"some"discriminatory"provisions"can"be"observed"in"certain"laws"which"although" have"limited"applicability"in"the"modern"context"can"however"run"counter"to"the"accepted" norms"recognised"in"the"national"policies"on"HIV"/"AIDS." "" For" instance" Section" 13" of" the" Suburban" Dairies" and" Laundries" Ordinance" No.38" of" 1908" provides" that" ‘no" dairyman," cowJkeeper," or" purveyor" of" milk" shall" knowingly" allow" any" person"suffering"from"any"infectious"disease,"or"having"recently"been"exposed"to"infection" from"a"person"so"suffering,"to"milk"cows"or"to"handle"vessels"used"for"containing"milk,"or"to" assist"in"the"conduct"of"the"business"of"the"dairyman,"until"he"has"satisfied"the"health"officer" that"all"danger"of"communication"of"infection"to"the"milk"or"of"its"contamination"has"ceased’."" " When" interviewed," it" was" demonstrated" that" the" discrimination" in" the" workplace" is" extremely" prevalent" and" the" lack" of" enforceable" laws" constitutes" a" major" issue.) “The) workplace)policy)and)the)National)policy)have)not)reached)the)people)and)the)language)is)not) simple) and) should) thus) be) simplified.) The) law) is) too) broad) and) the) people) cannot) understand”.79Reform"in"this"area"is"urgently"needed"to"avoid"stigma"and"discrimination"and" protect"the"rights"of"PLWHA.) ! " " ! ! ! ! ! ! ! ! ! ! ! ! ! !

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 79"Anonymous"Interview,"Support"Group,"8"April"2013."

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Section!4! ! National!Policies!! ! " " The" policy" brief" has" discussed" specific" policies" in" relation" to" HIV/AIDS" in" Sri" Lanka." This" section"briefly"maps"these"out"for"greater"clarity,"demonstrating"the"areas"that"need"urgent" reform."" ! !

4.1! National!HIV/AIDS!Policy!of!Sri!Lanka!! " National" HIV/AIDS" Policy" of" Sri" Lanka" provides" in" Article" 3.12" that" as" a" majority" of" the" reported"HIV"infections"are"in"the"most"productive"15J49"age"group."In"addition"to"other" reasons," this" aspect" needs" to" be" given" attention" with" reform" and" when" attempting" to" strengthen"HIV/AIDS"prevention"efforts"in"the"world"of"work."" " The" National" HIV/AIDS" Policy" undertakes" to" mobilise" the" Government" of" Sri" Lanka," Employers’" and" Workers’" organisations" and" the" private" sector" to" play" a" key" role" in" this" effort"and"endorses"adoption"of"the"guidelines"of"the"ILO"Code"of"Practice"on"HIV/AIDS"in" World"of"Work"for"development"of"workplace"policies"and"programs."" " !

4.2! National!Policy!on!HIV/AIDS!in!the!World!of!Work!! " National"Policy"on"HIV/AIDS"in"the"World"of"Work"supported"by"the"International"Labour" Organisation" was" adopted" by" the" government" of" Sri" Lanka" in" 2010" with" the" objective" of" preventing" HIV" infection" among" the" workers" and" their" families," to" ensure" a" supportive" working"environment"without"stigma"and"discrimination"for"workers"and"their"families,"to" promote"access"to"treatment,"care"and"support"and"to"protect"the"rights"of"those"infected" and"affected.80"The"policy"incorporates"the"10"key"principles"of"the"ILO"Code"of"Practice"on" HIV/AIDS"and"the"world"of"work.81" " • Recognition"of"HIV"/"AIDS"as"a"workplace"issue" • Non"discrimination""" • Gender"equality" • Healthy"and"safe"work"environment" • Social"dialogue" • No"screening"for"purposes"of"employment" • Confidentiality" • Continuation"of"employment"relationship" • Prevention" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 80"ibid"" 81)ibid"

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• Treatment,"care"and"support"

Best!Practices! ! South!Africa! ! The!Labour!Relations!Act!of!199582! " • Stipulates" that" employees" have" a" right" to" privacy" with" regard" to" their" personal" and" private"information,"including"any"personal"medical"information"

