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        A manual for
         UN trainers
           HIV & HUMAN RIGHTS

    The Pacific Regional Rights Resource Team (RRRT) would like to express gratitude to all of the individuals
    and organisations who contributed to the development of this training manual.

    UNDP, UNAIDS and the UN AIDS Team for financial, technical and editorial support. To the Pacific Islands
    Aids Foundation (PIAF) for co-authoring sections, editorial support as well as supplementing the manual with
    brochures on legal rights. To the ‘HIV & STI programme at SPC for lending large portions of information,
    editing and feedback.

    Truly a partnership effort, this manual represents to us what can be achieved when we all work as one; an
    essential approach when combating HIV.

    Sandra Bernklau
    Project Manager

    Photos compliment of the South Pacific Tourism Organisation (SPTO).

                                    Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                    HIV & HUMAN RIGHTS    

Across the Pacific the HIV epidemics are at different stages. Some nations have barely been touched; in
others, a generalised epidemic across particular groups is already underway.

At the end of 2007 the latest epidemiological estimates from the World Health Organisation (WHO) and Joint
United Nations Programme on AIDS (UNAIDS) suggested that over 70,000 people were living with HIV in the
Oceanic region. But what is frightening is that we simply do not have adequate data from most countries in the
Pacific to make accurate estimates.

However, one thing has become clear – research has shown that the behaviours that put people at risk for HIV
infection, and the social environments that make them vulnerable, are all present in the Pacific region. High
amongst the risk factors is the unequal legal and human rights environment across the region that most affects
those people already at higher risk of HIV infection such as males who have sex with males, and sex

We recognise that we are all different – different in culture, different in lifestyles, and different in our behaviour.
Often we exclude others who are different – we build barriers, which we think will protect ourselves. We deny
the very existence of behaviour outside our own and our cultural norms and in many instances we deny people
who are different from ourselves their rights. However, our experience in responding to HIV shows that silence,
cultures of exclusion, and rights-abrogating environments fuel the epidemic.

This means that if we don’t address the intersection of human rights and HIV, we are all at risk in the Pacific of
a serious HIV epidemic. Whether the epidemics here in our region progress or not will depend on the decisions
made and actions taken now, not in ten years. That is why this manual addressing HIV and human rights is so

All UN member states in the Pacific have endorsed a General Assembly Resolution calling for universal access
to treatment and prevention by 2010. Implementing this resolution requires broad mobilisation, and building of
coalitions and partnerships to deal with HIV. This is a problem that can only be solved if everybody in society,
in every sector, takes up their responsibility, and responds to our epidemics shoulder by shoulder in a respectful
and rights-protecting environment.

On behalf of the UNAIDS, I would like to offer special thanks to the individuals at the Pacific Regional Rights
Resource Team (RRRT) and the United Nations Development Programme (UNDP) who worked so hard to
produce this manual on HIV and human rights for the Pacific region.

We wish you success in your work and hope that you’ll find this manual a useful tool both inside your
organisations and in your programmes.

Stuart Watson
UNAIDS Pacific Programme Coordinator

                                   Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                           HIV & HUMAN RIGHTS        



Module 1: HIV 101

Session plan                                                                                                    12
Contents                                                                                                        13
Activity: Basic knowledge of HIV                                                                                21
Handout: Basic information on HIV                                                                               
Activity : Three circles sorting game                                                                           6
Handout: High, medium & low-risk behaviours                                                                     8

Module 2: Human Rights 101

Session plan                                                                                                    30
Activity: What are human rights?                                                                                8
Activity: Categories of rights & duty bearers                                                                   9
Handout: Simplified version of the Universal Declaration of Human Rights                                        40

Module 3: HIV & human rights

Session plan                                                                                                    44
Contents                                                                                                        46
Activity: HIV & human rights                                                                                    6
Handout: Common scenarios                                                                                       9
Activity: Human rights of PLHIV                                                                                 61
Handout: Pictures                                                                                               6

Module 4: HIV stigma & discrimination

Session plan                                                                                                    64
Contents                                                                                                        66
Activity: Definitions of stigma & discrimination                                                                74
Activity: Mapping stigma & discrimination in our communities                                                    75

                          Challenging Stigma & Discrimination - A manual for UN trainers

    CONTENTS (cont’d)
    Module 5: Addressing stigma & discrimination

    Session plan                                                                                78
    Contents                                                                                    80
    Activity: Rights-based approaches for SAD                                                   8
    Handout: Case studies
    Activity: Challenging stigmatising statements                                               86
    Activity: Addressing stigma & discrimination                                                87
    Handout: Common scenarios                                                                   88

    Module 6: HIV & the law

    Session plan                                                                                94
    Contents                                                                                    96
    Activity: Strengths & weaknesses of national HIV responses                                 112
    Activity: Confidentiality & partner notification                                           113
    Handout: Questionnaire: Confidentiality & partner notification                             114

    Module 7: Advocacy

    Session plan                                                                               116
    Contents                                                                                   117
    Activity: Defining advocacy                                                                125
    Activity: Advocacy planning in practice                                                    126
    Handout: Advocacy framework                                                                127

                              Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                 HIV & HUMAN RIGHTS   7

AIDS     acquired immunodeficiency syndrome
ART      antiretroviral therapy
ASO      AIDS service organisation
BOR      Bill of Rights
CRC      Convention on the Rights of the Child
GIPA     greater involvement of people living with or affected by HIV and AIDS
HAMP     HIV and AIDS Management & Prevention act
HIV      human immunodeficiency virus
IBOR     International Bill of Rights
ICCPR    International Covenant on Civil and Political Rights
ICESCR   International Covenant on Economic, Social and Cultural Rights
IEC      information, education & communication
ILO      International Labour Organisation
MTCT     mother-to-child transmission
NRTI     nucleoside reverse transcriptase inhibitor
NNRTI    non-nucleoside reverse transcriptase inhibitor
OHCHR    Office of the High Commissioner for Human Rights
PI       protease inhibitor
PIAF     Pacific Islands AIDS Foundation
PIC      Pacific Island country
PICT     Pacific Island countries & territories
PLHIV    people living with HIV
PNG      Papua New Guinea
RRRT     Pacific Regional Rights Resource Team
SMART    specific, measurable, attainable, reasonable and time-bound
STI      sexually transmitted infection
SPC      Secretariat of the Pacific Community
TB       tuberculosis
TRIPS    Trade Related Aspects of Intellectual Property Rights
UDHR     Universal Declaration of Human Rights
UN       United Nations
UNAIDS   Joint United Nations Programme on HIV and AIDS
UNDP     United Nations Development Programme
UNESCO   United Nations Educational, Scientific & Cultural Organisation
UNGASS   United Nations General Assembly Special Session
UNICEF   United Nations Children’s Fund
UNHCHR   United Nations High Commissioner for Human Rights
VCCT     Voluntary Confidential Counselling and Testing
WHO      World Health Organisation
WTO      World Trade Organisation

                Challenging Stigma & Discrimination - A manual for UN trainers
8           HIV & HUMAN RIGHTS

    The HIV pandemic is having enormous health, social and economic consequences across the globe. In some
    countries, it is reversing the development achievements of the past few decades. In comparison to the worst
    affected parts of the world, the prevalence of HIV in the majority of Pacific Island countries and territories
    remains low. However, numbers infected and affected are growing and in some countries the rate of increase
    is disturbing.

    Since the first case of HIV was reported in the Pacific region in 1984, the response has been largely led by
    donors focusing on HIV as a health issue. There has been little in the way of addressing HIV as a human rights

    Within the Pacific, a commonly held belief is that the relative isolation of our island nations will contain or
    protect us from the disease reaching epidemic proportions. However, failure to effectively prevent its future
    spread will pose a direct and significant threat to the sustainable health, economic and social development
    goals of the Pacific communities.

    Furthermore, lessons learnt from the devastating impact of the HIV pandemic in other parts of the world,
    especially the sub-Saharan Africa region, should clearly indicate to the Pacific that HIV must be addressed
    effectively now.

    In early 2004, the Fiji, Samoa and Papua New Guinea UN HIV Theme Groups held a joint Pacific Region
    UNAIDS Management Meeting and agreed to prioritise three key advocacy issues in relation to HIV: (i) stigma,
    discrimination and human rights, (ii) youth and (iii) gender. RRRT/UNDP was tasked to produce this manual as
    part of the first priority listed, with the support of the AIDS Team made up of UNAIDS, UNDP, UNICEF, UNIFEM,
    WHO, UNFPA, ILO and the UNDP Pacific Centre.

                                     Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                   HIV & HUMAN RIGHTS   9

This manual is designed for use by staff and trainers in United Nations agencies, government and non-
government organisations and the private sector to highlight the link between HIV and human rights with a
particular focus on stigma and discrimination.

Its specific objectives are to:

    Identify the links between HIV and human rights,

    Recognise that HIV-related stigma and discrimination can appear in a variety of forms, levels and
    contexts, and

    Enrich understanding of a rights-based approach in addressing HIV, stigma, discrimination and other
    human rights violations.

How to use this manual

This manual aims to be user friendly and flexible; its seven modules can be used sequentially or independently,
depending on the learning objective, the audience and the time available.

Each module contains a session plan, a contents section and at least two activities:

      Each session plan is a suggested way of presenting the information in each module, incorporating the
      activities (and handouts, if any),

      The contents sections comprise the background reading material and can also be used as a resource
      manual by trainers, and

      The activities in each chapter are designed for collective participatory learning and provide step-by-
      step instructions for trainers to follow, as well as handouts that can be photocopied if required.

Trainers are recommended to provide participants with the contents and activity handouts whilst retaining the
session plans and activity sheets themselves to facilitate sessions.

Because HIV is an unfolding pandemic, this manual would need to be updated regularly, drawing on information
provided through sources such as the Secretariat of the Pacific Community (SPC), UNAIDS, the World Health
Organisation (WHO), UN publications and the Internet.

                                  Challenging Stigma & Discrimination - A manual for UN trainers

     HIV 101
12    M O D U L E                1
                                              SESSION PLAN HIV 101

     Objectives                                                            Refer participants to Module 1: Contents and explain
                                                                           the terms.
     The aim of this module is to provide basic information
     on HIV. Please note that we strongly recommend that a                 Step 3a Three circles sorting game
     skilled HIV educator resource this first training module.
                                                                             Group activity                    30 minutes
     By the end of the session participants should be able
                                                                           Refer to Three circles sorting game activity sheet and
                                                                           follow instructions.
         •       Appreciate the scale of HIV in the Pacific
                                                                           Step 3b Modes of transmission
         •       Understand the most important issues
                 surrounding HIV                                             Brainstorm & lecture              30 minutes
         •       Understand how HIV is transmitted                         This session again covers key ideas to emphasise to
         •       Describe how HIV is diagnosed                             understand HIV. Ask participants to make suggestions
         •       Outline methods to prevent HIV                            about the following concepts before delivering the
         •       Identify ways to treat HIV
                                                                                        A.        How and what transmits
     Suggested training materials
                                                                                        B.       HIV infection
     Activity:     Basic knowledge of HIV
                                                                                        C.       Diagnosing HIV
     Handout: Basic information on HIV
                                                                                        D.       The window period
     Activity:     Three circles sorting game
                                                                                        E.       Voluntary confidential counselling
     Handout: High, medium & low-risk behaviours
                                                                                                 and testing
     Step 1 Setting the scene: HIV in the Pacific                          Step 4 Prevention
      Mini lecture              15 minutes                                   Interactive lecture                 30 minutes
     This introductory session provides an overview                        This session focuses on prevention and avoiding
     of the status of HIV in the Pacific Island countries                  behaviour that puts people at risk of infection.
     and territories including: HIV statistics, risk-                      Participants can again be asked to suggest definitions
     taking behaviours, the transmission of HIV and                        for terms during the lecture, time permitting.
     an introduction to some of the basic human rights                                  A.       Mother-to-child transmission
     concepts relevant to HIV.                                                          B.       Safer ways of having sex
     Step 2a Basic knowledge of HIV                                                     C.       Abstinence & monogamy
      Group activity            2 hours                                                 D.       Condoms

     Refer to Basic knowledge of HIV activity sheet and                                 E.       Others

     follow instructions.                                                  Step 5 Treatment
     Step 2b Basic facts                                                     Mini lecture                      15 minutes
                                                                           This final session is a short lecture on the available
      Brainstorm & lecture           30 minutes
                                                                           treatment for HIV covering the following points:
     Write each of these terms below on the board and
                                                                                        A.       Maintaining health
     ask participants to guess what they mean. This is a
                                                                                        B.       Antiretroviral drugs
     key element in understanding HIV.
                                                                                        C.       Side effects of antiretroviral drugs
                  A.     HIV
                                                                                        D.       Cost and accessibility of antiretroviral
                  B.     AIDS
                  C.     STIs

                                          Challenging Stigma & Discrimination - A manual for UN trainers
                                  HIV 101           CONTENTS                                   M O D U L E
                                                                                               M O D U L E            11     13

                                                               Step 1 Setting the scene: HIV in the Pacific
                                                               The number of HIV cases in most Pacific Island
                                                               Countries and Territories (PICTs) remains low when
                                                               compared to other parts of the world. However, there
                                                               exist significant risk factors for HIV transmission
                                                               such as the high rates of STIs and teen pregnancies
     “It is widely recognised                                  which tell us that high risk behaviour is frequent, and

    that HIV and AIDS has                                      in particular that there is low usage of condoms in
                                                               the PICTs (SPC, 2005, p.19).
    the potential to decimate
                                                               HIV infections are on the rise and the Pacific may see
   not only the health status                                  a significant increase in people living with HIV and
  of Pacific populations, but                                  AIDS. The first HIV case in the Pacific was detected
also the social and economic                                   in 1984 and since that time over 8268 HIV infections

    fabric underpinning our
                                                               and 1672 AIDS cases have been reported. Over 98%
                                                               of the overall cases detected in the Pacific are in five
              communities.”                                    PICTs: French Polynesia, Guam, New Caledonia, Fiji
                                                               and Papua New Guinea. The majority of the cases
                          Lourdes Pangelinan                   have been in Papua New Guinea (89%) where the
    Former Director-General Secretariat of the                 number of infections is thought to be much higher
   Pacific Community (Regional HIV Strategy                    than official estimates due to lack of access to health
                          2004-8, 2005, p.8)
                                                               care and low surveillance (SPC, 2005, p.19).
                                                               Other risk factors common in the Pacific include:
                                                                           a significant amount of travel into, out of and
                                                                           within the region;
                                                                           uneven levels of development and poor
                                                                           economic growth;
                                                                           inequalities faced by women in all aspects
                                                                           of their lives;
                                                                           increasing levels of violence against women
                                                                           and gender discrimination;
                                                                           variable accessibility of health services, both
                                                                           preventive and curative;
                                                                           large rural populations without access to
                                                                           services and information;
                                                                           limited economic opportunities and high
                                                                           levels of unemployment which force people
                                                                           to engage in sex work as a means of
                                                                           generating income or in exchange for goods
                                                                           and services;
                                                                           in areas of conflict and social unrest, forced
                                                                           sex and gang rapes are high;

                              Challenging Stigma & Discrimination - A manual for UN trainers
14    M O D U L E             1

             limited knowledge about reproductive                       CUMULATIVE REPORTED HIV AND AIDS DEATHS
             health and access to information about HIV                 IN SELECTED PACIFIC ISLAND COUNTRIES TO
                                                                        DECEMBER 2005
             prevention; and,
             increasing substance abuse. (SPC, 2005,                                                       AIDS-          Female
                                                                         Country                           related HIV+
             pp.19-20)                                                                            positive                HIV+
     Cultural taboos often prevent open discussion of
                                                                         Fiji Islands             200       11    117     83
     sexual matters and further compound the situation.
                                                                         Kiribati                 46        23    30      16
     Religious beliefs that are interpreted in a way that
                                                                         Samoa                    12        8     8       4
     discourage the use of condoms may contribute to
                                                                         Solomon Islands          6          3    3       3
     unsafe sex and unwanted pregnancies, including
     misconceptions that marriage protects individuals                   Tonga                    14         8    7       7
     from HIV. The Church, given its high importance in                  Tuvalu                   9          2    8       1
     Pacific people’s lives, has enormous potential to                   Vanuatu                  2          2    0       2
     reverse the trend of HIV.
     The most at-risk populations in the PICTs are young                      Source: ‘A Review of the Pacific Regional HIV
     people and women. Given the youthful population of                       Strategy and Progress Towards Universal Access
                                                                              to Prevention Treatment, Care and Support’
     most PICTs, it is important that HIV prevention and
                                                                              World Health Organisation, SPC, cases reported
     testing efforts target young people. (SPC, 2005, pp                      as of December 2005. [http://www.wpro.who.
     19-20)                                                                   int/NR/rdonlyres/3558E98E-CFC8-4A48-B9DC-
     Women are at risk due to social and economic
     reasons which leave them more vulnerable to the                    Tuberculosis (TB) is a common co-infection with HIV.
     disease. Women are often unable to negotiate safe                  People infected with TB may also have HIV and not
     sex with their partners and economic vulnerability                 know it. The Pacific has a relatively high rate of TB
     means that they more often have less control over                  infection and low rate of detection. It is estimated
     decisions that affect their health and safety. For                 that 16,000 people in 22 PICTs become sick with TB
     example: “In Fiji, females accounted for 25% of                    every year (SPC, 2005, p.21).
     HIV positive cases in the 19-29 age group in 1989
     compared to more than 40% in 1998-2003. Most of
                                                                        Step 2 Basic facts
     these women are in a single-partner relationship and
                                                                        A.          What is HIV?
     / or are housewives so there is a paradox – behaviour
     that should be low risk is actually associated with high                 H     =          human
     vulnerability. The women are at risk not because of                      I     =          immunodeficiency
     their own behaviour, but because of the behaviour                        V     =          virus
     of their partners, because of their socio-economic                 HIV is the virus that causes AIDS. This virus attacks the
     situation and because of cultural/traditional practices”           immune system and weakens it. (A person’s immune
     (SPC, 2005, p.20).                                                 system is the body’s defence system, which protects
                                                                        it from diseases.) HIV infection makes the immune
                                                                        system deficient and the infected person becomes
                                                                        HIV infection is not a death sentence. A person can
                                                                        live a positive and productive life with HIV for a long

                                       Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                      M O D U L E                1   15

B.      What is AIDS?                                                These are:
A       =        acquired [get it from someone]                                         saliva
I       =        immuno     [body’s defence system]                                     sweat
D       =        deficiency [weakness, failure or                                       tears
                 inadequacy of the immune system]                                       urine
S       =        syndrome [collection of various                     HIV is spread most commonly by unprotected
                 diseases and symptoms]                              penetrative sexual contact with an infected partner.
AIDS is the end stage of HIV infection. At this stage                The virus can enter the body through the lining of the
various diseases attack the weakened body. These                     vagina, vulva, penis and rectum during sex.
are called opportunistic infections.                                 HIV is also spread through contact with infected
C.      Sexually transmitted infections                              blood. In this case, drug users frequently spread
STI stands for sexually transmitted infection, i.e. a                HIV by using contaminated injecting equipment.
disease or infection that is passed on through sexual                Transmission from patient to health care worker
activity. In the constant focus on HIV, STIs are often               or vice-versa via accidental needle-stick injuries or
forgotten despite the fact that they are dangerous,                  other medical instruments is possible, but rare. Other
and sometimes fatal. The presence of an STI indicates                methods of transmission include sharing needles,
unprotected sex, behaviour that puts people at risk of               razors or other tools for tattooing, circumcision or
HIV infection. There is also an increased chance of                  skin piercing.
HIV transmission when another STI is present. STIs                   Women can transmit HIV to their unborn babies during
serve as avenues for HIV to enter the bloodstream.                   pregnancy (through the placenta), at birth and through
STIs can have serious consequences:                                  breastfeeding (mother-to-child transmission).

                 some STIs can cause death, e.g.                     For infection with HIV to occur, two things must
                 HIV, syphilis                                       happen:

                 some STIs can cause infertility, e.g.                                  the virus must find a way to enter the
                 chlamydia, gonorrhoea                                                  bloodstream; and,

                 some can be passed from the                                            the virus must ‘take hold’.
                 mother to the baby, e.g.
                 HIV, syphilis, gonorrhoea                           This is more likely to happen if there is sufficient
                 some cannot be cured, e.g. HIV,                     virus in the fluid and one is exposed to the virus for a
                 genital herpes                                      longer time. A useful way of thinking about this is to
                                                                     use the word SAD:
Step 3 Modes of transmission
                                                                     S       =        sufficient quantities of the virus (i.e.
A.    How and what transmits?
                                                                                      semen, vaginal fluid, blood or breast
HIV is found in all fluids in the body of an infected
person. Body fluids that contain sufficient quantities
                                                                     A       =        access to the bloodstream
of the virus to facilitate infection are:
                                                                     D       =        duration of exposure must be long
                                                                                      enough (the risk of infection increases
              vaginal secretions/fluid
                                                                                      the longer a person is exposed to the
              blood                                                                   virus)
              breast milk                                            Human rights issues around transmission include
There are other body fluids that do not contain                      the following:
sufficient quantities of the virus to be infectious.                             access to information and education

                                    Challenging Stigma & Discrimination - A manual for UN trainers
16        M O D U L E          1

                no barriers to education about reproductive              Testing for HIV is voluntary (it’s your decision) and all
                health                                                   information about the test is confidential (only you
                                                                         and the health worker need to know the result). All
                access to health care and barrier methods
                                                                         persons receiving an HIV test should be asked their
                such as condoms
                                                                         permission for their blood to be tested. They should
                freedom from violence and
                                                                         be provided with counselling before the test, and
                coercion;especially for women and
                                                                         afterwards, regardless of the results of their test.
                children / youth
                                                                         The person being tested should be the only person
     These issues will be covered in more depth in                       informed of the test results (SPC brochure, 2006).
     Module 3                                                            There are human rights issues associated with VCCT.
     B.     HIV infection                                                These include:
     Infection with HIV may be asymptomatic (i.e. no                            Informed consent – this means there has been
     symptoms are shown), however, often there will                             an agreement to do something or to allow
     be illness resembling the influenza virus 6-8 weeks                        something to happen (i.e HIV testing) only after
     after the virus was contracted. These symptoms are                         all the relevant facts and possible consequences
     similar to many other viruses, so usually they are not                     are known.
     recognised as symptoms of HIV.                                             Privacy – this refers to the ability of a person to
     C.     Diagnosing HIV                                                      control their lives and personal affairs without
     The only way to tell if a person has been infected with                    intrusion, or to control the flow of information
     HIV is for that person to take a blood test called an                      about themselves.
     ‘HIV antibody test’ from a hospital or health clinic. For                  Confidentiality – assuring information (on HIV
     an HIV test, a blood sample is taken from the person                       testing) will be kept secret, with access limited
     and analysed. If the HIV antibodies are found in the                       to appropriate persons, such as the treating
     blood, it means the person has been infected with                          medical practitioner and pathologist.
     HIV and is ‘HIV positive’. Normally positive tests are              Both the matter of a person taking a test and the
     repeated to ensure accuracy (SPC, 2005).                            results of the test should be kept confidential because
     D.      The ‘window period’                                         a person has the right to determine who, when, and
     If someone has been infected with HIV it can take                   whether to inform others about matters concerning
     up to 3 months for the antibodies to show up in the                 their health. In addition, when confidentiality is
     blood. This is called the “window period”. This means               respected, people are more willing to receive an HIV
     that when a test is done in this period, an infected                test, which is essential to preventing transmission
     person can test negative even if they actually have                 to others and the first step to receiving treatment
     the virus and can pass it on to others (SPC, 2006).                 (EngenderHealth, 2004).

     E.      VCCT                                                        Issues of human rights and diagnosing HIV will be
                                                                         covered further in Module 3
     VCCT stands for voluntary confidential counselling
     and testing. VCCT spells out an approach which                      Step 4 Prevention
     is promoted for HIV testing in order for prevention                 According to UNAIDS (2007), 2.5 million people were
     efforts to be successful. The VCCT approach is meant                newly infected with HIV, and the overall number of
     to ensure that patients have all of the information and             people living with HIV continues to rise every year.
     support they need for further treatment. In addition,               There are many ways to prevent HIV, however the
     ensuring that tests are confidential will provide                   main obstacle to reducing HIV transmission is not the
     people with greater confidence to come forward to                   lack of prevention methods available, but the failure
     learn about their HIV status.                                       to use them.

                                        Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                    M O D U L E           1      17

An effective prevention strategy must include the                  becoming increasingly rare in many parts of the world,
provision of information and skills in addition to access          particularly in high-income countries.”
to prevention methods. It must also consider social                B.       Safer sex
factors, such as HIV-related stigma, sexual norms                  Safer sex means making sure that a person does
and gender inequalities that affect HIV prevention                 not get anyone else’s blood, semen, vaginal fluids or
efforts. It must encourage safer behaviours, reduce                breast milk into his or her body, as well as protecting
biological and social vulnerability to transmission,               partners while having sex. Safer sex reduces the risk
encourage use of prevention methods and promote                    of infection, but does not eliminate it.
social norms that reduce risk.
                                                                   Safer sex interventions in a country where there is
Cultural norms and beliefs are significant in supporting           a predominantly patriarchal society are difficult. The
prevention efforts, but may also fuel HIV transmission.            low status of women means it is not easy for them
Human rights play a significant role in preventing HIV             to protect themselves. Safer sex should be a mutual
by empowering people to access information and use                 agreement by both parties to make sex more enjoyable
available prevention methods. Successful prevention                and interesting. Safer sex also entails deciding when
strategies include the involvement of people living                and how sex should take place.
with HIV in order to learn from their experiences.
                                                                   Sexual practices can be seen on a continuum from
Barriers to achieving HIV prevention include fear,                 those which carry a high risk of infection to those that
denial and ignorance. HIV prevention efforts have                  carry little or no risk of infection.
been plagued by silence brought on by the denial and
                                                                   •     High-risk activities include:
stigmatisation that is associated with the disease.
                                                                                    vaginal or anal penetration without a
Since there is no vaccine for HIV yet, the only way
to prevent infection is to avoid behaviour that puts a
                                                                                    sharing uncovered sex toys
person at risk of infection, such as sharing needles and
having unprotected sex (UNAIDS, 2006). Behavioural                                  sharing needles, razor blades or any
change and use of condoms are the most common                                       sharp tool that can pierce or cut the skin
preventative measures being advocated globally.                    •     Activities with some risk include:
A.     Mother-to-child transmission (MTCT)                                       oral sex performed on a man without a
According to the WHO (2006): “Most children living                               condom
with HIV acquire the infection through mother-                                   oral sex performed on a woman without a
to-child transmission (MTCT), which can occur                                    barrier
during pregnancy, labour and delivery or during                                  vaginal or anal penetrative sex with a
breastfeeding. In the absence of any intervention,                               condom – the risk depends on how the
the risk of such transmission is 15-30% in non-                                  condom is used, its age and type of
breastfeeding populations. Breastfeeding by an                                   lubricant used with it
infected mother increases the risk by 5-20% to a total
                                                                                 monogamy – the risk depends on the
of 20-45%. The risk of MTCT can be reduced to under
                                                                                 behaviour of the partners
2% by interventions that include antiretroviral therapy
                                                                   •     Low-risk activities include:
(ART) given to women during pregnancy and labour
and to the infant in the first weeks of life, obstetrical                         oral sex on a man with a condom
interventions including elective caesarean delivery                               oral sex performed on a woman with a
(prior to the onset of labour and rupture of membranes),                          barrier
and complete avoidance of breastfeeding. With these                               deep (French) kissing
interventions, new HIV infections in children are

                                   Challenging Stigma & Discrimination - A manual for UN trainers
18       M O D U L E             1

     •    No-risk activities include:                                    common household oil and creams break down latex
                 abstinence                                              and should not be used as a lubricant. Treatments
                 erotic massage                                          for yeast infections which also contain oil will break
                 hugging and body rubbing                                down latex.

                 masturbation and mutual masturbation                    Condoms must be promoted in ways that help
                                                                         overcome personal and cultural obstacles to their
                 sexual fantasy
                                                                         use. Complex gender and cultural factors can be a
     C.     Abstinence and monogamy                                      challenge for HIV prevention education and condom
     The simplest way to avoid HIV infection is abstinence,              promotion. Due to gender norms and inequalities,
     meaning no sex at all. This, however, is an unrealistic             many women find it hard or impossible to negotiate
     expectation in an environment where women often                     with their partners to use condoms. According to
     do not have the power to negotiate safer sex or ward                UNAIDS, UNFPA and UNICEF (2004), only 4.9% of
     off sexual assault.                                                 married women of reproductive age use condoms.
     Another way to reduce the risk is to limit sex to a                 E.       Others
     monogamous relationship with an uninfected partner.                 There are other HIV prevention methods which are
     However, this also creates a false sense of security                currently used outside of the Pacific, or are being
     as the largest growing population becoming infected                 trialled for use. These are:
     with HIV globally are women. According to the latest
                                                                                    Female condoms: this is a soft polyurethane
     WHO (2007) and UNAIDS global AIDS estimates,
                                                                                    sheath that covers the vagina, cervix and
     worldwide, approximately as many women as men
                                                                                    external genitalia. Currently UNFPA and
     are living with HIV and in sub-Saharan Africa, women
                                                                                    other UN agencies are working towards
     constitute 61% of people living with HIV.
                                                                                    ensuring the female condom, or “femidom”,
     Many of the women who have become infected with                                is available widely.
     HIV, or are at high risk of becoming infected, do not
                                                                                    Dental dams: these are squares of latex that
     practise risky sexual behaviours; they are often in
                                                                                    are used during oral sex, both oral-vaginal
     monogamous relationships or are married. They are
                                                                                    and oral-anal.
     vulnerable due to the behaviour of their partners and
     because of their low economic and social status and                            Male circumcision: studies have indicated
     limited control over their lives (UNAIDS, UNFPA and                            that male circumcision may reduce the risk
     UNICEF, 2004).                                                                 of men becoming infected with HIV by up to
                                                                                    60%. However, it does not provide complete
     D.     Condoms
                                                                                    protection against HIV infection. Male
     The condom is one of the least expensive and                                   circumcision should never replace other
     most successful ways to prevent the spread of HIV.                             known effective prevention methods and
     Regular and correct use of a condom decreases the                              should be provided in a culturally-appropriate
     chances of HIV transmission by 10,000. To ensure                               manner (UNAIDS, 2007).
     safety and efficacy, condoms must be manufactured
                                                                                    Post-exposure prophylaxis: this is where
     to the highest international standards, they must not
                                                                                    anti-HIV drugs are given within an hour of
     be used after their expiration date, and they should
                                                                                    exposure (as with needle stick injuries),
     be stored away from direct heat sources.
                                                                                    however, while this treatment has had good
     Latex condoms are readily available and slightly more                          results, it is not 100% effective.
     reliable than other types of condoms. However, they
                                                                                    Vaccines: currently, there are no HIV vaccines
     can only be used with water-based lubricants such
                                                                                    that are effective in preventing HIV infection.
     as KY-Jelly. Oil-based lubricants such as coconut
                                                                                    While work is progressing with developing
     oil, body lotion, baby oil, cold creams and other

                                        Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                            M O D U L E               1   19

        a vaccine, ensuring it will be both safe and                     medical supervision. For this to happen there needs
        effective takes a long time.                                     to be a good doctor/patient relationship.
        Microbicides:     although    an    effective                    ARV treatment is not as simple as other health
        microbiocide is still in development, it is                      treatments. ARV regimens require constant medical
        envisaged that it would take the form of a                       support and supervision; persons being treated must
        gel, film, sponge, lubricant or time release                     be in a supportive situation where they are able to
        suppository and would provide primary                            take medications at specific times, where their other
        protection in destroying the virus prior to it                   health needs are being met, where they are not under
        infecting a partner.                                             stress and can maintain a healthy lifestyle with a
                                                                         balanced diet. As mentioned above, for a person to
Step 5 Treatment
                                                                         have this stability it is essential that their basic human
A.    Maintaining health
                                                                         rights such as access to housing, health care and
Once a person has been diagnosed with HIV, it is                         information are being met.
important for the person to have regular check-ups
                                                                         D.          Cost and accessibility of antiretroviral drugs
by their medical practitioner. Ideally, this should be
                                                                         Currently antiretroviral drugs are available through
a doctor whom the person can trust and establish a
                                                                         the Global Fund to Pacific Island countries at a
good rapport with.
                                                                         subsidised cost.
Even when people do not have access to expensive
                                                                         The manufacture of generic antiretroviral drugs
treatment, changes in behaviour will help them to lead
                                                                         means some drugs for HIV are not at a prohibitive
a better life, such as getting plenty of rest, exercise,
                                                                         price to Pacific Island governments. The ability for
a good balanced diet, good stress management, a
                                                                         a HIV-positive person to access these drugs is a
positive mental attitude and social support which is
                                                                         human right, just as it would be for them to access
culturally appropriate.
                                                                         antibiotics in cases of infection. It is expected that
Whether the human rights of the person with HIV
                                                                         more drugs will be manufactured generically as
are being met is a critical factor in their being able
                                                                         their patents expire, so the affordability of ARVs will
to remain healthy. These rights include access to
                                                                         become progressively realisable in the Pacific.
adequate housing, to adequate food and to a safe
                                                                         A person living with HIV must be able to access
environment which is free from violence and other
                                                                         appropriate and supportive health care in order to
forms of harassment.
                                                                         remain healthy and productive. For this to happen,
B.    Antiretroviral drugs
                                                                         they must not face discrimination in their ability to
HIV is a type of virus called a retrovirus. Drugs                        access health services. Health providers must be
developed to disrupt the action of HIV are known as                      trained in the provision of care to HIV-positive people
antiretroviral drugs (ARVs)                                              and made aware of the human rights that all people
Taking antiretroviral medication can be a complex                        have, regardless of their HIV status.
procedure, therefore it is critical that governments,                    If the immune system of a person living with HIV
including Pacific Island governments, provide health                     gets damaged then they become vulnerable to
services for HIV positive people, just as they would                     opportunistic infections. Their ability once again to
for other medical conditions. This is an important                       access health services becomes critical in their ability
human right, giving people living with HIV access                        to overcome infections.
to health services in a non-discriminatory and non-
                                                                         Health services play a prime role in the person living
judgemental manner.
                                                                         with HIV both in the prevention of infections and their
C.      Side effects of antiretroviral                                   treatment. It is important to understand this in the
There are commonly side effects from ARVs, so                            context of human rights.
any person under treatment has to have supportive

                                         Challenging Stigma & Discrimination - A manual for UN trainers
20     M O D U L E               1


      AIDSinfo. (2005). Glossary Entry: Window Period. US                  [
      Department of Health and Human Services (NIH).                       diseases/hiv-aids/Too%20little%20for%20too%20few.%
                                                                           Niras. (1997). ”Young Peoples Project”. : Port Vila, Vanuatu:
      AVERT. (2008). HIV Testing. [
                                                                           National Cultural Centre.
                                                                           Secretariat of the Pacific Community (SPC). (2005). The
      AVERT. (2008) Using Condoms, Condom Types and Sizes.
                                                                           Pacific Regional Strategy on HIV and AIDS 2004-2008.
      British Columbia Persons With AIDS Society (BCPWA).
      (2004). Positive Living Manual. British Columbia Persons
      With AIDS Society. [                   SPC & WHO. (2007). “A Review of the Pacific Regional
                                                                           HIV Strategy and Progress Towards Universal Access to
                                                                           Prevention Treatment, Care and Support”. [http://www.
      Center for Disease Control and Prevention (CDC). (2008)    
      “National Resources for HIV Testing. Frequently Asked                E85F5B033D19/0/HIV_AIDS.pdf]
      Questions About HIV and HIV Testing.” [http://www.hivtest.
                                                                           SPC. (2006). ”HIV testing”. [
      EngenderHealth.      (2004).   “Reducing    Stigma     and
                                                                           SPC. (2006). “HIV & AIDS: The facts”. [
      Discrimination Related to HIV and AIDS: Training for Health
      Care Workers”. [
      tech-library/hiv/reducing_stigma_participant_English.pdf]            SPC. (2006). ”Safe sex”. [
      Fiji Times. (2006, October 7). “Alarm over HIV Case Rise.”
                                                                           UNAIDS. (2006). “Fact Sheet: Oceania.” [http://data.unaids.
      Global Coalition on Women and AIDS. (2006). “Increase
      Women’s Control Over HIV Prevention”. UNAIDS. [http://                               UNAIDS. (2007). “Male Circumcision”. [http://www.unaids.
                                                                           UNAIDS, UNFPA & UNIFEM. (2004). “Women and HIV and
      Go Asia Pacific in Focus. (2004). “The Stigma of AIDS in
                                                                           AIDS: Confronting the Crisis”.
      Papua New Guinea”.
      Iniakwala, D. (2004). “Situational and response analyses for
      HIV and AIDS & STI prevention, control, care and support             UNFPA. (2006). “Female Condom: A Powerful Tool for
      services in Pacific region in relation to the components             Protection”.
      of the 1997-2000 regional AIDS/STD strategic plan”.
      Secretariat of the Pacific Community.
      International Federation of Red Cross and Red Crescent
                                                                           Vosanibola, A. (2006). “Regional ARV Procurement”.
      Societies. (2000). “Action with Youth - HIV and AIDS and
                                                                           Presentation to 2006 Pacific Islands Regional Multi-Country
      STD: A Training Manual for Young People.” (2nd Ed) [http://
                                                                           Coordinating Mechanism for HIV and AIDS, Tuberculosis
                                                                           and Malaria, Global Fund.
      8-0-0&a=d&c=who&cl=CL1.15&d=Js2981e]                                 World Health Organisation. (2006). “Antiretroviral drugs
                                                                           for treating pregnant women and preventing HIV infection
      Mediciens Sans Frontieres. (2006). Campaign for Access to
                                                                           in infants in resource limited settings, towards universal
      Essential Medicines. “Neither Expeditious Nor a Solution:
                                                                           access, recommendations for a public health approach”.
      The WTO August 30th Decision is Unworkable”. [http://]                           World Health Organisation. (2008). “HIV Testing and
      Mediciens Sans Frontiers. (2006). “Too Little for Too Few:
      Challenges for Effective and Accessible Antiretroviral               []
                                                                           Zuberi, et al. (2004). “HIV and AIDS, Stigma and Human
                                                                           Rights: A Localised Investigation of Hammanskraal
                                                                           Communities”. Centre for the Study of AIDS.

