Speak-Your-World: Human Rights and people living with HIV-TB co-infection

Speak-Your-World: Human Rights and people living with HIV-TB co-infection
Stop-TB eForum Resource Team

Members are welcome to share their experiences from the frontlines on the theme of human rights and people living with HIV/TB co-infection in their country's contexts.

As you know, World AIDS Day (1 December) is less than three weeks ahead of us. Also the 40th Union World Conference on Lung Health will soon open in Cancun, Mexico from 3-7 December 2009.

World AIDS Day, December 1
The theme of the World AIDS Day this year is 'Universal Access and Human Rights'. Global leaders have pledged to work towards universal access to HIV/AIDS prevention, treatment and care, recognising these as fundamental human rights. Valuable progress has been made in increasing access to HIV/AIDS services, yet greater commitment is needed around the world if the goal of universal access is to be achieved. Millions of people continue to be infected with HIV every year. In low- and middle-income countries, less than half of those in need of antiretroviral therapy are receiving it, and too many do not have access to adequate care services. The protection of human rights is fundamental to combating the global HIV and AIDS epidemic. Violations against human rights fuel the spread of HIV, putting marginalised groups, such as injecting drug users and sex workers, at a higher risk of HIV infection. By promoting individual human rights, new infections can be prevented and people who have HIV can live free from discrimination.
For more information on World AIDS Day, go to: http://www.worldaidscampaign.org/en/Key-events/World-AIDS-Day/ and http://www.avert.org/world-aids-day.htm

40th Union World Conference on Lung Health, Cancun, Mexico
The theme of the 40th Union World Conference on Lung Health is "Poverty and lung health". This theme is highly relevant for our colleagues who have to deal with the burden of HIV/AIDS, tuberculosis, asthma, pneumonia, tobacco-related and other lung diseases as well as the health consequences of air pollution. The important medical, social and economic consequences of lung health in high-burden countries will also be discussed at this conference. More information about the conference is available online at: http://www.worldlunghealth.org/Conf2009/website/

Members are encouraged to share their community experiences on human rights and TB-HIV co-infection in their national contexts. Comments are welcome till the International Human Rights Day (10 December).

The commentary from the members on human rights and TB-HIV co-infection will feed into the issue-framework the Key Correspondent team will use to write their articles in the lead up to and during the 40th Union World Conference on Lung Health in Cancun, Mexico. The summary will be then published on the HealthDev.net, disseminated widely through existing eForums and other platforms.


Stop-TB eForum Resource Team
Email: stop-tb@eforums.healthdev.org
Website: www.healthdev.net/site

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Dear Associates,
We know the theme of World AIDS Day – 2009 'Universal Access and Human
Rights'. Many patients in India unnecessarily experience excruciating
pain, because of restrictive drug regulations, lack of training for
Health Care Providers (HCP) and poorly integrated care result in
needless suffering for patients because they cannot get inexpensive
and effective medications. It felt as if someone was pricking me when
I find PLHIV feels death is the only solution. We believe that State
have an obligation to ensure that essential care and support must
available to PLHIV and that HCP receive adequate training in their
use. I find total failure by the State to fulfill this obligation
violates the right to health.
The failure to train HCP when most of students and young doctors
receive no training on care and support under the purview of Human
Rights because the State does not include such instruction in relevant
curricula and still HIV/AIDS Bill is pending. As a result, most HCP in
India simply do not know how to take care of the rights of PLHIV. I
focus specifically on the availability of treatment of patients and
support provided by the State. I further submit that the State's
failure to ensure that treatment may violate the prohibition against
torture and cruel, inhuman and degrading treatment because of the
widespread nature and severity of the suffering it causes.
In March, 2009 Executive Director of UNAIDS, Mr Michel Sidibe, in
Brazil promoted greater awareness of the interlinked epidemics of HIV
and TB, the need for universal access to HIV services for all people
in need, and the necessity to address stigma and discrimination in
Brazil's response to HIV. Although it is mostly preventable and
curable, tuberculosis (TB) is one of the leading causes of death among
people living with HIV globally. Of the 33 million people who are
living with HIV, only 20% of know their status, and only a tiny
fraction, 2% in 2007, were screened for TB according to the Global TB
Control 2009 report.
Mr Sidibe advocated that we have to stop people living with HIV from
dying of tuberculosis and Universal access to HIV prevention,
treatment, care and support must include TB prevention, diagnosis and
treatment. When HIV and TB services are combined, they save lives.
We must participate for the promotion of HIV/AIDS awareness,
protecting human rights, and ending stigma and discrimination,
especially for those most vulnerable to HIV and organize regular
meetings with representing people living with HIV, youth, women, and
lesbians, gays, bisexuals and transgenders to discuss these issues
within the global, national and local context.
For more information on this issue please visit:
Human rights and HIV
Let's join hands and work for universal access and human rights,
HIV/AIDS and World AIDS Day – 2009
Dr. Avnish Jolly

