National HIV/AIDS Assessment –Law, Ethics and Human Rights Project Grenada

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Title:
National HIV/AIDS Assessment –Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights
Physical Description:
146p; MS Word format of the report
Language:
English
Creator:
Keith H.W. Friday
Publication Date:

Subjects

Subjects / Keywords:
Caribbean Area, rights, hiv, discrimination, law, grenada, carriacou, Petite Martinique   ( lcsh )

Notes

Funding:
Support for the development of the technical infrastructure and partner training provided by the United States Department of Education TICFIA program.

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Caribbean IRN
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Caribbean IRN
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All rights reserved by the source institution.
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Full Text
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National HIV/AIDS Assessment-Law, Ethics

and IHuman Rights Project

Grenada



Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008


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file size constraints.

National IHIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
EXECUTIVE SUMMARY

The Grenada National AIDS Programme under the direction of the National
AIDS Council (NAC) has been working diligently to educate the public with
the aim of achieving its goal of reducing the number of HIV/AIDS cases in
Grenada. Albeit this, persons living with and affected by HIV/AIDS in
Grenada have continued to be marginalized and excluded due to stigma and
discrimination.

It has been recognized and accepted that legal reform together with
education is imperative in addressing the problem of stigma and
discrimination in any country. In light of this, CARICOM Heads of
Government recommended that Member States undertake a National
Assessment of the legal, ethical and human rights dimension of the laws and
policies on HIV/AIDS. The objectives of the assessment were as follows:

1. Promote the incorporation of human rights and non-discriminatory
practices in policy and legislation, in accordance with international


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National HIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
guidelines, best practices and commitments;

2. Increase meaningful participation of PLWHA and other vulnerable
communities in law and policy reform;

3. Produce a document that sets out the priority areas for law and policy
reform.

A review of the legislature and the incorporation of views from key
stakeholder groups including the NAC, private and public sector officials,
and civil society groups formed the basis of the assessment process.

The assessment revealed that the majority of laws dealing with health issues
were enacted prior to the emergence of HIV/AIDS. Therefore, the laws of
the State do not specifically make provision for such a disease. The legal
review indicated quite clearly that in many cases the methods legislated to
deal with "infectious diseases" are inappropriate to deal with HIV/AIDS.
The fact that HIV/AIDS is not mentioned in some of the other laws could


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National HIV/AIDS Assessment-Law, Ethics

and Human Rights Project

Grenada



Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
actually be beneficial. The review however, showed that many of the laws
of Grenada need to be amended to deal specifically with the problems of
HIV/AIDS related stigma and discrimination.
TABLE OF CONTENTS
Section 1- Introduction 5

Section 2- Objectives of Assessment 7

Section 3- Review of the Laws 8

Section 4- Consultations 22

Section 5- International Guidelines, Best Practices and Commitments 30


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National HIV/AIDS Assessment-Law, Ethics
and Human Rights Project
Grenada

Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights
Keith H.W. Friday
Consultant
January 2008

Section 6- Conclusion 46
Section 7- Recommendations 50
References 52
Appendix 53


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National HIV/AIDS Assessment-Law, Ethics

and Human Rights Project

Grenada



Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
ACKNOWLEDGEMENTS
I would like to acknowledge with thanks the assistance given to my by Mrs.
Carolyn Alexis-Thomas, Director, National AIDS Directorate; Mrs. Dianne
Roberts, Project Coordinator and my wife, Thourla.


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National HIV/AIDS Assessment-Law, Ethics

and IHuman Rights Project

Grenada



Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
I thank all the persons who made comments which contributed to this report.


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and Human Rights Project

Grenada



Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
SECTION 1: INTRODUCTION


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National HIV/AIDS Assessment-Law, Ethics
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Grenada


Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
The continuing increase of HIV/AIDS in the Caribbean has prompted
CARICOM Heads of Government to recommend that Member States
undertake a National Assessment of the legal, ethical and human rights
dimensions of the laws and policies on HIV/AIDS. This would involve the
joint efforts of all sectors of the country including Government and non-
government organizations.

The Grenada National AIDS Programme under the direction of the National
AIDS Council (NAC) has been working diligently to educate the public with
the aim of achieving its goal of reducing the number of HIV/AIDS cases in
Grenada.

Regardless of the many tremendous efforts to educate the public, persons
living with HIV/AIDS in Grenada have continued to be marginalized and
excluded due to stigma and discrimination. It has been recognized and
accepted that legal reform together with education is imperative in
addressing the problem of stigma and discrimination in any country.


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file size constraints.
National HIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
The factors giving rise to CARICOM's decision are the following:

1. A growing concern for the number of human rights abuse and
discriminatory treatment emerging from the advent of the HIV/AIDS
pandemic.

2. Emerging public health situations and concerns that are not adequately
addressed by existing laws and policies.

3. The participation and involvement of many local, regional and
international organizations in the fight against HIV/AIDS has
increased the need for a comprehensible legal and political framework
within which they should be encouraged to function.

