Children's rights and HIV and AIDS
The headline news of UNAIDS latest report reveals that the global AIDS epidemic is on the wane. The report, which marks World AIDS Day 2010, shows a decrease of almost 20 per cent in the number of new infections this year compared to the number of new infections recorded in 1999.
The findings further reveal that young people are leading this trend. In 15 of the most severely affected countries, HIV prevalence among 15- to 24-year-olds has fallen by more than 25 percent as a result of improved knowledge and consequent safer sexual practices. The incidence of mother-child transmissions has also dropped 24 per cent in the last five years.
Warning against complacency, the report reminds us that while knowledge among young people has increased, 15- to 24-year-olds are still particularly prone to new infections, with women and girls disproportionately at risk. In sub-Saharan Africa, for example, women and girls between 15 to 24 are eight times more likely to be living with HIV than men, largely as a result of gender-based violence and economic dependence on men, leaving them unable to negotiate safe sex. Furthermore, while advances have been made in access to treatment, only 35 percent of those who need it currently have access to HIV treatment.
The theme of this year's international day – universal access and human rights – recognises that a rights approach must be at the forefront of prevention and treatment efforts.
This piece draws attention to the particular importance of children's rights and HIV and AIDS in light of children and young people's heightened vulnerability. It comes in the wake of reports of dangerous attempts to limit children's access to information about a range of issues in the name of 'protection', such as sex education, drug use and sexuality – issues we must face up to in order to prevent the spread of HIV.
HIV and AIDS and the CRC
While the Convention on the Rights of the Child (CRC) does not specifically mention HIV and AIDS, there are provisions in the treaty that offer children protection from the consequences of HIV and AIDS. In addition, the Committee on the Rights of the Child has addressed the issue extensively in its Concluding Observations to States as well as its General Comment No. 3 on "HIV/AIDS and the Rights of the Child"
The issue of HIV and AIDS and children is not just about access to treatment as set out in article 24, but concerns the full spectrum of children's rights. Article 2 of the CRC, for example, establishes the right to non-discrimination on numerous grounds, including race, colour, sex and other status. HIV and AIDS falls under the latter. Children whose parents suffer from HIV and AIDS are also frequently subject to stigma and discrimination.
In November 2003, the UN Committee on the Rights of the Child adopted its General Comment on "HIV/AIDS and the Rights of the Child" which explains the relevant articles in detail and outlines some of the barriers to tackling the problem as it relates to children:
"Denying that a problem exists, cultural practices and attitudes, including taboos and stigmatisation, poverty and patronising attitudes towards children are just some of the obstacles that may block the political and individual commitment needed for effective programmes."
To illustrate the extent of this social stigma, in 2006 Turkmenistan revealed in its State party report to the UN Committee on the Rights of the Child that no cases of children with HIV and AIDS had been recorded.
And indeed, "patronising attitudes towards children" have often dictated sex education policy. Governments, teachers and healthcare professionals tread very carefully, concerned at not drawing the wrath of parents or, in some cases, media. As a result, education policy can be absent or confusing.
The General Comment states that: "Adolescents are also vulnerable to HIV and AIDS because their first sexual experience may take place in an environment in which they have no access to proper information and guidance."
Unfortunately, misunderstandings over sex education, particularly the misplaced view that it teaches children promiscuity or encourages them to be sexually active at a young age, can mean children do not get the preparation they require in order to have safe and healthy sex lives, whether as older children or as adults.
Furthermore, there is considerable evidence to suggest that just giving children a very scientific account of sex can fail to prepare them for the challenges involved in negotiating a sexual relationship. This can make them more susceptible to sexually transmitted diseases (STDs).
At the UN Special Session on Children in 2002, there was a concerted campaign, led most notably by the US, to limit mentions of sex in the final outcome document. The US delegation viewed abstinence as the primary strategy to prevent unintended pregnancies and HIV and AIDS. A delegate from Saudi Arabia reportedly praised the US for focusing on sexual abstinence: "The best, if not the only, kind of prevention is chastity. Chastity and abstinence is the number one solution."*
In the dark
The Committee on the Rights of the Child's General Comment No.3 on HIV and AIDS also expresses concern at discrimination on the basis of sexual orientation. It emphasises that "effective HIV/AIDS prevention requires States to refrain from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information, and that, consistent with their obligations to ensure the right to life, survival and development of the child (art. 6), States parties must ensure that children have the ability to acquire the knowledge and skills to protect themselves and others as they begin to express their sexuality."
Yet more than 80 countries continue to criminalise same sex relationships, according to UNAIDS; others try to hide their existence from children. In June 2009, for example, the Lithuanian parliament passed an amendment prohibiting the discussion of homosexuality in schools "to protect children", and banning any reference to it in public information that can be accessed by children.
