Societal enablers

Definition

Right-based HIV responses are dri­ven by struc­tural fac­tors, includ­ing polit­i­cal com­mit­ments and advo­cacy, laws, poli­cies, prac­tices, com­mu­nity mobi­liza­tion, stigma reduc­tion, local responses to change the risk envi­ron­ment, among other fac­tors. These are referred to here as the soci­etal enablers - they enhance the effec­tive­ness of HIV pro­grams by remov­ing imped­i­ments to ser­vice avail­abil­ity, access and uptake at the soci­etal level. The UNAIDS Strate­gic Frame­work 2020-2025 fur­ther pro­vides for soci­etal enablers as: a) Soci­eties with sup­port­ive legal envi­ron­ments and access to jus­tice; b) Gen­der equal soci­eties; c) Soci­eties free from stigma and dis­crim­i­na­tion; and d) Co-action across devel­op­ment sec­tors to reduce exclu­sion and poverty. Social enablers may take the form of any top-down or socially imposed influ­ence on sex­ual and repro­duc­tive health, such as pos­i­tive legal deter­mi­nants and social norms like gen­der equal­ity. Since they can greatly affect the health and well-being of entire pop­u­la­tions, soci­etal enablers can and should be lever­aged in the global fight against HIV. Many bar­ri­ers to HIV test­ing and treat­ment are soci­etal, so struc­tural mea­sures must be taken to counter them.

Other soci­etal enablers are more nuanced and inter­sec­tional. Sex­ism and homo­pho­bia, for instance, can man­i­fest in a range of fac­tors like vio­lence, microag­gres­sions, and lack of rep­re­sen­ta­tion in HIV pro­grams. In response, soci­etal enablers like com­mu­nity grants and aware­ness cam­paigns should be employed to sup­port dis­en­fran­chised groups and com­bat social stigma. Soci­etal enablers are most effec­tive when they are tai­lored to spe­cific coun­tries, com­mu­ni­ties, and key pop­u­la­tions. If they are overly broad or imprac­ti­cal to imple­ment in a given con­text, soci­etal enablers may have lit­tle-to-no impact on peo­ple’s sex­ual and repro­duc­tive health. Com­mu­nity lead­er­ship is there­fore fun­da­men­tal to devel­op­ing laws and poli­cies that respond to peo­ple’s lived expe­ri­ences of spe­cific social bar­ri­ers.

Precedents

2021 Global AIDS Strategy 2021-2026

• “ 60% of the pro­grammes sup­port­ing the achieve­ment of soci­etal enablers, includ­ing pro­grammes to reduce/elim­i­nate HIV-related stigma and dis­crim­i­na­tion, advo­cacy to pro­mote enabling legal envi­ron­ments, pro­grammes for legal lit­er­acy and link­ages to legal sup­port, and reduc­tion/elim­i­na­tion of gen­der-based vio­lence, to be deliv­ered by com­mu­nity-led orga­ni­za­tions.” (annex 2, 2025 tar­gets)

• “With its new tar­gets for soci­etal enablers, the Strat­egy demands that the same com­mit­ment and atten­tion to tech­ni­cal detail that has char­ac­ter­ized the HIV response’s pro­gram­matic efforts be applied to the urgent busi­ness of address­ing the social and struc­tural fac­tors that slow progress against AIDS. The Strat­egy pri­or­i­tizes lessons from recent suc­cesses and applies them more broadly, espe­cially in coun­tries where inequal­i­ties are enabled by puni­tive legal and pol­icy frame­works. Com­mu­ni­ties of peo­ple liv­ing with, affected by, or most at risk of HIV must be sup­ported and effec­tively resourced to gal­va­nize actions that can reduce inequal­i­ties in the response and to ensure that responses meet the needs of all peo­ple.” (para­graph 131)

