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[Dear subscribers, please find another cross-post of the ongoing UNDP-run e-discussion on taking recommendations of the Global Commission on HIV and the Law forward.] 

Opportunities and strategies to address challenges and to further advance the recommendations of the Global Commission on HIV and the Law

[Facilitator’s note: Please find three contributions, received with thanks from Cheryl Overs, Michael Kirby Centre for Public Health and Human Rights, Australia; Allan Maleche, KELIN, Kenya; and a joint contribution from Amara Bou, UNDP Cambodia with Bob Verbruggen, Phauly Tea, and Narmada Acharya, UNAIDS Cambodia to phase 1 and 2 of the e-discussion on “The Global Commission on HIV and the Law – Taking the Commission’s Recommendations Forward”. We welcome your contributions which can be posted online here, or alternatively via email to hivlawdiscussion@unteamworks.org. Kindly note that the discussion platform is publicly accessible. This e-discussion is organized by UNDP’s HIV, Health and Development-Net and the Network for UNDP’s Partnership with the Global Fund, and cross-posted on the UN Human Rights Policy Network – HuriTALK, DGP-Net, Gender-Net, the Asia Pacific Community of Practice on HIV, Gender and Human Rights (HIV-APCoP), the joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia (JUNIMA), the UNICEF HIV/AIDS Community of Practice, the Interagency Task Team HIV and Young People Community of Practice and the Global Commission on HIV and the Law mailing list. Thank you.]


Cheryl Overs, Michael Kirby Centre for Public Health and Human Rights, Australia:

What are examples of innovative or non-traditional partnerships that can be used to strategically advance human-rights based responses to HIV and to address some of the challenges that have been identified in the first phase of the discussion?

Although we haven't seen a rash of states decriminalising sex work in the wake of the Commission's recommendations I am certain it has been a gamechanger - or at least a tone changer. It has shifted the debate by giving an authoritative voice to sound arguments for law reform and provided a much needed tool that advocates locally, nationally and regionally are using in the long term struggle for sex workers rights that Meena Seshu described. Having said that, we all know that pressing short term problems continue in jurisdictions in which legislative reform of the criminal law is not feasible (including some in which it might not make much difference anyway).

However little information is available about law and policy reform that has worked locally although there are many examples including issuing identity documents to sex workers, changing the way evidence is collected and dealt with and allowing sex workers to claim pensions. Some of these seem to be very effective without attracting the same level of controversy as decriminalisation. For me a key way to advance the recommendations of the Commission is therefore to continue to develop a map of the law and its impact on sex workers globally with additional emphasis on local reform and administrative law. I have written more extensively about this in an article, Toward a legal framework that promotes and protects sex workers' health and human rights published earlier this year in Health and Human Rights.

Thank you,

Cheryl Overs
Senior Research Fellow
Michael Kirby Centre for Public Health and Human Rights
Melbourne, Australia.


Allan Maleche, KELIN, Kenya:

What actions have been taken in your country to follow-up on the findings and recommendations of the Commission or to promote an enabling legal environment for AIDS responses? What good practices or lessons have emerged from these activities?

Last week we held a three day regional capacity building workshop in Nairobi for senior police and prison officials. The workshop was done in parntnerhship with UNDP-Kenya and it sought to discuss matters relatign to HIV and the law. A news item on the workshop is availabe at http://kelinkenya.org/2013/07/law-enforcers-from-six-countries-commit-to... we welcome everyone to share their comments.

We have previously trained lawyers, healthcare workers and people living wtih HIV on matters realting to HIV and the law. Some of the  trainied participants including men who have sex with men, injecting drug users and sexworkers have participated in our consequent forums and  served as panelist to share thier perspective of why human rights is important and how its affectes thier ability to life a dignified life if not upheld.
Later in October and November we will be having dialgoues with Judges and Magaistrates on their role in taking forward the findings of the Global Commisson on Law and HIV.

