Ferguson Laura, Nicholson Alexandra, Henry Ian, Saha Amitrajit, Sellers Tilly, Gruskin Sofia
Program on Global Health and Human Rights, Institute for Global Health, University of Southern California, Los Angeles, California, United States of America.
HIV, Health and Development Team, United Nations Development Program, Istanbul Regional Hub, Istanbul, Turkey.
PLoS One. 2018 Feb 23;13(2):e0192765. doi: 10.1371/journal.pone.0192765. eCollection 2018.
There is growing recognition in the health community that the legal environment-including laws, policies, and related procedures-impacts vulnerability to HIV and access to HIV-related services both positively and negatively. Assessing changes in the legal environment and how these affect HIV-related outcomes, however, is challenging, and understanding of appropriate methodologies nascent.
We conducted an evaluation of a UNDP project designed to strengthen legal environments to support the human rights of key populations, in particular LGBT populations, women and girls, affected by HIV in sub-Saharan Africa. We analyzed data on activities designed to improve legal environments through a systematic document review and 53 qualitative interviews.
The project made substantial strides towards legal change in many places, and examples provide broader lessons for work in this area. Two core pillars appear fundamental: a government-led participatory assessment of the legal environment, and building the capacity of those impacted by and engaged in this work. Systematic attention to human rights is vital: it can help open new spaces for dialogue among diverse stakeholders, foster new collaborations, and ensure local ownership, nuanced understanding of the political landscape, attention to marginalized populations, and accountability for (in)action. Entry points for effecting legal change go beyond "HIV laws" to also include other laws, national policies and strategies.
Conducting legal environment assessments, multi-stakeholder dialogues, action planning and related activities, alongside capacity building, can contribute to changes in knowledge and attitudes directly relevant to reforming laws that are found to be harmful. Shorter-term goals along the causal pathway to legal change (e.g. changes in policy) can constitute interim markers of success, and recognition of these can maintain momentum. Increasing understanding of progress towards changes in the legal environment that can positively affect HIV-related outcomes is important in working to improve the health and lives of people living with HIV.
卫生界越来越认识到，法律环境（包括法律、政策及相关程序）对艾滋病毒易感性以及获得艾滋病毒相关服务既有积极影响，也有消极影响。然而，评估法律环境的变化及其对艾滋病毒相关结果的影响具有挑战性，且对适当方法的理解尚处于初期阶段。
我们对联合国开发计划署的一个项目进行了评估，该项目旨在加强法律环境，以支持撒哈拉以南非洲受艾滋病毒影响的关键人群，特别是 LGBT 群体、妇女和女孩的人权。我们通过系统的文件审查和 53 次定性访谈，分析了旨在改善法律环境的活动数据。
该项目在许多地方朝着法律变革取得了重大进展，这些实例为该领域的工作提供了更广泛的经验教训。两个核心支柱似乎至关重要：政府主导的对法律环境的参与式评估，以及建设受此工作影响并参与此项工作的人员的能力。对人权给予系统关注至关重要：它有助于为不同利益相关者之间开辟新的对话空间，促进新的合作，并确保地方自主权、对政治格局的细致理解、对边缘化人群的关注以及对行动（或不行动）的问责。实现法律变革的切入点不仅包括“艾滋病毒相关法律”，还包括其他法律、国家政策和战略。
开展法律环境评估、多利益相关者对话、行动计划及相关活动，同时进行能力建设，可促成与改革被认定有害的法律直接相关的知识和态度的转变。通往法律变革因果路径上的短期目标（如政策变化）可构成成功的中期标志，认识到这些标志可保持动力。在努力改善艾滋病毒感染者的健康和生活方面，加深对能够积极影响艾滋病毒相关结果的法律环境变化进展的理解非常重要。