World AIDS Day – 2009 theme is 'Universal Access and Human Rights’. It was observed around the globe to make people aware about the life-threatening disease and to raise concern for those afflicted with it. However, for some PLHIV (People Living with HIV) in India, it was a day that left them jobless, because National AIDS Control Organization (NACO) decided to end their one-year contracts as its outreach workers, five months after they were hired. Many PLHIVs in India unnecessarily experience excruciating pain, because of restrictive drug regulations, lack of planning and poorly integrated care result in needless suffering for patients because they cannot get respectable livelihood inexpensive and effective medications.

It felt as if someone was pricking me when I find PLHIV feels death is the only solution. We believe that State has an obligation to ensure that essential care and support must available to PLHIV. I find total failure by the State to fulfill this obligation violates the Right to Health and Life. As a result, most of State organs in India simply do not know how to take care of the Rights of PLHIV. I focus specifically on the availability of treatment of patients and support provided by the State. I further submit that the State's failure to ensure that treatment may violate the prohibition against torture and cruel, inhuman and degrading treatment because of the widespread nature and severity of the suffering it causes. Recently there was news that the long pending legislation on HIV/AIDS that aims to protect the rights of people living with the disease will be tabled in Parliament in its coming session. The Bill was drafted in 2006 to protect the rights of people living with the disease and to prevent and control the spread of the infection. It followed intensive discussions with different stakeholders, including PLHIV, sex workers and drug users, and has been pending with the government for the last three years
Oscar Fernandes, Chairman Parliamentary Forum for HIV and AIDS advocated in media that the consultation work on the Bill has been expedited as we want it to be tabled in the next session of Parliament. It is a serious matter and we want it be passed as soon as possible and the Parliamentary Forum is holding discussions with the Ministries of Health, Law and Social Welfare to work out the modalities for the Bill. He also added that it is unfortunate that the bill has been delayed and we are making all efforts to get it passed. The Bill will ensure Human Rights and Universal Access to prevention, treatment, care and support to the HIV
affected people.

Last month, letters for termination of services were given to many PLHIV employees of NACP-III working at its integrated counseling and testing centres. The letters stated that Union ministry of Health and Family Welfare, GoI had awarded a new project to a private agency which would start fresh recruitment. These people have to deal with the mental trauma of having contacted the life-threatening condition and the stigma that society attaches to it and we understand having regular earnings is necessary for these PLHIV is meaningful to live healthy life. When even survival is difficult, having something that makes life a little easier helps. But for many PLHIV in the country has taken away their only chance at earning a monthly income. Functions were held at all levels to mark World AIDS Day on 1st December, 2009 to spread awareness against the deadly disease. However, NACO, in a show of apathy, has decided to terminate the services of its outreach workers in the state, all of whom are HIV -positive, from November 30.

In the context of discrimination in employment on the basis of HIV status, there have been several progressive judicial pronouncements upholding the right of PLHIV to work. The most notable among these is the Bombay High Court's decision that an otherwise qualified person cannot be terminated from service unless he is medically unfit to perform the job functions or poses a significant risk to others at work. Another significant judgment was that, such a person should be accommodated in another job commensurate with his skills so long as that does not pose undue financial or administrative hardship to the employer. However, there is no model in India till date. In these conditions how State can withdraw job from PLHIV. Even under NACP-III there is mandate to involve PLHIV in the implementation of projects related with HIV/AIDS and mainstreaming at different level.

