Law and Health Initiative Digest

The Law and Health Initiative Digest is a monthly round-up of advocacy and grant-making activities supported by the Law and Health Initiative (LAHI) of the Open Society Institute and Soros foundations.  Each issue contains brief highlights of LAHI activities under each of our five priority areas.

In This Issue

• Health and Legal Services
• Human Rights and Patient Care
• HIV/AIDS and Human Rights
• Capacity Development
• Legal Strategies in Health Monitoring

Health and Legal Services

Continuation of Legal Aid to IDUs in Russia
In early 2009, LAHI and the International Harm Reduction Development Program renewed their support to several Russian NGOs integrating legal aid into harm reduction services in Russia. Building on lessons learned during the first round of support, grantees will continue to provide harm reduction program clients with quality legal services on issues such as arrest and pre-trial detention, sentencing, patients' rights, child custody, loss of identity documents, and access to housing. Each of the projects incorporates legal aid directly into existing harm reduction programs and also educates drug-using clients about basic methods of self-representation and how to protect their legal rights. Grantees will also aim to identify strategic cases to take to higher courts and the European Court of Human Rights.  LAHI and IHRD hope to begin efforts in 2009 to evaluate the impact of legal services on the quality and acceptability of harm reduction programs, as well as on clients' health and human rights.

Peer Exchange between Hospices in the Philippines and South Africa
The Hospice Palliative Care Association of South Africa (HPCA), a grantee of LAHI, OSI's International Palliative Care Initiative, and the Open Society Foundation–South Africa, conducted site visits in the Philippines to a hospice in-patient unit at a large state hospital and a pain management clinic at a private hospital. During the visits, HPCA presented a pioneering South African initiative seeking to deal with the legal needs of palliative care patients and families, improving their quality of life. Through the initiative, HPCA works with law students to run legal workshops with hospice staff, patients, and families. While Philippine universities encourage community work, there is currently no such program. During discussion, the hospice and clinic staff considered training volunteers to become community caregivers and create a link between local communities, the health sector, and hospice inpatient units. They also discussed approaching local universities to form partnerships. Currently, hospices in the Philippines lack community caregivers and have few palliative care nurses.  Palliative care doctors volunteer to visit patients in their homes within a 5 km radius of the hospital; they are able to meet only a fraction of palliative care needs. 

Advancing the Health and Human Rights of People Who Use Drugs in East Africa
The Open Society Initiative for East Africa (OSIEA) worked with LAHI and the Public Health Program's International Harm Reduction Development Program (IHRD) to assess the environment for harm reduction and legal services for people who use drugs in Kenya and Tanzania.  Although the evidence on illicit drug use in Kenya and Tanzania is based on a relatively small body of research, the assessment suggested strongly that drug injection is both widespread and unsafe enough to be characterized as an urgent public health problem in the two countries.  Worse, the policy environment in both countries does not favor the HIV prevention and care measures for drug users, such as needle exchange and drug dependence treatment, that have been proven effective in other parts of the world.  Police use possession of syringes as grounds for arrest and detention, and methadone is a scheduled drug in both countries.  Effective drug treatment remains out of reach to the overwhelming majority of people who need it.  HIV/AIDS programs in the two countries, though increasingly well funded, seem to have neglected drug users, including in failing to ensure that they have access to treatment for HIV.  The assessment concluded that there is an urgent need to place the health and human rights of people who use drugs on the policy and program agenda of Kenya and Tanzania, and to support civil society groups promoting the rights of drug users.  In 2009, OSIEA, IHRD and LAHI will develop a series of grants and advocacy activities to advance these goals.

