Socio-Economic Causes and Consequences of HIV / AIDS: A Focus on South Asia

HIV/AIDS is a major development challenge with implications beyond the health sector. Socio-economic factors such as gender inequality, poverty and livelihood issues, which are key causes of high mobility and migration of people and trafficking of women and children, also contribute to the spread of HIV/AIDS, and are, in turn exacerbated by it. These factors operate within the legal and ethical environment, which also influences responses to the HIV-affected.

The regional symposium discussed inter-related and complex issues pertaining to migration, trafficking, law and ethics and AIDS in South Asia. It promoted regional cooperation by emphasising trans-border challenges and responses. Representatives from countries in the region had the opportunity to learn, share information and develop mutually supportive policies and strategies.

Context of the Symposium: the 5th International Congress on AIDS in Asia & Pacific (5^th ICAAP)

There are people who would rather believe that AIDS only happens to foreigners, to those who have ‘sinned’, anyone but our families, our friends, our communities, ourselves. While we deny, we will not take action and therefore we expose our people to risk of infection from sheer ignorance.

Dr. Mohamed Mahathir, Prime Minister of Malaysia, Keynote Address

The Fifth International Congress on AIDS in Asia and the Pacific (5^th ICAAP), entitled, "The Next Millennium: Taking Stock and Moving Forward", was held in Kuala Lumpur, Malaysia, from 23^rd to 26^th October, 1999. It was attended by over 3,000 participants from 65 countries, representing governments, the media, NGOs, women’s groups, networks of people living with HIV and AIDS, community based organisations (CBOs), lawyers, academicians and research organisations. It was the first international conference on HIV/AIDS held in a Muslim country.

The Local Organising Committee of the 5^th ICAAP, led by the Malaysian AIDS Council, worked hard to facilitate a conference that was relevant to this vast and diverse region, and was a forum for a wide range of ideas, voices, discussion, debate, and commitment to implementation. The results were impressive. The Congress programme offered a vast body of information and experience, organised into four distinct tracks, representing laboratory research (A), clinical research and care (B), public health approaches and issues (C), and a broad range of social and behavioral sciences, including development issues (D). Four pathways across the tracks enabled delegates, if they wished, to choose sessions focussing on policy, gender, human rights, or youth and children.

The Congress opened with the voices of Malaysian people living with HIV and AIDS, highlighting the importance of inclusion, family support, and accessible and affordable health care and medication. Dr. Mohamed Mahathir, Prime Minister of Malaysia gave a powerful Keynote Address, emphasizing the importance of political will and of the compassionate involvement of religious leaders, and calling attention to the rights of migrant workers and the need to end discrimination against positive people in the workplace. In conclusion, he called for a summit of regional leaders to underline the seriousness of the AIDS pandemic and the need for urgent attention to combat it, and to facilitate better coordination. Video-taped messages from government leaders of Cambodia, China, and Fiji, and from Shri Atal Bihari Vajpayee, Prime Minister of India, reinforced the message of highest level political commitment.

The urgent need for strong commitment from political leaders, for a multi-sectoral response from all sections of society and for action now was the clear message running through the Congress. While acknowledging the tremendous diversity in Asia and the specificity of the spread of HIV in local contexts, some general themes and trends came out strongly, in tracks C and D:

Treat us with respect. We do not want to be treated specially; we only want to be treated like everyone else.

Session on Empowering Vulnerable Groups

In addition to the plenary and track sessions, other activities of the Congress included training sessions, skills-building workshops, satellite meetings, to allow further opportunities for interaction and information sharing, poster presentations and an exhibition hall with booths, and a community forum which highlighted the concerns of communities, families and individuals. The Regional Community Team appointed at this forum collated input throughout the conference to highlight major issues genuinely reflecting the needs of people including sex workers, drug users, men who have sex with men, transgendered people, migrant workers, people living with HIV/AIDS, young people and women. The observations of this team were presented at the Closing Ceremony, including calls for access to treatment, overcoming obstacles of the cost of medication and rejection by medical care providers, for the elimination of discrimination and stigmatisation, and for the effective representation and participation of all community groups in the policy and decision-making process.

The Congress has played a very important role in keeping HIV/AIDS on the agenda as a global and regional concern; the offer by Australia to host the next ICAAP in two years time will ensure that it stays there. Politically the Congress represented a major step forward, in the call of a head of government for a regional summit on HIV/AIDS. Participants viewing the epidemic from various specific perspectives in their everyday work and lives were given the opportunity to see it from many other angles, to place it in the context of the whole of human experience in the region and explore the commonalties across the different communities. The opportunity to meet and exchange ideas with those from other countries and sectors is being taken forward by many in the lively debate taking place on the "sea-aids" web-site. The Congress was also a landmark for an event of this scale, in that it was organised by a coalition of NGOs, which was successful in harnessing the support of governments, international organisations, NGOs, networks of people living with HIV/AIDS and the business sector.

The Congress provided a valuable opportunity to stress the importance of HIV/AIDS as a development issue. The country offices from the region, as well as the regional projects, sponsored several participants, including the UNDP HIV focal points, legal professionals, and NGO, government representatives and law enforcement officers.

Satellite Symposium of the Socio-Economic Causes and Consequences of the HIV/AIDS Epidemic in South Asia focussing on Migration, Trafficking of Women and Children and Increased Vulnerability to HIV/AIDS.

The Symposium was the special contribution of the UNDP Regional Project on HIV/AIDS in South and Southwest Asia at the 5^th ICAAP, and was organised in partnership with UNIFEM, UNFPA, UNICEF-ROSA, UNAIDS, and the National AIDS Control Organisation of India (NACO), together with other governments of the region. It was designed as a forum for discussion and feedback regarding critical areas and trans-border issues on which the project is working, pertaining to poverty and livelihoods, gender inequality, and the law and ethics, in particular migration and the trafficking of women and children. The intention was to give participants in the symposium an opportunity to take another look at their concern over HIV/AIDS, in the light of the imperatives of poverty and gender imbalances.

The agenda and the speakers for the Symposium were finalised through a consultative process with the UNDP HIV focal points and governments of the countries of the region. A conscious effort was made to ensure representation from all the participating countries as speakers and panel chairpersons, balancing government and NGO viewpoints. The presentations of the panel members and chairpersons are summarised below, and full papers received are reproduced in the Appendix. Master of Ceremonies for the Symposium was Dr. Mallika Sarabhai, and the Keynote Address was presented by Her Majesty Ashi Sangay Choden Wangchuk, Queen of Bhutan, given in full below. The opening remarks of all members of the Welcoming Panel, are also presented in full.

UN Assistant Secretary-General and UNDP Regional Director for Asia and the Pacific

At the outset, on behalf of the United Nations, let me extend a special welcome to all of you present here. You represent the network of policy makers and practitioners which will forge the broad and flexible front necessary to deal with the many complexities of the HIV epidemic, including those related to the trafficking of women and children and the increased mobility of people in search of opportunities - the focus areas for this evening’s discussion.

The prerequisite for any action is political will and commitment at all levels. In this regard, the presence at this Congress of Her Majesty the Queen of Bhutan, messages from Heads of State and from the Honourable Prime Minister Vajpayee, the presence of numerous Ministers and other representatives of government and civil society, including the media, is, indeed, encouraging. The UN Agencies are also working together to meet better the challenges of the 21st century.

The past decade has shown that the HIV epidemic is a major development problem with implications beyond the health sector. There is growing evidence to show that the epidemic is disproportionately affecting developing countries and is fuelled by poverty, gender inequality and social marginalisation. The HIV epidemic attacks our most vital resource - people - in their most productive years, a loss which impoverishes both families and countries.

The social and economic consequences of the epidemic are perhaps one of the most serious threats to sustainable human development. While HIV and AIDS threaten all segments of society, it is poor and marginalised people, and in particular women, who are especially vulnerable. Over 80 percent of HIV transmissions world-wide are through heterosexual contact, which means that women from all walks of life are increasingly infected.

On October 12, the Secretary General of the UN, Mr. Kofi Annan, welcomed a baby boy from Sarajevo, born two minutes after midnight – marking the world’s population shift to 6 billion people. In South Asia, which is home to one third of that population, the epidemic harbors many implications. The region is rapidly becoming the epicentre of the epidemic, with over 5 million people infected with HIV. Its huge population includes some of the people most vulnerable to HIV and AIDS – mobile workers and their families, rural families clustered in urban slums, women and children living and working under hazardous or exploitative conditions.

