A report on progress towards achieving law & human rights goals within the African Union (AU) Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa ( ) AWA CONSULTATIVE EXPERTS’ COMMITTEE MEETING OF COMMISSION OF THE AFRICAN UNION, NOUAKCHOTT, MAURITANIA MAY 2014

Outline of the Presentation Background to Human Rights, HIV, TB and Malaria Laws, Regulations and Policies to Increase Access to Medicines Understanding and Integrating Responses to Stigma, Discrimination & Human Rights Violations Remaining Challenge to focus on vulnerable and key populations – Gender Issues, Young People, Key Populations Recommendations 2

HIV, AIDS, TB and Malaria in Africa Unprecedented achievements to end HIV, TB and Malaria in Africa since 2000 o New HIV infections have diminished by 34% since 2001 o Over 7 million Africans are receiving treatment o Almost 13 million Africans have been treated for TB since 2000 o 33% reduction in the malaria burden o 1.1 million deaths from malaria averted since However HIV, TB and malaria remain a serious threat to development – 25.2 million people living with HIV in Africa in 2012 – 70% of all new HIV infections came from Africa – 80% of the 207 million malaria cases worldwide in 2012 were in Africa – 90% of deaths from malaria occur in Africa – 27 % of the 8.6 million people who developed TB in 2012 were from Africa – 75% of the estimated 1.1 million of all people with TB who are HIV-positive are from Africa. 3

Human Rights, HIV, TB & Malaria Vulnerable populations and key populations at higher risk feel impact of 3 diseases most severely for various reasons: – Unable to realise their basic rights to equality and autonomy – Poor access to resources, limited decision-making power – Poor access to basic information and services, including health services – Stigmatisation and discrimination increases isolation, fear and creates barriers to services – Laws criminalising populations exacerbates the risk environment, increasing the risk of HIV transmission. Vulnerable populations and key populations at higher risk of HIV include women and girls, youth, people with disabilities, migrants, prisoners, sex workers and their clients, people who inject drugs, indigenous people, internally displaced people and others. AUC Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Responses in Africa – Enabling legal and regulatory frameworks including laws, regulations, regulatory systems and policies; access to justice and law enforcement – Support vulnerable individuals and communities to know and claim rights – Through various interventions including law review & reform, stigma & discrimination reduction programmes, legal literacy, – Access to available, accessible, affordable and quality health care 4

Why law and human rights matters Science & tools to transform HIV exist but this is not sufficient Evidence from the AIDS 2031 report shows that between – Hard choices on who to treat – Rapid scale up – Legal and policy change Structural change is most effective Law and policy change is not a magic bullet in itself, but is cost- effective and underutilized tools Structural change (enabling legal environment) also facilitates access for vulnerable and key populations Source: Cost and Finance Working Group, aids2031 (across 139 countries) 5

Laws, Regulations & Policies to Increase Access to Medicines Continental, regional and national progress towards creating an enabling legal and regulatory environment for local pharmaceutical production and for increased access to medicines Continental initiatives include – the Pharmaceutical Manufacturing Plan for Africa (PMPA) & its Business Plan – the AU / NEPAD Agency’s African Medicines Regulatory Harmonisation (AMRH) Programme – The Draft AU Model Law on Medical Products Regulation and Harmonisation – An Action Plan for efforts to promote an enabling legal and policy environment for local production of quality pharmaceuticals in Africa. At national level, AU Member States continue to work towards creating a legislative environment and policy reform to incorporate the full use of TRIPS flexibilities and to avoid the incorporation of TRIPS-plus measures However further work and collaboration is required in order to make optimal use of the opportunities available to countries. 6

Understanding and Integrating Responses to Stigma and Discrimination Roll-out of the People Living with HIV Stigma (PLHIV) Index has increased awareness and understanding of stigma and discrimination A number of countries have reviewed overly broad provisions criminalizing the transmission of HIV in light of medical, scientific and legal evidence. Regional laws and national laws in at least 35 AU Member States protect rights to non- discrimination and equality in the context of HIV and AIDS. In strategies, plans, frameworks and guidance documents at continental, regional and national level, Africa is showing commitment to – Promoting human rights and gender equality in responses to HIV – The participation and inclusion of affected populations, particularly people living with HIV, and – Provision for programmes to work with civil society organisations, law and policy decision-makers and the judiciary to reduce stigma and discrimination. Challenge that remains is to ensure that commitment to human rights translates to ongoing law review and reform including for provisions criminalising HIV transmission and to implementation of key programmes to reduce stigma & discrimination. 7

Remaining Challenges Need to protect vulnerable and key populations in law and policy, strengthen their access to justice and improve law enforcement for violations Gender inequality, harmful gender norms and gender-based violence places women across Africa at risk, where they account for almost 60% of all people living with HIV. Over 20 countries still have laws specifically criminalising HIV transmission African youth face ongoing challenges accessing confidential and appropriate sexual and reproductive health information and services independently of their guardians. This is complicated by contradictory laws, policies and attitudes in African Member States relating to young people’s right to make autonomous decisions in relation to sex, marriage and accessing medical treatment. Finally, the HIV epidemic continues to have a profound effect on key populations at higher risk of HIV exposure. Laws that criminalise aspects of sex work, drug use, with increasingly draconian penalties and provisions, have been shown to increase stigma, discrimination and violence against key populations driving them underground and deterring access to health care. 8

Contradictory approaches: Legal approaches to status of minors Source: Global Commission on HIV and the Law,

Recommendations Continued prioritisation of rights-based responses to HIV, TB and Malaria in Law, Access to Justice and Law Enforcement with a focus on (i) increasing awareness and understanding of, accountability to and monitoring of rights-based responses to HIV as well as TB and malaria; (ii) broadening efforts to develop and implement protective, anti-discrimination laws and policies, and (iii) implementing programmes to protect all affected populations from stigma, discrimination and human rights violations, to increase access to justice and to improve law enforcement in the context of HIV, TB and Malaria. Strengthened efforts to protect the rights of vulnerable and key populations at higher risk of HIV exposure including (i) measures to increase the participation of affected populations in national, regional and continental responses to HIV, TB and malaria; (ii) the review and repeal of discriminatory, punitive and coercive laws and policies, such as criminal laws that place key populations at higher risk; (iii) strengthened measures to eradicate gender inequality, harmful gender norms, gender-based violence and to increase access to services for women and girls; and (iv) laws, policies and programmes to encourage young people’s access to sexual and reproductive health care Continue efforts to create an enabling legal and regulatory framework for access to medicines including through laws and measures to utilize TRIPS flexibilities, take advantage of the extension to become TRIPS compliant and advance an enabling legal environment for effective medicines regulation and for a flexible intellectual property framework. Prioritisation of human rights based responses to HIV, TB, malaria and health, including the needs of vulnerable and key populations, in the post-2015 development agenda. 10