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Amnesty International (AI) is calling for a human rights based approach to HIV/AIDS in all areas of prevention, treatment, care and support. This report on human rights and HIV/AIDS in the Dominican Republic and Guyana, highlights how human rights violations fuel the pandemic. Abuses of civil, political, cultural, economic and social rights increase people’s risk of HIV infection and those affected by HIV/AIDS are often denied their human rights. Where the human rights of people have been violated due to their actual or perceived HIV status the mechanisms to redress these violations are often inaccessible.
National responses to HIV/AIDS are increasingly determined by global health initiatives and guidelines, and financed by countries in the North and international agencies. In both the Dominican Republic and Guyana, donor governments and their policies have considerable influence over the response to HIV/AIDS, including on whether human rights obligations relating to HIV/AIDS are fulfilled.
AI believes that this is a crucial time in the fight against HIV/AIDS. Countries are scaling up efforts for universal access to prevention, treatment, care and support in an attempt to fulfil critical international commitments, such as the Millennium Development Goals and the Declaration of Commitment resulting from the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS in 2001. At this time of increased political momentum, AI believes that it is vital to establish the relevance of respect for human rights in these initiatives and endeavours to halt the HIV/AIDS pandemic.
The Caribbean has the second highest HIV/AIDS prevalence rate after sub-Saharan Africa. Despite national universal treatment programmes for HIV/AIDS in the Dominican Republic and Guyana many people lack access to HIV/AIDS related medication and health services. In the Dominican Republic the government acknowledges that nearly 70 per cent of all people requiring antiretroviral treatment are not receiving it, despite a grant from the Global Fund to Fight AIDS, TB and Malaria. Amnesty International encountered many cases of people unaware that treatment existed, or unable to access treatment because of the lack of essential health services in many areas.
In Guyana, HIV-related stigma and discrimination, including against men who have sex with men, pose a key barrier to HIV/AIDS related prevention, treatment and care, and is exacerbated by a lack of privacy and confidentiality. In many cases people living with HIV/AIDS fear ostracization which can lead to being forced to leave their community. Many try to hide their status by seeking treatment in a hospital far from where they live, complicating the cost and continuity of their treatment.
AI found that it is mainly the poor and marginalized – including Haitian migrants and Dominicans of Haitian descent, and the indigenous Amerindian population in Guyana -- that lack access to essential HIV/AIDS related medication, such as anti-retroviral treatment, and sometimes basic health services necessary to treat opportunistic infections.
In both countries, women, young people and whole communities lack access to adequate HIV/AIDS prevention methods, including comprehensive information, sex education and preventative tools that would help them to protect themselves from infection. Condoms are an essential tool in preventing new HIV infections, however in both Guyana and the Dominican Republic these are not readily and easily available since both religious groups and US donors have insisted on a strategy of abstinence and fidelity. AI believes the emphasis on abstinence and fidelity can be no substitute for effective safeguards that protect against HIV infection and fears that many lives are being lost unnecessarily in the Dominican Republic and Guyana because simple forms of protection and information on sexual health are not easily available. AI is especially concerned about the impact this approach has on the young.
Women are often more vulnerable to human rights abuses relating to HIV/AIDS, including sexual violence. In the Dominican Republic and Guyana, Amnesty International met several women that had been infected by a long-term partner or husband to whom they had been faithful.
HIV testing within Prevention of Mother to Child Transmission (PMTCT) programmes often means disproportionately more numbers of women than men test for HIV, are aware of their status and have to reveal it in a partnership or marriage. Women often face blame and or violence when they disclose their HIV status to their partners or husbands. In Guyana medical staff reported a number of cases of women not disclosing their HIV status to their husbands or partners for fear of the violence they might face.
Participation by civil society, including people living with HIV/AIDS, in the key national decision-making bodies relating to the HIV/AIDS pandemic is limited. This affects the effectiveness of prevention, treatment and care and support efforts by failing to integrate and address the specific needs of affected groups.
The right to privacy and confidentiality is insufficiently protected in the Dominican Republic and Guyana, but is vital to ensure that more people come forward to test for HIV and receive HIV/AIDS related treatment and care. Amnesty International’s report discusses a number of cases where confidentiality of a patient’s HIV status was not properly protected and the different repercussions that had, including dismissal from employment, on the basis of a person’s HIV status.
While Amnesty International recognizes the inroads made by both governments in their response to the challenge of HIV/AIDS, serious concerns relating to human rights and HIV/AIDS persist. Amnesty International is making recommendations to the governments of the two focus countries that the organization hopes will help contribute to a successful response to HIV/AIDS.
In the Dominican Republic Amnesty International urges the Presidential Commission on HIV/AIDS, COPRESIDA, to take immediate steps to ensure that all people in the Dominican Republic, including Haitian migrants and Dominicans of Haitian descent, have access to antiretroviral medicines and treatment for opportunistic infections, and work on developing a long-term strategy to ensure the sustainability of the HIV/AIDS treatment programme in the Dominican Republic.
Amnesty International is calling on the government of Guyana to ensure access to treatment for HIV/AIDS for the whole population, particularly people living in the hinterland, the indigenous Amerindian population, women and children.
In addition, Amnesty International is calling on all governments, including donors to:
Ensure that efforts to respond to HIV/AIDS respect, protect and fulfil human rights, particularly the right to health and the rights of women, and the provisions outlined in the UN Charter and the World Health Organisation Constitution.
Ensure that all funding provided to support the response to HIV/AIDS complies with international human rights obligations of both recipient and donor governments.
Affirm commitment to the United Nations International Guidelines on HIV/AIDS and Human Rights and ensure design and implementation of responses to HIV/AIDS is in accordance with the guidance summarized in these.
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This report summarizes a 56-page document (20,450 words), (AI Index: AMR01/002/2006) issued by Amnesty International in May,31st 2006. Anyone wishing further details or to take action on this issue should consult the full document. An extensive range of our materials on this and other subjects is available at http://www.amnesty.org and Amnesty International news releases can be received by email:
http://www.amnesty.org/email/email_updates.html
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