Out of a global population of 1.3 billion people who live in absolute poverty, that is with income below one dollar a day, South Asia houses 515 million people. 30-60% of the residents of urban centres live in slums and squatter settlements. Widespread income and human poverty and illiteracy deprive people of the information and control over their lives necessary to protect themselves from HIV.

The large scale mobile population in this region includes migrant workers from Bangladesh, India, Pakistan, Nepal and Sri Lanka looking for economic opportunities; refugees from Afghanistan into Pakistan and Iran; increasing numbers of women and girls trafficked from Nepal, India and Bangladesh; and large armies and paramilitaries on the move.

Migrants account for over 24% of the one billion people in India. Out of the 1 million Sri Lankans working overseas approximately 500,000 are women. The highest percentage of migrants to destinations both within the region and outside is in the 15-24 age group.

An estimated two-thirds of the total adult women, or 243 million women, in South Asia are illiterate. Due to their low economic and social status, women are less able to protect themselves from HIV. When infected they face the prospect of passing the disease to children they bear. They also take the greater share of the psychological, social and economic burden related to violence, alienation, loss of livelihoods, and caring for the sick. They are often not free to make their own decisions about sexual relations; neither are they free or adequately informed to secure safe passage to safe job opportunities.

The same factors which increase people’s vulnerability to HIV and AIDS are also responsible for increasing the vulnerability of women to being trafficked. For many women in South Asia, the social and economic obstacles to avoiding the risk of contracting HIV, or being lured or coerced to migrate to secure a livelihood, are particularly great. The trafficking of women and children is part of a pattern of migration and mobility of people within and across countries, which removes them from the protection of their communities and severs them from their systems of social support. These very factors are also the causes fuelling the continued spread of the HIV epidemic.

While the trafficking of women and mobility of people increases the risk and impact of HIV/AIDS, this should by no means imply that trafficked women or migrant workers are a common source of HIV infection. HIV/AIDS is only one of the many possible negative consequences of trafficking.

Migrant workers are often socially marginalised, and viewed as economic identities with little recognition being given to their human and social identities. They have a negative image in the eyes of host communities, and are blamed for social problems, including bringing in HIV from outside. They are also blamed for bringing back infection to the sending country. This attitude of blame must be stopped. The illegal and clandestine nature of the trafficking of women, and the blurring of the edges between trafficking and legal migration, make it difficult to ascertain accurate numbers of trafficked women. According to NGO sources there are 100,000 to 200,000 Nepali girls involved in the sex trade in India, and over 500 Bangladeshi women are illegally transported into Pakistan every day.

The Governments of the South Asian Association for Regional Cooperation, (SAARC), recognising the seriousness of the challenges faced, have called for collaborative action to fight the problems of poverty and the trafficking of women and children in the region.

What is especially disturbing is that the HIV epidemic in South Asia is continuing to evolve in an atmosphere of fear, prejudice and silence. In spite of the headway being made in terms of increased awareness and advocacy, denial still exists in some sections of society. A social response of blame, shame and discrimination towards HIV positive people or other marginalised groups, be they trafficked persons or migrant workers, will not help contain the epidemic or empower people. We need policies that reduce the stigma and build the self-esteem of affected people, to create an environment for the mutual trust which is essential for building social capital. Infected and affected people are powerful agents for change. They can and must be included in policies and programmes to facilitate social change.

This can be achieved only by linking HIV to the wider development debate, and by addressing the social and economic causes and consequences of the epidemic. Fortunately the South Asia Region is still considered to be in the early phase of the epidemic, with low levels of HIV, with the exception of India – and in India we have seen the government commitment to combat the epidemic grow at the highest levels.

This means that countries in the region have a comparative advantage in being in a position to take the timely and decisive action required to prevent the spread of HIV and alleviate its devastating impact on people and nations, and to learn from the experiences of other countries. The UN system provides an important conduit for countries to share that cumulative global and regional knowledge.

The United Nations have learnt much about AIDS and its interface with gender, poverty and governance, and we are still learning. We have learned that it is futile to concentrate our responses on behavioural change or technological initiatives, without addressing the structural or contextual factors which create or sustain people’s vulnerability. The HIV epidemic has brought into sharp focus many legal and ethical issues that determine the extent to which vulnerable people can protect themselves from HIV infection and economic, social and sexual exploitation.

We have learned that policies and programmes designed to foster sustainable human development, through good governance, poverty reduction, promotion of social equity and gender equality, can potentially have significant impact in not only controlling HIV/AIDS but also the trafficking of women and children. Measures which empower people, and especially women, to take control over their lives and exercise choices are of particular importance. There is an abundance of evidence to suggest that where these conditions are absent the HIV epidemic flourishes, complemented by social exclusion and exploitation of people.

HIV and AIDS, the trafficking of women and children and the marginalisation of migrant workers are comprehensive challenges to human development. They require an equally comprehensive response. Together with Governments and civil society organisations, be they networks of positive people or women working together, the UN system can bring a consortium of expertise in health, education, social development, economics and gender to foster innovative partnerships. Together we can facilitate sustainable solutions to meet the critical development challenges of the new millennium.

I am greatly honoured to be here today at such an important forum for humanity. We are meeting at a critical time for nations of the world as HIV/AIDS continues to spread in unprecedented numbers under difficult economic circumstances. This forum is, therefore, an occasion to take stock of our collective experiences and visions for the next millennium. I take this opportunity, on behalf of the organisers, particularly the United Nations Development Programme (UNDP), to extend a warm welcome to all the participants at this forum.

I also bring with me the warm greetings of His Majesty King Jigme Singye Wangchuk and the people of Bhutan. It is indeed a pleasure for me to share my thoughts at this important symposium which focuses on some extremely vital issues, the socio-economic causes and consequences of the HIV/AIDS epidemic in the South Asian region.

My personal commitment to improving social development in my country led me to accept the invitation to become a Good-will Ambassador for the United Nations Population Fund. I strongly believe that basic good health at the individual, family, community and national levels are the foundations for Bhutan's well-being, and the basis for our development.

Bhutan is committed to pursuing the challenge of ensuring "Gross National Happiness" for its people; and I wish this not only for us, but for the region as well.

We come from a region that is being seriously affected by HIV/AIDS. Over the years, I have also become increasingly concerned with its spread and the reports on reproductive health in South Asia. There are an estimated five million people in our region now infected with this disease, and the numbers are expected to double. This is alarming as wide-spread poverty makes the weakest in our societies more vulnerable to this disease.

It is imperative that we work towards raising the commitment and capacities of our governments, civil societies and development agencies to respond to the critical development challenges that the spread of HIV/AIDS brings to South Asia.

Today, I want to share with you some of the key elements of Bhutan's response to HIV/AIDS. I would also like to highlight some particular concerns with regard to health, gender and mobility in the context of our region.

On a midsummer morning in 1993, a frail man in his twenties was diagnosed with shingles by doctors at the National Referral Hospital. He was counseled to undergo an HIV test and was to be our first HIV positive patient. This young man died three years later from cerebral malaria in his local hospital. Fortunately, he died in the caring and compassionate support of his family and community.

Our challenge is to reduce the stigma associated with HIV/AIDS and to promote community acceptance of infected and affected people. HIV associated discrimination has a negative impact on people with HIV and their families. Families must not be made to suffer more than they already do when a member of the family contracts this disease that still knows no cure.

Bhutan has been fortunate in that we have not been as severely affected as many other countries. But we have learnt a profound lesson from the death of this young man. His case highlights the need to provide appropriate diagnostic facilities, and unbiased care in community settings; to protect the confidentiality and rights of the people affected with HIV/AIDS; and to promote community acceptance of infected and affected people.

To date, we have had 9 people diagnosed as HIV positive, of which 3 have died. Although the numbers are few, we are well aware of the epidemic in our neighbouring countries and the significant risks we face if appropriate multi-sectoral interventions are not intensified. While my country has not experienced first hand the devastating impact of AIDS that is transforming South Asia, we in Bhutan realize that AIDS knows no borders and that it brings with it enormous human suffering.

We have responded by developing a medium term plan to counter the spread of sexually transmitted diseases and AIDS. This plan provides a framework for joint efforts from government, private sector and civil society. The key elements of this plan include prevention activities, strengthening laboratory and surveillance facilities, training health workers and strengthening the monitoring and evaluation of national programs. We are also intensifying multi-sectoral interventions.

