37/74 2017 Social Forum - Report of the Co-Chair-Rapporteurs

GE.18-01548(E)



Human Rights Council Thirty-seventh session

26 February–23 March 2018

Agenda item 5

Human rights bodies and mechanisms

2017 Social Forum*

Report of the Co-Chair-Rapporteurs

Summary

In accordance with Human Rights Council resolution 32/27, the Social Forum was

held in Geneva from 2 to 4 October 2017. Participants considered the promotion and

protection of human rights in the context of the HIV epidemic and other communicable

diseases and epidemics. The present report contains a summary of the discussions,

conclusions and recommendations of the Forum.

* The annex to the present report is being issued in the language of submission only.

United Nations A/HRC/37/74

Contents

Page

I. Introduction ................................................................................................................................... 3

II. Opening of the Social Forum ........................................................................................................ 3

III. Summary of proceedings ............................................................................................................... 4

A. Keynote speakers and general statements ............................................................................. 4

B. Setting the scene: implementing health related Sustainable Development Goals

through a human rights perspective ...................................................................................... 5

C. Leaving no one behind: discrimination and the realization of the right to health ................. 7

D. Role of civil society in the context of epidemics .................................................................. 8

E. Communities leading programmes for health ....................................................................... 9

F. Health-care workers on the front line ................................................................................... 10

G. Building synergies for health: engaging diverse partners ..................................................... 11

H. International cooperation for global responses and national implementation ....................... 13

I. Access to medicines, diagnosis, vaccines and treatment

in the context of the right to health ....................................................................................... 14

J. The way forward ................................................................................................................... 15

IV. Conclusions and recommendations ............................................................................................... 16

A. Conclusions .......................................................................................................................... 16

B. Recommendations ................................................................................................................. 17

Annex

List of participants ......................................................................................................................... 20

I. Introduction

1. The Human Rights Council, in its resolution 32/27, reaffirmed the Social Forum as a

unique space for interactive dialogue between the United Nations human rights machinery

and various stakeholders, including civil society and grass-roots organizations.1

2. The 2017 Social Forum was held in Geneva from 2 to 4 October. It focused on the

promotion and protection of human rights in the context of the HIV epidemic and other

communicable diseases and epidemics. The President of the Council appointed the

Ambassador and Permanent Representative of Brazil to the United Nations Office at

Geneva, Maria Nazareth Farani Azevêdo, and the Ambassador and Permanent

Representative of Belarus to the United Nations Office at Geneva, Yury Ambrazevich, as

the Co-Chair-Rapporteurs of the Forum.

3. The programme of work was prepared under the guidance of the Co-Chair-

Rapporteurs, with inputs from relevant stakeholders, including United Nations agencies and

non-governmental organizations (NGOs). The present report contains a summary of the

proceedings, conclusions and recommendations of the Forum. The list of participants is

contained in the annex to the present report.

II. Opening of the Social Forum2

4. The meeting was opened by the Co-Chair-Rapporteurs of the Social Forum. Ms.

Farani Azevêdo emphasized that it was essential to strengthen health systems and promote

universal health coverage in order to provide long-term sustainable responses to future

epidemics. To be effective, those responses must include not only technical and financial

support, but also be firmly anchored in a human rights perspective. Realizing the right to

health entailed ensuring equal access to medicines and health-care services and addressing

social, economic and environmental determinants of health. Poverty, lack of sanitation, air

pollution, unsafe water and inappropriate waste disposal and management perpetuated the

transmission of vector-borne and infectious diseases and enabled the outbreak of epidemics.

Discrimination resulting from harmful social practices or restrictive legal norms were major

obstacles to the right to health. Those challenges required a multisectoral approach. The

interdependence between the human rights and the development frameworks had been

reaffirmed by the 2030 Agenda. The 2017 programme of the Social Forum was aimed at

building bridges between the Sustainable Development Goals and human rights obligations

and norms.

5. Mr. Ambrazevich stated that the promotion and protection of human rights in the

context of the AIDS epidemic and other communicable diseases and epidemics were

directly related to the complex challenges of finding the most effective ways to combat

those diseases. Each State needed to carry out careful analyses of systems and mechanisms

for ensuring a balance of interests of all stakeholders in that issue, particularly in the light

of the emergence of new challenges. To achieve the Sustainable Development Goals

relating to health, global progress should be made in economic, social and cultural rights.

That also required national dialogue between all interested parties, as well as effective and

action-oriented governance, adequate policy space, international cooperation, assistance

mechanisms, and national and international partnerships.

6. The Vice-President of the Human Rights Council, Mouayed Saleh, drew attention to

the resolutions adopted by the Council on issues related to physical and mental health, and

to the fact that health was an important element of the 2030 Agenda. Recent outbreaks of

Zika, cholera and severe acute respiratory syndrome (SARS) had illustrated that a

1 For further details on the Social Forum, see

www.ohchr.org/EN/issues/poverty/sforum/pages/sforumindex.aspx.

2 The full texts of the statements and presentations submitted to the Secretariat are available at

www.ohchr.org/EN/Issues/Poverty/SForum/Pages/SForum2017Statements.aspx.

comprehensive approach to public health challenges required broader social measures,

including tackling stigma and discrimination. Epidemics had also made clear that the right

to the highest attainable standard of physical and mental health enjoyed a symbiotic

relationship with other human rights. Health could only be improved when other human

rights were upheld.

7. The United Nations High Commissioner for Human Rights said that the human

rights principles of non-discrimination, participation and accountability were essential to

achieving more sustainable, inclusive and effective health systems. Recent outbreaks of

Ebola, Zika and cholera had highlighted the importance of basic infrastructure for the

enjoyment of the right to health, the need to uphold the right to comprehensive sexual and

reproductive health services and the need for special protection for health facilities during

armed conflicts. Focusing on the health of adolescents and supporting health workers as

human rights defenders made societies more sustainable. The 2030 Agenda provided an

opportunity to accelerate efforts to integrate all human rights, including the right to

development, and public health considerations into policies at every level.

III. Summary of proceedings

A. Keynote speakers and general statements

8. The Executive Director of the Joint United Nations Programme on HIV/AIDS

(UNAIDS), Michel Sidibé, recalled that almost 40 years before the establishment of the

Social Forum, people living with HIV had challenged indifference and created, championed

and led a transformative movement from a focus on disease to a people-centred approach.

Activists had broken the “conspiracy of silence”, which had helped change the trajectory of

the epidemic and make treatment more affordable. That progress in the HIV response had

been made possible by adopting an approach grounded in human rights. While 20 million

people were currently on antiretroviral therapy and AIDS-related deaths had dropped

sharply, millions still awaited treatment. Moreover, global solidarity and shared

responsibility were being questioned, and civil society space was shrinking. Stigma and

discrimination discouraged people from accessing prevention services, especially in the

cases of transgender and gay persons and people who injected drugs. A transformative

global agenda, powerful scientific and medical tools, strong and binding global human

rights frameworks, and programmes that worked to advance health all imposed a moral and

a legal responsibility to act.

9. The Director-General of the World Health Organization (WHO), Tedros Adhanom

Ghebreyesus, spoke about the importance of achieving universal health coverage to address

impending health challenges. Universal health coverage improved everyone’s health,

reduced poverty, created jobs, drove inclusive economic growth, promoted gender equality

and protected people against epidemics. However, social barriers prevented many people

from getting the care they needed, and included discrimination against adolescents,

refugees, sex workers, drug users, people in prison, the poor and people with minority

sexual orientation. Robust health systems should provide the services people said they

needed, not those that providers decided they needed. Civil society organizations,

community groups, Governments, United Nations agencies and for-profit companies should

work together to fulfil the political mandate of the Sustainable Development Goals to

improve health outcomes and transform health systems.

