Marginalised
Populations
http://www.nhrc.nic.in/report_hiv-aids.htm
§
Revise and
reformulate laws and processes (such as Section 377 of the Indian Penal
Code and the NDPS Act)
to enable the empowerment of marginalised populations and reach them
with HIV/AIDS prevention messages as well as care and support
mechanisms.
§
The revision of
the legislation must seek to mitigate the socio-economic factors that
cause people’s marginalisation as well as unsafe practices.
§
Legalise any
sexual activities undertaken with consent between adults, and in
connection with this adopt a clearly defined age for sexual consent.
§
Legitimise and
expand innovative harm reduction programmes to reduce harmful practices
including needle exchange and unsafe sexual activities, and expand
condom distribution among all marginalised populations.
General
- A comprehensive strategy to
prevent and control HIV-AIDS should combine a population based
approach of education and awareness enhancement with strategies for
early detection and effective protection of persons at high risk.
- An Action Plan for
implementation of these recommendations should be developed with focus
on specific areas of action and prioritised sequencing of
recommendations for early implementation within each of them. This may
be done through a working group comprising of representatives from the
NHRC, Ministry of Health and Family Welfare, Government of India and
UNAIDS who will identify the pathways of action and the agencies for
implementation.
Introduction
Background
and Objectives
The first ‘National Conference
on Human Rights and HIV/AIDS’ was held in New Delhi on 24-25 November
2000. The conference was aimed at initiating a dialogue between
concerned agencies and groups on the linkage between Human Rights and
HIV/AIDS prevention and management.
India has 3.86 million
people living with HIV/AIDS, the highest in any country after South
Africa. HIV in India is mainly transmitted through heterosexual contacts
placing large parts of the population at risk of infection. The stigma
surrounding HIV/AIDS, and certain vulnerable groups affected such as
injecting drug users, often leads to discrimination, which constitutes a
serious obstacle to HIV/AIDS control and management. It has been
established that understanding of Human Rights issues enhances
protection against HIV on both the individual and community level. At
the same time, promotion and protection of Human Rights as a central
component of the response to HIV/AIDS makes people and communities less
vulnerable to HIV/AIDS and mitigates the impact on affected and infected
persons.
Organised by the National Human
Rights Commission (NHRC) in collaboration with the National AIDS Control
Organisation (NACO), Lawyers Collective, UNICEF and UNAIDS, the
conference brought together Members of the NHRC and State Human Rights
Commissions (SHRC), officers from NACO and State AIDS Control Societies
(SACS), Inspectors General of Police in-charge of the Human Rights
Cells, UN agencies, NGOs, People Living with HIV/AIDS, and Human Rights
activists.
The objectives of the conference
were to:
(i) Discuss and identify major
issues in the HIV/AIDS related Human Rights framework
(ii) Build linkages between SHRC
and SACS
(iii) Identify future
interventions to create an enabling environment at various levels, and
(iv) Delineate measures to expand the response within a Rights-based
approach.
The conference was part of a
series of consultations on “Health and Human Rights” planned by the NHRC,
which elicited broad-based participation (including the Chairperson and
members of NHRC) and enabled participants to scrutinise the status of
HIV/AIDS protection, control and healthcare within the framework of
Human Rights. Partnering groups and individuals were able to fully
consider the immense value of recognising, promoting and protecting
Human Rights, creating an enabling environment, and recognising the
central role of law as essential components of the response strategies
to prevent and manage HIV/AIDS in India.
Consultative Process
The background
materials used as basis for the conference group discussions were the
product of a consultative process. A variety of stakeholders were
consulted to spell out the key issues governing ethics, law, and Human
Rights in relation to HIV/AIDS. All background materials were
distributed twice prior to the conference to a number of experts and
consultants all over India, including NACO and NHRC, for comments and
input. The invaluable feedback from this process has been carefully
considered and incorporated to the extent possible.
The papers on
Consent and Testing, Confidentiality, Discrimination in Health Care and
Employment
were written on the basis of the information and experiences shared
during a consultation jointly held with PWHA, health care workers, AIDS
Service Organisations (ASOs), Non Governmental Organisations (NGOs),
counsellors, trade unionists, Mumbai District AIDS Control Society,
UNAIDS and representatives of the legal community (Mumbai). The paper on
Women
was based on the same process as described above, but was complemented
with additional interviews and consultations with women’s NGOs, health
care workers, lawyers, UNIFEM
and UNICEF staff. (Mumbai and Jaipur).
