Articles

Breaking the Barriers of Stigma and Discrimination: Dr. Edward Greene

Defining Human Rights
The UN High Level Political Declaration on HIV and AIDS (2011) embodies a number of human rights principles. It recognises the importance of eliminating stigma and discrimination against people living with, and affected by HIV. It aims to eliminate inequality and violence against women and girls and denial of sexual and reproductive rights. It calls for a review of laws that impede an effective HIV response. It supports actions leading to the repeal of punitive laws and the abandonment of approaches that affect key populations. These are all consistent with the principles embodied in the UN Universal Declaration for Human Rights (1948) to which all countries of the Caribbean subscribe.

PANCAP’s Human Rights Initiatives

Human Rights have been high on the PANCAP agenda for some time. It was, for example, recognized as an element of the accelerated HIV response in the very first Caribbean Regional Strategic Framework 2002-2006. The CIDA-funded programme on Ethics, law and Human Rights formed an integral part of the work programme of the PANCAP Coordinating Unit (PCU) and initiated the discussions on model legislation for adoption at country level. Human Rights featured again in the sub-regional consultations in Sint. Maarten and Saint Lucia and a regional consultation in Jamaica, and led to the PANCAP publication on Universal Access to HIV Prevention, Care and Treatment (2006). The recommendations in this document informed the positions taken by the CARICOM/PANCAP delegates to the United Nations General Assembly Special Session (UNGASS) on HIV, in June 2006. Issues on Human Rights were further highlighted in the Caribbean Regional Strategic Framework 2008-2012. The PANCAP Coordinating Unit spearheaded the production of this Framework, from which the model anti-legislation to promote the rights of the people with HIV and key populations was developed.  

A landmark however is the PANCAP Conference on eliminating stigma and discrimination through the novel initiative of Champions for Change. The conference held in St Kitts and Nevis in November 2004, brought together parliamentarians, representatives of the private sector, regional and international institutions, faith based organizations, media, sports and cultural icons and people living with HIV and AIDS. Its outcomes included a number of concrete recommendations such as “targeted” conferences for the media, faith based organizations and the judiciary, as well as the development of criteria for Champions. In this last regard, over the course of its “evolution” designated champions included: Prime Ministers, such as Owen Arthur, then Prime Minister of Barbados, cricket greats, such as Courtney Walsh and Clive Lloyd, calypsonian, The Mighty Gabby, media personality Barbara Gloudon, among others.

In September 2010,  a symposium jointly coordinated by UNAIDS, PANCAP/CARICOM and the University of the West Indies (UWI)  under the leadership of Sir George Alleyne, then UN Special Envoy for HIV in the Caribbean,  explored the varying components of human rights. Among its conclusions was that anchoring stigma and discrimination within the broader concept of Universal Human Rights, provided an expedient framework for achieving positive results.

What is briefly illustrated here, are the serious attempts by regional scholars, professionals, practitioners, activists, among others, to come to terms with the principles and practices of human rights.  The issue however is: to what extent has there been effective implementation of the policies highlighted in the various conversations, publications and declarations?  


Missed opportunities

The 2004 PANCAP-initiated Champions for Change initiative underpinned a vision for broadening the base of advocacy against stigma and discrimination. By incorporating a cross section of stakeholders as crucial allies to champion and spread the appropriate messages, it was anticipated that national and regional consciousness and responses to end HIV stigma and discrimination would be stimulated. In other words, champions would act as catalysts for change. This is fully illustrated by the regional private sector pledge to the 2004 conference which matured in 2005 with the launching of the Pan Caribbean Business Coalition for HIV and AIDS at the Fifth Annual General Meeting of PANCAP. It is also illustrated by the pledge of a development partner at that same 2004 conference, which was realized by a grant for the establishment of a Research Unit on Stigma and Discrimination in the Caribbean.

On this last issue, it would be remiss of me if I did not share my view that this Unit located in an “untested “NGO was misplaced. Aligned to a more accredited socio-economic research Unit in UWI as was intended, it would have provided an appropriate environment for this new genre of policy research. It would also have complemented training and capacity building for students, policy makers and other key practitioners including from Civil Society across the region.