Human Rights in Patient Care

Sex Workers in Kenya Face Glaring Human Rights Violations
In the report "Documenting Human Rights Violations of Sex Workers in Kenya," the Federation of Women Lawyers (FIDA Kenya) detail the abuses experienced by sex workers in six locations in Kenya, and analyze the policy framework that undermines sex workers' access to rights. Pervasive stigma and discrimination against sex workers and a lack of legal recourse leaves sex workers disenfranchised and vulnerable to egregious human rights violations. The study finds that Kenya's laws and practices in relation to sex work breach its own constitutional provisions and violate standards contained in international human rights instruments which Kenya has ratified and agreed to abide. Among other things, the report calls on the Kenyan government and state institutions to address the human rights concerns of sex workers by reviewing present laws and polices to ensure they adequately protect and respect sex workers' rights, providing access to legal aid, educating sex workers about their rights, and instituting mechanisms for them to obtain redress for violations committed against them. The report also serves as a tool for sex workers and their allies to advocate for these and other measures for rights protection. This grant was supported in partnership with LAHI and OSIEA.

Putting Forced Drug Rehabilitation on the Human Rights Agenda
LAHI participated in a recent expert consultation organized by OSI's International Harm Reduction Development Program (IHRD) on human rights abuses committed in the name of forced drug dependence treatment.  In drug "treatment" centers throughout much of Asia and the former Soviet Union, drug users are subjected to a horrific range of abuse including forced labor, un-medicated withdrawal, chaining, caging, verbal abuse, and involuntary medical experimentation.  Treatment is rarely voluntary or subject to judicial oversight; drug users typically enter through the criminal justice system or as a result of mass drug testing without consent or judicial authorization.  The meeting brought together a unique group of human rights advocates, United Nations human rights and health officials, and people who use drugs to discuss strategies for adopting a health and human rights approach to drug treatment.  Experts developed concrete recommendations for human rights documentation, strategic litigation, Geneva-based human rights advocacy, and research to shift the paradigm of drug treatment away from punishment and law enforcement.  Several UN human rights experts expressed openness to the argument that abuses in the name of drug dependence treatment may amount to prohibited forms of torture or cruel, inhuman or degrading treatment or punishment.

Armenian Health Rights Web Site Wins a Prestigious Award
In December 2008 the web site created in conjunction with the Armenian Practitioner Guide - www.healthrights.am - won the main award in the category "e-Health" in the 3rd All-Armenian E-content Competition.  The Armenian Practitioner Guide, currently being developed with the support of LAHI, the Open Society Assistance Foundation-Armenia, and OSI's Human Rights and Governance Grants Program, is part of a series of practical, "how-to" manuals for lawyers on using legal tools to protect basic rights in the delivery of health services.  The guides will cover both litigation and alternative mechanisms such as ombudspersons and medical licensing bodies. They will examine patient and provider rights and responsibilities and procedural mechanisms for protection at national, regional, and international levels.  

HIV/AIDS and Human Rights

Launch of the Inheritance Legal Network in East and Southern Africa
At the end of 2008, OSI grantees WLSA-Malawi (Women and Law in Southern Africa Research and Education Trust in Malawi) and the Federation of Women Lawyers in Kenya launched an Inheritance Legal Network in East and Southern Africa.  In much of East and Southern Africa, AIDS has dramatically magnified the effects of discriminatory inheritance laws and of a legal and policy framework that denies women adequate protection.  Disempowered and financially dependent widows are more vulnerable to infection and have reduced ability to cope with illness.  The Inheritance Legal Network provides the opportunity for country advocates using law-based strategies to confront inheritance violations to share resources on a regional level and develop joint initiatives. 

HIV/AIDS Policy and Law Review Features Human Rights at AIDS 2008
The Canadian HIV/AIDS Legal Network launched the latest edition of its flagship publication, the HIV/AIDS Policy and Law Review, featuring an OSI-supported special section on human rights activities at the 2008 International AIDS Conference in Mexico City.  The Legal Network was OSI's lead partner on creating a week-long Human Rights Networking Zone during the conference.  The special section reproduces some of the most important presentations related to law, ethics, and human rights at the conference, including on sex work, LGBT rights, harm reduction, the rights of prisoners and detainees, women's human rights, and more.  Articles by LAHI staff and partners include "Lessons from Africa: combating the twin epidemics of domestic violence and HIV/AIDS" by Tamar Ezer (see below), "Pretrial detention: scale and relevance to HIV/AIDS" by the Open Society Justice Initiative's Denise Thomasini-Joshi, "Using strategic litigation to strengthen rights in southern Africa" by Priti Patel, and overview pieces by Ralf Jürgens and Jonathan Cohen.  The wide distribution of the Legal and Policy Review will allow those who could not attend the conference to benefit from the rich offerings on law, ethics, and human rights.  The new issue is available in English, French and Spanish on the Legal Network's website, www.aidslaw.ca.   

