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4.6 HIV/AIDS
UNDP is working on HIV prevention and the reduction of its impact. As the key development partner, and co-sponsor of UNAIDS, UNDP helps countries to put HIV at the centre of national development and poverty reduction strategies; build national capacity to mobilize all levels of government and civil society for a coordinated and effective response to the epidemic; and promote and protect the rights of people living with HIV, women, vulnerable and marginalised populations. Minority groups are one of the key populations at higher risk to HIV. Interventions for addressing HIV prevalence in minority groups must take a ‘social determinants of health’ approach. According to the World Health Organization, social determinants of health are shaped by the conditions in which people live and work, conditions that are created by inequalities in access to power and resources; these social determinants are “mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries”.31 Ethnicity, language and religion are among the factors that can influence health inequities. Public policy responses to HIV may not be effective for minority populations if strategies are based on addressing risk factors characteristic only of majority populations and not adapted to minority cultures and social realities. Minorities living with HIV may have unequal access to health care because of discrimination in health care services, lack of culturally adapted healthcare or higher poverty levels that reduce affordability of retroviral care. Existing infrastructure for medical services may be more limited in remote or impoverished areas where minorities are settled. Minorities are more vulnerable to HIV-related disease in countries where they have higher incidences of injecting drug use and human trafficking. Gender inequality and unequal power relations between and among women and men continue to be major drivers of HIV infection. HIV prevalence in women and girls is closely associated with intimate partner violence, challenges in negotiating safer sex and other manifestations of gender inequality. Gender inequality and harmful gender norms are not only associated with the spread of HIV but also with its consequences, such as violence targeted toward HIV positive women and girls. These risk factors might impact differently on women and girls from minority groups because of different cultural practices and different experiences of social exclusion. For example, some minority women are more vulnerable to human trafficking, because of higher levels of poverty or because they live close to transit routes where prostitution is predominant, increasing the risk of contracting HIV. There is a clear relationship between HIV and human rights violations. Stigma, discrimination and violence are often directed toward persons because of their real or perceived HIV status and because of behaviours, such as sex work, injecting drug use or same-sex relations. People who are marginalised may be disproportionately exposed to human rights abuses, both in general and as related to HIV. People living with HIV face additional stigma and discrimination, often deterring their access to treatment, care, support and prevention services, and resulting in multiple discrimination. Promoting and protecting the rights of people living with HIV, especially those who are marginalised, is critical to an effective AIDS response and fundamental to yielding public health and development benefits for populations as a whole. UNDP works with countries to create enabling human rights and gender responsive environments. UNDP supports countries to address gender inequalities – through the empowerment of women and girls and sexual minorities (i.e. men who have sex with men, transgender populations, lesbians and bisexuals), while also engaging with men and boys to challenge harmful gender norms. In order to reduce the prevalence of HIV in ethnic, religious and linguistic minority groups, specific policy interventions should be developed. Taking into consideration of the social determinants of health approach, prevention measures need to be culturally attuned and focused on the risk factors that are particular to each minority community. Minorities could be trained as health care providers to improve community HIV prevention programmes. Minority health workers could ensure that culturally appropriate health information is made available in minority languages, while also addressing discrimination issues that minorities may face from health workers. Box 11 outlines some of the efforts in the United States to reduce higher HIV prevalence among minority groups. Special efforts are needed to reach minorities in remote areas and to provide primary health care services that are adapted to minorities’ cultures, environments and traditional medical practices. Box 12 illustrates some lessons learned from HIV education projects in the remote areas of the Upper Mekong region.
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