Table 1.
Study and intervention characteristics, HRBA elements incorporated, and study findings from 23 studies
| 1st Author, publication date, country, study design | Study Population | Sample | Human Rights Program Category; Intervention Duration | Socio-ecological Levels; Right to Health Attributes | HRBA Principles; Implicit /ExplicitA | HIV-related Outcomes | Results (Positive, Negative, No effect; Details) |
|---|---|---|---|---|---|---|---|
| Evaluation Studies | |||||||
| Argento, 2011 [63], India, Qualitative post-test only | Sex workers, LGBTQB, Police, General population | 34 SWs; 12 key informantsC | Sensitization of law makers and law enforcement agents; Not specified | Community; Availability, Accessibility, Acceptability |
Accountability, Linkages/Implicit | Violence against women (VAW),, human rights violations | Positive; Strategies to combat violence against women among sex workers developed; violence from the police reduced; remaining challenges: risk of violence from regular partners who do not want to use condoms. |
| Beletsky, 2011 [59], USA, Observational repeated cross-sections | Police | 94 | Legal literacy, Sensitization of law makers and law enforcement agents; One, 30-min session | Individual; Accessibility, Acceptability, Quality |
Empowerment/ Implicit | Knowledge of harm reduction programs, health risks from needle stick injuries | Positive; Trainee’s knowledge increased; no significant increases in attitudes. |
| Beletsky, 2013 [65], Kyrgyzstan, Observational cross-section | Police | 313 | Legal literacy, Sensitization of law makers and law enforcement agents; 46-h “Special Course” on harm reduction for senior officers; ad-hoc shorter modules delivered to new police trainees | Individual; Accessibility, Acceptability, Quality |
Empowerment, Non-discrimination, Participation, Accountability, Linkages/ Implicity | Legal and policy knowledge of PWID and SW, opinions about referral to harm reduction, intent to confiscate syringes | Positive; Trainees more likely to: support referral to harm reduction; indicate no intent to confiscate syringes; understand sex worker detention policies and procedures after occupational exposure. Knowledge of policy on routine ID checks for sex workers significantly lower for trainees. |
| Beletsky, 2012 [66], Kyrgyzstan, Observational cross-section | Police | 319 | Legal literacy, Sensitization of law makers and law enforcement agents; Instruction 417 promulgated in 2009 | Policy; Accessibility, Acceptability, Quality | Non-discrimination, Participation, Accountability/ Implicit | Knowledge and attitudes towards: harm reduction, due process for detention of SWs, occupational exposure, past and intended future practices with vulnerable groups | Positive; Knowledge of Instruction 417D assoc. with better knowledge and attitudes towards harm reduction and due process for detention of sex workers. Younger, junior officers and those in rural areas may not be well informed about the policy. |
| Du 2011 [42], USA, Observational cross-section | General population (aged 18–64) | 281,826 | Monitoring and reforming laws, policies and regulations; CDC “opt-out” HIV testing strategy recommended in 2006 | Policy; Availablity, Accesibility | Not applicable | Ever tested for HIV | Positive; Compared with residents of “high morbidity-opt out” states, those living in “high morbidity-opt in” and “low morbidity” states had lower odds of being tested for HIV. |
| Dworkin, 2014 [55], Kenya, Qualitative post-test only | Women | 50 | HIV-related legal services, legal literacy; GROOTs-Kenya developed the “Community Land and Property Watch Dog model” in 2005 | Community; Availability, Accessibility, Acceptability | Non-discrimination, Accountability/ Implicity | Women’s access to and ownership of land | Positive; Local mediation has greater success than formal court system in securing women access to their land; community-level solutions important for responding to property rights violations. |
| Ellen, 2015 [60], USA, Observational repeated cross-sections | At-risk Youth | 2559 (aged 12–24) | Monitoring and reforming laws, policies and regulations, Sensitization of law makers and law enforcement agents; the Connect to Protect project ran 2002–2012, data collected 2007–2010 | Organizational, policy; Availabiltiy, Accessibility | Empowerment, Accountability/ Implicit | No. of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing | No effect; Exposure to structural changes was not statistically significantly associated with any of the outcome measures. |
