UNDP South Africa Country Director's speech at the Stigma Index Workshop

Sep 8, 2016

UNDP South Africa Country Director, Mr. Walid Badawi

TOPIC: HUMAN RIGHTS, HIV AND TB IN DEVELOPMENT.

Programme Director, Mr. Pierre Brouard,

Ms. Agenbag Government support and programme review manager at SANAC,

Distinguished guests,

Ladies and gentleman,

All protocols observed.

On behalf of UNDP and the entire UN Joint Team on AIDS, I would like to express our gratitude for being given the opportunity to partner with SANAC to host this consultative meeting on stigma and discrimination.

As members of the UN Joint Team, we at UNDP value our partnership with SANAC, which will enable us to work together, and with other stakeholders, as those present here today, to ensure an AIDS and TB free and stigma free South Africa by 2030.

This consultative meeting could not have come at a more opportune time, following just weeks after the International AIDS conference, in which South Africa showcased to the world its response to the AIDS epidemic, while continuing to put in place programmes and actions to attain a key goal of the 2030 National Development Plan, namely an AIDS free generation and a concomitant reduction in TB cases and TB deaths and at the same time pursue the Sustainable Development Goals’ commitment of “leaving no one behind” while taking measures to achieve relevant goals and targets under SDG 3 on health.

In addition, this consultative meeting comes at a time when the country, led by SANAC, in partnership with all stakeholders, is in the process of developing a new Strategic Plan for HIV, TB and STIs.  I understand that in this regard, SANAC has launched a series of stakeholder and online consultations to feed into the development of the first public draft of the NSP (2017-2022) and that today’s deliberations will also feed into that process. I am glad to confirm that my HIV team at UNDP, together with the UN Joint team on AIDS will be participating in these consultations to provide support building on the UN’s global experience and expertise gathered over many years of support to countries around the world.

Ladies and Gentlemen, I have been requested to provide a few remarks on Human Rights, HIV and TB in development. But before I do that, let me begin by first acknowledging the heavy burden that South Africa bears in relation to the twin epidemics of HIV and TB, while at the same time celebrating South Africa’s successes in taming these epidemics.

In terms of the burden that South Africa carries: According to the WHO Global Tuberculosis Report (2015) South Africa is amongst the countries with the highest burden of TB disease globally with an estimated incidence of 834 per 100 000 and also the highest number of people living with HIV, at 6.3 million people according to Spectrum estimates.  HIV is the major driver of the TB epidemic in the country with high co-infection rates at 61%.TB remains the leading cause of death among people living with HIV with the mortality rate estimated by WHO at 134 per 100 000 population in 2014.

Now to some success stories that we are well aware of but do deserve special mention: the SANAC Enhanced Progress Report (2015) reflects on some of the notable successes as being: the achievement of the country’s targets for antiretroviral treatment and for the prevention of mother-to-child transmission, with about 3.2 million on HIV treatment (the largest programme in the world) and a reduction of mother-to-child HIV transmission rate to 1.5% at 6 weeks post-partum against the target set in the current NSP of less than 2%. One of the greatest impacts of the ART programme has been the increase in life expectancy from 53 years in 2006 to 61 years in 2012, this is certainly an astounding statistic. More recently, the country launched the ground breaking test and treat programme, which will enable all people testing HIV+ to be put on treatment immediately, regardless of their CD4 count. This is indeed a first for South Africa. With regard to TB, the same report indicates that 30 million people have been screened for TB in health facilities and there have been reductions in incidence in mortality from its peak in 2013. However, much more needs to be done to bring the TB epidemic under control. We congratulate the country for these ground breaking achievements.

Ladies and gentlemen, let me now turn to my assigned topic: Human Rights, HIV and TB in Development. The results of the South African Stigma Index Survey, which will be the focus of today’s deliberations, are significant because for the first time, they provide empirical evidence of the levels of stigma, discrimination and its impact on people living with HIV and their families. The results indicated that, although South Africa has made good progress in dealing with HIV related stigma, overall, about one-third of people living with HIV who took part in the study still reported some form of stigma, and more than 40 % of PLHIV expressed feelings of internalized stigma.  The survey has therefore highlighted the fact that many people living with HIV in South Africa are still compromised through ongoing stigma and discrimination.

During the 2015 World AIDS day, Deputy President, Mr. Cyril Ramaphosa, reiterated that “in the course of addressing the HIV and TB epidemics we must enhance our focus on the human and legal rights of people infected and affected by HIV and TB”.

