thematic area, the analysis identifies the strengths and opportunities as well as the gaps and challenges Ethiopia faces in the implementation of policies and the provision of services and in the protection against stigma and discrimination of children living with or affected by HIV. The analysis was carried out from a human rights perspective.
Facts about the legal and policy framework analysis
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“We started out with a meeting where we discussed how to tackle problems brought on by HIV, AIDS, stigma and discrimination because Ethiopia suffers from heavy denial and a lack of awareness about these issues. We found that we had to tackle the problems systematically. Then, SENSE was developed.
We signed a Memorandum of Understanding.
Two resource persons researched the issue and different stakeholders held meetings and present-ed the materials. We got input from everyone and the project was further developed. Different geographical areas and criteria were suggested by the Danish Institute for Human Rights and Save the Children. The Amhara Region was selected as the intervention area.
In the regional capital of Bahir Dar, the stakeholders called for a meeting. The Danish Institute for Human Rights and the Ethiopian Human Rights Commission presented the ideas and the stakeholders provided their input, which was then included.
We also participated in a large amount of capacity building. As our commission is newly established we are short of many things and have many limitations. The Danish Institute for Human Rights and Save the Children are very experienced, so we share experiences and are building relationships for the future.
SENSE gave us the insight to consider stigma
and discriminations as human rights violations.
We have got many recommendations and we have realised that we need a new law on stigma and discrimination. This will be our next step. We will work jointly with the stakeholders because we already did the research with them.
We are not law makers but we can identify the gaps and present them to the government.
HAPCO, the Ministry for Women, Youth and Children and the Ministry of Education should also recognise the gaps, act on them and show the gaps to the government. If our findings from the legal and policy analysis are not implemented, there will be no impact.
Our activities as a human rights commission will not stop. If people want to complain about HIV-related stigma and discrimination, they should know that it is their right. Therefore, we also need to link with communities. We only have a minor link to the field, but recently we got regional offices and we will use this new opportunity. We may also link to HAPCO regionally and we will participate in the develop-ment of the Code of Action and Practice.
Let’s work on it.”
Meseret Mamo, Senior Children &
Women Human Rights Expert and Molla Abela, Senior Researcher, Ethiopian Human Rights Commission
Human rights commission working to improve legislation
a member of the guideline committee, thus enabling it to include relevant issues and to learn from the SENSE project on stigma and discrimination against children impacted by HIV and AIDS. Save the Children has also commented on the Ethiopian government’s new roadmap on HIV and AIDS, which did not contain indicators on stigma and discrimination.
Several UN entities were also involved in the project.
OHCHR, UNAIDS and UNESCO participated in consulta-tions and workshops as did NEP+. UNESCO also helped
identify relevant consultants and provided technical assistance for the development of the Code of Action and Practice.
Throughout all processes at all levels, experience sharing and common learning have taken place in order to kick start new processes and make adjustments according to current findings. A very dynamic ownership by all stakeholders, in-cluding governmental, non-governmental and the UN, was developed thanks to the inclusiveness of the process. This could not have been established by advocacy alone.
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“We’ve been involved in the assessment at field level, looked into the gender aspect and helped identify consultants. We have provided quality standards of terms of reference and we have commented on terms of references worked out for the development of the Code of Action and
Practice. Strategically, we’ve joined hands forquality education in a safe environment and for community empowerment.
SENSE explored deep and hidden areas, helping us to fight harmful cultural practices. It also taught us how to maximise the support we give to girls and their involvement. Seemingly, SENSE takes place at school level, but it also reaches outside
schools, thereby helping to strengthen the social capital in general.
This project uniquely sees what is happening from the children’s perspective. Children raise their voices and are given space for learning and developing their own ideas, and they are received with respect. This is very innovative in Ethiopia.
We will use this cooperation to look for more projects to do with Save the Children.”
Samuel Asnake, Coordinator, Capacity Building for Education for All, UNESCO
Children are received with respect
Central to the SENSE project is the cooperation with the national coordinating agency on HIV/AIDS, HAPCO, the Ethiopian Human Rights Commission, UNESCO and other relevant government, UN and non-governmental stakeholders at national, regional and grass-roots level.