There are other instances which, in my opinion, may be classified as missed opportunities to advance the human rights agenda. These include a failure to consolidate the mainstreaming of youth and media into the frontline of PANCAP’s strategic implementation. With respect to youth, one avenue for doing this was through to the continuation and expansion of the CARICOM Youth Ambassador-led  Mini Grants project aimed at building leadership capacity and response in youth-led NGOs.  The other more recent example was failing to fully capitalize on the opportunities provided by a cohesive partnership with media and in particular to use existing robust structures such as the CBMP to do so. This organisation’s sustained network of broadcasting partners (106 stations in 24 countries), with a daily commitment for broadcasting dedicated messages to reach diverse populations and its LIVE UP Brand is a significant mechanism for enhancing information education and communication that is far reaching. Its accelerated programmes with the social media and collaboration with key populations, in particular, the Caribbean Vulnerable Communities Coalition in its   planning and delivery of such programmes is on the right track. As I said before at the Fifth AGM of this body; “including the voice of the marginalized vulnerable and creating openness and innovation in the discussion on eliminating stigma and discrimination, may yet prove to be the biggest area where there is the greatest success. And it must continue.”

Taking Corrective Action: Confronting the hard issues

I anticipate that as UN special Envoy I could build on the work being undertaken by the PANCAP umbrella with the support of UNAIDS.  My work programme for 2012-2013, for example, places emphasis on an accelerated human rights agenda. Based on visits to Antigua and Barbuda, Barbados, Jamaica, St Kitts and Nevis and Saint Lucia, there has been support for the holding of national consultations on human rights with a view to eliminating stigma and discrimination. These consultations, to be spearheaded by the National HIV Councils in collaboration with faith based organizations and youth groups, will draw on the body of work carried out by the  PANCAP Coordinating Unit and UNAIDS. The immediate intention is to open up the debate on general issues such as mechanisms for removing the barriers to reducing stigma and discrimination and more specific ones such as laws criminalizing same sex sexual conduct.

This is a most appropriate time to confront the hard issues that must be resolved rather than “[swept]… under the carpet". Most  Heads of Governments, Ministers of Health and leaders of faith based organizations  with whom I  have spoken, welcomed this type of open discussion that could provide the basis for  action and, where possible, legal reforms and practices of tolerance.  In the final analysis, attitudes towards men who have sex with men tend to have a multiplier effect by creating a cultural crisis faced by other communities such as women, injecting drug users and sex workers. And this must be urgently addressed.
         

Breaking down the cultural barriers on human sexuality

The Lancet issue (July 2012) carried several articles which appropriately identified the optimism on the possibility of achieving an AIDS free generation. This view is supported by the results of a study which showed that early initiation of antiretroviral therapy reduced the risk of HIV transmission to unaffected partners by 96%. Findings like these are at the heart of the thrust of treatment as prevention. While this is good news, the countervailing views caution that basing policies solely on the results of  science may yet prove to be the “Achilles heel” of prevention and control. The high cost of the new drugs for example is one consideration. It excludes the poor and vulnerable groups from access, especially in developing countries.  Another is stigma and discrimination that fuels the spread of AIDS which  is largely based on cultural and moral factors. Hence, there is need to couple biomedical with behavioural research to achieve the most favorable results. By this I mean that elimination of stigma and discrimination can be achieved mainly by understanding and accepting diverse sexual behaviour among men and women. To achieve this goal requires breaking down the cultural barriers through information, education and communication about human sexuality. Unfortunately these are matters that people often wish to avoid.   

The passing of the UN Resolution to protect the rights of lesbians, gays, bisexuals and transgenders (LGBT) in June 2011 provides some impetus to breaking down the cultural barriers. It was accompanied by an instruction to the High Commissioner for Human Rights to document discriminatory laws around the world against people based on sexual orientation and gender identity. This is important in view of the fact that homosexuality is criminalized in seventy countries, five of which can impose the death penalty for this “offence” against the law.
 

