Intersectionality

Definition

Inter­sec­tion­al­ity refers to the recog­ni­tion of the ways in which social iden­ti­ties over­lap and, in some cir­cum­stances, can cre­ate com­pound­ing expe­ri­ences of dis­crim­i­na­tion and oppres­sion. Alli­den­ti­ties are inter­sec­tional. Race, eth­nic­ity, gen­der, sex­ual ori­en­ta­tion, and other traits inform the way peo­ple view them­selves and are treated in soci­ety. Inter­sec­tion­al­ity is also a key con­sid­er­a­tion in the HIV response because it can com­pound vul­ner­a­bil­i­ties to the HIV pan­demic, or con­versely, give peo­ple access to mul­ti­ple sources of sup­port. For exam­ple, gen­der non­con­form­ing peo­ple who inject drugs may need more spe­cific and inten­sive inter­ven­tions than cis­gen­der peo­ple who inject drugs because they face mul­ti­ple types of stigma and dis­crim­i­na­tion.

In prac­tice, account­ing for inter­sec­tion­al­ity may take the fol­low­ing forms: con­duct­ing sur­veys of key pop­u­la­tions to see what sup­ple­men­tary sup­ports are needed, adding gen­der affir­ma­tion and racial equity mod­ules to train­ings for law enforce­ment and health­care providers, pro­vid­ing both male and female con­doms, and invest­ing in peer out­reach and edu­ca­tion net­works to engage crim­i­nalised pop­u­la­tions. Inter­sec­tion­al­ity should be a vital con­sid­er­a­tion in both the craft­ing and enforce­ments of HIV laws and poli­cies.

As reflected in the Lan­guage Com­pendium, sev­eral inter­na­tional doc­u­ments have acknowl­edged that “indi­vid­u­als can hold mul­ti­ple iden­ti­ties across dif­fer­ent spec­trums” and that indi­vid­ual expe­ri­ences of these iden­ti­ties are “inter­con­nected.” “Impor­tantly, the com­plex inter­sec­tions between the struc­tural bar­ri­ers which affect key pop­u­la­tions and their gen­der, dis­abil­ity, edu­ca­tion, race, reli­gion and socioe­co­nomic sta­tus can­not be ignored.” More­over, the Spe­cial Rap­por­teur on the Right to Health has called for an “inter­sec­tional and rights-based approach to vio­lence that addresses the root causes of such vio­lence, includ­ing the binary con­cep­tu­al­iza­tion of gen­der and het­ero­nor­ma­tive norms, and patri­ar­chal, racist, ableist and cap­i­tal­ist oppres­sion and deter­mi­nants of health in law and prac­tice, is urgently needed.”

Precedents

2021 Global AIDS Strategy 2021-2026

• “Pri­or­i­tize peo­ple who are left behind due to their gen­der, age, sex­ual ori­en­ta­tion or gen­der iden­tity or occu­pa­tion. Ensure that women and girls who face inter­sect­ing forms of dis­crim­i­na­tion and vio­lence (e.g. indige­nous women, women with dis­abil­i­ties, women who use drugs, women in prison, female sex work­ers and trans­gen­der women) receive the tai­lored ser­vices and sup­port they need, and ensure that they are mean­ing­fully engaged in HIV-related deci­sion-mak­ing. Ensure access to rights lit­er­acy and mean­ing­ful com­plaint and redress mech­a­nisms for vio­la­tions of their human rights in the con­text of HIV.” (para­graph 153(f))