This situation has brought out a number of legal, ethical and Human Rights issues to the forefront as HIV/AIDS is more of a social problem rather than a medical problem. Its Human Rights violations with PLHIVs and they have been discriminated. HIV/ AIDS has highlighted the inequalities, wide spread stigma, discrimination and denial of fundamental human rights. On the other hand, it is the denial of Human Rights that makes certain sub populations, more vulnerable to HIV than other High Risk Groups (HRGs) i.e. Sex workers (SWs), Men having Sex with Men (MSM) and Intravenous drug users (IVDUs).

On the other hand three main legal-ethical and Human Right issues involved in a public health to combat HIV/AIDS, which arise in Integrated Counselling Testing Center (ICTC) settings, are Consent, Confidentiality of HIV status and Discrimination on the basis of HIV in health care, employment & other services..

Counselling is based on the requirement of informed and voluntary consent of the person being tested. This policy on consent is important because we understand that HIV is not curable and the stigma is also attached to it. Knowledge of HIV positive status itself may lead a person to untold trauma including suicide and revenge. So, counseling is needed which is a confidential interaction between a client and a counselor / Health Care Provider (HCP) aimed at enabling the client to cope with stress/ strain and make a personal decision related to HIV/ AIDS testing as well as cope the consiquences. The counselor should be aware of the GATHER technique, (Greet, Ask, Tell, Help, Explain and Re-visit). Counselor should have empathy i.e. recognition and understanding thoughts and emotions. Counseling in ICTC consists of pre test counseling (informed and voluntary consent for testing) and post test counseling before handing over the test result.

The counseling process includes an evaluation of a personal risk of HIV transmission and facilitation of preventive behavior. During medical emergency where an unconscious patient is brought to a hospital, consent may not be taken. Here, principle of honesty permits HCP to interfere with bodily integrity of the patient. In others, proxy consent could be taken where client is incapacitated (physically ill /mentally unsound /pediatric patient) and is unable to give consent. After testing, a reactive test result is confirmed by two more tests based on different principle/antigen. If the test result is negative and person is practicing high risk behavior he/she may be in the window period. He/she should be re-tested after 3 to 6 months according to National Testing Policy .The test result is given only after post test counseling. This explains the need for counseling and testing center where adequate voluntary testing facilities, pre and post test counseling are available. Because of danger of vertical transmission to infants born to HIV positive mothers, prevention of parent to child transmission (PPTCT) centers are opened where pregnant women are counseled and made to realize the importance of test but are not tested without informed and voluntary consent. So, routine offer is not routine testing. UNAIDS/WHO does not support mandatory testing of individuals even for employment or for providing healthcare facilities except for safety purposes(screening donors of blood, semen, organs or tissues in order to prevent transmission of HIV to recipient of biological products) and informed consent is also a pre requisite for conducting research . UNAIDS issued a guidance in May 2000, the document regarding HIV preventive vaccine research it contains 18 specific guidance points regarding the conduct of research. Research regarding Drugs & Vaccine against HIV/AIDS involving human rights should also address legal and ethical issues. Highest ethical standards must be upheld when collecting behavioral or biological data on HIV/AIDS because of the stigma and human rights issues as study participants may experience emotional, psychological, social, physical and economical harm. Both the ICMR and Central drug standard organization have established guidelines for biomedical and clinical research in India. Much of the legal and ethical debate around HIV infection zeroes on the conflict between society's right to protect itself against the spread of disease and the rights of infected people to confidentiality and civil liberty. Measures intended to protect the individual also protect society. There is also a need in society to develop a behavior change towards PLHIV and accept them what they are rather than what they do. In the face of AIDS this new community crisis, we should all be humble and determined.

Confidentiality arises when there is a confidential relationship the nature of which may be dependent on factors of trust, knowledge and skill, e.g. HCP - patient relationship. Confidential information, i.e. information that would otherwise not be divulged, which has the necessary quality of confidence about it and has been imparted in circumstances imparting an obligation of confidence.

Doctrine of Privacy and Confidentiality are incorporated in Constitution of India (Article 21) which states that confidence entrusted by a patient to a physician and defects/dispositions in character of a patient observed during medical attendance should never be revealed unless required by laws of the state. According to Goa Public Health (amendment) act 1986, Indians including Foreigners can be forced to submit for testing for HIV at the discretion of health officer. Once tested, Section 51 of Goa public health act and local municipal laws provide for the notification of HIV/AIDS cases. Confidentiality is very important in ICTC because of the stigma attached to the epidemic. Maintaining the confidentiality of individual is crucial for protecting public health. People, particularly those at high risk, will access these services (including prevention, testing, care and support) only if they are sure of the confidentiality. It is stressed not only in medical and national ethics but has even been recognized in common law.

