UNDP’S Role in promoting human rights, gender equality and enabling legal and policy frameworks for health, including for vulnerable and key populations
UNDP’s work on health and development
UNDP’s work on health contributes to its broader commitment to eradicate poverty, reduce inequalities, strengthen effective and inclusive governance and build resilient and sustainable systems for health.
UNDP’s Strategic Plan 2018-2021 sets out the direction for a new UNDP, optimized to help countries achieve the 2030 Agenda for Sustainable Development. UNDP supports country programmes to successfully address diverse development challenges, including health, through support to:
eradicate poverty, including through addressing structural barriers to women’s empowerment and providing basic social protection and effective services and infrastructure
accelerate structural transformations for sustainable development, including by addressing inequalities and exclusion and strengthening governance, and
build resilience to crises and shocks.
UNDP’s HIV, Health and Development Strategy aims to reduce inequalities and social exclusion that drive HIV and poor health.
UNDP’s HIV, Health and Development Strategy 2016-2021: Connecting the Dots elaborates UNDP’s work on HIV and health in the context of the 2030 Agenda for Sustainable Development.
UNDP aims to support countries to implement large scale health programmes, including reaching some of the most hard-to-reach populations, and to strengthen institutions to deliver essential services in challenging and high-risk country contexts. UNDP aims to achieve these goals through three interconnected areas of action.
Reducing inequalities and social exclusion that drive HIV and poor health – e.g. by promoting human rights and gender equality, challenging harmful gender norms, eliminating gender-based violence and empowering women and girls, vulnerable and key populations
Promoting effective and inclusive governance for health – e.g. by creating enabling legal, regulatory and policy frameworks health and strengthening governance to address health, and
Building resilient and sustainable systems for health.
UNDP’s Capacity Development for Resilient and Sustainable Systems for Health Strategy aligns with the UNDP Strategic Plan and HIV, Health and Development Strategy, adopting an integrated approach to support the implementation of the Plan and Strategy in the health sector.
It aims to promote:
Respect for and promotion of human rights and gender equality
Meaningful engagement of people living with HIV, vulnerable and key populations for effective governance.
National ownership, capacity and resilience for effective and sustainable responses to HIV, health and related development challenges.
Being risk-informed to effectively cope with and recover from conflict, natural disasters and other humanitarian crises.
Building the evidence base for action, and
Delivery based on Value for Money, to provide services of the right quality, level and cost.
Through its headquarters, regional and country level offices, UNDP provides guidance, policy advice and technical support to partners to:
Generate evidence for rights-based public health interventions to respond to health issues such as HIV, TB and malaria, through legal environment assessments and audits, national dialogues, research and ongoing monitoring
Support the development of programmes and plans to reduce stigma, discrimination, gender inequality and violence for people living with and affected by HIV, TB and malaria and for vulnerable and key populations, such as law and policy review and reform, strengthened access to justice and improved law enforcement practices
Provide policy papers, guidance notes and best practice on rights-based responses, and
Support the participation of empowered communities, vulnerable and key populations through capacity strengthening, legal literacy, supporting meaningful participation in forums and advocacy initiatives.
The Strategy recognises the need to protect the rights of all people, including children, women, young people, men who have sex with men, people who use drugs, sex workers and clients, transgender people and migrants, to ensure access to life-saving services. In terms of the Division of Labour, UNDP convenes work to protect human rights, reduce stigma and discrimination including in health care, support legislative and policy review and reform and promote access to justice and strengthened law enforcement, in order to create an enabling legal and policy environment for HIV-related health care for vulnerable and key populations.
UNDP partners with WHO to scale up integrated, multi-sectoral responses to advance health and well-being and reduce health inequities.
UNDP works in close partnership with the World Health Organisation (WHO) to support countries to strengthen the capacity of their health systems, including by addressing the social, economic and environmental determinants of health. The UNDP-WHO Memorandum of Understanding signed on 4 May 2018 aims to support countries to scale up integrated, multi-sectoral responses to advance health and well-being and reduce health inequities. It focuses on, amongst other things, collaboration to support countries to strengthen the capacity of health systems, including by addressing the social, economic and environmental determinants of health, to achieve universal health coverage.
UNAIDS Strategy 2016-2021 Strategy A call to reach the 90–90–90 treatment targets, to close the testing gap and to protect the health of the 22 million people living with HIV who are still not accessing treatment.
Follow up to the Global Commission on HIV and the Law
Much of UNDP’s current work on HIV, human rights, gender and enabling legal frameworks is based on follow up to the findings of the Global Commission on HIV and the Law.
What is the Global Commission on HIV and the Law?
On behalf of the Joint United Nations Programme on HIV/AIDS (UNAIDS) family, UNDP established an independent Global Commission on HIV and the Law in June 2010 to examine the impact of law on HIV responses and to catalyse country level action for legal environments that protect human rights and halt and reverse HIV.