The level of public awareness on STD and AIDS is high in Bhutan -- a result of active campaigns to inform, educate and communicate health messages. People are beginning to understand the dangers of this epidemic, which claimed 2.5 million lives last year globally. This message is reaching our homes, our schools, and our hospitals.

But despite our success in limiting the spread of this disease, we recognise the immense challenges ahead. Our foremost challenge will be to educate our youth, who are the most vulnerable. By the year 2000 we aim to reach 75% of people between the ages of 15 to 49. We want them to understand and to be able to protect themselves from HIV/AIDS.

We recognise that women are not only at greater risk of being infected, but that AIDS affects them as care givers in the family. We are fortunate in Bhutan that gender discrimination is not a problem. Our women have been provided with improved health care services and are also learning about the disease through adult literacy classes and outreach clinics. A formal policy has been adopted to provide prenatal treatment of AZT to pregnant women with HIV.

At this juncture, we need to focus our attention on the vulnerable groups; persons who are being marginalised by societal and structural factors. We must pay heed to the variations in income, education, ethnicity and gender status, to different forms of sexuality, and mobility of people and how they some people may be side-lined in our programmes.

Women in our region are often more vulnerable due to their economic subordination. This is also because women often have no voice in matters relating to sexual relationships. According to the Human Development Report, South Asia is the least gender sensitive region in the world with low, social and economic status accorded to women. By the year 2000, we will have an estimated 243 million illiterate women in our region. I believe that we must work together to educate, encourage and empower our girls and women.

What is of concern is that the women from South Asia, who are already at an economic and social disadvantage, are being increasingly affected and infected. The growing prevalence of HIV infection in women also means a growing problem of children infected and affected. The epidemic's impact in terms of suffering is truly alarming. It leaves in its wake orphans and widows; it impoverishes families and communities; it increases the burden on health care systems, and results in falling life expectancy and rising mortality rates.

In South Asia, the increasingly serious problem of trafficking of women and children and their increased vulnerability to AIDS require urgent attention from governments and non-governmental organisations. In this context, the Male Convention adopted by SAARC is a welcome beginning.

Based on the global, regional and national experiences of the past years, we now know what works and why.

Fortunately, AIDS is preventable and prevention strategies that are timely and multi-sectoral do work, as demonstrated by the well known and successful initiatives in Thailand and Uganda.

Bhutan's experience also shows that government commitment, coupled with effective policies and programs, does yield dividends. It is not incidental that Bhutan has only a limited number of HIV infections to date. It is also extremely important to take the window of opportunity that we talk about in prevention, care and support.

We have learnt from the HIV/AIDS tragedy that has affected the region, and the entire world. At this most significant gathering at the end of the century, I would like to make a strong plea to governments, communities and civil society. Let us ensure that our preventive strategies are gender balanced, and that they focus on the empowerment of women, rather than depending solely on male compliance. Unless women are placed in the centre of analysis, we will not be able to create an environment for change.

Before Bhutan’s first AIDS patient died in a local hospital, he reached out to society by sharing his experience through the media. He pointed out how important it is to be cared for and loved, no matter what path he had taken. He appreciated the fact that he was never stigmatised and discriminated against. I have taken this message to heart and urge that we all work towards strengthening public knowledge and awareness through mass media and advocacy campaigns to reduce the stigma, fear, prejudice, silence and discrimination against people living with and affected by HIV/ AIDS.

Let us also be sensitive to the social and economic causes and consequences of HIV/AIDS. I am confident that together we will be able to raise awareness and enhance the commitment of political leaders, policy makers and development practitioners to this important cause.

Governments must put HIV/AIDS as a priority on their development agenda. Together we can promote effective policies and multi-sectoral strategies. We can bring about partnerships among the various stakeholders at the global, regional and national level. We can encourage advocacy and promote innovative strategies to meet the critical challenges of combating HIV/AIDS in South Asia.

I believe the time for action is now. Together, we can try to leave a legacy of a safer, happier and healthier world for our children and their children after them.

There are strong ties binding the countries of this region together. We live together as neighbours, following a history of 200 years of colonial rule shared by most countries of the region. After 50 years of development under various forms of government, this region is still considered one of the most backward in the world. This is reflected in such indicators in the Human Development Report as illiteracy, life expectancy and maternal and infant mortality rates. Large sections of the populations of these countries still live with poverty, indicated by illiteracy and unemployment. This leads to large-scale intra- and inter-country migration across the region in search of employment.

The issue of HIV/AIDS has suddenly brought all these aspects of the region into prominence. Since the first AIDS case in India, in 1986, and in neighbouring countries at about the same time, it has spread rapidly. Now there are an estimated 5 million people living with HIV/AIDS in the region, 3.5 million in India alone. However, what is important is not the numbers now but the peculiar characteristics of this region and its people, which make it highly vulnerable to spread of HIV, unless governments and civil society take notice and effective action.

There are several important social and economic causes of this vulnerability. The first of these is migration, which is mostly male oriented in search of work. Men living in slums away from home can be vulnerable to behaviours which expose them to infection. The sex workers they visit in red light areas are also often from neighbouring countries.

Drug use is increasing, owing to the proximity of the region to the Golden Triangle in the East. It was early a corridor for drugs, but now is also a region of consumption. Use was earlier oral, but now is shifting to injecting drug use, with the sharing of syringes, which is one of the fastest modes of transmission of HIV.

The lack of blood safety is another important cause. Though there are blood banks there is a chronic shortage of safe blood for the people of the region, especially in rural areas.

Trafficking of women and children across the borders of the region is another cause. Though we know this is problem, it is difficult to tackle because of poverty, backwardness and low education levels of people in the region, and lack of adequate technical resources and capability to find evidence.

Lack of political will to confront the epidemic can be a major cause of its spread. Until recently, in this region HIV/AIDS was not regarded as an important issue at all. Luckily, in India we have come out of this phase; in fact, HIV/AIDS is now regarded as the most serious public health issue facing the country.

What will be the consequences of these causes? The reality of the spread may not be grasped by looking at percentage points of prevalence. The population is so large that even an increase of 0.1% means that huge number of people have become infected. In India this would mean one million people. This increase will put enormous pressure on the health care system. Already in some hospitals in Mumbai and Chennai 20-30% of the beds are taken up with patients who are HIV positive. This is just the beginning.

TB is a large problem in the region. It is known that 60% of AIDS cases in this part of the world involve TB. The HIV/AIDS-TB correlation will be another big public health challenge of these countries in the near future.

This pressure on precious resources can be gauged by the fact that in India, in the first 5 years of the National AIDS Programme we have spent something like Rs.2,800 million. In the next 5 years it will be something like Rs.14,250 million. This is almost a five-fold increase in the commitment of resources by the Government of India and the bilateral and multilateral donors who are giving us funds for this purpose. And this is only a small part. The state governments and union territories, around 32 in number, also have to commit infrastructural resources, such as hospital beds, doctors, medicines, and other support services. If we monetise these it will lead to a much higher figure.

Though over time the epidemic will lead to changes in indicators such as life expectancy, these small percentage changes will not reflect the scale of the epidemic. To see the increase in AIDS we must look at other indicators, such as the increase in hospital beds occupied by people who are HIV positive, and the increase in the number of deaths from unknown causes.

How can we address this problem? As individual nations we will have to take action in each of our countries, but there is also a strong case for regional cooperation. This is where a number of initiatives are going to be taken if we have the type of dynamic leadership shown by the Queen of Bhutan. I hope that this position will be taken up by the political leadership in other countries. Recently we had a meeting in Kathmandu at which a number of regional issues were discussed, including trafficking, lack of political advocacy and lack of technical resources, and three or four important issues were identified for priority handling. We are looking for a forum in which we can bring the political leaders of the South Asian countries together to establish a programme for common action. The day this happens will be a bright day for South Asia, in face of this epidemic which is endangering the region.

I am happy to be amongst you all to speak on behalf of countless numbers of trafficked women and girls and those living with HIV/AIDS. Indeed, I am hopeful that this conference will bring a ray of sunshine for millions of people whose days on earth are numbered for want of care and love.

My name is Sima Lama and I am 18 years old. I spent my childhood in India and underwent primary education there, as my father was employed by the Indian Police.

Later, when he retired, the whole family settled down in my father’s birthplace in Lalitpur, Nepal. As I grew up, being a girl it was expected of me to do the household chores. My daily routine consisted of collecting fuel-wood and fodder for the animals, as well as grazing them.