" • Employers" are" not" required" to" disclose" information" that" is" confidential" and" which," if" disclosed," may" cause" substantial" harm" to" an" employee" or" that" is" private," personal" information"relating"to"an"employee,"unless"that"employee"consents"to"the"disclosure"of" that"information""

" The!Employment!Equity!Act!of!199883! " • The"Act"provides"that"no"employer"may"ask"an"employee"to"take"an"HIV"test"to"find"out" their"HIV"status."This"also"applies"to"applicants"for"jobs."If"an"employer"feels"that"an"HIV" negative"status"is"an"‘inherent"requirement’"of"a"job,"they"would"have"to"prove"this"to" the"Labour"Court"in"an"application"for"permission"to"require"an"employee"to"test"for"HIV." Without"this"application,"confidentiality"is"absolutely"protected"

" • An"employee"is"under"no"obligation"to"disclose"his"or"her"HIV"status"to"an"employer,"any" other"employee"or"anyone"associated"with"the"organisation"

" • The"Act"makes"provision"for"every"workplace"over"50"people"to"have"workplace"policies" and" programmes" relating" to" employment" equity," and" to" report" on" progress" to" the" Department"of"Labour"at"regular"intervals"

! India! " MX&of&Bombay,&Indian&inhabitant&vs.&M/s!ZY&(AIR!1997!Bombay!406)! " The" Bombay" High" Court" considered" the" question" of" whether" an" employer" can" lawfully" terminate"the"employment"of"a"person"with"HIV."" " Facts"of"the"case"involved"the"termination"of"a"worker’s"services"by"an"insurance"company" upon"being"found"HIV"positive."The"company"argued"that"his"medical"condition"had"led"to"a" problem"in"the"workplace,"as"other"workers"had"refused"to"work"with"him."" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 82"Open"Society"Foundation"for"South"Africa:"A"best"practice"guide"to"HIV"disclosure,"2009" 83"ibid""

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" Court" took" the" position" that" where" a" worker" has" a" contagious" disease" that" could" be" transmitted" by" the" normal" activities" of" the" workplace," his" or" her" employment" could" reasonably" be" terminated." However," because" the" worker" in" this" case" was" still" able" to" perform"his"normal"job"functions"and"did"not"pose"any"risk"to"fellow"employees,"it"would"be" ‘arbitrary" and" unreasonable’" to" terminate" his" employment," and" in" breach" of" the" equality" clause"in"the"Indian"Constitution." " " X&v&State&Bank&of&India!(2002)84! " Facts" of" the" case" involved" denial" of" employment" on" grounds" of" his" HIV" positive" status," despite"medical"experts"declaring"individual"concerned"to"be"fit"to"perform"the"job."" " The"court"relying"on"the"decision"in"MX"v."ZY"(AIR"1997"Bombay"406)"held"that"X"could"not" be" denied" the" opportunity" of" employment." The" Court" directed" the" respondent" bank" to" employ"the"petitioner"on"first"available"vacancy"and"observed"that"‘protection)and)dignity)of) the)HIV)infected)persons)is)essential)to)the)prevention"and)control)of)HIV/AIDS.)Workers)with) HIV)related)illness)should)be)treated)the)same)as)any"other)worker)with)an)illness.’85) " ! ! !