| Fang, 2004 [64], Taiwan, Observational repeated cross-sections | General population | Not applicableE | Monitoring and reforming laws, policies and regulations; Free HAART access implemented in 1997 | Policy; Availability, Accessibility, Quality | Non-discrimination/ Implicit | HIV transmission rate, incidence of syphilis and gonorrhea | Positive; After free access to HAART was established, the estimated HIV transmission rate decreased by 53%. There was no statistically significant change in the incidence of syphilis. |
| Grangeiro, 2011 [67], Brazil, Observational repeated cross-sectionsF | General Population | 812 municipalities | Monitoring and reforming laws, policies and regulations; MOH strategies for municipalisation of the response to AIDS first implemented 1994–2002 with the second phase launching in 2003 | Policy; Availability, Accessibility, Acceptability, Quality | Empowerment, Non-discrimination/ Implicit | HIV testing, HIV incidence by key populations, presence of AIDS services, prevention coverage, mortality | Positive; Municipalities included from 1994 to 1998 showed higher chances of providing HIV diagnostic testing, of having AIDS services, and reducing cases involving heterosexual, homosexual/bisexual, and IDU transmission as compared to those “included in 2003” and “not included”. Municipalities with a more structured response were associated with better results. |
| Gruskin, 2013 [25], Kenya, Qualitative post-test only/secondary analysis of program data | PLHIVG; Survivors of gender-based violence | IDIs (no. NS) and FGDs (no. NS), with legal and health staff, patients, and clients. Review of legal aid records (450/LACE), and client cases (73/COVAW)and 18/CHAK). | HIV-related legal services, Legal literacy, Training of health care providers on human rights and medical ethics; three legal intervention programmes, earliest indicated start of one of these programmes was 2007 | Community; Availability, Accessibility, Acceptability, Quality |
Participation, Accountability/ Explicit | Access to and utilizations of health services among PLHIV and survivors of violence | Positive; Increases in client’s practical knowledge and awareness about how to access legal aid and claim their rights, to communicate with healthcare providers and to improve their access to healthcare and justice. In turn, providers became more adept at identifying human rights violations and other legal difficulties, which enabled them to better support clients. |
| Homaifar, 2005 [56], Senegal, Observational cross-section | Sex workers | 60 | Monitoring and reforming laws, policies and regulations; Senegal legalized the practice and registration of all sex trade workers in 1969 | Individual, policy; Availability, Accessibility | Non-discrimination/ Implicit | Knowledge of sexual health, circumstances of daily life, sexual history, patient knowledge of contraceptives and STIs, condom use, risk of contracting HIV | Positive; Increased knowledge of health, adamant in contraceptive use, desire to put health before money, demand use of condoms, due to the registration requirements and increased knowledge lower chances of putting themselves in HIV risky situations |
| Jardine, 2012 [49], Vietnam, Qualitative post-test only/Observational cross-section/secondary analysis of program data | Police | 36 mixed KIIs 27 police surveyed |
Monitoring and reforming laws, policies and regulations, Sensitization of law makers and law enforcement agents; in 2006 Vietnam instituted the HIV/AIDS Law which included comprehensive harm reduction measures | Organizational; Availability |
Non-discrimination, Accountability/ Implicit | Police knowledge and attitudes about harm reduction; police actions towards PWID in the context of harm reduction | No effect; Police still target PWID and engage in contrary activities; lack knowledge of harm reduction (in the context of police training, laws and policies); don’t support NSP; lack national training for ward police in harm reduction |