We were by no means well-off. In order to sustain the family my parents readily agreed to my working as a domestic servant in the capital city of Kathmandu. A woman by the name of Pratima befriended me shortly after I began work there. She used to live nearby and I came to regard her as my liberator from the drudgery of household labour. She promised me a better life, a better job. What a dream!

I jumped at the prospect of earning a better living and ran away from the house with her to embark on a "lucrative business", accompanied by Ramesh Lama, a man whom she introduced me to as her uncle. Little was I to know that a worse fate awaited me in the hell-hole brothel of Bombay. My trust, my faith – all had been betrayed. I was abandoned and destitute. I was sold by the very people I had trusted to begin a better life with. Sold off like an animal. My world fell apart. How low can people get, how far will they stoop for money?

My ordeal had just begun. When I refused to comply with the Madam’s wishes to engage in commercial sex like the other inmates of the brothel, I was not only denied food but also beaten and tortured for several days. After nearly a month the police raided the brothel. The madam of the brothel was arrested and jailed. I was sent with four other girls to a remand home, Deoran, in India, before being repatriated to Nepal. There I was given refuge in MAITI Nepal, an organisation working for victims like me. To this day and ever more I shall remain grateful to my rescuers who delivered me from that hell, to the love and succor that I am fortunate to experience once again.

MAITI Nepal helped me to file a case against those who had trafficked me. Till now nearly 70 such middlemen have been arrested through the efforts of MAITI Nepal. I live with the hope that those traffickers who duped me will also be brought to justice one day.

MAITI Nepal has taught me to face the world with confidence and renewed courage and encouraged me to help other women in unfortunate circumstances. These days I am working as a volunteer in the transit home in Karkavitta, at the Nepal-India border, in apprehending traffickers and potential victims of trafficking. At the transit home we offer counseling services to these victims, as well as to people with HIV/AIDS who come to seek help. HIV/AIDS patients are ill-treated and shunned in our society. Last year, when two of my friends died, we had to pay NRS.7000 each for their last rituals, whereas it costs other people only NRS.800-1000. The reason was that they had died of AIDS. I hear people talking of human rights, but people with HIV/AIDS don’t have human rights even after death.

Especially if it is known that one has been sold off, then they automatically assume that one is infected with HIV/AIDS. I appeal to each one of you to dialogue with your governments, to dispel such assumptions, and help the victims become survivors. It is only when we will be able to translate the caring spirit of this 5^th ICAAP Conference into action will such problems be mitigated and the level of awareness be raised. This will enable us to enjoy our rights and spend whatever is left of our life here on earth, happily. I shall be carrying back the warmth of this conference, and will be sharing my beautiful experience here when I get back home.

Within any population, patterns of infection reflect underlying patterns of social and economic inequality. Gender inequality, poverty and livelihood issues are increasingly emerging as important factors in the demography of AIDS. While HIV/AIDS threatens all segments of society, it is poor and marginalised people, and in particular women, who are especially vulnerable. This vulnerability is heightened by the migration and mobility of people which are widespread within and between the countries of the region, and to destinations outside, and are intrinsic to the changing patterns of economic life.

Mobility and migration are not in themselves risk factors for HIV, but can create conditions in which people are more vulnerable. Separation from spouse, family and socio-cultural norms, together with isolation and loneliness, and a sense of anonymity, can lead to situations which make migrants and mobile workers more susceptible to exposure to HIV. It is then carried back to their families, the intended beneficiaries of the income from the migration.

These issues were addressed in this panel by speakers from the Maldives, Sri Lanka and Pakistan, and introduced by a short video, "Voices from the Region: Migration and Legal and Ethical Issues", by Abha Dayal and Puneet Tandon. The film depicts actual migrant workers, from Nepal, Bangladesh and Sri Lanka, speaking of their experiences, with comments from government, NGO and UN spokespersons. It highlights the importance of migration to find work for people who come from situations of poverty and absence of job opportunities, and provides insight into the isolation, human needs and vulnerability of migrant workers, often in a hostile host environment. The effect on families left behind, especially daughters, who can become very vulnerable, and issues relating to mandatory testing and deportation of migrant workers without counseling, are also addressed.

1. Panel Opening Remarks: Ms. Husna Razee, Executive Secretary, FASHAN, Maldives

South Asia is experiencing an unprecedented increase in mobility and population pressure. The vulnerability of an individual to HIV is affected by both societal and individual factors, which influence both mobility and behaviour. Societal factors include the power structure, social norms, gender relations and attitudes towards the individual, while factors at the individual level include caste, class, wealth, gender and knowledge. In discussing these issues it is essential to think in terms of real people. What these people have in common is that they work in low paid, unskilled jobs, in hostile environments, and their vulnerability arises from their human need for company, intimacy and sex.

2. Presentation by Mr. Jayantha Liyanage, Chairman, Bureau of Foreign Employment, Sri Lanka

Placing AIDS in South Asia in the global context of the epidemic, and the poverty context of the region, the paper focuses on the experience of migrant workers. Mobility has always been a coping mechanism in face of the natural and human-made imbalances in our environment. Attitudes which view migrant workers as the carriers of imported disease, leading to HIV testing and summary deportation, reflect lack of understanding of the realities in the migration process that make migrant workers themselves vulnerable to HIV/AIDS in the host country. Women migrant workers, who are often ignorant of sexual issues and subject to abuse, are particularly vulnerable.

Most contracts for South Asians going to the Middle East, for example, are for two-three years, leading to the separation of spouses for extended periods of time. Both the migrating spouse and the one left behind might have other sexual relationships, with the risk of HIV arising from the low incidence of condom use, lack of knowledge regarding STDs and HIV/AIDS, lack of negotiating power of the woman, and the tendency not to disclose sexual infidelities. Ignorance and social inhibitions have become the strongest allies of the virus.

Trafficking, particularly of young women, has become a prolific business, with lower risk and greater reward than trafficking drugs. One of the primary causes of the explosive increase in trafficking is the asymmetrical economic development in the Asian region. While the penetration of consumer goods into the rural regions of South Asia has lured people into the cash economy, the only commodity they can offer in exchange is their women. Traffickers organised in syndicates prey on the poverty of families. The global trafficking of young girls can be described as a modern form of slavery.

In conclusion, it should be placed on record that while the labour of migrants has helped build and support the economies of receiving countries, they have not received the corresponding support, or protection in law. Sending countries are reluctant to jeopardize political and economic relations with more powerful receiving countries, by taking up the cause of migrant workers. Migration and HIV/AIDS have parallel characteristics, both being global concerns rooted in issues of social equity and development. It is thus essential for all countries to be involved in finding solutions to this problem.

3. Presentation by Mr. Mushtaque Ahmed, General Manager, Overseas Pakistanis Foundation (OPF), Ministry of Labour and Manpower, Pakistan

Human survival depends on a continuous adequate and suitable livelihood, but the world today is afflicted with hunger, poverty and disease. The percentage of children who are malnourished is significantly higher in South Asia than anywhere else in the World, and millions of women in the region do not have the knowledge, means or freedom to act in the best interests of themselves and their children. An estimated 22-35% of the population of Pakistan lives below the poverty line. Should hunger have the face of a South Asian child?

Migration because of the pressure of poverty is not new in this region. Labour migration in the subcontinent began on a significant scale in 1834, following the official end of slavery in the British Empire. By 1932 an estimated 28 million workers had gone abroad, mainly to East Asia and the Caribbean. The record annual migration for Pakistan, 196,093, was in 1992. The potential of overseas migration from Pakistan is limited by low levels of literacy and skills, the very low participation of women in the labour force, and the high wages asked by Pakistani workers. Thus migration from Pakistan is likely to be no more than 120,000 per annum in the next few years. The main purpose of migration is to earn money and improve the standard of living of the family. Remittances are an important pillar of the economy.

The official statistic for HIV positivity in Pakistan is 1364, and 170 for AIDS. More than 80% of these people diagnosed with HIV have been migrant workers in the Middle East. These countries conduct mandatory HIV/AIDS testing for all foreign workers before joining service, and again at the time of renewal of their visa. Those found to be HIV positive are deported without being informed, which is a violation of their human rights, and leads to the infection unwittingly being passed on to their spouses. Investigations by the OPF have shown that deported workers do not know the cause of deportation, attributing it to the employer’s dissatisfaction.

Pakistan also faces the problem of illegal and undocumented migrants. Approximately 0.2 million women illegal migrants have come into Pakistan, mostly across the eastern border, and are engaged in sex work. From the north 3 million migrants have come in because of instability in Afghanistan. Many are boys aged 8-16 who work in small hotels and in the transport sector, and are often sexually abused, placing them at risk of HIV/AIDS.