Children and Young People
and
their vulnerability to HIV was mainly a research product, based on UN
documents, national and international data, conference reports and
doctrine. Three background papers were based on reports and feedback
from meetings and conferences: A report from the national meet launching
the ‘National Forum for Advocacy and Support for Sex Workers’ (Chennai,
28-30 April 2000), served as basis for the backgrounder on
Sex Workers’
vulnerability to HIV/AIDS. The paper on
People Infected/Affected
was based on the 1999 Needs Assessment Study of People Living With
HIV/AIDS conducted by INP+,
as well as the INP+ Strategic Plan for 2000-2002, while the
vulnerabilities of
Sexual Minorities
were discussed mainly on the basis of a conference held in May 2000
organised by the Humsafar Centre, Mumbai (‘Looking into the next
Millennium’). The paper on
Injecting Drug Users
was largely based on the information and experience shared by NGO
representatives from Manipur and Delhi during a consultation held in
Delhi.
Recount
of the Proceedings
The
Inaugural Session
The inaugural session pointed to
a clear link between Human Rights, HIV/AIDS, and Development. It
emphasized the necessity for harmonization between individual rights and
community interests, ready access to drugs as an assertion of Human
Rights, and the involvement of civil society and central and State
governments in the response to HIV/AIDS.
Shri N. Gopalaswami, Secretary
General of the NHRC, welcomed the guests and participants.The Union
Minister of Law, Justice and Company Affairs, Shri Arun Jaitley
inaugurated the Conference. Justice Shri JS Verma, Chairperson of the
NHRC presided over the function. Shri Javed Ahmed Choudhary, Secretary
(Health), Ministry of Health and Family Welfare and Dr Brenda Mc
Sweeney, UN Resident Co-ordinator addressed the Conference and
articulated issues that provided a basis for the deliberations over the
next two days.
Shri Javed Choudhary emphasised
that respect for Human Rights is important in the management of any
disease, and a balance needs to be found between individual rights and
community rights. On the issue of access to drugs, he suggested
international support should focus on enabling purchase of patents of
drugs instead of disease control programmes. He also pointed to a need
for much greater investment in vaccine research. With respect to groups
in vulnerable situations such as sex work, he stated there is a need for
the recognition and acceptance of the existence of such contexts. He
felt that the opposition to such recognition was misplaced in as much as
it did not consider the contextual realities.
Dr Brenda McSweeney expressed a
sense of happiness that HIV is finally being viewed within the Rights
framework. She considered the decentralisation of the national programme
as a positive development. She articulated three significant issues in
the HIV/AIDS context. Firstly, she pointed out that the HIV/AIDS
epidemic is a development issue and focus needs to be brought on issues
of gender, mobility, economics and marginalisation. Secondly, HIV/AIDS
is significantly different from other diseases because of the stigma and
discrimination attached to it. Pointing to the seriousness of ostracism
in health services and employment, she emphasised that the right to
dignity should be central in the response to the epidemic. Finally, she
emphasised the significance of a proper system of law and ethics in the
HIV/AIDS context. While pointing out that the present international
guidelines were based on experiences worldwide, she cautioned the
gathering that the contextual sensitivity of these guidelines should be
tested. At the same time, she stated that the rights of every group
affected by the epidemic need to be recognised and respected, and any
coercive action would be counterproductive.
In his inaugural address, Shri
Arun Jaitley first outlined the progress of the human rights movement
and the development in the conceptualisation of rights. He opined that
the meaning and content of rights have been fine-tuned in the last two
decades to a commendable extent, whereby today we find that rights have
specific meanings and are not merely abstractions. Shri Jaitley went on
to identify a few of the significant and contentious legal issues that
have been raised in the HIV/AIDS context, which include confidentiality,
consent in testing, and the right to marry. Recognising that the
interests of the community and the individual’s rights both need to be
respected, he urged more debate on these issues. In the context of
consent to testing, he suggested that the element of persuasion would
clearly be essential in the legal response but that it may not be
sufficient, considering the population of the country. Finally, Shri
Jaitley pointed out that other legal and policy issues that need greater
focus in the HIV/AIDS context include information and broadcasting,
fundamental rights and economics.
