Laar Amos, DeBruin Debra
Department of Population, Family, and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Box LG 13, Legon, Accra, Ghana.
Center for Bioethics, University of Minnesota, 410 Church Street S.E MN, Minneapolis, 55455-0346, USA.
BMC Int Health Hum Rights. 2017 Aug 2;17(1):20. doi: 10.1186/s12914-017-0129-z.
In line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations - populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana's response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights.
Ghana's response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana's guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation's HIV epidemic is real: criminalization impedes key populations' access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly. The right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to public health services provision to these populations. Doing so will require political will and sufficient planning toward prioritizing HIV prevention, care and treatment programming for key populations.
加纳现行的刑法典已有半个世纪历史，目前将一些关键人群的行为定为犯罪并予以惩处，这些人群被认为感染或传播人类免疫缺陷病毒（HIV）的风险较高。男男性行为者（MSM）和性工作者（SWs）就属于这一类别。本文分析了限制权利的法律的制定和实施如何不仅限制了权利，还在关键人群和普通人群中加剧了HIV感染风险和脆弱性。本文源自一个项目，该项目评估了指导加纳应对HIV疫情的关键文件的伦理敏感性。评估以公共卫生伦理的主要框架以及国际人权法案的相关条款为指导。
加纳应对HIV疫情的措施未能充分解决关键人群的权利和需求。尽管国家应对措施在公共卫生方面取得了一些成功，但在解决权利问题方面的切实努力仍处于起步阶段。加纳应对HIV的指导文件中没有倡导对这些关键人群进行非刑事化、非刑罚化或减少伤害的方法。限制权利的法规对该国HIV疫情的影响是真实存在的：刑事定罪阻碍了关键人群获得HIV预防和治疗服务。鉴于他们是桥梁人群，直接影响加纳关键人群的任何因素都会间接影响普通人群。毫无保留地享有能达到的最高健康标准的权利通常被视为一项基本人权。不幸的是，这项权利目前加纳的性工作者和男男性行为者无法享有。本文支持将非刑事化作为促进这项权利的一种手段。面对对非刑事化的反对，本文提出了具体的减少伤害策略，作为促进健康和提升关键人群被削弱的权利的方法。因此，作者呼吁加纳消除为这些人群提供公共卫生服务的障碍。这样做将需要政治意愿和充分的规划，以便优先为关键人群开展HIV预防、护理和治疗项目。