HIV transmission through medical transfusions results from lack of extensive screening facilities. Poverty and lack of socioeconomic security is also leading to a rise in drug addiction, and the sharing of needles is commonplace.

Suggested prevention measures include provision of culturally-specific information, improvement of infrastructure, involvement of religious and community leaders, needle exchange programmes, and the social marketing of condoms. Prevention of the spread of the virus requires improved health of women, and socioeconomic security.

It is clear that HIV is spreading rapidly, and that it is directly linked to mobility. Therefore, there is a need for a comprehensive strategy addressing the issues of poverty, gender discrimination, stigmatisation and civil strife. This policy should encompass access to health services and information, improvements in the working and living conditions of migrants, the involvement of migrants in planning HIV protection services, the adoption of a gender perspective, and research. To ensure that these areas are effectively addressed, cooperation will be essential between all countries of the region, the international community, and civil society. Without this cooperation and joint efforts, HIV will continue to wreak social and economic costs and claim lives.

The most vulnerable of all migrants, the most vulnerable of all women, are those who are trafficked, removing the last vestiges of choice, or control over their lives. Trafficking of women involves recruitment by force, coercion, or deception, or by debt bondage of the woman herself or her family, exploitation, and the accrual of profits of her labour to the recruiter or other third party. The trafficking of women and children is increasing significantly in the region. People are being trafficked by land, water and air routes within and between countries of South Asia, as well as to the Middle East, Far East, and other countries outside the region.

Issues relating to trafficking were addressed in this panel by speakers from Bangladesh, India and Nepal. The topic was introduced by a video, "Voices from the Region: Trafficking and Legal/Ethical Issues" by Abha Dayal and Puneet Tandon, which

gives voice to girls, some of them extremely young, who have been trafficked from Nepal and Bangladesh and sold into prostitution and other forms of exploitation.

The 5-minute film highlights the role of family members in selling girls, their helplessness and the abuse they suffer, and their inability to insist on condom use by clients. 90% of trafficked Nepali girls returning from India are estimated by one NGO spokesperson to be HIV positive. It is pointed out that sex workers are blamed for spreading the virus, but they could never have had HIV if it had not been brought to them by male clients. A senior police officer talks of the practical difficulties of controlling trafficking at the open, porous borders. Comments by NGO, UN and government spokespersons raise issues regarding the role of the state in providing protection, the risk to women arising from their lack of rights and increasing poverty, the powerlessness of HIV infected women, and the invisibility of the whole issue of trafficking, and a holistic response is called for.

Mobility is a fundamental human right which should not be curtailed in our efforts to try to deal with the very real and frightening threat of HIV. Migration and trafficking are two separate issues. The right of people to leave their place of origin in search of livelihood is a fundamental right, so that when we take measures to stop trafficking they should not be measures to stop migration. Experience in Bangladesh has shown that when such measures are taken trafficking merely goes underground, and those people who are vulnerable become even more vulnerable.

Seldom is the trafficker unknown to the person being trafficked. The experience narrated by Sima is typical of the evidence collected by AOS again and again. The message which needs to be conveyed is that the trafficker you need to fear is in your own neighbourhood and has a known face.

A key factor in the ability of people to protect themselves from AIDS is education about the nature of AIDS, what causes it, and how people can prevent it. In some countries there is a tendency to think that as AIDS does spread through some behaviours which are considered socially unacceptable, all that needs to be done is to control these behaviours. Evidence has shown us that a large number of women have been infected within the respectable institution of marriage. It is thus clear that following a policy of controlling certain behaviours will not be useful policy in curtailing AIDS.

Each day victims of this trade face violence, intimidation, rape and torture from pimps, brothel owners, and even law enforcement agents. This sexual servitude is maintained through overt coercion, physical abuse, emotional blackmail, economic deprivation, social isolation and death threats. All who perpetuate attitudes and values that view children as economic commodities contribute to this trade, which results in unimaginable human suffering and violates nearly every human right.

Experts believe that there are more than 200,000 Nepalese girls and women working in the Indian sex industry. It is estimated that between 13 and 15 girls every day are trafficked to major cities in India, with ages ranging from 7-24. More than 20% are under 16 years old. Fear of AIDS and other STDs is erroneously leading to a greater demand for younger girls. Cross-border trafficking from communities in Nepal which have no history of prostitution is a relatively new practice. It is with sadness that we see that our land, known as the birthplace of Buddha, and for Hindus, the birthplace of Sita, is now known as a land which trafficks its girls.

The root causes are multiple and complex. They include poverty, lack of employment opportunities, low social status of the girl child, a general lack of education and awareness, an open 1500km border with India, lax laws and a weak law enforcement machinery. The silence maintained by the affected communities further compounds the problem.

Though an estimated 6000 girls per year are trafficked from the Nepalese villages, police records of the last 20 years show only 1600 reports of missing girls. Most are not filed by immediate family members, indicating tacit compliance with the traffickers. Girls are lured with false promises by men who are native to their villages, acting on behalf of agents of Nepalese origin, often with the connivance of influential people in the villages. Yet girls who manage to escape and return to Nepal are often not accepted into their communities, and may be forced to continue to sell sex to survive.

Studies in Mumbai have found as many as 65% of sex workers to be HIV positive, with 50% suffering from two or more STDs, and a high incidence of other infectious diseases,including TB.

In addition to addressing the problem at the point of origin, it must be tackled at the point of destination. Intervention programmes have to be implemented simultaneously to curtail both supply and demand. The aim is to create an environment which is not conducive to trafficking. Solutions are complicated because of the strong links with organised crime, and the cross cutting legal, policy, public health and human rights issues which make the funding and programming of interventions difficult. Rehabilitation and preventive programmes are co-dependent, and neither can exist in isolation.

Awareness and advocacy: the objective is to place the issue firmly in the political agenda, exert pressure for increased prioritisation of social development, and mobilise co-operation and funding for efforts to address the commercial sexual exploitation of children. It is important to listen to the victims of the sex trade and enlist their active participation in raising awareness.

Prevention: programmes should be more vigorous in combating poverty and encourage communities to build early warning and support systems so that families are less likely to be tricked. Laws must be strengthened and strictly enforced, and training and adequate resources be provided for law enforcement personnel.

Protection: includes removing victims from situations in which they are sold and purchased for sex, providing care and shelter, and criminalising and penalising those who sexually exploit children.

Reintegration and rehabilitation: comprehensive legal, socio-medical, and psychological services are necessary for both the victims and their families, together with provision of alternative means of livelihood. Community education is required to facilitate reintegration.

Information: the quality of information collected, and the speed with which it can be shared, directly influences the effectiveness of anti-trafficking programmes.

MAITI Nepal is an NGO working with high risk and abused children, and with women affected by trafficking, AIDS, sexual abuse, or domestic violence. The cross-border nature of the problem means that MAITI Nepal’s major focus is on the supply side of the problem. It’s activities include running a rehabilitation centre, prevention camps in high risk areas, transit homes for rescued victims and a hospice, direct action against traffickers, and mobilising local populations to fight trafficking. Programmes are run on four key principles:

3. Presentation by Ms. Binoo Sen, Member Secretary, National Commission for Women, India

Existing social systems have ensured that gender inequality is perpetuated. Gender inequality is deeply rooted in power equations, sexuality, self-identity and social institutions. Any attempt to combat the inequality paradigm must confront the cultural beliefs and social structures that perpetuate it.

Despite various international attempts to ameliorate the condition of women and children through appropriate policy and structural changes, old forms of gender discrimination and oppression have reappeared in alarming fashion. One of these is trafficking. Based on quick returns and viewing women and children as the "golden goose", it shamelessly denigrates the image and dignity of women universally.

The trade involves a web of hidden, profitable, efficient and expanding trade networks and movements of people between countries of origin, transit and destination. It is a cross border issue with regional and global manifestations. The marginalisation of women and children with limited access to economic resources is the key factor pushing them into the trade, together with religious practices, social customs, consumerism, illiteracy and deprivation. The trafficking spectrum has been expanded to include forced labour, begging, drug trafficking, camel jockeying and domestic work.

Social disintegration has led to emotional insecurity and isolation from key social support systems. Across the social spectrum women face limited access to health care and information regarding the functioning of their bodies. Trafficking has exposed women to health risks that destroy the mental and moral framework of the individual. There are growing instances of HIV/AIDS, STDs and maternal mortality amongst trafficked women and children.

