Monday, June 24, 2024

Human rights and HIV/AIDS: A response to Mogae and Lewis

Former President Festus Mogae and Stephen Lewis are quoted by as having said…..”In South Africa and across Africa, HIV continues to prey on women, sex workers and men who have sex with men. It is clear that to end the HIV epidemic; we must protect and support these groups. Yet our countries that disempower these groups and make them more likely to be infected with HIV. We cannot hope for an HIV free generation when we have laws that marginalize and punish those most vulnerable to the disease”

It is must be noted that this is not the first time former President Festus Mogae is calling for explicit decriminalization of sodomy and showing sympathy to Men who have sex with Men (MSM) and voluntary sex work. What is new however is that Mogae has brought in Stephen Lewis, a partner from the ‘Global Commission on HIV/AIDS and Law. Both Mogae and Lewis are global icons. They have become the darlings of the International Aids Community and have showed considerable amount of commitment in the fight against HIV/AIDS. They have the passion, the love, dedication and the desire to succeed in the fight against HIV/AIDS. Whenever Stephen Lewis talks, you simply can’t ignore him, whenever Festus Mogae talks you simply just can’t ignore him either. Stephen has the courage and Mogae has the bravery and the boldness. I must confess, I have come to like them, the two fall within what I have termed the league of seven global health champions, i.e. Paul Farmer (Partners in Health), Paul Hunt (UN Special Rapporteur on rights), Margaret Chan (WHO), Michel Sidibe (UNAIDS) and German Velasquez (special advisor for health and development at South Centre, Geneva).

Mogae and Lewis must be applauded for calling for the abolition of laws and cultural practices that undermine and discriminate against women. Countries must reform and do away with gender based discrimination and must ensure that women become key agents in health care provision, centrally involved in the design, management and delivery of health services. While women and men share similar health challenges, the differences are such that the health of women deserves particular attention.

Whilst I do agree with Mogae and Lewis that there is sodomy in Africa and that there is also voluntary sex work, perhaps there is need to come up with intervention strategies that will not be seen and perceived as promoting immorality and as well as promoting commercial sex work as a profession. The development of such strategies must be geared towards empowering women and addressing the institutional, structural and cultural imbalances that make them vulnerable and make them resort to sex work for survival and to earn a decent life. There are many factors that drive women into sex work and there is need to address those factors as well as to address the social determinants drivers. There should be political commitment and policy agenda set to address women’s vulnerability and one of them should be to rehabilitate voluntary sex workers as opposed to be seen to be promoting it by way of finding resort and resolve in human rights. Such commitment and drive should take similar form and shape as reflected in their current commitment that calls for decriminalization of sex work and sodomy.

For many the right to health may seem to be very remote as it has been argued by the Nobel Prize winner Amartya Sen (2008). First there is what is called the legal question. How can health be a right since there is no binding legislation demanding just that? The legal question assumes that the idea of right has to be inescapably legal. There is a long tradition of thinking of right in terms of social ethics and what good society must have.

Secondly there is the feasibility question, how can the state of being in good health be a right, when there is no way of ensuring that everyone does have good health. This is based on common confusion about what can or cannot be a right. If feasibility were a necessary condition for everyone to have any right, it would be nonsensical to say that everyone has the right to liberty in view of the difficulty in ensuring the life and liberty of all against transgression, Paul Farmer

Lastly there is the policy question. Why think of health rather than health care, as a right since health care is under the control of policy making and not the actual state of health of the people. The policy question points to the important fact that good health care is something we can legislate about. Thus a human right can serve as a parent not only of law, but also of many other ways of advancing that cause of right. The right to health has similarly broad demands that go beyond good health care. There are political, social, economic, scientific and cultural actions that we have to take for advancing the cause of good health for all, Amartya Sen (2008).

Africa is fatigued and overwhelmed by global health reforms that are forever on the increase and she not being given an opportunity and responsibility to set up the agenda and her voice heard and respected without the cosmetic cover up and use of human rights and law as an excuse. Africa needs lifesaving drugs and it needs to be supported and assisted to set up its own manufacturing pharmaceutical industries that will help it reduce its over dependence on hand outs and aid to procure ARVs. Africa needs patents rights to be dealt away with and the market to be liberalized for it to be able to procure generic ARV drugs. Africa needs second line combination drugs that will be able to assist those patients who have shown virological failure in first line treatment regime. Africa has patients who inevitably require treatment options beyond their second line regime. It is not only cultural laws, customs and policing of voluntary sex workers that matter. Mogae knows this better, so does Stephen Lewis.

The positive impact of vaccines on public health is well documented. The World Health Assembly first discussed the Decade of Vaccines in 2011 and it is expected to validate a new Global Vaccine Action Plan (GVAP) 2012. It is almost a decade since the Doha Declaration, in which governments affirmed the need to prioritize health over trade, access to affordable medicines over intellectual property right. But a decade later, the struggle to access medicines in developing countries continues. Africa wants vaccines that are affordable and this should be the work that pre-occupies champions of HIV/AIDS. Everything else should become secondary. It should not just be a matter of pushing a policy agenda for donor support. African leaders have continued to show solidarity and support on global health initiatives, former President Festus Mogae had to demonstrate political commitment by taking a live HIV/AIDS test, in Kenya, Cabinet Ministers in Raila Odinga’s administration had to circumcise publicly and it has been argued elsewhere that Raila also had to circumcise in order to win elections. What therefore is next? Is the world waiting for the first African leader to show bravery and come out and declare publicly his sexual orientation? Even advocates and champions are too quick to declare their sexual orientation in that they do not practice sodomy.

That there is sodomy in Africa is an undeniable fact, but sodomy is a taboo in many African cultural practices and it is normal for people to react with shock and disbelief towards its decriminalization. To them the idea is Western. There is need to determine the extent and the magnitude of sodomy in the many African countries. What proportion of the country is sodomised and what intervention strategies are needed to address it. Similarly it is an undeniable fact that voluntary sex work is rife in Africa. It is practiced almost everywhere from corporate industry to church, from offices to street selling. Transactional sex has become a norm and a practice. It is a tit for tat and men must not be left out of the equation in any form in the proposed interventions strategies. There are Men with hidden sexual behaviors, those who are husbands during the day and gays at night. They too must be brought in the equation. There is prostitution even in Men who have sex and an emergence of a fashion crazy statement of being gay. I have read somewhere in Mmegi blog that sodomy has more money and young lads who have also been introduced in the world of drugs have to maintain the city life style. This needs to be discussed as well.

In applying human rights approach, there is a tendency of always taking a partial approach by some people and thus failing to acknowledge and address how to take action on poverty and powerlessness for instance. I.e., the right to an adequate standard of living and the right to food, proclaimed at the World Conference on Human Rights in Vienna 1993. These are practically never addressed and discussion is always limited to social and legal discrimination, employment, privacy and confidentiality, the right to information and education, freedom of expression and association, freedom of movement and freedom from in human and degrading treatment.

The irony is that the International Aids Community has loudly trumpeted its commitments to respect for human rights in the fight against AIDS, however, when it comes to addressing vulnerability of sex work for instance there is absence for strategy and action plan save for talk shows.

Thabo Lucas Seleke is a Fulbright Scholar currently serving as a Global Health Fellow, Geneva, Switzerland. He writes here in his personal capacity.


Read this week's paper