2021 HRC resolution on human rights in the context of HIV and AIDS

• “Requests the United Nations High Com­mis­sioner for Human Rights to pre­pare a report, in con­sul­ta­tion with Gov­ern­ments, civil soci­ety, com­mu­nity-led orga­ni­za­tions and other stake­hold­ers, describ­ing the action being taken and rec­om­mend­ing action to be inten­si­fied or ini­ti­ated to meet the inno­v­a­tive tar­gets on soci­etal enablers, as rec­og­nized in the Polit­i­cal Dec­la­ra­tion on HIV and AIDS adopted by the Gen­eral Assem­bly in 2021, and to address the remain­ing gaps, and to present the report to the Human Rights Coun­cil at its fifti­eth ses­sion.” (para­graph 31)

2019 Political declaration of the HLM on UHC

• “Imple­ment high-impact poli­cies to pro­tect peo­ple’s health and com­pre­hen­sively address social, eco­nomic and envi­ron­men­tal and other deter­mi­nants of health by work­ing across all sec­tors through a whole-of-gov­ern­ment and health-in-all-poli­cies approach.” (para­graph 26)

• “Build effec­tive, account­able, trans­par­ent and inclu­sive insti­tu­tions at all lev­els to end cor­rup­tion and ensure social jus­tice, the rule of law, good gov­er­nance and health for all.” (para­graph 56)

2018 Political declaration of the third HLM on NCDs

• “Reaf­firm the pri­mary role and respon­si­bil­ity of gov­ern­ments at all lev­els in respond­ing to the chal­lenge of non-com­mu­ni­ca­ble dis­eases by devel­op­ing ade­quate national mul­ti­sec­toral responses for their pre­ven­tion and con­trol, and pro­mot­ing and pro­tect­ing the right of every­one to the enjoy­ment of the high­est attain­able stan­dard of phys­i­cal and men­tal health, and under­score the impor­tance of pur­su­ing whole-of-gov­ern­ment and whole-of-soci­ety approaches, as well as health-in-all-poli­cies approaches, equity-based approaches and life-course approaches.” (para­graph 15)

2016 Outcome Document of the Session on the World Drug Problem

• “Inten­sify, as appro­pri­ate, the mean­ing­ful par­tic­i­pa­tion of and sup­port and train­ing for civil soci­ety orga­ni­za­tions and enti­ties involved in drug-related health and social treat­ment ser­vices, in accor­dance with national leg­is­la­tion and in the frame­work of inte­grated and coor­di­nated national drug poli­cies, and encour­age efforts by civil soci­ety and the pri­vate sec­tor to develop sup­port net­works for pre­ven­tion and treat­ment, care, recov­ery, reha­bil­i­ta­tion and social rein­te­gra­tion in a bal­anced and inclu­sive man­ner.” (para­graph 1(q))

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

• “Calls upon all gov­ern­ments to enact and inten­sify the imple­men­ta­tion of laws, poli­cies and strate­gies to elim­i­nate all forms of gen­der-based vio­lence and dis­crim­i­na­tion against women and girls in the pub­lic and pri­vate spheres and harm­ful prac­tices, such as child, early and forced mar­riage, female gen­i­tal muti­la­tion and traf­fick­ing in per­sons, and ensure the full engage­ment of men and boys in order to reduce the vul­ner­a­bil­ity of women and girls to HIV.” (para­graph 3)

2016 HRC Resolution on civil society space

• “Urges States to cre­ate and main­tain, in law and in prac­tice, a safe and enabling envi­ron­ment in which civil soci­ety can oper­ate free from hin­drance and inse­cu­rity.” (para­graph 4)

2016 Political Declaration on HIV and AIDS

• “Call for increased and sus­tained invest­ment in the advo­cacy and lead­er­ship role, involve­ment and empow­er­ment of peo­ple liv­ing with, at risk of and affected by HIV, women, chil­dren, bear­ing in mind the roles and respon­si­bil­i­ties of par­ents, young peo­ple, espe­cially young women and girls, local lead­ers, com­mu­nity-based orga­ni­za­tions, indige­nous com­mu­ni­ties and civil soci­ety more gen­er­ally, as part of a broader effort to ensure that at least 6 per cent of all global AIDS resources are allo­cated for social enablers, includ­ing advo­cacy, com­mu­nity and polit­i­cal mobi­liza­tion, com­mu­nity mon­i­tor­ing, pub­lic com­mu­ni­ca­tion and out­reach pro­grammes to increase access to rapid tests and diag­no­sis, as well as human rights pro­grammes such as law and pol­icy reform and stigma and dis­crim­i­na­tion reduc­tion.” (para­graph 64(a))