Collaborating directly with relevant ministries and government offices, UN organisations and other significant stakeholders and jointly addressing HIV-related stigma and discrimination, SENSE adheres to the “Three Ones” principles adopted by the International Conference on AIDS and STIs in Africa (ICASA) in 2003.
The “Three Ones” principles determine standards for harmonising coordination and the strategic planning and monitoring of national HIV and AIDS responses. The principles are:
• One agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners.
• One national AIDS coordinating authority, with a broad-based multi-sector mandate.
• One agreed country-level monitoring and evaluation system.
In keeping with international principles
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SENSE has taken a very innovative ‘from global to local and back again’ approach to its programming on HIV-related human rights. Linking global and local aspects was one of the reasons behind the success of securing funding for the SENSE project.
A human rights based approach to programming calls for a focus on non-discrimination, participation and empowerment addressing not only the needs of the most vulnerable popu-lations but also accountability in the project partnership.
It also calls for the explicit linking of programming to the international human rights framework and its standards.
SENSE has taken all these aspects into account.
As one of 189 ratifying countries of the UN Convention on the Rights of the Child, Ethiopia has committed to the implementation of the human rights standards outlined in the convention. Subsequently, Ethiopia has to report on its implementation of the convention every five years to the Geneva-based Committee on the Rights of the Child, which monitors how UN member states are implementing the convention. The committee is also known as one of eight UN human rights treaty bodies.
When a country reports to the Committee on the Rights of the Child, the committee consecutively provides recom-mendations to the State Party. In a 2006 review, the
commit-Programming human rights:
From global to local and back again
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tee recommended that Ethiopia give greater priority to the protection of the rights of children, including children affected by or living with HIV.
The committee urged Ethiopia to:
• Provide effective support programmes for children in vul-nerable families, such as those affected by HIV and AIDS.
• Provide assistance to extended families that care for children of parents who have died of AIDS and for child-headed households.
• Develop a policy to prevent discrimination against children living with and affected by HIV/AIDS.
Global recommendations at local level As the Ethiopian government had accepted these recommen-dations, SENSE made it a specific goal to help the Ethiopian government address the recommendations, thus linking global human rights standards with local realities to ensure the im-plementation of activities that address the needs of children.
Comparing the recommendations to the national data, which showed very limited coverage of services for children living with or affected by HIV and AIDS, along with the very programmable committee recommendations, helped identify not only the needs and rights to be upheld, but also helped define the design of SENSE.
Ultimately, the recommendations provided by the global UN Committee on the Rights of the Child are benefitting the children and the communities at a highly local level.
Human rights treaty bodies and HIV
The positive experience of programming around human rights recommendations in SENSE provided inspiration for taking a closer look at how all the UN human rights treaty bodies have addressed the issue of HIV-related human rights.
As a result, the Danish Institute for Human Rights conduct-ed a mapping of all HIV-specific recommendations made by the United Nations treaty bodies from 2005-2010. Every sin-gle report to all of the treaty bodies from every country that is a party to the international human rights conventions was identified and subsequently analysed.
The treaty bodies appear to have addressed HIV extensively and the data were revealing. Recommendations on HIV by the treaty bodies of 89 countries were found, while HIV appeared in 127 separate reports. Providing important inspiration for future programming aimed at protecting children, the vast majority of the recommendations, similar to the approach taken by the SENSE project, addressed women or children.
The SENSE project has also helped shed light on popula-tion groups that HIV-related human rights monitoring and standards for protection had not been extended to because, as a closer analysis revealed, the treaty bodies had failed to define how the HIV-related human rights of the most-at-risk populations should be protected. Sex workers, intravenous drug users, men who have sex with men and people in prison or detention were almost never the focus of HIV-specific recommendations, and subsequently their human rights were not being upheld.
Findings taken further into the UN
The findings were published in the report HIV/AIDS and the International Human Rights Treaty Bodies, 2005-2010, which immediately caught the interest of UNAIDS, the Office of the High Commissioner for Human Rights (OHCHR) and other organisations working at the global level.