Why is this important? As we may be aware, discrimination is a human rights violation and is prohibited under international human rights law and most national constitutions. Discrimination exacerbates risks and deprives people of their rights and entitlements, fuelling the HIV epidemic. Democratic South Africa is founded on the highest ideals of a constitution that accords an equal status to the dignity and rights of all citizens as it does to all of our rights to economic freedom and access to a full and comprehensive package of public services including health, education and social support. The spirit and letter of the Constitution obliges the state to fulfil its multiple responsibilities, and enjoins communities, families and individuals to play their part in ensuring that we all live free of prejudice, fear and discrimination.

Addressing stigma and discrimination is an exceedingly important aspect of mitigating the effects of HIV and TB. Stigma and discrimination is not only harmful for people living with HIV and TB and their families, but also leads to undesirable health behaviours that may aid their spread by pushing these diseases further underground. Individuals who do not disclose their HIV and TB status and do not seek treatment may be more likely to pass the infection to others. Furthermore, stigma and discrimination dissuade any potentially-exposed individuals from accessing testing. On the whole, these effects limit the success of any HIV and TB intervention on both the treatment and prevention sides.

Access to legal-aid services for people living with HIV/AIDS and TB, particularly those among already-vulnerable populations, is central to a more effective response. Legal aid plays an important role in guaranteeing protection from discrimination and getting redress for rights. In this regard, I am happy to note that Legal Aid SA and SANAC have entered into a partnership aimed at providing and facilitating access to quality legal services largely pertaining to HIV/AIDS and TB related stigma and discrimination.

So what is the link between Human Rights, HIV, TB and Development? The recently adopted 2030 Agenda for Sustainable Development (2030 Agenda) reflects and responds to the increasing complexity and interconnectedness of health and development. Issues of widening economic and social inequalities, rapid urbanization, threats to climate and the environment, combined with the continuing burden of HIV, TB and other infectious diseases and the emergence of new health challenges, such as the growing burden of non-communicable diseases (NCDs) all converge to create a multi-faceted development challenge which requires an integrated and holistic response. Universality, sustainability and ensuring that no one is left behind are hallmarks of the 2030 Agenda. The Sustainable Development Goals (SDGs) recognize that many areas of development have an impact upon health or an important health dimension and that multisectoral, rights based and gender-sensitive approaches are essential to addressing health-related development challenges.

Ladies and gentlemen, UNDP is a Cosponsor of the Joint United Nations Programme on HIV/AIDS (UNAIDS), a partner of the Global Fund to Fight AIDS, TB and Malaria, and a cosponsor of several other international health partnerships. UNDP’s Strategic Plan 2014–2017 recognizes the wide-ranging social and economic impacts of HIV and TB and the synergies between health and sustainable development. The plan addresses HIV and TB as cross-cutting issues, and draws attention to the rights of people living with HIV and TB. UNDP is mandated to reduce HIV and TB-related discrimination and violence against women; strengthening local governance and national capacities to secure more equitable access to services for people affected by HIV and TB; and reinforcing the rule of law and reform of legal systems. In this regard, the UNDP South Africa country office and the regional office are working with judges, and the Association of Women Judges in South Africa to build their capacity to address issues related to human rights, gender, HIV, TB and the Law.

As a development agency, UNDP’s commitment to HIV, TB and other major health challenges is based on the principles that health is both a driver and outcome of development and that actions across a wide range of development sectors have a significant impact on health outcomes. Evidence shows that just as health shapes development, development shapes health. The conditions in which people live and work, including factors such as poverty, exclusion, inequality, social status, housing and environmental and political conditions, have a major impact on health and well-being. Conversely, healthy people, who live in an environment where their rights are respected and promoted, and where gender equality thrives, are better able to contribute to the social, political and economic development of their communities and countries. Such an approach will help to ensure the sustainability of HIV and TB results and support the achievement of the goals of the UNAIDS Strategy 2016-2021, the Global Fund Strategy 2017-2021 and contribute to progress on the SDGs.

With these brief remarks, I would like to commend SANAC for playing a leading role in driving several programmes on stigma and discrimination  since 2014,  with a range of stakeholders that include people living with HIV, government departments, civil society, the private sector and development partners – this depicts a truly multi-sectoral response. It is my belief that today’s meeting will come up with innovative actions and programmes on which to build and scale up those interventions in order to counter stigma and discrimination. It is also my hope that the open window created by the   development of the New Strategic Plan will provide the opportunity and impetus to strengthen the gaps identified in the area of human rights, stigma and discrimination, an issue highlighted during the evaluation that was undertaken on progress of the implementation the current NSP.

Finally, let me leave you with a quote from the High Level Panel on Ending Aids which took place in New York in June this year, under the sub-theme, and I quote:

…”upholding the values of inclusion and social justice is fundamental to creating societies that advance dignity and share the benefit of wealth and health for all. Every person, no matter of their HIV or TB status, should be allowed to love, to live in peace and to be able to contribute to the health and economy of their community”.