Justice Verma, in his
presidential address, emphasised that HIV/AIDS is one of the most
pressing Human Rights issues. He said that the right to health under
Article 21 of the Constitution puts a responsibility on the State to
devise a response. At the same time, he pointed out that the
responsibility was not the State’s alone, the involvement of the
community was equally important. In addition to the Constitutional
mandate of protecting fundamental rights, Justice Verma pointed to the
international obligations that apply in dealing with the problem. The
focus of the State’s response, Justice Verma stated, must be two-fold.
The first objective should be to ensure that there is no more
transmission of HIV infection, and the second to ensure that drugs are
available. He further pointed out that it is time for the dialogue and
activity around these issues to shift from conference rooms to the
streets. He suggested that interventions, including those by NGOs, must
be sensitive to the cultural context and each step should be
strategically decided so that it is not counterproductive.
The
Plenary Presentations
Additional Secretary of Health and
Project Director of the National AIDS Control Organisation (NACO), Mr
JVR Prasada Rao, offered an overview of the HIV/AIDS scenario in India.
The priorities of the Response to HIV/AIDS are outlined in Phase II of
the National AIDS Control Programme (NACP II). It has the twin goals of
reducing the transmission of HIV, and increasing India’s capacity to
respond to the epidemic. Based on epidemiological observations, the
programme focuses on preventive strategies in States with low-level
epidemics, while dual strategy of prevention and control is the focus in
the remaining States.
The plenary presentation on the
global situation by Mr Gordon Alexander, Senior Country Programme
Adviser for UNAIDS India, provided a useful perspective for the
participants on the urgency of the situation, the importance of drawing
on lessons learnt in other countries, and the urgency to identify Indian
solutions -now.
Reading out a letter to a friend
and HIV/AIDS activist Dominic D’Souza, Mr Anand Grover, Lawyers
Collective, highlighted the importance of law and promotion of human
rights to effectively control the spread of HIV/AIDS. He also urged the
participants to empathise with people living with HIV/AIDS, and act
humanely but urgently to stem the spread of the epidemic.
Group
Discussions
Professionals, experts and
activists with extensive experience on HIV/AIDS from within the national
and State governments, academic institutions as well as from civil
society deliberated on the critical issues to be addressed along two
broad themes: issues crosscutting HIV/AIDS and Human Rights issues, and
those relating to vulnerable groups and environments. The first day of
group deliberations was devoted to Human Rights issues within the public
health framework especially for those affected by HIV, and issues of
informed voluntary consent and testing, confidentiality, and
discrimination in employment. Marginalized groups such as women in
vulnerable environments, children and young people, people living with
HIV/AIDS, and discrimination affecting marginalized communities were the
focus of deliberations during the second day of the conference.
Consent
and Testing
The Human Rights issues
identified by the group regarding the problem area of ‘Consent and
Testing’ included the right to health and safety, the right to
information, the right to make autonomous choices without coercion, the
right to refuse, and informed consent for testing including counselling
procedures. An initial discussion on the right to self-autonomy
identified the basic principles of and established guidelines to
biomedical ethics, the code of conduct for physicians and researchers,
as well as justice, beneficence – non-malfeasance and other principles,
required in support of the right.
The
group started by discussing consent to testing in the blood bank
setting where both the donor’s and recipient’s rights need to be
considered. It was argued that the safety of the recipient and not the
status of the donor should be the primary concern in a blood bank, and
counselling centres need to be set up if the blood bank’s duty is to
extend to informing donors of their HIV status.
The
extent to which facilities for voluntary testing should be made
available was also discussed. Recognising the added value of HIV testing
as a source of knowledge that can be beneficial to both the individual
and the community, the group agreed upon the optimal situation in which
every citizen should have access to voluntary testing. Also, it would
give the individual the autonomy, to choose whether or not to undergo
testing. Not allowing the individual to make informed autonomous choices
would be a violation of the right to self-autonomy. The group expressed
concern over a concept of diminished autonomy applied in the case of
women, children, mentally disadvantaged prisoners, refugees, and ethnic
groups. It questioned the right of others to give consent on their
behalf.
The group felt that a
comprehensive protocol is needed. For testing in the hospital setting,
the opinion that consent to testing should be applicable to all medical
interventions and not only to HIV tests prevailed. There was also a
discussion on the need to differ from normal hospital care settings and
emergency settings in the context of universal precautions and the
window period.
The
group further discussed the advantages of respecting consent to testing.
