Stigma and Discrimination Issues Persist in Implementation of US Global AIDS Programs

Ending HIV-related stigma and discrimination is critical for prevention, treatment and care for millions. PHR?has analyzed the four completed PEPFAR country partnership framework agreements, plus a late-stage draft of Kenya's agreement, to determine how they address several issues related to stigma and discrimination:

  1. whether they promote legal and policy changes required to create a protective legal environment for women, people living with HIV/AIDS and other marginalized populations;
  2. whether they address health sector stigma; and
  3. whether they acknowledge people with disabilities as a population at heightened risk for contracting HIV.

The partnership framework agreements, and more specific five-year implementation plans that will follow, will guide PEPFAR's work in each country with an agreement over the next phase of PEPFAR.So how did PEPFAR do?PHR found that although PEPFAR's newly released five-year strategy incorporates the vital goals of stigma-free HIV programs and reaching even the most marginalized populations, the initial partnership framework agreements inadequately address these issues. Most of the agreements reviewed failed to address the need for legal and policy reform with respect to curtailing stigma and discrimination and securing the equal rights of women. Those that did were incomplete with respect to issues or populations covered, or were vague as to the extent of the commitments being made. Similarly, the majority of agreements did not address stigma and discrimination within the health sector, and the approach of the several that did specifically address this concern did not appear to be comprehensive. Only one agreement recognized people with disabilities (in particular, people with mental disabilities) as a group at heightened risk of contracting HIV.The overview of PHR's findings and recommendations, and the full analysis, are available on our website.PHR urges that future partnership framework agreements, as well as the implementation plans, much more fully address these issues. We recognize that progress in some cases requires addressing deep, culturally-rooted stigma and may not always be possible within the context of these agreements. Yet the US government must actively and vigorously use all sources of leverage and planning, including these agreements, to promote respect for human rights of all people. Part of any strategy to do so should include increased support for women's organizations and organizations comprised of and representing marginalized populations. Such organizations will have a central role in helping societies overcome stigma, in advocating for legal and policy changes and in holding governments accountable for enforcing policies that protect human rights.

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