Holistic Approaches to Combat the Intersection of HIV/AIDS and Domestic Violence
In the new issue of the HIV/AIDS Policy and Law Review, LAHI examines innovative programs to combat the deadly linkage between HIV/AIDS and domestic violence.  Domestic violence both increases women's vulnerability to HIV infection and impedes testing, disclosure, and treatment, exacting a heavy toll on women's lives.  The article features the work of LAHI and OSIEA grantees, such as CARE, the Christian Health Association of Kenya, and the Coalition on Violence Against Women.  These programs aim to provide holistic care and address social, economic, and legal barriers to well-being and treatment by integrating legal services into health and economic empowerment programs.  Please find the article at: www.aidslaw.ca/publications/publicationsdocEN.php?ref=906. 

Strategy Meeting on Ending Coerced Sterilization in Namibia
The Southern Africa Litigation Centre (SALC), OSISA, and LAHI organized a three-day capacity building and strategy meeting aimed at creating a comprehensive advocacy plan to end the forced and coerced sterilization of HIV positive women in Namibia.  The International Community of Women Living Positively (ICW), Legal Assistance Centre (LAC), and SALC participated in the strategy session which covered, among other things, the benefits and potential pitfalls of using litigation within the context of a broader advocacy plan.  The LAC with assistance from ICW and SALC has filed cases in the High Court in Namibia on behalf of a handful of HIV-positive women who were subjected to sterilization without their informed consent.  At least three of the cases are expected to come to trial in 2009.  ICW with assistance from SALC continues to pursue additional advocacy strategies to ensure that the practice does not continue and to obtain redress for victims outside of the court process. 

LAHI Grantee Issues Report on Human Rights Abuses in Namibian Prisons
In partnership with Wyoming University, the AIDS Law Unit of the Legal Assistance Centre in Namibia released a report highlighting serious human rights abuses suffered by prisoners living with HIV and AIDS.  The findings elaborate a host of serious shortcomings in the delivery of health care in custodial settings in Namibia: testing and counseling are not readily accessible to inmates; some wardens are indifferent to inmates with HIV while others are openly hostile; discrimination against HIV-positive inmates by other inmates and wardens is prevalent, forcing many to forego testing to avoid the stigmatization faced by those who are HIV-positive; and obtaining access to antiretroviral medication can take days, weeks, or even months. According to the report, inmates are routinely subjected to overcrowding, violence, sexual assault, rape, sub-standard nutrition, and inadequate sanitation. Prisoners living with HIV or AIDS suffer disproportionately due to insufficient nutrition and the absence of a strict regimen of clinical visits and access to medication. Although in 2007 the Namibian Ministry of Health and Social Services found that out of 494 out of 4,031 inmates were HIV-positive, the report suggests that this number could be much higher, pointing out that 90 percent of people with HIV or AIDS do not know their status and that HIV counseling and testing services are largely absent in prisons. The report contains several recommendations, including training of prison wardens on HIV/AIDS, introducing more health-care providers in prisons, implementing existing policies on HIV/AIDS within the prison system, ensuring access to post-exposure prophylaxis to those who are raped in prison, and overturning Namibia's anti-sodomy law to facilitate the promotion of condom distribution in prisons in accordance with domestic and international health and human rights obligations.