As stigma is attached to HIV status, people do not come forward for
testing. A conducive and enabling environment should be present for this
to happen. This entails preparation of the patient both physically and
psychologically to face the trauma of social ostracism. Also, it would
include counselling on safe practices to prevent transmission. It was
felt that testing without consent should occur only in exceptional
cases, and that a comprehensive protocol regulating such testing is
needed, as well as awareness generation to prevent its non-intended use.
The major concern, however,
was the question of making rights operational and the issue of
strengthening infrastructure and training staff to enable them to know
when to use protection measures. For the operationalising of rights, the
provision of adequate time and information for the individual to enable
him/her to reflect and make an informed decision on testing was
considered a prerequisite. In addition, the need to obtain written
consent for research/drug testing was recognized.
Confidentiality
The starting point of the group
discussion was that HIV/AIDS is a Human Rights issue involving health
care and social problems. During the discussion, the group identified
several instances when breach of confidentiality actually makes both
prevention and management of HIV/AIDS difficult as such breach is not
covered by any law.
It was argued that to bring
both infected and affected persons closer to health care services,
confidentiality would need to be guaranteed. Otherwise, the risk is that
people will avoid health care services, and HIV/AIDS will remain beyond
the control of public health.
It was concluded that health
care professionals need more clarity through formal
guidelines/regulations as to when it is necessary to allow the release
of information on a patient’s sero-status. This might be in relation to
partner notification or in the interest of adequate further health care.
The group felt that respect for
confidentiality plays a paramount role in HIV/AIDS response as
guaranteed confidentiality motivates people to come forward and trust
health care services. Disclosure of HIV status should therefore only be
made in exceptional circumstances, to be specified in law.
Discrimination
in Health Care
The right to equal treatment
and the right to health are fundamental rights. Patients and care
providers must both be made aware of rights and risks of HIV/AIDS. An
anti-discrimination law covering not only public institutions, as
presently provided by the Constitution, but also private institutions
would be needed to ensure minimum standards of non-discrimination, and
to put all health care within the framework of the rule of law. For
both public and private institutions, providing safe working
conditions/universal precautions and PEP would encourage
non-discrimination, as would adequate supply of essential drugs. Ongoing
orientation and training of health care workers at all levels would be
useful to fight discrimination in the health care setting. There is no
valid reason why HIV/AIDS patients should be isolated or why they should
not have access to treatment provided for any other illness.
Role models in all disciplines
must be motivated and encouraged. It would be advisable for health care
professionals to train other health care professionals, as it would
strengthen their profession from within, and at the same time,
contribute to both de-stigmatisation as well as a more enabling
environment to manage HIV/AIDS in health care settings.
Another recommendation for
increasing the awareness and knowledge among health care professionals
about HIV/AIDS is for each State to set up a multi-sectoral consultative
body on HIV/AIDS in health care for advice and dissemination of
information to health care workers. Such a consultative body could
consist of members of State Human Rights Commissions, State AIDS Control
Societies, Directorates of Health Services, Human Rights Cells in Police
head quarters, PWHA, NGOs, Indian Medical Association (IMA), and the Law
Department. This body may also look into the overall Human Rights issues
relating to HIV/AIDS and suggest practical solutions.
People have very little
knowledge about HIV/AIDS and other STD. Information on HIV/AIDS could be
made available at all health care institutions – not only the ones
relevant to STD or ante natal care (ANC). This information should be
simple and practical and make the people aware of the risks and the
rights, if exposed or infected.
An additional way of dealing
with and eventually reducing discrimination that is based on HIV/AIDS,
would be to offer a legal framework which includes anti discrimination
clauses that have jurisdiction both in the public and private sphere and
are valid in both emergency and non-emergency situations.
At the same time, resources
should be made available for both State and private health care
institutions to ensure a safe working environment for health care
workers, so that they can contribute in the best way to the prevention
and management of HIV/AIDS. This should aim at non-isolation of HIV/AIDS
patients, a standard procedure for the protection of confidentiality of
sero-status, accessibility to treatment of opportunistic infections, as
well as anti-retroviral medication.
Discrimination in
Employment
Articles 14 and 16 of the
Constitution guarantee equal treatment before the law, but only have
jurisdiction in the public sector. Although one could argue that the
guarantee stretches into the private sector, more concrete legislation
on non-discrimination would be useful. There is need and a
constitutional obligation for the State to regulate the private sector
also.
The group identified several
urgent issues for discussion including (i) pre-employment testing, (ii)
sensitisation of employers (a positive climate has to be created among
corporate leaders), (iii) armed forces as a particularly vulnerable work
place, (iv) child labour, and (v) women in employment.
