SUMMARY REPORT

of Online Consultation on
What Strategies would you prioritise to address the needs and rights of key affected women and girls in HIV and AIDS programmes?

BACKGROUND
Most countries in the Asia Pacific region are experiencing concentrated epidemics, with men who have sex with men (MSM), sex workers (SW) and their clients, and people using drugs (PUD) identified as the key affected populations (KAPs). Programmes for KAPs should be designed to include women and girls such as female drug users, female and transgender sex workers and female partners of MSM, PUD, sex workers and PLHIV. For example, women and girls have specific sexual and reproductive health needs that are often not sufficiently addressed in HIV and AIDS programmes. Furthermore, key affected women and girls lack opportunity and support to have their voices heard. In order to ensure more attention to women and girls at ICAAP and beyond, the Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA), Citizen News Service (CNS) and SEA-AIDS eForum Resource Team facilitated an online consultation in lead up to the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP). It was open for comments during 1-20 August 2011. GUIDING QUESTION was: What strategies would you priorities to address the needs and rights of key affected women and girls? In your response, please clarify who you consider key affected women and girls and what are the main challenges in ensuring a more enabling environment for these women and girls? Please share examples.

KEY ISSUES/ PROBLEMS
 There is lack of common understanding on what populations will constitute key affected women and girls due to which programmes are not specific to meet unique needs of key affected women and girls  Gender-based violence, stigma, discrimination and criminalisation of key affected women and girls further exacerbate their vulnerabilities to HIV  Low or negligible awareness about safe sex and sexually transmitted infections (STIs) including HIV among key affected women and girls increases their vulnerability to HIV
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 Low awareness, high cost, poor availability and accessibility of STI (including HIV) protection and/or contraceptive options, especially those designed for women to initiate and use, such as female condoms, is another challenge.  Funding gap for research and development of more women-initiated prevention options like vaginal and rectal microbicides and vaccines is another key challenge  Coverage of harm reduction services is not only gravely inadequate but also insensitive to the gender and needs of key affected women and girls such as female injecting drug users (IDUs) and female partners of IDUs  Criminalization of drug use and unfriendly, risky and unsupportive healthcare service facilities, including reproductive and sexual health services, further compound the problem  Programmes addressing HIV and Sexual Reproductive Health (SRH) are not working collaboratively as desired  HIV and hepatitis B and C vulnerability in key affected women and girls is a neglected issue  Community systems of key affected women and girls are weak and doesn‘t involve them with dignity and rights as equal partners in designing and delivery of programmes for their community  Mental health needs of key affected women and girls such as transgender populations are not met through HIV specific counselling  Basic human rights of female drug users and female sex workers are not respected or protected  HIV investments made on key affected women and girls is not quantised and tracked  Enabling legal environment is missing where key affected women and girls easily get their legal rights of property, employment and social welfare schemes  A scarcity of financial support exists to substantively develop the leadership of women, particularly networks of women living with HIV and key affected populations of women and girls  Enabling women to take a leading role in efforts to change the HIV trajectory is a key to reversing the HIV epidemic which is not optimally reflected in the current HIV responses

NARRATIVE SUMMARY
Most countries in the Asia Pacific region are experiencing concentrated epidemics in
what are called key affected population (KAP), which include men who have sex with men (MSM); sex workers and their clients; and people using drugs. HIV and AIDS programmes for KAPs should be designed to include and sufficiently address the sexual and reproductive health needs of key affected women and girls, such as those women living with HIV, female sex workers, female drug users, transgender women (hijras and other gender variants), wives/partners of drug users, and wives of MSMs. It is imperative that we have zero tolerance for gender based violence, stigma, discrimination and criminalisation of key affected populations of women and girls. Apart from having to suffer a debilitating illness, women/girls living with HIV/AIDS are also facing the trauma of denial of property rights; lack of access to basic human rights like 2|Online consultation on key affected women and g irls