Responses in India to date have largely been through the enactment and enforcement of legislation, such as amendments to the Immoral Traffic Prevention Act (ITPA). A Plan of Action drawn up in 1997-8 identifies 11 action areas to tackle sexual exploitation of children, including the forming of a nodal agency for the trafficking of women and children. India has also drafted a regional SAARC Convention on Preventing and Combating Trafficking in Women and Children for Prostitution in the South Asian region.

The Rawalpindi Resolution of 1996 urges SAARC member states to combat inter and intra-country trafficking in children. At the SAARC Summit in Male in 1997 member states agreed to adopt a regional convention on trafficking and work together to eliminate it.

Apart from initiatives at the government level, NGOs from Bangladesh, India and Nepal are actively collaborating to combat cross-border trafficking, and have suggested various actions. In India more than 80 NGOs in ten states work actively among sex workers.

A comprehensive approach is essential to address the political, economic, social, legal and institutional aspects of trafficking, dealing with both the perpetrators and the victims. Political will and commitment of governments is foremost and critical, and a consensus on what constitutes trafficking is necessary. Prevention strategies include the involvement of the community, the spreading of information at the grass-roots level, including returnees to build awareness amongst village girls and elders, and integrated community development schemes in areas from which girls are trafficked.

Awareness building and advocacy, including gender sensitisation and the involvement of the media, legislation and its effective enforcement, international cooperation in controlling networks of traffickers, rehabilitation and re-integration of victims, and research, data collection and information dissemination are all necessary strategies to tackle trafficking.

When we talk about the right to mobility for employment we are not talking about children, who should not be in employment of any kind, whether it be factories, domestic work or sex work. The problem with human rights advocacy is that often it is only lip service on behalf of those whose rights we are advocating, without providing services to enable them to access their human rights in a meaningful way. This requires deeds, as well as words.

Women who have exercised their right to migrate for a better life and have ended up being trafficked should not be forcibly repatriated, but should be protected and given opportunities where they are. To achieve this would require a concerted effort by all governments of the region. All of us in society are complicit when the violation of the rights of one section of society takes place.

The HIV epidemic has brought into sharp focus many legal, ethical and human rights issues. The fact that those now most at risk of HIV infection are those who are already socially and economically vulnerable, means that the need to incorporate human rights concerns into HIV policy has a particular significance.

The legal and regulatory framework, and the prevailing cultural and ethical values and practices in a society, interact with economic conditions to determine the degree of control which people have over their life-circumstances, and the choices available to them. In terms of the epidemic they determine both the extent to which people have the power to protect themselves from HIV infection, particularly poor, vulnerable and marginalised people, and the responses to people living with and affected by HIV/AIDS.

Legal and ethical issues were discussed in this panel by speakers from India, Sri Lanka and Bangladesh.

The question of what law and ethics have to do with HIV was well answered by the late Jonathan Mann in an article in The Scientific American. When the epidemic started in America in 1981 most HIV positive people were white, upwardly mobile, and homosexual. Now the majority are poor black women. Why? They do not have the rights which enable people to protect themselves against the virus. Rights are like green leaves in a forest; fire spreads more rapidly in a dry forest without green leaves.

Women without rights are especially vulnerable. In countries of S. Asia a man can rape his wife and it is no rape in law. If not satisfied he can divorce her. How can she negotiate for safe sex in such a situation?

Generally there have been two types of legal response to HIV, which are diametrically opposed and may be termed the isolationist response and integrationist response. The first entails mandatory testing, breaching of confidentiality, and discrimination leading to the isolation of the HIV positive person. In the second response testing is voluntary and confidentiality maintained, and there is no discrimination, resulting in the integration of the HIV positive person in society.

Restricting the rights of HIV positive people exacerbates the epidemic. In such an environment they will go underground, and will not avail of the services offered. The paradox identified by Justice Michael Kirby remains true: in order to control and prevent the further spread of the HIV/AIDS epidemic, we must promote and protect the rights of those who are infected and those who are most at risk. The question of whether society or the individual is to be protected is a false debate: there can be no protection of society if the rights of the individual person are not protected.

2. Presentation of paper submitted by Ms. Sunila Abeysekera, INFORM, Sri Lanka (paper presented on her behalf by Sriyani Perera, Alliance Lanka)

Throughout the Asia and Pacific region today we see societies in crisis. Poverty and economic deprivation remain major problems that confront the majority of our people. There are problems of governance and social structures are disintegrating under the many complex pressures of modern life and globalisation.

In this context, the HIV epidemic has unleashed on our communities many demons from the past. In is strange how, in modern societies on the verge of a new millennium there are still many of the attitudes and prejudices against disease and human sexuality that prevailed in the so-called Middle Ages. People with HIV are often demonised, driven out of their homes and jobs, penalised, hunted and sometimes killed. More often than not they are blamed for their disease.

In Sri Lanka AIDS was first detected in 1986. Though the recorded figure for people who have tested HIV positive is 276, the estimate of people living with HIV in Sri Lanka today is 6,000 or more. Because of the prejudices that are manifested even within the medical profession, as well as the criminalisation of homosexuality, many people are reluctant even to go to the clinics for testing.

Anyone who has knowledge that a person has tested positive for HIV is obliged to report it to the nearest police station, which will monitor the person from then on. In addition, under a 1987 amendment to the Quarantine and Prevention of Diseases Ordinance it is compulsory for any person treating someone with AIDS to notify the details to the authorities. These laws and attitudes are the first steps that destroy the confidentiality of people living with HIV/AIDS.

Prejudice within the health service sector is another major issue, for example in an incident when nurses refused to work on an emergency operation when they discovered that the patient was HIV positive. There are problems in the training of medical staff, and in such simple and practical matters as having an adequate supply of surgical gloves on hand.

The continuing myth that there are particular social groups or sectors who are more vulnerable to HIV than others, means that people who are already on the margins of society encounter even greater hostility, through being viewed as the possible bearers of HIV. For women the burden of being vulnerable to all forms of violence and abuse is never more sharply felt than when they find themselves also the target of suspicion on the basis that they might be HIV positive.

International responses to discrimination against those living with HIV and AIDS have included the publication of International Guidelines on HIV and Human Rights, which have been circulated to all member states of the United Nations. In addition, among the human rights that have been clearly defined in the International Bill of Rights and are now a definitive part of international law, are several that, if defended, could have a direct and positive impact on the lives of those living with HIV/AIDS, including the rights to privacy, liberty and security, freedom of movement, work, education and to marry. The right to privacy is one of the most contested, the issue at stake being how to balance the needs and interests of the HIV affected individual with those of the larger community.

There need to be many legal reforms, as well as rewriting of administrative procedures, before the full human rights and dignity of a person living with HIV/AIDS can be recognised. In Sri Lanka reform is needed in the Contagious Diseases Ordnance, the Quarantine and Prevention of Disease Ordnance, the Penal Code Section referring to offences affecting public health and safety, and sections of the Criminal Procedure Code that call for a "person to abstain from a certain act" if that act could be construed as causing "danger to human life, health or safety".

Mandatory screening has been identified as having a very limited role to play in programmes for HIV prevention and control, while being extremely invasive of the privacy of the individual concerned. Both the WHO and the Council of Europe have come out strongly in favour of voluntary testing, with informed consent and with guarantees of confidentiality and access to counseling. Other concerns include restrictions on the liberty and freedom of movement of persons living with HIV/AIDS, and the vulnerability of those in prison to discrimination and ill-treatment because of their HIV status.

Prejudices and discrimination against people living with HIV and AIDS may have the most dire consequences. Due to fear of humiliation and hostility many persons do not seek medical assistance or advice, and remain in the shadows, passing on the infection to others, without seeking help themselves.

The part of the problem that is in the domain of law can be addressed by preparing plans of action, and providing national laws and international frameworks and standards. The other side of the problem is the patterns and normative standards of human behaviours, which we can describe as ethics, and are far more difficult to change.

Bangladesh is the ninth most populous country in the world and one of the most densely populated. 35% of GDP is from agriculture, in which 65% of the workforce is engaged. Indicators illustrate the poverty concerns of the country. Strategically located at the junction of South and Southeast Asia, Bangladesh is also a transit port for trade, as well as illicit trafficking including drugs, and blood and blood products. The trafficking of women and children is not uncommon.