Oppose the Criminalization of HIV Transmission!  Ten Reasons Why
At the December 2008 International Conference on AIDS and Sexually Transmitted Diseases in Africa, a  broad coalition of leading AIDS groups denounced a trend in applying criminal law to HIV transmission, issuing ten reasons why criminalizing HIV transmission is bad for public health and human rights.  LAHI co-produced the document along with the Open Society Initiative for East Africa, the Open Society Initiative for Southern Africa, the United Nations Development Program, the AIDS and Rights Alliance for Southern Africa, and other partners.  The document argues that passing new criminal laws specific to HIV transmission is likely to have many negative consequences for the response to HIV, particularly for women.  Some laws are drafted so broadly that women who transmit HIV during pregnancy, childbirth, or breastfeeding can be prosecuted.  In some places, serious criminal charges have been laid against HIV-positive people for activities such as biting, spitting, or scratching that carry zero to negligible risk of HIV transmission.  Wherever they occur, experts say, prosecutions for HIV transmission tend to spread misinformation about how HIV is transmitted and promote fear and stigma against people living with HIV.  "Criminalizing HIV transmission will backfire and harm the very people it is intended to protect," said Jonathan Cohen, one of the document's co-authors.  The document was released at a press conference that included representatives from UNAIDS, UNDP, and the International AIDS Society.  It is available in multiple languages at www.soros.org/initiatives/health/focus/law/articles_publications/publications/10reasons_20080918. 

Capacity Development

LAHI Partners Present at the Global Alliance for Justice Education Meeting
In December 2008, LAHI partners participated in a panel on promoting public health through clinical legal education at the Global Alliance for Justice Education meeting.  To an international audience of clinical legal instructors, partners presented on the power of law school partnerships to address human rights violations and legal issues impacting health in the contexts of HIV/AIDS, palliative care, patient care, and access to medicines.  In Thailand, the Chiang Mai University Legal Clinic has taken HIV/AIDS and human rights lessons to detention centers, prisons, and village community centers.  In South Africa, students have conducted workshops on will-writing, family law, and debt to hospice caregivers and nurses working with palliative care patients.  University of Pretoria students have submitted a request to the African Commission on Human and Peoples' Rights to identify access to essential medicines as a component of the right to health, outline governing standards, and establish a working group to ensure implementation at the national level.  At Donesk National University in Ukraine, students provide legal services to protect patients from human rights abuses within the health system.  All these projects aim to develop a cadre of legal professionals with an understanding of health issues and the challenges facing underserved and socially marginalized groups.

Legal Strategies in Health Monitoring

Kyrgyzstan Health Care System Rife with Abuse, Say Patients
Four reports sponsored by LAHI, the Sexual Health and Rights Project, IHRD, and the Soros Foundation–Kyrgyzstan provide shocking evidence of widespread human rights violations and abuses in hospitals and clinics throughout Kyrgyzstan.  Released on November 20 and widely covered in the Kyrgyz media, the reports are based on firsthand research conducted by Kyrgyz organizations working with people with physical and mental disabilities, sex workers, and people who use drugs.  Investigations conducted in Bishkek, Osh, Jalal-Abad and Issyk-Kul provinces revealed that medical workers at hospitals and clinics often deny medical care to people in need, insult people from socially marginalized groups, and fail to provide the quality of care necessary to ensure citizens' good health. At the same time, medical workers themselves struggle to survive on low wages and working in difficult circumstances, with a lack of medicine and other necessary supplies.  The law in Kyrgyzstan and international norms recognize people's right to decent and accessible health care, yet the four reports show that these commitments have not moved from paper to practice.  The reports are unique in that they are among the first of their kind to document systematic abuses of patients' rights in Central Asia, and are fully researched and written by community-based NGOs with technical assistance from OSI and the Soros foundation.  Representatives from OSI and the reports' authors spent a week in Bishkek prior to the launch meeting with officials to discuss remedies.  "Kyrgyzstan's health system needs serious changes related to protection of patient's rights," said Kumar Bekbolotov, Executive Director of the Soros Foundation in Kyrgyzstan.  "In order to be a truly healthy society, our government leaders must ensure that all patients, especially the most vulnerable, are treated with respect and receive high quality health care."