In sub-Saharan African prisons, the prevalence of HIV ranges from twice as high to fifty times as high as levels for the non-imprisoned in the same regions. As part of her research on prison health monitoring for a new Human Rights Watch report, Todrys toured 16 Ugandan prisons and interviewed 164 inmates. Overcrowding, poor ventilation, sex trading, and lack of condoms led to increased infections. Yet despite high rates of transmission, only one of the 223 prisons in Uganda has a medical facility equipped to provide adequate treatment for HIV/AIDS and tuberculosis. Only one-tenth of one percent of PEPFAR funds to Uganda are directed towards prison health.

According to Todrys, “There is a better approach: fund human rights-based approaches, which emphasize government accountability and evidence-based programs—that is, programs that have been shown to work. Pressuring the Ugandan government to end abusive practices that increase HIV transmission, for example, costs very little compared with treating HIV after infection has occurred.”

The abuses that must be addressed include the slow-moving criminal justice system that leads to overcrowding in prisons, the criminalization of men having sex with other men, which leaves all-male prisons devoid of condoms, and forced labor in prisons that worsen the health of those suffering from HIV/AIDS. Ugandan HIV programs must be scaled up to address the massive HIV epidemic in prisons, and Todrys insists that a rights-based approach is the only way to reach this marginalized population.

Photo: Olek Remesz via Wikimedia Commons

As written, the draft law threatens human rights and progress toward universal access to treatment. The most alarming changes include the criminalization of intentional transmission of HIV, which could result in life imprisonment; compulsory testing of drug users, pregnant women, sex workers, and victims and charged offenders of sexual violence; and forced disclosure of HIV status. The government’s role in providing access to affordable treatment has been removed from the legislation.

“We know what works and what doesn’t in fighting HIV,” said Beatrice Were of the Uganda Network on Law, Ethics & HIV/AIDS. “This bill, unfortunately, is full of ineffective approaches that violate human rights and will set us back in our efforts to fight the AIDS epidemic and expand HIV programs nationwide.”

The bill’s most troubling traits are particularly unjust to women and high-risk groups. Because women are tested for HIV during pregnancy, a disproportionate number of women will know their HIV status and will thus be prosecuted disproportionately. The bill does not consider and protect a women’s inability to negotiate condom use or to tell a partner about her status — a partner who may have transmitted the disease to her in the first place. The HRW analysis finds that women who transmit HIV to their infants by feeding them breast milk would face criminal prosecution. Although the legislation exempts mother-to-child transmission “before or during the birth of the child,” the law does not protect mothers after child birth — the period of time when breastfeeding occurs. Additionally, there is little mention of counseling or support services for minors.

In short, the bill fails to provide a legal framework favorable to the effective national management of the epidemic. It fails to chip away at the more elusive yet fundamental perpetuators of the disease: stigma and discrimination.

The bill also arrives on the heels of a widely condemned piece of pending legislation, the Anti-Homosexuality Bill, which “prohibits and penalizes homosexual behavior” in Uganda. The bill, proposed on October 14, 2009, contains a life imprisonment punishment for an “offence of homosexuality.” Punishment by death is recommended for those committing “aggravated homosexuality,” whereby the “offender”— or, a partner in a homosexual act — is HIV-positive, or the other partner is disabled or under 18 years old. Those charged would be forced to take an HIV test. The bill also carries penalties for individuals who know about gay persons but do not report them, striking a severe gash in the progress of HIV prevention and treatment efforts by alienating this high-risk group.

The bill will enter Parliament shortly and will most likely become law in early 2010. Its myriad egregious clauses, such as the death penalty, could be altered slightly, but their fates remain to be seen. The gross human rights violations that lurk in the bill — discrimination of vulnerable groups, roadblocks to treatment, privacy of HIV status — will no doubt be carried through to law in some capacity, and these violations bear a striking resemblance to those in the HIV/AIDS bill.

Despite its numerous critiques of the proposed HIV/AIDS law, the HRW report does not ignore some welcome attributes of the legislation, noting that several changes may “improve the potential for human rights protections.” For example, neglecting to inform one’s sexual partner of HIV status and failure to protect oneself from transmission is no longer criminalized, and children born to HIV-positive women will receive treatment and care. Still, the bill lacks a fundamental commitment to protecting the rights and the health of its citizens.

In early December, Elizabeth Mataka, the UN Special Envoy on AIDS in Africa, added her voice to those of the bill’s dissenters. “I emphasize the importance of creating a social environment conducive for HIV prevention and to refrain from laws that criminalize the transmission of HIV and stigmatize certain groups in the population,” she remarked in Kampala, Uganda, on December 2. “These laws can only fuel the epidemic further and undermine an effective response to HIV.”

Her lips to Parliament’s ears.

It is estimated that 250,000 children, some age 10 or younger, are currently recruited into armed conflicts around the world and used as soldiers, guards, messengers, or sex slaves. Such recruitment of children occurs most often in conflict zones such as Colombia, Democratic Republic of Congo, Uganda, and Sri Lanka. The use of child soldiers has been officially prohibited by a UN treaty ratified by 126 countries since 2002. Children in conflict areas are guaranteed special protection under the Optional Protocol to the Convention on the Rights of the Child and the Worst Forms of Child Labour Convention.

It is no surprise that rehabilitating child soldiers is a difficult and lengthy process. Because of the severe trauma they suffer, children who have been in combat require extensive long-term support to be re-integrated into communities, says UNICEF spokesman James Elder. He explains that child combatants “live in a theatre of violence and suffering…Instead of hope, fear defines their childhood.”

Additionally, the crimes of child soldiers, or of the larger group they belong to, can make community re-integration even more difficult. Their role as combatants entails committing violent crimes, and children sometimes join armies out of a desire for revenge. For example, child soldiers in the LRA “were both brutally abused and abusive, killing attempted escapees, captured soldiers, and civilians”. Because of this, child soldiers are often treated no differently by government forces than adult soldiers. When children are released into society, they can face acts of discrimination or revenge from communities that have been affected by violence. Nations must address the concerns of both child soldiers and their victims in attempts at rehabilitation. Some experts even argue that not prosecuting child soldiers can lead to further human rights violations, as commanders may order children to commit the worst crimes because of their immunity.

Dance/movement therapy (DMT) is one new approach to rehabilitation that recently began in Sierra Leone for the Orphan Boys of Koindu, a group of former child soldiers. A psychosocial counseling team integrated healing and purification rites traditionally done in the area with Western psychological techniques to “foster both acceptance and accountability”.

Education and vocational training are also critical elements of rehabilitation, say many experts. Education provides a means for children to make a living and avoid returning to combat, and enhances community. One former child soldier in Sierra Leone explained: “The community becomes happy when they see us engage in productive activities such as schooling, trading, mining, or farming. However, if you are stubborn and unsettled, they get worried.”

More links:

Child Soldiers Photo Exhibit

UN Security Council Open Debate on Children and Armed Conflict (transcript and video of Grace Akallo’s speech)

Child soldiers fighting in the DRC (video)

Human Rights Watch: Fighting for their Lives

The Red Hand Campaign

Pawn of Politics

Secretary-General calls for “bold action” to end human trafficking

UN: Children and Armed Conflict

FXB Center Research Program on Children and Global Adversity