4. The creation of common standards to which all practitioners can
subscribe.
The action plan formulated by CARICOM, for the implementation of


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National HIV/AIDS Assessment-Law, Ethics
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Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
Priority Area 1 accords with a rights-based approach to combat the
HIV/AIDS pandemic involving:

1. Emphasis on capacity building.

2. Greater involvement of persons living with HIV/AIDS (PLWHA) in
all decisions affecting them.

3. A multi-sectoral approach to ensure effective consultation and wider
participation.

4. Appropriate priority setting and fast tracking of issues particularly
those specific to the national context.

With a relatively small population, the number of new cases reported is on
the rise and must be of great concern. Prevention, treatment and care are
critical. The unavailability and high cost of medication and employer
provided benefits are but some factors that hamper the fight against


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National HIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
HIV/AIDS.

Until the stigma is broken down and persons infected with and affected by
HIV/AIDS are certain that they would not be discriminated against or if
discriminated against actions can be taken, fighting the HIV/AIDS pandemic
in the Caribbean would not be easy. Additionally, keeping credible data on
Sexually Transmitted Infections, particularly HIV/AIDS would be next to
impossible. Person's fear of being stigmatized greatly affects the quality of
data collected. There is also the lack of cooperation in the area of contact
tracing and partner referrals for counseling and treatment. This hinders the
efficiency of HIV/AIDS surveillance and makes it difficult to determine the
extent of exposure.

The issue of confidentially is also a major concern. People who may require
HIV testing are hesitant, for fear that their identity might be known, thereby
exposing them to prejudice, discrimination, rejection and loss of
employment.


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National HIV/AIDS Assessment-Law, Ethics

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Grenada



Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
What can we do to break or remove the stigma and discrimination?
SECTION 2: OBJECTIVES OF ASSESSMENT

To collect background information on the status and contents of law, policies
and practices impacting on PLWHA, vulnerable groups and other affected
communities in the following areas but not limited to:


o Public Health Legislation


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National HIV/AIDS Assessment-Law, Ethics
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Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
o Criminal Laws and Prison Laws
o Anti-Discrimination Laws
o Privacy and Confidentiality Laws
o Employment, Social Security and Insurance Laws
o Consumer Protection and Housing Laws

To assess the changes needed in priority areas identified above to achieve
therein the incorporation of human rights and non-discrimination practices in
national policy and legislation in keeping with international guidelines, best
practices and commitments, so as to strengthen national capacity to reduce
the spread of HIV/AIDS.


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Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
SECTION 3: REVIEW OF THE LAWS


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Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
THE CONSTITUTION OF GRENADA

The Constitution is the supreme law of Grenada; its provisions are
entrenched and cannot be changed without strict and onerous procedures
being fohowed. Chapter one (1) of the Constitution entitles every person in
Grenada to certain fundamental rights and freedoms and it protects those
rights. Among those rights are the protection of right to life, protection of
right to personal liberty, protection from inhumane treatment, protection
from deprivation of property, protection of freedom of movement and
protection from discrimination. Many of these fundamental rights and
freedoms could be used to deal with violations of the human rights of
PLWHA and persons affected by HIV/AIDS.

Section sixteen (16) of the Constitution gives to every person who alleges
that any of their fundamental rights and freedoms have been, is being or is
likely to be contravened the right to apply to the High Court for redress.


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National HIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
The problem here, however, is that these are rights guaranteed between the
State and its citizens. These rights could therefore only be enforced against
the State. While a citizen could seek redress for a breach of his/her
fundamental rights and freedoms brought about by action of the State he/she
cannot likewise complain about breaches inflicted by his/her fellow citizens.

PUBLIC HEALTH ACT, CAP 263

The Public Health Act, (Cap.263) is the law that regulates the public health
of Grenada. It is a very old law passed on the 2'^'^ November, 1925. It has
had very few amendments since that time. Needless to say it was around
way before the existence of HIV/AIDS and has not been modified to take
this disease into consideration.

This Act sets up a Sanitary Authority with the Chief Medical Officer as its
Chairman. This Act also makes provision for the appointment of Public


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Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
Health Inspectors.

Sections 8-16 deals with the operation of bake houses. Section 8 makes it
unlawful for anyone suffering from an infectious disease to be employed to
work in a bake house. There is a requirement for persons to get a medical
certificate stating that he/she is free from such diseases. The certificate is to
be kept by the owner or manager of the establishment for a period of twelve
months. The medical examination is to be undergone every year in the
months of June and December by anyone cooking in a bake house.

It is to be noted that there is a general definition of "infectious diseases"
appearing in PART II of the Public Health Act where "bake houses" are dealt
with. The definition which appears in section 8 speaks of "infectious
diseases or tuberculosis, syphilis, erysipelas, lupus, yaws, itch or any open or
running noses." What is the effect of this? Presumable although HIV/AIDS
was not known to medical science when these laws were passed in 1925 the
ordinary meaning of the words "infectious diseases" would be applied. The


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National HIV/AIDS Assessment-Law, Ethics
and Human Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
World Health Organisation defines "infectious disease" as a "disease caused
by pathogenic micro-organism, such as bacteria, viruses, parasites or fungi;
[and] can be spread, directly or indirectly, from one person to another."
HIV/AIDS is caused by a vims and therefore the part dealing with bake
houses would incorporate HIV/AIDS as an infectious disease since the
meaning of the term "infectious disease" is not limited by a definition in the
legislation.