                                          Challenging Stigma & Discrimination - A manual for UN trainers
               BASIC KNOWLEDGE OF HIV                              ACTIVITY                           M HUMAN RIGHTS
                                                                                                      HIV &O D U L E          1      21

Objectives                                                                       The most significant transmission category
     To discuss basic information related to HIV.                                for adults is sexual, and for children it is
                                                                                 transmission from the mother.
     To discuss the myths and preconceptions about
     HIV, transmission and other basic facts.                          Discussion points:
                                                                                 What is the popular perception of the
                                                                                 epidemic in your country?
                                                                                 Do people think HIV is an “African” disease?
Materials                                                             2.   It is possible to determine if a person has HIV just by
Flipchart paper and pens                                                   looking at him or her. FALSE
Handouts                                                                         It is not possible to determine whether a
Handout: Basic information on HIV                                                person has HIV by looking at him/her. The
                                                                                 only way to determine if a person is HIV
Suggested method                                                                 positive is to take an HIV test. There are
Distribute the questionnaire (handout) and allow                                 several different types of HIV tests that are
participants a maximum of 15 minutes to complete                                 available.
the questions individually.                                                      It is important to understand that there is
Lead a discussion on each of the questions and any                               a ‘window period’ where a person can test
questions that may arise for the remainder of the                                negative, when in fact he or she is positive.
time.                                                                            The window period is the period between the
*Note: the exercise is a suggested model only, trainers                          onset of HIV infection and the appearance
should feel free to modify questions.                                            of detectable antibodies to the virus. In the
                                                                                 case of the most sensitive HIV antibody
Notes for trainer
                                                                                 tests currently recommended, the window
Make it clear that the exercise is not a test. It is a
                                                                                 period is about 3 to 4 weeks. This period
participatory way of stimulating discussion and
                                                                                 can sometimes be longer (approximately
sharing knowledge among participants. Highlight
                                                                                 6 weeks) if one uses less sensitive tests. In
that the issues that are identified are not meant to be
                                                                                 some cases, the window period can be up to
exhaustive – they are simply examples to stimulate
                                                                                 12 weeks or (in rare cases) between 6 and 12
discussion and debate. Emphasise that participants
                                                                                 months before antibody tests can give positive
can ask any questions or seek clarification on any
                                                                                 results. In such cases the tests erroneously
issue that may arise, and that there is no such thing
                                                                                 show that the person is not infected. In this
as a ‘stupid question’.
                                                                                 period the person is already infectious and
Use this exercise to emphasise the important points                              may unknowingly infect others.
contained in Module 1: Contents. The relevant
                                                                      Discussion points:
discussion points for the questionnaire follow:
                                                                                 Do you know where in your area you can get
1.   It is estimated that 40 million people worldwide are
                                                                                 tested for HIV?
     living with HIV and AIDS, two-thirds of these (25-28.2
                                                                                 What prevents people from going to be tested?
     million) in sub-Saharan Africa. TRUE
                                                                                 How can these issues be addressed?
          UNAIDS estimates for the end of 2007 suggest
                                                                      3.   Condoms, when used consistently, can significantly
          a total of 33.2 million people worldwide living
                                                                           reduce the risk of HIV transmission. TRUE
          with HIV, more than 95% of whom live in
          developing countries (UNAIDS 2007 AIDS                                 The primary mode of HIV transmission is
          Epidemic Update)                                                       through unprotected sex.

                                     Challenging Stigma & Discrimination - A manual for UN trainers
        M O D U L E           1

               Carefully     monitored       studies   have                          on the regimen, to the infant after birth,
               demonstrated that consistent and correct                              HIV transmission from mother to child can
               use of natural rubber latex condoms (together                         be reduced by up to two-thirds. However,
               with water-based lubricants as required) are                          provision of this treatment can be expensive
               an effective means of preventing unwanted                             and requires access to confidential HIV
               pregnancy and sexually transmitted diseases                           testing, adequate counselling, and effective
               (including HIV).                                                      health and psychosocial services.
               In the last few years, non-latex synthetic                 Discussion points:
               condoms for both men and women have                                   Many women are still not presenting
               been introduced. However it is likely to be                           themselves for testing, even though
               several more years before these are made                              Nevirapine (an antiretroviral drug which
               widely available.                                                     reduces the vertical transmission of the virus,
               Younger and less experienced users break                              that is prenatally: mother to child) is available.
               condoms more frequently than do those who                             What are some of the possible reasons for
               have learned to use condoms properly.                                 this and what can be done about it?
               Promising research on microbicides is under                5.    Most people living with HIV do not know they have the
               way to provide a safe, effective, female-                        virus. TRUE
               controlled method of prevention.                                      A conservative estimate from UNAIDS/WHO
               The female condom can be inserted several                             is that 9 out of 10 people who are infected
               hours before sex occurs. It is safe and less                          with HIV are unaware of their infection. This
               likely to break than the male latex condom.                           means that more than 29 million people in
               The female condom may also give women                                 the world today have no idea that they are
               more control over determining whether or not                          HIV positive.
               condoms are used in a sexual encounter.                               The only way to determine whether or not
     Discussion points:                                                              one is HIV positive is to go for a test.

               What is the current situation concerning                              People are more likely to seek testing if,
               condom quality control, distribution and                              in addition to confidentiality and a non-
               availability in your country?                                         discriminatory environment, adequate care
                                                                                     and support services are made available and
               What institutions in your country oppose
               condom use and sex education amongst
               youth?                                                                Where HIV infection is stigmatised and
                                                                                     discrimination occurs against those living
               What more do you think needs to be done?
                                                                                     with HIV, there is little incentive for those who
     4.    HIV can be transmitted from a mother living with the
                                                                                     may have been at risk to go for an HIV test.
           virus to her unborn or newly born child. TRUE
                                                                                     Advantages of being tested include the ability
               Women can transmit HIV to their unborn babies
                                                                                     to protect loved ones, to be able to plan for
               during pregnancy (through the placenta), at
                                                                                     the future and motivation to seek prompt
               birth and through breastfeeding.
                                                                                     treatment in the event of subsequent illness.
               HIV-positive women are advised not to
                                                                          Discussion points:
               breastfeed when safe alternatives exist and
                                                                                     A national AIDS policy and legislation are
               are available.
                                                                                     very important tools to ensure respect for
               Studies have indicated that by providing
                                                                                     individual rights and protection of persons
               antiretroviral treatment to women during
                                                                                     living with HIV. Are you aware of any such
               pregnancy and delivery and, depending

                                         Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                       M O D U L E             1     

         policies and/or laws in existence in your                    7.    Studies show that teaching young people about sex
         country?                                                           and condom use encourages them to have sexual
         How can people living with HIV become a                            intercourse. FALSE
         meaningful resource in your country?                                     Studies support the notion that teenagers
6.   HIV infection is immediately fatal. FALSE                                    are highly sexually active, with most young
                                                                                  people beginning sexual activity in their
         Having HIV does not mean that a person has
                                                                                  teenage years. Rates of partner change
                                                                                  are also higher during the teens and early
         A few weeks after HIV infection, a person may
         have flu-like symptoms. This is sometimes
                                                                                  Studies in several countries indicate that
         called sero-conversion illness. After that,
                                                                                  multiple sexual partnerships are very common
         an average of 5 to 7 years will pass without
                                                                                  amongst youth.
         another sign of infection – although that delay
         can range from a few months to 10 years.                                 While condom use tends to be higher in
         However, even when a person does not have                                younger age groups than in older groups,
         symptoms, the virus is still multiplying in his/                         it also tends not to be peak until the early
         her body, and he/she can pass it to other                                twenties, highlighting the importance of
         people. Mild symptoms may occur when the                                 work with teenagers who may be less able
         immune system first starts to weaken (many                               or comfortable about obtaining and using
         of these illnesses can be effectively treated or                         condoms.
         prevented), but they become more severe as                               Multicultural, multi-country studies show that
         the AIDS stage of HIV infection is reached.                              teenagers who receive sex education are
         In some countries (most notably industrialised                           more likely to postpone initiation of sexual
         nations, but also some countries in Latin                                activity. When they do initiate sex, they are
         America and Thailand), people who are found                              better able to negotiate protected sexual
         to have HIV have access to combination                                   intercourse than those who do not receive
         antiretroviral therapy which reduces the                                 sex education.
         amount of HIV in the blood, delays the onset                             Where information, skills, training and services
         of AIDS and its disease manifestations, and                              are made available to young people, they are
         increases the survival time of people living                             more likely to make use of them than older
         with HIV and AIDS.                                                       people. Young people may be most willing
         In countries all over the world people                                   to adopt safer behaviours at the beginning of
         living with HIV are sharing information and                              their sexual ‘careers’. Peer education, which
         campaigning for more equitable access to                                 includes young people talking to other young
         treatment.                                                               people, has been shown to be an effective
         Much can be done to prevent and treat
         symptomatic illness. For example, other                                  Barriers to providing HIV and sexual health
         sexually transmitted infections can facilitate                           education in schools may include the sensitive
         HIV transmission. However, most of these                                 nature of the subject and fear of opposition,
         infections can be detected and treated at                                together with the difficulties inherent in
         affordable costs.                                                        balancing priorities between this and other
                                                                                  topics in an already full curriculum.
Discussion points:
                                                                                  Collaborative approaches to addressing these
         What is the situation in your province/island/
                                                                                  obstacles might include: the development of
         region in terms of availability of treatment
                                                                                  partnerships between policymakers, religious
         and services for people living with HIV?

                                      Challenging Stigma & Discrimination - A manual for UN trainers
4        M O D U L E           1

               and community leaders, parents and teachers,                             who are not sex partners are no more likely to
               establishment of a clear policy framework for                            be infected with HIV than members of other
               such activities and the development of locally                           households. If mosquitoes, bedbugs, lice
               appropriate and sensitive curricula.                                     or other insects in a crowded home could
           Discussion points:                                                           spread the virus, there would be more people
                                                                                        infected with HIV in the households of people
               What is the situation for young people in your
                                                                                        living with HIV.
               country in terms of receiving sex education
               and having access to condoms and sexual                       10. Most AIDS deaths occur amongst those in the prime of
               health services?                                                  their productive and reproductive lives. TRUE

     8.    There is no HIV vaccine research being undertaken at                         The age groups most affected by HIV
           present. FALSE                                                               are those in their prime employment and
                                                                                        reproductive years (i.e. 20-29, 30-39 years of
               Research is currently under way on the
               development of three types of vaccines:
                                                                                        For the family, HIV-related illness leads to
                   o    to prevent infection;
                                                                                        a loss of earnings, medical expenses and
                   o    to prevent progression after infection;
                                                                                        eventually to funeral costs, all of which
                                                                                        can drive a household into ever-deepening
                   o    to prevent perinatal transmission.                              poverty.
               Several issues affect the effective availability                         The introduction of HIV to female-headed
               of vaccines in developing countries. These                               households tends to make them poorer and
               include the cost of transportation and                                   less able to provide education and health
               administration, as well as the cost of the                               care for children.
               vaccine itself.
                                                                                        At the national level, the loss of human capital
     Discussion points:                                                                 and revenue will be especially devastating
               What are some of the ethical issues regarding                            in countries where educated, skilled and
               vaccine trials?                                                          professional people are most affected by the
     9.    Mosquitoes transmit HIV. FALSE                                               epidemic.
               The parasite that causes malaria is                           Discussion points:
               transmitted through the saliva of mosquitoes                             To what extent do you think the social and
               and not through sucked blood. HIV thrives                                economic development dimensions of the
               in blood, not in saliva, and is a specifically                           epidemic are clearly understood amongst
               human-hosted virus. When mosquitoes bite,                                policymakers in your country?
               they suck blood into the stomach. They then                              What implications do you predict for your
               inject saliva that contains the malaria parasite                         country’s future social and economic
               to replace that blood. This fluid is toxic to                            development?
               humans and is what produces the itching
               reaction. Mosquitoes do not inject blood.
                                                                             *Note: Activity adapted from:
               There are significant differences in the                      Zuberi et al. (2004). “HIV and AIDS, Stigma and Human Rights: A
                                                                             Localised Investigation of Hammanskraal Communities.” Centre for the
               infection rates amongst different age groups.
                                                                             Study of AIDS.
               If mosquitoes transmitted the virus, infection                United Nations Development Programme. (1999) “First Caribbean HIV
               rates would be evenly distributed amongst all                 & Development Workshop: Facilitators Manual.” [
               age groups.
               Several studies of families of people living
               with HIV show that those household members

                                            Challenging Stigma & Discrimination - A manual for UN trainers
         BASIC INFORMATION ON HIV                              HANDOUT                                  M O    U
                                                                                                       M O DD U LL EE   11   

Instructions: This questionnaire covers basic facts about            6. HIV infection is immediately fatal.
the HIV pandemic. Please read the questions and circle your
                                                                           True                False       Don’t know
response to each.

                                                                     7. Studies show that teaching young people about
1. It is estimated that 40 million people worldwide
                                                                        sex and condom use encourages them to have
   are living with HIV and AIDS, two-thirds of these
                                                                        sexual intercourse.
   (25-28.2 million) in sub-Saharan Africa.
                                                                           True                False       Don’t know
    True            False          Don’t know

                                                                     8. There is no HIV vaccine research being undertaken
2. It is possible to determine if a person has HIV just
                                                                        at present.
   by looking at him or her.
                                                                           True                False       Don’t know
    True            False          Don’t know

                                                                     9. Mosquitoes transmit HIV.
3. Condoms, when used consistently, can
   significantly reduce the risk of HIV transmission.                      True                False       Don’t know

    True            False          Don’t know
                                                                     10. Most AIDS deaths occur amongst those in the
                                                                         prime of their productive and reproductive lives
4. HIV can be transmitted from a mother living with
                                                                         (i.e. 20-29, 30-39 years of age).
   the virus to her unborn or newly born child.
                                                                           True                False       Don’t know
    True            False          Don’t know

5. Most people living with HIV do not know they
   have the virus.

    True            False          Don’t know

                                    Challenging Stigma & Discrimination - A manual for UN trainers
       M O D U L E            3
                                         ACTIVITY THREE CIRCLES SORTING GAME

                                                                         for the benefit of other participants and to place the
                                                                         chit in the circle it considers appropriate. In so doing,
         To discuss       high,   medium       and      low-risk
                                                                         the team members concerned should justify why they
                                                                         chose that particular circle for placement of their chit.
         To discuss facts, myths and misconceptions                      Allow discussion and allow participants from other
         about HIV.                                                      groups to agree or disagree with the team’s choice of
     Time                                                                circle. The team should feel free to transfer its chit to
     1 hour                                                              another circle if it has changed its mind on the basis
                                                                         of the whole group discussion.
                                                                         Invite the participants to set aside chits that might
         Flipchart paper and pens                                        require further investigation in cases where there is
         Tape                                                            no consensus or the participants have recognised
         Depending on the size of the group, also provide                their need for more information.
         about 20 or more small slips of paper (called                   Distribute handout when the exercise is over.
         ‘chits’), each with a statement concerning a
                                                                         Notes for trainer
         behaviour of high, low or no risk of infection – for
         example, unprotected sex with a woman who is                    Use this exercise to highlight the important points
         menstruating, or breastfeeding by a HIV-positive                found in Module 1: Contents
         mother.                                                         The following are high, low and no-risk behaviours:
                                                                         High risk
         Bowl/basket in which to place chits
                                                                                     Vaginal or          anal   penetration   without   a
     Handout: High, medium & low-risk behaviours
                                                                                     Sharing uncovered sex toys
     Suggested method                                                                Sharing needles, razor blades or any sharp
     On the flipchart paper, draw three large circles                                tool that can pierce or cut the skin
     and label them “high risk”, “low risk” and “no risk”                Some risk (the group can discuss and decide where
     respectively. Stick up the labelled circles at the front            these should be placed)
     of the room.
                                                                                     Oral sex performed on a man without a
     Ask the participants to divide themselves into teams                            condom
     of 2-3 people.
                                                                                     Oral sex performed on a woman without a
     Show the participants the bowl of chits and explain                             barrier
     that each chit has a different behavioural statement
                                                                                     Vaginal or anal penetrative sex with a condom
     written on it representing a different degree of risk
                                                                                     – the risk depends on how the condom is
     for HIV transmission. Pass the bowl around to each
                                                                                     used, its age and the type of lubricant used
     group and ask each team to pick one ‘chit’. Continue
                                                                                     with it
     to do so until all chits have been distributed.
                                                                                     Monogamy – the risk depends on the
     Ask the teams to read their chits and to decide, as
                                                                                     behaviour of both partners
     a group, in which of the three circles it should be
                                                                         Low risk
     placed: high, low or no risk. Team members should
     be prepared to justify their choice of circle in which to                       Oral sex on a man with a condom
     place their chit. Allow between 15 and 30 minutes to                            Oral sex performed on a woman with a
     do this, depending on the number of chits/teams.                                barrier
     Invite each team in turn to read its statements aloud                           Deep (French) kissing

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No risk
          Erotic massage
          Hugging and body rubbing
          Masturbation and mutual masturbation
The facilitator should not take sides or act as a
final judge in ambiguous cases, but should guide
the discussion and encourage the participants to
critically examine their points of disagreement and to
seek further information.

*Note: Activity adapted from:

Zuberi et al. (2004).HIV and AIDS, Stigma and Human Rights: A
Localised Investigation of Hammanskraal Communities. Centre for the
Study of AIDS.

United Nations Development Programme. (2000). “Strengthening
Community-Based Responses to HIV and AIDS in India: HIV and
Development Programme.” [

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                                                            M HUMAN RIGHTS
                                                            HIV &O D U L E   1   8


High risk
            Vaginal or   anal   penetration   without   a
            Sharing uncovered sex toys
            Sharing needles, razor blades or any sharp
            tool that can pierce or cut the skin

Some risk
            Oral sex performed on a man without a
            Oral sex performed on a woman without a
            Vaginal (biological factors makes vaginal
            sex far more risky for the woman) or anal
            penetrative sex with a condom – the risk
            depends on how the condom is used, its age
            and the type of lubricant used with it
            Monogamy – the risk depends on the
            behaviour of both partners

Low risk
            Oral sex on a man with a condom
            Oral sex performed on a woman with a
            Deep (French) kissing

No risk
            Erotic massage
            Hugging and body rubbing
            Masturbation and mutual masturbation

30   M O D U L E               2
                                      SESSION PLAN HUMAN RIGHTS 101

     Objectives                                                          E.     Are rights a new idea for the Pacific?
     To introduce participants to human rights concepts,                 F.     What are some examples of human rights?
     terms and definitions as a foundation to building
     their knowledge about human rights law and its
                                                                         Step 2 Features of human rights
     application.                                                               Brainstorm & lecture             15 minutes
     By the end of the session participants should be                    Write each of these features on the board, and ask
     able to:                                                            participants to guess what they mean. This is a key
                                                                         element in understanding human rights.
           Define human rights
                                                                         A.       Human rights are inherent
           List examples of human rights
                                                                         B.       Human rights are inalienable
           Explain how the concept of human rights law
           developed                                                     C.       Human rights are indivisible
           Describe the contents of the                                  D.       Human rights are universal
           Universal Declaration of Human Rights
           (UDHR) and explain its purpose                                Step 3 Duty bearers & their obligations
           Divide the articles of the UDHR into specific                        Brainstorm & lecture             15 minutes
           categories of rights                                          This is a short session that focuses on state human
           Define the various different kinds of                         rights obligations and violations by asking and
           discrimination                                                answering the following questions:
                                                                         A.       How can a state respect human rights?
     Suggested training materials
                                                                         B.       How can a state protect human rights?
     Activity:    What are human rights?
                                                                         C.       How can a state fulfil human rights?
     Activity:    Categories of rights & duty bearers
                                                                         D.       How can a state violate human rights?
     Handout:     Simplified version of the Universal
                  Declaration of Human Rights                            Step 4 Development of human rights
     Step 1a What are human rights?                                             Interactive lecture              10 minutes
          Group activity                 15 minutes                      This is a brief explanation of how human rights
                                                                         developed. It is important that participants
     Refer to What are human rights? activity sheet and
                                                                         understand that rights are not a “new” concept, but
     follow instructions.
                                                                         have been around for centuries. It is just that the UN
     Step 1b What are human rights?                                      codified them in a uniform way.

          Large group brainstorm          15 minutes                     Step 5 Universal Declaration of Human Rights
     This session begins by allowing participants to                            Mini lecture                     15 minutes
     begin thinking about what human rights mean to
                                                                         Ask and answer the following questions:
     them. You may decide to compare answers with
     those that participants provide before beginning                    A.       What is the UDHR?
     your lecture.                                                       B.       What does it contain?
     Put up various responses on a board on the
     following:                                                          Step 6 The International Bill of Rights
     A.   What is a “right”?                                                    Mini lecture                     10 minutes

     B.   What does respect for a right mean?                            Ask and answer the following question:

     C.   What are “human rights”?                                       A.       What is the IBOR?

     D.   Who has these rights?

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Step 7a Categories of rights
     Interactive lecture      25 minutes
On the board, write the terms civil and political rights
and social, economic and cultural rights and ask the
group to define them:
A.     What are the two main types of rights?                          “Girls may also be coerced into
B.     What are civil and political rights?                            early and short-term sexual
C.     What are economic, social and cultural
                                                                       relations by men known in some
                                                                       societies as ‘sugar daddies’ who
Step 7b Categories of rights & duty bearers
     Group activity          45 minutes
                                                                       are usually more than 10 years
Refer to Categories of rights & duty bearers activity
                                                                       older than their partners. These
sheet and follow instructions.                                         men entice girls with necessities
Step 8 Derogation of human rights                                      such as food, money or school fees
      Mini lecture           10 minutes                                or luxuries such as expensive
Ask and answer the following question:                                 gifts in exchange for sex.
A.     What does it mean to “derogate” a right?
                                                                       According to surveys in Kenya,
B.     When can a right be derogated?
                                                                       Uganda and South Africa ‘sugar
Step 9 Culture and human rights                                        daddies’ prefer girls because they
      Mini lecture           15 minutes
                                                                       believe them to be ‘pure’ (HIV
It is good to get participants to start thinking about
these issues here, but keep in mind your discussions                   negative). Because such men are
could go on for some time unless you keep a tight
                                                                       unlikely to use protection, they
                                                                       put young girls at risk of
Step 10 Discrimination
      Interactive lecture    30 minutes
                                                                       contracting HIV.”
                                                                                                                           Yakin Erturk
Ask participants the following questions before                                           Special Rapporteur on Violence Against Women
providing the answers:
A.     What does discrimination mean?
B.     What does a right to non-discrimination
C.     What is lawful and unlawful discrimination?
D.     What is direct discrimination?
E.     What is indirect discrimination?

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                                       CONTENTS HUMAN RIGHTS 101

     “Human rights are foreign to no culture and native to all nations;
     they are universal”
                                                                                                                    Kofi Annan
                                                                                        Former United Nations Secretary-General

     Step 1Introduction                                                   D.       Who has these rights?
     A.     What is a “right”?                                            You do, I do, everyone has them; they belong to
                                                                          every human being. They are UNIVERSAL: male and
     A “right” is like an entitlement or a permission to do               female, rich and poor, black and white, religious and
     or claim something. It cannot be “given” or                          non-religious. They belong to everyone EQUALLY.
     “removed”, but is always there. Rights can be
     “violated” or denied when society refuses to                         E.       Are rights a new idea for the Pacific?
     recognise or fulfil a claim made through that right.                 The fundamental principles of human rights can be
     A right cannot be used to stop someone else from                     found in virtually all cultures, religions and
     exercising their right. For example, the right to                    philosophical traditions. For example, Christianity
     freedom of conscience and worship includes both                      talks of loving your neighbour as you love yourself.
     the right to choose one’s own belief and the right to                F.       What are some examples of human rights?
     not have someone else’s beliefs forced onto you.
                                                                                   The right to equality and non-discrimination
     B.     What does respect for a right mean?
                                                                                   Freedom of movement
     To respect the rights of another person is to value
     that person’s humanity rather than personality or                             Freedom of religion
     other qualities (such as status or wealth). It means                          The right to a nationality
     treating others with respect regardless of your
     opinions about their race or beliefs.                                         The right to life

     C.     What are “human rights”?                                               The right to a fair trial

     Human rights are sometimes defined as the basic                               The right to privacy
     standards without which people cannot live life in                            The right of peaceful assembly
     dignity as human beings.
                                                                                   Freedom of opinion and expression
     Human rights are those rights that every human
     being possesses and is entitled to enjoy simply                      Step 2 Features of human rights
     because they are human. All humans are born with                     Even though there is currently still a lot of debate
     these rights, they cannot be taken away, or only                     over the different definitions and content of the term
     given to some people. They are a natural part of                     ‘human rights’, international law is generally agreed
     being human.                                                         upon its four basic features:
     Human rights are a legal claim because they are                               Human rights are inherent;
     now a part of law in most Pacific Island constitutions
     and in international conventions, for example, such                           Human rights are inalienable;
     as the Convention on the Rights of the Child (CRC).                           Human rights are indivisible; and,
     Human rights are based on the fundamental principle                           Human rights are universal.
     that all people have an inherent (i.e. are born with)
     human dignity and that regardless of sex, race,                      A.       Human rights are inherent
     colour, language, national origin, age, class or                     This means that they do not have to be given,
     religious beliefs, they are equally entitled to enjoy                bought, earned or inherited. They are inherent
     their rights.                                                        because each person is born with them.
     Human rights come with responsibilities; claiming                    Human rights belong to all human beings. It is
     one’s rights should be done without infringing, or                   irrelevant whether the rights are recognised in a
     infringing as little as possible, on the rights of                   country or whether they have been granted by any
     others.                                                              system of law.

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The inclusion of human rights in most of Pacific                       right to work. The exercise of the right to health may
Island constitutions (as well as state ratification of                 require an independent judiciary that enforces
human rights conventions) establishes a standard                       environmental legislation, and so on. Human rights
of commitment for human rights in our region. Most                     are interrelated and there is no hierarchy of rights.
constitutions in the Pacific Islands contain provisions
for human rights in what is called the constitutional                  Step 3 Duty bearers & their obligations
bill of rights (BORs).                                                 Human rights are state obligations. The freedoms of
B.     Human rights are inalienable                                    individuals and groups are linked to the obligation of
                                                                       the state to respect, protect and fulfil people’s
This means human rights are the right of each and                      rights. However, the spirit of constitutions and
every human being; they cannot be transferred from                     international conventions should apply to the private
someone, or taken away by a government. Nor can                        sector as well and this is referred to as ‘horizontal
that person choose or agree to give up their rights.                   application’.
Some human rights can be limited in terms of the                       A.       State obligations are as follows:
law in certain circumstances. However, there are
certain rights that cannot be limited in any situation,                Respect – the state is required to refrain from doing
and the limiting of rights does not mean that they                     anything to violate the integrity of the individual or
stop existing.                                                         his/her freedom of action. For example, the state
                                                                       must not engage in torturing people in order to
A good example of this inalienability of human rights                  obtain information, whatever the circumstances.
can be seen in the case of prisoners; although
prisoners have some rights limited (for example,                       Protect – the state should prevent other individuals or
movement, freedom and liberty) they still are entitled                 groups from violating the integrity, freedom of
to their human rights (for example, freedom from                       action, or other human rights of the individual. For
torture, the right to food and water, a fair trail etc).               example, the state should put in place laws to
                                                                       ensure that people living with HIV are not
C.     Human rights are indivisible                                    discriminated against at work.
All human rights are of equal importance and certain                   Fulfil – the state is required to secure possibilities for
rights cannot be classified as more important than                     everyone within their jurisdiction to cover their
others (i.e. they are not hierarchical in nature).                     needs, such as their right to work, to an adequate
In terms of implementation, certain rights                             standard of living and to education. For example,
(economical, social and cultural) may have to be                       the state must create conditions that will make it
prioritised according to the availability of resources                 possible for all children to go to school, such as by
in a country. This is especially true for the poorer                   making education free or by providing fee exemptions
countries where so many rights compete for a                           for those that cannot afford to pay.
limited pot of resources.                                              It is important to note that all human beings have
Also, human rights may come into conflict with each                    the obligation to exercise their rights responsibly –
other, which requires a balancing of rights that is                    that is, nobody should use human rights as a means
difficult to achieve and often requires making difficult               to deny human rights to others. Individuals have
choices.                                                               duties to other individuals and to the communities in
                                                                       which they live; all people have the obligation to
D.     Human rights are universal                                      contribute to the realisation of human rights. These
Human rights apply to every person EQUALLY                             obligations are generally set by national legislation.
regardless of nationality, culture, status, age, sex, or               Therefore, the state should have both the will and
race or any other category. No person should be                        the necessary capacities to respect, promote and
discriminated against simply because of whom he                        fulfil its own obligations and to ensure others within
or she is or what he or she believes in. The law                       its territory do so as well. Indeed, the state is liable
applies equally to rich and poor, men and women.                       under international human rights law if it fails to take
                                                                       reasonable steps to prevent or stop certain abuses
Human rights are NOT relative and are not                              in the private sphere (for example, domestic violence,
subordinate to culture or custom.                                      workers’ rights under ILO conventions).
An important characteristic of human rights is that
they are interdependent. For instance, inadequate
health services or lack of education affect a person’s

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4   M O D U L E              2

     B.     Violations by the state                                      It is more than just that human rights concepts
                                                                         were first categorised and standardised within the
     Human rights violations committed by the state are
                                                                         UDHR framework on 10 December, 1948. This
     of three types:
                                                                         framework set down a list of human rights and
          Omission – not enacting laws or                                fundamental freedoms. These were considered
          policies to protect human rights. For example,                 minimum standards by which governments should
          the absence of laws preventing                                 treat their citizens so this became a legitimate
          discrimination against people living with                      concern, rather than only a domestic issue.
          HIV, or through not having specific laws that
                                                                         Since then, the concepts outlined by the United
          protect women and children against violence
                                                                         Nations have been adopted by almost every nation
          in the home.
                                                                         around the world. They are concepts that apply to
          Breach – these are violations of laws that                     all people, regardless of race or culture.
          have been enacted. For example, when
          the local government evicts people from state                  Step 5 The Universal Declaration of Human
          land without following the correct                             Rights (UDHR)
          policies that are in place, or when equal                      A.        What is the UDHR?
          pay or maternity labour provisions are not
          enforced.                                                      The Universal Declaration of Human Rights:
          Arbitrary derogation – violations due to the                            Is a common understanding of the people
          arbitrary suspension of liberty (for example,                  of       the world concerning the inalienable rights
          during emergency rule).                                                 of all members of the human family.
     It is important to note that rights are not absolute.                        Is a historic document expressing a
     Bills of rights generally provide that rights can be                         common definition of human dignity
     limited in certain circumstances, as long as the                             and values.
     limitation is ‘reasonable and justifiable in an open                         Is truly “universal” in that it is valid for every
     and democratic society’. The limitation must take                            human everywhere, regardless of whether
     into account several factors, including the nature of                        their governments have formally accepted
     the right, the nature and extent of the limitation, the                      its principles or ratified its covenants.
     purpose of the limitation and whether there are less
     restrictive means that could accomplish the same                             Is a set of moral rules or guidelines.
     purpose. However, certain rights (like the right to                 Is the foundation document for international human
     life) can never be derogated, despite the                           rights conventions (currently there are nine
     circumstances.                                                      conventions ) which are bound by law.
     Step 4 Development of human rights                                  B.        What does the UDHR contain?
     What we call human rights are to be found in all the                It contains 30 articles that recognise the inalienable
     world’s great religions – Christianity, Buddhism,                   rights of all human beings. These articles may be
     Hinduism and Islam as well as in more local cultures                divided into two categories:
     and systems of belief.
                                                                                   Civil and political rights
     Historically, the ideas of human rights can be traced
                                                                                   Economic and cultural rights
     as far back to the Greek Philosophers (Plato,
     Socrates and Aristotle) but the development of                      While the declaration is not legally binding, it is
     human rights as the term is understood today began                  important because it brought about a change in
     during the 17th and 18th Centuries. This was a time                 thinking about the role of the international
     of revolution and emerging democracy in England,                    community.
     America and France.
                                                                         As they are not “laws” in themselves; the principles
     Human rights as we define them today have their                     of the UDHR had to be transformed into conventions/
     origin in the Universal Declaration of Human Rights                 treaties to make them legally binding on countries
     (UDHR). After the atrocities committed against certain              that agreed to them. This resulted in two conventions
     peoples in World War II, the members of the United                  (called covenants) that distinguished between the
     Nations decided to enshrine (by putting in writing)                 different types of rights covered in the earlier
     the values and principles that would govern the                     session:
     actions of the governments of the world.

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       The International Covenant on Civil and                         Political rights are the rights citizens have to
       Political Rights (ICCPR), which                                 participate in the political life of their community and
       covers civil and political rights.                              society. They include:
       The International Covenant on Economic,
       Social and Cultural Rights (ICESCR) for
                                                                                The right to vote
       economic, social and cultural rights.
                                                                                Freedom of expression
Step 6 The International Bill of Rights
                                                                                Freedom of opinion
All the fundamental rights contained in every human
rights treaty or convention originated from what is                             Freedom to attend meetings
known as the ‘International Bill of Rights’ (IBOR).                             Freedom to join trade unions or other
The IBOR consists of the UDHR together with the                                 organisations
ICCPR and the ICESCR and the various protocols
to these covenants.                                                    C.       What are economic, social and cultural rights?

The IBOR forms the ethical and legal basis for all of                  These rights attempt to guarantee individuals the
the human rights work of the United Nations and                        right to education, water, employment etc in as far
provides the foundation upon which the international                   as resources permit. They are generally “non-
system for the protection and promotion of human                       justiciable”, that is, they cannot be enforced by a
rights has been developed.                                             court of law. But they can be claimed through
                                                                       avenues such as trade unions, voicing complaints
Subsequent conventions have elaborated on the                          at meetings and voting.
IBOR by focusing in greater detail on specific human
                                                                       These rights give people the opportunity to
rights areas or specific groups of vulnerable people
                                                                       participate in the economic, social and cultural life
Step 7 Categories of rights                                            of the community. They are concerned with the
                                                                       basic necessities of life such as food, water and
A.     What are the two main types of rights?                          shelter, and how people live and work together.
Human rights are traditionally grouped into two                        Examples of economic rights:
broad categories:
                                                                                The right to work/employment
       Civil and political rights; and,
                                                                                The right to fair wages and equal
       Economic, social and cultural rights.                                    remuneration for work of equal value
However, it must be remembered that the United                         Examples of social rights:
Nations has argued that human rights should not be
categorised as such. Categories can give the                                    The right to adequate health care
assumption that one category takes precedence or                                The right to an education
is more important than another. As noted earlier, all
human rights are INDIVISIBLE.                                                   The right to a decent home, food and shelter

B.     What are civil and political rights?                            Examples of cultural rights:

These rights are concerned with protecting the                                  The right to take part in cultural life
individual from abuse of power by the state. Civil                              The right to celebrate religious festivals etc
rights are the rights citizens have to liberty and
equality, and include:                                                          The right to enjoy the recreational life of
                                                                                one’s community
       Freedom of opinion
                                                                       Economic, social and cultural rights are seen as
       Freedom of movement                                             rights that can be achieved progressively given the
       The right to liberty of person                                  limited resources of states, particularly in the
                                                                       developing world. Accordingly, states are obliged to
       Freedom to practice religion                                    prove that maximum progress is being made given the
       The right to a fair trial                                       constraints they face. This requires adequate budget
                                                                       allocation and the elimination of corruption, but also
                                                                       adequate financial assistance and other forms of
                                                                       cooperation between states.