The Commission was built on three mutually reinforcing axes:
a high-level Commission that analysed evidence and added insight and weight to develop findings and recommendations, chaired by President Cardoso of Brazil;
a Technical Advisory Group that helped generate evidence and build consensus; and
Regional Dialogues that ensured inclusion and participation of affected communicates and law- and policy-makers.
The Commission issued its landmark 2012 report, Risks, Rights and Health, which includes key findings and recommendations on evidence-informed and rights-based responses to HIV. Between 2012 and 2018, UNDP and its partners have supported 89 countries to advance the Commission’s recommendations.
In 2018, the Commission released a Risks, Rights and Health Supplement that was launched in July 2018 at the International AIDS Conference in Amsterdam. The Supplement highlights developments since the 2012 report in science, technology, law, geopolitics and funding that affect people living with HIV and its co-infections. Its 30 recommendations add to those of the 2012 report which Commissioners noted were as relevant as they were in 2012.
In 2012, the Global Commission on HIV and the Law recommended critical rights-based responses to create enabling legal environments for HIV, in its report Risks, Rights and Health, In the 2018 Supplement, the Commission highlights ongoing and new priorities for addressing law and human rights for vulnerable and key populations, to end AIDS and TB by 2030.
The Global Commission’s 2018 Risks, Rights & Health Supplement finds HIV and its co-infections continue to disproportionately affect vulnerable, marginalized and criminalized populations. Key populations and their sexual partners account for 47% of new HIV infections in 2017. Adolescent girls and young women aged 15-24 account for 20% of all new HIV infections. In addition, progress to end AIDS is curbed by other epidemics - viral hepatitis and tuberculosis, co-infections that complicate and threaten the lives of people with HIV and vice-versa.
In this changing landscape of advances in medicine, science and technology, yet increasing restrictions on vulnerable and key populations and the organisations that support them, the Global Commission’s 30 new recommendations amplify and extend those of the 2012 report.
The 2018 Risks, Rights & Health Supplement reiterates the importance of outlawing discrimination, repealing punitive laws and enacting protective laws to promote public health and human rights for effective responses to HIV and its co-infections, particularly for vulnerable and key populations. While recognising the significant protective steps taken by dozens of jurisdictions over the past 6 years, informed by public health evidence and human rights obligations, the Commission raises several concerns in 2018, including the following:
As of July 2018, 68 countries continue to criminalize HIV non-disclosure, exposure or transmission or to allow the use of HIV status to enhance charges or sentences on conviction. HIV prosecutions have been reported in 69 countries. This is taking place at a time when scientific evidence now shows a zero risk of HIV transmission from an HIV-positive person with a suppressed viral load.
The criminalization and imprisonment of people – people who use drugs, TB patients who do not adhere to or complete their treatment – places them at increased risk of exposure and often excludes them from effective treatments for HIV, TB and viral hepatitis.
Anti-sex work laws remain problematic in several countries, eroding the safety, control and earnings of sex workers.
Between 2012 and 2015, more than 60 countries drafted or enacted laws, or stepped up enforcement of older ones, to outlaw harass, vilify, attack or bankrupt civil society organisations and international aid groups that support them.
With 258 million immigrants, including 28,5 million refugees and asylum seekers, countries have adopted restrictive immigration policies, including visa denials, screenings and deportation, based on health status.
Adolescent girls and young women are being left further behind. Criminalisation, discrimination, violence and legal and human rights barriers continue to undermine women's and girl's ability to access sexual and reproductive health care to protect their health and realise their rights.
In the 2018 Risks, Rights and Health Supplement, the Commission presents 30 recommendations to ensure effective, sustainable health responses consistent with universal human rights obligations. Some important recommendations include:
Governments must prohibit in law all forms of discrimination against people living with and vulnerable to HIV, TB or viral hepatitis.
Governments must ensure that everyone living with or at risk of acquiring HIV, TB or viral hepatitis has affordable access to the most effective, high-quality health technologies, including diagnostics, medicines and vaccines for HIV, TB and viral hepatitis.
Governments must stop restricting organisations but instead enact laws that provide an enabling environment for civil society organisations to operate, including those providing services to populations living with or affected by HIV, TB or viral hepatitis.
Governments must not deny entry to, and must provide migrants, including asylum seekers or refugee applicants, access to the full range of health services including for HIV, TB and viral hepatitis regardless of immigration status. Governments must provide this standard of care in detention and confinement settings.
Governments must require proof, to the applicable criminal law standard and based on the best available scientific evidence, of intent to transmit HIV when adjudicating cases of HIV transmission. They must prohibit the prosecution -of women living with HIV for choices they make during and after their pregnancy, including breastfeeding children.
The Commission’s 2012 report, Risks, Rights and Health, the 2018 Risks, Rights and Health Supplement and the comprehensive database of resources on the Global Commission on HIV and the Law website provide detailed information on the findings and recommendations of the Commission and a database of resources relating to key HIV, law and human rights issues.
