How does a 'human rights based approach' work out on the ground? Lessons from South Africa

Published: October 29, 2014

Roger Pebody
Original Article:

While international rhetoric on HIV and AIDS frequently invokes human rights, putting these ideas into practice in specific settings remains challenging, according to a process evaluation of an intervention in rural South Africa published in the October issue of Culture, Health and Sexuality. Although female health volunteers understood gender inequalities to be a key obstacle to an effective local response to HIV, they had little interest in abstract notions of women’s rights or in directly confronting men. Their efforts to have their work socially recognised or materially rewarded in the local community were frustrated. Project funders prioritised ‘numbers reached’ over longer-term objectives.

Scientists, policy makers and activists frequently emphasise that protecting and promoting human rights is a prerequisite to a successful response to HIV. For example, “Rights here, right now” was the slogan for a recent International AIDS Conference. Appeals to human rights were key to the Treatment Action Campaign’s successful movement to improve access to antiretroviral therapy and are central to discourse on ‘key populations’ (men who have sex with men, sex workers, etc.).

Although freedom from discrimination and the right to health are enshrined in South Africa’s constitution, there is a yawning gap between these principles and the grim realities of people’s lives. This study was conducted in an isolated rural area of KwaZulu-Natal characterised by poverty, illiteracy, women’s subordination, and poor access to health services. The prevalence of HIV was high and antiretroviral therapy was not available at the time of the research in 2003 to 2008, meaning that HIV infection was effectively a death sentence.

Informal care by women was the only support available to many dying of AIDS. There was a group of about 80 volunteers, mostly untrained and working for no pay, travelling up and down hills to homesteads some distance apart. The women fetched wood and water, bathed the sick (diarrhoea was a significant problem) and helped people’s families in other ways. There was little local recognition of their efforts, due to negative attitudes towards both women and HIV. Burn-out was common.

A foreign-funded non-governmental organisation (NGO) worked with the women to establish a community project with three aims: to develop their skills and strengthen their ability to lead the local response to HIV and AIDS; to build a more supportive social environment for their work (including the support of local leaders and the church); and to link volunteers with partners in government departments and NGOs.

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