In the Indian HIV/AIDS
scenario, main work-place concerns were identified as follows:
a)
Pre-employment check-up: Should pre-employment
check-up be allowed, given the fact that it might lead to difficulty for
those not qualifying health-wise to earn a living (which is guaranteed
in the Constitution)? The group agreed that this scenario would
constitute discrimination and should be specially prohibited through
national and State legislation as well as within corporate
regulations.
b)
Routine health check-up: Should employers be
able to terminate the employee’s contract if a routine health check-up
reveals HIV status? The group agreed that it should not, and that
employment in spite of positive HIV status should be protected through
national and State legislation, as well as through corporate
regulations.
c)
Reasonable accommodation: The group agreed
that as reasonable accommodation is granted people affected by other
diseases,
it should be granted also in the case of HIV.
d)
Benefits to HIV positive employees and
families: As employees who suffer from other illnesses are entitled to
benefits such as provision of medical services and compensation of
medication expenditure by the employer, the same should be the
entitlement of employees suffering from HIV, and their families.
National and State legislation as well as corporate regulations should
guarantee these benefits.
e)
Treatment costs: There is most likely an
increased need among HIV positive employees to undergo different
treatments for opportunistic diseases. It would be advisable that the
costs of such treatment be subsidised by either the State or the
employer so that the employee can continue to serve the employer as well
as earn a living.
It was mentioned that the
employers already approached claim that the workforce and the police
will not allow HIV awareness in the workplace, as it touches upon
socially unaccepted topics. Finding ways of involving the workforce in
HIV prevention would be useful, although this would entail difficulties
due to the fact that only about five per cent of the workforce is
organised enough to be easily addressed.
The group felt that the presence
of representatives of the ministry of labour and the Confederation of
Indian Industry (CII) would have been most useful to the discussion.
Having these institutions on board as partners within the response
strategy is crucial to reaching out to the large mass of the Indian
workforce. The group was informed that complaints concerning
compassionate employment related to HIV/AIDS are already on the rise.
Confusion about, or lack of
information on, CII policy on HIV/AIDS was noted as a persistent
problem. Unless it is known, a policy cannot be implemented. The group
was informed that there are more than hundred laws related to the well
being of the workforce, or the standards of workplace, but they are
rarely implemented. A large reason for this is that there is no
awareness of the laws. A person’s right to such information could be
successfully conveyed through the media, as it is a good way to empower
groups. The cost of HIV to large and small companies would be useful to
know, to motivate employers to plan for the impact and consequences of
HIV/AIDS.
Affirmative action or positive
discrimination would be beneficial in the form of insurance benefits and
health care benefits, which is the norm with diseases other than
HIV/AIDS.
In
the long-term perspective, protecting against discrimination in
employment would make both the employers and the employees better
prepared for the future and to respond to HIV/AIDS.
Women in vulnerable
environments
Not
only are sex workers in vulnerable situations but also single women,
those living on the streets, married young women, college students,
female migrant workers, women survivors of sexual abuse and rape, etc.
There was discussion on the issues of poverty, sexual abuse, neglect of
the girl child, and forced marriages, which could result in girls being
trafficked into prostitution. Further, police harassment, denial of
health care and other services add to women’s vulnerabilities.
While HIV/AIDS is seen as a multi-sectoral issue, there are contentious
issues with respect to law, matrimonial relations, and female sexuality,
which are based on power structures and certain cultural sanctions
regulating women in society. Cross cutting issues of class, gender,
sexuality and poverty deprive women of their Human Rights. Silence
around issues of sex and sexuality, comes in the way of HIV related
education, making informed and responsible choices difficult. It also
contributes to sex workers being seen as aberrations, deviants and
dissidents, which heighten their vulnerabilities.
HIV/AIDS has also thrown up areas of conflict over rights such as
informed consent, confidentiality and partner notification, which work
differently for men and women. The gender dimensions in these areas need
further investigation, understanding, and tackling.
In
the group there were divergent opinions on sex work. This included the
terminology used to define it, the decriminalisation of
sex work, and the right of sex workers to organise. Some
expressed the view that prostitution, increasingly replaced by the term
sex work, is a derogatory term that violates human dignity and Human
Rights. They urged that laws that target men and pimps should be framed
instead of recognising sex work and the status of sex workers. The
majority of the group participants argued however that such an approach
would cause constraints on preventive and curative strategies adopted
for HIV/AIDS. Using concept of morality within HIV prevention strategies
results in the construction of women as good and bad, and shifts
attention away from sexual behaviours, attitudes and practices. If the
focus were premised on Human Rights, it would instead lead to
empowerment, which has proven useful in HIV prevention efforts.