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     The international human rights framework recognises                nationals. Indeed, nationalist, ethnic or class
     that states would be complying with their obligations              interests can prevail over human rights only if human
     as long as they strive to ensure that human rights are             beings are no longer considered as such.
     respected for all, within their available human and
     financial resources.

     Step 8 Derogation of human rights
                                                                        Step 10 Discrimination
     There are exceptional circumstances when a state
     may be allowed to temporarily suspend certain                      A.        What does discrimination mean?
     human rights. To derogate means to ‘detract’ or to
                                                                        Discrimination means treating people in different
     ‘divert’ from something for a limited time.
                                                                        ways because of perceived or actual differences, for
     ‘Derogation’ allows a state to withhold the operation              example, because of their sex, race, religion, political
     of certain human rights provisions but only in                     opinions, creed, sexual preference and so on. We
     exceptional circumstances, most often in the case                  may discriminate against a particular group of
     of national emergencies. For example, during the                   people, just as we may discriminate in favour of a
     attempted coup in the Fiji Islands in May 2000, the                particular group of people.
     military restricted people’s freedom of movement
                                                                        Another word often used is ‘prejudice’. Prejudice is
     for security purposes.
                                                                        an inbuilt belief or assumption, for example, “the
     Some essential rights, called ‘fundamental rights                  poor are lazy”, “women are not as smart as men”,
     and freedoms’, can never be derogated. For                         and “black people are dirty”. It causes people to act
     example, the right to freedom of movement (internally              discriminatorily.
     – for example, an imposed curfew) is a derogable
                                                                        We treat people differently every day; we all
     right but the freedom of speech and expression is
                                                                        discriminate in the ordinary course of our lives. But
                                                                        some forms of discrimination are illegal, such as
     The right to derogation is always strictly limited                 racial discrimination – for example, you cannot turn
     because of the potential for abuse by the state. A                 down a person for a job merely because of their
     state of emergency must be declared under the                      race.
     constitution of a country and under very strict
                                                                        B.        What does a right to non-discrimination mean?
     conditions. Even a lawful state of emergency would
     not entitle the authorities to discriminate against                The right to non-discrimination is a fundamental
     people living with HIV, for example, and other                     right and freedom contained in virtually all
     minority groups as all derogable rights must be                    constitutions of the world. In most human rights
     evenly applied.                                                    conventions, it is usually found in the first or second
     Step 9 Culture and human rights
                                                                        Of all the fundamental right and freedoms, it is
     Many people say that human rights are only for the                 probably the most important and certainly the most
     rich countries and that poor countries cannot afford               controversial because it turns upside down
     the luxury. Some developing countries argue that                   thousands of years of tradition and culture of all
     human rights are a “white man’s” Western philosophy                known societies in which people were treated
     and that human rights are not universal. However,                  differently because of their innate or supposed
     the same countries whose governments denounce                      characteristics. That is, people received different
     human rights as a “Western imposition” may have                    treatment based on their race, colour, sex, economic
     vibrant human rights movements at the grassroots                   status, belief etc.
                                                                        The right to non-discrimination forces people to
     Indeed, claims of ‘cultural relativism’ are often used             reconsider and evaluate their fundamental beliefs
     as a justification to deny human rights. ‘Relativist’              and prejudices. It says that prejudice and
     arguments on human rights deny the possibility of                  discrimination based on a characteristic is wrong.
     universal norms on how human beings should be
     treated. Such ideas suggest that whereas human                     If humans are socialised to believe something of a
     rights may be relevant for some countries and                      person based on a real or supposed characteristic,
     cultures, they are not necessarily so for others.                  it is difficult to change that belief. But the right to
     However, this argument is flawed in the sense that                 non-discrimination and equality, or, put another
     there are no ‘Fijian’ or ‘Tongan’ human beings; there              way, the freedom from discrimination, is inherent to
     are only human beings and Fijian or Tongan                         human rights and democracy.

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“Human rights teach us in a direct, straightforward manner that we are at
the same time identical and different.”
                                                                                                                      Boutros Boutros-Ghali
                                                                                                    Former United Nations Secretary-General

C.     What is lawful and unlawful discrimination?                    E.       What is indirect discrimination?
An employer may make a decision to employ Person                      Indirect discrimination is more difficult to find and
A and not Person B because they may believe that                      prove because it is not so obvious. It is often based
Person B may not be a team player in a position                       on policies, laws and practices that are part of the
where teamwork is essential. They may choose one                      structures of society.
candidate over another because they assess that
                                                                      Indirect discrimination occurs also because social
his or her leadership skills may not be as good as
                                                                      and cultural attitudes cause officers of the courts,
another person’s leadership skill. This is lawful, or
                                                                      law enforcement agencies and associated agencies
legitimate, discrimination.
                                                                      to interpret laws and procedures in ways that
However, if the reason for employing Person A was                     discriminate. This type of indirect discrimination
based on a characteristic not relevant to the position                may be called ‘procedural and interpretative
advertised, then the employer’s decision is                           discrimination’.
discriminatory. If Person B was not given the job
                                                                      The law may also be indirectly discriminatory where
because she was a woman and the employer
                                                                      it fails to correct discrimination. Here discrimination
personally didn’t think that she could handle the
                                                                      occurs not because the law does something, or
workload because of characteristics associated
                                                                      does it badly, but because it does not correct
with her gender, for example fragility, then the
                                                                      something. This may be called ‘discrimination by
employer’s decision can be challenged on the
grounds of discrimination.
D.     What is direct discrimination?
Direct discrimination is obvious – the reason why it                  REFERENCES
has occurred is clear, for example, “You can’t come
in here, this club is for whites only”. It can be directly            Pacific Regional Rights Resource Team (RRRT).
and expressly based on a person’s sex, race,                          (2002). Pacific Human Rights Training Manual.
language etc or it can be a decision based on                         Unpublished.
assumptions about an individual or group of                           Tomàs, A. (2003). A Human Rights Approach to
individuals.                                                          Development: Primer for Development Practitioners.
An example is a church, which does not allow people                   Geneva: Office of the High Commissioner for Human
to become ministers because of their sex or sexual                    Rights (OHCHR)
orientation, regardless of their skill and other relevant             [
Direct discrimination involves comparing one group                    RBA%2520Primer%2520.pdf+Tom%C3%A0s+(20
or type of person to another; there is an obvious                     03),+A+Human+Rights+Approach+to+Developmen
‘comparator’, for example, he is black and she is                     t:+Primer+for+Development+Practitioners,+Office+
not, therefore we will give the job to her.                           of+the+High+Commissioner+for+Human+Rights+(
Direct legal discrimination may be obvious in
legislation or legal practice. For example, if legislation            Zuberi et al. (2004). “HIV and AIDS, Stigma and
states that men are permitted certain rights and                      Human Rights: A Localised Investigation of
women are not.                                                        Hammanskraal Communities.” Centre for the Study
                                                                      of AIDS.

                                   Challenging Stigma & Discrimination - A manual for UN trainers
8   M O D U L E             2
                                       ACTIVITY WHAT ARE HUMAN RIGHTS

     Objectives                                                                    What do you think might happen if babies
                                                                                   and adults are deprived of these?
            To become familiar with human rights in
            general.                                                      Notes for trainer
     Time                                                                 This is a useful exercise for participants to:
            15 minutes                                                             Start thinking about human rights.

     Materials                                                                     Identify the participants’ level of
                                                                                   knowledge         of human rights.
            Flipchart paper and pens
                                                                                   Highlight the difficulties in agreeing on
            Picture of a baby                                                      what should constitute a human right.
            Tape                                                          The exercise could lead into a discussion about
                                                                          the balancing of rights. The types of rights that
     Handouts                                                             should ideally be part of the list include: human
            None                                                          dignity, equality, life, freedom and security of the
                                                                          person, privacy, freedom of religion, freedom of
     Suggested method                                                     expression, freedom of association, freedom of
     Stick up a picture of a baby (or have participants                   movement and residence, safe and healthy
     draw their own) at the front of the training room.                   environment, education, housing, health, rights of
     Break up the participants into small groups of 4-5                   children, right to information, right to language
     people. Each group should select one person to                       and culture.
     report back to the plenary session. Ask the groups                   During the discussion, ensure that the important
     to consider what the baby would need to have for                     points from Module 2: Contents are highlighted,
     a full life as a human being. Each group should                      including what rights are, the features of rights,
     agree upon a list and these are to be noted on                       the categories of rights and where rights come
     flipchart paper.                                                     from.
     Allow 15 minutes for groups to present their lists.
     In order to save time, have one group present their
     list and thereafter have groups just add to the list,
     or suggest changes. Once all groups have                             *Note: Activity adapted from:
     presented and the list is complete, lead a                           Zuberi et al. (2004), “HIV and AIDS, Stigma and Human Rights: A
     discussion, asking the following questions:                          Localised Investigation of Hammanskraal Communities.” Centre for
                                                                          the Study of AIDS.
            Why do you think the baby needs all those
            items in the lists? What good will these do                   Asia-Pacific Council of AIDS Organisations (APCASO). (2002).
                                                                          HIV and AIDS and Human Rights: A Training Manual for NGOs,
            for the baby?
                                                                          Community Groups and People Living with HIV and AIDS.
            Does the baby deserve all these? Why or
            why not?
            How about you? Do you deserve to have
            what the group thinks the baby should
            enjoy? Why or why not?
            Are there other things that adults must
            have to enjoy a full life? What concepts/
            ideas do you think can be used to refer to
            all the things babies and adults need to
            have in order to lead a full life or to live as
            human beings?

                                       Challenging Stigma & Discrimination - A manual for UN trainers
               CATEGORIES OF RIGHTS                               ACTIVITY                               M O D U L E
                                                                                                         M O D U L E                  1
                                                                                                                                      2       9

                                  & DUTY BEARERS

Objectives                                                             Spe-         Sourc- Vic-          Viola-       State       Ways
       To determine the dynamics and                                   cific        es:      tims        tors         Ac-         of
       interrelationship of the categories of                          right        Interna-                          count-      prtect-
       human rights, those whose rights have been                                   tional                            ability     ing
       violated, and duty bearers.

       4 minutes

       Several articles from local newspapers                          Notes for trainer
       containing stories reflecting issues related to                 Use this exercise to highlight the relevant points in
       different human rights contained in the                         Module 2: Contents, including that the state is the
       Universal Declaration of Human Rights                           primary duty bearer with respect to respecting,
       (UDHR)                                                          protecting, promoting and fulfilling human rights,
       Flipchart paper and pens                                        and what this means.
                                                                       This exercise can also highlight that different kinds
Handouts                                                               of rights are interrelated and equal. It is not possible
       Handout: Simplified version of the Universal                    to ensure one category of rights without the other.
       Declaration of Human Rights                                     For example, if a woman is sick and cannot access
                                                                       health care, she cannot go out to look for work. She
Suggested method                                                       is unable to access social assistance because she
Divide participants into groups of 4-5 people. Ask                     cannot go to the local social welfare office without
groups to choose one person who will report back in                    transport money. She does not have money for food
the plenary session. Distribute the handout:                           and cannot get better without the food. When there
Simplified version of the Universal Declaration of                     is a local government election, she is unable to go to
Human Rights and one of the news articles to each                      vote because she did not register when it was time
group.                                                                 to do so, and anyway, she does not have the money
                                                                       for transport to go to the voting station. Thus, several
Ask each group to answer the following questions:                      of her human rights are being affected: access to
       What rights are found in the news article?                      health care, access to social assistance, access to
       What kinds of rights are these?                                 food and her right to vote.
       Who are the victims? Who are the violators?
       Is the state accountable? In what way is the
       state accountable?
                                                                       *Note: Activity adapted from:
       How can these rights be protected?
                                                                       Zuberi et al. (2004). “HIV and AIDS, Stigma and Human Rights: A
On the flipchart, draw the following table and ask                     Localised Investigation of Hammanskraal Communities.” Centre for the
                                                                       Study of AIDS.
groups to follow the format to make it easier for
presentation:                                                          Asia-Pacific Council of AIDS Organisations (APCASO). (2002). HIV
                                                                       and AIDS and Human Rights: A Training Manual for NGOs,
Reconvene in plenary and have each group report                        Community Groups and People Living with HIV and AIDS.
back on their news article.

                                    Challenging Stigma & Discrimination - A manual for UN trainers
40   M O D U L E             3
                                       HANDOUT SIMPLIFIED VERSION OF THE
                                        UNIVERSAL DECLARATION OF HUMAN RIGHTS

     Summary of preamble                                                 11.     The right to be considered innocent until proven
     The General Assembly recognises that the inherent
     dignity and the equal and inalienable rights of all                         means someone accused of a crime cannot
     members of the human family is the foundation of                            be treated as though they have committed
     freedom, justice and peace in the world. Human                              the crime unless it is proven, and they
     rights should be protected by the rule of law. Friendly                     have a right to defend themselves.
     relations between nations must be fostered. The
                                                                         12.     Freedom from interference with privacy, family,
     peoples of the UN have affirmed their faith in human
                                                                                 home and correspondence
     rights, the dignity and the worth of the human
     person, the equal rights of men and women and are                           means no one can enter a person’s home,
     determined to promote social progress, better                               open their letters, or bother them or their
     standards of life and larger freedom. They have                             family without a good reason
     promised to promote human rights and a common                       13.     The right to free movement within and out of the
     understanding of these rights.                                              country
     Summary of the Universal Declaration of Human Rights                         means everyone has the right to travel as
     1.     The right to freedom and equality means                              they wish in their country, or to leave or
            everyone is free and we should all be                                return to their country.
            treated in the same way.                                     14.     The right to asylum in other countries
     2.     Freedom from discrimination means                                    means everyone has the right to go to
            everyone is equal despite differences in                             another country and ask for protection if they
            race, colour, sex, language, religion,                               are being persecuted or are in danger of
            health status and opinion for example.                               being persecuted.
     3.     The right to life, liberty, and security of                  15.     The right to a nationality means everyone has
            person means that everyone has the right                             the right to belong to a country. No one has
            to live, and to live in freedom and safety.                          the right to prevent another from belonging
     4.     Freedom from slavery means no one has the                            to another country if one wishes to.
            right to treat another person as a slave.                    16.     The right to marriage and family means
     5.     Freedom from torture and degrading                                   everyone has the right to marry and have a f
            treatment means no one has the right to                               amily, and that men and women have the
            hurt or torture another person.                                      same rights when they are married or
     6.     The right to recognition as a person before
            the law means everyone has the right to be                   17.     The right to own property means everyone has
            treated equally by the law.                                          the right to own things and nobody has the
                                                                                 right to take these away without a good
     7.     The right to equality before the law means
            the law should apply in the same way for
            everyone.                                                    18.     Freedom of belief and religion means everyone
                                                                                 has the right to practise and observe their
     8.     The right to remedy by a competent tribunal
                                                                                 religion, and to change their religion if they
            means everyone has the right to ask for
                                                                                 want to.
            legal help when their rights are not
            respected.                                                   19.     Freedom of opinion and information means
                                                                                 everyone has the right to say what
     9.     Freedom from arbitrary arrest and exile
                                                                                 they think and to give and receive
            means no one has the right to imprison or
            to expel anyone from their country without
            good reason.                                                 20.     The right of peaceful assembly and association
                                                                                 means everyone has the right to take part in
     10.   The right to a fair and public hearing means
                                                                                 meetings and to join associations in a
           everyone has the right to a public trial before
                                                                                 peaceful way.
           impartial decision makers.

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                                                                                                    M O D U L E
                                                                                                    M O D U L E   1
                                                                                                                  3   41

21.   The right to participate in government and in free
      elections means everyone has the right to
      help choose and take part in their

22.   The right to social security means everyone has
      the right to social security and the
      opportunities to develop their skills.
23.   The right to work and the right to join trade unions
      mean everyone has the right to work for a fair
      wage in a safe environment and to join a
      trade union.
24.   The right to rest and leisure means each work
      day should not be too long to allow rest, and
      everyone should be able to take regular paid
25.   The right to adequate living standard means
      everyone has the right to have what they
      need to live, such as food, housing and
      medical care.
26.   The right to education means everyone has the
      right to go to school.
27.   The right to participate in cultural life means
      everyone has the right to share in his or her
      community’s arts and sciences.
28.   The right to social order means everyone must
      respect the ‘social order’ that is necessary
      for all these rights to be available.
29.   Community duties essential to free and full
      development means everyone must respect
      the rights of others, the community and
      public property.
30.   Freedom from state or personal interference in
      these rights means no one has the right to
      take away any of the rights in this

                                   Challenging Stigma & Discrimination - A manual for UN trainers

44        M O D U L E          3
                                        SESSION PLAN HIV & HUMAN RIGHTS

     Objectives                                                           Step 3 A human rights approach to HIV
     The aim of this module is to explain why HIV is a                     Interactive lecture           15 minutes
     human rights issue. By the end of the session                        This is a short session on how human rights can be
     participants should be able to:                                      used to respond to HIV by providing answers to the
            Explain the link between HIV and human                        following questions:
            rights                                                        A. How can the promotion and protection of
            Appreciate governments’ human rights                             human rights reduce vulnerability to HIV?
            obligations related to HIV                                    B. What human rights are affected by HIV?
            Identify the worst affected by HIV-related                    Conclude session with examples of results yielded
            human rights violations                                       using a human rights approach to HIV.
            Describe a human rights approach to HIV
                                                                          Step 4 The International Guidelines on HIV and
            Recognise the International Guidelines on                     Human Rights
            HIV and Human Rights, the UNGASS
            Declaration and MDGs                                          Mini lecture         15 minutes
                                                                          Refer to Module 3: Contents and provide answers
     Suggested training materials
                                                                          to the following questions:
     Activity:   Human rights & HIV
                                                                          A. When, where and why did these guidelines
     Handout: Common scenarios                                               appear?
     Activity:   Human rights of people living with HIV                   B. What is their purpose?
     Step 1 Human rights revision                                         C. What are the guidelines?
     Short review        5 minutes                                        Step 5 The UNGASS Declaration of
     Remind the group that human rights do not only                       Commitment on HIV
     include the economic and social rights necessary                     Mini lecture         15 minutes
     for dignified living, such as the rights to adequate
     health, food, water, education and work; it is                       Refer to Module 3: Contents and provide answers
     important to emphasise that human rights are about                   to the following questions:
     equity and justice too.                                              A. When, where and why did the declaration
     Step 2a What is the link between HIV and
     human rights?                                                        B. What is its purpose?
     Large group brainstorm           15 minutes                          C. What is the connection to human rights?
     This session begins by allowing participants to                      Step 6 The Millennium Development
     begin thinking about the relationship between HIV                    Goals (MDGs)
     and human rights. You may decide to compare
     answers with those that participants provide before                  Mini lecture         10 minutes
     beginning your lecture.                                              Refer to Module 3: Contents and provide answers
     Write various responses on the board on the                          to the following questions:
     following:                                                           A. When, where and why did the goals appear?
     A.     In what areas are HIV and human rights                        B. What are their purposes?
                                                                          C. What is the connection to human rights?
     B.     What does it mean to respect, protect or
            fulfil rights?                                                Step 7a Rights-based approaches - examples
     C.     Who is most affected by HIV?                                  Mini lecture         15 minutes

     Step 2b Human rights & HIV                                           Refer to Module 3: Contents.

     Group activity    1hour
     Refer to Human Rights & HIV activity sheet and
     follow instructions.
                                        Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                  M O D U L E                3       4

Step 7b Human rights of people living with HIV
Group activity 1 hour
Refer to Human rights of people living with HIV
activity sheet and follow instructions.

Step 8 Conclusion
Mini lecture   10 minutes
This last session provides a summary of the main
points and concluding comments. Refer to

                                                                  “Be very clear that the enemy is
                                                                  the illness, and not the victims. I
                                                                  think the human rights approach
                                                                  is now recognised universally as
                                                                  the right approach, and the more
                                                                  you compassion you show for the
                                                                  victims the more successful HIV
                                                                  measures have been.”
                                                                                                                Hon Misa Telefoni
                                                                                              Deputy Prime Minister of Samoa, 2007

                             Challenging Stigma & Discrimination - A manual for UN trainers
46   M O D U L E            3

     Step 1 Human rights review                                         The relationship between HIV and human rights
                                                                        appears in various areas:
     Human rights are rights that belong to all people
     simply because they are human beings. They do not                            Increased vulnerability – certain groups are
     have to be given, bought, earned or inherited. They                          more vulnerable to contracting HIV as they
     apply to everyone in the world and they cannot be                            are unable to realise their civil and
     taken away by others or given away by people.                                political,and economic, social and cultural
     Human rights are codified in international instruments                       rights. Individuals who are denied the rights
     such as the Universal Declaration of Human Rights                            to freedom of association and access to
     (UDHR) and the Convention on the Rights of the                               information may not be allowed to discuss
     Child (CRC). Often, as is the case in Fiji, human                            issues related to HIV, participate in AIDS
     rights are included in the constitution in a bill of                         service organisations and self-help groups,
     rights.                                                                      and ay not be able to take other preventive
                                                                                  measures to protect themselves from HIV
     Step 2 Human rights & HIV                                                    infection. Women, youth, children and
     Human rights are linked with the spread and impact                           minority groups are more vulnerable to
     of HIV on individuals and communities around the                             infection if they lack access to information,
     world. A lack of respect for human rights fuels the                          education and services necessary to ensure
     spread and worsens the impact of the disease, while                          sexual and reproductive health and
     at the same time HIV undermines progress in the                              prevention of infection. People living in
     realisation of human rights. This link is apparent in                        poverty are often         unable to access
     the disproportionate incidence and spread of the                             HIV care and treatment, including anti-
     disease amongst certain groups. Depending on                                 retroviral drugs and other medications for
     social, legal and economic conditions, these groups                          opportunistic infections.
     include women children, minority groups and                                  Stigma and discrimination – the rights of
     particularly those living in poverty. The overwhelming                       people living with HIV are often violated
     burden of the pandemic today is on developing                                because of their presumed or known HIV
     countries, where the disease threatens to reverse                            status, causing them to suffer both the
     vital achievements in human development. HIV and                             burden of the disease and the
     poverty are now mutually reinforcing negative forces                         consequential loss of other rights.
     in many developing countries.                                                Stigmatisation and discrimination may
     The connection between HIV and poverty is                                    obstruct their access to treatment and may
     complex.                                                                     affect their employment, housing and other
                                                                                  rights. This, in turn, contributes to the
            No developed country has HIV prevalence >                             vulnerability of others to infection, since
            0.05%.                                                                HIV-related stigma and discrimination
            95% of people living with HIV (PLHIV) live in                         discourages individuals infected with and
            developing countries.                                                 affected by HIV from contacting health and
                                                                                  social services. The result is that those
            HIV primarily affects people of working age (                         people most in need of information,
            Fiji peak: 20-29, 30-39 yrs).                                         education and counselling will not benefit
            PLHIV and their families face reduced                                 even where such services are available.
            incomes and erosion of savings (for                                   Thus, while there may be formal equality,
            example, health care, funeral costs).                                 there is a serious question about whether
                                                                                  people living with HIV are able to claim their
            Poverty may prevent treatment of STIs                                 rights.
            which increases risk of contracting HIV.
            Poor men, women and children may need to
            resort to unprotected ‘transactional' sex to
            provide for their families.
            Poverty increases vulnerability to HIV
            infection and worsens the impact and
            spread of the disease while contracting HIV
            intensifies poverty and the pandemic itself.

                                     Challenging Stigma & Discrimination - A manual for UN trainers
                                                                                                     M O D U L E
                                                                                                     M O D U L E              1
                                                                                                                              3    47

Personal testimony                                                    the use of condoms for married couples, even when one
                                                                      of them is infected with the AIDS virus. HIV can be spread
Irene is a ni-Vanuatu woman. When she was
                                                                      not only through sexual contact, but through the
diagnosed HIV positive, she faced multiple levels
                                                                      exchange of body fluids, such as blood transfusions. In
of discrimination as a result of stigma in her home
                                                                      developing countries, the use of condoms protects
country. Once her HIV status was known, other
                                                                      against other highly contagious diseases, such as
mothers would hold their children away from her
                                                                      hepatitis, as we need to do everything possible to combat
when she went shopping and buses and taxis
                                                                      AIDS. Under certain conditions, the use of condoms is
would not stop for her. She resigned from her
                                                                      necessary. Those who are afflicted have an obligation to
Health Department job in Port Vila because they
                                                                      protect the other partner.”
could not afford her treatment and was later asked
to leave her home.                                                    B. Respecting, protecting and fulfilling human rights
 Irene Malachi, personal testimony, 2006                              From a human rights perspective, people are
                                                                      entitled to enjoy the conditions that would enable
       An effective response is impeded – e f f e c t i v e
                                                                      them to realise their health and wellbeing. This
       HIV prevention, treatment, support and care
                                                                      means that under international law, governments
       strategies are hampered in an environment
                                                                      are obliged to respect, protect, and fulfill the rights
       where human rights are not respected.
                                                                      of people.
       Discrimination against people with HIV
       undermines society’s efforts to prevent HIV                    But what does it mean to respect, protect, or fulfill
       infection and to limit the impact of the HIV                   human rights?
       pandemic on society. Lack of recognition of                          Respecting a human right means that
       human rights not only causes unnecessary                             governments cannot violate the right directly.
       personal suffering and loss of dignity for                           For example, governments cannot deny
       people living with HIV, but it also contributes                      prisoners with HIV the same quality of medical
       to the spread of the pandemic. When human                            care that is available in the community.
       rights are not respected and people face
       discrimination, lack of privacy and                                  Protecting a human right means that
       confidentiality     and     other      negative                      governments have to prevent others from
       consequences, they are less likely to seek                           violating the right, and to provide some form
       counselling, testing, treatment and                                  of redress when the right is violated. For
       support.                                                             example, governments should protect people
                                                                            with HIV from discrimination in their jobs or
       In the past, some groups have maintained                             when they seek accommodation and should
       a     strong postion on prevention and                               provide ways to challenge discrimination
       treatment measures and further obstructed                            through the courts or human rights
       such initiatives as the rights-based                                 commissions.
       response, arguing, for example, that
       condom use conflicts with values, norms                              Fulfilling a human right means that
       and inherent belief systems. However, with                           governments have to take steps – pass
       more programmes targetting these groups                              laws, make regulations, set up
       there has been a shift in opinion and                                programmes,provide funding – to realise the
       inclination towards a human rights reponse                           right. For example, governments must enact
       to HIV.                                                              or strengthen laws and fund programmes that
                                                                            promote the equality of women, enact or
In the past, the Catholic Church has steadfastly opposed                    strengthen laws that prohibit discrimination
all means of artificial contraception, even the use of                      against gay men, repeal laws and regulations
condoms for those infected with the HIV virus. HIV is                       that harm sex workers or takes steps to
widespread in the developing world, where the church is                     eradicate poverty. Where progressive
active on the grassroots level. It has always maintained                    realisation of the right is permitted (this is not
the position that birth control should be exercised by                      the case with political and civil rights),
abstinence or natural means, such as the rhythm method,                     governments are obliged to demonstrate that
which has been mocked by critics as “Vatican roulette”.                     they are making steady progress. In addition,
However, more progressive members of the church have                        the obligation of wealthier countries in fulfilling
spoken out on condom use to halt the spread of AIDS,                        rights extends beyond their borders. It
such as Cardinal Carlo Maria Martini, who in an interview                   includes providing technical and financial
in an Italian weekly magazine (L’Espresso, 24 April 2006)                   support to poorer countries.
stated that: “Up to now, the church had also condemned

                                    Challenging Stigma & Discrimination - A manual for UN trainers
48   M O D U L E             3

     C.     Most at risk groups or vulnerable groups                      they are more likely to be sexually exploited,
                                                                          assaulted and inclined to engage in transactional
     HIV strikes hardest where human rights are least
                                                                          sex for survival. Many turn to the streets or to
     protected, particularly among people and
                                                                          hazardous work to make ends meet, placing them
     communities on the margins of society. Individuals
                                                                          at risk of violence and HIV infection. Poverty, low
     or groups who suffer discrimination and lack of
                                                                          income status, illiteracy, conflict and power
     human rights protection are both more vulnerable
                                                                          imbalances directly contribute towards added
     to becoming infected and less able to cope with
                                                                          vulnerabilities of women, children and other groups
     the burdens of HIV.
                                                                          like migrant workers, sex workers and seafarers.
     Failure to promote and protect human rights has
                                                                          Women and the girl child
     made the HIV pandemic worse for many
     populations:                                                         HIV is on the rise in all parts of the worlds, spreading
                                                                          in particular amongst women and girls.
          HIV was initially perceived as a health issue;
                                                                          Discrimination against women, due to gender
          today it is increasingly recognised as a cross-
                                                                          inequality, is multiple and compounded. This
          cutting issue of development, security and
                                                                          means that women are made vulnerable to the
          human rights that impacts differently on all
                                                                          disease both because they may not be able to
          segments of the population. As mentioned
                                                                          participate in decision making at an equal level
          earlier, the impact is greater on vulnerable
                                                                          with their male counterparts. A prime example of
          groups. Vulnerability is defined as being:
                                                                          this is the unequal power relationship of women
            1.       Capable of being physically or                       which results in the inability of women to negotiate
                     emotionally wounded; and                             safe sex practices with their partners and husbands.
                                                                          In addition to the lack of power in society in
            2.       Open to attack or damage.
                                                                          decision making, women are doubly vulnerable
     It is a known fact that some groups in comparison                    due to their low status and lack of economic power;
     to others experience stigma and discrimination as                    all of which restrict women’s access to education,
     they either belong to a particular class, group,                     health care and other services that might aid in
     sexual preference or gender. Systemic and                            protecting them from HIV (Erturk, 2005).
     historical discrimination further heightens their
                                                                          Gender attitudes as well as the relative
     vulnerability thus making them more susceptible
                                                                          powerlessness of women and girls render them
     to HIV infection. Research shows that women
                                                                          more vulnerable to the pandemic in a variety of
     exposed to HIV are at least twice as likely to
                                                                          ways such as:
     become infected with HIV as their male
     counterparts. Women’s subordinate position in                            Low levels of education, coupled with cultural
     sexual relations as well as their biological conditions                  attitudes surrounding women and sex, make it
     makes heterosexual sex the most common way                               more difficult for women to obtain information
     the disease is transmitted in many parts of the                          about HIV;
     world. Women’s susceptibility to HIV is exacerbated
                                                                              Women do not have the power to refuse sex
     by unequal power between women and men. Any
                                                                              or demand the use of condoms or other
     group considered less equal in society will be at
                                                                              preventative methods. This is seen as a
     greater risk of contracting HIV. Example; women.
                                                                              critical and global barrier to preventing the
     children, persons with disabilities, sexual minorities,
                                                                              spread of HIV;
                                                                              Lack of economic opportunities can oblige
     By increasing the vulnerability of children, the
                                                                              them to enter into and remain in dangerous
     pandemic increases the victimisation and
                                                                              relationships, including commercial
     exploitation of children. As arguably the most
                                                                              sex work.
     dependent and thus vulnerable members of
     society, HIV threatens the health and life chances                   Feminised poverty and women’s lower socio-
     of children in families affected by the disease. The                 economic status is directly connected to the
     poverty cycle and deprivation of basic needs such                    commercial sex industry. In many cases, women
     as food, shelter, education, love and care has                       and children are coerced or tricked into prostitution,
     resulted in children caring for themselves and their                 or are driven into transactional sex in return for
     siblings, particularly in cases where their parents                  goods. Women and children who are victims of the
     have died of AIDS. In most PICs, children are often                  commercial sex industry have higher susceptibility
     hidden, voiceless and excluded from society. The                     to HIV and violence than most other population
     power imbalance increases their vulnerability as                     groups. For example, a sex worker who is earning
                                                                          to feed and educate her three children will either

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“As patriarchy intersects with other sites of oppression such as class, race,
ethnicity, displacement etc., discrimination becomes compounded, forcing
the majority of the world’s women in situations of double or triple
                                                                                                               Radhika Coomaraswamy
                                                                                  Former Special Rapporteur for Violence Against Women

by fear of survival or violence, engage in unsafe                   as they are obliged to give birth so the male lineage
sexual behaviour without a condom for a few extra                   continues. In most PICs, land is passed through
dollars; this is a common reality for many sex                      the patrilineal line, and this practice impacts on
workers.                                                            women’s reproductive choices. In order to maintain
                                                                    control over traditional land and resources, women
In many countries the commercial sexual
                                                                    play a key role in ensuring that a male child is born
exploitation of women, children and men has
                                                                    to inherit land. This limits women’s access to birth
become a lucrative business where they are
                                                                    control, condom use and abortion.
trafficked across borders and states. According to
the United Nations Population Fund, between                         A young man in India became HIV positive and did
700,000 and 2 million women are trafficked across                   not inform his wife. The man was working for a
international borders annually. Women who are                       company in the city of Mumbai when he became ill
trafficked across borders often find themselves in                  with tuberculosis and was diagnosed with HIV.
situations with high probability of contracting HIV.                This information was not disclosed to his 21-year-
                                                                    old wife, who was living with her in-laws in a rural
Globally the highest infected groups are
                                                                    area of South Kerala. He came home to recover
heterosexual women in monogamous relationships.
                                                                    and supported by his parents’ wishes wanted his
In the domestic setting, the gender power
                                                                    wife to become pregnant, even though she had
imbalance may result in violence accompanied by
                                                                    asked that they wait until he recovered. She came
sexual abuse including marital rape, all of which
                                                                    to know that her husband had HIV and the dangers
further increases the risk of HIV infection amongst
                                                                    it posed only when she was eight months pregnant
married women. In these settings it is difficult, if
                                                                    and he was seriously ill. Her husband died three
not impossible, for women to negotiate for safer
                                                                    months after the baby was born and she went back
sex. The sexual norms and values for women and
                                                                    to her parents’ house where she and the baby lived
girls reinforce unequal power relations between
                                                                    at the mercy of others.
men and women.
                                                                    Source: Reproductive Health Matters, 2000
Gender norms related to sexuality often place men
in dominant roles and women in subordinate roles
and this limits a women’s ability to control her
                                                                    Everyone has a right to have a family (UDHR, Article
sexual engagement – for example, a woman may
                                                                    16). However, women’s ability to access this right
not ask her husband to wear a condom for fear of
                                                                    has also been affected by HIV. Many women, when
being beaten up or being seen as promiscuous.
                                                                    found to be HIV positive, are encouraged to abort
Women and girls are conditioned to believe that
                                                                    their children. While mother-to-child transmission
femininity inhibits knowledge and assertiveness.
                                                                    (MTCT) may take place during pregnancy, childbirth
For instance sexual innocence, virginity and
                                                                    or while breastfeeding, medically it has been
motherhood are about passivity; women and girls
                                                                    proven that with proper access to ART and
are not to be knowledgeable about sex, and this
                                                                    prevention measures, the risk of transmission
limits their access to information and education on
                                                                    reduces significantly. Despite this medical
HIV prevention. If a woman will want to access
                                                                    breakthrough, in most communities women living
information on HIV or condom use, this will be
                                                                    with HIV who decide to have children are
deemed contemptible as these actions are
                                                                    continuously criticised and blamed for the
inconsistent with culture and conservative gender
                                                                    reproductive choices they make.
norms. Women’s reproductive role to procreate
further increases their vulnerability to HIV infection,

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     “In India, motherhood is perceived as the ultimate validation of womanhood. With t
     reported to be common for women to be stigmatised and blamed for passing on the in
     due to high value already awarded to male children.”