10. An advocacy officer at AfricAid Zimbabwe, Loyce Maturu, shared her experience as

a young person living with HIV and tuberculosis. Living with HIV was difficult due to

stigma, obstacles in access to care and lack of confidentiality in health facilities. There was

a need for evidence-based, differentiated care models and to ensure that there were AIDS-

free generations. Investment was required in peer-led interventions and comprehensive

sexual and reproductive health education. Young people living with HIV needed not only

treatment but also interventions that supported and motivated them to stay on treatment and

remain healthy. The fight against HIV could be won only by believing in the voices of

affected populations and by making them partners and decision makers.

11. The Director-General of the World Trade Organization (WTO), Roberto Azevêdo,

described the contributions of WTO to the realization of the right to health. Innovation was

vital for new treatments as diseases evolved, but to benefit those in need of treatment,

effective and equitable access to medicines was necessary. The Agreement on Trade-

Related Aspects of Intellectual Property Rights (the TRIPS Agreement) provided

exceptions and limitations and was to be implemented in a manner conducive to social and

economic welfare. The 2001 Doha Declaration on the TRIPS Agreement and Public Health

had marked a major milestone in increasing access to medicines. It had led to the

amendment of WTO trade rules to allow for generic medicines to be produced under

compulsory licences for export to countries with limited or no pharmaceutical production

capacity for treating affected populations. WTO had also taken measures to reduce the costs

of and delays in shipping medicines internationally and to cut tariffs on medicines. There

could be no higher calling for the international community than to work together to fulfil

the right to health. WTO, working jointly with others, would continue to ensure that trade

supported the fulfilment of that right.

12. Following the presentations, representatives of Bahrain, Cabo Verde (on behalf of

the Community of Portuguese-speaking Countries), Egypt, Ghana, the Islamic Republic of

Iran, Mexico, Panama, the Philippines, Portugal, South Africa, the Association of World

Citizens, the Elizabeth Glaser Pediatric AIDS Foundation, the Global Forum on MSM &

HIV, the Stop AIDS Alliance and the World Social Forum took the floor. They underlined

the need to address challenges faced by specific groups, such as children, adolescents,

women, migrants, refugees, persons deprived of liberty, sex workers and lesbian, gay,

bisexual, transgender and intersex persons. Those challenges included discrimination,

criminalization of vulnerable groups, the shrinking of civic space, barriers to access to

medicines and unaffordable prices, and a lack of funding for health and other policies

addressing the social determinants of health. Overcoming those challenges was a collective

endeavour that should build on the 2030 Agenda commitments. Proposals for addressing

those challenges included the adoption of universal health-care systems, the collection of

disaggregated data in a manner respectful of key populations, the inclusion and

participation of civil society and youth in policymaking and implementation, increasing

investments in community-led programmes and decriminalizing drug use and behaviours

common among affected populations. Some speakers encouraged countries to include HIV-

related human rights issues in their universal periodic review reports and recommendations,

their reports to human rights treaty bodies and their voluntary national reviews on the

Sustainable Development Goals.

B. Setting the scene: implementing health related Sustainable

Development Goals through a human rights perspective

13. The Chair of the Committee on Economic, Social and Cultural Rights, Virginia Bras

Gomes, said that while the policies, targets and indicators that had been adopted for the

fulfilment of the Sustainable Development Goals would, in principle, lead to the realization

of rights, that realization did not depend only on policies. It was the human rights

framework that could strengthen the fulfilment of the Goals. If States complied with their

non-discrimination and equality obligations, the 2030 Agenda commitment to leave no one

behind would be achieved. Fulfilment of the right to access to information and education

campaigns could prevent the spread of sexually transmitted infections. The right to health

required the availability of an adequate number of functioning health-care facilities,

services and goods and the promotion of social determinants of good health, such as

environmental safety, economic development and gender equity. The targets and indicators

in Sustainable Development Goals 3, on ensuring healthy lives, and 5, on gender equality,

could contribute to realizing the right to health of people affected by AIDS and other

diseases.

14. A Portuguese Parliamentarian, Ricardo Baptista Leite, recalled that the

decriminalization of drug use in Portugal in 2000 had contributed not only to decreasing

crime, but also to the decrease in drug consumption and the prevalence of infectious

diseases, especially HIV and viral hepatitis. A parliamentary resolution developed by an

all-party group on HIV in collaboration with civil society, health-care workers and health

industries had become the backbone of health policy on HIV in Portugal. In the same spirit

of consensus among stakeholders, Portugal had been able to secure a financially sustainable

strategy on hepatitis medication, ensuring access for all patients. The quality of life of

people living with HIV should be as important an objective as biomedical targets relating to

treatment. Parliamentarians could play an active role in responding to epidemics by

approving national budgets, changing policies and building bridges between people and

Government. He called for support for the work of “Unite”, a global network of

parliamentarians that focused on combating AIDS, hepatitis and tuberculosis.

15. The Vice-President of Helen Keller International, Joseph Amon, emphasized that

rigorous and routine monitoring was a means of accountability, which was a key human

rights principle. While specific indicators and regular reporting constituted an important

tool to promote the right to health for all, indicators did not always tell the whole story.

National averages could hide significant inequalities between regions, age groups and

among most at risk populations. Data could also be inaccurate. True accountability required

both disaggregation of data and broad participation with communities to validate what was

presented. The Sustainable Development Goals called for an end to the epidemic of

neglected tropical diseases, which mainly affected people living in poverty, in sub-standard

housing and without adequate water and sanitation. The success of health programmes

stemmed not only from scientific advances but also from the promotion and protection of

human rights, including the right to health, education, non-discrimination, freedom from

violence, access to justice, gender equality and participation. The health sector had an

important role to play, but could not address human rights abuses and social determinants

of vulnerability alone.

16. A representative of the World Social Forum, Armando de Negri, said that the Forum

facilitated discussion of alternative proposals for inclusive globalization that fostered the

people’s well-being and radical democracy based on social justice. It had established a

thematic forum on social rights related to health and social security, which was aimed at

promoting health systems based on the universality, integrity and equality of all human

rights, including the right to development. A new balance of power was needed

internationally, which could be achieved only through correlations of power in national

Governments, parliaments, the judiciary and the media that favoured solidarity instead of

individualistic and fragmented political thinking. To reverse the concentration of wealth,

democracy should be strengthened and political power distributed fairly. Otherwise, the

Sustainable Development Goals would be overcome by the wealth-concentrating dynamics

of capitalism, impeding the realization of economic and social rights and a life of dignity

for all.

17. During the interactive dialogue, representatives of Brazil, Chile, Ecuador, Portugal,

the Global Forum on MSM & HIV, the Institute for Planetary Synthesis and the People’s

Health Movement took the floor. Participants considered that the Sustainable Development

Goals and human rights, including the right to health, were mutually reinforcing

endeavours, and recalled the importance of accountability, participation, non-discrimination

and international solidarity in order to implement the Goals. Some speakers recalled the

importance of disaggregating data when reporting, welcoming indicator 3.3.1 of the Goals.

Participants also called for a multi-stakeholder approach to the implementation of the Goals

and for the preservation and promotion of civil society space in relation to health

programmes. Some speakers recommended preventive approaches to health that addressed

the social determinants of health and better accountability mechanisms to address

discrimination in health systems. The panellists were asked about the meaning and

operationalization of universal health coverage (target 3.8 of the Goals) from a human

rights perspective and about the roles of stakeholders, including parliamentarians and treaty

bodies.

18. In response, Mr. Baptista Leite acknowledged the importance of disaggregating data,

but stressed that Governments should not be excused from acting due to the absence of

data. He argued that data related to the Sustainable Development Goals should be produced

at the local level for a central registry. He underscored that universal health coverage could

ensure better health outcomes and lower costs by preventing more serious health problems.

