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Protection of PLHIV’s Rights Between Political Will, Stigma, and Dogma in Southeast Asia

On August 8th, ASEAN celebrated its anniversary. There are still many problems facing this region, including more problems of human rights violations, ranging from Rohingya refugees who were expelled from their own country, environmental issues that violate the agrarian rights of the community and damage the environment with very broad and permanent impacts, intimidation and terror against human rights activists, sexual violence, or intolerance, to violations of the rights of People Live with HIV (PLHIV).

According to UNAIDS data, around 3.5 million people are living with HIV in the Southeast Asia region. More than 99% of PLHIV in ASEAN reside in five countries: Indonesia, Malaysia, Vietnam, Myanmar, and Thailand. Since 2010, the region has made progress in combating the epidemic, with successful condom programs in most countries.

Between 2010 and 2015, AIDS-related deaths and new HIV infections have decreased in all high-burden countries except Indonesia and Malaysia. Both countries have rarely experienced declines in HIV cases, and these regions are far from achieving the target of being 90% HIV-free by 2020 and ending AIDS by 2030. These two countries, which have the world’s largest Muslim populations, face significant moral barriers in reaching key populations of PLHIV and providing fair access to services for PLHIV from ISPs.

According to the 2018 gender justice assessment in Indonesia, the religious moral views of health workers in several areas remain a barrier to providing equitable health services to groups. Stigma and discrimination in health services also continue to hinder key populations, especially MSM and transgender, from accessing services. Research also highlights the severe impact of discriminatory practices on PLHIV. With 20% of key population cases and 10% of cases at primary health services experiencing high rates of loss to follow-up, it’s clear that stigma and discrimination are significant barriers. Health service providers’ refusal to treat PLHIV in general clinics exacerbates these issues, isolating individuals and undermining their health outcomes.

The 2020 External Study of the Health Sector’s Response to HIV and AIDS in Indonesia (WHO, 2020) highlighted that the incidence and prevalence of HIV among MSM and trans women remain high in most regions. While in Malaysia in the last decade, sexual transmission became the main mode of transmission, and MSM is expected to become the main key population in Malaysia in year 2030 as projected using the Asian Epidemic Model (AEM) 2022 Global AIDS Monitoring, Country Progress Report. Despite improvements in life expectancy, social justice for PLHIV key populations in ASEAN region, including MSM, transgender, and sex workers remains inadequate.

While legal and policy frameworks are insufficient in addressing social justice issues for PLHIV. Local laws and local/regional AIDS commissions fail to mitigate stigma, discrimination, and violence effectively. In Indonesia, the discrimination reflected in the new penal code (KUHP) that exacerbates discrimination by potentially criminalizing LGBT individuals, sex workers, and women, which hinders HIV response efforts. Additionally, there has been no transformation in the working methods and perspectives of health workers, as biased moral views remain an obstacle to achieving the specific goal of reducing discrimination against PLHIV.

All in all, discrimination in health services, and stigma from law, government and religious figures, combined with a lack of protective laws, perpetuates social injustice and barriers for PLHIV to access service. Therefore, addressing stigma and discrimination in service provision through participation of religious figures to transform the perspective of health service providers is essential to improving access to and quality in HIV services.

Various interfaith meetings have been held by religious leaders from various influential institutions in each country in the Southeast Asian region, but they have not discussed much about the rights of PLHIV. In the future, so that meetings of religious leaders are not just lip service, there must be courage for influential religious leaders to mobilize religious organizations to voice the importance of various health services that can be accessed by PLHIV.

قَالَ رَسُولُ اللهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ: “مَنْ عَادَ مَرِيضًا أَوْ زَارَ أَخًا لَهُ فِي اللهِ، نَادَاهُ مُنَادٍ: أَنْ طِبْتَ، وَطَابَ مَمْشَاكَ، وَتَبَوَّأْتَ مِنَ الْجَنَّةِ مَنْزِلًا”.
(رواه الترمذي وقال: حديث حسن، وفي بعض النسخ غريب).

I heard Messenger of Allah (ﷺ) saying, “Whosoever visits an ailing person or a brother of his to seek the Pleasure of Allah, an announcer (angel) calls out: ‘May you be happy, may your walking be blessed, and may you be awarded a dignified position in Jannah”. [At- Tirmidhi, who categorized it as Hadith Hasan].

Basically, every religion has arguments from holy books that support protection for PLHIV, as above; it’s just the political will of religious leaders in the Southeast Asian region in using religious arguments that support PLHIV services or, on the other hand, turning their backs on the humanitarian message in holy books.