right to food, education and healthcare; loss of employment opportunities; and increased vulnerability to violence and social indignities. Many of them contract the disease from their husbands, but are then thrown out of the family without any social and financial protection. There is an immediate need to create enabling and free legal services for them (not just on paper, but in reality) to get what is theirs lawfully, but has been denied to them by an uncaring society. Financial stability in the form of proper employment and share in family property is what they need urgently. If there are sensitive lawyers who can help community-based networks of key affected women and girls to get them their due, it will be a huge help. Access to basic legal services is essential to helping PLHIV women and their families. There is a need to increase awareness about safe sex in the key affected populations of women and girls. Linkages and synergies between HIV and SRH, and their interrelationships within broader issues of public health, development and human rights, will have to be strengthened. An overwhelming majority of HIV infections are sexually transmitted. Both HIV, and sexual reproductive ill-health, is driven by common causes, including gender inequality, poverty and social marginalization of the most vulnerable populations. Not only do women need preventative options that they can choose to use freely but the gender inequalities that make it harder for women to insist on safer sex must also be addressed. Unfortunately, most women are either unaware of or are unable to access existing new women-initiated HIV prevention and/or contraceptive options such as female condoms. As advocates, we should urge decision makers to endorse policies that raise awareness of and access to existing protection options for women, and adequately fund research, development and eventual introduction of safe and effective microbicides and vaccines which are in the clinical research pipeline stage. There should be targeted interventions, under harm reduction, to specifically address the needs for Female Injecting Drug Users (FIDUs) and female partners of male IDUs. Despite of advocacy for gender balance, nothing much seems to be done on the ground. Harmonising policies on harm reduction and de-criminalising drug use is important in communities where injecting drug use has been proven to be a driver of HIV epidemic. It is a human rights issue to reduce the existing stigma in general healthcare services towards FIDUs and female partners of male IDUs, and provide friendly, safe and supportive sexual reproductive healthcare (SRH) facilities to them. We also need to scale up harm reduction services and make them more gender sensitive to their needs. Focusing on HIV prevention in sex workers has been cited as the most cost-effective investment in Asia and the Pacific. Decriminalizing and destigmatizing sex work is essential but not sufficient. There should be meaningful participation of sex workers in development and implementation of policies which ensure their access to legal and social justice; provides them with SRH services which also address the prevention/treatment/support for HIV/AIDS; and eliminates violence in all HIV programmes targeting sex workers and their clients.

―Are we really taking any steps to address their issues or are we still treating them as a hidden population and therefore difficult to address?‖

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Mental health issues of transgender populations, particularly sex workers, are not being addressed adequately. Mental health needs of transgenders are huge as they are neglected and maltreated by society, and even by their own ―Hence key affected family/ friends, which causes a lot of trauma. Depression, harassment, relationship problems, women and girls will loneliness, and social isolation, are some of the have to be engaged in pressing mental health concerns that have been identified in skill building workshops for transgender making decisions on community. Their counselling should deal with developing, designing, sexual and reproductive health, and also adequately implementing, address their mental health problems, going beyond HIV prevention, care and support issues. monitoring and Basic human rights of key affected communities of and programmes.” women and girls have to be protected at all costs. One respondent felt that the Global Fund to fight AIDS, Tuberculosis and Malaria (The Global Fund) should not fund programmes in those Asian countries that violate basic human rights and accepted universal ethical standards in health care—for example funding of compulsory detention centres for drug users and sex workers, and/or compulsory or highly coercive testing of sex workers for STIs and HIV. It was also felt that HIV and hepatitis B and C vulnerability should be addressed and that HIV investments made on affected populations of women and girls need to be quantised and tracked. The Global Forum on MSM & HIV (MSMGF) feels that HIV investments must be accounted for and funders must reflect that in their budgets and track their investments by population. Donor agencies must communicate and coordinate to ensure adequate coverage without duplication, and aim for a higher level of accountability to the affected communities. The UNAIDS Agenda for Women and Girls, calls for appropriate systems to be established to investigate and document violence and the link between HIV and different forms of violence against all women and girls, including key affected populations such

evaluating HIV policies

―Stigma, discrimination and the criminalisation of key affected populations prevent women from reporting acts of violence against them and seeking assistance and redress‖

as sex workers, women living with HIV, women who use drugs, young women and transgender women. Stigma, discrimination and the criminalisation of key

affected populations prevent women from reporting acts of violence against them and seeking assistance and redress. Furthermore, there is growing concern that antitrafficking laws and policies, put in place to protect people from exploitation, are being used by law enforcers to arrest sex workers or demolish sex work establishments, thereby increasing vulnerability. Hence key affected women and girls will have to be engaged in making decisions on developing, designing, implementing, monitoring and evaluating HIV policies and programmes. It was felt that there is domination from Male MARPs (mostat-risk-populations) group and a lack of key affected women and girls at decision making level. Local advocacy networks for women and girls should be involved in making favourable policies. Members of affected communities of women and girls need capacity building and must be competent enough to contribute effectively in programmes addressing their community, so that there is ‗Nothing About Us Without Us‘. 4|Online consultation on key affected women and g irls