Mr. de Negri called for an institutional architecture that enabled the participation of patients

and affected populations in social policies and in the implementation of the Sustainable

Development Goals. He argued that the Goals were the object of a “battle of ideas”, with

concepts such as universal health coverage still open for interpretation, which could leave

many behind. Ms. Bras Gomes emphasized the role of disaggregated data in identifying

discriminatory practices and ensuring that no one was left behind economically and in

terms of policies and rights. Human rights treaties required that national action plans

encompass accessibility, availability and affordability, particular in implementing Goal 3.

Mr. Amon stressed the need to ensure a people-centred approach to health and direct

engagement with local communities, to ensure that rights were respected in the fight to end

all epidemics. He called for strengthened cooperation between civil society and

Governments.

C. Leaving no one behind: discrimination and the realization of the right

to health

19. The Interim Executive Director of the Global Fund to Fight AIDS, Tuberculosis and

Malaria, Marijke Wijnrocks, said that the Fund had made it a strategic objective to increase

investments in programmes to remove human rights-related barriers to health services. The

programmes attacked stigma and discrimination, taught people about their health-related

rights, provided legal support, reduced harmful gender norms and gender-based violence,

improved the attitudes and practices of health-care workers and the police, and made laws

and regulations protective of health. The Fund had made it a requirement that all countries

include those programmes in their grant proposals. Civil society, Governments, the United

Nations system, other technical partners and donors should help promote more effective

programmes for removing human rights-based barriers to health. She hoped they would all

join in the move from human rights principles to human rights programmes supporting

people to be effective players in determining their own health and well-being.

20. The Chair of the Committee on the Protection of the Rights of Persons Living with

HIV and Those at Risk, Vulnerable to and Affected by HIV of the African Commission on

Human and Peoples’ Rights, Soyata Maiga, described the Commission’s efforts to integrate

HIV and health in its work and mandates. Addressing those issues was critical, as Africa

was particularly affected by HIV and many countries had laws and policies that represented

barriers to effective HIV responses. The Committee she chaired had been established in

2010 with a broad mandate that included conducting fact-finding activities on the situation

of persons living with HIV and those at risk, and engaging States, civil society and others

on the measures needed to advance human rights in response to HIV. The Commission took

steps to protect the human rights of persons living with HIV and those at risk by receiving

communications concerning human rights violations; issuing urgent appeals, general

recommendations and thematic studies; and adopting resolutions on health, HIV and human

rights. She recommended that all stakeholders integrate a human rights-based approach to

drawing up and implementing plans, policies and programmes to combat HIV.

21. A member of the Regional Steering Committee of the Asia Pacific Transgender

Network, Phylesha Brown-Acton, presented data illustrating the challenges and barriers

faced by transgender people in accessing transgender-competent general or mental health

care. Transgender women were 49 times more likely to be affected by HIV than the general

population. There was a need for transgender-positive interpretations of human rights law

and jurisprudence, a strong commitment to enforcement of international obligations, and

space for transgender voices. The lack of acknowledgement of indigenous specific

terminologies for transgender identities in declarations, systems, mechanisms and processes

resulted in them being referred to in demeaning and dehumanizing ways. Ignoring

indigenous terminology impeded effective country responses and the achievement of fast-

track targets. Moreover, the lack of data on indigenous and transgender peoples resulted in

them being left behind.

22. A representative of the Zero TB Initiative, Ulaanbaatar, Batbayar Ochirbat, said that

tuberculosis patients in Mongolia experienced discrimination in terms of access to

medicines, diagnosis and treatment. The poor availability, poor quality and high prices of

medicines were significant problems. The health sector was one of the most corrupt in the

country, which undermined the credibility of the data it produced and the quality of

treatment provided. The fight against corruption, underfunding, and the lack of political

will and commitment were cumulative challenges that needed to be faced in order to fight

diseases effectively. Since the capacity of Governments in the global South was low, NGOs

should lead the fight against discrimination and efforts to combat tuberculosis and HIV in a

cost-effective manner. NGOs in Mongolia had succeeded in reducing the cost and

improving the quality of drugs. He welcomed the partnerships WHO and the Global Fund

to Fight AIDS, Tuberculosis and Malaria had set up with local communities to identify and

remedy discriminatory practices against children with tuberculosis.

23. During the interactive dialogue, representatives of Panama, Ukraine, the Domino

Foundation and the International Federation of Anti-Leprosy Associations took the floor.

The issues they raised included violations of the right to health of people who used drugs,

minorities and persons living with HIV in Crimea; the need to access high-quality health

services for all persons; the close link between mental health, HIV and treatment adherence

patterns; the specific needs of specific groups; discrimination against people affected by

neglected tropical diseases, including leprosy; and the importance of not leaving behind

indigenous peoples and people living in rural communities.

D. Role of civil society in the context of epidemics

24. The Executive Director of the Global Network of People living with HIV, Laurel

Sprague, said that people living with HIV lived at the intersection of a health condition and

social prejudice. They had created the principle of Greater Involvement of People Living

with or Affected by HIV/AIDS, which had resulted in their increased representation in

various policymaking bodies at all levels. Ending AIDS required a real right to health; the

right to non-discriminatory employment and education for people living with HIV; putting

a stop to gender-based violence, discriminatory gender norms and laws, arbitrary arrests

based on lesbian, gay, bisexual and transgender identity, drug use, sex work or HIV status;

and addressing poverty and the other social determinants of health that made some people

and communities more vulnerable to HIV than others. Ending AIDS without ending

prejudices and social hierarchies would be a failure.

25. The Strategic Initiatives Advisor to the Board of African Men for Sexual Health and

Rights, Kene Esom, recommended breaking the silos that continued to divide human rights

and public health work both in national ministries and in international organizations.

Funding for community work on health was either for public health interventions or human

rights interventions, which restricted the allocation of funds to one area or the other.

However, the distinction between them was blurred in the case of many organizations that

supported marginalized groups affected by communicable diseases. Other challenges

included the shrinking of civil society space through reprisals or restrictive NGO

regulations, and the denial of due process. Health-care workers often did not know about

the work of the Human Rights Council to prevent and prohibit reprisals, and did not

therefore benefit from it. Stigma, discrimination and persecution also impeded the delivery

of quality health services that left no one behind.

26. The Regional Director for Latin America and the Caribbean at the Centre for

Reproductive Rights in Colombia, Catalina Martínez Coral, described how the 2016 Zika

outbreak in Latin America had disproportionately affected pregnant women due to the

increase in the number of abortions and of babies born with microcephaly. Many countries

had ignored reproductive rights and reacted by recommending the postponement of

pregnancy. That recommendation was unworkable in a region where 55 per cent of

pregnancies were unplanned, the availability of contraception was limited and sexual

violence was widespread. The region also had legislation criminalizing with harsh

sentences most if not all cases of abortion. She recommended that States recognize

women’s rights to make an informed decision about their bodies and family planning,

provide access to contraception and safe abortions, update health workers in rural areas

about the virus and provide good quality free maternal health services. She recommended

that international organizations keep putting pressure on States to adopt systemic human

rights-based responses to public health crises.

27. The representative of Brazil delivered the statement of the Director of the

department for sexually transmitted infection, HIV/AIDS and viral hepatitis of the Brazilian

Ministry of Health, Adele Benzaken, explaining how health policies, particularly the

management of the HIV/AIDS epidemic, had been democratized and highlighting the

importance of community participation in ensuring effective strategies to fight epidemics

and realize human rights.