     In summary, in the context of the HIV pandemic,                     many areas of their lives including harassment,
     gender inequality has proven fatal. Gender based                    verbal and physical abuse and denial of basic
     violence, discrimination and stigma reinforce one                   rights.
     another and subjugate women, leaving them more
     vulnerable to infection and less likely to access
     effective prevention, treatment, care and support                   Prisoners depend on the state to give them the
     programmes and services.                                            resources to prevent infection with HIV and other
                                                                         diseases, to protect their privacy, to protect them
                                                                         from violence and to provide them with health care.
     The United Nations Convention on the Rights of                      Failure to fulfill these rights, such as provision of
     the Child (CRC) drafted in 1989 is a global covenant                condoms and HIV awareness, has contributed to
     on the rights of children. It holds countries morally               HIV transmission among prisoners and made the
     and ethically bound to honour the rights of children                impact of HIV infection worse.
     as outlined by the convention – including protection
                                                                         Commercial sex workers
     from HIV. In the context of HIV, the CRC has spelt
     out principles for reducing children’s vulnerability                State responses to sex work and intravenous drug
     to infection and to protect them from discrimination                use put a disproportionate emphasis on controlling
     because of their real or perceived HIV status.                      these activities through criminal and public health
                                                                         law. This approach stigmatises commercial sex
     The pandemic impacts on children; they become
                                                                         workers and injecting drug users and neglects or
     caregivers for their parents who are slowly dying of
                                                                         undermines alternative responses to sex work and
     AIDS, they are orphaned and they become
                                                                         drug use that prevent disease and promote health.
     protectors and providers for their younger siblings.
                                                                         These groups often exist on the fringes of society
     The risk of infection is very high as well, as they
                                                                         and because their behaviour is seen as ‘deviant’,
     become subject to sexual violence, trafficking, the
                                                                         they face additional prejudice and discrimination
     child sex trade and discriminatory traditional
                                                                         aside from their HIV status.
     practices – for example, arranged marriage, genital
     mutilation and sorcery. In some parts of the Pacific,               Migrant workers
     Africa and Asia, they are further subject to sexual
                                                                         There are many reports of violations of the human
     abuse by people who are of the belief that a HIV
                                                                         rights of migrant workers that have an impact on
     person can be cured if they engage in sexual
                                                                         their health and wellbeing. Many migrant workers
     activities with virgins. This heightens the
                                                                         experience oppressive working conditions, such
     vulnerability of children. With the increasing
                                                                         as working 12 hours or more a day for 6 or 7 days
     numbers of HIV amongst adults, children have
                                                                         a week; inadequate food and unhealthy sleeping
     become subject to sexual assault, incest and rape,
                                                                         quarters provided by the employers, etc. Sexual
     as they are seen as being the ‘safer’ group for
                                                                         and physical abuses are yet other occupational
     sexual engagement.
                                                                         hazards many migrant workers are confronted
     Sexual minority groups                                              with. These conditions increase the vulnerability of
                                                                         migrants to various types of diseases and infections
     Hostility    toward     homosexual, bisexual and
                                                                         including HIV. Migrant workers are often not able
     transgendered people has created environments that
                                                                         to seek consistent health care due to changing
     are silent about their existence, fail to support them
                                                                         locations. The right to healthy working and living
     in their personal and social development, and deny
                                                                         conditions, the right to health education, and the
     them the information, resources and services that
                                                                         right to affordable and accessible health care are
     are necessary for their health. These groups face
                                                                         only three examples of rights that governments
     multiple levels of stigma and discrimination in

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the increasing risk of married, monogamous women contracting HIV, it was
nfection to her unborn child. Blame is accentuated if a male baby becomes infected,

                                                                                                                       Radhika Coomaraswamy
                                                                                         Former Special Rapporteur for Violence Against Women

         should guarantee for their migrant populations.                    population. In addition, disabled populations have
         These groups are denied fundamental human                          traditionally been left out of planning, research and
         rights which further increases their vulnerability to              data collection in response to HIV which has even
         HIV infections. In the Pacific, HIV infection is                   further isolated this group from treatment, care and
         increasing amongst seafarers in Kiribati largely due               support.
         to lack of information on HIV prevention.                          Sources
         Persons with Disabilities                                          HIV/AIDS and People With Disability; By Nora Ellen Groce, June
                                                                            2003, Reprinted from The Lancet, April 26, 2003
         Persons with disabilities are found to be at much
         greater risk of contracting HIV than the general                   ‘People with Disabilities are at High Risk for HIV, but Absent from
         population. All of the factors which increase a                    AIDS Stats’
         populations vulnerability to HIV are found in this                 Step 3 A human rights approach to HIV
         group; poverty, discrimination, lack of access to
         education and information, barriers to accessing                   A human rights approach may be defined as a
         health care and a higher rate of sexual activity as                framework for the pursuit of human development
         well as vulnerability than the general population.                 that is normatively based on, and operationally
         According to the Lancet, 2003, “Disabled individuals               directed to, the development of capacities to
         (both male and female) around the world are more                   realise human rights.
         likely to be victims of sexual abuse and rape than                 A human rights approach states that the process
         their non-disabled peers. Factors such as increased                of development is as important as the outcome,
         physical vulnerability, the need for attendant care,               and that indeed the process largely determines the
         life in institutions, and the almost universal belief              type of outcomes resulting from development
         that disabled people cannot be a reliable witness on               activities.
         their own behalf make them targets for predators.
         In some countries, parents of intellectually disabled              Rights-based programming applies guiding
         children now report rape as their leading concern                  principles to ensure an adequate development
         for their children’s current and future well-being”.               process. The two major principles are
         Persons with disabilities suffer from compounded                   ACCOUNTABILITY and NON-DISCRIMINATION,
         discrimination (poverty + disability + HIV) and are                although a simple acronym (PANEL) is often used
         less likely to access treatment, care and support                  to clarify the implications of rights-based
         due to the fact that they are an already stigmatized               programming. The acronym PANEL stands for:

          P articipation
          A ccountability
          N on-discrimination, equality and attention to vulnerable groups
          E mpowerment
          L inkages to human rights standards,progressive realisation of rights and non-

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    M O D U L E             3

     Guiding principles in human rights-based programming

          Guiding principle          Programming implications
          PARTICIPATION                Create channels of participation for poor and disadvantaged people (
                                     e.g. PLHIV).

                                      Active, free and meaningful – time and resources to develop capacities

                                         Adequate capacities are a development result in itself (empowerment).

          ACCOUNTABILITY               Objective guidance to set responsibilities.
                                       Capacity development – build on existing strengths and solutions to
                                     respond; target weaknesses and vulnerabilities.
                                       Include civil society oversight elements.
                                       Strengthen risk analysis.

                                         Identify most vulnerable groups and target them explicitly.
          EQUALITY AND                   Develop data disaggregation.
          ATTENTION TO

          EMPOWERMENT                  Target necessary capacities to claim and exercise rights – build on
                                     existing strengths and solutions, target weaknesses and vulnerabilities.

                                         Linked to active, free and meaningful participation.

          LINKAGES TO HUMAN            Standards are a roadmap to the scope of the problem and the desired
          RIGHTS STANDARDS           results – they also prevent ‘capture’ of decisions and set minimum
                                     guarantees for poor and disadvantaged groups.

                                       Stress on monitoring progressive results and assessing the risk of

     There is clear evidence that where individuals and communities are able to realise their rights – to education,
     free association, information and, most importantly, non-discrimination – the personal and societal impact of
     HIV is reduced. The protection and promotion of human rights is essential to preventing the spread of HIV and
     to mitigating the social and economic impact of the pandemic. The reasons for this are three-fold. The
     promotion and protection of human rights reduces vulnerability to HIV infection by:
     1.    Addressing its root causes;
     2.    Lessening the adverse impact on those infected and affected by HIV; and,
     3.    Empowering individuals and communities to respond to the pandemic.
     Adopting a human rights approach helps people who are most vulnerable to the infection and at the same
     time, disadvantaged, to have access to the necessary information and services they need to protect
     themselves. This includes getting correct information, affordable health care, appropriate social support, and
     protection against violence and discrimination.
     An effective international response to the pandemic must therefore be grounded in respect for all civil, cultural,
     economic, political and social rights, as well as the right to development, in accordance with international
     human rights principles, norms and standards. States’ obligations to promote and protect HIV-related human
     rights are defined in existing international treaties.

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HIV -related human rights include:                                  to privacy, non-discrimination and freedom from
                                                                    cruel and degrading treatment. Section 39 of the
    the right to life
                                                                    Fiji Constitution states that “every person has the
    the right to liberty and security of the person                 right to basic education and equal access to
                                                                    educational institutions”; this is their first attempt
    the right to the highest attainable standard of
                                                                    to incorporate ESCR into their supreme law.
    mental and physical health
                                                                    For example, Tonga’s Constitution dates back to
    the right to non-discrimination, equal
                                                                    1875 and contains only a succinct Declaration of
    protection and equality before the law
                                                                    Rights with limited application for human rights
    the right to freedom of movement                                freedoms. The Declaration of Rights covers the
    the right to seek and enjoy asylum                              following: Clause 1. Declaration of freedom; Clause
                                                                    2. Slavery prohibited; Clause 4: Same law for all
    the right to privacy                                            classes; and Clause 5: Freedom of worship.
    the right to freedom of expression and opinion                  Vanuatu has a Bill of Rights chapter that protects
    the right to freely receive and impart                          the civil and political rights of the people. Chapter
    information                                                     2, Part I Fundamental Rights states that: “all the
                                                                    people are entitled to the following fundamental
    the right to freedom of association                             rights and freedoms of the individual without
    the right to marry and found a family                           discrimination on the grounds of race, place of
                                                                    origin, religious or traditional beliefs, political
    the right to work                                               opinions, language or sex … protection of privacy,
    the right to equal access to education                          security of person, protection of the law, freedom
                                                                    of expression.”
    the right to an adequate standard of living
                                                                    United Nations human rights treaties and
    the right to social security, assistance and                    conventions and their committees provide the
    welfare                                                         normative legal framework, as well as the necessary
    the right to share in scientific advancement                    tools for ensuring the implementation of HIV-
    and its benefits                                                related rights. Some Pacific Island countries have
                                                                    very progressive constitutions as they have specific
    the right to participate in public and cultural life            provisions that allow courts to apply public
    the right to be free from torture and other cruel,              international human rights law where relevant as in
    inhuman or degrading treatment or punishment                    Section 43 (2) of Fiji’s 1997 Constitution, Article 15
                                                                    (5)(c) of the Constitution of Tuvalu and Section 17
These rights are contained in such UN international
                                                                    of the Tuvalu Interpretation and General Provisions
treaties as the Universal Declaration of Human
                                                                    Act (Cap 1A), and Article 39 (3) of the Constitution
Rights (UDHR), the International Covenant on
                                                                    of Papua New Guinea.
Economic, Social and Cultural Rights (ICESCR)
and the International Covenant on Civil and Political               Step 4 The International Guidelines on HIV and
Rights (ICCPR). A number of Pacific Island                          Human Rights
countries have ratified international conventions
such as the Convention on the Elimination of All                    The International Guidelines on HIV and Human
Forms of Discrimination Against Women (CEDAW)                       Rights were developed at the Second International
and the Convention on the Rights of the Child                       Consultation on HIV and Human Rights, convened
(CRC) and have taken measures in domestic                           in Geneva in September 1996 by the United Nations
application of the international human rights                       High Commissioner for Human Rights (UNHCHR)
framework.                                                          and the Joint United Nations Programme on HIV
                                                                    (UNAIDS). In 2001, the Commission on Human
The Solomon Islands is the only Pacific Island                      Rights (now referred to as the Human Rights
country that has ratified ICESCR (on 17 March                       Council) adopted a resolution which stated that
1982). The first step towards domestication of                      the right to the highest attainable standard of
international human rights law has been the                         health includes access to anti-retroviral therapy for
inclusion of bill of rights chapters in most Pacific                HIV. Following this, a Third International
constitutions. It is important to note that all the                 Consultation on HIV and AIDS and Human Rights
constitutions embody civil and political rights such                was held again in Geneva, which led to the birth of
as freedom of expression, the right to life, the right              the 2006 Consolidated Version of the International
                                                                    Guidelines on HIV and Human Rights.

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      The guidelines provide comprehensive, detailed, and                         and equal basis have access
      specific guidance on how human rights should be                             to quality goods, services and information
      promoted and protected in the context of the HIV                            for HIV and AIDS prevention, treatment,
      pandemic. Although they are not a treaty that binds                         care and support, including antiretroviral
      governments, they set an internationally-recognised                         and other safe and effective medicines,
      standard for governments to live up to. The                                 diagnostics, and related technologies for
      guidelines can be described as being ‘soft’ public                          the treatment of HIV and related
      international law, which is persuasive and carries                          opportunistic infections.
      moral force.                                                        7.      Implement and support legal support
      The guidelines focus on three crucial areas:                                services to educate people affected by HIV
                                                                                  about their rights, develop expertise on
        1. Increasing the capacity of governments for
                                                                                  HIV- related legal issues and use means
           multi-sectoral coordination and
                                                                                  other than courts, such as human
                                                                                  rights commissions, to protect the rights of
        2. Widespread reform of laws and legal                                    people affected by HIV.
           support services, with a focus on anti-
                                                                          8.      Promote an enabling and prejudice-free
           discrimination, protection of public health
                                                                                  environment for women, children and other
           and improvements in the status of women,
                                                                                  vulnerable groups. Both states and
           children and marginalised groups; and
                                                                                  communities are to play a role in achieving
        3. Support and increased private sector and                               this.
           community participation to respond
                                                                          9.      Promote the distribution of creative
           ethically and effectively to HIV.
                                                                                  education, training and media programmes
     The twelve guidelines are as follows:                                        designed to change attitudes of
                                                                                  discrimination and stigmatisation around
        1. Encourage states to adopt a multi-sectoral
           approach through an effective national
           framework.                                                     10.     Translate human rights principles into
                                                                                  codes of conduct with accompanying
        2. Enable community organisations to carry
                                                                                  mechanisms to implement and enforce
           out activities in the field of ethics, human
                                                                                  these codes.
           rights and law. The guidelines support
           consulting widely with such organisations                      11.     States should ensure monitoring and
           in drafting all HIV policies.                                          enforcement mechanisms to guarantee
                                                                                  and protect HIV-related human rights.
        3. Review and reform public health laws to
           adequately address HIV.                                        12.     States should share experiences
                                                                                  concerning HIV-related human rights
        4. Review and reform criminal laws and
                                                                                  issues at an international level and
           correctional systems to ensure that they
                                                                                  through UN agencies such as UNAIDS.
           are consistent with international human
                                                                                  (ICASO, 1999)
           rights obligations and address HIV without
           targeting vulnerable groups.                                   The International Guidelines on HIV and Human Rights are
                                                                          intended to be used to promote and protect human
        5. Enact or strengthen anti-discrimination
                                                                          rights in the context of HIV. The guidelines are
           laws to protect vulnerable groups. It is
                                                                          designed to provide a tool to assist states in creating
           important to ensure privacy,confidentiality
                                                                          a positive response to the pandemic based on
           and ethics in research involving human
                                                                          human rights; a response that is effective in reducing
                                                                          the transmission and impact of HIV. The guidelines
        6. Enact legislation to provide for the                           attempt to take existing human rights norms and
           regulation of HIV-related goods, services                      mould them into a series of practical, concrete
           and information in order to ensure                             measures states can adopt to fight the pandemic.
           widespread availability of quality                             Ideally, all states will adopt the guidelines. While the
           prevention measures and services,                              guidelines themselves are not legally binding on
           adequate HIV prevention and care                               states, they are based upon previously existing legal
           information, and safe and effective                            obligations in international human rights law and
           medication at an affordable price.                             represent an internationally-recognised standard
                                                                          for governments to live up to.
           The guidelines say it is important to
           ensure that all persons on a sustained
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Step 5 The UNGASS Declaration of Commitment                         The UNGASS Declaration of Commitment on HIV
on HIV                                                              is not a legally binding document. However, it is a
                                                                    clear statement by governments concerning that
In June 2001, state heads and representatives met                   which they have agreed should be done to fight
at the United Nations General Assemby Special                       HIV and that which they have committed to doing,
Session (UNGASS) dedicated to HIV and AIDS                          often with specific deadlines. As such, the
under the theme “Global Crisis, Global Action” in                   declaration is a powerful tool with which to guide
New York. The leaders gathered with a sense of                      and secure action, commitment, support and
urgency to address the global epidemic with                         resources for all those fighting the pandemic, both
leadership, honesty and action.                                     within and outside government.
The meeting was a historic landmark, highlighting                   Declaration of Commitment on HIV and AIDS,
the fact that, in only 20 years, the HIV pandemic                   2001
has caused untold suffering and death worldwide,
destroying      entire     communities,      undoing                Step 6 The Millennium Development Goals
development gains, and posing a serious threat to                   (MDGs)
whole continents, as is currently the case for Africa.
                                                                    In September 2000, the Millennium Declaration
But the UN Special Session also served to remind
                                                                    was endorsed by 189 heads of states during a
the world that there is hope. We now know that,
                                                                    summit-level meeting at the UN General Assembly
with sufficient will and resources, communities and
                                                                    in New York. The declaration is an unprecedented
countries can turn this pandemic around.
                                                                    global commitment and one of the most significant
At the meeting, state heads and representatives                     United Nations documents of recent time. It sets
issued the Declaration of Commitment on HIV and                     out in a single framework the key global challenges,
AIDS, which fully integrates human rights within                    outlines a response to these challenges and
the goals and targets that member states have                       establishes measures for judging perfomance
committed themselves to undertake.                                  through a set of goals and targets on development,
                                                                    goverance, peace, security, health and human
The declaration also underscores the links between
                                                                    rights. The Millennium Development Goals (MDGs)
poverty, underdevelopment and illiteracy to the
                                                                    are eight goals supported by 18 targets and 40
spread and impact of HIV; that stigma, silence,
                                                                    plus indicators. Goal 6 is specific to HIV and
discrimination, denial and lack of confidentiality
undermine prevention and care efforts; that gender
equality and the empowerment of women and girls                     Goal 6: Combat HIV and AIDS, malaria and other
are fundamental to reducing vulnerability; and that                 diseases
access to medication in the context of pandemics
                                                                    Countries are encouraged to combat HIV through
such as HIV is fundamental to the realisation of the
                                                                    their programmes, policies and national strategies.
right to health.
                                                                    The main responsibility for the achievement of the
Human rights issues are addressed throughout the                    MDGs lies with governments. MDGs promote
operative sections of the declaration, in particular                poverty reduction, education, maternal health,
with regard to addressing, through the promotion                    gender equality, and aim at combating child
and protection of human rights, factors which                       mortality, HIV and other diseases.
increase vulnerability to and impact of HIV
infection.                                                          Step 7 Rights Based Approaches – Examples
The Declaration of Commitment on HIV endorses                       From a needs approach to a rights based
that an effective and sustainable response to the                   approach
HIV crisis must ensure respect for ALL human                        Traditionally, development practitioners developed
rights, especially those that guarantee non-                        responses based on ‘needs’ as opposed to rights.
discrimination, equality and the meaningful                         They viewed people as objects with needs. Rights-
participation of infected, affected and vulnerable                  based approaches turn this around by viewing
groups.                                                             people as subjects with claims. Rights always
It is the first time that a declaration on HIV has                  imply obligations which are often legal obligations
acknowledged the importance of accountability.                      by the state.
To this end, the declaration calls for strengthening                Case studies
of national monitoring mechanisms for HIV-related
human rights.                                                       Positive examples of rights-based approaches in
                                                                    HIV programmes include:

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     Stepping Stones                                                     gathering, information sharing and information
                                                                         checking bridges between journalists and the
     ‘Stepping Stones’ is a programme that has had                       regional health sector. Among its benefits, Health-
     remarkable success worldwide, improving negative                    e gives journalists direct access to regional
     gender norms and empowering communities to                          technical advisers and a discussion space to table
     bring about change specific to their needs in                       stories on HIV stigma and discrimination (PRSIP,
     relation to HIV vulnerability. This is a workshop                   2007).
     series designed as a tool to help promote sexual
     and reproductive health, including addressing                       Stronger laws protecting the rights of people
     gender, sexuality, HIV and STIs, gender violence,                   infected and affected by HIV in PNG
     communication and relationship skills. A total of 23                The first case of HIV in the Pacific was reported in
     facilitators from 13 communities were trained at                    PNG in 1987. Since then the prevalence of HIV has
     the inaugural Stepping Stones workshop carried                      risen dramatically. PNG now has one of the highest
     out in Fiji in June 2006 through the Pacific Regional               rate of HIV in the Asia-Pacific region. Lack of a
     HIV and AIDS Project Small Grants Scheme.                           protective legal environment with anti-discirmination
     Positive outcomes reported by participants have                     laws, privacy and access to health policies has
     included improved communication with their                          further fuelled the epidemic in most developing
     community, family or sexual partner, new skills and                 countries. Human rights have major relevance for
     confidence to speak about HIV and sexual health                     shaping appropriate responses to the HIV epidemic
     issues, improved relationships with sexual partners,                and other global health challenges, including
     improved HIV-related behaviour change, an                           offering system-wide public health responses and
     improvement in gender equitable attitudes among                     identifying deficiencies in the legal system.
     men, less community fighting and better                             International human rights law creates state
     communication and trust between parents and                         obligations to respect, protect and fulfil fundamental
     children. Six communities in Fiji and two                           rights such as the right to privacy, gender equality,
     communities in the Solomon Islands are now                          non-discrimination and access to anti-retroviral
     implementing the programme, while Kiribati and                      drugs. Fulfilment of these rights is a critical step
     Vanuatu have initiated pilot programmes (PRHP,                      towards an effective response to HIV prevention
     2007).                                                              and management. Laws that are discriminatory
     Love Patrol                                                         and inconsistent to human rights further act as a
                                                                         barrier in upscaling response to HIV.
     According to a street poll undertaken in Vanuatu of
     1,445 people (45 per cent male and 55 per cent                      The lack of legal protection and increasing stigma
     female), 86 per cent of those surveyed watched                      and discrimination are some of the factors
     the ‘edutainment’ series Love Patrol broadcast on                   influencing this trend. The role of the law within the
     local television (for more on the series, see Module                response to HIV is closely linked to the protection
     7). They stated that Love Patrol portrayed real life                of human rights. Laws shape society by providing
     and showed what was actually happening in                           an institutional framework that is supportive of
     Vanuatu. As a result of watching the series, 52 per                 PLHIV (Jowitt, 2004).
     cent increased their understanding on HIV, which                    In response to the impending epidemic, the PNG
     was previously a taboo subject and very foreign to                  Parliament passed the HIV and AIDS Management
     them. Meanwhile, 39 per cent understood what                        and Prevention (HAMP) Act in June 2003. This was
     AIDS was and 13 per cent were clear on how HIV                      the first legal intervention in the South Pacific. The
     was transmitted. The series provided viewers with                   Act provides anti-discrimination measures and
     the opportunity to understand HIV and issues                        protects the right to privacy and confidentiality.
     around transmission, stigma and discrimination,                     (See Module 6 for more on the HAMP Act.)
     with the majority describing it as enjoyable,
     educational and relevant to their communities                       Step 8 Conclusion
     (PRSIP, 2007).
                                                                         The late Jonathan Mann, then Director of the World
     Health-e Online                                                     Health Organisation’s Global Programme on HIV,
                                                                         was one of the first to clearly recognise that
     Health-e Online, a network for journalists covering
                                                                         promotion and protection of human rights is an
     health and HIV issues in the region, was launched
                                                                         essential component in preventing transmission of
     at the 2007 Pacific Islands News Association
                                                                         HIV and reducing the impact of HIV.
     (PINA) conference in Honiara, Solomon Islands. It
     provides opportunities to build information

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One aspect of this is that coercive public health                  However, there have been successes, activities
measures drive away the people most in need of                     and practices from other parts of the world that
such services and fail to achieve the public health                Pacific Island countries can certainly learn from.
goals of prevention through behavioural change,                    Rights-based approaches to the HIV pandemic
care and support.                                                  have yielded results by:
Another, more important aspect of the linkage                          Enhancing public health outcomes: Protecting
between protection of human rights and effective                       a person’s right – particularly a person
HIV programmes is apparent in the fact that the                        living with HIV – to achieve the highest
incidence spread of HIV is disproportionately high                     attainable standard of physical and mental
among the poorest and most marginalised in                             health has brought about increased confidence
society – groups who already suffer from a lack of                     in health systems. In turn, this has led more
human rights protection and from discrimination                        people to seek and receive relevant
and/or marginalisation by their legal status. Lack                     information on HIV prevention, counselling and
of human rights protection disempowers these                           care.
groups to avoid infection and to cope with HIV, if
                                                                       Ensuring a participatory process linking patients
affected by it.
                                                                       and care providers that has improved the
Mann identified four reasons why human rights must be                  relevance and acceptability of public health
protected in the context of HIV:                                       strategies.
  1.   Because “it is right to do so”;                                 Fostering non-discriminatory programmes that
                                                                       include marginalised groups more vulnerable to
  2.   Because preventing discrimination helps
                                                                       HIV infection.
       ensure a more effective HIV prevention
       programme;                                                      Scaling up the HIV response through
                                                                       empowering people to claim their rights to gain
  3.   Because social marginalisation intensifies
                                                                       access to HIV prevention and care services.
       the risk of HIV infection; and,
                                                                       Enhancing the accountability of states through
  4.   Because “a community can only respond
                                                                       people seeking redress for the negative
       effectively to HIV and AIDS by expressing
                                                                       consequences of health policies. Legal action
       the basic right of people to participate in
                                                                       based on human rights has been a vehicle to
       decisions which affect them”.
                                                                       enforce people’s right to gain access to health
       (Gruskin, Mills & Tarantola, 2007)                              care, including antiretroviral treatment.
Sadly, in various parts of the world, grave HIV-
related human rights violations continue to occur
with depressing regularity. Furthermore, serious
gaps prevail between the times that governments
pass laws and policies and when they actually
implement them. What is needed is a move from
rhetoric to action and to the adoption of coherent
HIV strategies based on the promotion of both
human rights and public health.

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     “Disclosure of HIV status and human rights: the duties and
     responsibilities of couples, medical professionals, family
     members and the state.” (2000). Reproductive Health Matters.
     Erturk, Y. (2005). Integration of the human rights of women and
     the gender perspective: violence against women. Intersections
     of violence against women and HIV and AIDS. Report of the
     Special Rapporteur on violence against women, its causes and
     consequences. Geneva, Switzerland: United Nations,
     Commission on Human Rights, 2005 Jan 17. (E/CN.4/2005/72).
     Gruskin, S., Mills, E. & Tarantola, E. (2007). “History, principles
     and practice of health and human rights.” The Lancet. Volume
     370, Issue 9585: 449 – 455.
     International Council of AIDS Service Organisations (ICASO).
     (1999). An Advocate’s Guide to the International Guidelines on
     HIV and AIDS and Human Rights. Toronto: ICASO.
     Jowitt, A. (2004). “Creating a Framework for HIV and AIDS
     related legal reform in the South Pacific.” Journal of South Pacific
     Law. Volume 8, Issue 1 [
     Keeping the promise: Summary of the Declaration of the
     Commitment on HIV/ AIDS. UN General Assembly, Special
     Session on HIV and AIDS, 25-27 June, 2001. [http://data.unaids.
     Pacific Regional HIV and AIDS Project (PRHP). (2007). “Fiji
     Stepping Stones Evaluation Report”. [
     “PRSIP Annual Progress Report Pacific Regional Strategy
     Implementation Plan 2004-2008” (2007) (Draft)
     “Reproductive rights, human rights and ethics.” (2000).
     Reproductive Health Matters. Vol. 8, No. 15: 148-163.
     Tomàs, A. (2003). A Human Rights Approach to Development:
     Primer for Development Practitioners. Geneva: Office of the High
     Commissioner for Human Rights (OHCHR).

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                 COMMON SCENARIOS                           HANDOUT                                     M O D U L E
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                                                                                                                                      3      9

Objectives                                                                     How human rights violations create
                                                                               barriers to HIV prevention as well as care.
         To explain the relationship between human
         rights and HIV.                                                       The larger structural human rights
                                                                               violations (for example, poverty and
         To identify the human rights associated                               gender), which increase the vulnerability
         with HIV.                                                             for some groups of people.
Time                                                                           The right of access to health care and what
1 hour                                                                         that means to people living with HIV.

Flipchart paper and pens
                                                                     *Note: Activity adapted from Zuberi, F., Jones, P. & Viljoenm F.
Handouts                                                             (2004). HIV/ AIDS, stigma and human rights, a localised investigation
                                                                     of Hammanskraal communities. A report of the Tswelopele research
Handout: Common scenarios                                            project of the Centre for the Study of AIDS. Pretoria: Centre for the
                                                                     Study of AIDS at the University of Pretoria.
Suggested method
1.       Divide the participants into groups of 5-6
         people. Ask that one person from each                       The following are common scenarios:
         group be selected for the report back in
                                                                     Case 1
         the plenary session.
                                                                     A group of chiefs want all people living with HIV
2.       Provide each group with ONE case study
                                                                     banished to an outer island. Vocal chiefs have also
         from the Common scenarios handout.
                                                                     demanded mandatory testing for the entire
3.       Ask participants to discuss the case                        population so PLHIV can be identified and
         assigned to the group by answering the                      isolated.
         following questions:
                                                                     Case 2
                 What HIV-related human rights are
                 being violated in the scenario?                     A mother in a rural village has been infected by her
                 Who is committing the human                         HIV-positive husband, who was a seaman and
                 rights violation(s)?                                who has died. Her neighbours are gossiping about
                                                                     her and as a result, she is not allowed to bathe in
                 Where has the state failed in its                   the village stream, attend church or work on her
                 obligation/duty,resulting in the                    husband’s land.
                 human rights violation?
                                                                     Case 3
                 Who else, besides the state, failed
                 in its obligation/duty,resulting in                 A soldier has been passed over for a promotion in
                 the human rights violation?                         the military because of his HIV status. He did not
                                                                     give his consent to being tested and upon hearing
4.       Reconvene in a plenary session. Have                        the result was not counselled on his options.
         each group read out its case study and                      Despite being the most qualified candidate for the
         report its answers to the questions.                        position, he was informed that he did not meet all
5.       Open the floor for questions, clarifications                the criteria.
         and challenges.                                             Case 4
Notes for trainer                                                    A female teacher has had her HIV test results
Emphasise the following issues:                                      released to the school head teacher by the doctor.
                                                                     The doctor did not ask for the teacher’s consent
         The belief of ‘innocent’ and ‘deserving’                    but felt that it was appropriate for the school to
         people living with HIV: i.e. that children are              know. The head teacher pressures the teacher to
         innocent, but adults are considered to be                   resign.
         deserving, especially those who are
         homosexual or considered to be ‘too’
         sexually active.

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     Case 5
     A domestic worker is sent for a test by her employer
     and then fired when she tests HIV positive. She
     was unaware she was being tested for HIV. Her
     husband leaves her and refuses to be tested

     Case 6
     A young woman contracts the HIV virus after being
     raped. When she discovers her HIV positive status,
     she tells her family, who pressure her to drop the
     charges against her rapist because the family
     knows him. She reports the matter to the police
     but the case is dropped for lack of evidence.

     Case 7                                                              “Fundamental human rights are
     A young female student falls pregnant to an older                   important, not because they are
     male student. At her first antenatal check-up she
     tests positive for HIV. As a result, the school expels
                                                                         contained in international
     her saying it would set a bad example to other                      constitutions and laws. Their
     students and it is their policy to discourage teenage
     pregnancy.                                                          importance lies in the fact that such
     Case 8                                                              rights are basic for every human
     A pregnant woman goes to a clinic for an antenatal                  being for no reason other than the
     checkup. She is tested for HIV without her consent.
     A doctor then informs her that she is HIV positive
                                                                         humanity and unique individuality
     and must have an abortion.                                          of each of us ...”
                                                                                            Justice Michael Kirby of the High Court of Australia
     Case 9
     Religious groups demand disclosure of the names
     of HIV positive people in the interest of the
     community. They also demand that mandatory
     testing is introduced so as to identify all those
     living with the virus.

     Case 10
     Country X has limited funds for anti-retroviral
     therapy (ART) for PLHIV but manages to purchase
     generic ART at a low cost and starts a treatment
     programme. WTO regulations, soon to come into
     effect, prevent the government from continuing to
     purchase the drugs at a lower cost.

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                                                                                                                                  3       61


         To discuss the human rights of people
         living with HIV (PLHIV)


1 hour


Flipchart paper and pens


Handout: Pictures
                                                                            “It is silence, exclusion and isolation
                                                                            that limit our ability to provide the
Suggested method
                                                                            care and services needed by people
Divide the participants into groups of 6-7. Distribute
the pictures to the various groups and ask them to                          living with HIV. It is the silence,
discuss the pictures, considering the following
questions:                                                                  exclusion and isolation of our leaders
         Who is the PLHIV in this picture? Why is he                        that prevent us from developing and
         or she the PLHIV?
         What is happening in this picture?                                 marketing effective HIV prevention
         What right is affected in this picture?
         What is the picture showing about the                              efforts.”
         treatment of PLHIV?
         What do PLHIV need in order to achieve                                                                 Aggleton & Parker, 2002
         this right?

Notes for trainer

This exercise is a way to introduce how human
rights impact on people living with HIV. They show
how PLHIV should be treated – with respect, love,
allowed to have children, etc.

*Note: Activity adapted from Zuberi, F., Jones, P. & Viljoenm F.
(2004). HIV/ AIDS, stigma and human rights, a localised investigation
of Hammanskraal communities. A report of the Tswelopele research
project of the Centre for the Study of AIDS. Pretoria: Centre for the
Study of AIDS at the University of Pretoria.

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6   M O D U L E   3
                       HANDOUT PICTURES

                       Challenging Stigma & Discrimination - A manual for UN trainers

                             MODULE 4

                                                  HIV STIGMA &

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64   M O D U L E              4
                                      SESSION PLAN HIV STIGMA & DISCRIMINATION

     Objectives                                                          Step 2b Definitions of HIV stigma &
     By the end of this module participants should be                    discrimination
     able to:                                                            Short lecture                  15 minutes

          Define the different kinds of HIV stigma and                   This is a short session on the theoretical definitions
          discrimination.                                                of stigma and discrimination including:

          Identify the causes of HIV stigma and                          A.     The different kinds of stigma.
          discrimination.                                                B.     Common forms of discrimination.
          Explain the various impacts of HIV stigma and                  C.     The different levels at which discrimination
          discrimination.                                                       can occur.
          Give examples of HIV stigma and
                                                                         Step 3 Stigma, discrimination and human
     Suggested training materials                                        Short lecture                  15 minutes
     Activity: Definitions of stigma & discrimination
                                                                         Refer to Module 4: Contents.
     Activity: Mapping stigma and discrimination in
               our communities                                           Step 4 The causes
                                                                         Interactive lecture            15 minutes
     Step 1 Introduction
     Mini lecture             10 minutes                                 This session focuses on the different causes
                                                                         of HIV stigma and discrimination by asking
     Present the background of stigma and discrimination
                                                                         participants and providing answers for the
     highlighting the following:
                                                                         following questions:
     A.     HIV stigma and discrimination has been
                                                                         A.     How has HIV been described in your
            around as long as the disease.
     B.     Other diseases have also been marked by
                                                                         B.     What stereotypes surround HIV?
                                                                         C.     Why has stigma affected people living with
     C.     What makes HIV different from other
                                                                         Step 5 The impacts
     Step 2a Definitions of HIV stigma &
                                                                         Mini lecture         15 minutes
                                                                         Refer to Module 4: Contents and provide answers
     Group activity           45 minutes
                                                                         to the following questions.
     Refer to Definitions of stigma & discrimination
                                                                         A.      What is the impact of stigma and
     activity sheet and follow instructions.                                     discrimination on vulnerability?

                                                                         B.     What is the impact of stigma and
                                                                                discrimination on PLHIV?

                                                                         C.     What is the impact of stigma and
                                                                                discrimination on women?

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                                                                                                                         4     6

Step 6a Examples
Mini lecture           15 minutes

Refer to Module 4: Contents and provide examples
of common environments where stigma and
discrimination take place including:

A.   The workplace
                                                                  “We were frightened and confused
B.   Health care                                                  and wondered when we were going
C.   Living in small communities                                  to die. I had to hide the cause from
Step 6b Mapping stigma and discrimination in                      my family because I was scared
our communities
                                                                  they might chase us away.”
Group activity         45 minutes                                                                               Tomasi Peka
                                                                                                                 PLHIV, Fiji
Refer to Mapping stigma and discrimination in our                                                 NZ Herald, 27 October 2005
communities activity sheet and follow instructions.

Step 7 Conclusion
Mini lecture           10 minutes

This last session provides a summary of the
main points and concluding comments. Refer to

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66   M O D U L E            4
                                     CONTENTS HIV STIGMA & DISCRIMINATION

     Step 1Introduction                                                families and caregivers. It affects not only those
                                                                       who are stigmatised, but also those who stigmatise
     Since the pandemic’s beginnings, stigma and
                                                                       them through their attitudes or their actions – in the
     discrimination have only served to add to the
                                                                       community, on the job, in professional capacities,
     spread of HIV. Existing in every country and region
                                                                       in public office or in the media.
     of the world, they have created major barriers to
     preventing further infection, alleviating impact and              Step 2 Definitions
     providing adequate care, support and treatment                    A.        What is stigma?
     (Aggleton & Parker, 2002).
                                                                       Simply put, to stigmatise is to label someone and
     According to Aggleton, Wood, Malcolm and Parker                   see them as inferior because of an attribute they
     (2005): “The stigma associated with HIV has                       have. It also has important consequences for the
     silenced open discussion, both of its causes                      way in which individuals come to see themselves
     and of appropriate responses. Concealment                         (Kidd & Clay, 2003).
     encourages denial that there is a problem and
     delays urgent action. It causes people living with                Importantly, stigmatisation is a process of
     HIV to be seen as a ‘problem’, rather than as a                   devaluation rather than a thing. The qualities to
     solution to containing and managing the disease”.                 which stigma attaches itself to (for example, the
                                                                       colour of the skin, the way someone talks, the
     Stigmatisation associated with HIV is underpinned                 things that they do) can be quite random (Caraël
     by many factors, including:                                       et al, 2000).
          lack of understanding of the illness;                        Within a particular culture or setting, certain
          misunderstandings about how HIV is                           characteristics are seized upon and defined
          transmitted;                                                 by others as unworthy or wrong. People who
                                                                       are stigmatised are usually considered deviant or
          lack of access to treatment;
                                                                       shameful and are often believed to have deserved
          irresponsible media reporting on the                         what has happened by doing something wrong. As
          pandemic;                                                    a result, they are shunned, discredited, rejected or
          the incurability of AIDS; and,                               penalised.

          prejudice and fears relating to a number                     Much HIV-related stigma builds upon and
          of socially sensitive issues including                       reinforces earlier negative thoughts. Often
          sexuality,disease and death, and drug use                    these ‘wrong doings’ are linked to sex or to illegal
          (Aggleton, Wood, Malcolm & Parker, 2005).                    and socially frowned-upon activities. Men who
                                                                       become infected may be seen as homosexual or
     HIV is not alone among illnesses and diseases
                                                                       as having had sex with prostitutes. Women with
     in being marked by stigma. Other conditions,
                                                                       HIV are viewed as being ‘loose’ or as having been
     such as epilepsy, mental illness, cancer,
                                                                       sex workers.
     leprosy, tuberculosis and syphilis have been
     stigmatised both in the past and the present.                     The family and community often perpetuate
     What distinguishes HIV from many illnesses and                    stigma and discrimination, partly through fear,
     diseases are the many dimensions of HIV-related                   partly through ignorance, and partly because it is
     stigma.                                                           convenient to blame those who have been affected
     In many ways the stigma of HIV has had an even
     wider reach and a greater effect than the virus                   Stigma is linked to power and domination
     itself. The stigma of HIV affects the lives not only              throughout society as a whole. It plays a key role
     of people with HIV, but also of their partners,                   in producing and reproducing relations of power.