After 36 years, who still remembers CEDAW?

Lies Marcoes

Director of Rumah Kita Bersama Foundation

The day before the commemoration of the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), which falls July 24, I exchanged greetings via WhatsApp with Ibu Saparinah Sadli and Nursyahbani Katjasungkana, two prominent figures in the implementation of this convention. I asked them which of the issues in CEDAW was most relevant nowadays, as this year marked the 36th anniversary of Indonesia’s passing the convention into law.

Ibu Sap, as we call her, was one of the most eminent persons, along with Ibu Achi Luhulima, the late Ibu TO Ichromi, the late Ibu Sumhadi, Ibu Syamsiah Ahmad, Nursyahbani, and several others, who were active in disseminating CEDAW.

But Ibu Sap sent a pessimistic message to me. “Other than activists and Komnas Perempuan [the National Commission on Violence against Women], are there still any government officials or legislators who remember CEDAW?” This question left me thinking. Indeed, who (still) remembers CEDAW today?

CEDAW is one of the most fundamental human rights agreements in the United Nations system of international agreements. It contains a guarantee of substantive equality for women through elimination of all forms of discrimination based on gender prejudice.

The UN adopted the convention in 1979. It is a global agreement that defines the principles of women’s rights as human rights. It contains norms and standards for the obligations and responsibilities of each state party for eliminating discrimination against women.

Indonesia passed the convention into  law on July 24, 1984 under Law No. 7/1984. Since then the convention became legally binding and mandated Indonesia to take efforts to eliminate gender-based discrimination against women and to report its progress. The government has an obligation to produce reports on developments in its implementation of elimination of gender discrimination.

Ibu Sap’s question is therefore relevant here. We simply need to ensure that the government is really doing something to eliminate gender-based discrimination and report it to the CEDAW Committee at the UN. As far as I know, Indonesia has often failed to submit the reports.

The most relevant issues with regard to discriminatory practices actually remain the same from year to year. Nursyahbani has reminded us about two important issues. First is eliminating stereotyping of women, which is currently becoming even more serious due to the rise in primordial and conservative religious views in defining the roles and status of women.

Rumah KitaB is currently conducting research in five regions to see how gender norms are applied to women, particularly women who work. Statistics show that women’s participation in the (formal) work force only stands at 58 percent against 80 percent for men.

The participation rate is stagnant in the productive years, particularly for women who hold mid-level positions. They resign after they marry and have children. Their income is too low to hire a nanny to care for their children, while the state also fails to provide safe and inexpensive day care centers.

The other even more serious problem is the growing belief that a “good” woman is one who stays at home. A process of “domestification” is occurring as a result of conservative ideological views based on religious arguments.

We should be thankful that the legal age for marriage has now been set at 19 for both males and females. Yet the efforts to prevent child marriage still require hard work, as 20 regions still record an inexcusably high rate of child marriage.

In fact, the Marriage Law needs an overhaul as it condones gender inequality. The law contains an article which explicitly states that the man (husband) is the head of the household, while the woman (wife) is a housewife. This definition leads to practices that are incredibly discriminatory against women, with far-reaching consequences, including in the world of work.

Normatively, women are always seen merely as supplementary breadwinners, whatever their actual marital status. In reality, there are many women who head households, whether married, single, abandoned by husbands or divorced, and are the main earners of support for their families. The Women Breadwinner Empowerment (PEKKA) Foundation has reported a rise in the number of members, and the average age of women breadwinners is getting lower.

Given their “supplementary” status, working women in every sector are vulnerable to marginalization or exclusion. And even when they manage to perform, they lack sufficient bargaining power to support themselves as employees. They are also vulnerable to violence, including sexual assault.

For Indonesia, CEDAW is indeed a pearl of great price. Efforts are needed to explore it further. The outreach on CEDAW needs to be mobilized again, as its pioneers did in the early 1990s. Some of them were grouped under the Women’s Studies Center of the University of Indonesia, who partnered with NGOs concerned with the issue of elimination of gender discrimination.

Implementation of CEDAW should not be entrusted to state institutions, such as the Women’s Empowerment and Child Protection Ministry, because discriminatory practices continue to occur everywhere. We need a large-scale campaign on the benefits of the implementation of CEDAW for fulfillment of women’s rights, with achievements that will be duly noted by the UN and by countries that are concerned about gender-based discrimination.

***

The writer is researcher at Rumah KitaB. The original article was published on rumahkitab.com.