We could cross reference (Part II) of this Act with (Part IV). Part IV, the
heading of which is "Notifiable Infectious Disease", has a definition of
"infectious disease." Section 38 reads:

"In this part the expression "infectious disease" means small pox,
chicken pox, alastrim, leprosy, poliomyelitis, yellow fever, cholera,
diphtheria, membranous group, the disease known as scarlatina or
scarlet fever, and fevers known by any of the following names:
typhus, enteric group, typhoid and para-typhoid, relapsing, and


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National HIV/AIDS Assessment-Law, Ethics
and Human Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
includes any other infectious disease to which this part has been
applied by regulation in the manner provided by this Act."

This definition is specific and definitely does not include HIV/ADIS nor any
other infectious disease not specifically mentioned in the definition.
"HIV/AIDS", however, could be included as one of the diseases by simple
regulations made by the Minister.

Part V of the Public Health Act is headed 'Epidemic and Endemic Diseases'.
Section 59 gives to the Sanitary Authority the power to make regulations

"for the treatment of persons effected with any epidemic, endemic or
infectious disease, and for the prevention of such disease and more
particularly -

for the isolation and detention of persons suffering from
such disease..."


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National HIV/AIDS Assessment-Law, Ethics
and Human Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
Martinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
Again in relation to this Part there is no definition of "infectious disease"
and it could be successfully argued that the ordinary dictionary meanings of
those words apply. In such a case HIV/AIDS could be included.

It is instrumental also to look at the Public Health Regulations made under
the Public Health Act. Regulation 6 seeks to extend the definition of
"infectious disease" appearing in Part IV of the Act by adding the following;

"tuberculosis, infantile paralysis, cerobro-spinal meningitis, Spanish
influenza and dysentery, chicken pox, poliomyelitis."

This extended definition is restricted to Part IV of the Act. It follows,
therefore, that whenever the term 'infectious diseases' is used in the
regulations, unless that regulation is tied to Part IV of the Act, the term
would be given its ordinary dictionary meaning and the disease HIV/AIDS
could be captured.


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Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
Of note are regulations 87-100 which deals with "Epidemic, Endemic and
Infectious Diseases". Regulation 87 gives to any medical officer the duty of
visiting without delay, any person who he is aware or suspects of suffering
from an infectious disease and reporting the facts immediately to the Chief
Medical Officer.

The house where an infected person resides could be isolated and the police
notified to enforce strict observance to the isolation.

Regulation 90 gives to the Sanitary Authority the power to remove the
affected person to a hospital. The regulation also makes provision for the
hoisting of a yellow flag by day and a red lamp at night over an isolated
house or hospital and notices posted in the vicinity and with the local press
warning all persons against communicating in any way with persons within
such hospital or house. While we have not had widespread use of these
regulations in relation to HIV/AIDS we must be aware that they exist and


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National IHIV/AIDS Assessment-Law, Ethics
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Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
ensure that their application is not extended. We have had cases of infected
persons being isolated within hospitals especially when HIV/AIDS first
came to light.

Regulation 111 to 118 deals with the interment of persons dying of an
infectious disease. These regulations give directions as to where such bodies
could be buried, the depth of the grave and the type of grave. Importantly,
regulation 116 speaks to prompt burial directing that "no body of a person
who has died from an infectious or contagious disease shall remain unburied
longer than twelve hours."

THE POLICE ACT, CAP. 244

Section 16- of the Police Act (Cap.244.) sets out the qualifications of persons
for appointment to the Police Force. A candidate is required to pass a "medical
examination as to his bodily fitness to be held by the Governor General."
Regulation 5 of the Police Regulation puts it slightly differently. It states that


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National HIV/AIDS Assessment-Law, Ethics
and IHuman Rights Project
Grenada


Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
each candidate shall be certified by a Medical Officer appointed by the Chief
Medical Officer for the purpose, to be in good health, of sound constitution
and fitted both physically and mentally to perform the duties of a police
constable."

In either case it is clear that a candidate must undergo medical examination
before he is admitted to the police force. It is ironic, however, that the Act
and the Regulations makes no provision for the continuing health status of a
police officer.

THE QUARANTINE ACT, CAP. 271

Grenada's Quarantine Act is dated 1^^ December, 1947. This is long before
the known introduction of HIV/AIDS. The Act was geared to deal with the
known infectious diseases of that time. Quite frankly, this law has not been
used recently. This Act however, sets up a Quarantine Authority which has
the power to quarantine persons arriving or leaving Grenada by means of


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National HIV/AIDS Assessment-Law, Ethics
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Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
ship or aircraft.

This Act gives to a Health Officer the authority to isolate any person
suffering or suspected to be suffering from any infectious disease until in the
opinion of the Health Officer that person is free from infection or though not
free from infection he does not pose undue danger to public health.
"Infectious diseases" has been defined as "any epidemic or acute infectious
disease and include open pulmonary tuberculosis but does not include
venereal disease."

Since HIV/AIDS is an infectious disease, it is conceivable that this
legislation could be used to isolate persons infected with HIV/AIDS arriving
or leaving Grenada by ships or aircraft.