4.3!Migrant!workers! ! " Although"remittances"made"by"the"migrant"workers"significantly"contribute"to"the"national" economy,"there"is"limited"safeguards"for"those"who"go"in"search"of"employment"overseas" with"regular"reports"in"the"media"documenting"the"violence"and"harassment"faced"by"them." A" particular" problem" is" also" the" lack" of" health" care" and" support" provided" to" migrant" workers."Reports"have"documented"external"migrant"workers"returning"with"HIV/AIDS"to" Sri"Lanka"and"steps"must"be"taken"to"minimise"their"vulnerabilities.86" ! A"key"issue"faced"by"the"migrant"workers"is"the"mandatory"testing"for"HIV/AIDS"without" obtaining" consent" of" the" migrant" worker." The" mandatory" testing" for" HIV/AIDS" is" compulsory" by" all" countries," which" receive" migrant" workers" from" Sri" Lanka." Some" countries87"require"compulsory"HIV/AIDS"testing"prior"to"departure"while"a"few"countries" such" as" UAE" and" Bahrain" require" medical" tests" each" time" migrant" workers" renew" their" visa.88"" """""""""""""""""""""""""""""""""""""""""""""""""""""""" 84"Lawyers"Collective"India"website,"URL:"http://www.lawyerscollective.org/hivJandJlaw/judgementsJaJ orders.html"" 85"X)of)Mumbai)Indian)Inhabitant)v)State)Bank)of)India,"Writ"Petition"No."1856"of"2002,"per"A.P."Shah"J,"at"8." English"translation"available"at"http://www.globalhealthrights.org/wpJcontent/uploads/2012/12/HCJ2004JXJ v.JStateJBankJofJIndia.pdf" 86"Sri"Lanka"National"HIV"/"AIDS"Country"Progress"Report"2010"/"2011" 87"‘Mandatory"HIV"testing"for"employment"of"migrant"workers"in"eight"countries"of"SouthJEast"Asia:"From" discrimination"to"social"dialogue’’,"available"at,"http://www.ilo.org/wcmsp5/groups/public/JJJasia/JJJroJ bangkok/JJJsroJbangkok/documents/publication/wcms_112972.pdf,"last"accessed"on"31"May"2013" 88"UNDP"Bangladesh"‘HIV"Vulnerabilities"faced"by"women"migrants,"“From"Bangladesh"to"the"Arab"States”,"2009," available"at," http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2009/200911_undp_banglad esh_en.pdf,last"accessed"on"31"May"2013""

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Mandatory"HIV"/"AIDS"testing"for"HIV"are"discriminatory"and"stigmatising"which"violates"a" person’s" right" to" privacy." Further," the" International" Labour" Organisation" (ILO)" code" of" practice"on"HIV"/"AIDS"also"states"mandatory"testing"is"not"required"for"migrant"workers"" ‘Migrants"workers"are"often"required"to"sign"papers"agreeing"to"the"HIV"/"AIDS"screening" tests"without"being"told"what"it"is"about"or"what"it"is"for’.89"Further,"it"has"been"reported" that" the" tests" are" conducted" by" 16" private" medical" institutions" without" any" government" regulation" or" control.90"It" has" been" reported" that" the" test" results" are" sent" to" recruitment" agencies"and"not"to"the"person"who"was"tested,"violating"the"principle"of"confidentiality."" The"law"which"regulates"labour"migration"in"Sri"Lanka"is"the"Sri"Lanka"Bureau"of"Foreign" Employment" Act" No." 21" of" 1985" which" is" silent" about" medical" testing" and" issues" of" confidentiality."National"Labour"Migration"Policy"adopted"by"the"Government"of"Sri"Lanka"in" 2009"recognises"the"importance"of"regulating"medical"testing.91"A"study"conducted"by"the" Ministry"of"Health"and"International"Organisation"for"Migration"(IOM)"in"2012,"concluded" that" the" recommendations" made" under" the" National" Labour" Migration" Policy" concerning" confidentiality"have"yet"to"be"translated"into"action.92" ! ! National!Labour!Migration!Policy! ! • The" policy" objectives" include:" minimising" negative" impacts" of" migration" and" to" work" towards"the"fulfilment"and"protection"of"all"human"and"labour"rights"of"migrant"workers."" ! • Recognises"that"HIV"vulnerability"faced"by"migrants"is"an"important"issue"despite"" Sri"Lanka"being"listed"among"countries"of"low"HIV"prevalence."" " • It"notes"that"while"migration"is"not"a"direct"risk"factor"for"HIV"infection,"there"are" economic," socioJcultural" and" political" factors" in" the" migration" process" that" make" migrant"workers"particularly"vulnerable." " " • Undertakes" to" regulate" health" testing" in" order" to" ensure" dignity," privacy" and" confidentiality"of"the"migrant"worker" " • It" proposes" to" monitor" health" impacts" of" migration" and" creates" awareness" among" migrants"about"possible"health"risks,"including"HIV"infection" ! " ! ! ! ! ! !