Last year, Uganda announced a draft law stipulating draconian punishments for people alleged to be lesbian, gay, bisexual or transgendered – namely life imprisonment or, in some cases, the death penalty. The law violates the rights of LGBT children, as well as children with HIV, and children who are merely suspected of having a same-sex liaison.
While the Anti-Homosexuality Bill has now been shelved, attacks against gay people are on the increase, fuelled by media reports publishing details of those it believes to be homosexual. In a further development in the region, Kenya's Prime Minister, Raila Odinga, this week announced that anyone engaging in sexual relations with a member of the same sex will be subject to legal action.
UNAIDS' report also reveals how States have sought to circumscribe the physical movement of people living with HIV: the free travel of people living with HIV is restricted in 51 countries, territories and areas. Such laws are not only discriminatory and unjust—they also drive HIV underground and inhibit efforts to expand access to life-saving HIV prevention, treatment, care and support." (p. 10)
Indeed, a recent report by UNICEF revealed that while the rate of HIV infections is declining in the rest of the world, Eastern Europe and Central Asia are suffering an increase, particularly among young people, as a result of drug use, high-risk sexual behaviour and social stigma which prevented people seeking treatment.
As our recent editorial on children and drug use reported, children are neglected in the design of policy and programmes on drug use which again renders them more susceptible to HIV and other infections. Professor Paul Hunt, former UN Special Rapporteur on the right to the highest attainable standard of health, has noted that "discrimination against drug users can hinder HIV prevention efforts: people will not seek HIV counselling, testing, treatment, and support if this means facing discrimination, lack of privacy or confidentiality, alienation or in some cases, the threat of incarceration.
Children additionally experience age-related discrimination in accessing confidential counselling and/ or health services – the Committee on the Rights of the Child has pointed out the need to establish confidential services to numerous States in its Concluding Observations, including Bahrain, Georgia, Kiribati and Uzbekistan, among others.
There have also been reports of violations of children's right to privacy in which their HIV status has been revealed. In the UK, for example, children with HIV have been turned away and excluded from primary and secondary schools in contravention of anti-discrimination laws. In one case, a child who did not know about her condition was made aware of it by a teacher. Under the Disability Discrimination Act 2005 it is illegal to discriminate against anyone with HIV. The National Aids Trust repeatedly asked for specific guidance on HIV for teachers from the Department of Children, Schools and Families (DCSF). They were told that the State had 'no plans' to update an existing information kit for schools on how to implement the Act, which only mentions HIV 'in passing'. Full story.
* Jennifer Kitts and Katherine McDonald, “United Nations Special Session on Children: children's rights under attack”, CMAJ, April 30, 2002; 166 (9), http://www.cmaj.ca/cgi/content/full/166/9/1155
- Factsheet: The criminalisation of HIV
- Factsheet: Towards the Finish Line: Youth and Universal Access 2010
- International Guidelines on HIV/AIDS and Human Rights
- International Technical Guidance on Sexuality Education
- Global Youth Coalition on HIV/AIDS
Children's rights and HIV and AIDS
Eastern Europe and Central Asia: An underground HIV epidemic in is intensifying at an alarming pace, fuelled by drug use, high-risk sexual behaviour and high levels of social stigma that discourage people from seeking prevention information and treatment, according to a report released by UNICEF. Download the report.
Discrimination won out in China this week when a court ruled against a man who said he was denied a teaching job after his prospective employer learned he was HIV-postive. Meanwhile in Beijing, a children's AIDS charity founded by the jailed dissident Hu Jia this week announced its closure after repeated scrutiny by the tax authorities, reports the New York Times. Full story.
Iin the United States, progress in the fight against AIDS in the southern United States is also being stymied by state laws and policies that impose ineffective approaches and fuel stigma and discrimination against people living with HIV, according to Human Rights Watch.
In the report, "Southern Exposure: HIV and Human Rights in the Southern United States," Human Rights Watch documents the practices that undermine public health and progress on combating HIV in the region where the epidemic is growing at the fastest rate in the nation. These include the refusal of southern states to provide comprehensive sex education in the schools, state laws that impede access to sterile syringes, and criminal penalties for exposing others to HIV. Download the report.
While India has stemmed the AIDS epidemic 'it miserably failed in prevention of parent to child transmission of HIV', says the AIDS Society of India (ASI), a professional body of doctors specialising in HIV care, according to SIFY news. Full story.
Meanwhile, fewer than one in four Zambian children who should be on life-saving anti-retroviral drugs is receiving them. The country planned to increase the number of children on ARVs from the present 20,000 to 120,000, but inadequate facilities pose a major stumbling block, reports Inter-Press Service News. Full story.