| Jones, 2005 [57], South Africa, Qualitative post-test only | PLHIV, non-PLHIV (i.e. members of social clubs, youth groups, local govt. councillors, health care workers, NGO volunteers) | FGDs (no. NS), KIIs (no NS), clinic observations (no. NS) | Monitoring and reforming laws, policies and regulations; NS | Policy; Availability, Acceptability |
Non-discrimination/ Explicit | Knowledge and understanding of human rights as they relate to PLHIV, ability to access rights if needed | No effect; Participants are still subject to HR violations, such a breach of confidentiality, forced HIV testing, denial of or poor quality health care services, etc. Fear of stigma keeps many people from disclosing their status. Little to no impact of the national policies and laws in place to protect the rights of PLHIV. |
| Martinez, 2007 [61], USA, Observational repeated cross-sections | People who inject drugs | 1578 | Monitoring and reforming laws, policies and regulations; Legislation passed in 2000 allowed SEPs in CA | Policy; Availability, Accessibility |
Non-discrimination, Empowerment, Participation/ Implicit | HIV testing, impact on PWIDs (overall arrest, arrest or citation for drug paraphernalia, etc) | Negative; Legal SEPs increased odds of clients being arrested or cited for drug paraphernalia |
| Rich, 2007 [62], USA, Observational repeated cross-sectionsF | People who inject drugs | 473 | Monitoring and reforming laws, policies and regulations; Rhode Island passed legislation in 2000 completely legalizing the sale of non-prescription syringes by pharmacists | Policy; Availability |
Accountability, Non-discrimination/ Implicit | Syringe use of PWID (frequency, whether or not it was used, etc) | Positive; Those with legal access were more likely to utilize pharmacies as a source of sterile injection equipment. |
| Sarnquist, 2007 [43], USA, Observational repeated cross-sections | Pregnant Women | 496 | Monitoring and reforming laws, policies and regulations; 1995 California law mandating an HIV test and treatment offer to every pregnant women | Policy; Availability, Accessibility |
Not applicable | Offers of HIV testing and treatment | Positive; No. of offers of HIV testing and treatment significantly improved |
| van Rensburg, 2007 [58], South Africa, Observational cross-section | PLHIV, Survivors of violence | 304 | Legal literacy; Lifeline Opened in 1971 | Community; Availability, Accessibility |
Non-discrimination, Participation/ Implicit | GBV and HIV knowledge awareness, attitudes, GBV and HIV risk factors, behaviour changes, disclosure, availability and accessibility of support and care, relationships and condom use | Positive; GBV and HIV awareness/knowledge levels were high, perceived GBV is high as is perceived risk; positive changes in behaviour were noted to prevent HIV; high incidence of women being subjected to GBV; difference noted between age, older respondents less likely to know legal rights. |
| Policy Reviews | |||||||
| Ahmad, 2013 [51], South Africa, Policy review | PLHIV, Pharmaceutical companies, General Population | N/A | HIV-related legal services, Monitoring and reforming laws, policies and regulations, Legal literacy; TAC was established1998 | Individual, organizational, community; Availability, Accessibility |
Accountability, Empowerment, Non-discrimination, Participation/ Explicit | Access to ARVs | Positive; Efforts of the Treatment Action Campaign resulted in access to nevirapine in public hospitals, reinforcement of the decision that led to access to ARVs in prison, Pfizer committing to supply free-of-charge fluconazol to public healthcare clinics and PMA withdrawing claim against Government, allowing the Government to reduce essential drugs prices. |
| Ainsworth, 2003 [52], Thailand, Policy review | Sex workers (primary), Clients of sex workers, General population (focus on young men) | NS | Monitoring and reforming laws, policies and regulations,,, Sensitization of law makers and law enforcement agents; Thailand’s policy response to AIDS prior to 2000 | Policy; Availability, Accessibility |
Empowerment, Non-discrimination, Accountability, Participation/ Implicit | Condom use, risk sexual behaviour, reported STD cases, HIV prevalence | Positive; Change from punitive legal and policy environment to rights-based. Condom use in brothels rose significantly; the No. of reported STD cases declined while the No. of STD clinics grew and drug stores reported decrease in sale of antibiotics for STD and increase in sale of condoms; HIV prevalence among 21-year old army conscripts decreased. |