"""""""""""""""""""""""""""""""""""""""""""""""""""""""" 89"CARAM"Asia,"Dilshani"Samaraweera,"Sri"Lanka’s"irresponsible"Ministers"and"Migrants"rights,"Sunday"Times," 26"August"2007,"available"at,http://sundaytimes.lk/070826/FinancialTimes/ft310.html,"last"accessed"on"31" May"2013" 90)Ibid" 91"Technical"Report"‘Sri"Lanka"Migration"Health"StudyJ"2012’"Page"9,"available"at," http://www.migrationhealth.lk/pdf/625044129.pdf,"last"accessed"on"31"May"2013" 92"Technical"Report,"Sri"Lanka"Migration"Health"Study,"Study"on"Outbound"Migration,"2012,"p."33" http://migrationhealth.lk/pdf/625044129.pdf,"last"accessed"on"31"May"2013"

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Section!7! ! Conclusion! ! " There"has"been"an"increase"in"awareness"of"HIV/AIDS"in"Sri"Lanka"over"the"last"few"years." In"turn"this"has"led"towards"an"influx"of"resources"targeting"the"needs"of"PLWHA."Although" there" is" greater" awareness" and" interest," in" this" policy" brief" CPA" highlights" the" onJgoing" problems" faced" by" PLWHA" including" violence," stigma" and" discrimination." However," awareness,"interest"and"resources"alone,"will"not"address"the"problem."As"illustrated"in"this" policy" brief," legal" and" policy" reform" is" necessary" to" prevent" the" spread" of" HIV/AIDS" and" protect"the"rights"of"PLWHA"and"vulnerable"communities."" " At" the" national" level," there" must" be" more" attention" and" initiative" from" the" political" leadership" on" HIV/AIDS" and" related" issues." This" should" be" public" statements" and" other" initiatives"to"raise"awareness"of"HIV/AIDS."Steps"should"also"be"taken"at"the"national"level" to"provide"support"for"PLWHA,"vulnerable"communities"and"their"families."" " It"is"paramount"reform"in"the"legal"and"policy"framework"is"undertaken"immediately."Legal" and" policy" reform" should" be" inclusive" and" transparent." It" is" important" that" PLWHA," vulnerable" communities," their" families," service" providers," community" groups" and" I/NGOs" are"involved"in"the"formulation"of"legislation"and"policies."Furthermore,"it"is"not"merely"a" matter"of"legislation"alone"but" moreover"of"ensuring" that" such" a" legal" framework" is" fully" implemented."This"requires"training"and"educating"administrators,"medical"staff"and"others." Finally,"the"legal"and"policy"framework"should"be"underpinned"by"human"rights"principles" and"accordingly"take"note"of"the"principles"of"confidentiality"and"informed"consent."" " " ! ! !

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Section!8! " Recommendations! ! The"following"set"of"recommendations"have"been"compiled"on"the"basis"of"the"findings"of" the"research"conducted"by"CPA"including"specific"recommendations"made"by"PLWHA"and" community" groups." CPA" notes" that" some" of" these" recommendations" have" been" made" previously"but"reiterates"their"importance"in"the"present"context"and"urges"stakeholders"to" take"necessary"steps"to"fully"implement"what"has"been"listed"below."The"recommendations" are"listed"in"accordance"with"specific"thematic"fields."" ! ! National!HIV/AIDS!Policy! " The"Government"should"strengthen"the"existing"policy"framework"by"introducing"one"that"is" based"in"a"rights"framework"and"formulated"in"an"inclusive"and"transparent"manner,"which" includes"all"relevant"stakeholders"including"PLWHA."The"policy"should"recognise"the"rights" of"PLWHA""raise"specific"issues"such"as"the"importance"of"confidentiality,"the"implications"of" mandatory"testing,"the"importance"of"counselling"and"address"care"and"support"for"PLHWA."" " " HIV/AIDS!Legislation!! " CPA" recognises" the" importance" of" legislation" based" on" a" rights" framework," which" can" provide"protection,"if"implemented,"to"PLWHA"and"vulnerable"communities."In"this"regard," the"following"are"important:"" " Urgently" reform" legislation" including" introducing" amendments" to" laws" that" are" discriminatory"as"highlighted"in"this"policy"brief."This"includes"changes"that"are"proposed"to" the"Penal"Code"and"Vagrants"Ordinance." " Introduce" legislation" that" provides" for" protection" and" prevents" discrimination" at" the" workplace"and"medical"institutions.""! " ! HIV/AIDS!Sensitisation!Programme! ! There"is"an"urgent"need"for"greater"awareness"of"HIV/AIDS"and"related"issues,"which"can" directly" impact" reducing" stigma" and" discrimination" and" provide" for" better" protection" to" PLWHA"and"vulnerable"communities."Thus,"it"is"paramount"that"sensitisation"programmes" are"conducted"among"a"cross"section"of"actors"including"medical"staff,"government"officials," private"sector"actors"and"others."These"programmes"can"be"at"the"national"level"with"the" involvement"of"all"stakeholders."" "