THE HOSPITALS ACT, CAP 135

This Act provides for the detention of a patient suffering from a contagious


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Review of the Laws of Grenada, Carriacou and Petite
IVIartinique for implications of discrimination and breach
of human rights

Keith H.W. Friday
Consultant
January 2008
infectious disease by the chief medical officer. Section 17 reads as follows:

"So long as any patient in a hospital continues to suffer from a contagious or
infectious disease, it shall be lawful for the chief medical officer of a
hospital to detain such person therein for such time as may in his judgment
be necessary for the purpose of securing the public against the spread of
such contagious or infectious disease, and for such purpose to take all
reasonable measures to restrain such person within bounds and to prevent
his escape."

Section 18 goes on to give to any medical officer of the hospital, any police
officer or sanitary officer the authority to pursue and apprehend any person
detained under the authority of section 17 who have absconded without
having been discharged.
THE PRISIONS ACT, CAP 254


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Section 26 of the Prisons Act, (Cap. 254) gives to the Commissioner the
authority, if he receives a certificate from a medical officer stating that a
prisoner is suffering from a communicable disease, to direct the removal of
that prisoner to a hospital until the medical officer in charge of the hospital
certifies that the prisoner has ceased to require treatment at that hospital.

Here again the question arises, what is a "communicable disease"? The term
is not defined and it is unclear whether HIV/AIDS fits into this expression.
It may be said that this provision is helpful in that it authorizes the
Commission to seek medical assistance for a prison inmate; it does not go on
to protect the medical records of the prisoner.

Section 51(2) gives to the Minister the power to make regulations governing
"the medical examination, measuring, photographing, taking of fingerprints
and other records of prisoners."

One could argue that the Minister could under this provision make


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regulations protecting the medical records of the prisoners. This however
has not been done.

THE REGISTRATION OF BIRTHS AND DEATHS ACT, CAP. 280

Though as the name implies, this Act deals with the registration of births and
deaths, we are particularly concerned here with the registration of deaths.
Section 39 makes provision for a medical practitioner to furnish a certificate
of death setting out the cause of death of each person that dies.

This is important having regard to the prior discussions regarding the Public
Health Act. If the cause of death of a person is given as HIV/AIDS related,
for example, and that disease is interpreted as an infectious disease under the
Public Health Act, that burial would have to take place within twelve hours.
THE IMMIGRATION ACT, CAP. 145


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The Immigration Act gives to an immigration officer the authority to admit
aliens into Grenada. Section 4 (I) of that Act states that an immigration
officer, shah not give permission to an ahen to enter Grenada if the ahen is a
prohibited ahen. A prohibited ahen includes a "person certified by a medical
practitioner to be suffering from a contagious or infectious disease which
makes his entering into Grenada undesirable." It follows therefore, that a
person suffering from a contagious or infectious disease ought not to be
given permission to enter Grenada.

The Act goes on in section 8, to give to an immigration officer the authority
to grant a temporary permit to sick persons to enter Grenada. Section 8 states
that "an immigration officer may, with the consent of a medical practitioner,
grant a permit for a alien suffering from a contagious or infectious disease to
remain in Grenada temporarily for the purpose of treatment, subject to such
conditions as the medical practitioner may deem necessary for the protection
of the community."


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These provisions could be used to keep persons infected with HIV/AIDS
from entering the State or only allowing them to enter specifically for the
purpose of receiving treatment.

Since HIV is not spread through casual contact it is clear that these
restrictions do not protect the public from this particular virus. These
provisions therefore should never be used to keep out persons infected with
HIV/AIDS.

THE INSURANCE ACT, CAP. 150

It is common knowledge that insurance companies require a medical
examination before they offer persons life insurance policies. The results of
these medical examinations are not protected under this Act. If a person is
found to be infected with HIV/AIDS or any other ailment they are either
denied coverage or the premium is weighted to such an extent that the effect
is the same.


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What if the person is infected with some disease after the insurance policy is
in existence? Section 89 of the Act seeks to deal with such a situation. It
states that "nothing in any term or condition of a life policy or in the law
relating to insurance shall operate to except an insurance company from
liability under the policy or to reduce the liability of the company under the
policy on the ground of any matter relating to the state of health of the
person whose life is insured, other than the ground of the proposer's having,
when making the proposal or there after and before the making of the
contract, either,

(a) made an untrue statement of his knowledge and belief as regards the
matter, or
(b) failed to disclose to the company something known or believed by
him or regards that matter."

THE NATIONAL INSURANCE (Benefits) REGULATIONS, CAP. 205


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These Regulation made under the National Insurance Act makes provision
for sickness benefits. Regulation 3 provides that an insured person who is
incapable of work as a result of some specific disease, bodily or mental
disability shall be granted a sickness benefit. This provision deems an
insured person incapable of work if he/she is required to be absent because
he/she is under observation by reason of being a carrier or having been in
contact with a case of infectious disease.

This is interesting as it authorized the payment of a benefit to someone who,
having been exposed to an infectious disease is under observation.

THE RENT RESTRICTION ACT, 287

One of the constant complaints is that landlords try to evict tenants from
premises once they learn of that tenant's health status. While the Rent
Restriction Act does not deal specifically with persons suffering from illness.


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it seeks to protect persons from unjustified eviction.

Section 24 makes it an offence for any person to deprive a tenant unlawfully
of premises or attempt to do so. The section also makes it illegal for any
person with intent to cause a tenant either to give up occupation of premises
or to refrain from exercising any right in respect of the premises. If the
landlord does acts calculated to interfere with the peace and comfort of the
tenant he commits an offence. For example, if the landlord turns off the
water in order to evict the tenants, he commits an offence. A person found
guilty under this section of such an offence is liable to a fine two thousand
dollars or imprisonment of one year. A Magistrate also has the power to
reinstate the tenant in a case where he was actually illegally evicted.