Supreme Court of India has ruled on issue of the right of confidentiality of subjects with HIV infection and the breach of confidentiality in order to protect the health of third parties. In the opinion of the court, the right to privacy and confidentiality is not absolute. This right may be lawfully restricted in situations where third parties are at risk.

Community education programs, legislation and public health policies can assist in reducing the discrimination experienced by PLHIV. HCP may also require education with regard to discrimination and all the health services should have policies in place which prevent discrimination towards these patients by HCP. Otherwise the use of ICTC services may be limited due to the fear of discrimination which may, also, reduce the rate at which people return to collect their results.

With respect to discrimination in Health services, Article 21 of the Constitution of India guarantees the right to life and liberty to all persons, including the right to health. State health care institutions are appreciative to provide medical treatment to all persons without discrimination and abuse. Some other areas where PLHIV face discrimination include education, insurance, and travel. So, there is a need to institute an antidiscrimination legislation that will cover government, public and private settings. No statute exists which requires the HIV testing of employees in work place or prisoners. Only, defense forces' personnel are being routinely tested for HIV. There are no specific criminal offences made out for transmitting HIV which need to be addressed under IPC and CrPC.

There is also need to reform laws which marginalize women, children and eunuchs the most vulnerable group in the HIV/AIDS pandemic. We must think of their families, parents and friends. We should have law with effective implementation at all levels which should end discrimination and stigma.
Bill to bar HIV bias at workplace

New Delhi, Dec. 23: HIV/AIDS screenings on job applicants and existing employees may be banned under a proposed policy that says the infection should in no way affect employment.

The National Policy on HIV/AIDS and Work Place, crafted by the Union labour ministry with the International Labour Organisation’s assistance, will form part of the HIV bill being drawn up by the health ministry. The bill seeks to make employers liable for discrimination against staff with such diseases.

The labour ministry wants its proposals to cover all employers and workers, including applicants, across public and private sectors and the self-employed. All types of workplaces, contracts and all aspects of work, formal or informal, could be covered.

“There is no justification for asking job applicants or workers to disclose HIV-related personal information. Nor should workers be obliged to reveal personal information about fellow workers. Personal data covered by medical confidentiality should be stored only by personnel (who are) bound by rules on medical secrecy and should be maintained apart from other personal data,’’ the policy says.

A labour ministry official said the guidelines were intended to manage the impact of the epidemic in the sphere of work. “The threat of HIV to the Indian working population is evident from the fact that nearly 90 per cent of the reported infections are from the most productive age group of 15 to 49,” the official added.

According to the National AIDS Control Organisation (Naco), an estimated 2.31 million people in India were living with HIV/AIDS in 2007. Of this, 88.7 per cent were between 15 and 49 years, 7.5 per cent were aged 50 and above and 3.5 per cent were below 15. Around 0.34 per cent of the population has HIV/AIDS, Naco says, adding women account for 39 per cent of the cases.

“Stigma and discrimination at workplace gets reflected in loss of emplo yment and livelihood opportunities in addition to ostracism and seclusion faced by workers from known or presumed HIV status. It should never happen,” says the policy, now being circulated among ministries.

HIV infection can’t be a cause for termination of employment and those with HIV-related illnesses should be able to work for as long as they are medically fit in appropriate conditions, it says, adding that the treatment cost should form part of medical/welfare packages.

The policy seeks to address another problem area: exclusion of people with HIV from insurance schemes offered by public and private companies. The Insurance Regulatory and Development Authority (IRDA) should develop all-inclusive health insurance plans for such people, it says.

All workplaces — organisation, institution, businesses, company and others — should have an HIV/AIDS committee to coordinate and implement internal programmes for the infected. Multinationals can set up such HIV/AIDS panels too.

The labour ministry official said corporate houses were consulted and claimed several companies, including PepsiCo, Hindustan Unilever, Apollo Tyres and Crompton Greaves, had agreed with the guidelines in principle.

To monitor the policy’s implementation, the government plans to set up a steering committee on HIV/AIDS. It will comprise employers and worker organisations.