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                                                                                                                                4     67

“I feared being discriminated, from friends, relatives and the community at
large. Some kept their distance.”
                                                                                                                  Buraua Itimeemee
                                                                                                                    PLHIV, Kiribati
                                                                                                         NZ Herald, 27 October 2005

Ultimately, stigma creates, and is reinforced by,                           risky behavior such as unprotected sex so as
social inequality. It has its origins deep within the                       to reduce bringing attention to themselves.
structure of society as a whole, and in the norms                           Stigma therefore is directly related to the
and values that govern much of everyday life. It                            ‘silent spread’ of HIV.
causes some groups to be devalued and ashamed,
                                                                     Other important dimensions to consider:
and others to feel that they are superior.
                                                                            Often people do not understand the word
Stigma can be characterised as internal (‘felt’) or
                                                                            ‘stigma’ in English;
external (‘enacted’):
                                                                            Difficult to find a word in other languages
     Internal (or felt) stigma is the shame
                                                                            which is equivalent;
     associated with HIV and the fear of being
     discriminated against which is felt by people                          Differs in intensity – sometimes blatant,
     living with HIV. This kind of stigmatisation can                       sometimes subtle;
     lead to depression, withdrawal and feelings of                         Targeted mostly at people who are assumed
     worthlessness. It silences and saps the                                to be HIV positive;
     strength of already-weakened individuals and
                                                                            Targeted at stereotyped and scapegoated
     communities, and causes people to blame
                                                                            groups (women, sex workers);
     themselves for their predicament; and
                                                                            Reasons for stigma change according to the
     External (or enacted) stigma, on the other
     hand, refers to actual experiences of
     discrimination. This may include the                                   Disrupts social relations;
     experiencing of domination, oppression, the                            People hide their stigmatising attitudes; and
     exercise of power or control, harassment,
                                                                            HIV disfigures so stigma changes according
     categorising, accusation, punishment, blame,
                                                                            to the stage of the disease. Stigma increases
     devaluing, silence, denial, ignorance, anger,
                                                                            as the symptoms of the disease become
     social     inequality,     exclusion,      ridicule,
                                                                            more visible.
     resentment or confusion. It may sometimes
     lead to violence against PLHIV. Enacted                         B.        What is discrimination?
     stigma and discrimination have been described
                                                                     When stigma is acted upon, the result is
     as a collective dislike of what is unlike. Enacted
                                                                     discrimination. Discrimination consists of actions
     stigma is usually intentional, although people
                                                                     or omissions that are derived from stigma and
     are not always aware that their attitudes and
                                                                     directed towards those individuals who are
     actions are stigmatising.
                                                                     stigmatised (Aggleton, Wood, Malcolm & Parker,
     Stigma (both internal and external) leads                       2005). Discrimination occurs when a distinction is
     people to hide the knowledge of the disease                     made against a person that results in his or her
     from others and in some cases, to engage in                     being treated unfairly and unjustly on the basis

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     of their belonging, or being perceived to belong, to                 There is also discrimination occurring in institutional
     a particular group (Aggleton & Parker, 2002).                        settings – in particular, in workplaces, healthcare
                                                                          services, prisons and educational institutions. Such
     Once the process of stigmatisation is underway,
                                                                          discrimination takes place in institutional policies
     it becomes easy to discriminate against PLHIV
                                                                          and practices that discriminate against people living
     because people think they no longer have the
                                                                          with HIV, or indeed in the lack of anti-discriminatory
     qualities that make them worthy of respect and
                                                                          policies or procedures of redress.
     dignity. People act on their beliefs. This often
     creates active discrimination and human rights                       According to Aggleton, Wood, Malcolm and Parker
     abuses.                                                              (2005), examples of this kind of discrimination
                                                                          against people living with HIV include:
     Some of the common forms of discrimination/
     human rights abuses against PLHIV include:                                  In healthcare services, where PLHIV face
                                                                                 reduced standard of care, denial of access to
          Being denied employment;
                                                                                 care and treatment, HIV testing without
          Denial of proper medical care, or access to                            consent, breaches of confidentiality
          medical aid schemes;                                                   including identification to relatives and
          Victimisation of children if they or their                             outside agencies, negative attitudes and
          parents are living with HIV;                                           degrading practices by healthcare workers;

          Breaches of confidentiality, i.e. telling                              In the workplace, where PLHIV are denied
          someone’s status to another without                                    employment based on their status, may face
          consent;                                                               compulsory HIV testing and are excluded
                                                                                 from pension schemes or medical benefits;
          Being tested without giving informed
          consent; and                                                           In schools, where HIV-affected children may
                                                                                 be denied entry, or HIV-positive teachers
          Being denied insurance and home loans.
                                                                                 dismissed; and
     AIDS-related discrimination may occur at various
                                                                                 In prisons, where HIV-positive individuals
     levels. There is discrimination occurring in family
                                                                                 face mandatory segregation and
     and community settings, which is what individuals
                                                                                 exclusion from collective activities.
     do, either deliberately or by omission, so as to harm
     others and deny to them services or entitlements                     At a national level, discrimination can reflect stigma
     (Aggleton, Wood, Malcolm & Parker, 2005).                            that has been officially sanctioned or legitimised
                                                                          through existing laws and policies, and enacted in
     Examples of this kind of discrimination against
                                                                          practices and procedures. These may result in the
     people living with HIV include:
                                                                          further stigmatisation of people living with HIV and,
          Ostracisation, such as the practice of forcing                  in turn, legitimate discrimination. Discrimination
          women to return to their kin upon being                         also occurs through omission, such as the absence
          diagnosed HIV-positive, following                               of, or failure to implement, laws, policies and
          the first signs of illness, or after their partners             procedures that offer redress and safeguard the
          have died of AIDS;                                              rights of people living with HIV.
          Shunning and avoiding everyday contact;                         Step 3 Stigma, discrimination & human rights
          verbal harassment; physical violence;
                                                                          Stigma and discrimination are interrelated,
          Verbal discrediting and blaming;                                reinforcing and legitimise each other (Aggleton
          Gossip; and                                                     & Parker, 2002). Stigma lies at the root of
                                                                          discriminatory actions, leading people to engage
          Denial of traditional funeral rites and other
          traditional functions.
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                                                                                                                          4         69

in actions or omissions that harm or deny services
or entitlements to others. Discrimination is the
enactment of stigma and in turn, discrimination
encourages and reinforces stigma.
                                                                         WHICH LEGIMATE
What’s more, discrimination is a violation of human
                                                                                                                     WHICH CAUSES
rights. The principle of non-discrimination, based
on recognition of the equality of all people, is
enshrined in the Universal Declaration of Human
Rights and other human rights instruments. These
texts, among other things, prohibit discrimination                   Violation of
based on race, colour, sex, language, religion,                      human Rights
political or other opinion, property, birth or other
status (Aggleton & Parker, 2002). Furthermore, the
United Nations Commission on Human Rights (now
the UN Human Rights Council) has resolved that                                                     WHICH LEADS TO
the term ‘or other status’ used in several human
rights instruments should be interpreted to include
health status, including HIV and AIDS, and that                               Source: Aggleton, Wood, Malcolm & Parker
discrimination on the basis of actual or presumed                                                              (2005).
HIV-positive status is prohibited by existing human
rights standards.
                                                                    Step 4 The causes
                                                                    From early in the HIV pandemic, a series of powerful
Stigmatising and discriminatory actions therefore
                                                                    descriptions were used that served to reinforce and
violate the fundamental human right to freedom
                                                                    legitimate stigmatisation. These included:
from discrimination. In addition to being a violation
of human rights in itself, discrimination directed                         HIV as punishment – for example, for immoral
at people living with HIV or those believed to be                          behaviour;
HIV-infected, leads to the violation of other human
                                                                           HIV as a crime – for example, in relation to
rights, such as the rights to health, dignity, privacy,
                                                                           innocent and guilty victims;
equality before the law, and freedom from inhuman,
degrading treatment or punishment.                                         HIV as war – for example, in relation to a
                                                                           virus which needs to be fought;
A social environment that promotes violations of
human rights may, in turn, legitimate stigma and                           HIV as death – for example, through imagery
discrimination. The following diagram, developed                           such as the grim reaper;
by Mirium Maluwa and Peter Aggleton, shows the                             HIV as horror – for example, in which infected
cycle of stigma, discrimination and human rights                           people are demonised and feared; and
                                                                           HIV as ‘otherness’ – for example, in which the
                                                                           disease is an affliction of those set apart.

                                                                    Together with the widespread belief that HIV is
                                                                    shameful, these descriptions made up a series of
                                                                    ‘ready made’ but highly inaccurate explanations that
                                                                    have provided a powerful basis for both stigmatising
                                                                    and discriminatory responses. These stereotypes

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70   M O D U L E              4

     also allow some people to deny that they are                         to HIV infection and make people with HIV more
     personally likely to be infected or affected.                        vulnerable to sickness and death.

     There are a number of reasons why stigma affects                     Vulnerability can be personal or societal. Personal
     those who have HIV:                                                  vulnerability to HIV refers to the various factors
                                                                          in an individual’s development or environment
          HIV is a fatal disease, and this causes fear of
                                                                          that make them vulnerable – factors such as
                                                                          physical and mental development, knowledge
          HIV is often associated with behaviour which                    and awareness, behavioural characteristics, life
          is already stigmatised (for example, sex work                   skills and social relations. Social vulnerability
          and homosexuality);                                             is related to the contextual factors in society that
          HIV as incurable, fatal, evokes fear and                        affect personal vulnerability – factors such as
          shame through association of the disease;                       political structures, gender relationships, attitudes
                                                                          to sexuality, religious beliefs and poverty.
          People with HIV are often thought to be
          responsible for having contracted the                           All people living with HIV experience stigma and
          disease; and                                                    discrimination in some form or other. However,
                                                                          those who are the most disadvantaged or
          Religious or moral beliefs lead some people
                                                                          disempowered are the most vulnerable to HIV. The
          to conclude that having HIV is the result of a
                                                                          history of the pandemic has shown that those
          moral fault, such as promiscuous or deviant
                                                                          people who were marginalised, stigmatised and
          sex, that deserves punishment.
                                                                          discriminated against before HIV arrived have
     It is the combination of these ‘reasons’, together                   become those at highest risk of HIV infection.
     with their strength, that makes it so difficult to
                                                                          B.     What is the impact on the lives of people living
     overcome HIV-related stigma.
                                                                                 with HIV?
     Step 5 The impacts
                                                                          When people living with HIV describe their
     This pandemic of stigma has consequences:                            experience of the stigma and discrimination
     people with HIV have been prevented from seeking                     associated with the disease, it is clear that stigma
     or obtaining the health care and social support they                 and discrimination:
     require; adults with HIV have lost their jobs or have
                                                                                  Run through the entire experience of HIV
     been denied employment, insurance, housing and
     other services; children with HIV have been denied
     day care. Stigmatisation has also been a barrier                             Contribute to the isolation, lack of security
     to prevention efforts: because of their beliefs and                          and hardship that people experience;
     values, some people (and governments) have                                   Are often very subtle and hard to redress;
     chosen to withhold information about preventing                              and
     the transmission of HIV and have supported laws
                                                                                  Are very painful and stressful for people
     and policies that make the victims of stigma more
                                                                                  living    with HIV and their families.
     vulnerable to HIV infection.
                                                                          When people discover that they are HIV-positive,
     A.    What is the impact on vulnerability?
                                                                          one of the first things they have to decide is
     HIV-related stigma and discrimination – and stigma                   whether to tell family and friends. Because of the
     and discrimination on the basis of race, gender,                     stigma associated with HIV and the potential for
     sexual orientation, drug use, criminal status or                     discrimination, people with HIV are often afraid to
     imprisonment – make people more vulnerable                           tell others about their status.

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Gang rapes, knife attacks on wives, beating and sexual abuse of girls and
torture and murder of female “sorcerers” are among the many forms of
violence against women in Papua New Guinea. The threat of rape, sexual
assault and other violence is so great that women and girls cannot freely
move round their communities, go to school, to the market or to work.
The state’s failure to enable women to become safely involved in civil and
economic life severely constrains the full use of resources for national
                                           “Papua New Guinea: Women subject to gang rape, beatings and murder of female ‘sorcerers’”
                                                                                               Amnesty International News Online
                                                                                                                  4 September 2006

Stigma and the resulting stress, isolation, and lack               Step 6 Examples
of social support have significant negative impacts
                                                                   A. The workplace
on the health of people with HIV. People who feel
stigmatised by HIV and who lack the support they                   The workplace remains a potentially vulnerable
require are more likely to experience symptoms                     environment for people with HIV, whether they
of depression. As well, there is some evidence                     are currently at work, returning to work or looking
that stress has a negative effect on the immune                    for work for the first time. People with HIV in the
system.                                                            workplace:

D.   What is the impact on women?                                         Have experienced breaches of confidentiality
                                                                          regarding their HIV status;
Across cultures, stereotypes remain that people
living with HIV contracted the disease through                            Have often not had their needs
some sort of deviant activity. Studies reveal that                        accommodated with respect to the duties
women are stigmatised more directly and severely,                         they are able to perform, the schedule and
which exacerbates existing gender, social, cultural                       side effects of their drug regimen, the time
and economic inequities. When men contract the                            required for medical appointments and the
disease through sexual intercourse, their supposed                        need for leave for temporary illnesses;
predisposition for multiple partners is assumed to                        Have experienced cuts to their benefits or
be the norm. However women are most always                                have been laid off because of the cost to the
branded as ‘loose’, promiscuous and immoral.                              employer;
Overall women consistently face more and greater
discrimination and as a result are subject to gender-                     Have sometimes not claimed their benefits –
based violence at home and in their communities.                          or may not take antiretroviral therapy at all –
(Refer to section on Gender in Module 3.) HIV                             for fear of disclosure, harassment and being
also compounds myths and cultural stereotypes                             fired; and
of women. For example, in Papua New Guinea,                               Have sometimes found themselves in an
women who are being blamed for the spread of                              environment in which they have been
HIV are labeled as witches or sorceresses and are                         harassed, avoided or ostracised.
often tortured and killed

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     The risks of disclosure are felt not only by people                          of overall health status, immediately
     who are working when they discover they are HIV-                             or soon after test results become available;
     positive, but also by people who decide to return to                         and
     work because ART has sufficiently restored their
                                                                                  Provide substandard care to HIV patients.
     health. However, anticipating negative reactions,
     people may prefer not to return to a previous place                   C.       Living in smaller communities
     of employment and go where their HIV status is not                    For people living in smaller communities, where it
     known. Of course, this may require unaffordable                       is hard to remain anonymous, the need for secrecy
     further training and could be risky, particularly if one              is often greater than in cities. People with HIV
     has to explain a gap in work experience (Aggleton                     must sometimes go to great lengths to protect their
     & Parker, 2002).                                                      confidentiality.
     B.     Health care                                                    People with HIV often report that, when they
     In the first decade of the pandemic, there were                       disclose their HIV status, the response of the
     blatant and explicit examples of discrimination                       community is often more supportive than
     against people with HIV in healthcare settings.                       anticipated. But the impact of negative reactions
     These included refusing to provide care, avoiding                     in small communities such as existing in the
     or neglecting patients and making prejudicial                         Pacific is perhaps greater, since other avenues
     remarks. Such incidents have decreased, but there                     of support may be less available. Therefore,
     are still many examples of inappropriate treatment                    there is silence and secrecy, at great cost not only
     (Aggleton & Parker, 2002).                                            to the person with HIV but also the family of the
     Some healthcare workers continue to:
                                                                           The experience of stigma and discrimination
          Refuse to treat people with HIV;
                                                                           within a specific community may be complicated
          Breach client confidentiality by sharing test                    by the fact that the community itself might be a
          results with relatives and other staff;                          minority in the larger society and marginalised or
                                                                           discriminated against itself. This is often refered
          Refuse PLHIV medical procedures not
                                                                           to as compounded disability, for example being
          related to HIV;
                                                                           disabled and HIV positive. For the person with HIV,
          Not offer HIV testing or fail to diagnose HIV-                   it means that there may be nowhere else to go once
          related symptoms among people who are not                        one has been isolated within one’s own community.
          readily identified with a ‘risk group’;                          For the community, it means that it is difficult to
          Refuse to prescribe combination therapies                        address issues associated with vulnerability to HIV
          for certain groups of people – such as drug                      infection (such as sexual activity, gender inequality,
          users and the homeless – because they                            homosexuality etc) and supporting people with HIV
          assume these people will not be able to                          (Aggleton & Parker, 2002).
          maintain the drug regimen;
                                                                           Step 7 Conclusion
          Demand mandatory testing or insist on
                                                                           Stigma and discrimination are perhaps the greatest
          testing as a condition of providing
                                                                           catalysts for the spread of HIV. People with HIV are
                                                                           stigmatised as different because they are assumed
          Segregate PLHIV in special wards when                            to have been involved in ’immoral’ behaviour
          there is no clinical need to do so;                              such as extramarital sex or sex work. This is
          Discharge HIV-positive patients, regardless                      curious because often the greatest risk factor for

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the majority of women who contract HIV is their                    positive experience self-imposed stigma and many
husband/partner. Because in many countries HIV                     decide not to disclose their HIV status to anybody
leads to AIDS-related illness and ultimately death,                because they are terrified of how people will treat
people also stigmatise those with HIV because they                 them. Invariably, there is very little to be gained
are ignorant of the modes of HIV transmission and                  by being open about one’s status but a great
are afraid of contracting HIV from casual contact.                 deal to be lost, so most people choose to keep
It is important to note that HIV is not of course the              quiet and carry the burden of their secrecy in
first and only disease to be strongly stigmatized –                silence and isolation. Stopping stigma and
people suffering from leprosy, TB and mental illness               discrimination is one of the greatest challenges
among other conditions have long been feared,                      to stopping the spread of HIV.
shunned and denied equal treatment. However,
the taboos and gender inequalities surrounding sex                   REFERENCES
add powerful new stigmatising forces in the case of                  Aggleton, P. & Parker, R. (2002). A conceptual
sexually transmitted diseases as HIV.                                framework and basis for action: HIV and AIDS
                                                                     stigma and discrimination. Geneva: UNAIDS.
Most people do not imagine that HIV will ever enter                  [
their lives. They isolate people with HIV, ostracise                 JC891-WAC_Framework_en.pdf]
them, harass them, ridicule them and in some                         Aggleton, P., Wood, K., Malcolm A., & Parker,
instances physically assault them. They don’t want                   R. (2005). HIV-Related Stigma, Discrimination
                                                                     and Human Rights Violations: Case studies of
to associate with people who are HIV-positive                        successful programmes. Geneva: UNAIDS. [http://
because they are afraid of the shame and blame.            
Positive people with HIV are frequently treated in
morally disdainful and judgmental ways. Breaches                     Amnesty International. (2006). “Papua New
                                                                     Guinea: Women subject to gang rape, beatings
of confidentiality frequently precede discriminatory                 and murder of female ‘sorcerers’.” Amnesty
acts. Often positive people are denied treatment,                    International News Online. (Posted 4 September,
treatment is delayed, they pay more for health                       2006). [
services than untested or HIV-negative people pay                    asp?NewsID=17082]
and health workers patronise them. In the home,                      Caraël M. et al. (2000). Protocol for the
some positive people are not allowed to associate                    identification of discrimination against people living
                                                                     with HIV. Geneva: UNAIDS. [http://data.unaids.
freely with family members and are forced to eat                     org/Publications/IRC-pub01/JC295-Protocol_
and sleep separately. Many people have lost their                    en.pdf]
employment because of their HIV status. Many                         Kidd, R. & Clay, S. (2003). Understanding &
people’s skills are lost simply because they are                     Challenging HIV Stigma: Toolkit for Action.
diagnosed as positive and then subsequently lose                     CHANGE (USA), ICRW (USA). [http://www.icrw.
their work opportunities.                                            org/docs/2003-StigmaToolkit.pdf]
                                                                     Zuberi, F., Jones, P. & Viljoenm F. (2004). HIV/
Many positive people’s human rights are violated.                    AIDS, stigma and human rights, a localised
People known to be sex workers or men who have                       investigation of Hammanskraal communities. A
sex with men are further stigmatised. This leads                     report of the Tswelopele research project of the
to a vicious cycle: most people diagnosed as                         Centre for the Study of AIDS. Pretoria: Centre for
                                                                     the Study of AIDS at the University of Pretoria.

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                                            ACTIVITY DEFINITIONS OF STIGMA &

     Objectives                                                            Objectives
        To define the meaning of HIV stigma and                                   To identify different contexts in which HIV
        discrimination.                                                         and AIDS stigma and discrimination occur
                                                                                in the community.
        Give examples of HIV stigma and
        discrimination.                                                             To identify some of the common features of
                                                                                    stigma and discrimination.
     45 minutes
                                                                           45 minutes
     Flipchart paper and pens
                                                                           Flipchart paper and pens
     Suggested method
                                                                           Suggested method
     Divide the participants into groups of 5-6 people.
                                                                           1. The first part of the activity should be
     Ask that one person from each group be selected
                                                                              conducted individually:
     to report back in the plenary session.
                                                                           Ask individuals to draw a map, placing themselves in
     Ask participants:
                                                                           the centre of the map and then to draw all institutions
            1.   What do you think is the meaning of HIV                   that they interact with on a daily basis – this can
                 stigma? Give examples.                                    be their homes, family, the village, church, school,
            2.   What do you think is the meaning of HIV                   friends, youth groups, workplace or social club
                 discrimination? Give examples.                            groups. Let them know that these institutions and
                                                                           groups influence their lives and in most situations
     Reconvene in a plenary session. Have each group
                                                                           provide them with a sense of belonging.
     report its definition and examples.
                                                                           The facilitator then encourages individuals to
     Open the floor for questions, clarifications and
                                                                           imagine if they or a close member of their family is
                                                                           HIV positive – ask them how will these institutions
     Then refer participants to the ‘Definitions’ section of               and groups react, highlight the types and levels
     Module 4: Contents.                                                   of discrimination they will face; they should be
     Follow this with a short lecture that:                                encouraged to write stigmatising statements that
                                                                           they feel might be directed towards them by these
          Highlights the main points of Module 4:                          groups and institutions.
                                                                           2. Divide participants into groups of 4-5 people. Ask
          Clearly explains the definitions of the different                each group to appoint a facilitator and reporter and
          types of stigma and discrimination.                              then direct them to review the maps and common
          Emphasises the link to human rights.                             issues and statements emerging out of individual
                                                                           maps – this could be the main institutions that will
                                                                           discriminate, the types of discrimination and the
     *Note: Activity Adapted from Kidd, R. & Clay, S. (2003).
     Understanding & Challenging HIV Stigma: Toolkit for Action.           stigmatising statements. Keys issues, institutions and
     CHANGE (USA), ICRW (USA). [
                                                                           stigmatising statements should then be presented to
                                                                           the open plenary.

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                                                                                                                                          4      75

                          IN OUR COMMUNITIES

  Allow 30 minutes to complete this task.                             Some examples of stigmatisation and discrimination
  3. Reconvene in a plenary session. Ask groups
  to report back on their map. Ask the following                           At home, PLHIV are made to stay in back
  questions:                                                               rooms, are hidden from others in the
                                                                           community, are not fed properly and are
  A. Who are stigmatised? Who are discriminated
                                                                           forced to use separate utensils.
                                                                           In clinics, PLHIV are told to stand in separate
  B. Who is doing the stigmatising? Who is
                                                                           queues, are not provided proper medical care,
                                                                           are told to go home, etc.
  C. What forms of stigma and levels of
                                                                           In schools, children are victimised if they or
  discrimination take place in each context?
                                                                           their parents are living with HIV.
  D. How do you think that people who are
                                                                           In the street, shunning and avoiding everyday
     stigmatised or discriminated against would                            contact with PLHIV, verbal harassment and
  be affected?                                                             even physical violence.
                                                                           In the workplace, HIV positive workers are
  Notes for trainer                                                        denied medical insurance and promotions,
                                                                           avoided by colleagues and experience
  Point out that stigma and discrimination occur in                        breaches of confidentiality regarding their HIV
  many different contexts – the home, neighbourhood,                       status.
  school, clinic, workplace, marketplace, buses, bars,
  churches, at community taps and in other public                     *Note: Activity adapted from Zuberi, F., Jones, P. & Viljoenm F. (2004).
  places. In all of these contexts, it takes similar forms            HIV/ AIDS, stigma and human rights, a localised investigation of
                                                                      Hammanskraal communities. A report of the Tswelopele research project
  – isolation, naming and shaming, rejection, insults                 of the Centre for the Study of AIDS. Pretoria: Centre for the Study of
  and gossiping, amongst others.                                      AIDS at the University of Pretoria.

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                              MODULE 5

                                            ADDRESSING STIGMA &

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78     M O D U L E            5
                                       SESSION PLAN ADDRESSING STIGMA
                                       & DISCRIMINATION

     Objectives                                                           Step 2 Education
     By the end of the session participants should be able                Interactive lecture            15 minutes
                                                                          This session focuses on the need for education
         Understand the need for a multi-pronged response                 as a core component of any strategy by asking
         to stigma and discrimination.                                    participants and providing answers for the following
         Explain why education is key to addressing stigma
         and discrimination and identify the different kinds              A.      Why is education important to reduce or
         of educational programmes.                                               prevent stigma and discrimination?

         Emphasise the need for the greater involvement
                                                                          B.      What kinds of educational programmes have
                                                                                  a role?
         of people living with HIV in responding to stigma
         and discrimination.                                              C.      What is the difference between public,
                                                                                  professional and focused education?
         Describe how focused education can help in the
         workplace.                                                       Step 3 The greater involvement of people living
         Illustrate how access to treatment reduces stigma                with HIV
         and discrimination.                                              Short lecture         15 minutes

         Recognise how using the law can decrease                         This is a short session on the GIPA principle stressing
         stigma and discrimination.                                       the following main points:

                                                                          A.         The need for GIPA in policy making,
         Realise discrimination must be looked at in more
                                                                                     development and implementation of
         than one context.
     Suggested training materials
                                                                          B.         The link between GIPA and reduction in
     Activity: Challenging stigmatising statements                                   stigma and discrimination.
     Activity: Addressing stigma & discrimination                         C.         Examples of PLHIV activities.
     Handout: Common scenarios
                                                                          Step 4a The workplace
     Activity: Rights-based strategies for stigma &                       Interactive lecture            15 minutes
                                                                          This session focuses on the need for focused
     Handout: Case studies                                                educational programmes in the workplace including:

     Step 1 Introduction                                                  A.       What kind of programme is needed?
     Mini lecture    15 minutes                                           B.       The link with reduction in stigma and
     Present the introduction of Addressing Stigma &                               discrimination.
     Discrimination highlighting the following:                           C.       The special requirements of healthcare
     A. The need for multi-pronged interventions to                                workplaces.
         address stigma and discrimination.
                                                                          Step 4b Challenging stigmatising statements
     B. The four issues to understand before action is                    Group activity        1 hour
                                                                          Refer to Challenging stigmatising statements activity
     C. Links to other broader existing forms of                          sheet and follow instructions.
         inequality, exclusion and injustice.

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Step 5 Access to treatment                                       as well as the need to involve non-health related
                                                                 organisations for a broad-based and integrated
Mini lecture & group discussion 15 minutes
                                                                 approach to reducing stigma in the community.
Ask the group:
                                                                 Step 7b Addressing stigma & discrimination
        How can access to ART change the
                                                                 Group activity         2 hours
        perception of HIV and help to reduce stigma
        and discrimination?                                      Refer to Addressing stigma & discrimination activity
                                                                 sheet and follow instructions.
Step 6 Using the law
Mini lecture & group discussion 15 minutes                       Step 7 Rights-based strategies to address
                                                                 stigma & discrimination
Ask the group:
                                                                 Group activity         2 hours
        How can supportive legislative and policy
        environments empower communities to tackle               Refer to Rights-based strategies for stigma &
        stigma and discrimination?                               discrimination activity sheet and follow instructions.

Step 7 aIntegrating contexts                                     Step 8 Conclusion
Mini lecture     10 minutes                                      Mini lecture           10 minutes

Explain to the group the rationale behind the need               This last session provides a summary of the main
for targeting more than one context of discrimination            points and concluding comments. Refer to Contents

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80    M O D U L E             5
                                        CONTENTS                                  ADDRESSING STIGMA
                                        & DISCRIMINATION

     Step 1 Introduction                                                 3.     We need to stimulate a better understanding
                                                                                of how stigma and discrimination fuel the
     Given the intimate and close links between HIV-
                                                                                pandemic, and the role that greater access to
     related stigma, discrimination and human rights
                                                                                treatment could have in reducing prejudice
     violations, multi-pronged interventions are needed to
                                                                                against people living with HIV and associated
     address each of these issues. Action must be taken to
                                                                                denial of their entitlement to human rights;
     both prevent stigma and to challenge discrimination
     when it occurs, as well as to monitor and redress
     human rights violations. Clearly, everyone – from                   4.     It is critical to identify opportunities for action
     political and social leaders to community members                          and set clear objectives for results.
     and entertainers – has a role to play in fighting stigma            Moreover, one of the key lessons to be learned is the
     and discrimination. More and more initiatives are                   importance of tackling stigma and discrimination, not
     now successfully tackling the denial, ignorance and                 only in relation to HIV, but also in relation to the other
     fear that fuel the cycle of stigma, discrimination and              forms of inequality and exclusion that disempower
     human rights abuses.                                                those most vulnerable to infection. Broad-based
     HIV-related stigma and discrimination will only be                  action is needed to tackle the gender, racial and
     reduced if it is challenged simultaneously on several               sexual inequalities and stereotypes upon which HIV-
     fronts:                                                             related stigma and discrimination so often feed.

           Inside communities, where education and                       Step 2 Education
     media-based efforts can be directed at public
                                                                         Education is a key component in any strategy to
     opinion to improve the environment of people
                                                                         reduce or prevent stigma and discrimination against
     living with HIV; and
                                                                         people with HIV and populations affected by HIV for
          In settings such as workplaces, hospitals                      the following reasons:
     and clinics, places of worship and
                                                                                 Stigma and discrimination often occur in
     educational establishments, where equitable
                                                                                 settings not covered by human rights
     policies and educational programmes can
                                                                                 legislation, such as within families, among
          counter stigma, discrimination and human
                                                                                 friends or acquaintances, or in casual
          rights violations; and
          In the courts, where people can invoke legal
                                                                                 The goal is to prevent or reduce the stigma
          rights and duties in order to promote and
                                                                                 and discrimination that is associated with HIV
          protect the human rights of people living
                                                                                 or that contributes to HIV infection, not to
          with HIV.
                                                                                 respond to it after it has occurred;
     But what action is needed and what must be the
                                                                                 Only a small percentage of people who
     priorities? Four issues are clear:
                                                                                 experience discrimination seek redress even
     1.   We need clear thinking about the                                       when legal or procedural avenues are available
          definitions of stigma and discrimination,                              to them; and
          where they come from, particularly the social
                                                                                 Policies and practices that stigmatise or
          and cultural forces that fuel them, and what
                                                                                 discriminate may do so unintentionally. A
          they do;
                                                                                 process of education is required to bring such
     2.   We need to appreciate their links to broader                           unintended effects to people’s attention and
          existing inequalities and injustices and                               to effect changes in the offending policies and
          denial of individuals’ realisation of human                            practices.
          rights and fundamental freedoms;

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Three kinds of educational programmes have a                       Other examples of where focused              education
role in reducing or eliminating HIV-related stigma                 campaigns could be developed include:
and discrimination: public education, professional
                                                                          Local communities (urban or rural) where
education and focused education.
                                                                          people with HIV reside;
A.      Public education
                                                                          Children, staff and parents associated with
Public education is required to maintain or increase                        child care centres;
knowledge and awareness in the general population
                                                                          People involved in the school system; and
                                                                          In-service training of religious leaders and
     The modes of transmission of HIV;
                                                                          those working in faith-based organisations.
     The fact that in everyday activities there is
                                                                   Step 3 The greater empowerment of people
     virtually no risk of transmission of HIV;
                                                                          living with HIV
     The risks of infection associated with certain
     behaviours;                                                   The greater empowerment of people living with, and
                                                                   affected by, HIV is essential for the HIV response.
     Ways to prevent transmission of HIV;
                                                                   The ‘greater involvement of people living with HIV’
     The rights of people with HIV; and                            principle encourages the active involvement of
                                                                   people living with HIV in policy-making and in the
     The rights of populations affected by HIV.
                                                                   development and implementation of programmes.
B.      Professional education                                     Such involvement is central to de-stigmatising the
Professionals play a major role in preventing or                   pandemic and strengthening the capacity of affected
reducing stigma and discrimination against people                  communities to fight back.
with HIV or populations affected by HIV. This role                 Some of the most powerful efforts to curb HIV-
extends not only to their own attitudes and practices,             related stigma and discrimination are driven by the
but also to the influence that they have over the                  involvement of people living with, or affected by,
attitudes and practices of others.                                 HIV. Around the world, they have built organisations,
The stigmatising and discriminatory effects of                     campaigns and even mass movements that mobilise
professional policies and practices may be more                    action against the pandemic and that pressure
inadvertent than deliberate. In response, therefore,               their countries’ leaders to tackle the pandemic with
often what is needed is not only education about                   resolve.
non-discriminatory approaches to dealing with                      When PLHIV are brought to the forefront of the
people with HIV or populations affected by HIV, but                response, have increased community contact and
also information about HIV and AIDS that is up-to-                 are involved in all stages of interventions, a positive
date, comprehensive and holistic.                                  cycle comes into effect. As PLHIV become active
C.      Focused education                                          members throughout society, stigma against them
                                                                   is reduced, and consequently, this reduction in
Focused education – i.e. educational programmes
                                                                   discrimination encourages more people to publicly
for specific communities, populations or contexts
                                                                   identify themselves as HIV-positive.
– is required to allay fears, increase awareness
and sensitivity, and provide correct information to                PLHIV can facilitate activities in the workplace,
those who interact with people with HIV and their                  give presentations to religious leaders, organise
families. The goal of focused education is to create               empowerment groups, advocate for change in how
an environment in which people with HIV and                        they are treated by families or health providers, and
their families can live without fear of stigma and                 promote prevention by personalising their experiences