Allan Maleche| Executive Director

Kindaruma Road │P O Box 112 - 00200 KNH Nrb, 
Tel: 020 386 1596, 2515790 │Mobile: 0717 261 408
Fax: 020 386 1390 │ E-mail: amaleche@kelinkenya.org 
Website: www.kelinkenya.org


Amara Bou, UNDP Cambodia; Bob Verbruggen, UNAIDS Cambodia, Phauly Tea, UNAIDS Cambodia, and Narmada Acharya, UNAIDS Cambodia:

What actions have been taken in your country to follow-up on the findings and recommendations of the Commission or to promote an enabling legal environment for AIDS responses? What good practices or lessons have emerged from these activities?

Cambodia is a signatory to the Economic and Social Commission for Asia and the Pacific (ESCAP) resolution (66 and 67):  Cambodia has agreed with the ESCAP Resolution 66-10, which calls on States to “ground universal access in human rights and undertake measures to address stigma and discrimination, as well as policy and legal barriers to effective HIV responses, in particular with regard to key affected populations.” Likewise, it has also signed ESCAP Resolutions 67-9, which required States to recall the “Human Rights Council resolution 16/28 of 25 March 2011 on the protection of human rights in the context of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)”. Responding to this commitment, a review of the Legal and Policy Framework and multi-stakeholder dialogue towards creating an enabling environment is scheduled to take place in September- November 2013.

The activities conducted towards meeting the recommendation of the Commission on HIV and the Law report in Cambodia, are described below:

  1. Dissemination of the report of the global commission on “HIV and the Law: Risks, Rights and Health,”: The report of the Global Commission on HIV and Law was widely disseminated to relevant stakeholders in the Government; Civil Society; NGOs working on HIV; NGOs working on Human Rights and Legal aid; development partners; community networks of key affected populations; business coalitions as well as the United Nations family.
  2. A five year National Action Plan on Prevention of Violence against Women (NAP-VAW 2013-2017) has been developed by Ministry of Women Affairs (MOWA). UN Women, UNDP and UNAIDS provided a substantial amount of technical  input in integrating the needs of the key affected women including Sex Workers, female persons who use drugs, transgender women and women living with HIV. This resulted in the MOWA including these populations for the first time - in their definition of “women at a higher risk for Bender-based Violence (GBV)”. This articulates their special needs that require attention through policy, programme and legal environments and marks a significant stepping stone towards a sustainable way of addressing issues of key affected women in national plans on GBV.
  3. Dissemination of Explanatory Notes on Human Trafficking Law: The Explanatory Notes of the Law on Suppression of Human Trafficking & Sexual Exploitation (2008) was disseminated by the Ministry of Justice, with support from UNICEF. Relevant ministries, law enforcement institutions, international and local NGOs, Judges, prosecutors and representatives of key affected populations all participated in the event. The document intends to provide a clear and detailed explanation of  all 52 articles of the Law, which was enacted in 2008, whilst also mitigating  wrongful interpretations and implementation that have negatively impacted on access to HIV-related services by sex workers.
  4. A study on “An exploration of social exclusion of Lesbian, Gay and Transgender persons in families and communities has been conducted by the Social Protection Coordination United in the Council of Ministers, in some areas of Cambodia. The study shows that lesbian, gay, bisexual and transgender (LGBT) persons experience high levels of stigma, discrimination and exclusion in a variety of settings: the home, school, the workplace, health facilities as well as in public spaces.  They are subject to frequent gender‐based violence in both domestic spaces and workplaces. Other factors that can contribute to exclusion are poverty, illiteracy, lack of awareness regarding social protection mechanisms and how these can be accessed, some religious practices, cultural norms regarding gender, marital relations, family structure, and type of occupation (such as sex work).  However sexual orientation and gender identity (SOGI)‐based exclusion appears to be a major cross‐cutting feature that cannot be disregarded.
  5. Utilization of Stigma Index Report: The Report on Cambodian Stigma Index was disseminated in December 2012. The findings of the index have been utilized in advocacy efforts by the people living with HIV (PLHIV) communities as well as by policy makers. As a result, the findings of this report have informed the national standard operating procedure on treatment as prevention as well as subsequent review and survey. These findings are particularly significant as they conclusively show that HIV-related stigma and discrimination have direct implications on access to testing services, adherence to treatment and the quality of life of PLHIV. This report has been utilized for strategic evidence to inform policy and programme development and has simultaneously ensured evidence-and informed-based advocacy by PLHIV and community networks.
  6. Legal service for SWs: Community Legal service for sex workers was established and started operations in 2011 in Cambodia. The services were initiated in a joint partnership of UNAIDS/ILO/ OSI, AIDS FONDS, and the Michel Kirby Centre. The services reach more than 1200 sex workers in Phnom Penh, who are survivors of violence, and often arbitrarily arrested and detained. The rapid response team that was set up as part of the service, handles the immediate health and legal needs of these sex workers - including access to ARV and alternative dispute resolution services. As the result of their effectiveness, there is currently a motion to scale up these efforts through policies of the health programme and resource mobilisation in national proposals. The Police Community Partnership initiative complements the legal service by supporting and creating an enabling environment. 
  7. UNAIDS brochure on “Addressing Discrimination at country level” was translated into Khmer and disseminated widely to stakeholders.
  8.  Police Community Partnership Initiative (PCPI): Guided by the Ministry of Interior Strategic Plan (2008-2013), the Police Community Partnership Initiative (PCPI) was introduced in 2010 and has now been expanded to five provinces. It is aimed at creating an enabling environment to increase access to services of key affected populations (KAP), including sex workers, men who have sex with men, transgender people, and people who use drugs. Outcomes of the pilot include: improved police attitudes towards key populations, friendly involvement of police in coordinating and facilitating training sessions and related events, reduced fear of police among key populations and an increased care-and-service-seeking attitude.  Thus, there has been an increase in the utilization of services, there is better communication between the police and concerned partners, and there is confidence amongst entertainment establishment owners to cooperate with NGO partners in displaying and ensuring the availability of condoms in their venues. The initiative has been an integral part of the Cambodia 3.0 strategy towards achieving three zeros by 2020.  A plan for scaling up the initiative has been endorsed by the GFTAM.
  9. Boosted Continuum of Prevention to Care and Treatment (Boosted CoPCT)As part of the Cambodia 3.0 strategy, the Boosted Continuum of Prevention to Care and Treatment (Boosted CoPCT) constitutes one of the country’s strategies which aims to  maximize services delivery for KAP with special attention to those who run multiple risks. While a number of initiatives have  been introduced (i.e. integrated active case management, partner tracing, rapid testing, etc.) in order to ensure maximum coverage amongst these populations, the strategy also recognizes the importance of a human rights element and the special needs of KAP from the legal point of view. Such needs have been addressed (indirectly) through securing a good and peaceful environment (through PCPI as described above) in which KAP can come forward and obtain all (health and non-health) services they need.  Specific legal services will be covered by other partner organizations, USAID  in particular
