A healthcare worker accused of encouraging sex workers' ‘deviant behaviour’. A gay man lectured on sin. A transgender woman taken into police custody after visiting a health facility. These testimonies, documented in UNDP’s assessments of healthcare barriers in Africa, do not exist in isolation. They are fuelled by an increasingly hostile legal environment. For example, since 2005, 14 countries in West and Central Africa passed new laws criminalising HIV transmission [PDF].

But the dawn of 2020 means we are only a decade from the UN target for ending the HIV and tuberculosis (TB) epidemics.  Despite progress, achieving this goal is far from certain. Inequities in access to health services, often experienced by the most vulnerable, are more pronounced than ever. Is the world faltering in its commitment to leave no one behind?

Across the globe, people are fighting to uphold the fundamental right to health. Punitive laws are being challenged, lights are being shone on discriminatory practices and socially marginalized groups are demanding their voices be heard and their health needs met. These are valiant efforts. Yet the magnitude of the task, ending two of the deadliest epidemics the world has ever seen, far outweighs the current political commitment and investment. According to UNAIDS, just 0.13% of total AIDS spending by low-and middle- income countries is allocated to human rights programming [PDF].

Since 2016, UNDP and civil society partners have worked with governments to address legal barriers to health services, through a regional grant supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. This important work, carried out across 10 African countries, has transformed attitudes, increased access to justice, resulted in law and policy reform and used regional approaches to address the issues which may have been too sensitive to address at the country level. But how far has the dial been moved?

Clearly, the ambition must match the goal. Achieving universal health coverage as a reality requires expanding programmes to reach the most at risk, scaling up innovative approaches and sharing good practices across communities, countries and regions.

And strong networks of civil society organizations are essential to achieving this. As a trusted partner to marginalized groups, with invaluable local knowledge, they are uniquely placed to meet the needs of the most vulnerable. Given this, the shrinking of civil society space, as highlighted by the Global Commission on HIV and the Law [PDF], is not only unjustifiable, it will ultimately cost lives.

Consider people in prison, who are five times more likely to be living with HIV [PDF]. Effecting change in a prison system requires collaboration with law enforcement officials, coupled with evidence of successful approaches in similar contexts.

Which is why regional human rights trainings for law enforcement and healthcare workers are so effective. Take for example the Zambian prison workers, inspired to establish infection control committees after a regional training by KELIN. The result is a reduction in HIV and TB cases among inmates and staff.

Gathering and sharing evidence will also be imperative. In Côte d'Ivoire, a recently established Observatoire supported by Enda Santé documented 19 cases of human rights violations between October and December 2019. These included stigma, physical, psychological, sexual, economic and verbal violence, and support ranged from medical assistance, social mediation and legal counselling.

But this is only the first step. Using the evidence to advocate for political change is vital, but often fraught with political sensitivities. Uniting civil society organizations across the region to advocate collectively has helped overcome some of the most contentious and divisive issues.

Legal challenges to discrimination also reverberate far beyond any one individual case.  When a Nigerian man was fired based on his HIV status, he accessed legal support from Lawyers Alert and the Southern Africa Litigation Centre (SALC). The National Industrial Court found dismissing employees based on their perceived or actual HIV-status unlawful, awarding over five years’ of salary in damages. This ruling sets an important precedent for discrimination against people living with HIV in the workplace across the region.

Similarly, peer-learning helps countries navigate common pitfalls. When the Kenya National Commission on Human Rights presented their experience of conducting a national inquiry on human rights violations against LGBTI persons in Kenya, they highlighted the security risks of public hearings, particularly for marginalized groups. Following the workshop, organised by the AIDS and Rights Alliance for Southern Africa (ARASA), the Malawi National Commission on Human Rights cancelled their planned inquiry, which civil society feared could put LGBTI lives in danger, and instead focused on a national study which could protect peoples’ anonymity.

Efforts to uphold the right to health are making a tangible difference and should be lauded. But they remain fragmented. Regional approaches together with civil society organisations, supporting the most at risk, are one of the best defences against the epidemics. This will require coordination, funding and political will on an unprecedented scale. With only ten years to fulfil our commitment to end HIV and TB, the world cannot afford to fall further behind.

By Amitrajit Saha. Mr Saha is Team Leader of the UNDP HIV, Health and Development Team for Africa.

Note: The Africa Regional Grant on HIV: Removing Legal Barriers programme covers 10 countries - Botswana, Côte d’Ivoire, Kenya, Malawi, Nigeria, Senegal, the Seychelles, Tanzania, Uganda and Zambia - and is implemented in collaboration with the AIDS and Rights Alliance for Southern Africa (ARASA), Enda Santé, KELIN, and the Southern Africa Litigation Centre (SALC). Worldwide, UNDP supports HIV and health related legal and policy reform in 89 countries.