A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know?

Abstract

Background Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. Methods We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003–28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS’ key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. Results Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. Conclusion Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection. Electronic supplementary material The online version of this article (10.1186/s12879-019-3692-1) contains supplementary material, which is available to authorized users.

Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

“…Consistent with the limited body of evidence pointing to the importance of community-led advocacy for addressing structural barriers to HIV-related services [ 19 , 57 ], we observed meaningful gains in creating a more enabling environment for accessing HIV care in each participating country. Specifically, we identified nearly 100 changes, big and small, to which advocacy made a positive contribution.…”

“…The dearth of information on structural change linked to advocacy strategies in middle- and low-income countries is greatest. In a recent review covering the 12-year period between 2003 and 2015, Stangl and colleagues identified only 23 investigations of structural interventions—primarily interventions deploying advocacy strategies—designed to increase accessibility, availability, or acceptability of HIV-related resources by targeting human rights-related barriers [ 19 ]. Although the authors observed that the vast majority of the studies (86.9%) lent support to the promise of structural strategies for removing obstacles to care and for creating enabling environments, only one of the 23 interventions sought to address human rights barriers affecting gay, bisexual, and other men who have sex with men and transgender populations, in this case, a sex-worker-led initiative in India.…”

Ending discrimination in healthcare

“…A recent review found evidence of the impact of these types of human rights programmes (singly and combined) on HIV‐related outcomes for people living with HIV and key and vulnerable populations most at risk of HIV, ranging from decreased HIV risk behaviours to increased HIV testing to reduced incidence . The review examined research published between 2003 and 2015, but evidence of the positive impact of similar interventions both prior to and after these dates have also been published; for example, focusing on the training of health workers to reduce stigma and programmes promoting legal literacy and advocacy .…”

Realising Sexual and Reproductive Health Rights of Adolescent Girls and Young Women Living in Slums in Uganda: A Qualitative Study

“…23Empowerment comes from not only knowing your rights but also knowing that those in power are aware, duty-bound, and actively supporting these rights. (8,10) An additional strength of this study is in establishing partnerships and networking stakeholders and duty-bearers in their awareness and commitment to protection of AGYW's SRHR. The interviews with key informants brought additional depth, painting a wider picture of the structural causes effecting the realisation of AGYW's SRHR .…”

“…(5,8) For sexual and reproductive health, HRBA empower women to claim their rights and duty-bearers to ful l their obligations. (8,10) By focusing on non-discrimination, HRBA also speci cally consider those who are vulnerable, marginalized and discriminated against, (8,10) giving agency to the less powerful in society. Achieving these principles requires coordinated, multi-sectorial approaches, based on an analytical understanding of the needs of groups, available resources and challenges.…”