This Act therefore, does offer some protection to a tenant from abuse by his
landlord.
THE EMPLOYMENT ACT, 1999


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The Employment Act, 1999, was passed to set out the legal rights and
responsibilities of employees and employers.

One of the things that the Act seek to do is to prohibit discrimination with
respect to recruitment, training, promotion, terms and conditions of
employment, termination of employment or other matters arising out of the
employment relationship. The Act actually lists grounds on which an
employer cannot discriminate. It must be pointed out however that 'health
status' is not one of the listed grounds.

The Act lists 'disability' as a ground, but one would have to stretch the
definition of 'disability' to fit ones 'health status' into that definition.
Conceivable therefore, an employer would not offend this section if he fails
to employ a person based only on the person's HIV status.

Section 74 of the Act clearly prohibits the dismissal of an employee unless


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there is a valid reason for doing so. That section goes on to state grounds
that do not amount to valid reasons for dismissal.

Listed as grounds that do not amount to valid reasons for dismissal are a
person's race, colour, national extraction, social origin, religion, political
opinion, sex, marital status, family responsibility or disability. Here again
the question is whether a person's positive HIV status could be viewed as a
disability thereby preventing its use by an employer. This remains an open
question. An employee's temporary absence from work because of sickness
cannot be used as a ground for dismissal. Could an employer demand that
the employees take an HIV test as a condition of continued employment?
The Act does not give an employer that right. This matter was taken to court
in Botswana. In Diau v. Botswana Building Society (BBS), Case No IC
50/2003, Industrial Court, an employee refused to take a HIV test and was
dismissed. The Court ordered her reinstatement and awarded her
compensation.


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The Act in section 80 also gives an employee the right to terminate the
contract of employment where the employer's conduct has made it
unreasonable to expect the employee to continue his/her employment. In
such a case the employee is deemed to have been unfairly dismissed.

If therefore a person is forced out of a job by the action of his/her employer
that person could bring an action against that employer. The aggrieved
person would complain to the Labor Commissioner. If or when the Labor
Commissioner fails to settle the matter, it is referred to the Minister. If the
Minister then fails, the matter is referred to the Arbitration Tribunal.

Where the Arbitration Tribunal finds for the employee they can order the
reinstatement of the employee or the reengagement of the employee to a
position compatible to that in which that employee was engage prior to his
dismissal. They could also make an award of compensation in such a
situation.


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THE EDUCATION ACT, 2002

Section 14 of the Education Act, 2002, confers the right on all persons in
Grenada to receive an education appropriate to his or her needs.

Section 15 mandates the Chief Education Officer to provide an education
programme for every person of compulsory school age who resides in
Grenada. "Compulsory school age" means any age from five years to sixteen
years inclusive.

The Act however, by section 22(3) places on a parent of a child who is under
the age of eighteen, the duty to make known to the principal of the school,
information of any medical or other condition that the child has. This
information then becomes part of the child's school records. It could be seen
that this information could be of great importance, especially in an


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emergency Of great concern however, is what is done with the information
once it is collected.

Section 23, impose on every principal the obligation to establish and
maintain a student record for each student. This section also gives to the
student, the parent and sponsor of the student, the right to examine the
record. A sponsor is defined by the Act to mean "a person or body paying
the fees and or maintenance expenses of a student at an educational institute,
other than a parent of the student". This means for example, that if a
student is on a scholarship, the donor is entitled to view that student's record
which includes that student's health status.

It might be argued that while the sponsor is entitled to the student school
record he is not entitled to the medical records only to the student's
performance records. The Act however does not distinguish between the
two. The Act in section 23 goes on to make it an offence for anyone to
disclose information from a student's record in contravention of the Act.


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THE CRIMINAL CODE, CAP. 1 (1994 Continuous Revised Edition)

Section 137(29) makes prostitution illegal in certain circumstances. It states
that any person who "loiters about or importunes any passenger for the
purpose of prostitution ... shall be liable on summary conviction to a fine
not exceeding twenty-four dollars." It would seem that this section is aimed
at the person who operates on the streets and not one who operates within
premises. It could be said therefore that the prostitute within a brothel is not
committing a crime under the Criminal Code. When one looks at the fine
attached to this offence the offence seems almost innocuous. While this may
be so the stigma attaches ever so forcefully to the sex worker who operates
in this way or indeed any other way. The law in this area assumes that a
person engaged in sex work would be female and while it deals with
someone who procures a female to engage in "unlawful carnal connection" it
is silent with respect to someone who procures a male to do the same.


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The position of the person who procures a sex worker to ply her trade, in
other words her 'pimp', is in a different position. Section 188 states:
"Whoever-

(a) procures any female under twenty-one years of age to have unlawful
carnal connection, either within or without Her Majesty's Dominions,
with any other person;

(b) procures any female to become, either within or without Her
Majesty's Dominions, a common prostitute;

(c) procures any female to leave this State, with intent that she may
become an inmate of a brothel elsewhere;

(d) procures any female to leave her usual place of abode in this State
with intent that she may, for the purposes of prostitution, become an


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inmate of a brothel, either within or without Her Majesty's
Dominions, shah be Hable to imprisonment for two years..."