Replacing Laws against sodomy with creative use of traditional law and legislative initiatives

The laws against sodomy violate international law. Most Caribbean countries, however, have retained criminalization of consensual sex between adult men in its statutes, a legacy of British colonialism dating back to the late 19th early 20th century. Britain abolished these laws approximately 20 years ago. Many studies show the negative effects of sustaining such laws including the fact that they are impediments to access to HIV prevention and treatment. This, combined by the persistence of anti-gay rhetoric, has helped to sustain homophobia and stigma leveled in particular against men who have sex with men. As late as 2004, the US President’s Emergency AIDS Relief (PEPFAR), imposed the conditionality of “abstinence” to qualify for its awards

A legitimate response comes from the recently released Report of the Global Commission on HIV and the Law, chaired by Dr. Fernando Cardoso, former President of Brazil.  This report called for the repeal of punitive laws against sodomy and for the enactment of laws that facilitate and enable effective responses to HIV prevention, care and treatment services. In this regard, the Commission recommended that advocates can creatively use traditional laws to promote such priorities as women’s rights and health and gender sensitive sexual assault law. It also proposed that legislative initiatives and court actions should be informed by fairness and pragmatism.  In so doing, the Commission argues that nations can shrug off “the yoke of misconceived criminalization”.
 

PANCAP at the Centre of the Strategy to Eliminate Stigma and Discrimination

PANCAP is no doubt preparing for the 3rd iteration of its Caribbean Regional Strategic Framework (CRSF).  The circumstances surrounding its development are vastly different from those that accompanied the versions of 2002 and 2008. In 2002, the emphasis was placed on  projects to support  institutional strenghtening of core Partners including: the Caribbean Epidemiological Centre (CAREC), the Caribbean Health Research Council ( CHRC), the Caribbean Network of PLWA (CRN+),  and  UWI, among others. In 2008, the shifts from projects to programmes and to regional public goods with impact at country level were prominent. This time, the emphasis will perhaps be on shared responsibility, given the context of financial constraints, and the changing structure of the Partnership. This  may well mean that  PANCAP will need to   revamp its strategic directions  to attract and then  maximise the responses of development partners.  The  PANCAP Coordinating Unit must continue to function as the hub of the network in collaoboration with core agencies such as Caribbean Vulnerable Communities Coalition (CVC), Caribbean Broadcasting Media Partnership against HIV (CBMP)  and the Caribbean Business Coalition; complementary agencies such as UNAIDS, PAHO and CARPHA,  and supporting agencies, mainly  governments of the Caribbean and development partners. This model revolves around the notion of collective leadership and is also committed to the revival of CRN+ as a critical component of the PANCAP hub. The importance of research and strategic information must also become hallmarks of the new CRSF.

It is in this context that PANCAP must take the initative to reverse the missed opportunities. This should include placing human rights  as a one of  major the priorities of the CRSF (2013-2018), actively  engaging  with countries in their national consultations on human rights, placing greater emphasis on partnership with faith based organisations, establishing a mechanism for monitoring and sanctioning discriminatory activities,  and expanding the range of stakeholders as  Champions for Change.

At the recently concluded retreat of UN Special Envoys for HIV held in Geneva, it was agreed that the Envoys from the Regions of Africa, Asia, the Caribbean, Eastern European and Central Asia would work jointly and in collborations with the Executive Director of UNAIDS to create synergies that cut across regional intersts and established linkages between regional and global priorities.  This new construction of solidarity was seen as a most expedient way of contributing towards an AIDS Free Generation.  It was agreed that the Caribbean would take the lead in the accelerated agenda for human rights with special reference to the goal of eliminating stigma and discrimination.  This is no “low hanging fruit” but a “big ticket” item.  It cannot be achieved without the fullest cooperations based on factual information, conciliatory dialogue and engagement of national, regional and international stakeholders within the PANCAP movement.  This can be an historic moment.  Indeed, new challenges and new directions beckon PANCAP.