The quantification gap

By Enrique Restoy

Enrique Restoy, Senior Advisor, Human Rights on why the failure of the HIV response to develop better ways of analysing the impact of human rights is undermining efforts to achieve global targets for HIV treatment, prevention and non-discrimination.

There is little to dispute. Human rights matter in the response to HIV. Not only because people affected by HIV have the same rights as everybody else, but also as a key principle for advancing the end of AIDS.

As the HIV response rallies behind the UNAIDS 90:90:90 targets in the strong belief that ending AIDS is a possibility, it’s great to see zero discrimination targets being central to the new UNAIDS strategy. Human rights, including non-discrimination, are also at the core of the Sustainable Development Goals.

But hold on a minute, if human rights are so important, why are they repeatedly ignored  when key strategic decisions are being taken about how best to tackle the epidemic?  For instance, the treatment objectives in the new UNAIDS strategy are based on qualitative modelling data. However, the zero discrimination targets are not only considered in isolation to the treatment objectives, they are ambiguous and difficult to monitor. UNAIDS human rights targets have been criticised in the past for being poorly monitored.

So what can be done to improve this human rights-HIV relationship? From the point of view of investments, UN bodies, donors and governments must further prioritise the need to quantify the impact of human rights (context and programmes) on the effectiveness of the HIV response.  

But there are challenges. On context, there is overwhelming evidence that laws and practices persecuting same sex practices, sex work, drug use, not only breach their human rights, but also impact negatively on the effectiveness of the HIV response. It is challenging to quantify such impact on health outcomes since very often it is not direct. It coexists with a myriad of other structural factors or it is felt over a large number of years. However, there is a small but growing literature being developed in this area.

<p>REDLACTRANS on a march through the streets of Guatemala to demand an end to transphobia in Latin America.</p>

On human rights-based programmes at country level, although many are recognised HIV interventions, they are often presented as a means to respond to contexts where the human rights of people affected by HIV are abused. Emphasis is placed on the diagnosis of the problem through legal and policy analysis and the identification of such abuses. Today virtually all national strategic plans on HIV and AIDS incorporate such analysis and all include rhetoric around the need to base the HIV response on human rights principles. But very few countries analyse the various impacts of human rights interventions and incorporate such interventions in their work plans.

These challenges for quantitatively measuring the impact of human rights interventions in the same way as the impact of biomedical interventions contributes to the fact that very little funding from HIV donors is allocated to this kind of work. Out of 119 concept notes submitted by countries to the Global Fund to Fight AIDS, TB and Malaria in 2014, only around US $8M constituted specific human rights interventions, less than 0.1% of the total requested.

Not only does this represent a desperately small proportion of the total funding for HIV, the impact of the greater investments being made on biomedical interventions is seriously being undermined in the many countries which enforce punitive laws against people most affected by HIV. At present, there are at least 60 countries which have adopted laws that specifically criminalise HIV transmission, and over 78 jurisdictions which criminalise same-sex relations.

We intend to use this to improve our own programming, to build a better evidence base and to advocate for human rights to be truly at the core of HIV investments. If you have experiences, thoughts and comments on this issue, please do get in touch (erestoy@aidsalliance.org). We need a concerted effort by all parties from diverse disciplines to build a better understanding of the impact of human rights on the HIV response and on health more widely.