Section 190 criminalizes the holding of a woman against her will in a brothel
or in any premises so that she may be unlawfully and carnally known by any
man. The penalty in this case is two years imprisonment.

Some countries have actually legalized sex work. What this does is to bring
the sex worker within the protective fold of the law thereby making it
possible for these persons to come forward and take advantage of the
services provided within the health care system.

Although the law was clearly designed to punish to a greater extent the
person who facilitates a woman in the commercial sex business the society
places much more stigma on the shoulders of the sex worker. It is important
to note that the laws of Grenada refers to sex worker as a female and does
not recognize the male who is involved in sex work. Therefore this issue


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must be incorporated into any future amendments.

The Criminal Code also deals in some fashion with homosexuality. I put it
this way because of the way the section is worded. Section 431 states:

"If any two persons are guilty of unnatural connexion... each such
person shall be liable to imprisonment for ten years."

These provisions marginalize both of these groups and make it unlikely that
would come forward to seek any kind of assistance. These provisions need
to be looked at for possible reform.

While the law deals with "unlawful connexion" between two consenting
persons it also contemplates a situation of unnatural carnal knowledge by
force. Section 183 states that,

"whoever is convicted of unnatural carnal knowledge of any person,


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with force or without the consent of the person, shall be liable to
imprisonment for fifteen years."

This section could be used to deal with the "rape" of a male.

Women are also considered a vulnerable group. This is so because in many
instances they are exploited sexually by men. The Criminal Code in section
177 makes rape a criminal offence punishable by fifteen years
imprisonment. Rape is defined in section 194 as the "carnal knowledge of a
female of any age without her consent". By the very wording of the
definition it is clear that only females could be raped.

Section 179 makes it an offence for anyone to have sexual intercourse with a
female under sixteen years of age, whether with or without her consent.
Sections 183A, 183B and 183C added the crime of incest to the Criminal
Code. Quite significantly however, the law does not make any provisions
for the protection of boys as it relates to sexual matters.


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Another vulnerable group of women consist of those who have a mental
incapacitated. Some of these women are taken advantage of sexually and so
the law tries to protect them. Section 181 provides that,

"whoever unlawfully and carnally knows any idiotic or imbecile
female, whether with or without her consent, under circumstances
which do not amount to rape, but which prove that the accused person
knew, at the time of the commission of the offence, that the female
was an idiot or imbecile, shall be liable to imprisonment for two
years."

It is also to be noted that while at one time it was believed that a husband
could not be guilty of committing rape against his wife, case law now makes
it clear that he could. (R [1992] lAC 147)
Although there is this legal protection, on many occasions women do not


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come forward after being raped because of the process that they go through
both psychologically and by the legal system.

The problem starts with the medical examination after the incident. In many
cases people accuse the women of inviting the attack, either by putting
themselves in the wrong situation, wearing clothes that are too revealing or
leading the men on.

Once the matter reaches to court the matter becomes very public as in many
cases the trial proceeds in an open court. There is no formal requirement
that evidence of a victim in a rape case be given "in camera". There is also a
requirement that the evidence of rape must be corroborated. This means that
there must be independent evidence supporting the allegation of rape. (Ensor
[1989] 1 WLR 497). At times also the woman's sexual past becomes an
issue in the case. All these things combine to make it difficult for women to
come forward with an allegation of rape. Indeed, in many cases they keep
the incident to themselves and do not come forward for treatment. The


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effect of this on the possible spread of HIV/AIDS is clear.

This whole area of the law needs review. The law ought to be changed to
make it mandatory for rape cases and similar cases be conducted "in
camera"; this should not be left to the discretion of the particular judge.

THE CHILD PROTECTION ACT, 1998

This Act is designed to protect children at risk. It sets up an Authority and
gives that Authority the capacity to apply to a court for an order of
protection with respect to a child who is in need of protection. The Act
considers a child to be at risk, inter alia, where that child has been sexually
molested or exploited where the parent knows or should know and fails to
protect that child. Also, a child is considered at risk, in circumstances where
the child is in substantial risk for that type of abuse.

In making an order of protection, the court may order (a) that the child be


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placed with or returned to a parent, subject to the supervision of the
Authority for a period of at least three and not more than twelve months; (b)
that the child be made a ward of the Authority and be placed in a child care
home or foster home for a period not exceeding twelve months; or (c) a
combination of (a) and (b).

This Act also gives to the Authority the responsibility to establish and
approve child care homes. Among some of the things that the Authority must
do is to appoint a doctor for each child care home. The doctor has the
responsibility to compile a medical record of each child in the home. Section
25 mandates the person in charge of a home to inform the Chairperson of the
Authority and the Minister of any infectious disease contracted by a child.
The parents of the child must also be informed.

This Act also makes provision for foster parents. It is important to note that
the Act specifically prohibits single men from being a foster parent.