RECOMMENDATIONS
 Key affected women and girls should include those women and girls living with HIV, female sex workers, female drug users, transgender women (‘hijras’ and other gender variants), wives/female partners of drug users, wives of men-who-have-sexwith-men (MSMs) among others who are at heightened risk of HIV in local/ specific settings  Zero tolerance for gender based violence, stigma, discrimination and criminalisation of key affected women and girls  Increase awareness about safe sex and sexually transmitted infections (STIs) including HIV/AIDS among key affected women and girls by ensuring access to comprehensive sexuality education to them.  Endorsing policies and funding that raise awareness of and access to more protection options for women and girls and building the knowledge and skills of women and girls so that they can use these technologies effectively.  Increase investment to reach and provide services for key affected women and girls such as female partners of MSM, female IDUs, female partners of IDUs, transgender populations among others.  National HIV programmes should address gender inequality that makes it harder for women and girls to insist on and negotiate safer sex or using STI/HIV prevention options. It also should accelerate research, development and eventual introduction of safe and effective new STI/HIV prevention options including vaginal, rectal microbicides and vaccines.  More government and donor support is warranted to increase availability, affordability and accessibility of female condoms and other safe and effective STI/HIV prevention and/or contraceptive methods, particularly for key affected women and girls to initiate and use  Countries need to de-criminalize drug use and sex work and provide a friendly, safe and supportive healthcare service facility, including reproductive and sexual health services, for female injecting drug users (IDUs) and sex workers. Legal reforms must happen for supportive public health policies that do not criminalize sex work or drug use.  Scaling up of gender sensitive harm reduction services for female IDUs and female partners of IDUs needs to be taken up.  It is very important to address mental health needs of transgender population, especially sex workers through proper counselling. This is largely a neglected area. The drop-in centres and other AIDS-related healthcare service centres should provide counselling to transgender populations to deal with mental health issues and not just for issues related to STI or HIV/AIDS.  HIV investments made on affected population should be quantised and tracked. A new report produced by the Global Forum on MSM & HIV (MSMGF), indicates that most major bilateral, multilateral and private philanthropic funders that focus on HIV do not consistently track their investments targeting transgender people. Even 5|Online consultation on key affected women and g irls

domestic government funding does not do it at all. So very often the funds do not reach the affected populations for whom they were intended.  HIV prevention programmes should take a community and health system strengthening approach. Community Systems Strengthening can be done by building capacity of key affected women and girls, to make them competent enough to contribute effectively in programmes addressing their community by being involved in making decisions on developing, designing, implementing, monitoring and evaluating HIV policies and programmes. Also just coming from the affected community does not mean that the person is automatically equipped to be a peer counsel –they will have to be equipped for this.  Strengthen the linkages between HIV and Sexual Reproductive Health (SRH), and their inter-relationships within broader issues of public health, development and human rights. It is imperative to respect the basic rights of drug users and sex workers. Coercion and forced detention will always have a detrimental effect, and so will the wilful use of anti-trafficking laws to arrest sex workers or demolish sex work establishments, thereby increasing vulnerability.  Easy access to basic legal services is essential to helping women living with HIV obtain what the law provides for them (in most countries) but what society denies them: property ownership, employment opportunities and social protection coverage for basics like health care, food, water and shelter. If they are given free legal aid and helped to get what is rightfully theirs, it will go a long way in helping them lead a dignified life.  Address HIV, Hepatitis B and C vulnerabilities of key affected women and girls  Key affected women and girls must be engaged in making decisions on developing, designing, implementing, monitoring and evaluating HIV policies and programmes. Stigma, discrimination and the criminalisation of key affected populations prevent women from reporting acts of violence against them and seeking redress. Appropriate systems needs to be established to investigate and document violence and the link between HIV and different forms of violence against all women and girls, including key affected populations.  Members of affected communities of women and girls need capacity building and must be competent enough to contribute effectively in programmes addressing their community, so that there is ‘Nothing About Us Without Us’.

All comments are available online at: http://www.citizen-news.org/2011/08/online-consultation-topic-2-key.html

For more information, please contact: APA: rose@asiapacificalliance.org CNS: bobby@citizen-news.org

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