The estimated number of people with HIV/AIDS is 20,000, with prevalence of 2.6% amongst injecting drug users. Though the national prevalence of HIV infection is low, the reasons for Bangladesh to worry about HIV include:

A high level National AIDS Committee was formed in 1985. A comprehensive National AIDS/STD Policy has been formulated. To date no specific legislation or code of ethics related to HIV/AIDS has been adopted. The Constitution guarantees that all citizens are equal before law and have rights to equal protection of law, and provides against discrimination.

Protective laws need to be formulated in areas such as confidentiality, mandatory testing, informed consent, partner notification, right to information, discrimination in the workplace and appropriate workplace practices. No other disease has the same capacity as HIV/AIDS to arouse instant fear, particularly where knowledge is lacking, resulting in panic and discrimination. The framing of appropriate protective laws would enable an HIV positive person or a person at risk of contracting the disease, control over the right to privacy, dignity and equal opportunity, while retaining the interests of employers, non-infected family and community members, etc. Guidance for developing such a legal framework for the workplace are contained in the Statement from the Consultation on AIDS and the Workplace, 1988.

Proscriptive laws, which put sanctions on certain behaviours which could increase the risk of HIV infection, need to be considered with caution. These laws can be potentially coercive and create a disabling environment for those at risk. For example, strict enforcement of laws against prostitution, without provision of alternative sources of income, would drive them underground, making them harder to reach. The same would apply in the case of laws against homosexuality.

Law can play an instrumental role in proactively seeking change in underlying values and patterns of social interaction that create vulnerability to HIV infection. Though the Constitution guarantees equal rights and opportunities to women, they are discriminated against by laws such as those relating to marriage and divorce. Bangladesh was one of the first countries to ratify the Convention of the Rights of the Child, but penal measures against violation of the provisions of the Convention are still to be put in place. In a country like Bangladesh, where rights of children are yet to be unanimously recognised by society, creating scope for penal measures offers an opportunity for the law to be instrumental in establishing their rights.

In the context of HIV/AIDS as a human rights issue it would be worthwhile for Bangladesh and other such countries to work towards a unified code of ethics, with effective implementation. At a UNDP sponsored meeting in 1998 areas identified for action included public health, information law, discrimination, women and families, and employment issues. So far in Bangladesh a code of ethics has been formulated only for blood donations and transfusions. It is particularly important to develop and implement a code of ethics related to reporting on HIV/AIDS by the media. Legal provisions to penalise violation of codes in HIV/AIDS reporting would play a critical role in promoting an anti-discriminatory social environment.

The implementation of such legislation and codes faces a number of challenges, including lack of complete and correct understanding of HIV/AIDS by members of the judiciary and executive. Since the issue challenges traditional religious and cultural values, any political government dealing with it stands the risk of being accused of immorality, or promoting unconventional behaviour, and thus may not like to take responsibility. Introduction and implementation of a code of ethics is more difficult than legislation, and requires persuasion or teaching by experienced motivators.

In Bangladesh there have been recent attempts by NGOs to exploit to a fuller extent the powers and authority vested in the judiciary. A landmark case regarding the eviction of slum dwellers has demonstrated the positive role the judiciary can play in establishing the rights of the disadvantaged.

The central issue for HIV infected individuals and their families, communities, and workplaces, is the ability to continue a normal pattern of work and leisure as long as possible in fair and acceptable conditions. For resource-constrained countries like Bangladesh the true impact of HIV/AIDS in the context of other manifold priority problems needs to be carefully studied, and a universal consensus on the urgency of the problem developed. Those who have heard the alarm bell are too few in number.

Issues of consent to testing, confidentiality and discrimination are exacerbated in the case of migrant workers who face difficult situations, with no legal status or civic rights. We need to take pro-active steps to ensure that laws which protect citizens also apply to migrants, and to build on the recent trend to view the right to health and treatment as a human right available to citizens and non-citizens alike. This will require regional treaties which are enforceable, and legal remedies to treat migrant workers as part of the host country for health and civic amenities.

The proceedings were enlivened, and the messages delivered by the speakers reinforced, by a powerful mime play presented by JAGRAN, a group from India specialising in street theatre in mime. This theatre of body language easily cuts across language and national barriers. JAGRAN’s pantomime seeks to arouse consciousness of contemporary issues, opening the mind to the fact that THERE ARE POSSIBILITIES. Once this is done, the most crucial problems in the process of initiation of social action can be tackled.

The play highlighted the trafficking of women across international borders, the subsequent transmission of HIV, and the support that needs to be extended by community based organisations to stem the tide. Duration: 20 minutes.

An agent seeking to buy women and children is seen prancing in a border village. From a distance he spots a father, son and daughter, who are very poor and emaciated. He prepares his face to convey friendliness, approaches the family sitting on the road, and develops contact with the son, through showing concern for them. It takes a while for the agent to win over the son through his compassionate attitude. He says that he would be able to find a good job for his sister across the border. Though at first the father is very protective of his daughter he is eventually also convinced, and the daughter is also talked round and is made to accept the offer. The matter is finalised by a bundle of currency notes waved in front of the family, but the father and brother watch her go with heavy hearts.

The agent tells the girl of the fine clothes and jewellery she will get and she brightens up. The border policeman is bribed to allow her through. Once in the city the agent takes her straight to the brothel keeper, who haggles over the price. The girl is shocked and petrified by this turn of events, and tries, unsuccessfully, to resist. The brothel keeper beats her and forces her to submit to the first client. Being a virgin she brings a good price, and the client’s male ego is satisfied. Over a period of time and repeated sexual encounters the girl’s resistance breaks down.

One day she is sick and a medical examination reveals her to be HIV positive. She is brutally thrown out by the brothel keeper and crawls back to her village near the border, where her father and brother close their eyes to her. Completely traumatised and shattered she comes out onto the road. At this point a bunch of women and men are seen approaching with banners in their hands, proclaiming, "Denial of human rights to HIV patients is direct violation to United Nations Charter of Human Rights". They take her along with them, and put protective arms around her. The audience is asked to give their support by upholding the Charter of Human Rights.

Her Majesty was born in Thimpu on May 11, 1963, was educated in India and the United States of America, and has traveled extensively in Bhutan, where she has actively promoted health, education and family issues, with a particular focus on rural women. Her majesty has participated actively with women at the village level in the twenty districts of Bhutan, has visited schools, basic health units and hospitals and has had extensive dialogues on the social sector with government organisations and key stakeholders.

Her Majesty has also been active in the promotion of traditional textiles as an income generating and skills enhancement opportunity for women in Bhutan. The Peabody Essex Museum in Boston, United States of America, has organised an exhibition on Bhutanese textile art under the royal patronage of Her Majesty. Currently, the Special Commission is working towards the establishment of a textile museum under the patronage of Her Majesty.

Her Majesty has a comprehensive understanding of the constraints and the opportunities in the social and economic development. She believes that it is crucial to understand the cultural and social environment in order to be successful in working on reproductive health.

Nay Htun is presently the UN Assistant Secretary General/UNDP Assistant Administrator and Regional Director for Asia and the Pacific in the United Nations Development Programme, New York. He has long and extensive experience in promoting socio-economic development in Asia and the Pacific region, occupying senior positions in the United Nations, academia and industry. During the past 30 years he has been involved at the highest levels in the technical, managerial and policy aspects of development.

Prior to UNDP, he has held several significant positions such as the United Nations Environment Programme (UNEP) - UN Assistant Secretary General/Deputy Executive Director, Nairobi, Kenya; Regional Director and Representative for Asia and the Pacific, Bangkok; Senior Programme Officer/Deputy Industry and Environment Office, Paris; Director and Special Advisor, United Nations Conference on Environment and Development (UNCED) Geneva, Switzerland (the Secretariat that organized the "Earth Summit" in Rio de Janeiro, Brazil). He has also been responsible for liaising with business and industry, and in particular the Business Council for Sustainable Development, Geneva, Switzerland. Industry ESSO Thailand, Bangkok.

Apart from working in the development and private sector, he has also excelled in the field of academics, in his appointment as Fellow, Imperial College of Science, Technology and Medicine, London University, UK. In 1998, he was awarded the highest award the College can bestow; He also has several other degrees bestowed on him like Ph.D. Chemical Engineering, by the Imperial College, London, UK; Ms. Tech, Chemical Engineering and Fuel Technology, Sheffield University, UK. and D.I.C. Heat Transfer and Combustion, Imperial College, London, UK.

He has authored/co-authored over 60 publications on environment, natural resources management and sustainable development. He has addressed many major international, regional and national conferences as a keynote speaker during the past 20 years and continues to be an enthusiastic advocate for sustainable human development issues including HIV/AIDS at the global and regional level.

