1. Human Rights & HIV Post 2015 Development Agenda Human Rights & HIV Post 2015 Development Agenda KOSHUMA MTENGETI CHILDREN’S DIGNITY FORUM 1 Strategic Approaches for Intervention ARASA APF 15th & 16th April 2014

2. Why HIV is HR issue…… Stigma and discrimination as obstacles in delivering HIV prevention, care and treatment services. - Often entangled with the discrimination attached to being a woman, being poor, having a different sexual orientation, engaging in sex work or drug use, or being in prison Protection of human rights, both of those vulnerable to infection and those already infected, is not only important for individuals, but also produces positive public health results. 2

3. Global and regional statistics Globally, young women (aged 15–24), have HIV infection rates twice as high as in young men, and account for 22% of all new HIV infections and 31% of new infections are in sub-Saharan Africa. Expanding access to services has lagged for adolescent girls (age 10– 19) and young women, slowed by factors ranging from inadequate sex education and health information and inequity in power relations to legal requirements for parental or spousal consent. HIV treatment coverage continues to lag for children, at 28% compared to 56% for adults. Coverage of HIV prevention and treatment remains inadequate for key populations at higher risk, and especially for young people in these groups. Female sex workers, men who have sex with men and people who inject drugs are estimated to be 13, 19 and 22 times more likely to be living with HIV than the general population, respectively. In 2010– 2011, however, domestic funding accounted for less than 10% of total spending on HIV programmes for sex workers, men who have sex with men and people who inject drugs reflecting a lack of political will to provide services where they are most urgently required. 3

4. HIV Prevalence by Region Tanzania 5.1% Kagera 4.8% Mjini Magharibi 1.4% Kaskazini Unguja 0.1% Kusini Unguja 0.5% Kaskazini Pemba 0.3% Kusini Pemba 0.4% Njombe 14.8% Mtwara 4.1% Lindi 2.9% Pwani 5.9% Dar es Salaam 6.9% Tanga 2.4% Morogoro 3.8% Ruvuma 7.0% Iringa 9.1% Mbeya 9.0% Rukwa 6.2% Katavi 5.9% Kigoma 3.4% Tabora 5.1% Singida 3.3% Dodoma 2.9% Manyara 1.5% Kilimanjaro 3.8% Arusha 3.2% Mara 4.5% Simiyu 3.6% Mwanza 4.2% Geita 4.7% Shinyanga 7.4%

5. Key Statistics… 5.1% of Tanzanian adults age 15-49 are HIV-positive. 6.2% of women and 3.8% of men are HIV-positive. HIV prevalence among women and men has decreased from 5.7% in the 2007-08 THMIS to 5.1% in the 2011-12 THMIS. In Mainland Tanzania, the decline in total HIV prevalence between 2003-04 and 2011-12 is statistically significant (70%) versus 5.3%). Additionally, the decline is significant among men (6.3% versus 3.9%). HIV prevalence is higher in urban areas; in the Njombe region; among widowed, divorced or separated adults; and among uncircumcised men. 5% of couples are discordant for HIV, meaning one partner is HIV- positive while the other is not. 5

6. Statistics…….. 40% of women and 47% of men age 15-24 have comprehensive knowledge of HIV. 65% of women and 85% of men age 15-24 know a condom source. 9% of young women and 10% of young men age 15-24 had sexual intercourse before age 15. 59% of never-married women and 48% of never- married men age 15-24 have never had sexual intercourse. 49% of women and 32% of men age 15-24 have ever been tested for HIV and received the results.

7. Care and Treatment Data As of Sept 2013. Cumulative number enrolled in HIV care Children FemaleChildren MaleTotalAdult FemaleAdult MaleTotalGrand Total 50,425 47,215 97,640 792,143 408,619 1,200,762 1,298,402 Cumulative number on ART Children FemaleChildren MaleTotalAdult FemaleAdult MaleTotalGrand Total 30,905 29,779 60,684 473,013 264,315 737,328 798,012 Current number on ART Children FemaleChildren MaleTotalAdult FemaleAdult MaleTotalGrand Total 18,138 16,689 34,827 302,633 148,255 450,888 485,715 7

8. Challenges related to HIV and AIDS response Pre-2015 Exclusion of the some section of the society and marginalized populations i.e young girls and boys, MSM, people use drugs and sex workers. Relationship between HIV and HR -Abuses continue to fuel AIDS and HR violations worsen the impact of the disease. 8

9. Challenges related to HIV and AIDS response Pre-2015 Government’s commitment to create enabling legal environment on HIV responses have not translated to national policies and laws. -People living with HIV continue to experience discrimination at the work place, breaches of confidentiality in health care and often denied the right to be employed etc 9

10. Challenges related to HIV and AIDS response Pre-2015 Unrealistic Universal Access: - The HIVI/AIDS challenges are fuelled by a wide range of HR violations, including GBV, sexual violence and coercion faced by women and girls i.e child marriages and FGM, stigmatization of MSM, abuses against sex workers and people who use drugs, and violations of the rights of young people to information on HIV transmission. -Existing HR violation and stigmatization of people at high risk of infection i.e child brides, girls, young women, MSM, Sex workers are marginalize and drive these groups underground who desperately need information, prevention services and treatment. 10