2021 Political declaration on HIV and AIDS

• “Note with con­cern that the major­ity of coun­tries and regions have not made sig­nif­i­cant progress in expand­ing harm reduc­tion pro­grammes, in accor­dance with national leg­is­la­tion, as well as anti­retro­vi­ral ther­apy and other rel­e­vant inter­ven­tions that pre­vent the trans­mis­sion of HIV, viral hepati­tis and other blood -borne dis­eases asso­ci­ated with drug use, par­tic­u­larly those who inject drugs, and call urgent atten­tion to the insuf­fi­cient cov­er­age of pro­grammes and sub­stance use treat­ment pro­grammes that improve adher­ence to HIV drug treat­ment ser­vices, the mar­gin­al­iza­tion of and dis­crim­i­na­tion against peo­ple who use drugs, par­tic­u­larly those who inject drugs, through the appli­ca­tion of restric­tive laws, which ham­per access to HIV-related ser­vices, and in that regard, ensure access to and use of the full range of such inter­ven­tions, includ­ing in pre­ven­tion, treat­ment and outre ach ser­vices, pris­ons and other closed set­tings, and pro­mot­ing in that regard the use, as appro­pri­ate, of the tech­ni­cal guid­ance issued by the World Health Orga­ni­za­tion, the United Nations Office on Drugs and Crime and the Joint United Nations Pro­gramme on HIV/AIDS, and note with con­cern that gen­der-based and age-based stigma and dis­crim­i­na­tion often act as addi­tional bar­ri­ers for women and for young peo­ple who use drugs, par­tic­u­larly those who inject drugs, to access and use these ser­vices.” (para­graph 37)

2020 Resolution on violence against women migrant workers

• “Encour­ages States, as appro­pri­ate, to address prac­ti­cal bar­ri­ers, includ­ing lan­guage bar­ri­ers, that women migrant work­ers may encounter in coun­tries of des­ti­na­tion, and pro­vide them with ade­quate infor­ma­tion about their rights, includ­ing to con­sular assis­tance, prior to their depar­ture from their coun­tries of ori­gin.” (para­graph 32)

2016 Resolution on Women, the Girl Child and HIV and AIDS

• “Deeply con­cerned also by the increased vul­ner­a­bil­ity to HIV infec­tion faced by women and girls liv­ing with dis­abil­i­ties result­ing from, inter alia, legal and eco­nomic inequal­i­ties, sex­ual and gen­der-based vio­lence, dis­crim­i­na­tion and vio­la­tions of their rights.” (p. 34/62)

2016 Outcome Document of the Session on the World Drug Problem

• “Ensure non-dis­crim­i­na­tory access to health, care and social ser­vices in pre­ven­tion, pri­mary care and treat­ment pro­grammes, includ­ing those offered to per­sons in prison or pre­trial deten­tion, which are to be on a level equal to those avail­able in the com­mu­nity, and ensure that women, includ­ing detained women, have access to ade­quate health ser­vices and coun­sell­ing, includ­ing those par­tic­u­larly needed dur­ing preg­nancy.” (para­graph 4(b))

2016 Political Declaration on HIV and AIDS

• “Com­mit to elim­i­nat­ing bar­ri­ers, includ­ing stigma and dis­crim­i­na­tion in health-care set­tings, to ensure uni­ver­sal access to com­pre­hen­sive HIV diag­nos­tics, pre­ven­tion, treat­ment, care and sup­port for peo­ple liv­ing with, at risk of and affected by HIV, per­sons deprived of their lib­erty, indige­nous peo­ple, chil­dren, ado­les­cents, young peo­ple, women, and other vul­ner­a­ble pop­u­la­tions.” (para­graph 62(j))

2011 Political Declaration of the HLM on NCDs

• “Note with con­cern that the rapidly grow­ing mag­ni­tude of non-com­mu­ni­ca­ble dis­eases affects peo­ple of all ages, gen­der, race and income lev­els, and fur­ther that poor pop­u­la­tions and those liv­ing in vul­ner­a­ble sit­u­a­tions, in par­tic­u­lar in devel­op­ing coun­tries bear a dis­pro­por­tion­ate bur­den and that non-com­mu­ni­ca­ble dis­eases can affect women and men dif­fer­ently.” (para­graph 14)