UNAIDS and OHCHR took the findings further inside the UN system. The HIV/AIDS and treaty body study was refer-enced in a report to the UN Human Rights Council for its session on HIV/AIDS and human rights held at its March 2011 meeting session and the United Nations Human Rights Council passed a resolution (A/HRC/16/L.22) that specifically:
21. Invites the human rights treaty bodies, when considering national reports, to give particular attention to the protection of human rights in the context of HIV/AIDS;
22. Invites all special procedures to contribute further to the analysis of the human rights dimensions of the HIV/AIDS epidemic;
23. Encourages all States to include information on human rights in the context of HIV/AIDS in their national reports to be submitted to the Council in the framework of the univer-sal periodic review mechanism and in their reports submitted to treaty bodies.
SENSE played a substantial role
The report on HIV and AIDS and the treaty bodies, devel-oped based on experiences from the implementation of SENSE, undoubtedly played a substantial role in securing these decisions from the UN Human Rights Council calling for better monitoring and protection of HIV-related human rights in every member state of the United Nations.
In this way, the children, the schools and the local commu-nities in Bahir Dar and Debre Markos are linked to important decisions at the global level and may subsequently have an im-pact on the rest of the world.
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Throughout the lifetime of SENSE, lessons learned and key challenges have been addressed via adjustments to the project. They have been found at all levels and at times they were interrelated. Some challenges have been addressed as
“lessons learned” for the guidance of future projects.
Local level
• Socio-cultural patterns and community mobilisation:
There are a number of social and cultural patterns that determine how people live and behave in their surroundings and context. Thus, mobilising the commu-nity on HIV prevention, care and support requires a good understanding of the living patterns and culture of
a specific community. In this process, it is important to identify the most pertinent, well-rooted institutions and have a high level of acceptance in the community.
Hence, bringing behavioural change in relation to HIV-related stigma and discrimination requires, as a minimum, a proper understanding of the socio- cultural patterns and ways and means of involving these institutions and entities in project implementation.
• Children as change agents and role models: If provided with knowledge, comprehensive training, social activities, equipment, materials, facilities and support, children can become strong change agents in terms of mitigating
Lessons learned and some challenges
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Photo: Lotte Ladegaard
HIV-related stigma and discrimination. They can act as role models for other pupils and family members, all of whom are likely to change their attitudes and behaviour.
• Comprehensive approach needed for improving the well-being of vulnerable children: By combining multi-pronged strategies for the broader school community and ensuring an all-inclusive comprehensive package for the most vulnerable children, including food, school ma-terials and uniforms, in addition to medical, psychosocial and tutorial support, it is possible to make a significant difference in the status and well-being of children living with or affected by HIV.
• Broad involvement needed to secure sustainable in-come generating activities: There is often a common understanding in the communities that school-based income generating activities should merely be run by the school community. However, the success of these activi-ties also requires the engagement of various other stake-holders, like micro and small-scale enterprises, coopera-tives, credit and saving institutes, the Agriculture Office, and the Vocational Skills Training Institute. A lesson learned is that there is a need for a local coordination committee to follow up on the feasibility of the income generating activities, including the provision of advisory services to those who manage these activities.
• Improving conditions for out-of-school children: The project initially aimed at also addressing out-of-school children. Ultimately, SENSE did not directly address out-of-school street children, children engaged in sex work or other hazardous work, or child migrants. A lesson learned is that a school-based project like SENSE does not possess the tools and methods to reach these terri-bly hard to reach children who require a programme ap-proach that takes their specific problems into considera-tion. However, some out-of-school children have been reached indirectly through the project’s communication and awareness raising activities.
• Special care and support may create dependency:
Only 20 children in each target school were provided with the comprehensive package of care and support during the project, even though at least ten times as many children are in need of help, according to teachers and local government officials. Many teachers and local
government officials regretted that the project did not provide support to all of the children. At the same time, there is a danger that those who did receive the care and support package would become dependent on the support and would worry that it could stop if the income generating activities were not successful. An example of this dependency was the request from several recipients who wanted food distributed more frequently as they went hungry in between the quarterly food dispersals.
Although there is no doubt about the positive outcome of the care and support package, alternative support mechanisms should be carefully considered.