28. During the interactive dialogue, representatives of Islamic Republic of Iran, WHO,

the Association for Human Rights in Kurdistan of Iran-Geneva, the Global Forum on MSM

& HIV, the University College of Social Work at Geneva, the Stop TB Partnership, the

UNAIDS Global Reference Group on HIV/AIDS and Human Rights, the World Social

Forum and the Zero TB Initiative, Ulaanbaatar took the floor. Speakers addressed

challenges faced by specific groups, including drug users, ethnic minorities and

adolescents. The overlapping of those conditions aggravated marginalization in access to

health. Speakers also referred to the challenges faced in accessing medicines due to high

costs, and the shrinking civic space in countries where epidemics were widespread. One

participant emphasized the importance of finding ways to ensure that the economy

addressed social needs, including by maintaining universal health and social assistance

systems. Another participant emphasized the adverse impact of unilateral coercive

measures and sanctions on the enjoyment of the right to health in the countries affected by

those measures. Participants inquired about the role of civil society in collecting

disaggregated data concerning diseases and the role of the Office of the United Nations

High Commissioner for Human Rights (OHCHR) in promoting the right to health in the

context of communicable diseases. The representative of OHCHR described its permanent

cooperation with UNAIDS through, for example, publications on HIV and human rights

aimed at different readerships.

29. In response, Ms. Sprague said that affected populations had to claim their rights to

affordable treatment and forge alliances in order to achieve a power balance with

pharmaceutical companies. She called on the Human Rights Council to push for a

framework that would enable access to affordable treatment. She also called on

stakeholders to continue to push for and support space for civil society. Mr. Esom

emphasized that the Sustainable Development Goals were an opportunity to adopt an

intersectional approach to health and deliver social justice. He urged participants to join

forces and set up communities to tackle an economy that sustains epidemics. He drew

attention to the human rights of indigenous peoples, people in prisons and migrants. Ms.

Martínez Coral called for the progressive realization of the right to access to medicines.

Specific epidemics had provided lessons learned in terms of the need for comprehensive,

differentiated and intersectoral responses to broad human rights challenges.

E. Communities leading programmes for health

30. The Director of the United Nations Children’s Fund (UNICEF) Liaison Office in

Geneva, Marilena Viviani, said that adolescents were the only age group in which deaths

due to AIDS were not decreasing. Adolescents required prevention through regular HIV

testing that was easy to access, condoms, comprehensive sex education and high-quality

targeted social welfare and protection services. However, stigma, discrimination, fear and

ignorance undermined the success of those measures. New approaches based on the rights

of the child were needed. Children’s freedom of expression included the freedom to seek

and receive information or ideas, thus protecting the right to self-determination.

Community-based organizations were the most effective and reliable sources of

information for young people. UNICEF had therefore partnered with communities, as

illustrated in its cash transfers in sub-Saharan African countries, including Malawi and

Tanzania, and its delivery of health services to eastern Ukraine.

31. The General Secretary of the Swaziland Migrant Mineworkers Association, Vama

Jele, explained how many migrant mineworkers were recruited while healthy and were

fired once they had been affected by tuberculosis, silicosis or HIV. They then returned to

their homes and died or spread diseases in their communities, exacerbating poverty and

vulnerability. Inadequate compensation for mineworkers’ occupational diseases signalled a

number of human rights violations, but due to illiteracy, many workers were unaware of

their rights. The 2030 Agenda provided an opportunity to work beyond silos to integrate the

right to health at all levels for the benefit of vulnerable migrant mineworkers and their

families. He recommended tackling the challenges faced by that group, including through

capacity-building in unions and occupational health associations, prevention of diseases and

collection of disaggregated data, advocating for better labour laws and practices, and

reporting abuses and human rights violations.

32. The Chair of the Board of the International Network of People who Use Drugs, Brun

González Aguilar, explained that the legal prohibition and criminalization of drug use, as

well as historical and cultural factors, had all caused devastating consequences to people

who used drugs, including stigma, discrimination and other human rights violations. That

had made people who used drugs more vulnerable to contamination with HIV and hepatitis

C. The rights to education, freedom of religion, freedom of thought, privacy and self-

determination were affected by prevalent anti-drug policies. He recommended harm

reduction measures, including deconstructing stigmatizing notions and seeking more

rational, humane, objective cultural and social approaches. He echoed the call made by the

General Assembly at its Special Session on Drugs (in General Assembly resolution S-30/1)

to promote and strengthen regional and international cooperation in developing and

implementing innovative forward-thinking treatment-related initiatives. He added that

fewer than 11 per cent of people who used drugs actually needed treatment; the majority of

people who used legal and illegal drugs worldwide were non-problematic users.

33. During the interactive dialogue, representatives of UNAIDS, WHO, the People’s

Health Movement, Porn4PrEP and the World Social Forum took the floor. Participants

emphasized the importance of sexual education for sex workers and pornography actors.

They also spoke of the challenges faced by migrants, adolescents, women, drug users,

mineworkers, and persons living with HIV and affected by other diseases. They called for

child and social protection and labour policies to be strengthened as strategies to counter

epidemics, bearing in mind problems of scale and the interdependence of rights.

34. In his final remarks, Mr. Jele said that when mineworkers and their families,

including women, participated in programming, health, social and labour programmes were

more successful. Mr. González said that harm reduction strategies were entirely developed

by communities of people who used drugs, as few others considered them worth helping.

He cited as good practices the harm and risk reduction programmes implemented by peers

in Spain. Ms. Viviani stressed the importance of working in partnership to promote

education and of conducting outreach to the most marginalized children. She called for

health programmes at the community level to be strengthened and institutionalized.

F. Health-care workers on the front line

35. A representative of the International Committee of the Red Cross (ICRC), Esperanza

Martinez, explained that in armed conflicts, health workers and services were especially

protected by international humanitarian law and, in all cases, they were protected by human

rights law. The increase in battles in urban contexts amplified the effects of indiscriminate

attacks. Urban conflicts affected the social determinants of health and the rights to water,

sanitation, food and health. Protracted conflicts made health systems unable to cope with

crises at the times at which the need was most acute. The “Health Care in Danger” project

highlighted the multifaceted violence suffered by health-care workers. ICRC provided

practical guidelines on the rights and responsibilities of health-care personnel in conflict

areas, including on the right to privacy and on engaging with arms carriers. In order to

achieve the Sustainable Development Goals, there was a need to implement more

preventive measures against violations of human rights and international humanitarian law.

36. The Permanent Representative of Thailand, Sek Wannamethee, explained that his

country was the first in Asia to have eliminated mother-to-child transmission of HIV and

syphilis. Thailand offered free HIV testing and treatment for all, including migrant workers.

Despite those achievements, stigma and discrimination remained barriers in the HIV

response. The AIDS strategy in Thailand included specific targets to reduce HIV-related

discrimination. The Government had an evidence-based approach to tackling

discrimination. Levels of stigma and discrimination had been measured in health facilities

through a survey. Based on the results, the country combated discrimination at the

individual, health facility and community levels through participatory and active training of

health workers. Lessons learned from the experience included acknowledging that HIV-

related stigma and discrimination were common, the need to adopt an evidence-based

approach to combat stigma, adapt global guidelines to local contexts, create multi-

stakeholder partnerships, safe learning spaces and take a non-judgmental approach, and the

need for technical assistance and capacity-building.

37. The Director of the Saint John of God Catholic Hospital in Lunsar, Sierra Leone,

Brother Michael Musa Koroma, said that health workers and administrators were in a

unique position to use human rights to improve health-care systems. Front-line health-care

workers were often the only point of contact with the health system for millions of people

and many of them provided culturally appropriate health care, counselling to prevent the

spread of diseases and other health services. Their role in promoting human rights was

undermined by a lack of resources and knowledge, personal and societal beliefs and

attitudes and institutional norms. During the Ebola outbreak, hundreds of health workers

had died. The quality of care for the sick had been undermined by discriminatory and

disrespectful behaviours. Ebola suspects and their families had been quarantined without

basic supplies. Communities had been scattered due to a lack of information and mistrust.