2011 Political Declaration on HIV and AIDS

• “Remain deeply con­cerned that, glob­ally, women and girls are still the most affected by the epi­demic and that they bear a dis­pro­por­tion­ate share of the care­giv­ing bur­den, and that the abil­ity of women and girls to pro­tect them­selves­from HIV con­tin­ues to be com­pro­mised by phys­i­o­log­i­cal fac­tors, gen­der inequal­i­ties, includ­ing unequal legal, eco­nomic and social sta­tus, insuf­fi­cient access to health care and ser­vices, includ­ing for sex­ual and repro­duc­tive health, and all forms of dis­crim­i­na­tion and vio­lence, includ­ing sex­ual vio­lence and exploita­tion.” (para­graph 21)

Expert precedents

2022 Report of the Special Rapporteur on the Right to Health

• “A com­pre­hen­sive health response to vio­lence should look at the nature and extent of the harm caused by types of vio­lence, should take into con­sid­er­a­tion the con­text (that is, con­flict, dis­place­ment), loca­tion (rural, urban) and per­sonal char­ac­ter­is­tics of the sur­vivor (sex, gen­der iden­tity, dis­abil­ity, race, eth­nic­ity, age) and should take into account the inter­sect­ing forms of dis­crim­i­na­tion that exac­er­bate the impact of vio­lence on the sur­vivors’ enjoy­ment of the right to health.” (para­graph 87)

• “An inter­sec­tional and rights-based approach to vio­lence that addresses the root causes of such vio­lence, includ­ing the binary con­cep­tu­al­iza­tion of gen­der and het­ero­nor­ma­tive norms, and patri­ar­chal, racist, ableist and cap­i­tal­ist oppres­sion and deter­mi­nants of health in law and prac­tice, is urgently needed.” (para­graph 96)

2022 Report of the Independent Expert on SOGI: Law of Inclusion

• “The obser­va­tion of the Com­mit­tee on Eco­nomic, Social and Cul­tural Rights about per­sons with dis­abil­i­ties being treated as gen­der­less human rights and the obser­va­tion by the Com­mit­tee on the Rights of Per­sons with Dis­abil­i­ties that women with dis­abil­i­ties may be sub­ject to mul­ti­ple and inter­sec­tional forms of dis­crim­i­na­tion based on gen­der and dis­abil­ity are notable exam­ples of how iden­ti­ties may be described as points of entry into an analy­sis of the provi­lege and dis­crim­i­na­tion that are cre­ated at the point of inter­sec­tion of the mul­ti­ple iden­ti­ties that every per­son encom­passes in one body, includ­ing gen­der iden­tity.” (para­graph 24)

• “The under­stand­ing that inter­sec­tional analy­sis is fun­da­men­tal to address­ing vio­lence and dis­crim­i­na­tion against women, includ­ing les­bian, bisex­ual and trans women, has per­me­ated through pub­lic pol­icy, and many State sub­mis­sions acknowl­edged its impor­tance.” (para­graph 26)

2022 Report of the Independent Expert on SOGI: Practices of Exclusion

• “Fur­ther­more, although an inter­sec­tional approach acknowl­edges that indi­vid­u­als can hold mul­ti­ple iden­ti­ties across dif­fer­ent spec­trums, it also acknowl­edges that a per­son’s expe­ri­ences of these iden­ti­ties are inter­con­nected.” (para­graph 50)

2016 General Comment No.22 on the Right to Sexual and Reproductive Health

• “Cer­tain indi­vid­u­als and pop­u­la­tion groups that expe­ri­ence mul­ti­ple and inter­sect­ing forms of dis­crim­i­na­tion that exac­er­bate exclu­sion in both law and prac­tice, such as les­bian, gay, bisex­ual, trans­gen­der and inter­sex per­sons5 and per­sons with dis­abil­i­ties, the full enjoy­ment of the right to sex­ual and repro­duc­tive health is fur­ther restricted.” (para­graph 2)

