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An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine

Recently, a new issue of the Journal of the International AIDS Society has been published. One of the articles using the implementation learning evaluation approach examined the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. 

Since 2017, as a part of the Breaking Down Barriers initiative of the Global Fund, Ukrainian organizations have implemented HIV-related human rights programmes which seek to increase access to prevention and treatment services for key and vulnerable populations.

The Breaking Down Barriers initiative provides technical and financial support for the implementation of rights-based HIV, tuberculosis and malaria interventions in 24 countries. These include programmes aimed at addressing stigma and discrimination and ensuring people-centred healthcare and law enforcement practices, as well as programmes aimed at mobilizing communities and increasing legal literacy and access to justice.

The evaluation of the Breaking Down Barriers initiative in Ukraine used an implementation learning approach drawing on a document review of programme monitoring documents alongside key informant interviews with implementers, government officials and human rights experts. 

Based on the Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine.

These included programmes seeking to:

  • eliminate stigma and discrimination;
  • ensure the non-discriminatory provision of medical care;
  • promote rights-based law enforcement practices;
  • expand legal literacy (“know your rights”);
  • increase access to justice; i
  • mprove laws, regulations and policies;
  • reduce gender discrimination, harmful gender norms and violence against women and girls;
  • and mobilize communities for advocacy.

Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia’s invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.

The results of our evaluation found that Ukrainian organizations were successfully scaling up and adapting programmes addressing stigma and discrimination in communities and health settings; working to address harmful laws and police practices and increase legal literacy and access to justice; reducing gender discrimination and violence; and mobilizing communities affected. Ukrainian organizations responded resiliently to challenges, finding innovative solutions to reach those displaced and to ensure the continuity of HIV programmes.

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REAct SYSTEM IMPLEMENTATION IN UKRAINE: January – June 2023

UNDER THE CONDITIONS OF WAR AND ACTIVE HOSTILITIES IN SOME REGIONS OF UKRAINE, THE IMPLEMENTATION OF THE REACT SYSTEM CONTINUES, REACTOR’S REGISTER CASES OF RIGHTS VIOLATIONS OF KEY COMMUNITIES, INTERACT WITH CLIENTS AND PROVIDE THE NECESSARY ASSISTANCE AND SUPPORT.

In the first semester of 2023, thanks to the expansion of regional teams and the increase in the number of NGOs and REActors by 6 organizations and 10 people, respectively, 500 more cases were registered compared to the second semester of 2022.

Compared to the second semester of 2022, the share of cases when the client contacted the REActor in person rather than by phone increased. Currently, it is the personal appeal of clients to REActors that prevails.

Read more in the report below.

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REAct Project In Ukraine: Registered Human Rights Violations of HIV/TB Key Populations and Response to Such Violations

REAct (Rights – Evidence – Action) – it is a tool for monitoring and responding to human rights violations at the community level. In Ukraine the system has been implemented since 2019 by ICF “Alliance for Public Health” with the Global Fund support.

To document and respond to violations of the rights of key communities, vulnerable to HIV/TB 63 non-governmental organizations (NGOs) and 85 REActors are engaged in 18 regions of Ukraine in 2022.

During 2022, 2,900 cases of rights violations of representatives of the key communities were registered in Ukraine. 2,799 clients reported such cases, some of them appealed for help more than once.

Read more information about the implementation of the Project, registered appeals, guarantees, and the role of the state in the field of human rights protection in the new analytical report for 2022.

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Response stories

For family reasons: or what to do if denied employment due to the presence of children?

Almost 2,000 violations were recorded by the REAct system (Rights – Evidence – Actions) in 5 countries of Eastern Europe and Central Asia in 2020. Out of them, 235 happened in Moldova. Twelve partner organizations work with key groups in the country, but, unfortunately, a third of cases remain without a proper response. Fear of interaction with law enforcement agencies, mistrust of the law enforcement system – the victims do not dare to defend their rights and refuse to help themselves. However, there are those for whom it is important to be heard in this struggle. And REActors are ready to help them completely.

“You all say so” or refused can not be accepted

In Bendery (Moldova), due to financial difficulties in the family, a mother of many children, a representative of key groups (sex workers and communities of people who use drugs), beneficiary of the NGO “Milocerdie” decided to find a job as an event organizer. In one of the municipal institutions of the city, a vacancy was just opened and fully corresponded to her skills and work experience.The client’s older child having special needs and disabilities has been living in a specialized boarding school since childhood, while the younger children are attending a kindergarten. A woman takes care of children, her mother helps her when she needs to work she spends time with the children.

To get a job, the woman called a potential employer and expressed interest in the vacancy. She told about her experience, education and noted that she also has characteristics from previous jobs. As a result of the conversation, the head of the organization expressed interest in her as a specialist and invited her for an interview.