The care given and the measures taken to protect the dignity of those affected by the crisis

in the hospital in Lunsar provided lessons for the promotion of human rights in future

crises.

38. A representative of the International Federation of Medical Students’ Associations,

Frederike Booke, spoke about the links between human rights protection and access to and

utilization of health services, emphasizing the vicious circle of human rights violations

suffered by persons living with communicable diseases. To break the circle, the Association

had engaged in projects aimed at addressing discrimination in health care. In 2017, it had

adopted the Declaration of Commitment to Eliminate Discrimination in Healthcare and a

memorandum of understanding with youth-led organizations to increase medical students’

awareness and knowledge of the importance of fighting discrimination. Together with

partners, including local communities, the Association planned to develop an advocacy

brief on non-stigmatization of health care and a guidance note on building more inclusive

medical curricula.

39. During the interactive dialogue, representatives of Spain, UNAIDS, the Association

Miraisme International, the Centre for Reproductive Rights, the International Disability and

Development Consortium, the People’s Health Movement and the World Social Forum

took the floor. Participants praised the work and initiatives of front-line health workers and

students. Some asked questions about human rights in armed conflicts regarding data and

information on maternal health and reproductive rights. Others raised issues relating to

institutional involvement in non-discrimination initiatives, effectiveness of accountability

policies and training on the treatment of persons with disabilities. One participant inquired

how health workers in countries without health systems could be helped and how to foster

international solidarity to establish such systems.

40. Mr. Wannamethee described the tools Thailand had to measure stigma and

discrimination, and the country’s goal to reduce 90 per cent of stigmatization by 2030.

Global guidelines needed to be commensurate with local realities and all stakeholders

should participate in designing training materials. Brother Koroma called for training and

respect for front-line health workers’ rights. Accountability required infrastructure, faith-

based health institutions should complement the work of Governments, and the cultures of

local communities should be respected. Ms. Booke said that the opinions of persons with

disabilities and young health workers should be taken into account when designing

programmes to fight communicable diseases. Ms. Martinez called for reproductive health to

be embedded in overall primary health-care services, for community participation in health

care to be strengthened, and for parties to conflicts to respect commitments concerning

access to health care. She stressed that data systems in conflict settings were fragile and

required new partnerships.

G. Building synergies for health: engaging diverse partners

41. UNAIDS International Goodwill Ambassador and Chair of The Foundation for

AIDS Research, Kenneth Cole, praised the achievements that had been made since the first

awareness campaigns on HIV/AIDS in 1985, but reiterated that there was still much to be

done. Empowering those with the least resources was crucial to advancing the fight against

AIDS. It was important to connect and leverage resources beyond silos for making progress

with regard to the human rights, including the right to health, of people living with HIV.

For example, the Foundation’s efforts to help find a cure for AIDS by 2020 would be an

important contribution to the efforts of UNAIDS to end AIDS by 2030.

42. A senior human rights lawyer from the DLA Piper global law firm, Emily Christie,

spoke of the role private law firms played in assisting affected populations to access justice,

which was essential in order to achieve universal access to health care. In 2016, around 130

law firms had contributed some 2.5 million hours of pro bono legal support worldwide. Her

firm had been working with partners to create enabling and protective legal environments

and challenging harmful laws through law reform, legislative drafting and public interest

litigation. It had also worked on strengthening civil society and communities, assisting

them to engage with human rights monitoring mechanisms, supporting access to legal

services and providing training on health-related rights. It had assisted commercial clients

to integrate human rights in their operations. Pro bono work could effectively contribute to

achieving health, human rights and justice for all when undertaken in partnership with

experts in the field, civil society groups, governments, NGOs and United Nations

organizations.

43. A representative of the Belarusian Association of UNESCO Clubs, Dzmitry

Subtselny, described Belarusian programmes to combat HIV, which included access to

treatment, measures to protect the confidentiality of patients’ status and specific training for

health workers. Many members of vulnerable groups, such as people who used drugs, sex

workers and men who had sex with men, avoided treatment due to concerns regarding the

disclosure of their status. Civil society organizations acted on harm reduction, online

educational work on HIV-related issues, and carried out advocacy on protecting the human

rights of vulnerable groups. They also planned to monitor the quality of health-related

services to the affected population and the degree to which those services respected human

rights. Those activities were possible thanks to financial and technical support from the

United Nations system to Governments and civil society in middle-income countries.

44. A member of the Moldovan Council for the Prevention of Torture, Svetlana Doltu,

said that the main health issues in the penitentiary system of Moldova were drug

dependency, viral hepatitis, HIV/AIDS and multidrug resistant tuberculosis, and

combinations thereof. Despite the challenges it faced, the Republic of Moldova complied

with the United Nations Standard Minimum Rules for the Treatment of Prisoners (the

Nelson Mandela Rules) and provided the prison population with the same health-care

standards as the rest of the population without discrimination based on their status.

Treatment to prisoners affected by communicable diseases was provided in close

partnership with NGOs, including by engaging former prisoners. The Council for the

Prevention of Torture worked to improve prison conditions, addressing the social

determinants of health and the provision of HIV prevention services. While challenges

remained in addressing prisoners’ health issues in Moldova, much had been achieved

thanks to the work of many partners, including international organizations that had

provided technical and financial support.

45. During the interactive dialogue, the moderator and representatives of the African

Commission on Human and Peoples’ Rights and the Global Human Rights Clinic took the

floor. They asked about the role of business and sports communities, children, medical

doctors, confessional groups, law students and women’s organizations. Participants also

asked about harm reduction policies, legal protection and assistance in Africa, and access to

mental health services for persons living with communicable diseases.

46. Mr. Cole argued that businesses would understand that what was good for their

community was good for them. Ms. Christie called for efforts to build social justice and

include legal ethics in legal curricula, and for affirmative action to be taken in law schools

for groups subject to discrimination. It was important to deal with the legal, social, physical

and mental needs of populations. Mr. Subtselny referred to a health programme supported

by UNESCO on reproductive education for parents, and to the role of peers and role models

in education. Ms. Doltu said that a system of part-time medical work in prisons could

contribute to better health services in prisons. She called for more data to be collected on

the social impact of epidemics affecting women. All panellists called for more steps to be

taken to raise awareness of the positive impact of harm reduction policies in reducing

infections. They also called for the decriminalization of drugs and for efforts to put an end

to the stigmatization of drug users and other vulnerable populations.

H. International cooperation for global responses and national

implementation

47. The Permanent Representative of Switzerland, Valentin Zellweger, described his

country’s contributions to the fight against HIV and other communicable diseases at the

international and bilateral levels in a manner that broke silos. The UNAIDS governance

structure, which included civil society as members of the UNAIDS Programme

Coordinating Board, made a big difference as speaking directly with affected communities

allowed for an understanding of the implications of the policies and programmes on the

ground. Evidence demonstrated that a human rights and gender-based approach was more

effective. The six elements Switzerland considered crucial in the response to HIV were:

establishing a balance between prevention and treatment; placing gender equality and

human rights at the centre of the response; taking an evidence-based approach; aiming to

contribute to health systems and the achievement of universal health coverage; addressing

the underlying determinants of HIV; and taking a multi-stakeholder approach.

