Looking forward to progressive changes in laws and their implementation.
In the meantime, is the enabling environment in the country improving, or only in some places?
Better policies for at-risk populations, including people living with HIV
17 October, 2017
In areas of Myanmar, crackdowns against sex work and drug use can result in people going into hiding. When those people have HIV or other health problems, they may be unable to access the services they need to stay healthy. 3MDG partners are helping to create an environment where the right to health is a reality for everyone.
Challenges faced by vulnerable groups are often not solved through the provision of health services alone. 3MDG’s HIV Harm Reduction programme, along with providing services like HIV counseling and clean needles, focuses on creating an environment where it is possible for stigmatized and marginalized groups to access the health care that they need.
This is known as “creating an enabling environment.” 3MDG’s main partner in this work, UNAIDS, focuses on making changes to old, punitive and discriminatory laws and supporting policies towards decriminalization, anti-discrimination, and rights-based approaches.
For instance, they are involved in making changes to laws such as the 1949 Suppression of Prostitution Act which may have the unintentional result of driving vulnerable groups away from care. They have also advocated for the development of new laws, such as the Law on the Rights of People Affected by HIV.
Moving away from harsh punishments for sex workers
Over the last few years the 3MDG Fund, UNAIDS and the Sex Workers Network in Myanmar have been advocating for an amendment to the 1949 Suppression of Prostitution Act. Together with community groups, they are working to reorient the Act towards rights and anti-discrimination and away from harsh punishments for sex workers. For example, though sex work remains illegal in the new Act, the proposed amendment will significantly lessen the penalty faced by sex workers.
It will also “ensure that legal services are available for sex workers by establishing linkages with legal aid organizations or other relevant organizations," said Thuzar Win, Chair of the Sex Workers Network in Myanmar.
Though sex work remains illegal in the new Act, the proposed amendment will significantly lessen the penalty faced by sex workers.
These changes do not only influence sex workers. In the past, a woman could be arrested for possession of a condom because this was believed to be evidence of sex work. Though there is already an administrative order prohibiting this, its implementation has been weak and removing this provision entirely will provide more certainty. It is hoped that this will lead to more widespread condom use, and ultimately, reduced transmission of HIV and other diseases and less unwanted pregnancies.
This came about as a result of a study tour to Thailand organized in 2016 for government officials, parliamentarians, and representatives from the Sex Workers Network. The tour was jointly organized by UNAIDS and UNFPA, and the aim was to learn about best policies and practices in response to HIV among sex workers. Removing condoms as evidence of sex work was one of the recommendations from the tour report that was shared with officials from different ministries, members of Parliament and civil society. The report also recommended the development of more policies and programmes that protect the rights of sex workers and ensure their access to services, including legal assistance.
It is hoped that this will lead to more widespread condom use, and ultimately, reduced transmission of HIV and other diseases and less unwanted pregnancies.
Recognizing the rights of people living with HIV
A new law which is working its way through Parliament is the Law on the Rights of People Affected by HIV. The drafting of the law was initiated with a national-level consultation workshop in 2013, and community level consultations through 2014 and 2015.
Participants included representatives from ministries, UN agencies, local and international experts, development partners and representatives from key populations, such as people living with HIV, sex workers, people who use drugs and men who have sex with men. Through this process, a draft framework was developed.
The hard work paid off when the new government took office in early 2016, and this law looked to be one of the 44 identified priority laws to be passed as quickly as possible through parliament. This can be attributed to the active participation of people living with HIV and other representatives of key populations. The law is currently being reviewed by the Legal Affairs and Special Issues Commission, with the hope that once submitted it will quickly be made official.
The contents of the law focus on the rights of people living with HIV, in particular their right to health and the right to be free from discrimination. They also have the right to confidentiality about their status, and to consent to their treatment options.
Despite these upcoming changes at the policy level, it will take more effort to facilitate actual change on the ground. For example, to increase legal representation for this marginalized population, lawyers and legislators must also mobilize. Lawyers may be called upon to defend people who are victims of arbitrary arrest because of sex work or drug use. Without proper understanding of the issues that their clients may face, they will not be in a good position to defend their rights.
In recognition of this, UNAIDS organized a three day training workshop for 35 lawyers and legislators. This reinforced their critical role and gave them the skills they need to ensure the rights of their clients to access continuous care and receive fair treatment.
Lawyer, Daw Hnin Win Aung, found the workshop very helpful.
“We had the chance to learn and apply international experiences to the challenges faced by key populations in the country. This helps support amendment of the existing laws, development of new laws and ultimately, will help us work better for these groups,” she said.
As the process continues for the reformation of the 1949 Suppression of Prostitution Act and the Narcotic Drugs and Psychotropic Substances Law, it is believed that the Law on the Rights of People Affected by HIV will be a critical tool in protecting the rights of these criminalized and stigmatized groups. Ensuring that the right to health is a reality for everyone will require more education around the law and the continued mobilization of key groups – police, doctors, lawyers – who have significant influence.
Decriminalizing the use of needles and syringes to support Harm Reduction interventions
One of the most successful examples of recent advocacy efforts in Myanmar was the amendment to the 1917 Excise Act in 2015. The Excise Act dictates who is able to carry and use needles and syringes. Previously, this right was limited to doctors and as a result, people who inject drugs who were found in possession of needles could be arrested. They were criminalized rather than seen as patients in need of health services.
After the amendments in 2015, these restrictions were removed. This meant that health workers and organizations could better implement Harm Reduction programmes that include the provision of clean needles and syringes to facilitate safe injecting. The Narcotic Drugs and Psychotropic Substances Law is currently also under the process of amendment. It aims to further decriminalize people who use drugs.
They were criminalized rather than seen as patients in need of health services.
Alongside these policy efforts, UNAIDS and other 3MDG partners are also ‘creating an enabling environment’ in other ways. This includes conducting trainings in human rights-based approaches to HIV, conducting research on strategies to accelerate HIV response among sex workers, training to facilitate the harm reduction response at local level and working with the media to reduce stigma and discrimination.