  10. Review of Laws and Policies: HIV Law, Sex Wokers Law, Men who have Sex with Men etc: (UNDP Regional): UNDP Asia Pacific Regional Centre in Bangkok/Thailand, initiated a regional research project to review AIDS laws in Asia and the Pacific, Cambodia was included in this research. As part of the research process, UNDP Cambodia coordinated the inputs of the Joint Team ON HIV (JUTH) and provided joint technical inputs together with other agencies and organizations, as well as through local consultation.  Key important stakeholders included the National AIDS Authority, the UN joint team on HIV/AIDS, network of civil society working on HIV/AIDS (HACC), Cambodian People Living with HIV/AIDS Other Civil Society organizations including KHANA (who were closely engaged in formulating of the HIV/AIDS law in Cambodia) were consulted in this regional AIDS Laws review as well. This process also engaged these partners in legal areas related to HIV and helped them in broadening their understanding of HIV and its Laws better. The major concerns raised were the discrepancies between the law in paper and practice.
  11. Access to Generic Drugs: Since July 2012, the Ministry of Health (MOH), with support from the National Committee on Intellectual Property Rights (NCIPR), UNDP and UNAIDS, has developed a draft Law on Compulsory Licensing for Public Health. This was endorsed by senior members of the Ministries of Health and Commerce, and recently submitted to the Council of Ministers to be adopted by the National Assembly by mid-2014. The engagement between the Ministries of Health and Commerce on the issue of intellectual property rights and access to affordable generic medicine has also strengthened immeasurably, and augurs well for future policy dialogue and cooperation between health and trade. Furthermore, the Cambodian delegation at the WTO, following strong advocacy of the WHO, UNDP and UNAIDS to the Minister of Commerce, pushed for the extension of the transition period for Least Developed Countries (LDCs) for TRIPS compliance at the TRIPS Council meetings in 2012. This resulted in an extension of the TRIPS exemption period to July 2021.
  12. However, the Law on Patents, Utility Models and Industrial Design (2003) remains a significant threat to the long-term access to affordable generic medicines in Cambodia. This Law, and other procedural elements, go beyond the minimum standards set in the TRIPS Agreement (also known as ‘TRIPS+’) including criminalization of patent infringements and the existence of a “mailbox system”. The momentum gained from advocacy conducted during drafting the CL law and LDC extension will be leveraged in further advocacy in reviewing this draft Law. The UNDP and UNAIDS country offices have strongly engaged in advocacy, targeting the highest levels of government and Law makers - highlighting the need for cross-sectoral collaboration and policy coherence between health and trade.
  13. A review of Cambodia’s social protection schemes for incorporation of HIV sensitivity: Cambodia carried out a study on HIV-sensitivity social protection in Late 2012. While, many social protection schemes were meant to cover people living with HIV, particularly if they are poor, PLHIV and those affected by HIV still face barriers in accessing them.  Some of these barriers are specific to people affected by HIV such as HIV-related stigma and discrimination.  In addition to this study, joint advocacy efforts also has been made by UNDP, UNAIDS, ILO, WFP and UNICEF to bring together two key players of  HIV national programmes in order to create a policy dialogues towards ensuring HIV sensitivity of Social Protection implemented on the ground.
  14. Community groups of PLHIV and MARPs conducted various campaigns and events to raise awareness amongst different groups of stakeholders regarding their rights and demanding justice. Some the key events are described below:
  15. Dialogue with Law enforcement bodies (local authorities and police): Forum of Networks of PLHIV and MARPs (FONPAMs), an informal network of PLHIV and MARPs, organised a dialogue with Law Enforcement Bodies (Local Government authorities and Police) with the objective of strengthening their working relationship to promote and ensure access to HIV services by PLHIV and MARPs. The programme was supported by UNAIDS and hosted by the National AIDS Authority (NAA). Representatives of PLHIV, IDU, SWs and MSM/TG (key populations) raised their concerns to the local authorities and police and requested their support for improving access to the HIV services.  The local authorities and police personnel, who attend the programme, expressed their commitment to support the HIV programme from their level best. This has been considered an important positive step towards creating an enabling environment for key populations.
  16. “Know your rights” campaign: Community of Cambodian Women Living with HIV (CCW) organised a workshop on reproductive health (RH) services with women living with HIV and key affected women. These workshops were followed by advocacy measures to service providers, demanding full access to RH services for these populations. The campaign started in the Capital city and took place in another province in late 2012. In 2013 the campaign will be scaled up to ten provinces.
  17. LGBT Pride Week 2013 (12-19 May): The Cambodian LBGT community marked the pride week by organizing field trips, advocacy events, rallies, workshops on examining the anti-trafficking law impact on LBGT and provided community education outreach. The UN Country Team (UNCT) supported the campaign through a joint UN Op-Ed,  participating in selected events with  JUTH members and displaying the LGBT Rainbow flag at various  offices (UNAIDS and OHCHR). The activities were widely covered by the media and press releases were to be seen in both print and electronic sources.
  18. Representative of key affected populations advocated to relevant donors at donor embassies to protect Cambodia from trade related intellectual property rights,  promoting access to Anti Retro Viral Drugs (ARVs). 
  19. Community Leaders of Grassroots Organizations including LGBT groups organised a “Grassroots Organisations’ Campaign” from 13-24 June 2013 coinciding with the upcoming election campaign. The campaign seeks to raise attention on key issues faced by communities (LGBT, EWs, IDUs, and PLHIV and other marginalised people) among the public and with politicians. Several political leaders from the ruling and opposition parties attended the event and expressed their commitments to support this initiative.