48. The Executive Director of Partners in Population and Development, Joe Thomas,

said that involving vulnerable populations in developing responses and South-South

cooperation were ways of translating the key principles of the 2030 Agenda into action to

end HIV and other communicable diseases. There was a need to incorporate constantly

evolving data and evidence about differential vulnerability experiences. He echoed the

United Nations Secretary-General’s call for more support to South-South efforts towards

achieving internationally agreed development goals. The full realization of Sustainable

Development Goals 3, 5, 16 and 17 was intertwined with protecting and promoting human

rights. He described Partners in Population and Development’s governance and mandate on

South-South cooperation, including on sexual and reproductive health, and its potential for

improving HIV response in low- and middle-income countries.

49. The Executive Director of the South Centre, Vicente Paolo Yu, recalled that

international human rights instruments pointed to States’ duty to cooperate with each other.

The realization of the right to health and achievement of Sustainable Development Goal 3

required international cooperation on addressing barriers to access to medicines, research

and development of medicines, provision of health services and emergency humanitarian

assistance during pandemics. It was important to maintain policy space, flexibilities and

coherence in issues related to intellectual property to enable developing countries to cope

with new epidemics. Coping capacity was further affected by international economic, social

and environmental challenges. In order to further international cooperation, he proposed

that research and development for new drug discovery should be publicly funded and that

any new drugs discovered under that model should be patent-free or have public interest

patents. In addition, North-South cooperation remained essential, particularly in the

development of infrastructure for the delivery of public health services. Moreover,

strengthened South-South cooperation would foster the exchange of expert skills, training,

technology and capacity in delivering public health services.

50. During the interactive dialogue, the moderator and representatives of Ecuador,

Nigeria, UNAIDS and the World Social Forum took the floor. They raised points related to

examples of local good practices on key populations’ access to health, taking into account

local expertise and experience to provide inputs when planning global policies, and

questions on how to bring big business to the table and negotiate in a context of power

asymmetries at the global level. Some participants mentioned legal issues such as law as a

determinant of health, and the importance of imposing the duty to grant access to basic

medicines.

51. Mr. Zellweger described the transition of drug policies to harm reduction, a practice

promoted by Switzerland in its foreign cooperation. Laws that were based on human rights

and the promotion of gender equality were determinants of health. Evidence-based policies

should be applied, even when they ran contrary to certain cultural behaviours. Mr. Thomas

reflected on plurilateral and bilateral dialogue by emphasizing the work of Partners in

Population and Development to facilitate the sharing of information to solve issues related

to health, access to medicines and ageing populations. Mr. Yu considered that law could

shape society, making it a determinant of health, for good or for bad. In developing

countries, any changes in laws required in order to qualify for aid should be implemented in

full respect of rights, local officials and the role of the State. He called for the

implementation of the right to development. Panellists welcomed the Sustainable

Development Goals and related recent agreements as major achievements on international

cooperation, and called for further cooperation to implement them.

I. Access to medicines, diagnosis, vaccines and treatment in the context of

the right to health

52. The Chief Executive Officer of the World Hepatitis Alliance, Raquel Peck, argued

that the development of lifesaving medicines for hepatitis C had created hope for those

affected by that condition. However, extremely high medicine costs had left many behind;

indeed, only 1.5 million out of the 75 million who were infected had received treatment.

She gave some specific examples of advocacy by communities that had expanded the right

to access to medicines. NOhep was a global movement that aimed at the elimination of

hepatitis by empowering communities. Eliminating hepatitis went beyond the right to

health; it required steps to be taken to reduce inequalities, address poverty and tackle stigma

and discrimination. As technical solutions existed, no one should be dying from that

epidemic.

53. The Intellectual Property and Access to Medicines Lead at the International

Treatment Preparedness Coalition, Othoman Mellouk, praised the decision of the

Government of Malaysia to issue the first compulsory licence under trade-related

intellectual property rights (TRIPS) flexibilities for sofosbuvir, an expensive drug for

treating hepatitis C. That had been the result of actions by local civil society organizations.

Many middle-income countries were excluded from licences and prices arrangements and

had lower treatment coverage rates than lower-income countries. Civil society

organizations and communities had challenged big pharmaceutical companies despite the

power asymmetries. Developed countries were, on behalf of big pharmaceutical companies,

pushing for restrictive intellectual property demands in bilateral and plurilateral trade

treaties, with potentially adverse effects for the world’s poor. He called for stronger

international and national rights frameworks for a paradigm shift on the right to access

medicines.

54. Senior Researcher for the Global Health Unit of the University Medical Centre

Groningen, Ellen ´t Hoen, said that the distinction between communicable and non-

communicable diseases was artificial, as one group often caused diseases under the other

group. The right to health implied that States had the duty to ensure the availability,

accessibility, acceptability and good quality of medicines. Intellectual property norms

should be interpreted in a manner supportive of States’ human rights obligations. States had

a duty to use TRIPS flexibilities when it was necessary to ensure the right to access to

medicines. Echoing the United Nations High-level Panel on Access to Medicines, she

called for a coalition of like-minded countries to exert pressure for a global agreement on

health technologies, including a binding convention delinking research and development

costs from end prices of medicines and promoting transparency on costs of production.

55. The Medical Innovation and Access Policy Adviser for the Médecins Sans

Frontières Access Campaign, Elena Villanueva-Olivo, spoke about the Médecins Sans

Frontières Access Campaign to raise awareness about the need to improve medical tools in

crises. The Ebola outbreak in West Africa, during which there had been a lack of effective

diagnostics, treatments and vaccines, had illustrated the failure of the research and

development system to prioritize, develop and produce affordable drugs and vaccines. She

mentioned initiatives to prevent new gaps and failures, such as the WHO Research and

Development Blueprint and the Coalition for Epidemic Preparedness Innovations. She

expressed concern that Northern philanthropists and Governments, which funded nearly all

research and development, prioritized the protection of their own populations and economic

interests over the essential health needs of poor populations.

56. During the interactive dialogue, representatives of Belarus, Botswana, Brazil, Chile,

Ecuador, the Bolivarian Republic of Venezuela, OHCHR, the Asia Pacific Transgender

Network, the Elizabeth Glaser Pediatric AIDS Foundation, the Medicines Transparency

Alliance Mongolia and the PrEP Impact Trial took the floor. Many participants raised

issues concerning economic barriers to access to medicines, including the fact that market

and economic considerations took precedence over human rights. They also highlighted the

lack of transparency on pricing, “commercial” determinants of health, the devastating

impacts of epidemics on the economies of developing countries, and neglected tropical

diseases. Participants commented on international partnerships and partnerships between

Governments and civil society. A number of participants inquired about discrimination

within and among nations in access to medicines, diagnosis, pre-exposure prophylaxis and

resources, with specific reference to children, transgender women, and men who had sex

with men. Some mentioned the relationship between universal health coverage and access

to medicines.

57. Ms. Villanueva-Olivo said that access to medicines was necessary for universal

health coverage. Advocacy was then needed to ensure that WHO had a strong role in

promoting access to medicine and support for the adoption of TRIPS flexibilities. Ms. Peck

emphasized the need for global and domestic funding mechanisms, including for access to

vaccines. She reiterated the importance of partnerships with communities. Mr. Mellouk

argued that recognizing law as a determinant of health referred both to the text and the

implementation of laws. TRIPS flexibilities should be available in a non-discriminatory

manner and without yielding to pharmaceutical companies biased choices. Ms. ´t Hoen

argued that access to new essential medicines also affected developed countries. For

universal health coverage to be viable, it was necessary to deal with patents, market and

data exclusivities, including by delinking research and development from the market logic

and improving transparency in pricing.