                                  Challenging Stigma & Discrimination - A manual for UN trainers
8    M O D U L E             5

     for others. By delegating central responsibilities to                     Provide clear direction on how to combat
     PLHIV, programmes further emphasise the message                           discrimination toward people with HIV.
     that PLHIV can continue to lead productive lives and
                                                                         Workplace programmes can successfully change
     contribute to the development of their communities.
                                                                         HIV related stigma and discrimination. It is a violation
     The belief here is that a more personal relationship
                                                                         of an employee or prospective employee’s human
     with PLHIV (either through face-to-face conversations
                                                                         rights to be subjected to mandatory testing. Such
     or by hearing a testimonial from infected or affected
                                                                         discrimination is a violation of human rights and it
     individuals) will demystify and dispel misinformation,
                                                                         contributes to the spread of the epidemic by making
     generating empathy which, in turn, reduces stigma
                                                                         people afraid to get tested or disclose their HIV
     and discrimination.
     Encouraging and nurturing PLHIV networks and
                                                                         The workplace provides an excellent opportunity
     groups, therefore, is a crucial step for projects to
                                                                         to set standards that protect human rights and
     consider. Helping PLHIV to break down their sense
                                                                         to establish a supportive environment for those
     of isolation, develop a safe social space for them
                                                                         living with HIV. The ILO Code of Practice on HIV
     to then learn from each other, gain strength and
                                                                         and the World of Work provides basic principles
     identify priorities as a group can begin the process of
                                                                         to guide policy development, as well as guidelines
     normalising their presence within a community.
                                                                         for practical programming. A workplace policy on
     Note of caution: Because there are not many PLHIV                   HIV is a powerful instrument with which to combat
     in the Pacific who are public about their HIV status,               discrimination and encourage solidarity through
     it is important that these few courageous individuals               education and awareness raising.
     are not overburdened with representing PLHIV in
                                                                         Healthcare workplaces
     fora that require their participation. Additionally, it
     is equally important that PLHIV receive adequate                    Within healthcare settings, it should be ensured
     capacity building to carry out these public roles                   that codes of ethics and professional conduct for
     proficiently. The Pacific Islands Aids Foundation (PIAF)            healthcare services are in place and are enforced,
     provides such training of PLHIV through their AIDS                  and that their application to HIV is taught within
     Ambassador programme. It must be remembered                         professional training curricula. Sufficient forms of
     that PLHIV are already under enormous personal and                  redress should be offered if violations of professional
     health pressures without the added responsibility of                ethics occur.
     being expected to take action publicly.                             Practical HIV-related training for all healthcare
                                                                         workers should be encouraged to promote better
     Step 4 The workplace
                                                                         understanding, to promote confidentiality and to
     One place where focused education is important                      reduce unfounded anxiety.
     is the workplace. To create a supportive and safe
                                                                         To reduce stigma and discrimination in healthcare
     environment in the workplace for people with HIV, it
                                                                         settings, we need to address healthcare workers’
     is not enough simply to develop policies regarding
                                                                         fears about getting infected on the job and their need
     HIV in the workplace. It is also necessary to mount an
                                                                         to protect themselves through standard precautions.
     educational programme that:
                                                                         The use of universal precautions will not only allay
         Will inform staff about the principles behind the               staff anxieties, but will also help protect the identities
         policies;                                                       and rights of infected patients.
         Deal with issues that often arise around HIV;
                                                                         Step 5 Access to treatment
         Dispel myths and fallacies about HIV and
                                                                         Lack of access to antiretroviral treatment is a key
         populations affected by HIV; and
                                                                         issue that enhances or advances HIV-related stigma

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                                                                                                                                                  5       8

and discrimination in many countries. The perceived                 Fiji’s Prisons and Corrections Act 2006
‘untreatability’ of AIDS is a key factor contributing               Prisons have been one of the key target areas of
to the stigmatisation of many of those affected. The                legislative reform in regard to HIV in Fiji. Under old
increased access to treatment drugs remains one of                  Fiji law, both officers and prisoners were subjected
the greatest challenges.                                            to mandatory HIV testing, confidentiality was not
As long as HIV continues to be equated with serious                 maintained and HIV-positive prisoners isolated
illness and death, public attitudes towards the disease             – serving to fuel stigma and discrimination in the
seem likely to be slow to change. For this reason, as               country’s prisons. Guiding the new law’s drafters
well as on grounds of equity and justice, efforts must              were international human rights standards as laid
be made to extend the availability of antiretroviral                out in international treaties, related legislation and
drugs.                                                              the UN Minimum Rules and Standards for the
                                                                    Treatment of Prisoners. The end result: a new
Concrete action needs to be taken to ensure greater
                                                                    Prisons and Corrections Act 2006 that addresses
access to, and uptake of, treatment drugs. Helping
                                                                    stigma and discrimination by removing the old
people to understand that it is possible to live with
                                                                    provisions relating to separation of HIV-positive
HIV and recognising that treatment promises real
                                                                    prisoners, mandatory testing and further allows for
hope for the future are important steps in reducing
                                                                    VCCT, while encouraging the prison service to adopt
fear and anxiety about the pandemic. Greater access
                                                                    supportive attitudes towards people affected by HIV
to antiretroviral treatment can also help reduce
                                                                    to address discrimination, fear and prejudice.
stigmatisation and discrimination as community fears                    Source: Fiji Law Reform Commission, ‘Prisons review’ [
lessen and HIV is seen as a manageable disease.                                                             fj/common/Default.aspx?page=prisonsRev]

Globally, stark inequalities exist between those                   Legal protection for people living with HIV is a
countries where antiretroviral treatment is available              powerful way of redressing, and thereby mitigating,
and those where it is not. Steps must urgently be taken            the unequal power relations, the social inequality
to remedy this situation, not only because the current             and the exclusion that lie at the heart of HIV-related
generation of treatments prolongs and improves                     stigmatisation and discrimination. Anti-discrimination
quality of life, but also because the availability of              legislation is crucial as well as countries ratifying
treatment drugs can change perceptions of the                      international human rights treaties and making
pandemic, de-stigmatising HIV in the process.                      commitments to HIV specific declarations such as
                                                                   the UNGASS Declaration and the UN Millennium
Step 6 Using the law                                               Declaration, from which stems the Millennium
The law can be a powerful tool against stigma and                  Development Goals.
discrimination. The Papua New Guinea HIV and AIDS
                                                                   Training and support for existing legal aid institutions
Management and Prevention (HAMP) Act 2003 is an
                                                                   in developing their approach to human rights and HIV
example of how legislation with strong provisions for
                                                                   are also needed, alongside the creation of lawyers’
protecting people living with HIV can serve as a useful
                                                                   collectives specialising in HIV-related concerns. For
instrument for combating HIV-related discrimination.
                                                                   example, PIAF has a network of lawyers trained in
Such legislative and supportive policy environments
                                                                   gender issues that provide free legal advice to PLHIV in
can help empower communities to tackle stigma,
                                                                   the Pacific Islands. Training and supporting members
discrimination and human rights violations more
                                                                   of associations of PLHIV are also important, so that
                                                                   these associations can provide in-house paralegal
                                                                   counselling and advice.

                                                                   For more information on the above, see Module 6: HIV & the law.

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     Step 7 Integrating contexts                                        “Have more HIV drugs”

     In the same way that individuals are members of                    Vanuatu’s first person to come out
     a number of ‘communities’ throughout their lives,
                                                                        publicly about her HIV status Irene
     projects do well to look beyond any one context
     of discrimination. Even activities that focus on one
                                                                        Malachi has called for the provision
     context of discrimination almost exclusively can still             of ARV drugs to people living with
     strengthen their impact by acknowledging links with                the virus in the Pacific. Ms. Malachi
     other social arenas.                                               told a regional conference on HIV and
     Ultimately the model should move toward more                       AIDS in Auckland that HIV positives
     comprehensive integration. As HIV increasingly                     like her deserve the treatment, no
     impacts the development of countries, a growing
                                                                        matter how expensive. The Secretariat
     number of development agencies have incorporated
     HIV work into their mandates. Non-health-related
                                                                        of the Pacific Community estimates
     NGOs find that their areas of expertise have in                    treatment at US$290 per year for
     some way been affected by the pandemic and that                    an adult. For herself, Malachi said
     they cannot afford to ’compartmentalise’ HIV away                  retroviral drugs are not available in
     from community development. Any organisation or
                                                                        Vanuatu, so she had to make very
     institution can address the relevant HIV issues within
     its activities; the specific message here is that, in
                                                                        expensive trips to neighbouring New
     terms of stigma and discrimination, a multi-pronged                Caledonia every three months.
     attack is most likely to have the biggest impact.
                                                                        “I wish to get the treatment in my own
     Non-government organisations, can significantly                    country,” Irene told the conference.
     contribute     to     challenging     community-level
     discrimination by adding HIV to their agenda and                   The qualified nurse, who resigned
     contributing their specific strengths from their core              from Port Vila’s national hospital in
     functions. The role for HIV-focused projects in this               2002 after she tested positive, believes
     regard, therefore, is to provide information, technical
                                                                        the wider availability of ART would
     assistance, networking links and policy advocacy
     to facilitate such a broad-based and integrated
                                                                        encourage more HIV positive people
     approach to reducing stigma and discrimination in                  to come out (and be tested) because
     the community.                                                     non-availability of treatment makes
                                                                        HIV testing meaningless.

                                                                                                        PACNEWS, 27 October 2005

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Step 8 Conclusion                                                 Legal reform is a key factor in reducing all forms of
                                                                  discrimination. A key goal for HIV law reform is to
In order to respond positively and effectively to HIV-
                                                                  sanction and penalise discrimination against people
related stigma and discrimination, work has to occur
                                                                  living with HIV, and it is in this field of legislative change
simultaneously on several fronts. Vitally important is
                                                                  coupled with education which ultimately will change
communication and education to encourage better
                                                                  attitudes and facilitate the ability for people with HIV
understanding of HIV. Education dispels myths and
                                                                  to lead productive lives. International human rights
stereotypes about HIV, provides information about
                                                                  law can guide reform processes and also the drafting
the rights and dignity of people living with HIV and
                                                                  of model anti-discrimination legislation; for example,
populations affected by HIV, and creates a supportive
                                                                  the International Guidelines on HIV and Human Rights
environment for people with HIV.
                                                                  (see Module 6) shaped PNG’s HAMP Act and most
Also important are steps to promote understanding                 recently the Pohnpei Act in the Federated States of
and support for people living with HIV. It should be              Micronesia.
strongly encouraged to involve people living with
HIV in policy and programme development. This is
important to challenge community stereotypes and
prejudices.                                                       REFERENCES
Policies and laws must treat all people equally.
Governments, national authorities, businesses and                 Aggleton, P. & Parker, R. (2002). A conceptual
                                                                  framework and basis for action: HIV and AIDS
non-governmental organisations have been taken to
                                                                  stigma and discrimination. Geneva: UNAIDS. [http://
task for discriminating against, or failing to provide  
equitably for, people living with HIV.                            WAC_Framework_en.pdf]

In developing local responses, it is essential to                 Aggleton, P., Wood, K., Malcolm A. & Parker, R.
                                                                  (2005). HIV-Related Stigma, Discrimination and
focus on the deeper structures of inequalities that
                                                                  Human Rights Violations: Case studies of successful
fuel negative responses of stigmatisation and                     programmes. Geneva: UNAIDS. [http://data.unaids.
discrimination. The stigmas associated with HIV do                org/publications/irc-pub06/JC999-HumRightsViol_
not arise from out of the blue nor, sadly, can they               en.pdf]
be made to disappear with a smile and a few kind                  “Have more HIV drugs”. PACNEWS. 27 October,
thoughts. Without programmes and policies to tackle               2005.
the social divisions of gender and other disadvantaged            [
groups, HIV discrimination will continue. This is as              dynamic/containerNameToReplace=MiddleMid
true in the poorer countries of the world as it is in
the richer. Broad-based alliances need to be formed,              Article-full.tpl]
therefore, between those active in preventing HIV and
promoting care and those working in other fields – for
gender equality, for sustainable development and for
racial and sexual equality, for example.

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                                           ACTIVITY CHALLENGING STIGMATISING STATEMENTS

     Objectives                                                                   Homosexuality is a sin anyway.

         To identify statements that are stigmatising.                      Encourage participants to come up with their own
                                                                            examples of stigmatising statements relevant to the
         Develop arguments for challenging stigma when
         it occurs.
                                                                            Then ask participants:
     1 hour
                                                                               “What methods work best for challenging stigma?
     Materials                                                                 Be specific.”

     Examples of stigmatising statements written on                         Notes for trainer
     flipchart paper
                                                                            The most powerful responses are those that make
     Suggested method                                                       people stop and think, rather than attacking responses
                                                                            that make the stigmatiser defensive. Examples of
     Divide the participants into groups of 5-6 people. Ask
                                                                            strong responses:
     that one person from each group to take turns sitting
     in the ‘hot seat’.                                                           You only need to sleep with one person to get
     The person in the hot seat is expected to improvise
     challenges to statements that are presented one at                           My sister has HIV and she has a very healthy
     a time.                                                                      lifestyle.

     Examples of stigmatising statements                                          You may be in the same boat in a year’s time
                                                                                  so you should be more compassionate
         People who sleep around deserve what they
                                                                                  to people living with HIV now.
                                                                                  HIV positive women can have HIV negative
         Don’t stand too close to someone with HIV.
         I feel sorry for the children who get HIV.
                                                                                  You cannot catch HIV by sharing food with
         You deserve to get sick if you behave badly.                             people living with HIV.

         I don’t want my children to go to school with a
         child who is HIV positive.                                         *Note: Activity Adapted fromKidd, R. & Clay, S. (2003).
                                                                            Understanding & Challenging HIV Stigma: Toolkit for Action.
         She looked so thin, I said “Go and say goodbye                     CHANGE (USA), ICRW (USA). [
         to your mother”.

         If you have HIV, you must have slept with a
         woman who had an abortion.

         Doctors should not treat HIV patients because
         the disease is incurable.
         Don’t share food with HIV victims.

         If I got AIDS, I’d kill myself.

         Women with HIV should not have babies.

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                   ACTIVITY ADDRESSING STIGMA &                                                        M O D U L E
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                                                                                                                                     5       87


Objectives                                                                 replacement acts in a way that he/she thinks
                                                                           doesn’t stigmatise or discriminate and respects
•    To identify incidences of stigma and
                                                                           human rights.
                                                                           The drama runs its course with other
•    To practice strategies to address stigma and
                                                                           participants replacing members of the group
                                                                           until all incidences of stigma, discrimination or
Time                                                                       human rights violations have been remedied.

2 hours                                                             6.     After each ‘Stop-Start’ drama, the facilitator
                                                                           opens the floor to feedback and comments to
Handouts                                                                   elicit the important issues and lessons learnt.
Handout: Common scenarios
                                                                    Notes for trainer
Suggested method                                                         Participants should practice presentations first in
Stop-Start Drama                                                         a comfortable situation.

1.   Divide into groups of 8-10.                                         Participants can write down points on cards if they
                                                                         are nervous about role-playing in front of the
2.   Using the Common scenarios handout,
     participants choose a scenario or create one of
     their own.                                                          Depending on time, the facilitator may have to
                                                                         choose just one or two short dramas for the ‘Stop-
3.   Then participants develop short dramas, assign
                                                                         Start’ part of the activity.
     roles within their groups and practice their
     dramas                                                              It is important to invite feedback after each ‘Stop-
                                                                         Start’ drama to allow participants to reflect on the
4.   Next, participants perform their short dramas to
                                                                         issues raised and lessons learnt.
     the larger group.

5.   The ‘Stop-Start’ aspect of the drama-making is
     then introduced:
                                                                    *Note: Activity adapted from Kidd, R. & Clay, S. (2003). Understanding
     First, each group is asked to perform their short              & Challenging HIV Stigma: Toolkit for Action. CHANGE (USA),
                                                                    ICRW (USA). []
     dramas again. However, this time, participants
     are asked and encouraged to shout ‘STOP!’
     when they see stigma, discrimination or a
     human rights violation taking place.

     The participant who stopped the drama then
     replaces the person who was stigmatising,
     discriminating or committing the human rights
     The facilitator then says ‘START’ and the
     dramas       re-starts. Only this time the

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88    M O D U L E              5
                                         HANDOUT COMMON SCENARIOS

     The following are common scenarios:                                 Case 6
     Case 1                                                              A young woman contracts the HIV virus after being
                                                                         raped. When she discovers her HIV positive status,
     A group of chiefs want all people living with HIV
                                                                         she tells her family, who pressure her to drop the
     banished to an outer island. Vocal chiefs have also
                                                                         charges against her rapist because the family knows
     demanded mandatory testing for the entire population
                                                                         him. She reports the matter to the police but the case
     so PLHIV can be identified and isolated.
                                                                         is dropped for lack of evidence.
     Case 2
                                                                         Case 7
     A mother in a rural village has been infected by her
                                                                         A young female student falls pregnant to an older
     HIV-positive husband, who was a seaman, and who
                                                                         male student. At her first antenatal check-up she tests
     has died. Her neighbours are gossiping about her and
                                                                         positive for HIV. As a result, the school expels her
     as a result, she is not allowed to bathe in the village
                                                                         saying it would set a bad example to other students
     stream, attend church or work on her husband’s
                                                                         and it their policy to discourage teenage pregnancy.
                                                                         Case 8
     Case 3
                                                                         A pregnant woman goes to a clinic for an antenatal
     A soldier has been passed over for a promotion in the
                                                                         check up. She is tested for HIV without her consent.
     military because of his HIV status. He did not give his
                                                                         A doctor then informs her that she is HIV positive and
     consent to being tested and upon hearing the result
                                                                         must have an abortion.
     was not counselled on his options. Despite being
     the most qualified candidate for the position, he was               Case 9
     informed that he did not meet all the criteria.
                                                                         Religious groups demand disclosure of the names of
     Case 4                                                              HIV positive people in the interest of the community.
                                                                         They also demand that mandatory testing is introduced
     A female teacher has had her HIV test results released
                                                                         so as to identify all those living with the virus.
     to the school head teacher by the doctor. The doctor
     did not ask for the teacher’s consent but felt that it was          Case 10
     appropriate for the school to know. The head teacher
                                                                         Country X has limited funds for antiretroviral therapy
     pressures the teacher to resign.
                                                                         (ART) for PLHIV but manages to purchase generic
     Case 5                                                              ART at a low cost and starts a treatment program.
                                                                         WTO regulations, soon to come into effect, prevent
     A domestic worker is sent for a test by her employer
                                                                         the government from continuing to purchase the drugs
     and then fired when she tests HIV positive. She was
                                                                         at a lower cost.
     unaware she was being tested for HIV. Her husband
     leaves her and refuses to be tested himself.

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             RIGHTS-BASED STRATEGIES                             ACTIVITY                          M O D U L E
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                                                                                                                          5      89

                      FOR STIGMA & DISCRIMINATION

Objectives                                                         4. Groups should be encouraged to analyse the
                                                                      case studies, using the UDHR handout, and
    To identify incidences         of     stigma        and           answer the following questions:
                                                                          Who are the right holders / claim holders?
    To identify the rights violated when stigma and
    discrimination occurs.                                                Who are the duty bearers?

    To identify the duty bearers and right holders.                       What rights are being violated?

    To develop effective rights-based approach                            What are some of the stigmas that you think
    strategies to address stigma and discrimination.               are      taking place in your case study?

                                                                          What forms of discrimination are taking place?
                                                                          What are some actions that you can take to
2 hours
                                                                          address stigma and discrimination in the case
Handouts                                                                  study?

Handouts: Case studies and UDHR summary (Module
2 handout)
                                                                   Notes for trainer
Suggested method                                                   •     It is important to invite feedback after each ‘case
Brainstorming and case study analysis                                    study’ to allow participants to reflect on the issues
                                                                         raised and lessons learnt.
1. Divide into groups of 5-6.

2. Using the Case study handout participants
   choose a case study that the group then reviews
   and highlights the key issues.                                  * Source: RRRT

3. Groups choose a facilitator who will guide them
   through the group work and a rapportuer who
   presents on behalf of the group.

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90    M O D U L E             5
                                        HANDOUT CASE STUDIES

     Case 1                                                              refuse to let her work on her husband’s land. People
                                                                         are gossiping about her and avoiding her and there
     A group of chiefs have heard that someone in one of
                                                                         is discussion that the Chiefs of the village will ask her
     their villages has been diagnosed with HIV. Many of the
                                                                         to leave.
     villagers are unaware about how HIV is transmitted.
     It has caused panic, with rumors spreading about                    Case 3
     who may also have been infected. The villagers no
                                                                         J is a soldier who graduated at the top of his military
     longer allow the person diagnosed with HIV to leave
                                                                         academy class. He has risen quickly in the ranks, and
     his house, go to church, use the village water supply
                                                                         seems to have a bright future ahead of him. He is
     or attend traditional functions. His wife has lost her
                                                                         next in line for a promotion to make him the youngest
     job because of it, and their children have been told
                                                                         colonel in the military’s history. Before his promotion,
     by their teachers that they could no longer attend
                                                                         he is assigned to a brief overseas peacekeeping
                                                                         mission. Prior to his departure, he is required to
     The chiefs meet and decide that they want the panic                 undergo some tests. He is not informed that one of
     to stop. The solution they come up with is to have                  these tests is for HIV.
     everyone living with HIV banished to an outer island.
                                                                         A few days before he is supposed to leave, a nurse
     One of the chiefs says that everyone in their villages
                                                                         tells him that he is HIV positive. He is visibly shocked,
     should be tested to find out exactly who has HIV so
                                                                         however none of the medical personnel provide him
     they may be isolated.
                                                                         with counselling or information about the implications
     Case 2                                                              of having HIV.

     L and A live in a remote village with their two children.           The next day, his commanding officer informs him that
     They have been married for three years. In order to                 he has been removed from the peacekeeping mission,
     support the family A decides to take a job overseas                 and that he has been passed over for promotion since
     which requires him to be away eight months of the                   he does not meet all the criteria. He is asked by his
     year. When he returns, he becomes ill with what looks               commanding officer to consider resigning as he won’t
     like the flu. When his illness gets worse and remains               have “much work” for him to do in the near future.
     for two months L decides to take him to the nearest
                                                                         Case 4
     hospital, which is two hours away. A dies in the
     hospital, and the doctor tells L it was because he had              A is a school teacher. During the summer months, he
     HIV. L does not feel ill herself, however she decides               becomes ill and is diagnosed with HIV by his doctor.
     to get tested for HIV as well. She is diagnosed with                He is able to afford medication and by the time the
     the virus.                                                          school year begins he feels well enough to go back to
                                                                         work. A has informed his wife, who is also HIV positive.
     When she returns to her village she decides not to tell
                                                                         His wife is still working, but is getting ill more often. A
     anyone about her HIV status or the real reason her
                                                                         values his job, and his family relies on his income.
     husband died. However, one of the nurses working
                                                                         He misses his work, and looks forward to being in a
     in the hospital is also from their village. One day L’s
                                                                         classroom again.
     mother comes to her house telling her that she found
     out L is HIV positive from their neighbor. Soon, the                A few days before school starts, the school head
     rest of the village also finds out.                                 teacher asks to meet with him. The head teacher says
                                                                         that he received a call from A’s doctor informing him
     L is no longer allowed to bathe in the village stream.
                                                                         of A’s HIV status. The head teacher is now pressuring
     Her church refuses to let her attend services. Although
                                                                         him to resign. A did not consent to his doctor releasing
     she has two children to feed, her husband’s relatives

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                                                                                                                         5      91

any information about his illness. A confronts his                   with HIV. He contracted pneumonia despite S’s
doctor, who tells him that he felt it was appropriate for            best efforts to keep him healthy. The nurses in the
the school to know.                                                  hospital routinely took blood from the baby for tests,
                                                                     but asked S to have someone take the baby away
Case 5
                                                                     from the hospital because they did not want to keep
K’s job as a waitress at a busy restaurant in town                   it. The baby died after 5 months. S’s husband finally
requires her to work late on weekends. She sometimes                 decided to take a blood test after their child’s death.
gets worried when she has to walk home for a few
                                                                     One of the hospital nurses had a husband who
blocks in the dark, as she does not have her own
                                                                     was also a sailor at the same company where S’s
transport and the buses stop running by the time she
                                                                     husband worked. The nurse told her husband about
gets off work. However, her employer is good to her
                                                                     S’s status. The husband in turn told the company
and she does not want to leave her job.
                                                                     where he was employed. When S’s husband went
On her way home one evening K is confronted by a                     to the company to renew his license the operations
group of drunk men from the neighborhood. One of                     manager told him they couldn’t employ him anymore
the men rapes her. She recognises him as someone                     because he was HIV positive.
living two houses down from hers. At the hospital she
                                                                     S’s health deteriorated and she passed away in late
is given an HIV test without her knowledge, and she
is diagnosed with HIV.

K tells her family that their neighbor raped her. Her
                                                                     Case 7
family is at first shocked, but they are pressuring her              T is a 25 year old married woman. She found out she
to drop the charges because they do not want to                      was HIV positive when she was given an ante-natal
cause a scandal. One of her relatives works at the                   HIV test when she was pregnant with her first child.
hospital where she had her HIV test, so there has                    When her doctor told her about her positive status,
been gossip that she has HIV. People are spreading                   she was not given any information about HIV. She
rumors that the reason she worked late on weekends                   became depressed when she found out.
was because she was a prostitute. K’s employer
                                                                     Her husband tried to escape from the fact that he
heard the rumors that she had HIV and he told her he
                                                                     might have HIV. His girlfriend already tested positive,
could not keep employing her because she handled
                                                                     but she did not tell him about it, only saying that he
people’s food.
                                                                     should go to the hospital for a test himself. He did not
Case 6                                                               realize why until his own wife was tested positive.

S is a 29-year-old married woman. While pregnant                     T’s first child was born HIV positive. He died when he
with her second son, she was given routine ante-                     was a year and nine months old.
natal testing. The hospital did not inform her that this             The second time she got pregnant, T was placed on
included an HIV test. Two weeks later, the hospital                  AZT treatment, so that her baby was born negative.
told her she was HIV positive.                                       The doctors then told her to have a hysterectomy.
S was alone when she found out, because her                          At that time T still did not fully understand the
husband was working overseas as a sailor. S felt                     implications of HIV and she was at the mercy of her
betrayed because she trusted her husband to be                       doctors’ advice. She believed that she would keep
faithful while he was away. She thought of committing                losing her children to the disease, so she agreed.
suicide. When her husband returned she insisted that                 T is now still together with her husband. They have
he get an HIV test as well, but he argued that he could              just finished building a house and plan to open a
not go because he had to sail again the next day.                    small canteen. Her husband’s family knows about
S gave birth to her second baby, who was diagnosed

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     their HIV status. T has only told her mother, but her
     other family members do not know.

     Case 8
     V was a nurse whose job required her to work for
     a year in a remote clinic where there were several
     patients with HIV. It was difficult to obtain medical
     supplies such as gloves and syringes in the clinic, so
     hospital staff frequently had to make do with what they
     had, or go without some supplies. V herself became
     ill while she was working there and had to use the
     clinic’s facilities as a patient.

     V returned to her village and her family. She started
     feeling ill after the birth of her fourth child. She decided
     to go for a blood test and found out she was HIV
     positive. She asked her husband to take a test too,
     and he was also diagnosed with the virus.

     In the following weeks she became very ill. She
     decided to resign from her job so that she could use
     her severance pay to afford treatment. The pressure
     in her home became too much for her husband and he
     decided to leave her. V became depressed because
     the person she expected to be there for her most had
     abandoned her. All alone, V could no longer pay for
     her home so she had to leave it.

     She initially did not tell anyone else about her illness.
     However one day someone called her father’s employer
     and told him that his employee had a daughter with
     HIV. V asked her doctor if he told anyone about her
     status, but he said he did not.

     Soon, rumors began to spread throughout the village
     that she was HIV positive. Whenever V would go
     shopping, mothers would hold on to their children so
     they would not come close to V. Buses and cabs refuse
     to stop for her on the street. She no longer has a job,
     and she is taking care of four children, one of whom is
     HIV positive. Her siblings are supporting her.

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                              MODULE 6

                                                 HIV & THE LAW

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                                        SESSION PLAN HIV & THE LAW

     Objectives                                                          Step 2 The law in a nutshell
     The aim of this module is to explain how the law can                Short lecture          10 minutes
     be used in the HIV response. By the end of the session              This session introduces the law, its origins, sources,
     participants should be able to:                                     two main divisions and how laws are made in
          Explain the role of the law in the response to                 Pacific Island countries (PICs). Ask participants the
          HIV.                                                           following questions for discussion:

          Understand that current Pacific Island legal                         1. What is the definition of law?
          responses are insufficient.                                          2. What are some examples of different laws in
          Recap the International Guidelines on HIV and                           their countries?
          Human Rights.                                                        3. Can they share some of their experiences
          Summarise the provisions and remedies of the                            with the law?
          PNG HAMP Act.
                                                                         Step 3a Pacific Island legal responses
          Identify negative and positive legal interventions             Short lecture          10 minutes
          to create a protective and supportive framework                This session outlines the inadequacy of selected
          for PLHIV.                                                     current legal responses to HIV in the PICs.

          Recognise the issues surrounding                               Step 3b Strengths & weaknesses of national HIV
          confidentiality and informed consent.                          responses
     Suggested training materials                                        Group activity         1 hour

     Activity:    Strengths & weaknesses of national HIV                 Refer to Strengths & weaknesses of national HIV
                  responses                                              responses activity sheet and follow instructions.

     Activity:    Confidentiality & partner notification                 Step 4 International Guidelines on HIV and
     Handout: Questionnaire on partner notification                      Human Rights
                                                                         Mini lecture           10 minutes
     Step 1 Introduction
                                                                         This session provides a brief review of the International
     Short lecture     10 minutes
                                                                         Guidelines on HIV and Human Rights.
     This first session introduces the role of the law within
     the response to HIV and the link to the protection                  Step 5a A protective and supportive legal
     of human rights. Particular reference is made to the                framework
     right to health.                                                    Interactive lecture             30 minutes

                                                                         This is a session on how the law can be used to
                                                                         establish a protective and supportive framework for
                                                                         PLHIV covering the following points:

                                                                         A.      Negative legal interventions (with PIC

                                                                         B.      Positive legal interventions

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Step 5b Confidentiality & partner notification
Group activity    1 hour

Refer to Confidentiality & partner notification activity
sheet and follow instructions.

Step 6 Some issues requiring legal
Lecture           30 minutes

This session focuses on the issues surrounding
confidentiality covering the following points:

                                                                     “The increased visibility of people
A.   Confidentiality

B.   Informing another health worker
                                                                     with the disease in the community
C.   Informing the sexual partner of a patient

D.   Informed consent
                                                                     can result in greater community
                                                                     acceptance and support.”
                                                                                                                Aggleton, Wood,

                                                                                                         Malcolm & Parker (2005)

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                                            CONTENTS HIV & THE LAW

     “The HIV and AIDS pandemic is unlike any other humankind has known.
     The numbers speak for themselves: 65 million infected, 25 million dead, and
     counting. What role must the law play? The prevalence and incidence of
     HIV and AIDS strongly suggests that only an integrated community-based
     approach will be effective in countering the pandemic. In this, the law must
     have an enabling and facilitative role which places those with HIV and
     AIDS at the head of their priorities.”
                             Ratu Joni Madraiwiwi, former Vice President of Fiji. High-Level Regional Consultation on HIV and the Law, April 2007

     Step 1 Introduction                                                    The right to health thus translates into positive and
                                                                            negative obligations on states ‘to respect, to protect
     The law has an important impact on how the HIV
                                                                            and to fulfil’ the right. Among these obligations is
     pandemic is experienced in any country. This
                                                                            the requirement to adopt legislation and regulations
     became evident very early on in the pandemic
                                                                            that recognise and provide for realisation of the right.
     because many of the people affected, such as sex
                                                                            States must also maintain and support the social
     workers, women, gay men and drug users, were
                                                                            institutions and practices that deliver or protect these
     already the target of punitive (punishing legal
                                                                            rights in everyday life.
     provisions. Moreover, the fear generated by the
     pandemic has meant that responses relying upon                         The right to health is obviously central to any treatment
     punitive models of law have been common.                               of a human rights approach to HIV. However, given
                                                                            the massive impact of HIV over a wide range of
     The role of the law within the response to the HIV
                                                                            sectors of society, other rights are equally relevant in
     pandemic is closely linked to the protection of human
                                                                            the context of the HIV pandemic.
     rights. Law is developed in order to protect and
     support the general public; laws that discriminate                     Step 2 The law in a nutshell
     either directly or indirectly do not fulfill that mandate.
                                                                            The principles of human rights law relevant to HIV
     A positive legal response to HIV would help to
     create a society that is supportive of people living
     with HIV. It also helps shape society by providing an                         The right to non-discrimination, equal
     institutional framework that is supportive of people                          protection and equality before the law
     living with HIV.                                                              The right to life
     International human rights law establishes an                                 The right to the highest attainable standard
     obligation on states to respect, protect and fulfil the                          of       physical and mental health
     right to health. One of the first codifications of the right
                                                                                   The right to liberty and security of the person
     to health can be found in Article 25 of the Universal
     Declaration on Human Rights, which states:                                    The right to freedom of movement

       “Everyone has the right to a standard of                                    The right to seek and enjoy asylum
       living adequate for the health and well-being
                                                                                   The right to privacy
       of himself and of his family, including food,
       clothing, housing and medical care and                                      The right to freedom of opinion and expression
       necessary social services.”                                                 and the right to freely receive and impart

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     The right to freedom of association                            the law. In most countries in the Pacific, the law
                                                                    making body is the parliament, which is an arm of
     The right to work
                                                                    the government of the country or state. In the North
     The right to marry and found a family                          Pacfiic the predominant law making body is the
     The right to equal access to education                         congress.

     The right to an adequate standard of living                    A.         Sources of the law

     The right to social security, assistance and                   The law can be found in a number of places. It is not
     welfare                                                        all contained in one document or set of books. This is
                                                                    because the law has come from different places over
     The right to share in scientific advancement
                                                                    different periods of time. There is also an increasing
     and its benefits
                                                                    amount of international law that is being accepted
     The right to participate in public and cultural life           and applied in most countries in the world.
     The right to be free from torture and cruel,                   Constitutions
     inhuman or degrading treatment or punishment
                                                                    Under the hierarchy of law, the constitution is the
To understand the above rights one has to have a                    supreme law of the country. It has supremacy
basic understanding of what is the law, what are the                (dominance) over the country’s legislation, the
sources of law and how laws are created in the PICs.                common law and equity, and customary law. The
The law is a set of rules that affects the behaviour of             law comes ultimately from the constitution, found in
all citizens and others living within a country. If the             written form in the Cook Islands, Fiji, Kiribati, Nauru,
law says do not do something, anyone who does that                  Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu
thing, is said to have ‘broken the law’.                            (some countries such as New Zealand and the United
The law is a specific set of rules that is different from           Kingdom do not have a written constitution). The
others, such as the rules of a game, club or even                   constitution is a single written document that sets
religion or custom. The important difference is that                out the framework of government rather like a set
the law affects us all regardless of whether or not                 of plans for a house. The constitution provides a
we are members of a village, sports club, church or                 framework by which a country is governed. It may
race.                                                               regulate human rights and fundamental freedoms,
                                                                    citizenship, the executive and legislative powers of
Another major difference is how and who makes
                                                                    the state, the judiciary, the public service and state

    “No person shall be discriminated against because of his or her race,
  gender, ethnic or social origin, colour, sexual orientation, age, disability,
          religion, conscience, belief, culture, language and birth.”
                                                                                                           S38 Fiji Constitution

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     The constitutions of most Pacific Island countries                   The following diagram illustrates the law making
     are the result of consultations and sometimes                        process
     submissions: by the people of the country (i.e. by
     interested individuals or by groups), political parties,             POLICE
     and sometimes a commission which was set up to                                          JUDICARY/      EXECUTIVE/
     hear these recommendations and place them in a                                          COURTS         MINISTERS
                                                                                            Judges and
     sensible, coherent form. Any other laws that are not                                                   Cabinet Policy
     consistent with a constitution can be declared to be                                   interpret the
     of no legal effect (void).
     In most countries, the constitution is also very difficult
     to change; it is ‘entrenched’ – i.e. special procedures                                       MPs make law, debate
     must be followed to change the constitution. The
     constitutions of most PICs can only be changed or                   LAW                                                 BILL
                                                                         ( Signed by the                                     (Draft of the Law)
     amended by a two-thirds vote of all members of                      Prseident or
     parliament – for example, 38 of the 52 [s.85 of the                 Govener General)

     Samoa Constitution].
                                                                          International law
     As mentioned in Module 3: HIV & human rights, all
     PIC constitutions have a bill of rights chapter that                 The common definition of international law provides
     embodies a number of rights, ‘a bundle of rights’,                   that it is a set of rules generally regarded and
     that belongs to everyone irrespective of their race,                 accepted as binding in relations between states and
     ethnicity, sex or status. While there is no specific                 nations. These include international conventions,
     non-discrimination ground that deals with HIV, courts                treaties and declarations. In relation to human
     in other jurisdictions have used ‘disability’ and ’health            rights, it includes the International Bill of Rights,
     status’ grounds to include HIV.                                      which comprises the Universal Declaration of
                                                                          Human Rights, the International Covenant on Civil
                                                                          and Political Rights and the International Covenant
     Law made by parliament is called legislation.                        on Economic, Social and Cultural Rights.
     Legislation is the most common way laws are made.
                                                                          The Constitutions of two Pacific Island countries – Fiji
     Legislation takes the form of acts of parliament,
                                                                          and Tuvalu – expressly provide that the state is bound
     statutes or ordinances – for example, the Public
                                                                          to follow international human rights treaties: Section
     Services Act, Penal Code or Public Health Act. This
                                                                          43 (2) of the Fiji Constitution and Section 15 (5) of
     source of law is written. All actions of the parliament
                                                                          the Tuvalu Constitution. Section 39 (3) of the PNG
     must be in the forms of bills, which become acts
                                                                          Constitution gives the court discretionary powers to
     when given assent by the head of state.
                                                                          consider the entire body of international law. These
     During times of colonisation, these laws were made                   countries’ courts have used these provisions to
     up of the legislation and common law (see below) of                  determine human rights matters.
     the colonial powers. These introduced laws reflect
                                                                          The High Court of Tuvalu has taken a strict approach
     the basic legal systems that existed in the colonising
                                                                          by providing that the application of international law
     states. Since independence, most PICs now make
                                                                          in the courts of Tuvalu will only take effect if an Act of
     their own laws through their own parliaments.
                                                                          Parliament is passed to implement their provisions.
                                                                          The court, however, may recognise and apply human

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rights principles as a guide to understanding the                    Customary law
meaning of legislation where there is any difficulty in              Custom law or customary law is usually unwritten
interpretation.                                                      law and was in existence before the coming of the
Thus, the approach taken by most common law                          colonisers and the laws they introduced. It is part of
countries is that rules of international law embodied in             the law for all Pacific Island countries and in some
treaties form part of the domestic law, so long as they              PICs their constitution makes provisions for custom
do not violate local laws, which always dominate.                    law. It describes acceptable forms of behaviour that
                                                                     each individual and group, as a whole, need to follow.
Common law
                                                                     It is instrumental in maintaining harmony in villages,
Common law (and equity) is found by looking at                       between individuals, between different districts,
judgements of the superior courts and through the                    their environment and natural resources. Chiefs and
mechanism of ‘judicial precedent’. Judicial precedent                elders usually enforce these rules through existing
basically means the order in which decisions of the                  customary practices. Custom is therefore part of the
court are ranked. For our purpose, precedent here                    law only in so far as it is consistent with a country’s
means that the decisions of the courts of appeal or                  constitution. Even if the custom is accepted as part
high court have a higher rank than decisions of the                  of the law, it is still subject to be questioned by the
magistrates’ court and therefore the magistrates’                    courts and declared meaningless if it is inconsistent
court must follow those decisions.                                   with the constitution or if it offends the accepted
When we use the phrase ‘the common law’, we mean                     norms of humanity.
the law as it has been interpreted and developed by                  B.     The two main divisions of law
generations of judges who have considered actual
cases and have found there is no law to help them and                Criminal law
therefore have had to develop the law themselves.                    Criminal law concerns the relationship between the
The common law will develop differently in each                      state and the individual citizen. Criminal law states
country and has developed slightly differently in each               that some kinds of behaviour are forbidden (for
Commonwealth country.                                                example, murder, rape, stealing) and if an individual
A lawyer on each side will try to influence the decision             breaks the law it will result in the state prosecuting
of the judge. To support their arguments, they may                   him or her. If he or she is found to have committed
carry into court some examples of how similar                        a breach of the law, then the courts will hand down
cases have been decided in other countries – i.e.                    punishment on the individual on behalf of the state.
how the common law has been developed by those                       Criminal law deals with cases that call upon the penal
countries.                                                           code and the criminal procedure code.