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SECTION 4 CONSULTATIONS


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Consultations were held with the following:

1. Prisoners and prison Officer,
2. The National Youth Council,
3. Persons living with HIV/AIDS,
4. Caregiver of Persons living with HIV/AIDS,
5. The Grenada Chambers of Industry and Commerce/GEF,
6. Public sector representatives,
7. Staff Nurses at the General Hospital,
8. Grenada Nursing Association,
9. Public sector workers and general Public in Carriacou and Petit
Martinique,
10. Grenada Red Cross Society,
11. The Hotel and Tourism Association,
12. The Grenada National Council of the Disabled,
13. National Student's Council,
14. Grenada Bus Association,


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15. GNOW (through the National Assessment Team), ^
16. Grenada Coalition on the Rights of the Child (through the National
Assessment Team),
17. Grenada Trade Union Council (through a brief submitted to the
Consultant).

The consultation turned out to be very interesting and enlightening.
There was general consensus that there was stigma and discrimination
against persons living with HIV/AIDS and also their families. The
groups felt that the question of quarantine of persons with HIV/AIDS is
not acceptable. There is however, no known case of any person in
Grenada having been quarantined under the Quarantine Act because of
his HIV status.

With regards to employment all the groups believes that it is wrong to

^ The National Assessment Team is a multi-stakeholder committee that provides strategic
guidance to the National HIV/AIDS Assessment Process.


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discriminate against a fehow worker who is infected with HIV/AIDS.
Only one person in Carriacou expressed the view that she would not
work with someone if she knows that the person is HIV positive.

It was also expressed by another person in the business sector his
business would not employ someone if it was known that that person was
HIV positive. This was said to be a purely business decision as it was felt
that that infected person would eventually become a burden to the
company if and when they developed AIDS. This particular employer
drew a parallel with employing a pregnant woman. The pregnant
woman, it was said; after she had her baby would have to be paid while
another person had to be employed to do her job during her maternity
leave. Thus the company would have to pay two persons for doing the
same job. This employer however said that if an existing employee was
discovered to be HIV positive that person would not be dismissed but be
given all the support possible including medication. There was
consensus that the ILO Code of Practice for HIV/AIDS be adopted.


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All the groups expressed the view that in order to conquer stigma and
discrimination, education was a key factor. They believed that educating
persons on the issues relating to HIV/AIDS should begin at the primary
level. It was learnt that at the moment there is in the general school
curriculum a course dealing with family life and health issues. T his
could be an avenue through which HIV/AIDS information is
disseminated. At present, parents have the option to indicate whether
their children should take the class. The groups believed that these
classes should be mandatory.

There were great discussions in all the groups about the distribution of
condoms both to the general population and to prisoners.

There was general consensus that condoms should be distributed to the
general public, the question was, how? It was concluded that one
method of condom distribution should be through vending machines in


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Keith H.W. Friday
Consultant
January 2008
public areas. Also, it was suggested that "safe" areas should be set up
where persons, especially young persons, could go to get information on
all matters including health. These areas too could serve as distribution
points for condoms. The Health Centers and other institutions should
continue to serve as distribution points.

Distribution of condoms to prisoners was felt to be more problematic.
The prison authorities believe that the distribution of condoms in the
prison would be an admission that homosexuality exists in the prison and
that this might also be condoning homosexuality. Some prisoners,
however, admitted that homosexuality exists in the prison.

Also, we must remember that homosexuality is a criminal act in Grenada.
Many persons felt that the distribution of condoms in the prison would be
encouraging an unlawful act. It is interesting to note, however, that some
of the prisoners themselves opposed the changing of the Criminal law to
decriminalize homosexuality.


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Review of the Laws of Grenada, Carriacou and Petite
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Keith H.W. Friday
Consultant
January 2008
The consultation shows generally that while many people would support
the distribution of condoms in the prison for health reasons, there is
general opposition to repealing the laws against homosexuality.
Although research conducted by the NAD suggests otherwise. It could be
noted here that in July, 2007, a report entitled "Sexuality, Gender, HIV
Vulnerability & Human Rights in Grenada" was submitted to the United
Nations Human Rights Committee. This Report was submitted to the UN
as a shadow report by GrenCHAP, Hope Pals Foundation and the
Grenada Human Rights Desk et al. The Report focuses on the laws
relating to homosexuality and commercial sex work and advocates for a
repeal of those laws on human rights grounds. This report has already
generated some debate especially on the subject of homosexuality.

A major area discussed was that of confidentially. The discussions
revealed that in many cases a person's HIV status was revealed to the
general public through some source where confidentiality should have


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January 2008
been paramount. This problem has prevented many persons from
presenting themselves for HIV testing. It was revealed in Carriacou that
persons refused to be tested because when tested the results were known
by the public before they were known by the tested person. Persons had
several suggestions to deal with this problem. It was suggested that all
information dealing with testing should be individually coded to protect
the person's identity. It was also suggested that the old practise of public
officers signing an oath of confidentiality, be revived. Any officer
breaching the "oath" would then have drastic measures taken against
him.

Interestingly, a suggestion that came from one group was that where there
was a breach of confidentiality, say in an office, and the culprit could not
be detected, measures should be in place to punish everyone in that
office. This it was felt would create a system of self policing.

One person felt strongly that in some cases confidentially actually


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Consultant
January 2008
worked against infected persons. It was explained that an agency was
giving help to the general public but wanted to include HIV infected
persons in an anonymous way. That agency sought information on HIV
infected persons but was denied the information on the ground of
confidentiality. These are cases it was suggested where not sharing the
information might actually hurt the persons everyone was trying to help.
There is no doubt that co-operation between agencies on matters like
these is paramount.

