Human Rights

The Global Fund 2017-2022 Strategy, Investing to End Epidemics, strengthens our commitment to investing in programs that address human rights- and gender-related barriers.

The Global Fund partnership has also committed to integrate human rights principles – participation, equity, accountability and transparency – throughout the grant cycle.

Addressing human rights-related barriers to services

What are human rights-related barriers to accessing health services? They are obstacles that make it difficult or impossible for people to access prevention, care and treatment services. These barriers include:

• Stigma and discrimination based on health status, social/legal status, gender, and/or sexual orientation and gender identity. This includes stigma and discrimination in health care settings, communities, workplaces and schools.
• Gender inequality and gender-based violence. This includes discrimination against women and girls in health care provision, marital and property laws, and access to education and employment; harmful gender norms such as early or forced marriage, wife inheritance and female genital mutilation; rape and intimate partner violence.
• Punitive policies, practices and laws. These include practices and policies in health care settings involving mandatory testing, lack of informed consent, denial of health care, forced sterilization; illegal police practices (harassment, extortion, arbitrary arrests, violence); overly broad criminalization and incarceration.

Addressing these barriers is critical to ensuring that all those who need services can receive them, and critical to ensuring that Global Fund grants will have greater impact.

For example, uptake of HIV and TB testing and treatment – as well as retention in treatment – is greater when programs include efforts to reduce stigma and discrimination in health care settings and in communities. Such programs may include training of health care workers in nondiscrimination and human rights literacy programs.

Key populations are those who experience high epidemiological impact from HIV, TB or malaria combined with reduced access to services and/or being criminalized or otherwise marginalized. Key populations may vary within the context of the three diseases, but often include sex workers; lesbian, gay, bisexual, transgender and intersex people; people who inject drugs; men who have sex with men, prisoners, refugees, migrants and people with disabilities. Access to prevention and treatment programs for these populations is increased when grants include comprehensive programs to address human rights-related barriers.

Programs to reduce barriers

The Global Fund is aligned with the UNAIDS seven key program areas to reduce stigma and discrimination and increase access to justice. A group of TB experts has confirmed that these programs are also relevant for TB. The Global Fund now requires that all funding requests from countries, regardless of income level, include such programs, as well respond to key and vulnerable populations:

• Stigma and discrimination reduction
• Sensitization of health care workers on human rights and medical ethics
• Training of lawmakers and law enforcement officials
• Reducing gender inequality and gender-based discrimination and violence
• Legal/rights literacy
• Legal services
• Monitoring and reforming laws, regulations and policies

A group of malaria experts is currently considering the programs most effective in the malaria context.

Human rights and the grant life cycle

Many steps have been taken to embed human rights into the Global Fund’s way of doing business.

Beginning at the country dialogue stage, we work with countries to ensure that key and vulnerable populations are represented and involved in the process. For countries that need additional support on this issue, we facilitate technical cooperation throughout the funding request development process.

Applicants are required to identify key human rights barriers and to include programs that address these barriers in their funding requests.

Once the funding request has been approved, the grant agreement includes a clause specifically detailing five minimum human rights standards that countries are expected to meet:

• Non-discriminatory access to services for all, including people in detention
• Employing only scientifically sound and approved medicines or medical practices
• Not employing methods that constitute torture or that are cruel, inhuman or degrading
• Respecting and protecting informed consent, confidentiality and the right to privacy concerning medical testing, treatment or health services rendered
• Avoiding medical detention and involuntary isolation, to be used only as a last resort

Any individual or a group who has either personally experienced or witnessed a violation of one or more of these standards by an implementer of Global Fund grants can submit a confidential complaint to the Global Fund’s Office of the Inspector General.

Integrating human rights into all we do

Global Fund grant management staff have received training on human rights, gender and other cross-cutting issues, and these issues have been addressed in information notes and technical briefs for countries. In addition, a system has been set up to track the amount countries spend on interventions to address human rights-related barriers to services.

Our approach to human rights is established by the Global Fund Board and based on consultations with governments, human rights experts, civil society organizations and technical partners.