The group discussed Human Rights
violations with reference to access to health care and treatment, access
to information, bodily integrity and violence against women, and made
the following recommendations:
- Right to information and
communication: Accurate messages on transmission should be available
to different categories of women. Information should not be moralistic
and must address both preventive and curative aspects. Information
about the costs of treatment, including treatment of STDs, drugs and
counselling should also be available. Different packages should be
evolved and available for different population groups.
2.
Right to association (form groups) and to work
collective for common issues should be fostered.
3.
Need to work with Men: There is urgent need to
remove the silence around sexuality and to challenge the culture of
shame and blame linked to issues of female and male sexuality,
contraception choice and women’s right to bodily integrity
4.
Legal changes for empowering women to achieve
equality: Laws governing property, marital rape, domestic violence and
other areas that perpetuate inequality need to be amended. There is need
to advocate for the Domestic Violence Bill and Marital Rape Bill.
5.
Decriminalise sex work and focus on the
perpetrators: The group noted that a Bill is pending on ITPA. There is
need to decriminalise the prostitute not prostitution. This would reduce
the harassment and atrocities against sex workers by police and law
enforcement agencies.
6.
Rehabilitation and reintegration of sex
workers: This needs to be done with their participation and
consultation.
7.
Education for life skills: This is necessary
in order to empower girls and women.
8.
Use of alternative media: For communication
and reaching out to as many groups as possible, effective use needs to
be made of alternative along with mainstream media.
Children and Young People
The
starting point of discussion at the session on children and young people
was that even though the rights of children have been articulated in the
Convention on the Rights of the Child (CRC), there is a need to change
law and strategy of intervention in such a way that children and young
people are seen as people capable of exercising their rights. In
this context, the following issues were debated:
·
Society’s obligation to children
·
Whether children have Rights and can demand Rights, specifically in the
context of the Right to information.
A link
between the inability to access Rights and vulnerability to HIV/AIDS was
emphasised. Discussions dealt with children’s right to information, and
making services, especially reproductive health services accessible and
available to them.
The right to information: It was stated
that:
·
Although the CRC recognises the right to
information of children, there is a low awareness of the existence and
content of the CRC amongst government officials and policy makers
·
The right to information is cardinal in the
context of HIV/AIDS, as it is seen that with information about sexual
health, the rates of sexually transmitted infections have gone down in
some groups of children.
·
There is a need for subsidisation of advocacy
and information dissemination by the Government.
·
There is too much focus on the electronic
media. Alternative channels of information dissemination that are
culturally suited for dissemination of information related to sex and
sexuality should be used. In this context it was suggested that the
right to information should be linked with the Right to education.
The strategy to realise the
right to information, especially in the context of HIV/AIDS should
address the many different contexts in which children live, such as
streets, villages, urban centres, schools, children involved in labour
etc. In this regard there is a need for a clear policy that recognises
the limitations of social viewing of TV programmes and of other modes of
information dissemination. Similarly, it is necessary to consider the
particular requirements of different contexts in designing the strategy.
For example, information dissemination to children living on the street
may be effective only through outreach programmes. It was also
recognised that the use of existing social structures, such as the
family, may be made to get information across to children in different
settings.
The
policy should be clear as to what age group of children is targeted and
the language and information should be suited to the age. The policy
should be focussed on the various age groups beginning with the youngest
(between age 5 – 6).
On
information dissemination, some suggested modes include
telephone-counselling services, actual counselling, programmes through
educational institutions, etc.
It
was suggested that the media should be used as a connecting
agency that shares practical information (such as at which locations
services and information are available), rather than as an agency that
spreads mainly general messages. The group recognized that social
constraints hamper actual access to sensitive information: such as when
children/youth watch TV together with other family members who might
influence the information flow. A carefully structured strategy could
ensure that social constraints do not come in the way of children
accessing information and services.
Access to services: The following issues
were highlighted:
Children in various circumstances need access to a range of friendly
services, including health care, sexual health services, night shelters,
counselling, etc. There is a need to have structures in place to provide
support systems for children. Presently, health care services are not
suited to access by children, especially with respect to sexual health.