11. A positive PH outcomes can only be achieved when HR are placed at the core of national, regional and international HIV programmes. Here there are will be: Greater number of people testing for HIV, more people coming forward for HIV treatment and care services and generally people discussing HIV more openly in their communities. 11

12. Why a HR response to HIV Program and Advocacy Work: Based on HRBA Comprehensive PH outcomes, HR must be protected, respected and promoted. HRBA call for broader political, social and economic realities to be considered when addressing HIV in any community. When human rights inform the content of national responses to HIV, vulnerability to HIV infection is reduced and people living with HIV can live with dignity. 12

13. HR response to HIV……. Guarantees greatest possible access to SRH and HIV related services, including prevention, treatment, care and support programmes. When human rights principles guide the process by which local and national responses are implemented, the results are responses tailored to the needs and realities of those affected. Such principles include: »non-discrimination, »participation, »inclusion, »transparency and accountability. 13

14. HR responses to HIV…. Calls for the creation of an environment that fully addresses stigma and discrimination and which allows people living with and affected by HIV to participate in planning and programming Where States are: Providing comprehensive HIV prevention, care and impact mitigation programmes to all those in need, Supporting vulnerable people to be able to act on the information and services they receive, Allowing the full participation of all those affected in the design and implementation of HIV programmes, They are fulfilling their HIV-related human rights obligations and mounting an effective response to HIV. In contrast, where human rights are not respected, protected, and promoted, the risk of HIV infection is increased, people living with and affected by HIV and AIDS suffer from discrimination, and an effective response to the epidemic is often impeded. 14

15. Post 2015- Strategic Approaches The current MDG’s fail to address the centrality of human rights for sustainable development HR particularly the SRHR and equality need to underpin the post 2015 development framework SRHR be at the core of the HIV responses particularly with regards to young girls, high risk groups and hard to reach communities Making HR at the centre of the SRHR approach, meaning that girls, women & couples should freely decide if, when and whom to marry & when and how many children they want to have. Thus, provision of knowledge on and the access to methods of FP (which are not emphasised in the current MDGs) are key components of the SRHR approach & needs to be closely integrated into HIV prevention and response programmes and policies in post 2015 agenda. 15

16. Universal access to CSE & Youth friendly SRHR & S Universal access to CSE & Youth friendly SRHR & S 1 16 In Tanzania, 39% of married girls under the age of 18 are infected with HIV. HIV progressively becoming youth & female epidemic Amendment/repeal laws that prevent them to access SRHS 15 to 24 years old accounted 40% of all new infection 58% of PLHIV in SS Africa are women and girls PREVENTION and CARE INFORMATION ACCESS TO YOUTH FRIENDLY SERVICES COMPREHENSI VE KNOWLEDGE

17. Girls and Young people empowerment 17 How to protect themselves and make decision over their own bodies and families Challenging traditional gender roles and practices i.e child marriage, believes on virgin girls can cure HIV Gender sensitive education and SRH start early for the youth to be able to make well informed decision in their first sexual experience Girls 10-19 account 1/5 of all women of reproductive age, PMTC must start early to avoid +ve mothers transmitting virus to their children 50% of young women and 43% of young men age 18-24 had sexual intercourse before age 18.

18. Universal health coverage….. Access to equitable and quality health services to all including vulnerable and marginalized population-sufficient quantity, respectful of medical ethics and high quality. UHC must include HIV PTCS services and address social and structural barriers i.e stigma and discrimination of the vulnerable and marginalized populations. Health services providers need to be friendly to encourage people to access them and ensure they are responsive to the needs of people, particularly most vulnerable and marginalized Note: Without reducing the vulnerability of marginalized populations and addressing HR violations against PLW HIV, universal access will not be realized. 18

19. Funding…….. Long term sustainable and predictable funding needs to be identified and secured through innovative funding mechanism. Special funding approaches needs to be considered – a multi- sectoral response is the key - Private sector needs to share the responsibility to improve PH and access affordable goods and services. 19

20. Strengthen alliances with HR and gender equality movements: To advocate for access to justice; elimination of discrimination, violence and exclusion; and inclusive development focusing on responding to the needs of  PLW HIV,  Young people,  Women and girls,  Sex workers,  People who inject drugs,  MSN and gays,  Transgender people,  Prisoners,  Refugees and migrants, Focus to social and economic drivers of vulnerability to HIV transmission and disparities. 20 Repeal punitive laws that stigmatize& discriminate against these groups

21. Community mobilization and Engagement Community mobilization and community system strengthening should be at the core of the post 2015 development agenda. - Inclusion of the most vulnerable and marginalized population in funding and programming processes will provide important lessons learned for the post 2015 framework. Invest in communities to design, implement and monitor HIV, health and development programmes that are tailored to their needs. 21

22. 22 Health has emerged as a central theme, with young people calling for both increased access to healthcare with a particular attention to marginalized populations as well as increased quality of services. Priority have been in SRHR & Services, with an emphasis on addressing HIV, HIV was the only specific health condition referred to in the country youth consultations, stressing the need for increased funding to ensure young people’s access to HIV treatment and testing. HIV free generation is possible. BUT will require political commitment, community mobilization, adequate funding, a strengthened accountability framework, rights-based approaches to reach the most marginalized and addressing social determinants.

23. ASANTENI SANA 23