A health worker at a local health centre in Kinshasa, Democratic Republic of the Congo, prepares a vaccine injection. The dispatch of millions of COVID-19 vaccines to Africa started in February. Credit: UNICEF/Sibylle Desjardins
By Tlaleng Mofokeng
JOHANNESBURG, South Africa, Feb 25 2021 (IPS)
The UNAIDS 2020 Global AIDS Update gave us a clear indication why the world did not meet the Fast-Track targets by 2020. Inequality, perpetuated by structural oppression such as gender inequality; economic disparity; including human rights abuses and violations. For most of us living in sub-Saharan Africa, we don’t need a report to tell us this. Our lives are a litany of inequality we know deep in our guts.
Inequality is growing for more than 70% of the global population, solidifying divisions and hampering economic and social development. COVID-19 is impacting the most people in vulnerable situations the hardest— even as vaccines for COVID-19 are becoming available, there is great evidence of inequality in accessing them.
Inequality is the unfinished business of the AIDS, sexual and reproductive health and gender-based violence responses. Structural challenges are borne unfairly by individuals through differential access to healthcare
Confronting inequalities and ending discrimination is critical to achieving the Sustainable Development Goals, a collection of 17 interlinked global goals designed to be a blueprint to achieve a better and more sustainable future for all. We have less than 10 years remaining to meet these goals.
The right to health is interconnected with other rights, such as the right to information, the right to freedom and security, the right to equality and non-discrimination and the right to bodily autonomy.
Almost all these global goals are linked to important determinants of health therefore achieving them will impact the right to health for all.
We know that 2020 was a challenging year for many health systems across the globe from the highest level of national leadership to community-based health facilities. Because of COVID-19, human, financial and research resources have been diverted from other health programmes including HIV prevention, sexual and reproductive health and rights and gender-based violence services.
Unfortunately, this means that health systems in regions with high HIV rates are more susceptible to fragility. Sub-Saharan Africa is home to almost half the global population of people living with HIV. This makes the issue even more urgent. COVID-19, like HIV, is showing us what health systems lack in planning and resourcing.
In May 2020, a mathematical modelling group convened by UNAIDS and the World Health Organization (WHO) estimated that a six-month disruption to HIV services could lead to an additional 500 000 deaths from AIDS-related illnesses (including Tuberculosis) in sub-Saharan Africa in 2020–2021.
A six-month total disruption in these services was an extreme scenario and thankfully turned out to be less severe than feared. What this research did was to show us how vigilant we need to be about to HIV service disruptions and that the additional demands that COVID-19 has placed on health systems are real.
COVID-19 has shown the world that for many people across the globe, health is not simply a matter of individual health predispositions, but also a matter that is determined by economic and social conditions that influence the health of people and communities.
Inequality is the unfinished business of the AIDS, sexual and reproductive health and gender-based violence responses. Structural challenges are borne unfairly by individuals through differential access to healthcare. Socio-economic and structural factors interact with each other to generate and reinforce negative health outcomes that disproportionately affect poor and people in vulnerable situations.
Accordingly, human rights must be the basis of solutions and policy that centres people in vulnerable situations who are often neglected from health services goods and facilities such as women, indigenous people, people of African descent, people with disabilities, older persons, people experiencing homelessness, migrants and refugees and key populations, that is, sex workers, people who use drugs, and lesbian, gay, bisexual and transgender and gender-diverse people. These marginalized groups often lack access to HIV and other critical sexual and reproductive health, social protection and legal services.
It is important that we pay special attention to the role of laws, policies and practices that contribute to poor physical and mental health and in fuelling stigma against vulnerable people.
Every country in the world has at least one law that still criminalizes either same-sex sexual relationships, sex work, personal drug use or HIV exposure and transmission.
There are some countries in sub-Saharan Africa that are pockets of excellence. We hear stories of heroic individuals or communities who have ensured that people have access to increase adherence to HIV treatment against all odds. Many countries have implemented multi-month dispensing of antiretroviral medicines to three or six months, as recommended by the WHO.
But we do need successes to be much structural and far-reaching.
Comprehensive HIV management is an integral part of realizing sexual and reproductive health rights and is in line the state’s duty to respect, promote and fulfill the right to health. It is therefore incumbent on governments to repeal laws criminalizing HIV, non-disclosure, exposure, and transmission, as well as consensual sexual activities between adults and the criminalization of gender diversity, transgender identity or expression.
Sex work must be decriminalized and countries must prevent human rights violations of forced or coerced sterilization of HIV positive women.
In 2020, South Africa’s Commission for Gender Equality released a report that documents 48 cases where women were allegedly forced or coerced to undergo sterilization. There must be justice for such women, and we must prevent the occurrence of forced or coerced sterilization.
We must commit to the operationalization of the UNAIDS Rights in the time of COVID-19 report that calls on us to combat all forms of stigma and discrimination including those based on race, profession and those directed towards marginalized groups that prevent them from accessing care.
Ending inequality is the only way to achieve the right to health for all and it is everyone’s business to ensure that we do so.
Zero Discrimination Day is commemorated by the United Nations every year on 1 March. This year, the UN is highlighting the urgent need to take action to end the inequalities surrounding income, sex, age, health status, occupation, disability, sexual orientation, drug use, gender identity, race, class, ethnicity and religion that continue to persist around the world.
The views expressed herein are personal and do not necessarily reflect the views of the United Nations.
Tlaleng Mofokeng is the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. She is a South African medical doctor, author and broadcaster.
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