| Gruskin, 2009 [53], 133 Countries, Policy review | Vulnerable groupsH | 133 United Nations General Assembly Special Session Country Progress Reports | HIV-related legal services, Monitoring and reforming laws, policies and regulations; in 2001 the United Nations General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS (DoC) emphasized the centrality of human rights to an effective HIV response. | Policy; Availability, Accessibility |
Participation, Accountability/ Explicit | Legal environment barriers to access to HIV services | Positive; Increase in the No. of countries reporting on human rights issues between 2006 and 2008. 94% of reporting countries note that their national HIV policies explicitly mention the promotion and protection of human rights, yet only 22% of these countries report performance indicators to assess human rights compliance. |
| Gurnani, 2011 [54], India, Program monitoring data | Sex workers, Police, Lawyers, Media | Used data from 18 Districts where over 900 peer educators are employed and an average of 50,000 FSWs are contacted per month | HIV-related legal services, Monitoring and reforming laws, policies and regulations, Legal literacy, Sensitization of law makers and law enforcement agents; Karnataka Health Promotion Trust was established in 2003 with the aim of rapidly scaling up HIV prevention efforts | Individual, community, organizational; Availability, Accessibility, Acceptability, Quality |
Non-discrimination, Participation/ Explicit | Reduction in HIV risk, stigma and discrimination, violence | Positive; FSW membership in community-based organisations has notably increased and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4600 reported incidents of violence and harassment reported between 2007 and 2009, and monitoring of news stories has shown a 50% increase in the No. of positive media reports on HIV and FSWs. |
| Jeffreys, 2011 [50], China, Policy review | Sex workers | NA | Monitoring and reforming laws, policies and regulations, Sensitization of law makers and law enforcement agents; China’s Ministry of Health (MOH) and the WHO launched a pilot 100 Per Cent Condom Use Program in 2001 | Policy; Availability, Accessibility |
Empowerment, Accountability/ Implicit | Rates of Chlamydia infection, HIV prevalence, local condom sales in the pilot sites | Positive; PRC MoH estimates that health interventions had only managed to reach 40% of SWs and MSM by the end of 2009. It further estimates that only 41% of FSWs use condoms consistently (increase from baseline of 14.7% in 2001) and that fewer than 30% of men who have sex with men use condoms |
| Lazariu, 2015 [44], USA, Program monitoring data | General population (receiving health services) | 166 | Monitoring and reforming laws, policies and regulations; in 2010, New York State (NYS) Public Health Law mandates the offer of HIV testing to all persons aged 13–64 years receiving hospital or primary care services | Policy; Availability |
Not applicable | HIV testing | Positive; HIV testing volume increased by 13% following enactment. |
aExplicit/Implicit: denotes whether a human rights-based approach was explicitly stated by the researcher or implicit in described approach; B LGBTQ = lesbian, gay, bisexual, transgender, and questioning; C12 interviews conducted with transgender sex workers, police officers, brokers, boyfriends and lodge owners; number of interviews per group not specified. 2 focus group discussions were also conducted, one each with male and female sex workers; number of participants not specified; D Instruction 417 was disseminated by the Kyrgyz government prohibiting police interference with “harm reduction” programs, re-enforcing citizen rights, addressing police occupational safety concerns, and institutionalizing police-public health collaboration; E The rate of HIV transmission and number of PLHIV were estimated based on national surveillance data; F Study included a comparison population drawn from cross-sectional data collected in areas where the policy/intervention was not being implemented; G PLHIV = people living with HIV; H Vulnerable groups referenced: women, young people, MSM, sex workers, PWID, prisoners and migrants