The HIV bill, of which the policy will form a large part, will aim to make employers liable for any discrimination against staff with HIV/AIDS and make them responsible for guaranteeing such employees a safe working environment.
Positive Calcutta HC settles HIV patient's case in 3 days

Sumanta Ray Chadhuri / DNAThursday, December 24, 2009 2:10 IST

Kolkata: The Calcutta high court set a new benchmark on Tuesday by settling a property dispute in favour of a 32-year-old HIV+ widow in three days. This comes to the rescue of the Indian judiciary, which had become synonymous with inordinate delays.

The landmark judgment also reveals the humane side of the judiciary. For, it spared the ailing Pampi Das (name changed), a mother of two, the ordeal of doing the rounds of court and spending her savings fighting the case.

Pampi's husband, who ran a transport business with his brothers, died in 2006, three months after he came to know that he had AIDS.

When her brothers-in-law came to know that Pampi too was HIV+, they refused her share in the business.

Pampi ran from pillar to post for justice till a couple of months ago when she came across Burdwan Society of People Living with HIV/AIDS. The NGO introduced her to Solidarity and Action Against the HIV Infection in India (Saathi).

Saathi promptly filed a petition in the Calcutta high court on Pampi's behalf.
Justice Shankar Prasad Mitra, who heard the case, found no justification in prolonging the matter beyond absolute necessity and after three hearings, passed an order entitling Pampi to her husband's share of property, which is one-fifth of Rs50 lakh.

Hailing the judgment, Saathi's documentation officer Soma Roy Karmakar said, "In most cases, victims have to wait for years to get justice. But Pampi's case has given us a new hope."
Downturn caused job losses across sectors
Category » Business Posted On Thursday, December 24, 2009
United News of India
New Delhi, Dec 24:

Even as the economic slowdown resulted in job losses across sectors in 2009, a slew of policy measures like the formulation of the National Skill Development Policy, announcement of the National policy on HIV/AIDS and the World of Work, and raising of the National Floor Level Minimum Wage from Rs 80 to Rs 100 per day were taken by the government for the welfare of workers throughout the year.

A sample survey conducted by the Labour Bureau covering 2,581 units across important sectors like mines, textiles, metals, gems and jewellery, automobile transport and IT/BPO had revealed that there was loss of job to the extent of 0.25 million in the quarter January to March, which declined by 1.31 million between April to June and improved by 0.5 million in the quarter beginning July to September.

On its part, the Ministry of Labour and Employment, in a review of its activities during the year, has named upgradation of employment Exchanges on a Mission Mode, the passing of the Bill to amend the Workman's Compensation Act 1923 by both the Houses of Parliament and declaration of the National Policy on Safety, Health and Environment at Workplace as among its achievements during the year.

Sharing details about the national policy on skill development, approved by the Union Cabinet in February, Mr Sarada Prasad, Joint Secretary in the Labour Ministry, said it was aimed at linking education and skill training to 'employability' and increasing 'functional literacy' in the country.

It would help the youth gain access to decent employment and ensure India's competitiveness in the dynamic global labour market.

Further, the policy promotes public-private partnership to ensure that the needs of the industry are met, Mr Prasad told UNI.
At least 3.58 lakh people have been benefited up to November under the policy which covers at least 45 sectors, he said.

Training courses are offered through a network of 2,076 Industrial Training Institutes (ITIs) and 5,529 Industrial Training Centres (ITCs)located all over the country.

A separate scheme for providing ITIs in North-Eastern Region and Jammu & Kashmir is also being implemented. About 10.62 lakh training seats are available in the ITIs and ITCs with reservation for women, SC/STs, disabled and ex-servicemen.

Steps have also been taken to establish 1,500 new ITIs and 5,000 Skill Development Centres in PPP mode in unserviced blocks of the country in order to provide training facilities in such areas.

Employment Exchanges are being upgraded on a mission mode under e-governance project.

In order to reduce the disparity in minimum wages across the country, the Centre has mooted the concept of the National Floor Level Minimum Wage.

On the basis of increase in the Consumer Price Index, the Central Government has recently revised the National Floor Level Minimum Wages from Rs 80 per day to Rs 100 per day with effect from November 1. But it is only persuasive in nature, without any statutory backing.



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