The REAct client came for an interview and was interviewed by an HR department employee. As a result, he noted that they just need a specialist like her with such education, experience, and characteristics from previous jobs. And at the end of the interview, having already let the woman understand that she was suitable for this vacancy, he, by the way, asked about her marital status, the presence of children, etc. She spoke frankly about the children, to which she received a comment with the following message: “We do not need another mom with endless sick leave, time off, lateness, etc.” and that her candidacy does not suit. And the argument that her mother would help with children in case of need was answered with “You all say that.”.

What does the law “think” about this?

This incident falls under Article 141 of the PMR Criminal Code.
Article 141. Unjustified refusal to hire or unjustified dismissal of a pregnant woman or a woman with children under the age of three.

Unjustified refusal to hire or unjustified dismissal of a woman on the grounds of her pregnancy, as well as unjustified refusal to hire or unjustified dismissal from work of a woman with children under the age of 3 years, for these reasons, shall be punished with a fine in the amount of from 700 to 1700 minimum wages or mandatory works for a period from 120 to 180 hours.

Working mother of many children = reality?

As a result of the incident, the client asked for help from the NGO “Melocerdie” and was referred to REActor, who documented the case. The organization’s lawyer analyzed the situation. Initially, the client was asked to speak directly with the head of this organization, bypassing an employee of the HR department. He willingly made contact, trying to find out from the client the reason why she was refused and as a result of the meeting, the client was employed without any obstacles. A penalty was imposed on an employee who violated the law in relation to a client. In addition, a meeting was held with the head of the employing organization and the organization’s lawyer, during which the possible responsibility for such violations was explained.

We destroy stereotypes and move on!

The client refused to write a statement. She successfully completed the probationary period of 3 months – she is fully employed, her management is characterized as a responsible, executive, and qualified employee. And an employee of the organization, who violated the rights of a mother with many children, apologized for the prejudice and the use of stereotypes, recognizing the professionalism and responsible attitude of the new colleague to work.

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APH and ECOM Initiate Strategic Partnership to Improve Protection of KPs Rights via REAct Online Platform

Alliance for Public Health (APH) initiates strategic partnership with the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM) to improve advocacy and protection of the rights of key populations and people living with HIV in Eastern Europe and Central Asia (EECA).

The basis for expanding cooperation is the REAct tool. It is an online platform for monitoring and responding to violations of the rights of key populations and people living with HIV. Thus, statistical data and evidence base of offenses against men who have sex with men (MSM) and trans * people collected through the online platform REAct in seven EECA countries will be used for the development of alternative and shadow reports to UN committees and recommendations to improve the legal environment, as well as during planning advocacy activities in the EECA region.

It is important to note that, in addition to responding to violations, an important part of REAct’s work is the analysis of the collected information and joint efforts with partners for legislative changes and advocacy at the regional, country, and local level.

“Only joint efforts, synergy and cooperation between civil society organizations, regional networks, and stakeholders in countries can make an impact to the legal situation in each individual country and in the region as a whole, reduce the level of stigma and discrimination, and improve the quality of life of people,” says Victoria Kalyniuk, Regional Coordinator of REAct in the EECA region, Alliance for Public Health.

To date, more than 4,000 complaints about violation of rights, discrimination and legal barriers in accessing HIV prevention and treatment services are documented in REAct system. In 2020, of the total number of requests, from 2% to 17% (depending on the country) were reported by MSM and trans * people, but APH is confident that the real figure is much higher, given the particular precautions of representatives of these key populations.

“For us in the future, it remains the priority to provide maximum support and respect 100% confidentiality for people who ask for help. And the REAct online system copes with this task perfectly, having all the necessary technical characteristics for this, – said Victoria Kalyniuk. – We hope that thanks to cooperation with ECOM, we will be able to adjust the online system to the needs of beneficiaries and REActors, as well as expand cooperation with LGBT organizations in the countries. It is very important for us to develop more trusting interaction with representatives of this rather closed key population in the region, primarily in order to increase the scale of legal assistance provision to those in need of it. We will be able to achieve this by sharing the experience of APH and ECOM, REActors’ training, developing their professional and programmatic knowledge of the peculiarities and effective approaches to work.”

One of ECOM’s goals is to foster an enabling legal environment for HIV services for MSM and trans * communities by reducing stigma and discrimination, promoting and protecting human rights, and removing legal barriers and obstacles.

“An advocacy response to violations of the right to health and related other human rights is still quite ineffective in the EECA region for both the LGBT community and people living with HIV. To this end, ECOM collects information on human rights violations among LGBT people in EECA, which is included in analytical reports for the UN international legal mechanisms, – says Yuri Yoursky, ECOM Human Rights and Legal Issues Officer.  Over the past few years of ECOM and its regional partners’ active work, there are already the first results of successful international health advocacy for LGBT people at the UN level in Armenia, Belarus, North Macedonia, Tajikistan, and Uzbekistan, as well as in a number of other countries of the EECA region. And this only reinforces the ECOM’s assurance that international advocacy tools can be effective as well as easy and convenient to use for all male and female activists. Thus, the REAct tool will help improve the procedure for collecting cases of violation of rights in EECA countries, as well as simplify the process of analyzing data and using them in subsequent advocacy.