Goal 3.8 of the UN Sustainable Development Goals, the central global development agenda for 2015-30, adopted by the UN General Assembly in 2015, is a commitment by States to:
- achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
Universal Health Coverage, if truly universal and comprehensive, could assist in ending the AIDS epidemic. It has the potential to ensure comprehensive integrated approaches to heath service delivery and improving the capacity to address multiple health needs of people living with HIV or vulnerable to HIV.
Yet, whether, certain groups will be excluded from coverage, or certain forms of treatment or prevention services are left out of the UHC package of services, or broader social and structural barriers continue to operate, or are even created, that breach the human rights of, make a universal system inaccessible to, certain groups, will all depend on exactly how such a universal health coverage system is developed and implemented.
In particular, key populations*, people living with HIV, adolescent girls and young women have expressed concerns as to the potential for universal health coverage to exclude their communities or operate in such a way as to violate their human rights.
The Human Rights Centre Clinic will undertake research on a sub-set of these communities to determine how governments are either excluding or including them in their current UHC frameworks and what would need to be done to ensure the UHC framework is human rights compliant for these communities. The communities UNAIDS is interested in for the purposes of this research are:
- young women and young key populations who are survivors of violence
- young people who use drugs
- young transgender persons
‘Young’ is defined as being aged 15-24. These will be referred to throughout the project as the ‘communities of focus’. The communities of focus have been chosen due to a concern that these particular groups are not receiving the same level of attention as regards UHC as others.
In terms of the health and human rights concerns to be reviewed, while these will be determined in part through the research project, what we do know is that the following issues have been identified by communities of focus: what is included in the essential services package, how individuals access UHC (both physically and financially), integration of referrals to services for survivors of violence, the availability of late-night drop in centres or the need for an insurance card, fees, broader human rights determinants such as criminalisation, age discrimination, parental consent laws and practices, stigma and discrimination, lack of comprehensive sexuality education that covers gender identity. These all impact the accessibility and acceptability of health services in relation to the communities of focus.
At the same time, it should be possible to create an inclusive and completely universal health coverage framework. A human rights-based approach to UHC would include, among other things, participatory decision making, proactive outreach and tailored strategies for those most left behind, community education on rights and entitlements, free health care for those that need it, education and information to all, and the removal of discriminatory practices, policies and laws as well as the provision of a framework of accountability and remedy. However, more information and good practice examples are needed on what countries can and are doing to ensure universality of health coverage.
*UNAIDS considers gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.