• Some of the most vulnerable children could have bene-fitted more: As SENSE was based on volunteerism, some of the most vulnerable, and especially younger children living with or affected by HIV, did not become as involved in the Mini Media Club and other awareness raising activities as children from comparatively more well-functioning families. Volunteering requires personal strength and surplus energy, which many children living with or affected by HIV and AIDS are not in possession of. However, volunteerism and participation are empow-ering in themselves and would have added personal strength to the vulnerable children’s lives. An extra effort to involve these children more could have made the pro-ject even more successful.
• Success with a complaint mechanism in schools: By introducing a simple and easily accessible complaint mechanism, pupils can make good use of it and submit complaints, particularly if it is clear to them that school teachers and staff take both the mechanism and resulting complaints – and thus their pupils – seriously. The sug-gestion and complaint boxes in the schools were a big success and to some extent even more so than expected because the children complained about all sorts of things, not just stigma and discrimination.
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• Emphasis on networking ensures that a project remains integrated in society: SENSE aimed to develop well-functioning networking mechanisms in the schools, between schools, between civil society organisations, communities and local level government institutions as well as at national level between Save the Children, other relevant civil society organisations, the Ethiopian Human Rights Commission and the UN. Putting due emphasis on networking from the design phase of the project and integrating systems for networking endows a project with a much better chance of sustained integra-tion in Ethiopian society after the project is phased out.
• Continued stigma in unreached communities remains a challenge: Not all schools in the intervention areas participated in the project and not everyone in the communities has received the knowledge spread by the involved schools and communities. This may be one of the main reasons for why stigma and discrimination per-sist in some areas of Debre Markos and Bahir Dar.
Basically, large communities still remain unexposed to the awareness spread by SENSE and when the children living with or affected by HIV enter these uninitiated communities, they are still at risk of humiliation.
• Eradicating stigma takes time: It takes time to eradicate stigma and discrimination based on fear and lack of knowl-edge. In this context three years is a very short period.
Many people in Debre Markos and Bahir Dar have started greeting their neighbours, who are living with HIV, and children have integrated their HIV-affected classmates into their games; however, some people probably still do not want to share a meal with someone associated with HIV.
• Manifestations of stigma and discrimination change over time: Stigma and discrimination also change in appear-ance over time. This means that even in communities where people claim that stigma has been eradicated, new and more subtle kinds of discrimination may still take place or develop.
Regional level
• Regional involvement is a challenge: SENSE generally did not manage to create much regional level involvement apart from adding to existing reporting relationships. This is most likely due to the decentralised governance struc-tures in Ethiopia, whereby it is more natural to work
closely with local level authorities that have a more direct influence on local level processes. The lack of regional involvement also shows working at the local level where activities are implemented is perhaps less complicated.
National level
• Working with partners that require government approval takes time: Having partners like the Ethiopian Human Rights Commission entails government approval of key documents and processes that can sometimes take longer than working directly with local level entities.
The approval of the final policy and legal framework analysis report by the Ethiopian Human Rights Commission, identification of policy issues and subse-quent advocacy have thus been delayed.
• Recognising stigma and discrimination as human rights violations: Instigating changes to government structures is challenging and three years is indeed an extremely brief amount of time in a bureaucracy that governs around 80 million people. For the same reason, SENSE had to discard its goal of changing the official HIV report-ing format. However, SENSE definitely has affected policy level in many ways, not least by opening public officials’
eyes to the fact that HIV-related stigma and discrimina-tion is a human rights violadiscrimina-tion.
• Enhancing sustainability by working at all levels: By working with and strengthening systems at all levels, including in schools, the community, government offices and the Ethiopian Human Rights Commission, the sus-tainability of the project is significantly enhanced, as there will be systems and mechanisms in place within the vari-ous entities to handle, monitor and possibly report on stigma and discrimination after the project has ended.
Global level
• Great advantages to programming based on UN recommendations: The recommendations by treaty bodies such as the Committee on the Rights of the Child can provide important guidance on interventions and principles to be integrated into the programming and implementation processes. At the same time, this approach enables a project that supports a state in meeting the human rights obligations it has agreed to at the international level.
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