• “Sub­stan­tive equal­ity requires that the dis­tinct sex­ual and repro­duc­tive health needs of par­tic­u­lar groups, as well as any bar­ri­ers that par­tic­u­lar groups may face, be addressed. The sex­ual and repro­duc­tive health needs of par­tic­u­lar groups should be given tai­lored atten­tion. For exam­ple, per­sons with dis­abil­i­ties should be able to enjoy not only the same range and qual­ity of sex­ual and repro­duc­tive health ser­vices but also those ser­vices which they would need specif­i­cally because of their dis­abil­i­ties.” (para­graph 24)

1999 General Recommendation No.24 on women and health

• “While bio­log­i­cal dif­fer­ences between women and men may lead to dif­fer­ences in health sta­tus, there are soci­etal fac­tors that are deter­mi­na­tive of the health sta­tus of women and men and can vary among women them­selves. For that rea­son, spe­cial atten­tion should be given to the health needs and rights of women belong­ing to vul­ner­a­ble and dis­ad­van­taged groups, such as migrant women, refugee and inter­nally dis­placed women, the girl child and older women, women in pros­ti­tu­tion, indige­nous women and women with phys­i­cal or men­tal dis­abil­i­ties.” (para­graph 6)

Evidence

2022 WHO Consolidated Guidelines on Person-centred HIV Strategic Information

• “Epi­demi­o­logic research con­ducted through national sur­veys, clin­i­cal tri­als and cohort stud­ies has shown that HIV inci­dence varies con­sid­er­ably between and within dif­fer­ent geo­graphic areas and pop­u­la­tion groups in a coun­try.” (p. 189)

• “In mature epi­demics HIV preva­lence tends to be lower among preg­nant women above age 20 than among non-preg­nant women, with the rel­a­tive dif­fer­ence grow­ing with increas­ing age and older age of sex­ual debut. In con­trast, preg­nant ado­les­cents, ages 15-19 years, tend to have higher HIV preva­lence than non-preg­nant ado­les­cents.” (p. 205)

• “A recent analy­sis of pro­gramme-dri­ven sur­vey data col­lected among ado­les­cent girls (ages 16 to 19 years) who sell sex in Zim­babwe reported a steep rise in HIV preva­lence, from 2.1% among those age 16 years to 26.9% among those age 19.” (p. 208)

2022 WHO Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations

• “Impor­tantly, the com­plex inter­sec­tions between the struc­tural bar­ri­ers which affect key pop­u­la­tions and their gen­der, dis­abil­ity, edu­ca­tion, race, reli­gion and socioe­co­nomic sta­tus can­not be ignored. For exam­ple, cis­gen­der women and trans and gen­der diverse peo­ple expe­ri­ence extremely high rates of vio­lence, racial minori­ties are over-rep­re­sented in many prison set­tings, and all these fac­tors increase stigma and dis­crim­i­na­tion.” (p. 3)

2021 State of World Population

• “Women expe­ri­enc­ing abuse in mar­riage are one-and-a-half to three times more likely to test pos­i­tive for HIV and two to four times more likely to report another sex­u­ally trans­mit­ted infec­tion.” (p. 48)

2016 Prevention Gap Report

• “Women who inject drugs faced higher lev­els of stigma, dis­crim­i­na­tion and vul­ner­a­bil­ity to harm than their male coun­ter­parts. Those who had expe­ri­enced sex­ual vio­lence were more likely to be liv­ing with HIV than other women who inject drugs.” (p. 27)

• “HIV preva­lence among women who inject drugs is often greater than their male peers, high­light­ing a need for gen­der-sen­si­tive harm reduc­tion inter­ven­tions. In 24 of 35 coun­tries report­ing to the 2016 Global AIDS Response Progress Report, median HIV preva­lence among women was 50% higher, with a range of 2% to 530%.” (p. 44)