Human Rights of Women Living with HIV in the Americas The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners to maximize results for the AIDS response. The Inter-American Commission of Women (CIM) is the main hemispheric policy forum for the promotion of women’s rights and gender equality. Created in 1928 - in recognition of the importance of women’s social inclusion to democratic strengthening and human development in the Americas – CIM was the first inter-governmental organization established to promote women’s human rights and gender equality. The Organization of American States (OAS) brings together the nations of the Western hemisphere to promote democracy, strengthen human rights, foster peace, security and cooperation and advance common interests. The origins of the Organization date back to 1890 when nations of the region formed the Pan American Union to forge closer hemispheric relations. This union later evolved into the OAS and in 1948, 21 nations signed its governing charter. Since then, the OAS has expanded to include the nations of the English- speaking Caribbean and Canada, and today all of the independent nations of North, Central and South America and the Caribbean make up its 35 member states. Human Rights of Women Living with HIV in the Americas Author: Dinys Luciano Co-author: Martín Negrete Editor: Marijo Vázquez Copyright ©2015 UNAIDS and CIM/OAS All rights reserved UNAIDS Regional Support Office for Latin America and Comisión Interamericana de Mujeres (CIM) the Caribbean 1889 F Street NW Gonzalo Crance Street, # 166, Washington, DC, 20006 Ciudad Del Saber, Clayton. Estados Unidos Panama City, Panama Tel: 1-202-458-6084 Tel: 00507 301 4600 Fax: 1-202-458-6094 Webpage: www.onusida-latina.org E-mail: [email protected] Facebook Webpage: http://www.oas.org/cim https://www.facebook.com/ONUSIDALATINA Facebook: Twitter https://www.facebook.com/ComisionInteramericanaDeMujeres @OnusidaLatina Twitter: https://twitter.com/OnusidaLatina @CIMOEA https://twitter.com/CIMOEA Design and layout: Celina Hernández The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the CIM or the OAS concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The opinions expressed are those of the authors and do not necessarily reflect the opinion of the OAS or the CIM. Human Rights of Women Living with HIV in the Américas 5 Table of Contents Introduction 12 1. Methodological aspects 14 2. Public policies: Legal framework and programmatic responses 17 3. Status of the rights of women living with HIV: Progress and challenges 23 3.1 Right to life 23 3.2 Right to non-discrimination and equality before the law 27 3.3 Right to the highest attainable standard of health 33 3.4. Right to a life free of violence 37 3.5. Right to not be subjected to cruel, inhuman, or degrading treatment 40 3.6 Right to education 44 3.7 Right to work 45 3.8. Right to social protection and an adequate standard of living 48 3.9 Right to form a family 50 3.10 Right to information 55 3.11 Right to participation 58 4. Funding to further the rights of women living with HIV 61 5. Coordination of the HIV response and participation 66 6. Information and knowledge-management systems 68 7. Conclusions and recommendations 70 List of tables 1. Legal framework and programmatic responses to discrimination, sexual and reproductive health, and gender violence 19 2. Current use of and access to ART in stigma and discrimination studies in six Latin American countries (2008-2014) 25 3. Countries that reported including stigma and discrimination against persons with HIV in their national HIV plans and that have specific 27 programs (GARPR, 2011) 6 4. Experiences of discrimination in stigma and discrimination studies in eight Latin American countries (2008-2014) 28 5. Experiences of discrimination in dental and sexual and reproductive health services in stigma and discrimination studies in eight Latin American countries (2008-2014) 29 6. Legal framework for key populations in Latin America and the Caribbean according to 2011 and 2014 GARPR reports 32 7. Persons who report that they were forced to take an HIV test or were given the test without providing their consent or receiving counseling in stigma and discrimination studies in seven Latin American countries (2008-2014) 36 8. Experiences of various forms of psychological, physical, and sexual violence in stigma and discrimination studies in seven Latin American countries (2008-2014) 39 9. Cases of health professional coercion for sterilization in stigma and