The judges will look both at the legislation and the                 In criminal law, the state is the prosecution and has to
common law cases and will make a decision based                      prove its case ‘beyond a reasonable doubt’.
on both of these. In future, that decision may itself                Civil law
become part of the common law of that country.
                                                                     Civil law regulates or affects the relationship between
Common law may eventually become part of written
                                                                     individuals. Civil law deals with those laws that affect
legislation but until it does, it exists only in judgements
                                                                     agreements and contracts, land and neighbours,
of the superior courts of that country as found in the
                                                                     families (i.e. husbands, wives and children in the cases
reports of cases. It is therefore often called ‘case
                                                                     of marriage, divorce and succession in regards to how
law’. Case law is based on the principle of precedent
                                                                     property is dealt with upon the death of someone), and
(lower courts must follow the decisions of higher
                                                                     business and commerce. The party who is ‘wronged’
                                                                     brings the action to court.

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      If someone breaks civil law, the state does not punish              outbreak by identifying, isolating and/or compulsorily
      the wrongdoer but the courts try to deal with the                   treating people infected with particular diseases.
      problem between the parties and put things right by                 Tonga’s previous legislation of 1989 provides an
      way of ordering payment of money as compensation.                   example of an approach based on public health
      Here the court works out the value of the wrong or                  concerns. Between 1989, when HIV was first added
      damage into a monetary value. Another word used                     to the schedule of notifiable diseases in Tonga, and
      in the courts is to call this amount of compensation                the commencement of the revised Public Health Act
      ‘damages’.                                                          1992 in May of 1993, if you were HIV positive you
      The burden of proof in civil cases is less than in                  were:
      criminal cases. In a civil case, an individual has to                      Required to consult a medical officer and
      prove their case on the balance of probability or to                       submit     to treatment;
      ‘the reasonable satisfaction of the court’.
                                                                                 Required to inform the person in charge of any
      Step 3 Pacific Island legal responses                                      public conveyance that you were HIV positive;

      Despite the importance of integrating human rights                         Not allowed employment in or about any dairy,
      into HIV law reform and management programmes,                             factory, shop, hotel, restaurant, childcare place
      there have been very few legal changes in the Pacific                      or food-related business;
      region in response to HIV. However, many PICs are                          Not allowed to attend college; and
      currently planning to respond to the pandemic through                      Not allowed to use public wells to draw water.
      legislative reform.
                                                                          Whilst the Public Health Act 1992 (Tonga) removes
      There have been two types of HIV-specific legal                     these harsh limits on ones’ freedom, the underlying
      changes in the region; those that have taken a positive             approach to the law reform is not based upon
      and human rights compliant approach, and those that                 human rights, but is instead based upon notions of
      have treated HIV as a public health issue.                          identification and control through restrictive measures.
      Two positive approaches, the PNG HAMP Act and                       Sections 140 and 143 give medical practitioners and
      the Pohnpei HIV Act will be covered below, however                  authorised government officials the power to isolate
      the most common HIV-specific legal changes in the                   and treat PLHIV, and to restrict their employment
      region have been through amendments to countries                    opportunities.
      Public Health Acts such as the inclusion of HIV in                  On the other hand, the inadequacy of existing laws
      the schedule of notifiable or infectious diseases (for              does provide an opportunity. Because so many of the
      example, in Tonga, Samoa and more recently, Fiji).                  legal issues thrown up by the HIV epidemic are new,
      These countries have included HIV in the schedule of                the development of new legal principles and solutions
      notifiable or infectious diseases in their Public Health            will be required. There is therefore an opportunity to
      Acts, meaning that medical proof is required by law to              direct the law to have ethics drive law reform and not
      notify the authorities if such a disease is presented.              the other way around.
      Vanuatu’s Public Health Act 1994 makes similar
      changes, although the relevant parts of this Act have               Step 4 International Guidelines on HIV and
      never come into force.                                              Human Rights
      Unfortunately, these changes don’t create a supportive              There are considerable resources to assist Pacific
      environment for people living with HIV. The system                  Island countries in legal reform initiatives. The
      surrounding notifiable diseases in public health                    International Guidelines on HIV and Human
      legislation is not aimed at looking after the rights of             Rights were developed at an expert consultation
      people with a notifiable disease. Instead, such laws                of government, UN, academic and civil society
      aim to give the state the power to manage a disease                 representatives, convened in 1996 by the United

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   “Pacific countries, with their unique cultures, need
    to learn about the paradox and observe its lessons.
   Harsh laws will not achieve these objectives, as any
  lawyers can tell. Instead, sensible policies, redress for
   discrimination and suitable law reform – as well as
    unyielding honesty and provision of access to new
     anti-retroviral drugs – will be the chief weapons
   against the spread of HIV and AIDS and against its
            burden on those already infected.”
                                                                                                                    Justice Michael Kirby
                                                                                 Fiji Law Society 50th Anniversary Convention, May 2006

Nations High Commissioner for Human Rights                         makes these guidelines better understood by providing
(UNHCHR) and UNAIDS. The guidelines contain                        examples of good legislative and regulatory practices
12 specific principles on how human rights should                  for each of the guidelines.
be promoted and protected in the context of the
                                                                   Step 5 A protective and supportive legal
HIV pandemic and represent acknowledgement, at
the highest levels, of the importance of law reform                framework
in the provision of an enabling environment for HIV                The law is not just about assigning blame, but
prevention and management.                                         rather should be used to establish a protective and
The guidelines recommend a national approach of                    supportive legal framework for people affected by HIV
widespread reform of laws and legal service provision,             rather than a punitive (punishing) one. Because of the
with an emphasis on anti-discrimination, protection                nature of the pandemic, the environment which you
of public health and improvement of the status of                  should hope to create through the development of a
women, children and marginalised groups.                           supportive legal framework would more likely be one
While the guidelines themselves are not legally binding
on states, they are based upon previously existing                       Encourages people to seek counselling, testing
legal obligations in international human rights law and                  and other support services;
represent an internationally-recognised standard for                     Encourages people to disclose their status to
governments to live up to.                                               partners;
The guidelines were followed in 1999 by the Handbook                     Facilitates the provision of medical as well as
for legislators on HIV and AIDS, law and human rights                    other support for PLHIV; and
which was developed by UNAIDS and the Inter-
                                                                         Prevents stigma and discrimination by those
Parliamentary Union (IPU). The handbook presents
                                                                         affected by HIV.
concrete measures that legislators and state officials
can take to implement the 12 International Guidelines              More punitive legal environments will not create an
on HIV and Human Rights. In doing so, the handbook                 environment where PLHIV or those affected by HIV

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      will feel safe or supported in seeking assistance                    arbitrary restrictions on dissemination of information.
      and support such as testing, counselling and
                                                                           Laws that permit HIV testing without consent or
      treatment. Rather a punitive legal environment will
                                                                           the detention of people with HIV.
      be characterised by blame, stigma, discrimination
      and fear.                                                            The Vanuatu Immigration Act (Cap 66) regulates and
                                                                           controls immigration into the country. Under Section
      Negative legal interventions
                                                                           4 (1) of the Act, a Principal Immigration Officer may
      Negative legal interventions arise from laws that do not             require any person who desires to enter Vanuatu to
      have the desired effects. The laws that we do not need               submit to be examined by a government medical
      are the laws which discriminate against people with                  officer. This provision clearly could lead to mandatory
      HIV, which distance them from their communities and                  testing.
      which make it less likely that these people will share
                                                                           Immigration and travel laws that restrict the
      in the common interest to reduce the transmission of
                                                                           movement of people with HIV between countries.
      HIV. Examples of such laws are:
                                                                           Section 10 of the Samoa Immigration Act (1966)
      Laws that make homosexuality a criminal
                                                                           under ‘Prohibited Immigrants’ states that it shall be
                                                                           an offence for any person to land or remain in Samoa
      The Fiji Penal Code Sections 175 and 176 effectively                 if the person refuses to submit to examination by the
      outlaw homosexual acts between males despite a                       Director General of Health or a person authorised
      provision in the Constitution (Section 38) that prevents             by him, after this person is required to submit to
      discrimination on the grounds of sexual orientation.                 examination under Section 6 of this Act. So, should
                                                                           an immigrant refuse to submit to examination by the
      The Cook Islands Crimes Act (1969) Section 154
                                                                           Director General of Health this person becomes a
      deals with indecency between males and provides
                                                                           prohibited immigrant.
      that consent is no defence for such an act. This
      provision is aimed at prohibiting homosexuality, and                 Section 10 (1)(f) of the same Act also makes it an
      more specifically indecent acts between males, but                   offence for “any person certified by the Director
      does not include a corresponding offence for such                    General of Health or any medical authorised officer
      acts by females.                                                     to be suffering from a contagious disease which is
                                                                           loathsome or dangerous” for such person to land or
      Offences relating to drug use and prostitution
                                                                           remain in Samoa. Thus, if a person was tested HIV
      that have the effect of making it harder to reach
                                                                           positive, they would presumably be disallowed from
      drug users and sex workers with HIV care and
                                                                           entering Samoa.
      prevention measures.
                                                                           These laws have no place in a sensitive and
      The Vanuatu Penal Code (Cap 135) provides in
                                                                           sensible response to HIV and need to be
      Section 101 that “no person shall procure, aid or
      facilitate the prostitution of another person or share in
      the proceeds of such prostitution whether habitual or                Positive legal interventions
      otherwise, or be subsidised by any person engaging in
                                                                           There are positive legal interventions that can actively
      prostitution.” This offence carries a maximum penalty
                                                                           promote a supportive environment for PLHIV. These
      of imprisonment of five years.                                       interventions are much needed in Pacific Island
      Censorship and broadcasting laws that restrict                       countries and include:
      the dissemination of safe sex information.                                Constitutional definitions of discrimination that
      The Solomon Islands Broadcasting Act (Cap 112)                            include a prohibition against discrimination on
      Section 24 gives the Minister the right to prohibit                       the grounds of disability, health status and
      material being broadcast, which opens the door to                         sexual orientation (only one Pacific Island

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    country, Fiji, has so far included disability and                  The PNG HAMP Act (2003)
    sexual orientation);
                                                                       The first significant legislative change in the region
No Pacific Island country has stand alone,                             that has been drafted from a human rights perspective
comprehensive          anti-discrimination       legislation.          is the Papua New Guinea (PNG) HIV and AIDS
However, the constitutions of all Pacific Island                       Management and Prevention Act (HAMP) 2003.
states have broad provisions granting all citizens                     This Act was prepared to implement, as far as was
equality before the law on the basis of general                        possible, the recommendations of the International
non-discrimination provisions. Some Pacific Island                     Guidelines on HIV and Human Rights. The aims of
constitutions have a general equality provision with                   the Act explicitly incorporate a human-rights approach
specific definitions of discrimination. In general, all                into the management of the epidemic, incorporating:
citizens are entitled to certain basic rights, regardless
                                                                          The prevention of the spread of HIV; and
of their religion, race, place of origin, political opinions,
colour, religion or creed and so on.1 Apart from Fiji, no                 The management of the lives and protection from
Pacific Island constitution specifically protects people                  discriminatory practices of people who are
living with disabilities, and none includes ‘health                       infected or affected by HIV.
status’ as a prohibited ground, making it problematic                  Section 11 of the Act makes it unlawful to deny a
for discrimination on the grounds of HIV status to be                  person access to a means of protection from HIV
challenged (Jalal, 2008). In order to deal strategically               infection of himself or another, without reasonable
with the HIV pandemic, all Pacific Island constitutions                excuse. This has a wide range of applications, from
must be amended to prohibit all forms of discrimination                provision of condoms and HIV awareness materials
but specifically, sexual orientation, disability, health               to means of disinfection of needles in prison to
status, social status, sex and gender discrimination.                  provision of PEP (Post Exposure Prophylaxsis). PEP
It is also possible to pass stand alone comprehensive                  kits are not commonly available in the Pacific. PEP
anti-discrimination legislation.                                       kits comprise a combination of the ‘morning after’ pill
    Human rights laws that give legal effect to rights                 and ARTs. They are meant to reduce the possibility of
    such as the right to non-discrimination, privacy,                  tranmission of HIV within a 72-hour timeframe after
the right to protection against unlawful search                        exposure. They are commonly made available to
and seizure and rights to protection against                           victims of sexual assault.
    unlawful detention;                                                The HAMP Act at Part II forbids HIV discrimination
    Anti-discrimination laws that will provide redress                 against a person infected or affected by HIV in a
    in the event of discrimination in employment,                      wide range of situations, including discriminatory
    housing, access to health care etc. against                        treatment of prisoners and remandees, and in relation
    people with HIV or their family or friends;                        to employment.

    Legal provisions that protect the confidentiality                  The Pohnpei AIDS Prevention and Control Act of
    of a person’s HIV status;                                          (2006)

    Laws compelling a person’s consent to be given                     This is new legislation relating to the prevention
    before HIV testing is undertaken; and                              and control of HIV in Pohnpei (Federated States of
                                                                       Micronesia) that institutes a statewide HIV information
    Laws that encourage appropriate workplace
                                                                       and education programme, a comprehensive HIV
    practices – for example, infection control
                                                                       monitoring system and the Pohnpei AIDS Council.
    procedures and HIV education for employees.
                                                                       Some of the progressive provisions of this law are as

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       Section 2 (1): The state shall promote public                       Section 34. Discrimination in schools. No
       awareness about the causes, modes of                                educational institution shall refuse admission or
       transmission, consequences, means of                                expel, discipline, segregate, deny participation,
       prevention and control of HIV through a                             benefits or services to a student or prospective
       comprehensive statewide, educational and                            student on the basis of his/her actual, perceived
       information campaign organised and conducted                        or believed HIV status. The right to education
       by the state. Such campaign shall promote                           and non discrimination is observed in this
       value formation and employ scientifically                           provision.
       proven approaches, focus on family, as a basic
                                                                     While there are many examples, what is essential is
       social unit, and be carried out in all schools,
                                                                     that the approach to any legal policy on HIV must be
       training centres, workplaces, and communities.
                                                                     to use the law, not as a weapon, but as a protective
       This provision promotes the right to information,
                                                                     instrument that respects the worth of all individuals
       to access information on HIV in schools,
                                                                     and reinforces cooperative efforts to deal with the
       training centres, workplaces and communities;
                                                                     effects of HIV.
       Section 2: The state shall extend to every
                                                                     This view of the role of the law in response to HIV is
       person believed to be or known to be
                                                                     reflected in The Pacific Regional Strategy on HIV and
       infected with HIV full protection of his or her
                                                                     AIDS (2004-2008). The Regional Strategy, endorsed
       human rights and civil liberties. (2)(a):
                                                                     by Forum Island leaders, provides a number of
       Compulsory HIV testing shall be considered
                                                                     concrete actions to ensure the creation of this
       unlawful unless provided in this Act.
                                                                     supportive social and legal environment, including
       This provision protects the inherent right to
                                                                     that countries support the “development of legislation,
       privacy and protects PLHIV from discrimination
                                                                     policies and ethical guidelines that protect the rights
       on actual or perceived HIV status;
                                                                     of people infected and affected by HIV and AIDS.”
       Section 2(4): The state shall positively address
                                                                     Step 6 Some issues requiring legal interventions
       and seek to eradicate conditions that aggravate
       the spread of HIV infection, including but not                A.         Confidentiality
       limited to, poverty, gender inequality,
                                                                     It is not common in the Pacific for constitutional bills of
       prostitution, marginalisation, drug abuse and
                                                                     rights to enshrine the right to personal privacy, although
       ignorance. This provision extends the
                                                                     the right to human dignity is provided for generally.
       obligation on the state to address the problems
                                                                     Privacy of property is protected in most Pacific Island
       and factors that cause vulnerability and further
                                                                     constitutions, but personal privacy is only protected in
       heighten the spread of HIV;
                                                                     Fiji’s Constitution. If personal privacy was protected, it
       Section 7. HIV and AIDS education for Pohnpeians              would mean that an individual is entitled to have his or
       going abroad. The Pohnpei Government                          her HIV status kept confidential; in other words, HIV
       recognises that the national government is                    status is private and should not be disclosed to others
       primarily responsible to ensure that all the                  without consent. However, people have a common
       overseas Pohnpeian travellers and workers are                 law right to confidentiality. To divulge information
       cognisant of the risk of HIV infection while                  which is highly personal could be detrimental not only
       overseas. This section is progressive as it                   for the individual but also for people around them,
       acknowledges the vulnerabilities of migrant                   such as partners and family members. While this is an
       workers in relation to HIV infection and further              important principle, there are no laws that stop a third
       establishes the responsibility on the state to take           party such as a neighbour or friend from disclosing
       measures to educate them; and                                 a person’s status. While in theory it is possible to
                                                                     bring a legal action against a third party for breach

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of confidentiality, the costs involved would be too                   breach of the fudiciary relationship between the patient
expensive or resource intensive, and the result would                 and the healthcare worker. A supportive environment
most probably not be worth the effort, time and money                 is necessary for any patient in order for them to make
involved in the application.                                          the best decisions about their health, and counselling
                                                                      is critical as this stage. Only a relationship built on
This principle of required confidentiality is referred
                                                                      trust and mutual respect will foster an environment
to as ‘fiduciary duty or obligation’. This requirement
                                                                      were those affected by HIV will feel safe to come
forbids any reference to, or discussion about, a client
                                                                      forward for support, testing and treatment.
except within a professional relationship and only with
the consent of the client. The fiduciary duty imposed                       If Universal Precautions are followed, there
on counsellors, health practitioners, lawyers and                          is no need for any other healthcare worker to
healthcare workers is black and white in that they                               know about a patient’s HIV status.
have to maintain strict confidentiality concerning all                 Universal precautions refers to the procedure of
personal information, for example, HIV status, at all                  treating every patient as if he or she is infected
times.                                                                 and therefore taking the appropriate precautions
In the case of fiduciary relationships, there are                      to minimize risk, such as using gloves and other
policies or laws in place, or the courts have clarified                barriers, handling needles correctly and aseptic
the position. In general, if these professionals                       techniques. A new term being used is standard
violate confidentiality, the matter can be taken to the                precautions, which involves taking more extensive
professional bodies or a civil case can be launched.                   measures such as handling equipment or items
In certain cases, a criminal case of defamation (false                 in the patient environment likely to have been
disclosure of information that impacts on the reputation               contaminated with infectious body fluids in a manner
of that individual) can also be launched.                              to prevent transmission of infectious agents.

There are various ethical guidelines and legal rules                  C.         Informing the sexual partner of a patient
which state that doctors, nurses, psychologists and
                                                                      A very controversial area has been the issue of
other healthcare professionals must keep all patient
                                                                      disclosure of status to the sexual partner of the patient.
information, including HIV status, confidential.
                                                                      A healthcare worker should ensure that a patient has
B.       Informing another health worker                              counselling on the advantages of telling his or her
A healthcare worker cannot disclose a patient’s status                partner. A trusting relationship between the patient
even to another healthcare worker unless consent has                  and the healthcare worker and ongoing counselling
been obtained first, even if more than one healthcare                 will assist in facilitating an informed and consented
worker in the hospital is treating the patient, by virtue of          disclosure of their HIV status to their spouses or
a common law fiduciary relationship of confidentiality.               partners.

If a patient refuses to agree to this information being               In the context of HIV, the World Health Organisation
given to other healthcare workers, then the healthcare                (WHO) encourages ‘beneficial disclosure’ of a patient’s
workers must respect his/her decision. One of the most                status. Some prerequisites of this type of disclosure
important factors influencing the realtionship between                are:
the healthcare worker and the person being treated is                       It is voluntary disclosure and it respects the
trust. It is built on the understanding that whatever is                    dignity and autonomy of a patient’s status;
discussed remains a private issue between the two.
                                                                            It maintains confidentiality;
Therefore it is required that all healthcare workers
                                                                            It leads to beneficial results for the individual, his
protect the privacy of every patient and refrain from
                                                                            and her sexual partners and family;
disclosing his or her HIV status to a third party or
another health worker. This disclosure will amount to a                     It meets ethical imperatives so as to maximise

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          good practices for both infected and uninfected;                consent to testing or treatment. In other words, every
          and                                                             person has the right to be treated with respect and
          It leads to greater openness in the community                   as an individual who makes their own decision about
          about HIV.                                                      their body. This means a patient must consent to all
                                                                          medical treatment.
      In order to encourage beneficial disclosure, an
      environment should be created in which more people                  All adults who have legal capacity and are of sound
      are willing and able to get tested for HIV, and are                 mind are able to give consent. Mentally ill patients may
      empowered and encouraged to change their behaviour                  require assistance to give consent or others may be
      according to the results. This can only be done if:                 able to give consent for them. Couples must consent
                                                                          to treatment individually, meaning that one partner
         Voluntary counselling and testing services are
                                                                          cannot consent for the other. Both must provide their
                                                                          own consent.
         Partner counselling is based on informed
                                                                          Consenting to medical treatment means a person:
         consent of the source client (PLHIV) and
         maintains confidentiality of the source client;                        Must understand the nature of the treatment that
         and                                                                    is proposed; and,

         The trust relationship between the doctor/                             Must give their permission for the treatment
         healthcare worker and the patient is maintained                        verbally or in writing.
         at all times.                                                    Many people speak about informed consent. In other
      Patient confidentiality must be upheld. If this is not              words, the person makes a decision to agree to the
      guaranteed, some people will be deterred from                       medical treatment, but only after they have been given
      seeking treatment and informing their partners. In the              all the information they need to make their decision.
      absence of support systems in place, this fear merely               As stated above, consent has two parts to it –
      creates anxiety and conflict. In addition, it may lead to           information and permission. With an HIV test, a person
      greater risk-taking behaviour amongst those who are                 must know what the test is, why it is being done and
      attempting to hide their status.                                    what the result will mean for him/her before agreeing
      A positive example of this approach is detailed in                  to their blood being taken.
      Section 32 of the Pohnpei AIDS Prevention and Control               Before a test, a person should receive pre-test
      Act of 2006 which states that: “Any person with HIV is              counselling, followed later by post-test counselling:
      obliged to disclose his/her status and health condition
                                                                                Pre-test counselling is a counselling session
      to his/her sexual partner at the earliest opportune
                                                                                which is held before the HIV test is done. As a
                                                                                patient, it helps you look at the effect the test will
      Informed consent                                                          have on you and your family; and
      Consent involves both information and permission. A                       Post-test counselling is counselling which
      person must be provided with all relevant information                     takes place after the HIV test results have been
      before he/she is examined, treated, tested, given                         received. It helps you understand and accept
      medicine or operated on. He/she must provide his/her                      the effect a negative or a positive result will have
      express permission to undergo the treatment or test                       on your life.
      either orally or in writing.
                                                                          For example, in Fiji the requirements for informed
      People have the right to refuse medical treatment                   consent can be set aside in certain cases, including:
      and testing. They should not be forced or tricked to

                                                                                 Testing done on blood donations;

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    Mentally ill patients;                                         as a pre-condition to obtaining a benefit (such as
                                                                   employment) or a service (such as healthcare), or to
    Anonymous and unlinked testing for research
                                                                   exercising a right or the enjoyment of a right (such
    purposes; and
                                                                   as freedom of movement).
    Needle-stick injury.
                                                                   The person has the option to refuse mandatory HIV
If an HIV test is done without informed consent, a                 testing, but can as a result, forgoes access to the
person’s rights may have been violated. Advice can                 benefit or service, or exercise of the right.
then be sought from a lawyer on:
                                                                   Mandatory testing is also carried out without the
     A civil claim – for example, for invasion of                  knowledge of the person tested, for example as
     privacy, dignity and bodily integrity; or,                    part of a ‘general’ health test required for employment,
     A criminal charge – for example, of assault,                  immigration etc. Note: ANY testing of people
     against the healthcare worker and any person                  whether for HIV or any other ailment should be
     they were acting on behalf of such as an                      conducted with the full and informed consent the
     employer.                                                     patient.

A healthcare worker can also be reported to the                    Generally, a positive HIV test result will lead to a denial
Ministry of Health or his/her professional body. They              of access to that service or benefit, or denial of the
may hold an enquiry to find out what happened and to               relevant right. For example, an employer requiring
decide on what action to take against the healthcare               all prospective employees to test negative for HIV in
worker.                                                            order to qualify for employment.

Mandatory testing                                                  Mandatory testing almost always involves a
                                                                   confidentiality breach as test results are normally
HIV testing is an essential response to HIV. However,
                                                                   given to the person/authority/company requiring the
respect for human rights should be a precondition for
                                                                   test (as well as, or instead of, to the person who has
any HIV-related testing. At all times testing should be
                                                                   been tested).
conducted in a manner that the human rights of people
who are being tested are fully protected. These rights             Testing should be conducted in a manner that
include:                                                           respects a person’s dignity and does not result in
                                                                   abuses such as stigma, discrimination or violence.
    The right to information – to make
                                                                   Voluntary confidential counselling and testing (VCCT)
    informed decisions;
                                                                   should be encouraged.
    The right to security of person –
    to decide which medical procedures                             The four key elements for VCCT are:
    should be conducted on self;                                   1.     Pre-test counselling
    The right to privacy – to decide when,                         2.     Voluntary, informed consent
    how, who to reveal medical conditions to;
                                                                   3.     Post-test counselling
    not to be interfered with without consent;
    and                                                            4.     Confidentiality

    The right to equality – not to be treated                      These elements are compliant with human rights
    in a way that discriminates against a                          principles and standards as they ensure:
    group of people.                                                      The right to privacy is respected because
Mandatory testing is the requirement that a certain                       VCCT prevents interference with one’s body
person, or group of people – such as employees,                           without consent; and
hospital patients, police etc – must be tested for HIV,

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           The right to security of a person is                                often seeks to criminalise people who are alleged
           quaranteed as it lets one decide what is done                       to be have wilfully transmitted HIV to another. For
           to one’s body.                                                      example, Section 144 of Tonga’s Public Health Act
                                                                               1992 provides that “a person who has contracted
      Mandatory testing is not the only way nor is it the
                                                                               a notifiable disease, which includes HIV, AIDS and
      right way to increase testing! When people know
                                                                               AIDS-related Complex (ARC) and has knowingly
      that their dignity will be protected, and treatment
                                                                               exposed other people to the risk of being infected, is
      provided, they generally come forward voluntarily
                                                                               guilty of an offence”.
      in large numbers for testing.
                                                                               Some believe that the heavy hand of criminal law
      Mandatory testing is against constitutional bill of rights
                                                                               can protect others from getting infected. However,
      provisions that protect one’s right to privacy, right to
                                                                               this type of law has a negative impact on reaching
      security of persons and equal treatment. For example,
                                                                               the main goal that is to reduce the transmission of
      Fiji Chapter 4, Section 37: “ Every person has the right
                                                                               HIV. Such laws further stigmatise PLHIV, by labelling
      to personal privacy, including the right to privacy of
                                                                               them as ‘deviants’ and ‘criminals’ and further prevents
      personal communications.”
                                                                               others who might be infected to access testing and
      Therefore individuals can file a constitutional action                   treatment. All PICs have criminal laws which contain
      if their fundamental human rights are violated. Other                    an array of offences that could be applied to instances
      actions that may be possible are criminal trespass                       of criminal behavior where HIV is transmitted.
      and tortious liability cases in court.
                                                                               For example, the Penal Code of Vanuatu provides two
      Aside from the legal arguments, if the primary objective                 offences relevant to the transmission of HIV and any
      is to reduce the transmission of HIV, mandatory testing                  other crime in which the perpetrator intends harm:
      does not meet that objective because there is no
      possible way of using mandatory testing to accurately                    INTENTIONAL ASSAULT
      ascertain the HIV positive population in any country.                    107. No person shall commit intentional assault on
      In order to use mandatory testing to find out the total                  the body of another person.
      population of a country who are HIV positive, you                        Penalty:
      would need to do the following:
                                                                               (a) if no physical damage is caused, imprisonment
           Seal off all of the borders in the country and not                       for 3 months;
           allow any travel in and out;
                                                                               (b) if damage of a temporary nature is caused,
           Submit every man, women and child to an HIV                              imprisonment for 1 year;
                                                                               (c) if damage of a permanent nature is caused,
           Ensure that every man, women and child is not                            imprisonment for 5 years;
           exposed to the HIV virus for a 3-month period
                                                                               (d) if the damage caused results in death, although
           (no unprotected sexual intercourse can take
                                                                                    the offender did not intend to cause such death,
           place); and
                                                                                    imprisonment for 10 years.
           Then test the entire population again.
                                                                               UNINTENTIONAL HARM
      This is the only sure way to find out who in your country
      has HIV. Practical?                                                      108. No person shall unintentionally cause damage
                                                                               to the body of another person, through recklessness
      Wilful transmission / criminalisation                                    or negligence, or failure to observe any law.
      Most countries in the Pacific region are currently                       Penalty:
      considering reforming their existing Public Health
      Acts. A majority response to legislative reform in HIV                   (a) if the damage so caused is purely temporary,

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   imprisonment for 3 months;                                             This will not help in combating the increased
(b) if the damage so caused is permanent,                                 infection.
   imprisonment for 2 years;                                              Denunciation: There is greater danger of
(c) if the damage so caused results in death,                             creating hysteria, fear and distrust then in
   imprisonment for 5 years.                                              actually gaining anything from denouncing the
                                                                          accused. Would you come forward to seek
To date, no person living with HIV in the region
                                                                          counselling and medical support if you would
has ever been charged with unlawful infection. In
                                                                          run such a risk in future once it is known that
other jursidictions it has been hard to prove wilful
                                                                          you have HIV?
transmission. Proving ‘wilful’, as in the intentional
transmission of HIV, is a very difficult exercise for                     Deterence: Deliberate transmission is rare and
lawyers and the courts; clear intent to transmit HIV                      hard to prove. Also in PICs the cultural taboos
must be proven beyond reasonable doubt and proper                         and religious sanctions on condom use are
scientific evidence is needed to identify the source of                   strong and it is therefore hard to deter people
transmission.                                                             from engaging in risky sexual activities.
                                                                          Counselling systems are also weak and in
The purposes of criminal law are:
                                                                          some countries not available. Pacific
     Retribution – punish the offender for morally                        societies have less information on HIV, thus
     blameworthy behaviour.                                               increasing the risk of transmission. In addition,
     Denunciation – publicly denounce the                                 women do not have power over themselves
     blameworthy behaviour.                                               and are often subject to marital rape,
                                                                          sexual assault and domestic violence.
     Deterence – deter the offender and others from
     engaging in high-risk behaviour.                                     Prevention of harm: Imprisoning people for
                                                                          transmission in prisons will worsen the situation
     Prevention of harm – prevent the offender from
                                                                          inside prisons and after release. Prisons are
     harming other people.
                                                                          high-risk environments as inmates do not have
     Rehabilitation – so that the offender will not                       access to condoms and information on HIV
     engage in prohibited conduct once released                           prevention.
     from prison.
                                                                          Rehabilitation: It is difficult to see how
By creating a separate HIV-related offence, will we                       incarcerating people living with HIV will actually
be able to successfully control or eliminate high-risk                    serve the purpose of rehabilitation. The cold
behaviour which transmits HIV? This will have the                         reality is that PLHIV who serve time in prison
opposite effect as the law will further stigmatise and                    are unlikely to reoffend when they get
discriminate against particular groups of people and                      out as they will be too sick to do so.
drive the disease undergound. The purpose of the
                                                                   Creating effective HIV-related strategies in the Pacific
criminal law will not be achieved, for example:
                                                                   is a long and difficult process. The law should be used
     Retribution: The heavy evidential burden of                   to address the overall objective: to eliminate or reduce
     proving knowledge and intention is very                       the transmission of the virus and to minimise the
     difficult; most likely the prosecuted will be                 personal suffering and social harm caused by the
     those who are already marginalised and                        disease. Supportive legal interventions are those that
     stigmatised, for example, gay men or                          are consistent to international guidelines and human
     commercial sex workers, and it will                           rights standards.
     further increase stigma and discrimination.

