Silenced and Forgotten: HIV and AIDS Agenda Setting Paper for Women Living with HIV, Sex Workers and LGBT individuals in Southern African and Indian Ocean States

The goal of this 16-page report is to share the outcome of a consultative process with women living with HIV (WLHIV), sex workers (SW), and lesbian, gay, bisexual and transgender (LGBT) individuals to develop a regional advocacy strategy on HIV and AIDS. As stated in the report, the impact of the HIV and AIDS epidemic is felt hardest by the individuals who are infected or affected by the disease, and in particular by individuals who are especially vulnerable to HIV infection due to stigma and discrimination, poverty, a lack of access to education, health and other services that promote HIV awareness.

For this reason, in October 2010, UN Women issued a call for proposals to work with three marginalised groups – namely women living with HIV (WLHIV), sex workers (SW), and lesbian, gay, bisexual and transgender (LGBT) individuals – to develop a regional advocacy strategy on HIV and AIDS. UN Women chose the Open Society Initiative for Southern Africa (OSISA) to conduct the work. The goal of the project was to build the capacity of WLHIV, SW, and LGBT groups to develop a regional action plan to address the specific and shared HIV and AIDS challenges that continue to confront them in ten southern African countries – Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe – and three Indian Ocean states – Comoros, Mauritius and Seychelles.

The following are some of the challenges presented by the three groups:

• Research and knowledge: There is a lack of evidence based and focused research outlining the situational needs of women living with HIV, sex workers, and LGBT individuals as well as lack of recognition of lesbian women and transgender people as groups that are vulnerable to HIV and AIDS. There is also an exclusion of women living with HIV, sex workers and lesbian, bisexual and transgender individuals from vital research around microbicides, reproductive cancers, HPV vaccines, and contraceptives.
• Legal frameworks and access to justice: Most countries in the region have laws that
  criminalise same sex conduct and sex work activities. Even if such activities are not explicitly outlawed, penal codes based on so-called ‘morality’, criminalise sexual relations that are regarded as 'immoral', 'indecent' or 'crimes against the laws of nature' and so forth.
• Access to health: Health service delivery systems do not recognise the diverse rights of women living with HIV, sex workers and LGBT individuals. Health service providers also lack training and sensitivity to the specific HIV care, treatment and support,
  and sexual reproductive health needs and rights of women living with HIV, sex workers and LGBT individuals – thereby making health care centres potential sites of exclusion, physical and emotional violence.
• Access to information and education: There is a lack of tailored information, education, and communication (IEC) material for women living with HIV, sex workers, and LGBT individuals. They also usually lack the space, representation, and participation within the information and education arenas to give legitimate voice to their communities. The media is often discriminatory, non-objective and biased, evidenced in its lack of – or negative – coverage of issues related to women living with HIV, sex workers and LGBT individuals, which further fuels stigma, discrimination, and prejudice against them; increases their vulnerability to HIV.
• Movement building and strengthening: The prevailing legal, cultural, social and religious contexts are major obstacles to movement building and strengthening for women living with HIV, sex workers, and LGBT individuals. For example, the marginalisation of women living with HIV, sex workers and LGBT individuals and organisations by the broader human rights, health and social movements impedes movement building and strengthening.
• Resource allocation and mobilisation: There is a lack of national government funding for women living with HIV, sex worker, and LGBT organisations with most of them not being included in country health programme budget allocations. In cases where funding does exist, the allocations are very minimal and insignificant. There is limited availability of and access to funds for women living with HIV, sex worker, and LGBT groups and organisations. There is also a lack of core support for women living with HIV, sex worker, and LGBT individuals and organisations, which leads to organisations being understaffed and inadequately resourced with key staffing skills and this negatively impacts on the execution of programmatic intervention.

The document includes, amongst others, the following recommendations for key stakeholders:

• Governments should: Review and repeal all laws that implicitly or explicitly criminalise HIV transmission and sex work, and where applicable enforce protective laws that already exist to end the marginalisation and exclusion of women living with HIV, sex workers, and LGBT individuals. They should also enact and implement laws and policies that create an enabling environment and ensure equal access to health and justice services. There is a need to invest in restructuring and capacity strengthening of health care delivery systems to respond to the specific health care needs of women living with HIV, sex workers, and LGBT individuals, as well as hold perpetrators of violence against these groups accountable for their crimes and enforce stiffer punishments.
• Civil society should: Advocate for laws/clauses in constitutions and other legislation that prohibit discrimination of any kind based on an individual's sex, gender, sexual orientation, HIV status, choice of profession or any other status. They should also advocate for evidence-based health programming that reduces HIV transmission and protects the sexual and reproductive health and rights of women living with HIV, sex workers and LGBT individuals and work with the media to respect and uphold the sexual and reproductive health and rights of these groups by objectively reporting on issues. The media should uphold ethics and strictly adhere to codes of conduct as prescribed in various national, regional, and international instruments. There is also a need to ensure mutual and meaningful partnerships exist between all social movements, particularly with women living with HIV, sex worker, and LGBT movements.
• UN Women should: Urge governments to repeal punitive laws, like the criminalisation of HIV transmission, sex work and adult consensual same sex relations, as well as ensure that programming on violence against women includes women living with HIV, sex workers, and LGBT individuals.
• Donors and International Partners should: Fund and support the transformation of the public health service so that it responds to the specific HIV treatment, care, and support needs of women living with HIV, sex workers, and LGBT individuals. This includes ensuring that
  funding for vital research around microbicides, reproductive cancers, HPV vaccines, and contraceptives includes women living with HIV, sex workers, lesbian and bisexual women, and transgender people.

The report concludes that development programmes work best when they reflect local realities and respond to both rights violations and lack of access to services. Basic and 'beyond basic' needs programming should be planned together from intervention design, with a clear step-by-step process to move from one to the other. A rights-based approach to programming is crucial for the achievement of long term and sustainable empowerment of marginalised groups.