How has UNDP supported follow up to the GCHL findings?
UNDP provides country-level technical assistance to support human rights, gender equality and enabling legal and policy environment for access to HIV and related health care services.
Since the release of the Commission’s 2012 report, UNDP has supported follow up, strategically supporting country-level implementation of the recommendations through the provision of technical assistance.
UNDP facilitates and supports multi-stakeholder consultative processes to review a country’s legal and policy framework for HIV, health, human rights and gender equality issues affecting vulnerable and key populations. Support is further provided to take follow up actions to strengthen laws, policies, access to justice and law enforcement, in the context of HIV and health, to promote human rights, achieve gender equality and eradicate gender-based violence.
UNDP’s policy and programme support, working with government, civil society and UN partners to implement the findings and recommendations of the Global Commission on HIV and the Law, includes:
Legal environment assessments or legal audits, including related advocacy
National dialogues on HIV and the law, including action planning
Legislative review and/or reform, including related advocacy
Human rights training, capacity strengthening and consultations with members of the judiciary
Outreach to Parliamentarians, capacity development and consultation
Access to justice and legal services, including rights-based training for law enforcement; and
Community-based advocacy on stigma and discrimination, including through the media and community and religious leaders.
Case Study Seychelles addresses critical enablers in national HIV response
After conducting an assessment of the legal, regulatory and policy framework to respond to HIV in Seychelles in 2013, government, civil society and development partners took various steps to address critical enablers, hereby strengthening the legal and policy framework for affected populations.
This included, amongst others:
Updating the Misuse of Drugs Act, 2016 to provide for needle and syringe exchange and substitution therapy programmes as well as for the referral of people who use drugs to effective rehabilitation programmes in place of imprisonment
Repealing section 155 of the Penal Code to decriminalise sex between men
Amendments to the Employment Policy to strengthen protection for employees with HIV, and
Working with immigration authorities to ensure that details of HIV status are no longer required for a Gainful Occupation Permit.
Global Commission on HIV and the Law: Risks, Rights & Health, GCHL, 2012 This report presents persuasive evidence and recommendations that can save lives, save money and help end the AIDS epidemic.
Advancing Human Rights, Equality and Inclusive Governance to End AIDS, UNDP, 2017 This Issue Brief provides a short overview of the Commission’s report and a snapshot of outcomes it has contributed to.
Global Commission on HIV and Law: Supplement, GCHL, 2018 Highlights developments since 2012 in science, technology, law, geopolitics, and funding that affect people living with or at risk from HIV and its coinfections.
Global Commission on HIV and the Law: 5 Facts Five takeaways to remove legal barriers to HIV prevention and treatment and to end discrimination against people living with and affected by HIV.
Promoting gender equality and eradicating gender-based violence
UNDP works to address gender inequality
UNDP works to address gender inequality, negative gender norms and gender-based violence, to promote the health and development of all, leaving no-one behind.
Gender equality is a core component of UNDP’s work on health and development and is critical for achieving the 2030 Agenda for Sustainable Development. It is central to UNDP’s Strategic Plan 2018-2021 and in line with UNDP’s Gender Equality Strategy 2014-2017.
UNDP is committed to supporting multisectoral efforts to promote gender equality and empower women and girls, through targeted, gender-focused programmes that address negative gender norms, prevent sexual and gender-based violence, create enabling legal frameworks for women and girls and promote access to HIV and sexual and reproductive health services and access to justice for rights violations.
Achieving gender equality and addressing gender-based violence is critical to promoting sexual and reproductive health, including ending AIDS.
UNDP works closely with UN partners, such as UN Women, UNFPA and UNICEF, and country stakeholders, to eliminate violence against women. Achieving gender equality is also part of UNDP’s role in the Joint UN Programme on HIV/AIDS (UNAIDS), in which UNDP works with other co-sponsors, led by UN Women, to meet the HIV-related needs of women and girls and address gender-based violence.
UNDP policy and programme support includes, amongst other things:
Supporting gender equality in national health programmes
Creating enabling legal and policy environments for access to sexual and reproductive health services
Eliminating discrimination and violence against women and girls,
Working with government, civil society and UN partners to implement the findings and recommendations of the Global Commission on HIV and the Law on issues affecting women and girls, and
Eliminating sexual and gender-based violence in humanitarian settings.
The 2017 European Union-United Nations Spotlight Initiative to Eliminate Violence Against Women (the Spotlight Initiative) is a global initiative by the UN and the European Union (EU) to call for and invest in action towards eliminating all forms of violence against women and girls, as part of achieving the 2030 Agenda for Sustainable Development. The Spotlight Initiative aims to respond to all forms of violence, with a particular focus on domestic and family violence, sexual and gender-based violence and harmful practices and sexual exploitation.