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There"should"also"be"awareness"raising"among"the"media"to"ensure"reporting"that"does"not" lead" to" further" stigma" and" discrimination." The" Government" should" work" with" state" and" private" media" institutions" to" provide" awareness" on" HIV/AIDS" and" train" media" actors" in" sensitised"reporting."" " Leadership!&!Coordination!! " The"Government"must"take"the"lead"in"addressing"HIV/AIDS"and"related"issues"in"Sri"Lanka." The"NSACP"with"the"support"of"the"relevant"ministries"should"take"the"lead" and" bring" in" others"including"PLWHA,"professional"groups,"religious"actors,"private"sector,"UN,"I/NGOs" and"community"groups" in"the"response"towards"HIV/AIDS." The"following"are"some"steps" that"can"be"taken"immediately:"" " Initiate" prevention" efforts" with" the" involvement" of" Government" officials," I/NGOs," media," religious"leaders"and"the"private"sectors." " Provide" support" and" allocate" funds" for" dropJin" centres." These" centres" can" provide" a" safe" space"for"vulnerable"groups"to"visit"during"the"day"and"include" resources" for"counselling" and"information"on"reproductive"health."" " ! Treatment!and!Care! " The" Government" must" ensure" that" resources" such" as" medication" and" support" groups" are" available"and"accessible"to"all."This"also"includes"the"availability"of"ARTs."It"is"also"important" that" medical" staff" are" provided" with" necessary" training" to" provide" treatment," care" and" support"for"PLWHA."" " Prior"to"being"tested"for"HIV,"individuals"should"be"informed"of"the"available"treatment."Pre" and"post"counselling"should"be"mandatory."" " Treatment"for"STDs"should"be"widely"available"in"all"medical"institutions."" " "

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TAB 13

11/26/2019 HIV risk in Sri Lanka | Daily News HIV risk in Sri Lanka

Thursday, November 29, 2018 - 01:00 Print Edition Features Nadira Gunatilleke

On November 13, 2011, consultant venereologists and health professionals in Sri Lanka predicted that in future (by 2015 and beyond), MSM (men having sex with men) will be the main cause for the spread of HIV in Sri Lanka. The highest number of HIV infections in the Sri Lankan history was reported last year (2017) and the number is 285.

According to consultant venereologists, every week around six new HIV infections are detected in Sri Lanka and the estimated number of HIV infected persons in the country is around 4,200. One-third of those infected do not know that they are HIV positive. The new HIV infected persons detected in the country are between the ages of 15 and 49. The new HIV infections among youths have shown an upward trend over the last five years. Earlier, it was young adults around 30 and 35 who were susceptible to HIV infection, but now the age has gone down to 20–25.

It takes one year to 10 years from the date of becoming HIV positive to develop AIDS. Between one to three months, there may be little viral manifestation with symptoms such as mild fever, lymph-node enlargement, mild skin rash, etc. But it will disappear on its own.

If a patient is infected with the HIV virus, he or she may live without any symptoms for one year to 10 years. During this period, the HIV virus lives in their blood and sexual secretions. From HIV positive blood or sexual secretion contaminated with HIV virus, the HIV virus enters into the body of a normal person through blood or through the mucous membrane of the genital organ, anus or mouth.

Even with the HIV virus present in the blood, the blood tests results for HIV may be negative, if tested within three months from the date of infection. This is because the antibody development takes about three months from the date of infection.

This period is being called ‘the window period’. If we use a more sensitive test (antigen detecting test), the window period will be reduced to less than two weeks. https://www.dailynews.lk/2018/11/29/features/169766/hiv-risk-sri-lanka 1/3 11/26/2019 HIV risk in Sri Lanka | Daily News MSM acts as a bridge between safe persons and HIV infected or risky persons. HIV spreads mainly through sex workers and spousal relationships, either in the past or the present. MSM stands at number two among the high-risk groups. Sex workers are on the top of the list.