J. The way forward

58. The director of the Thematic Engagement, Special Procedures and Right to

Development Division of OHCHR highlighted the 2030 Agenda and its call to leave no one

behind as key for discussions on human rights related to health. Stigmatization,

criminalization and discrimination worsened epidemics. Civil society’s role was crucial, but

it was often under attack and its space was shrinking. States should foster civil society’s

legal, policy and financial enabling environment. The human rights-based approach to

access to medicines was the best way to promote policy coherence in that area. Echoing the

call made by the High-level Working Group on the Health and Human Rights of Women,

Children and Adolescents for policy shifts, she recalled the importance of the protection of

rights through and to health, of the role of health workers in defending human rights and

their empowerment and protection, and of improved participation of all stakeholders,

including communities and parliamentarians, in leaving no one behind in the advancement

of health related human rights.

59. The Director of the Rights, Gender, Prevention and Community Mobilization

Department at UNAIDS presented five themes the Forum had reiterated from previous

discussions. First, discrimination affected different groups and people in different ways,

hampering access to public goods and services. Second, the voices of the most affected

people should be included in policy design and implementation, including by having civil

society on the boards of international agencies. Third, communicable and non-

communicable diseases were all avoidable and had as a common denominator inequality

and inequity in access to health services. Fourth, access to medicines should be ensured at

affordable sustainable prices, by, for example, tackling the monopoly of intellectual

property through TRIPS flexibility and price delinking mechanisms. Fifth, collection of

disaggregated data could decrease the invisibility of inequity in access to services of

specific populations.

60. The Director of the AIDS and Rights Alliance for Southern Africa, Michaela

Clayton, noted that although there were many commonalities in the kinds of discrimination

experienced in the health field, it was important to name the grounds of discrimination in

the context of each health condition and explicitly name the key populations affected. In

addition to challenges, many examples of good practice had been shared during the Social

Forum and it was now time to act. Action should include scaling up people-centred

programmes, funding human rights interventions, increasing access to justice and removing

barriers to civil society participation. To ensure marginalized communities had access to

services, the involvement of Ministries of Health was not enough; Ministries of Justice, of

the Interior and of Security should also be engaged. She called for an increased role for

OHCHR in health and for WHO in human rights. She also called for the issues of stigma

and discrimination to be discussed at the World Health Assembly.

61. Concluding remarks were made by representatives of OHCHR, WHO, AfricAid, the

African Commission on Human and Peoples’ Rights, the Asia Pacific Transgender

Network, the Belarusian Association of UNESCO Clubs, the Global Forum on MSM &

HIV, the Coordinating Committee of the International Conference on AIDS, the

International Federation of Medical Students’ Associations, the People’s Health Movement,

the Stop TB partnership, Swaziland Migrant Mineworkers Association and the World

Social Forum. Participants mentioned groups facing specific challenges and offering

opportunities, including health-care workers and students, migrant workers and

undocumented migrants, refugees, people who used drugs, indigenous peoples, rural

communities and the urban poor, children, adolescents transgender people, men who had

sex with men, and sex workers. Empowering those groups was essential to ensure access

and adherence to treatment. That could be done by focusing on general social needs as

common denominators between the different groups. Those groups should also participate

in collecting disaggregated data. Participants called for multi-stakeholder and multisectoral

alliances. International human rights systems could be instrumental for promoting

accountability in delivering the right to health. States should actively engage in

international negotiations and cooperation to promote human rights in health, such as at the

high-level meeting on tuberculosis to be convened by the General Assembly in 2018.

Specific social policies should be provided to all. States should review counter-terrorism

and other norms that attacked civil society space and funding. Many participants called for

preventive approaches and more human rights education and awareness on the part of

different stakeholders.

IV. Conclusions and recommendations

62. The following conclusions and recommendations emerged from the 2017 Social

Forum.

A. Conclusions

63. The high level of engagement at the Social Forum demonstrated that human

rights in the context of health and communicable diseases was an important topic on

the agenda of different international organizations, Governments, organized civil

society, communities and the private sector. Fulfilling the right to health was

considered one of the highest challenges faced by the international community. It was

recognized that upholding human rights, including the right to health, was essential to

broader efforts to promote peace and development. However, from the discussions, it

had become clear that stigma, discrimination, misuse of criminal laws and other

human rights violations continued to act as barriers to effective responses to HIV and

other communicable diseases and epidemics and that often, human rights were not

adequately integrated into health responses. In many countries and regions

throughout the world, the populations most affected by HIV were made more

vulnerable by laws that criminalized same-sex sexual relations, sex work, drug use,

HIV non-disclosure, exposure or transmission. Addressing such laws had been

highlighted as imperative in order to respond to HIV and advance health for all.

64. The 2030 Agenda and the Sustainable Development Goals offered a framework

for multisectoral action to realize human rights in the context of HIV and other

communicable diseases and epidemics. The Sustainable Development Goals, with their

promise of leaving no one behind, called for the meaningful participation of civil

society and communities in health responses, including at decision-making tables. The

2030 Agenda for Sustainable Development also called for universal health-care

coverage, access to quality essential health-care services and access to safe, effective,

quality and affordable medicines and vaccines.

65. Stigma, discrimination, marginalization and criminalization worsened

epidemics, undermined prevention efforts and hindered access to lifesaving public

services and goods by key populations and groups in vulnerable situations. Several

groups faced specific challenges, including migrants, refugees, persons with

disabilities, indigenous peoples, poor populations, children, adolescents, women,

transgender people, men who had sex with men, people who used drugs, people

deprived of their liberty and sex workers. Many speakers emphasized the importance

of collecting data about the impact of epidemics among those populations, of

disaggregating data and of ensuring the participation of affected communities and

civil society in data collection and analysis efforts, and in the political debates and

decisions informed by that analysis.

66. Participants noted that the economic, social, legal and “commercial”

determinants of health included poverty, substandard housing, inadequate water and

sanitation, a lack of social security, gender inequality, a lack of access to health-care

services and safe, effective, quality and affordable medicines, the marginalization of

certain groups and the criminalization of certain behaviours, such as sex between

consenting adults of the same sex, drug use or sex work.

67. It was recognized that civil society and affected community organizations were

crucial actors in the protection of human rights in the context of communicable

diseases. However, in many countries they were under pressure and their space was

shrinking due to restrictive laws and policies and a lack of funding. Their in-depth

knowledge of the challenges faced in particular regions and by particular groups

risked being ignored in the design of global and local strategies against epidemics and

other diseases.

68. Health-care workers were on the front line of the fight against epidemics and

other diseases, often working under poor working conditions, lacking appropriate

resources and protection against infection. Appropriate training and information,

including human rights education and training, could empower health workers and

students preparing for health-related careers to promote and protect the human

rights of patients and communities and to provide discrimination-free care.

69. Diverse partners across sectors need to be mobilized in order to address the

many human rights challenges in the context of communicable diseases. There were

many encouraging examples of good practices, programmes and initiatives

implemented by national, international and regional human rights mechanisms and

institutions, governmental bodies, civil society and affected community organizations,

Parliamentarians, the private sector, law firms, faith-based institutions, celebrities,

national mechanisms on the prevention of torture and others.

70. Much had been done in terms of international cooperation. However, to

maintain the momentum created by the adoption of the Sustainable Development

Goals, it was necessary to advance North-South and South-South cooperation in

addressing human rights in the context of communicable diseases, and to ensure

meaningful civil society and community engagement at all levels. Joint efforts for

realizing economic, social and cultural rights, as well as the right to development,

could contribute to the social and economic determinants of health.

71. Access to safe, effective, quality and affordable medicines, vaccines, treatment

and diagnosis was a necessary condition for the full enjoyment of the right to health in

the context of communicable diseases.

B. Recommendations

72. A number of priority areas for action had emerged from the discussions during

the 2017 Social Forum to better promote and protect human rights in the context of

HIV and other communicable diseases and epidemics. All stakeholders should better

coordinate health and human rights-related work in a manner that breaks silos. At

the international level, OHCHR, UNAIDS, WHO, WTO and other organizations

should increase their cooperation to address human rights issues in the context of HIV

and other communicable diseases and epidemics. At the national level, different

governmental bodies should adopt common understandings to protect the human

rights of especially affected groups by including their needs in national plans and

policies.