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      10 Good Reasons Not To Criminalise HIV                              of sexual behaviour, and incapable of truly just
                                                                          application. No one suggests that a person knowing
       HIV is a virus, not a crime. That fact is elementary,
                                                                          he has HIV, who sets out intending to infect another,
       and all-important. Law-makers and prosecutors
                                                                          and achieves his aim, ought to escape prosecution
       overlook it. We must fight this new burden of
                                                                          (such as deliberately stabbing someone with an
       moralising stigma and persuade them of how wrong
                                                                          injecting needle containing blood with HIV) [13]. He
       their approach is.
                                                                          has set out deliberately to harm another and he has
      First, criminalisation is ineffective. These laws and               achieved his purpose as surely as if he had wounded
      prosecutions don’t prevent the spread of HIV. In the                his victim with a firearm or a knife. In all these cases,
      majority of cases, the virus spreads when two people                the victims and their society seek justice because
      have consensual sex, neither of them knowing that                   harm was caused with clear intention.
      one (who may be in the early, highly infectious stage               But in cases where there is no deliberate intention,
      during and soon after seroconversion) has HIV. That                 the categories and distinctions of the criminal
      will continue to happen, no matter what criminal                    law become fuzzy and incapable of offering clear
      laws are enacted, and what criminal remedies are                    guidance – to those affected by the laws and to
      enforced. Criminalisation will not stand in the way of              prosecutors. Some laws target either ‘reckless’ or
      the vast majority of HIV transmissions.                             ‘negligent’ transmission of or exposure to HIV. Others
      Second, criminal laws and criminal prosecutions are                 advocate criminalising only ‘reckless’ transmission of
      a shoddy and misguided substitute for measures that                 or exposure to HIV. We know that the ‘reasonable
      really protect those at risk of contracting HIV.                    person’ often has unprotected sex with partners of
                                                                          unknown sexual history in spite of the known risks.
      AIDS is now a medically manageable condition. It is                 That’s why we have an HIV epidemic, and that’s why
      a virus, not a crime, and we must reject interventions              interventions to reduce unsafe sex are so important.
      that suggest otherwise.
                                                                          Seventh, many of these laws are extremely poorly
      Third, far from protecting women, criminalisation                   drafted. This is partly because of evidentiary burdens
      victimises, oppresses and endangers them. In Africa                 and the difficulty of satisfying them (that is, who
      most people who know their HIV status are female.                   infected whom). Because it is difficult to prove an
      This is because most testing occurs at ante-natal                   offence that involves consensual sex, and because
      healthcare sites. The result, inevitably, is that most of           of the difficulties of applying the categories of the
      those who will be prosecuted because they know – or                 criminal law, many of these laws end up being a
      ought to know – their HIV status will be.                           hodge-podge of confused legislative intent and bad
      Fourth, criminalisation is often unfairly and selectively
      enforced. Prosecutions and laws single out already                  Eighth, and perhaps most painfully to those living
      vulnerable groups – like sex workers, men who have                  with HIV, criminalisation increases stigma. From the
      sex with men and, in European countries, black                      first diagnosis of AIDS 27 years ago, HIV has carried
      males.                                                              a mountainous burden of stigma. This has been for
                                                                          one over-riding reason: the fact that it is sexually
      Fifth, criminalisation places blame on one person
                                                                          transmitted. No other infectious disease is viewed
      instead of responsibility on two. This is a hard but
                                                                          with as much fear and repugnance as HIV. Because
      important thing to say. HIV has been around for
                                                                          of this, stigma lies at the heart of the experience of
      nearly three decades. For nearly three decades the
                                                                          every person living with or at risk of HIV.
      universal public information message has been that
      no one is exempt from it. So the risk of getting HIV (or            Ninth, criminalisation is a blatant disinducement
      any sexually transmitted infection) must now be seen                to testing. It is radically incompatible with a public
      as an inescapable facet of having sex. The risk is                  health strategy that seeks to encourage people to
      part of the environment, and practical responsibility               come forward to find out their HIV status. AIDS is
      for safer sex practices rests on everyone who is able               now a medically manageable disease. Across Africa,
      to exercise autonomy in deciding to have sex with                   the life-saving drugs that suppress the virus and
      another.                                                            restore the body to health are becoming increasingly
                                                                          available. But why should any woman in Kenya want
      Sixth, these laws are difficult and degrading to apply.
                                                                          to find out her HIV status, when her knowledge can
      This is because they intrude on the intimacy and
                                                                          only expose her to risk of prosecution? The laws put
      privacy of consensual sex.
                                                                          diagnosis, treatment, help and support further out of
      The legal concepts of negligence and even                           her reach.
      recklessness are often incoherent in the realm

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And this brings us to the tenth and last point, which is
about belief, and hope – words all too seldom heard
in this epidemic. Criminalisation assumes the worst
about people with HIV, and in doing so it punishes
vulnerability. The human rights approach assumes
the best about people with HIV and supports

Modified from original source:


  Handbook for Legislators on HIV and AIDS,                                   Jalal, I. (1998). Law for Pacific Women: A Legal
  Law and Human Rights. (1999). UNAIDS/Inter-                                 Rights Handbook. Suva: Fiji Women’s Rights
  Parliamentary Union (IPU)                                                   Movement (FWRM).
  Hamblin, J. (1992). People Living With HIV: The                             Jalal, I. (2008). “An Overview of the Legal
  Law, Ethics And Discrimination. United Nations                              Protection against Discrimination in Pacific
  Development Programme (UNDP).                                               Island Countries.” (Suva: Pacific Regional Rights
  HIV and AIDS, Ethics & Human Rights: Cook                                   Resource Team). Unpublished paper produced for
  Islands In-Country Report. (2003). Suva: Institute                          the Equal Rights Trust, London.
  of Applied Legal Studies (IJALS), University of the                         Jowitt, A. (2004). Creating a Framework for HIV and
  South Pacific (USP).                                                        AIDS Related Legal Reform in the South Pacific.
  HIV and AIDS, Ethics & Human Rights: Samoa In-                              University of the South Pacific (USP).
  Country Report. (2003). Suva: Institute of Applied                          Model Legislation on HIV and AIDS: A Background
  Legal Studies (IJALS), University of the South                              Paper. (2005). Canadian HIV and AIDS Legal
  Pacific (USP).                                                              Network.
  HIV and AIDS, Ethics & Human Rights: Solomon                                Peavoy, D. (2005). The Criminalisation of HIV and
  Islands In-Country Report. (2003). Suva: Institute                          AIDS in the Pacific Islands: Why using the criminal
  of Applied Legal Studies (IJALS), University of the                         law to fight HIV and AIDS is not the answer. Cook
  South Pacific (USP).                                                        Islands: Pacific Islands AIDS Foundation.
  HIV and AIDS, Ethics & Human Rights: Vanuatu                                Stewart, C. (2004). Enabling Environments: the
  In-Country Report. (2003). Suva: Institute of Applied                       Role of the Law, Workshop on “HIV and AIDS in
  Legal Studies (IJALS), University of the South                              Papua New Guinea: Priorities for Policy & Social
  Pacific (USP).                                                              Research”
  HIV and AIDS and Human Rights: Young People in                              The Constitution of the Republic of the Fiji Islands
  Action. (2001). UNESCO, UNAIDS. [http://unesdoc.                            (1998)]
                                                                              The Pacific Regional Strategy on HIV and AIDS
  HIV and AIDS, Human Rights & the Law: A Training                            (2004-2008). (2004). Noumea: Secretariat of the
  Manual. (2005). Suva: Institute of Applied Legal                            Pacific Community (SPC).
  Studies (IJALS), University of the South Pacific
  (USP).                                                                      The Universal Declaration of Human Rights

                                             Challenging Stigma & Discrimination - A manual for UN trainers
112     M O D U L E            6
                                         ACTIVITY STRENGTHS & WEAKNESSES OF
                                         NATIONAL HIV RESPONSES

      Objectives                                                               Monitoring and documentation of human rights
          To identify specific state obligations and duties in
          the protection and promotion of human rights in                      Community organising
          the field of HIV.                                                    Capacity-building of local government units
          To identify gaps and weaknesses in national HIV                                                              Suggested
          responses.                                                                                                   ways of
                                                                          Programme/              Strengths &
      Time                                                                                                             improving
                                                                          activity                weaknesses
      1 hour                                                                                                           activity
      Flipchart paper and pens
                                                                          Example: HIV
      National HIV country strategies                                     education or
      Handouts                                                            programmes
      None                                                                among out-of-
                                                                          school youth
      Suggested method
                                                                          in poor urban
      Divide up the participants into groups of 6-7. Assign               communities
      each group an area to work on. Provide each group with
      flipchart paper and marker pens and instruct them to
      list down the concrete actions and programmes which
                                                                         Notes for trainer
      the state and its agencies are currently undertaking
      and directed at prevention and control of HIV.                          If participants are not aware of the government
                                                                              or national HIV responses, they can make
      In a table (see below) beside each activity/programme
                                                                              suggestions as to what they think should be
      of the government, ask participants to identify the
      strengths and weaknesses/gaps and suggestions of
      how to improve the government or national response                      States have the primary responsibility of
      to HIV. Below are some areas where the government                       implementing strategies that protect human rights
      may have concrete actions:                                              and public health. A rights-based response to HIV
                                                                              involves establishing appropriate governmental
          Public health care/services/treatment including
                                                                              institutional responsibilities, implementing law
          counselling and testing
                                                                              reform and support services and promoting a
          Education/information/training                                      supportive environment for groups vulnerable to
          Employment/livelihood                                               HIV and for those living with HIV.


          Women and children
                                                                         *Note: Activity adapted from HIV and AIDS and Human Rights: A
                                                                         Training Manual for NGOs, Community Groups and People Living
                                                                         with HIV. (2002). Asia Pacific Council of AIDS Service Organisations

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                                 PARTNER NOTIFICATION

Objectives                                                        Each group nominates a group leader to facilitate
                                                                  the discussion and make a presentation at plenary.
    To create awareness about the legal and ethical
                                                                  The group must come up with both legal and ethical
    issues that affect the lives of PLHIV related to
                                                                  arguments to support their decision based on the
    confidentiality and partner notification.
Time                                                              Before presenting, each participant is given the
1 hour                                                            questionnaire handout to fill in individually. The
                                                                  facilitator then provides the answers to the plenary
Materials                                                         before presentations and group discussion.
                                                                  Notes for trainer
Flipchart paper and pens
                                                                  The questions raised are sensitive and require careful
Handouts                                                          analysis through public information and consequent
                                                                  debate. This is essential to prevent uninformed
Handout: Questionnaire: Confidentiality & Partner
                                                                  decision making by policymakers and planners.
                                                                  The important thing is that good and effective
Suggested method                                                  counselling and accurate information on the epidemic
Write the following statement on the whiteboard:                  needs to be in place before any laws or judgements
                                                                  on partner notification are outlined or enforced.
         A doctor should notify the husband or wife
         about the HIV status of a patient living with            The answers to the questionnaire are as follows:
         HIV without informing the patient first.
                                                                  1. a) 20%
Divide the participants into five groups and give each
                                                                        b) 20%
group one of the following statements:
                                                                        c) 50%
    1. Should a person have the right to know about
       their partner’s HIV status?                                2. 0%
    2. Should this confidential information be                    3. 60%

    3. How should this sharing of information be
       undertaken and by whom?

    4. Will it necessarily violate the doctor-patient
                                                                  *Note: Activity adapted from Gender, HIV & Human Rights: A
       relationship?                                              Training Manual. (2000). UNIFEM, UNFPA, UNAIDS & UNIFEM.
    5. What about the right to confidentiality?

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                                                  CONFIDENTIALITY & PARTNER NOTIFICATION

      Choose one answer each for the following                                     2. __________________ of the STD clinics in Delhi,
      questions:                                                                        India, have a contact card or referral slip for partner
      1. a) In Cote d’Ivoire, Africa, under a UNAIDS pilot                              notification.
          project, __________________ of women refused                                  80%
          to be tested for HIV.
                                                                                          (Source: NACO – Study to Map Patterns of Risk
          5%                                                                                            Behaviour in the State of Delhi)
          b)__________________ of those tested did not
          return for the test results.

                                                                                   3. A 1993-94 survey in South Africa of more than 700
          20%                                                                           HIV-infected clients who had been in counselling
          5%                                                                            sessions at an AIDS service group found that
                                                                                        more than _________ had not told their spouse or
          c) __________________ of those tested positive
                                                                                        regular partner of their positive HIV status.
          did not inform their partners of the result.

       (Source: Relevance of Current Trials to Breastfeeding Policy & Practice
                                                              – Vande Pierre)                                  (Source: New York Times, December 4, 1998)

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                              MODULE 7


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116     M O D U L E             7
                                       SESSION PLAN ADVOCACY

      Objectives                                                         Step 2 Case studies of successful campaigns
           To introduce participants to the concepts, terms              Mini lecture           10 minutes
           and definitions of advocacy.
                                                                         Refer to Module 7 Contents and take participants
      By the end of the session participants should be able
                                                                         through the successful advocacy case studies used
                                                                         to address stigma and discrimination:
           Establish a group definition of advocacy.
                                                                                       A.      Religion
           Explain how advocacy can be used to address
           stigma and discrimination.                                                  B.      Media / Information, Education &
           Appreciate several case studies of successful                                       Communication
           advocacy campaigns.
           Understand and describe the basic steps to
                                                                         Step 3a Basic steps to undertake advocacy work
           undertake advocacy work.                                      Lecture 30 minutes

      Suggested training materials                                       This session focuses on the basic steps to be
                                                                         undertaken when conducting advocacy work that can
      Activity:    Defining advocacy
                                                                         be translated into an advocacy plan. These are:
      Activity:    Advocacy planning in practice
                                                                                    A.         Identifying the problem
      Handout: Advocacy framework
                                                                                    B.         Conducting research on the chosen
      Step 1 a Defining advocacy                                                               problem

      Group activity   1 hour                                                       C.         Forming an alliance/network

      Refer to Defining advocacy activity sheet and follow                          D.         Developing an advocacy campaign
      instructions.                                                                            plan

      Step 1b Using advocacy to address stigma &                         Step 3b Advocacy planning in practice
      discrimination                                                     Group activity         2 hours
      Mini lecture     10 minutes                                        Refer to Advocacy planning in practice activity sheet
      This is a short session that outlines roles advocates              and follow instructions.
      can take to prevent and remedy discrimination against
      people living with HIV.

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                                                                                                                                     7       117

“Advocacy is not just about getting to the table with a new set of interests;
it is about changing the size and configuration of the table to accommodate
a whole new set of actors. Effective advocacy challenges imbalances of
power and changes thinking.”
                                                                                                    Lisa VeneKlasen & Valerie Miller, 2002

Step 1 Using advocacy to address stigma &                           Maire took to conducting workshops for church youth
                                                                    leaders, talking to different groups and touring across
                                                                    Fiji. People responded warmly and humanely; after
Advocacy has been central to the effort to support                  hearing her story, young people clamoured to hug her,
people with HIV, prevent the transmission of HIV                    have photos taken with her and get her autograph.
among marginalised populations, and protect the                     Such was the response that one of the church people
human rights of people with HIV and populations                     shared a concern with UNAIDS that Maire may be
affected by HIV. Throughout the world, advocates have               “glamourising” HIV. However, Maire’s going public
worked within their communities and their countries to              did more to get Pacific people to talk about the issues
give voice to the concerns of people with HIV.                      that need to be addressed and reduce the stigma
Advocates have developed strategies to address                      and discrimination against people living with the virus
HIV within their communities. They have lobbied                     than probably most of the workshops that had been
governments for policies, programmes and resources                  conducted on AIDS in the previous decade. As part of
that meet the needs of people with HIV in ways that                 her commitment to advocating for greater awareness
are culturally appropriate, effective, non-discriminatory           of the epidemic within the Pacific Island communities,
and just. They have been at the forefront, along with               Maire chose to visit the rural areas in Fiji that year to
others, in the effort to advance and protect the human              share her story “with the people who need to know
rights of people with HIV.                                          more about HIV and AIDS”, rather than attend larger
                                                                    international conferences on HIV. Maire was awarded
HIV ambassadors
                                                                    the PINA Media Freedom Award for “her contribution
In 1998, when University of the South Pacific                       towards getting Pacific people to talk more openly and
Journalism student Maire Bopp-Dupont discovered                     honestly about sensitive subjects that needed to be
she was HIV positive and returned to Tahiti, she                    discussed in the era of AIDS”.
remembered once hearing that the Pacific needed a                     Documented by Steven Vete, UNAIDS Asia Pacific Leadership Forum
human face to AIDS. So, when the annual meeting                                        (APLF) Sub Regional Coordinator, November 2007
of the Pacific Islands News Association (PINA) was
held in Tahiti in December that same year, Maire
accepted an invitation to ‘go public’ during a session
being run by UNAIDS. The media listened to Maire’s
story and reacted positively, writing stories about her
experience … and the documentary Maire’s Story,
produced by New Zealander Ingrid Leary, was born.

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118    M O D U L E            7

      “Continuing advocacy is needed for social change in response to HIV and
      AIDS-related stigmatisation and discrimination. The role of people living
      with HIV and AIDS and of religious and political leaders in such a process
      cannot be underestimated.”
                                                                                                             Aggleton and Parker, 2002

      Advocates and advocacy have a number of roles                            Undertaking media advocacy at the local,
      in preventing and remedying discrimination against                       regional, and national levels;
      people with HIV and populations affected by HIV.
                                                                               Working with public officials, professionals and
      These include:
                                                                               the private sector to develop programmes that
          Developing organisations and creating                                will prevent or reduce discriminatory behaviour
          opportunities for people living with HIV (PLHIV)                     among the general public, among professionals
          to express their views and plan their strategies;                    and providers, in the workplace, at school and
                                                                               within specific communities;
          Recognising and describing HIV-related
          stigma and discrimination as it is experienced                       Working with researchers to ensure that
          by PLHIV;                                                            research is ethical, that studies include
                                                                               affected populations, and that the affected
          Documenting, analysing and publicising
                                                                               populations benefit from the outcomes of
          instances of HIV-related stigma and
                                                                               Advocating with politicians and public officials to
          Supporting those who have experienced stigma
                                                                               ensure that governments in their countries
          and discrimination, whether by accompanying
                                                                               implement the International Guidelines on HIV
          them to meetings and appointments, advocating
                                                                               and Human Rights; and
          on their behalf, or assisting in some procedure
          of redress;                                                          Monitoring their countries’ performance in
                                                                               meeting their international treaty obligations
          Intervening on behalf of people with HIV or
                                                                               pertaining to human rights, particularly as they
          populations affected by HIV in legal
                                                                               apply to HIV, but also in concert with
          proceedings, legislative processes and
                                                                               organisations advocating on other or
          policy development;
                                                                               related issues.

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Step 2 Case studies of successful campaigns                          storylines. The series has become very popular in the
                                                                     region as it communicates HIV issues while drawing
A. Religion                                                          on Pacific culture and humour.
While many outreach projects that diffuse their                      Stigma and discrimination DVDs
messages through revered members of the
                                                                     The Pacific Islands Aids Foundation (PIAF) has
community help reduce stigma against PLHIV, when
                                                                     launched DVDs that cover personal stories of positive
such encouragement comes from spiritual leaders,
                                                                     people in the Pacific (in Samoa, Fiji and Vanuatu).
the impact can be significantly greater as it carries the
                                                                     Their stories (such as Irene’s Story and Peati’s Story)
additional authority of an accepted ethical system.
                                                                     focus on stigma and its impact on their fundamental
Faith-based organisations dispelling myths and HIV-related           rights when their HIV status was disclosed. These
stigma                                                               HIV ‘ambassadors’ convey a series of messages
UNAID’s Asia Pacific Leadership Forum, in partnership                though these DVDs, which include the importance
with the Pacific Council of Churches, have developed                 of protection of human rights, such as the right to
a pamphlet “Exploding the Myths” to dispel four of the               privacy and the right to employment, and have called
myths surrounding HIV and AIDS. This is an attempt                   for effective responses from government for the
to promote open and honest discussions about sex,                    prevention and management of HIV.
sexuality and HIV because nothing spreads HIV                        PIAF legal rights pamphlets
more quickly than silence. The pamphlets have been
                                                                     Early publicity campaigns throughout the Pacific
translated into Bislama, i-Kiribati, Solomon Islands
                                                                     region emphasised the dangers of HIV and the
Pidgin and Fijian.
                                                                     inevitability of death, focusing more on prevention
B.       Media / Information, Education & Communication              and control rather than the rights of people infected
(IEC)                                                                and affected with HIV. In later years, however, efforts
Early publicity campaigns throughout the Asia-                       to redress the damage of these original public health
Pacific region emphasised the dangers of HIV and                     messages have emerged in force. The Pacific Islands
the inevitability of death, reinforced existing gender               Aids Foundation, in consultation with the Pacific
stereotypes and focused on the vilification of ‘core                 Positive People’s Network, has developed a series
transmitters’ such as sex workers (Lyttleton, 1996).                 of user-friendly pamphlets on the legal and human
The prevalence of these themes prompted two authors                  rights relating to PLHIV. These pamphlets, that
to state: ”As a result, HIV and AIDS are perhaps even                have been included with this manual, cover critical
more stigmatised in Asia and the Pacific than in other               legal issues that the members of the network have
parts of the world” (Tan & Brown, 1994).                             identified based on their experiences, providing basic
                                                                     information on, among other things, how to access
Love Patrol
                                                                     the courts, freedom of movement, employment rights
Love Patrol, a HIV-prevention TV series put together                 and the right to treatment.
by Wan Smolbag, the Secretariat of the Pacific
Community (SPC) and the Pacific Regional HIV
                                                                     Step 3 Basic steps to undertake advocacy work
and AIDS Project (PHRP) was launched in Vanuatu                      There are a number of basic steps to be undertaken
and Fiji in early 2006. This homegrown Pacific                       when conducting advocacy work that can be translated
‘soap opera’ increased Pacific Islanders’ access to                  into an advocacy plan. These are:
innovative HIV behavioral change communication
                                                                          A. Identifying the problem;
– otherwise known as ‘edutainment’. Love Patrol
introduces issues relating to HIV and other sexually-                     B. Conducting research on the chosen problem;
transmitted infections (STIs), sexual health, marriage                    C. Forming an alliance/network; and
and relationships, youth culture and unemployment
                                                                          D. Developing an advocacy campaign plan.
into a soap opera with likeable characters and strong
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      “The challenge is to find a form of educational material to which the
      younger generation can relate. Many people in this age group are unable
      to read or have little access to books, whereas DVD players are ubiquitous,
      even in quite remote areas – as is a love of watching DVDs … School
      teachers, parents and traditional authorities often find it hard to talk to
      youth, at school or outside it, about issues related to sexuality. If an HIV
      epidemic is to be averted, there is a need to find a way to make it easier
      for parents, teachers and youth to discuss these issues without fear or
      shame. Edutainment, in particular TV soaps that are culturally relevant to
      viewers, can open the door to such discussions.”
                                                                                                                          SPC, 2007

      A.    Identifying the problem                                      seen in other modules of this training manual). Those
                                                                         obligations are to:
      Advocacy work is necessary because there are
      problems or issues in the community that need to                   Respect human rights – not to take measures that
      be addressed. These problems or issues usually                     violate human rights;
      require a formulation or revision of existing policies
                                                                         Protect human rights – to take action to prevent or
      or programmes.
                                                                         provide remedy for violations by others; and
      AIDS service organisations are able to identify the
                                                                         Fulfill human rights – to take positive steps so that
      problems that are faced by PLHIV. Since there may be
                                                                         rights can be fully exercised, for example through
      numerous problems, this may require a prioritisation
                                                                         laws and budgetary allocations.
      of the problems. It is important to consult with PLHIV
      about what they consider to be the most important                  C.       Conducting research on the chosen problem
      issues before deciding which one(s) to prioritise. It              Once the problem/issue has been prioritised, it
      may be helpful to consider the following questions                 is crucial to conduct research to gather relevant
      when deciding what problems/issues to focus on:                    information that will establish the impact of the
            Will a solution to this problem result in a real             problem and help to identify a possible solution.
            improvement in people’s lives?                               The research does not need to be complicated, but
                                                                         should answer the following questions:
            Is the solution to this problem realistically
            achievable?                                                         What is it about the situation that is
                                                                                unacceptable or wrong and needs to be
            Are there other groups/organisations interested
            in the solution of this problem?
                                                                                Who is affected by this problem?
      When identifying human rights issues to advocate
      for, it is important to keep in mind that states that                     In what ways are these individuals/groups
      have signed international human rights treaties have                      affected by this problem?
      three major obligations concerning human rights (as                       What factors in the community influence this
                                                                                problem (for example, values, attitudes,
                                                                                economic difficulties, etc.)?
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The table on the following page outlines some examples of human rights issues in the context of HIV and
states’ human rights obligations:
 Examples of states’      State action to respect        State action to protect                   State action to fulfill human
 human rights             human rights                   human rights                              rights

 Example 1:               Refrain from adopting          Take measures that                        Adopt laws that protect
                          laws authorising               sanction employers,                       the rights of people living
 Right to non-            compulsory HIV                 hospitals, schools and other              with HIV to education,
 discrimination of        testing of people              institutions from taking                  employment, health care etc.
 people living with HIV   before marriage,               discriminatory measures                   Provide legal means (e.g. by
                          military service,              against people living with                financing legal aid) to obtain
                          immigration or                 HIV.                                      redress when rights are
                          appointment to                                                           violated.
                          government office.
 Example 2:               Authorise condom               Ensure that health care                   Establish and finance
                          distribution (or syringe       institutions do not turn                  HIV education, condom
 Right to health          exchange for injecting         people living with HIV away               distribution, needle/syringe
                          drug use).                     and that they provide the                 exchange, access to
                                                         best available care. Make                 treatment and care, access to
                                                         confidential HIV-testing                  a good diet for people living
                                                         easily available.                         with HIV etc.
 Example 3:               Refrain from actions           Adopt laws that prohibit                  Adopt strategies that affirm
                          that can make                  domestic violence and                     women’ rights to equality
 Women’s and              women and children             abuse, female circumcision,               before the law: provide
 children’s right to      more vulnerable. For           forced marriages. Take                    funding for women’s groups
 equality                 example: limiting              measures to prohibit child                and for assistance to women
                          women’s right to               abuse and discrimination                  and children who have been
                          work, to divorce, to           against HIV orphans.                      abused within or outside the
                          own property; and                                                        family.
                          limiting children’s
                          right to information,
                          education, food and

     What actions/efforts have been taken to try to                and materials, newspapers and other media reports.
     address this problem? By whom?                                D.       Forming an alliance/network
     What was the reaction of the decision makers?                 After identifying the potential partners, hold a meeting
     What can be done to try to resolve the                        or two to identify the problem, to go over the research
     problem?                                                      and to generally get ‘buy-in’ regarding the importance
                                                                   of the issue. After these meetings, a core group
Again, it is important to involve in the process those
                                                                   ranging from 5 to 10 members (depending on the
who are affected by the problem. It is not a good idea
                                                                   number of people who are interested, the importance
to assume an understanding all of their concerns or
                                                                   of the issue, etc.) can be chosen to further develop
                                                                   the advocacy plan, mobilise resources and map out
Possible sources of information include: past                      the strategies that are to be used. This group will also
and present records of NGOs/community-based                        provide the day-to-day leadership.
organisations and individuals involved in similar
                                                                   It is important for this group to reach consensus on
work, evaluation and progress reports, publications
                                                                   its mandate, overall aims and the various roles and
and newsletters, government records, documents

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122     M O D U L E               7

      responsibilities of its members. Members of the core                     The Pacific Regional HIV and AIDS Project
      group will be expected to commit to undertakings
                                                                               The Pacific Regional HIV and AIDS Project (PRHP) is
      and follow through with what they have said they will
                                                                               a programme that brings together partner agencies
      do. Thus, it is important to select this group carefully,
                                                                               to work together to reduce the region’s vulnerability
      keeping in mind the workload of various organisations
                                                                               to and impact from the HIV epidemic. The PRHP
      and individuals.                                                         has been designed in response to the need for
                                                                               teamwork and for even better planning, technical
      “It is important to emphasise that                                       design, management and evaluation of HIV and AIDS

      advocacy for human rights in the                                         responses in the Pacific.

                                                                                                    For more, see
      context of HIV and AIDS is not
                                                                               E. Developing an advocacy campaign plan
      about making concessions to people
                                                                               One of the first tasks of the core group is to develop
      living with HIV and AIDS, or                                             an advocacy plan. This can be achieved through a
                                                                               series of meetings, where ideas are brainstormed
      to vulnerable groups. It is about                                        and agreed upon, and through consultations with
      recognising the rights that already                                      individuals who are in a position to provide support
                                                                               and input into the design and conduct of the advocacy
      belong to every human being…”                                            campaign. These may include academics, health
                                               UNESCO/UNAIDS, 2001             professionals, religious leaders and media people.

                                                                               There are several important elements of the advocacy
                                                                               plan, including:
      The Pacific Regional Strategy on HIV and AIDS
      (2004-2008)                                                              1. The statement of objectives. It is particularly
                                                                                  useful if the objectives are stated in a SMART
      In August 2004, Pacific Island leaders endorsed
                                                                                  format, i.e. the objectives are specific, measurable,
      a new Pacific Regional Strategy on HIV and AIDS
                                                                                  attainable, reasonable and time-bound. Some
      (2004-2008). The goal of the strategy is:
                                                                                  examples of SMART objectives are to raise the
          To reduce the spread and impact of HIV, while                           level of knowledge on and understanding of HIV
          embracing people infected and affected by the                           of the police force in the municipality by 25 per
          virus in Pacific communities;                                           cent by the end of the year or to incorporate the
          To acknowledge the traditional, cultural and                            teaching of HIV and human rights into the high
          religious values of the Pacific communities;                            school curriculum of at least 20 per cent of public
                                                                                  schools in the district by the end of the year.
          To affirm the protection and promotion of human
          rights;                                                              2.	 Identification	 of	 the	 principal	 targets	 of	 the	
                                                                                   advocacy campaign. An advocacy campaign
          To build on partnerships;
                                                                                   may have many ‘targets’. Targets are those who
          To embrace a multisectoral approach; and                                 have the capacity to respond and bring about
          To be sensitive to gender and vulnerable                                 the desired changes the organisation/coalition is
          groups.                                                                  seeking. However, the targets may have varying
                      For more, see
                                                                                   degrees of influence, and because resources are
                                             regionalstrategy%20-red.pdf           limited, it is important to focus on those that are
                                                                                   essential to achieve the desired outcomes. They
                                                                                   would include those with the greatest influence

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   and power to bring about the desired changes.                        to fundraise for the resources, if required, and the
   For example, if the objective is to have HIV and                     people/group responsible for each activity.
   human rights incorporated into the high school
                                                                   5. Implementation, monitoring and evaluation
   curriculum, then the key targets would include
                                                                      of the plan of action. Once the plan of action
   officials in the Ministry of Education.
                                                                      is implemented, monitoring becomes necessary.
3.	 Identification	 of	 potential	 allies/supporters	                 This involves keeping track of how the various
    who may be interested in the issue and may be                     activities are being carried out, the problems
    mobilised in the advocacy campaign activities.                    encountered, adjustments in the plan that need
    This again broadens the support base for the issue                to be made, and what results are being achieved.
    and increases the pressure that is placed on the                  The information gathered during the monitoring
    relevant targets. It is very useful to try to engage                and evaluation will be useful for developing any
    the media and community leaders to present the                      future initiatives. Remember that change may be
    problem and the proposed solution.                                  slow and that in many cases advocacy requires
                                                                        ongoing engagement. It can take several months
4. List of activities. The plan of action should
                                                                        to several years to achieve the objectives.
   also contain a list of activities that will be
   undertaken during the advocacy campaign.                        Key practical tips for advocacy campaigns …
   These activities can include, for example: having
                                                                        Learn about human rights, their contents and
   forums, discussion meetings and information
                                                                        existing procedures for their protection.
   dissemination meetings at community level;
   the production and distribution of information,                      Be well prepared and well informed about the
   education and communication (IEC) materials to                       issue which is the focus of your advocacy.
   key target groups; holding press conferences,                        Involve people living with HIV in the identification
   writing press releases and letters to the editor;                    of human rights advocacy issues.
   presenting on radio and television; circulating a
                                                                        Have a media strategy – involve someone who
   petition; holding a mass demonstration; organising
                                                                        knows how to get press coverage.
   cultural shows/activities like concerts and plays;
   or lobbying parliament on the issue. The list of                     Choose your timing well – if you’re targeting
   activities should include agreed upon dates for                      parliament or cabinet, get advice about the best
   completion, the resources required for each                          time to lobby.
   activity, including human, material and financial                    Think strategically – use the most appropriate
   requirements, and should include ideas on where                      strategies and opportunities to get your message

                                                                        When addressing government officials in petitions,
                                                                        letters or meetings, remember that brief, clear
                                                                        statements describing the specific action that
                                                                        you want to be taken are more effective than long
                                                                                          Source: UNESCO and UNAIDS, 2001 (adapted.)

                                  Challenging Stigma & Discrimination - A manual for UN trainers
124    M O D U L E   7

      “AIDS is a war against humanity! Don’t be ashamed! Speak out! Because if
      you keep quiet you are signing your own death warrant.”
                                            Nelson Mandela, Closing remark at 2002 International AIDS Conference Barcelona, Spain


                         Aggleton, P. & Parker, R. (2002). A conceptual
                         framework and basis for action: HIV and AIDS
                         stigma and discrimination. Geneva: UNAIDS.
                         HIV and AIDS and Human Rights: Young People in
                         Action. (2001). UNESCO, UNAIDS. [http://unesdoc.
                         Lyttleton, C. (1996). “Messages of distinction: The
                         HIV and AIDS media campaign in Thailand.”
                         Medical Anthropology 16: 363-389
                         Secretariat of the Pacific Community (SPC). (2007).
                         Pacific AIDS Alert Bulletin. No 36, Nov 2007. [http://
                         Tan, M. & Brown, T. (1994). “Social policy, human
                         rights and HIV and AIDS in Asia and the
                         Pacific.” AIDS 8 (Suppl 2): S207-S213.
                         VeneKlasen, L. & Miller, V. (2002). A New Weave
                         of Power, People & Politics: The Action Guide for
                         Advocacy and Citizen Participation. Oklahoma:
                         World Neighbours.

                             Challenging Stigma & Discrimination - A manual for UN trainers
                       DEFINING ADVOCACY                        ACTIVITY                               M O D U L E
                                                                                                       M O D U L E                  1
                                                                                                                                    7     125

Objectives                                                         In the plenary, ask participants to identify three to
                                                                   five similarities among the groups’ responses to the
    To deepen participants’ thinking about what                    first question and three to five differences. Write the
    advocacy is.                                                   similarities and differences on two different sheets of
                                                                   flipchart paper and discuss.
    To reach a common definition of advocacy to
                                                                   Ask participants to debate and agree on the four
    guide further discussion.                                      or five most important outcomes and activities
                                                                   and circle these. In plenary, establish a common
Time                                                               definition that all participants endorse.
1 hour                                                             Conclude with a brief reflection about whether
                                                                   and how the discussion changed participants’
Materials                                                          understanding of advocacy.

Flipchart paper and pens                                           Notes for trainer
Handouts                                                           Advocacy involves activities directed at different
                                                                   audiences, goals and strategies. Developing a
                                                                   common definition can improve communication in the
Suggested method                                                   advocacy planning process.

Divide participants into small groups and ask them to
discuss the following questions. Their thoughts should
be noted on flipchart paper to share with the group in
                                                                   *Note: Activity adapted from VeneKlasen, L. & Miller, V. (2002). A
plenary.                                                           New Weave of Power, People & Politics: The Action Guide for Advocacy
       What is advocacy?                                           and Citizen Participation. Oklahoma: World Neighbours.

       Name three outcomes of effective advocacy?
       What kinds of activities does advocacy involve?

                                  Challenging Stigma & Discrimination - A manual for UN trainers
126   M O D U L E              7
                                         ACTIVITY ADVOCACY PLANNING IN PRACTICE

      Objectives                                                                attainable advocacy plan following the basic steps
                                                                                and containing the main elements of an advocacy
          To engage participants in advocacy planning
                                                                                plan. Allow 45 minutes to complete this exercise.
      Time                                                                5. Reconvene in a plenary session and have each
      2 hours                                                                group give a presentation on their advocacy
                                                                          Optional:        After each group has presented, discuss
      Flipchart paper and pens                                                             with participants which of the five advocacy
                                                                                           campaigns presented can be adopted and
                                                                                           implemented by the group present. Once
      Handout: Advocacy framework                                                          an advocacy campaign has been agreed
                                                                                           upon, the initial members of the core
      Suggested method
                                                                                           team can be chosen from the participants
      1. Divide the participants into groups of 6 to 7                                     and the way forward discussed.
         people. There should be five small groups in
         total. Provide groups with flipchart paper and                   Notes for trainer
         pens. Tell the groups to identify the five most                  This exercise is about making the theory real for
         important or key human rights problems/issues                    the participants. Also highlight that the strategy plan
         in their community that are related to HIV. Ask                  does not need to be complicated, but can be simple
         groups to write down the five key problems and                   as long as it is clear, with roles, responsibilities and
         also the reasons for choosing these as the most                  deliverables.
         important. Allow for 20 minutes to complete this

      2. When each group has completed their list, ask
         each group to present their lists with justifications.           *Note: Activity adapted from:

         When all groups have presented, process the                                 Zuberi, F., Jones, P. & Viljoenm F. (2004). HIV/ AIDS,
                                                                                     stigma and human rights, a localised investigation of
         different responses, highlighting the common                                Hammanskraal communities. A report of the Tswelopele
                                                                                     research project of the Centre for the Study of AIDS. Pretoria:
         themes. Get the plenary session to agree on the
                                                                                     Centre for the Study of AIDS at the University of Pretoria.
         five most common problems. Allow 30 minutes
         to complete this exercise.
                                                                                     HIV and AIDS and Human Rights: A Training Manual for
                                                                                     NGOs, Community Groups and People Living with HIV.
      3. Give a mini-lecture on the advocacy framework.                              (2002). Asia Pacific Council of AIDS Service Organisations
         Distribute handout to guide people in the next                              (APCASO).
         part of the exercise.

      4. Reconvene into small groups, ensuring that
         there are five groups in total. Assign one of the
         five problems identified to each of the groups.
         Instruct them to develop a simple, realistic and

                                         Challenging Stigma & Discrimination - A manual for UN trainers
            ADVOCACY FRAMEWORK                              HANDOUT                                    M O D U L E
                                                                                                       M O D U L E          1
                                                                                                                            7   127

1. Select an issue or problem you want to address.

2. Analyse the problem and gather information on
   the issue/problem.

3. Develop aims and objectives for your advocacy

4. Identify your targets.

5. Identify your allies.

6. Identify your resources.

7. Create an action plan.

8. Implement, monitor and evaluate.

                                                                                            8      Implement and evaluate

                                                                           7      Create Plan

                                                          6      Identify Resources

                                               Identify Allies

                              4     Identify Targets


             Analyse Problems

1      Select Issue

                                  Challenging Stigma & Discrimination - A manual for UN trainers


                           Challenging Stigma & Discrimination - A manual for UN trainers
                                                                 HIV & HUMAN RIGHTS   129


Challenging Stigma & Discrimination - A manual for UN trainers


                           Challenging Stigma & Discrimination - A manual for UN trainers

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