Sri Lanka needs to be vigilant about the increasing occurrence of HIV infections and needs to take all available precautionary measures to ensure the HIV prevalence rate doesn’t rise.

It is estimated that there are around 35,000 homosexuals (gay persons) in Sri Lanka. Commercial sex workers and MSM are two main causes for the increase in the HIV positive population. MSM will be the main cause of the spread of HIV.

According to health professionals, there are certain factors we have to take care of to maintain our low HIV and AIDS prevalence rates. There are certain internal and external forces that envy our extremely low HIV and AIDS prevalence rates. Therefore we have to be vigilant and active when it comes to maintaining these low prevalence rates. It is Sri Lanka’s rich cultural heritage and religions that protect its society from HIV and AIDS. Experts say Sri Lankan culture doesn’t encourage people to engage in risky sexual practices and always encourages them to protect themselves and their loved ones. It discourages pre-marital sex. All the religions in Sri Lanka espouse the same views. All communities and religions in the country encourage Sri Lankans to be faithful to themselves and to their spouses.

What should we be concerned about to maintain our low HIV and AIDS prevalence rates? The following are the main factors Sri Lanka should be focused on at the moment. There are certain groups of persons such as migrant workers, drug addicts (who use needles to inject drugs), commercial sex workers, MSM (men having sex with men), LGBT (lesbians, gays, bisexuals and transgender persons) in our society. The percentage of such persons is very low. The majority of them live invisibly while some politically and financially powerful LGBT persons live openly. But all of them face the same risk when it comes to health and HIV or AIDS.

When they visit health institutions, the authorities should ensure that they receive the best health care service plus education without any discrimination. This is the only way of minimising the spread of HIV in Sri Lanka.

The NGOs engaged in HIV or AIDS prevention should be careful as they are working with high-risk groups.

Homosexuals and lesbians and their organisations also have a big responsibility to look after their own health and the health of their partners, families, and friends. These specific groups of persons face an additional risk because of their risky https://www.dailynews.lk/2018/11/29/features/169766/hiv-risk-sri-lanka 2/3 11/26/2019 HIV risk in Sri Lanka | Daily News sexual behaviour. It is a well-known fact that commercial sex workers are at a greater risk and they need to wear condoms. But sometimes their clients do not allow them to wear condoms. Another well-known fact is that the majority of MSM do not wear condoms for various personal reasons. LGBT persons often face the same problem.

Special attention should be paid to encourage the above groups of persons to use condoms and get themselves tested for HIV regularly. Still, the majority of HIV and AIDS awareness programmes do not focus on them.

It is of little benefit to educate the same educated target groups such as journalists all the time.

It takes extra work for the NGOs to find out strategies and implement them, but it should be done no matter how expensive and hard it is.

https://www.dailynews.lk/2018/11/29/features/169766/hiv-risk-sri-lanka 3/3 TAB 14 (https://www.gaystarnews.com/) NEWS (HTTPS://WWW.GAYSTARNEWS.COM/ARTICLE/CATEGORY/NEWS/) Trans woman and HIV advocate murdered in Sri Lanka (https://www.gaystarnews.com/article/trans-woman-hiv-advocated- murdered-sri-lanka/)

06 SEP 2017 (https://www.gaystarnews.com/)

A trans woman who was a tireless community advocate was killed in a violent attack in Sri Lanka.

Sanath Kumara, 34, received head injuries after she was beaten over the head with a club on Tuesday. Police said they had found multiple wooden clubs at the scene.

The brutal attack happened in Dambulla in the Matale District about 150km north-east of the capital, Colombo. Kumara’s body was found in the parking lot at Dambulla Hospital at 5am on September 5. (https://www.gaystarnews.com/) Earlier that morning at about 3am, someon called Kumara’s sister from her own cell phone. The caller swore at Kumara’s sister and said he had killed Kumara, according to a report in Sri Lanka’s Daily Mirror.

Matale District Judicial Medical Ofcer, BD Vidarathna told BBC Sinhala that his ofce was still determining the cause of death. But he did notice a signicant head injury. Community advocate Kumara was a trans woman who had not yet come out.

She worked as a HIV peer educator and helped to raise HIV awarenes among trans communities.

Dambulla Police said they were investigating leads but had not yet found the perpetrators.

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