73. The Sustainable Development Goals and the human rights framework should

be seen as mutually reinforcing. Human rights should guide the implementation of

health-related Sustainable Development Goals and in addressing communicable

diseases. Countries should report on human rights in the context of HIV and other

communicable diseases and epidemics during their universal periodic reviews and in

their other periodic human rights reports, as well as in their voluntary national

reviews on the Sustainable Development Goals. In implementing target 3.8 of the

Goals on achieving universal health-care coverage, including financial risk protection,

access to quality essential health-care services and access to safe, effective, quality and

affordable essential medicines and vaccines for all, States should consider the

development and strengthening of universal health-care systems and policies on access

to medicines and vaccines, including through international cooperation.

74. To address epidemics from a human rights perspective, States should adopt,

strengthen and implement evidence-based policies and programmes to tackle stigma,

discrimination and criminalization of key populations. Stakeholders should collect

data on how epidemics are having an impact on different populations in order to leave

no one behind. Data should be disaggregated by, inter alia, age, sex, race, gender,

urban/rural, social and legal status. Affected communities and civil society should

meaningfully participate in data collection and analysis. States should take into

account empirical evidence demonstrating positive outcomes of experiences related to

the decriminalization of drug use and harm reduction projects and programmes in

formulating national policies.

75. States and other stakeholders should protect the rights of marginalized

communities to and through health. In doing so, power imbalances should be

corrected by including the voices of those communities in policy design and

implementation and data collection. They should be empowered through the joint

struggle for and provision of more general social needs, such as quality education,

health literacy, sufficient amounts of safe and nutritious food, access to safe drinking

water and sanitation, employment and effective access to justice.

76. States and other stakeholders should cooperate with civil society organizations

and affected communities and foster their role in ending epidemics and achieving the

Sustainable Development Goals by protecting and expanding civic space. That should

be done by providing an enabling legal, policy and financial environment for civil

society organizations and affected communities. States should review policies that

restrict civil society space and funding. States should also review and reform laws that

may contribute to stigma and discrimination, including criminal and other laws that

have been shown to have a negative impact on public health. International agencies

should consider the voices of the most affected people in their decision-making

processes.

77. States and other stakeholders should increase efforts to address discrimination

in health-care settings. Health-care workers should be empowered and recognized as

agents who can promote and protect the human rights of patients and communities.

Their human rights, including their labour rights, should also be protected. In order

to ensure that health workers have the necessary capacity to provide discrimination-

free health-care, issues related to human rights, non-discrimination, free and

informed consent, confidentiality and privacy should be integrated into pre- and in-

service training curricula for health workers. Best practices on such training and

education programmes and materials should be shared.

78. Multi-stakeholder and multisectoral alliances should be built. Diverse partners

should focus on their strengths and potential to contribute to the promotion of human

rights in the context of communicable diseases. The private sector, including

businesses and law firms, should engage in empowering communities by providing

them with resources and building capacity. Parliamentarians should bridge the gap

between communities and governments and unite in alliances to promote good

practices across countries. In some contexts, new partners, such as grass-roots

movements, national preventive mechanisms against torture and even arms carriers

in conflicts, have unique access to otherwise unreachable vulnerable groups and

should promote and protect their rights.

79. North-South and South-South cooperation should continue to focus on

establishing the infrastructure needed to develop health systems, and to foster

partnerships with civil society in countries where health systems are already in place

in order to exchange expertise to address similar problems.

80. States should take into account human rights obligations in global health in

multilateral and regional discussions and decisions. International and regional human

rights mechanisms are encouraged to promote human rights and accountability in

health, particularly in the context of HIV and other communicable diseases and

epidemics. Good practices and lessons learned from such work should be shared

between the different human rights and health mechanisms.

81. A human rights-based approach to access to safe, effective, quality and

affordable medicines and vaccines is crucial to the fulfilment of the right to health and

should be taken into account in the context of policies related to intellectual property

rights and relevant international agreements on the matter.

Annex

List of participants

States Members of the Human Rights Council

Albania, Belgium, Botswana, China, Cuba, Ecuador, France, Georgia, Ghana, India,

Indonesia, Iraq, Mexico, Morocco, Netherlands, Nigeria, Panama, Portugal, Qatar,

Slovenia, South Africa, Switzerland, Venezuela (Bolivarian Republic of).

States Members of the United Nations

Algeria, Angola, Argentina, Austria, Azerbaijan, Bahrain, Belarus, Brazil, Cabo Verde,

Chile, Costa Rica, Cyprus, Czechia, Egypt, Guatemala, Iran (Islamic Republic of), Israel,

Italy, Jordan, Kazakhstan, Myanmar, Nicaragua, Nigeria (National Agency for the Control

of AIDS), Norway, Pakistan, Peru, Republic of Moldova (Council for the Prevention of

Torture), Senegal, Serbia, Spain, Sweden, Thailand, Trinidad and Tobago, Ukraine,

Zimbabwe.

Non-Member States represented by observers

Holy See

Intergovernmental organizations

African Commission on Human and Peoples’ Rights, Community of Portuguese-speaking

Countries, International Development Law Organization, Gulf Cooperation Council,

Organization of Islamic Cooperation, Partners in Population and Development, South

Centre, World Trade Organization.

United Nations

Joint United Nations Programme on HIV/AIDS, Office of the United Nations High

Commissioner for Human Rights, Stop TB Partnership, United Nations Children’s Fund

(UNICEF), United Nations Educational, Scientific and Cultural Organization, United

Nations Office for Project Services, United Nations Population Fund, World Health

Organization.

Non-governmental organizations and others

AfricAid, AIDES, AIDS and Rights Alliance for Southern Africa, AIDS Foundation,

African Men for Sexual Health and Rights, Asia Pacific Transgender Network, Asian-

Eurasian Human Rights Forum, Association DREPAVIE, Association Miraisme

International, Association for Human Rights in Kurdistan of Iran-Geneva, Association of

World Citizens, Belarusian Association of UNESCO Clubs, Caissa, Centre for

Reproductive Rights, African Commission of Health and Human Rights Promoters,

Company of the Daughters of Charity of St. Vincent de Paul, DLA Piper law firm, Domino

Foundation, Elizabeth Glaser Pediatric AIDS Foundation, Global Forum on MSM & HIV,

Global Human Rights Clinic, Global Human Rights Group, Global Network of People

living with HIV, Harm Reduction International, Health Development Center AFI, Helen

Keller International, Institute for Planetary Synthesis, International Aids Conference

Coordinating Committee, International AIDS Alliance, International Committee of the Red

Cross, International Disability and Development Consortium, International Federation of

Anti-Leprosy Associations, International Federation of Medical Students’ Associations,

International HIV/AIDS Alliance, International Investment Center, International Network

of People who Use Drugs, International Treatment Preparedness Coalition, OCAPROCE

International, Partnership Network International, Médecins Sans Frontières Access

Campaign, People’s Health Movement, Swaziland Migrant Mineworkers Association,

Porn4PrEP, Saint John of God Catholic Hospital, Sierra Leone, The Foundation for AIDS

Research, Transparency Alliance-Mongolia, UNAIDS Global Reference Group on

HIV/AIDS and Human Rights, VIVAT International, World Hepatitis Alliance, World

Social Forum, Zero TB Initiative, Ulaanbaatar.

Academic institutions

Global Health Law Groningen Research Centre, University College of Social Work,

Fribourg, Switzerland, University College of Social Work, Geneva, Switzerland.