2011 Political Declaration of the HLM on NCDs

• “Encour­age the devel­op­ment of mul­ti­sec­toral pub­lic poli­cies that cre­ate equi­table health-pro­mot­ing envi­ron­ments that empower indi­vid­u­als, fam­i­lies and com­mu­ni­ties to make healthy choices and lead healthy lives.” (para­graph 43(a))

2010 ILO Recommendation concerning HIV and AIDS and the world of work

• “High­light­ing the role of the work­place in facil­i­tat­ing access to pre­ven­tion, treat­ment, care and sup­port ser­vices, the Rec­om­men­da­tion calls for the devel­op­ment, adop­tion and imple­men­ta­tion of national tri­par­tite work­place poli­cies and pro­grammes on HIV and AIDS and on occu­pa­tional safety and health, which are to be inte­grated into national devel­op­ment plans and strate­gies. These poli­cies and pro­grammes are to be devel­oped by mem­ber States in con­sul­ta­tion with the most rep­re­sen­ta­tive orga­ni­za­tions of employ­ers and work­ers, with the involve­ment of other actors, includ­ing orga­ni­za­tions rep­re­sent­ing per­sons liv­ing with HIV, and tak­ing account of the views of rel­e­vant sec­tors, par­tic­u­larly the health sec­tor.” (para­graph 5)

2007 WHA Resolution on progress in the rational use of medicines

• “Urges mem­ber states to develop and strengthen exist­ing train­ing pro­grammes on ratio­nal use of med­i­cines and ensure that they are taken into account in the cur­ric­ula for all health pro­fes­sion­als and med­ical stu­dents, includ­ing their con­tin­u­ing edu­ca­tion, where appro­pri­ate, and to pro­mote pro­grammes of pub­lic edu­ca­tion in ratio­nal use of med­i­cines.” (para­graph 1(4))

1995 Beijing Declaration and Platform for Action

• “Encour­age all sec­tors of soci­ety, includ­ing the pub­lic sec­tor, as well as inter­na­tional orga­ni­za­tions, to develop com­pas­sion­ate and sup­port­ive, non-dis­crim­i­na­tory HIV/AIDS-related poli­cies and prac­tices that pro­tect the rights of infected indi­vid­u­als.” (para­graph 108(c))

Expert precedents

2022 OHCHR Annual Report on Human Rights and HIV/AIDS

• “Rec­om­mend that States allo­cate and ring-fence bud­getary resources for soci­etal enablers, includ­ing stigma and dis­crim­i­na­tion reduc­tion, the elim­i­na­tion of gen­der-based vio­lence, reduc­ing gen­der inequal­i­ties and harm­ful gen­der norms, increas­ing access to jus­tice and action to sup­port law reform.” (para­graph 54(a))

• “Rec­om­mend that States allo­cate funds to com­mu­nity-led and com­mu­nity-based orga­ni­za­tions to lead on activ­i­ties to imple­ment soci­etal enablers, par­tic­u­larly those tar­get­ing key and vul­ner­a­ble pop­u­la­tions.” (para­graph 54(c))

Evidence

2020 Evidence Review of the UNAIDS Strategy 2016-2021

• “Women’s access to prop­erty and inher­i­tance rights can be vital for pre­vent­ing HIV infec­tion or mit­i­gat­ing its impact. Yet, cus­tom­ary laws and prac­tices con­tinue to inhibit women’s access to land in 90 coun­tries, daugh­ters do not have the same inher­i­tance rights as sons in 34 coun­tries, and wid­ows lack inher­i­tance rights in 36 coun­tries” (pp. 74)