It is therefore necessary to make the present health care sector more
children friendly and at the same time create a series of appropriate
contact points that are children and young people friendly.
There is a need for a co-ordinated response to children’s health needs,
especially in situations such as child sexual abuse. In this context it
was suggested that paediatric wings should have special facilities to
deal with Child Sexual Abuse that would make single point services such
as counselling, health care, legal assistance, etc., available to the
child.
Other legal issues:
The
Juvenile Justice Act (JJA) was discussed along with its limitations. The
Juvenile Justice System presently focuses on the institutionalisation of
neglected children. This strategy has been seen to be ineffective and
has given rise to the perception amongst children that the State is an
enemy. It was felt that the JJA is sorely inadequate and needs to be
reviewed in order to facilitate the shift to alternate methods of
providing care (non-custodial care). In this regard, the ‘Juvenile
Justice (Care and Protection of Children) Bill 2000’, (which has since
been passed by the parliament and has received the assent of the
President) was mentioned.
There is a need for a comprehensive law to deal with child sexual abuse.
Such a law should cover sexual abuse of boys as well as girls.
Presently, it is only the rape laws and the provision dealing with
sodomy that provides criminal sanction to sexual abuse. These
substantive laws and the procedural laws, such as the Indian Evidence
Act and the Code of Criminal Procedure, are inadequate and inappropriate
in dealing with cases of child sexual abuse. Along with the new law,
systems must be put in place to provide support and services.
There is a need to make legal remedies accessible to children, to
empower them to demand their rights. This would include, among others,
the recognition of children as capable of giving valid consent.
Representatives from the medical sector raised the issue of young
people's capacity to give valid consent to an HIV test. In the absence
of the recognition of the capacity of a young person to give valid
consent, consent has to be taken from the legal guardian. This implies
that a young person who may have information about HIV and would like to
get tested would not be in a position to do so without the guardian’s
approval. This has serious implications for willingness to get tested
and access to services by adolescents. This issue also has implications
for the right to confidentiality. There is need for a clear policy to
deal with this dilemma.
Respecting Human Rights
- crucial in dealing with HIV/AIDS
‘Respect for Human Rights helps to reduce
vulnerability to HIV/AIDS, to ensure that those living with or
affected by HIV/AIDS live a life of dignity without discrimination and
to alleviate the personal and societal impact of HIV infection.
Conversely, violations of Human Rights are primary forces in the
spread of HIV/AIDS. … Implementing a Human Rights approach is an
essential step in dealing with this catastrophic threat to human
development.’
Acronyms and
Abbreviations
AIDS Acquired Immune Deficiency
Syndrome
ASO
AIDS Service Organisation
ANC Ante Natal Care
AZT Zidovudine
CDC
Centre for Disease Control (in Atlanta, USA)
CII
Confederation of Indian Industry
CRC Convention
on the Rights of the Child, 1989
CEDAW International
Convention on the Elimination of All Forms of Discrimination Against
Women, 1979
HIV Human Immunodeficiency Virus
ICPD
International Conference on Population and Development, Cairo 1994
IEC
Information, Education and Communication
IDU
Injecting Drug Use [er, -ers]
IMA
Indian Medical Association
INP+
Indian Network for Positive People
IPC
Indian Penal Code
ITPA Immoral
Traffic in Women and Girls Prevention Act, 1986
JJA
Juvenile Justice Act
KNP+
Karnataka Network for Positive People
NACO
National AIDS Control Organisation
NDPS
Narcotic and Psychotropic Substances Act
NGO
Non Governmental Organisation
NFHS
National Family Health Survey
NHRC
National Human Rights Commission
OHCHR Office of the
[UN] High Commissioner for Human Rights
PEP Post Exposure Prophylaxis
PHC
Primary Health Care Centres
PWHA
Person/People Living with HIV/AIDS
RTI
Reproductive Tract Infections
SACS
State AIDS Control Societies
STD
Sexually Transmitted Disease
STI
Sexually Transmitted Infection
TB Tuberculosis
TRIPS Trade Related Aspects of
Intellectual Property Rights
(WTO Agreement)
UNAIDS
Joint United Nations Programme on
HIV/AIDS
UNHCHR United Nations High Commissioner
for Human Rights
UNICEF United Nations Children’s Fund
UNIFEM
United Nations Development Fund for Women
VCT
Voluntary Counselling and Testing
WTO
World Trade Organisation
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