Way forward:

Cambodia is committed to take the recommendations of the Commission on HIV and Law forward. Cambodia is planning to conduct a review of legal and policy frameworks with the recommendation of the Commission of HIV and the Law at the last quarter of 2013. This will be followed by a national stakeholder consultation, where all the relevant stakeholders will develop and agree on a specific action plan to be taken in order to address the gaps identified in the review.

The plan also includes advocating at a high political level, to senior level Government Officials; and the First Lady of Cambodia - who is also an Asia Pacific Leadership Forum Leader on HIV- and the National Champaign on the Secretary General’s action plan on Maternal and Child Health. This high level advocacy will be held by the special envoy to the Secretary General on HIV in the Asia Pacific, who also is a member of the Commission on HIV and The Law.

What are examples of innovative or non-traditional partnerships that can be used to strategically advance human-rights based responses to HIV and to address some of the challenges that have been identified in the first phase of the discussion?

First of all, the recommendation of the Commission should be fully understood by the duty bearers as well as the rights holders. For this, the UN should take special actions to disseminate the recommendations to various stakeholders.

Where the government is lagging behind is ensuring protective legal frameworks to the key affected populations. Then, accelerated actions towards strengthening the state’s accountability need to be taken. In the meantime, partnerships with human rights groups, as well as the law and justice sectors need to be further strengthened to fulfil the role of empowering rights holders to claim their rights and demand legal protection.  In case of discrimination, traditional mechanisms of conflict resolution and faith-based leaders are to be fully engaged to actively improve the situation through i.e. dispute resolution. The individuals that have leadership skills and can advocate for legal justice, should be mobilised to improve the relationship between leaders and the key affected populations.  Different opportunities available to strengthen partnerships in different countries can be explored, to engage in common HIV response.

In the context of an evolving development framework, what are the opportunities and challenges for maintaining attention to rights-based approaches to HIV and health?

HIV work needs to shift from a public health to a rights based approach. While working with the health sector is essential to sustain treatment initiatives, it is equally important to work with human rights; the gender sector as well as the finance and social sector to ensure rights based approach to HIV response. There are funding challenges with the partners to address HIV as a human rights issue, which is why the HIV sector should start mobilising resources to prepare, which there may be a need to link this sector with broader human rights funding. Donors also need to gradually shift away from projects to programmes. It is acknowledged that the human rights impact on HIV is not a small one, and no shortcuts can be taken: it might take much longer than in other fields, but donors should be willing to fund a comprehensive programme rather than solely picking up the areas that ensure (more) tangible results.

As part of sustaining livelihood of people living with HIV, Cambodia government is increasingly expanding of Social Protection system to ensure that national social protection services are accessible to those affected by, highly vulnerable to, and living with HIV.  

  • Amara Bou, Programme Analyst-HIV, UNDP Cambodia
  • Verbruggen Bob, Senior Strategic Information Adviser, UNAIDS Cambodia
  • Phauly Tea, MARPs adviser, UNAIDS Cambodia
  • Narmada Acharya, Social Mobilization Advisor, UNAIDS

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