Shri J.V.R. Prasada Rao joined the Indian Administrative Service in 1967 and was assigned to West Bengal. During the turbulent decade 1967 to 1977 in West Bengal politics, Mr.Rao held important positions in District Administration, including posts of District Magistrate and Collector. He worked in the Department of Atomic Energy, Government of India in a key assignment in the Nuclear Fuel Complex at Hyderabad, and served as Commissioner, Commercial Taxes, and Secretary Finance and Taxation in West Bengal. At the national level, as Finance Secretary in the Department of Ocean Development he successfully negotiated important international treatises, including the Law of the Sea Convention and the Antarctic Treaty. He joined the Ministry of Health in July, 1997 and now looks after major National Health Programmes for HIV/AIDS, Tuberculosis, Leprosy, Cancer and Blindness.

Sima Lama is only 18 years old, but has a vast traumatic experience behind her, having been a victim of trafficking. Being a girl, she faced severe discrimination at the hands of her own family, who thrust upon her the responsibility bringing in some income. She was tricked and betrayed, and sold to a brothel in India, where she refused to relent in spite of severe physical torture. As luck would have it, the brothel was raided by the police and all the girls were taken into custody and sent to a remand home. Now Sima Lama is working as a social worker with MAITI Nepal, assisting the border authorities in Nepal in identifying and rescuing young girls from being trafficked. She also provides counseling to AIDS patients and imparts skill development training and education to make them feel of service to society.

Husna Razee is the Executive Secretary of FASHAN, a non-governmental organisation in the Maldives working for promoting self-help and empowerment, especially in the areas of women and development and gender issues, child rights, AIDS prevention and prevention of drug use. It is the only NGO, in Maldives working on gender issues, and she is one of the most active advocates on HIV/AIDS issues in the country.

Ms. Razee has had many years of experience in the public health administration of Maldives, and from 1993-95 was Director, Health Promotion and Disease Control. Presently, she holds the post of Director General, Institute of Health Sciences, Maldives College for Higher Education. As Head of the Institute, she is responsible for overall management, including the planning and quality control of training programs for paramedical personnel (both pre-service and continuing education), and also for advising the Minister of Health on policy issues with respect to training. In addition she undertakes teaching of health promotion and health education.

Ms.Razee a member of national bodies and is the most active advocate of HIV/AIDS issues in the Maldives, and an expert on gender issues. She recently participated as a Resource Person in the Gender Mainstreaming Workshop in Male, Noonu and Addhu Atolls, which was an UN Inter-agency and Government of Maldives initiative. She has produced a draft report on 20 years of Gender & Development in the Maldives, which will be distributed once it is finalised.

Mr. Jayantha Liyanage is was admitted as an Attorney-at-law of the Supreme Court of Sri Lanka in 1978, and has also been admitted as a solicitor in UK and a barrister in Australia. He is presently Chairman of the Sri Lanka Bureau of Foreign Employment, a Public Corporation established by an Act of Parliament to develop overseas employment opportunities for Sri Lankans, issue licences, monitor and control local recruitment agents and look after the welfare of migrant workers and their families. Mr. Liyanage was Chairman of the Sri Lanka Foreign Employment Agency (Pvt.) Ltd. from 1997 to May 1999, and was Managing Director of a company in Malawi, from 1995 to 1997. He has visited most countries of the Middle East, Seychelles, Singapore, Cyprus and elsewhere to promote foreign employment opportunities for Sri Lankans.

Mushtaque Ahmed is the General Manager of the Overseas Pakistanis Foundation (OPF), under the Ministry of Labour and Manpower, Government of Pakistan. He has considerable experience in the area of migration management, and has contributed significantly in various migration crisis situations in the country such as the Kuwait War and the change of regulations in UAE, and has played an important role in the formulation and implementation of migration specific laws and policies.

Mushtaque Ahmed is one of the most experienced persons in Pakistan in the area of migration policy development, and has presented papers in many conferences.

Binoo Sen joined the Indian Administrative Service in July, 1967. In addition to many other assignments she has been Chief Electoral Officer in Madhya Pradesh where she conducted the elections in 1993. Mrs. Sen was Development Commissioner, Madhya Pradesh and Principal Secretary, Panchayats (local governing bodies) in 1994 when the elections to Panchayats took place, and was responsible for organising the training of newly elected Panchayat members. At the national level she has been Joint Secretary in the Ministry of Water Resources and Joint Secretary in the Department of Personnel from 1985-91. Till September 1997 she was Joint Secretary in the Department of Women and Child Development, where she was responsible for early childhood development programmes and oversaw the activities of UNICEF, CARE and WFP in these areas. She joined the National Commission for Women in September 1997.

Anuradha Koirala was a teacher for twenty years and is now the Director of Maiti Nepal, an NGO which assists girls who have been sexually abused or trafficked. Maiti Nepal provides counseling, training, and income generating programmes to girls who return from India. It also creates community awareness in the high-risk villages of Nepal, regarding HIV/AIDS and trafficking for forced prostitution. For her work Anuradha Koirala has been awarded:

Anand Grover is a practising advocate in Mumbai, India, though he originally graduated as a biochemist from the University of Surrey in England. He has been engaged in public interest law from the beginning of his law practice in 1981, and founded the Lawyers’ Collective, which has handled a number of public interest cases relating to environment, human rights, women’s rights law etc. He entered the HIV field in 1988 when he conducted the case of the celebrated HIV activist, Dominic D’Souza, and has handled some of the most important cases on HIV/AIDS in India, including the case of MX v. ZY, in which the Bombay High Court held that an HIV positive person cannot be denied recruitment in a public sector organisation and that s/he can sue in a court of law while suppressing his/her identity.

In 1997 he set up the Lawyers’ Collective HIV/AIDS unit. The unit is active in taking up cases of HIV positive persons, and advocacy for the rights of HIV positive persons. The unit has launched a campaign for the right to marry, which the Supreme Court of India has restricted recently in the judgement of Mr. X v. Hospital Z.

Ms. Sunila Abeysekera is the Executive Director of INFORM Human Rights Documentation Centre, Colombo. She has an MA in Development Studies from the Institute for Social Studies, Netherlands, from where she also won an award in 1994 for a research paper entitled ‘Women’s Human Rights: Questions of Equality and Difference’. She is a member of the editorial board for the Harvard School of Public Health Journal on Health and Human Rights, and South Asia-Coordinator for the Asian Forum for Human Rights and Development (FORUM-ASIA), and is associated with many human rights related bodies both in Sri Lanka and internationally.

Ms. Abeysekera has been actively involved in women’s issues and human rights issues, for twenty years, and is the recipient of the 1998 UN Human Rights Prize, which is awarded once in five years to five human rights’ defenders, worldwide. She is also a trainer in gender issues and the integration of gender into human rights work. She has been commissioned to conduct regional workshops by FAO (in Nepal, 1997), by the Asian Forum on Human Rights and Development (in Thailand and in Sri Lanka in 1997), by the Global Alliance against Trafficking in Women (in Kampala in 1997), and by IWRAW Asia-Pacific (in Philippines in 1996). She also prepared a Background Paper for the UN Expert Group Meeting on Integrating Women’s Human Rights.

Akhtar Imam is by profession a Barrister-at-law and Advocate in the Supreme Court of Bangladesh. He was called to the bar at Lincoln’s Inn, 1970, and practised in London till 1979. He has also taught law at the University of Dhaka for a number of years, as well as in colleges and institutes in London. He is Chairman of the Marie Stopes Clinic Society, a Bangladeshi NGO affiliated to Marie Stopes International, UK, working actively in the area of reproductive health, including STDs and HIV/AIDS. He is an active Rotarian and President-Elect of one of the noted Rotary Clubs of Dhaka city.

Dr.Mallika Sarabhai has an MBA from the Indian Institute of Management Administration, Ahmedabad, and a doctorate in Organisational Behaviour from Gujarat University. Her career is multidimensional and includes films, dance, theatre, television, choreography, direction of films, and publications. Since 1997 she has been a lead soloist dancer at the Darpana Academy of Performing Arts, specialising in Bharatnatyam and Kuchipudi, and has given dance performances all over the world.

Dr.Sarabhai is a member of the Citizen’s Commission for National Issues and has been bestowed with many awards and honours, including:

Doctor of Letter, honoris cause, by the University of East Anglia, U.K., Ojaswini Woman of the Year, 1998, and Chevalier des Palmes Academiques, by the government of France, in 1999.