discrimination studies in seven Latin American countries (2008-2014) 42 10. Educational level of women and men interviewed in stigma and discrimination studies in five Latin American countries (2008-2014) 44 11. Discriminatory practices in the educational sphere in studies of stigma and discrimination in four Latin American countries (2008-2011) 45 12. Employment status of the participants in stigma and discrimination studies in six Latin American countries 46 13. Job loss and rejection and negative changes in employment due to HIV status in stigma and discrimination studies in six Latin American countries (2008-2011) 47 14. Food shortage rates among the population interviewed in stigma and discrimination studies in two Latin American countries 49 15. Barriers to housing access in stigma and discrimination studies in five Latin American countries 49 16. Situations related to reproductive rights and the right to form a family in stigma and discrimination studies in eight Latin American countries (2008-2014) 52 17. Coercion by a health professional in the past 12 months on abortion, birth, and feeding due to the mother’s HIV status 53 18. Medical coverage of pregnant HIV-positive women receiving ART to prevent mother-to-child transmission (2013) 54 19. Sources of HIV financing and percent international financing by country (2007-2013) 64 7 List of graphics 1. Percentage of women and men from 15 to 49 years of age who took an HIV test in the past 12 months (2007-2013) 36 2. Percentage of women from 15 to 24 years of age with comprehensive knowledge of HIV (2007-2011) 56 3. Percentage of young women who used a condom in their most recent act of sexual intercourse (2009-2013) 56 4. Percentage of men and women from 15 to 19 years of age who used a condom in their most recent act of sexual intercourse (2009-2013) 57 5. Percentage of women with multiple sexual partners who used a condom in their most recent act of sexual intercourse (2003-2013) 57 6. Percentage of transgender sex workers who used a condom in their most recent act of sexual intercourse (2009-2013 58 8 Acknowledgements The preparation of this document was coordinated by Hilary Anderson of the Inter-American Commission of Women of the Organization of American States (CIM/OAS). The responses to the questionnaire sent by the following OAS member states are acknowledged and appreciated: Argentina, Belize, Chile, Colombia, Costa Rica, Dominica, El Salvador, Honduras, Guatemala, Mexico, Dominican Republic, Suriname, Trinidad and Tobago, and Uruguay. The More Peace Less AIDS Foundation also returned the completed questionnaire. The materials contributed by the regional networks ICW Latin America Chapter, Movimiento Latinoamericano y del Caribe de Mujeres Positivas [Latin American and Caribbean Positive Women’s Movement] (MLCM+), the Network of Women Sex Workers from Latin America and the Caribbean (RedTraSex), Red de Jóvenes Positivos de Latinoamérica y el Caribe [Network of HIV-Positive Young People from Latin America and the Caribbean] (Red J+LAC), and the Latin America and Caribbean Network of Trans Persons (REDLACTRANS) in connection with the online course “Strengthening the human rights of women living with HIV in Latin America” are appreciated. These materials were used in the preparation of this report. The comments made on the preliminary draft of this report by the following individuals are acknowledged and appreciated: • Ana Cristina C. Santos Universida de Federal de Alagoas/Campus do Sertão. Núcleo de Estudos e Pesquisas sobre Diversidades e Educação no Sertão Alagoano (NUDES/UFAL) • Andrea Mariño RedTraSex (Central Office, Argentina) • Arely Cano ICW Latina (Regional Office) • Elena Reynaga RedTraSex (Central Office) • Eugenia López Balance – Mexico • Jimena Avalos Chapín Balance – Mexico • Sandra Patricia Arturo de Vries María Fortaleza Foundation – Colombia • Shirley Eng UNAIDS Latin America • Susana Chávez PROMSEX [Center for the Promotion and Defense of Sexual and Reproductive Rights] – Peru 9 Abbreviations and acronyms 3TC Iamivudine AIDS Acquired Immune Deficiency Syndrome ANICP+VIDA Asociación Nicaragüense de Personas Positivas Luchando por la Vida [Nicaragua Association of HIV-Positive Persons Fighting for Life] ART Antiretroviral therapy ARVs Antiretrovirals ATV/r Ritonavir-boosted atazanavir AWID Association for Women’s Rights in Development AZT Zidovudine CAPSIDA Centro de Atención Profesional para Personas con SIDA [Center for Professional Care of Persons with AIDS] CCM Country