The nurses believe that coding should be extended to prescriptions in
order to protect persons from stigma and discrimination. They however
have concerns because they believe that the full information of a patient's
medical history ought to be made available to the caregivers so that the
treatment of the patient is not compromised.

Also of concern for many of the nurses was the issue of confidentiality in
situations where an infected person continues to engage in risky sexual


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Keith H.W. Friday
Consultant
January 2008
behaviour without the knowledge of their sex partner. There is a case
where an HIV infected woman continues to have children. There is
authority to suggest that in cases like these the interest of the community
becomes paramount and it is permissible for the unsuspecting partner to
be informed. There is a common law "duty to warn" someone known to
be at risk of HIV infection as a result of information gained through a
confidential relationship (R v. Cuerrier).

The Public Health Act requires that anyone intending to sell food to the
public must first obtain a food handler's permit from a medical doctor.
While the Act does not name HIV as one of the factors to be taken into
consideration, the discussions reveal that it is routinely done. One
PLWHA indicated that she wanted to apply for a food handler's permit
but was convinced that she would not be successful because of her status.
This clearly indicates the mindset of some PLWHA who routinely shy
away from situations for fear of rejection and discrimination.


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Consultant
January 2008
The Grenada Hotel and Tourism Association believes that while an HIV
test is not presently required for someone to obtain a food handler's
permit one should be. This is so especially for some classes of
employees. Chefs, they said are prone to cut themselves and an infected
chef could be a danger.

Many persons indicated that in order to get a life insurance policy they
were required by the insurance companies to do an HIV test. The results
of the test in many cases are given either to the insurance agent or
directly to the insurance company, without the concurrence of the person
tested. This was seen as a major breach.

The problem apparently goes further. One PLWHA indicated that when
an insurance company with whom she had an existing insurance policy
found out about her "HIV status", her life insurance policy was promptly
revoked. Revocation of a life insurance policy under such circumstances
is clearly illegal. However, she was not aware of this until after the


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Consultant
January 2008
limitation period for bringing an action against the insurance company
had expired.

This clearly shows that while there is a general need for educating the
public on HIV/AIDS, it is equally important to educate PLWHA about
their rights and responsibilities.

The issue of testing young persons was also discussed. This is important
because there are young persons who would like to be tested without the
consent of a parent or guardian. There is consensus that a child needs the
permission of a parent before he could to be tested. The question is, at
what age is a child free to be tested without parental consent? The law in
Grenada has several age limits up to which parental permission is
required. The age of majority is twenty one (21), the age at which
someone could be married without parental consent is twenty one (21),
the voting age is eighteen (18) and the age of sexual consent is sixteen
(16). Many persons hold the view that the age at which a child should be


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tested without parental consent ought to be synchronized with the age of
sexual consent. Other persons, however, express the view that the age of
sexual consent is too low and ought to be increased.

Some persons also held the view that there ought to be no age at which a
child needed parental consent to be able to be tested. It was felt that there
may be many reasons why a child does not want to obtain parental
consent. It may be that the child is being sexually abused in the home
and while the Child Protection Act does offer some protection it might
not be the appropriate method to be used at that time. The idea is that all
persons at risk should have the right to get tested.

The consensus is that mandatory testing ought not to be done under any
condition. However, one group felt very strongly that there should be
mandatory testing of the whole population at least every two years. This
group believes that this is too important an issue to leave to a person's
voluntary decision.


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January 2008
It was however reported that all pregnant woman were tested with or
without their consent. It would appear that pregnant women are not even
asked to give their consent to being tested for HIV/AIDS. Some groups
supported mandatory testing of pregnant mothers.

Some nurses also felt that all persons who are undergoing any medical
procedure involving blood or body fluids should be tested. There was
consensus however that health practitioners should at all time use the
universal infection control precautions. It was discovered that in many
cases the universal infection control precautions were only used to deal
with infectious cases. This in itself promotes stigma and discrimination
as it advertises to all and sundry the nature of the patient's illness. The
universal infection control precautions should be used at all times. The
lack of these measures also exposed persons to infection in cases where
they ought not to be.


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Consultant
January 2008
What about willful transmission of HIV? Most people felt that there
should be a law against willful transmission of the vims in cases where it
could be proven that a person knowingly engaged in acts that
intentionally transmitted the vims to another. To be noted is the
Canadian case of R v. Cuerrier where the Supreme Court held that where
sexual activity posed a significant risk of serious bodily harm there was a
duty on an HIV positive person to disclose his/her status. Failure to do so
would invalidate any consent to sexual intercourse thereby making the
act an assault.

An interesting recommendation emanated from the consultations, it was
suggested that a health ombudsman be appointed. This ombudsman
would receive and deal with complaints regarding health issues. It was
felt that the ombudsman should deal with complaints relating to health
issues and not be restricted to HIV/AIDS issues.

A National Consultation was also held to discuss the issues. This


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Consultant
January 2008
national consultation was addressed by the Minister of Health, Hon. Ann
David-Antoine who is the Chair of the National AIDS Council. She
expressed Government's continued support to the fight against
HIV/AIDS. She shared with the meeting the tangible ways in which
Government is giving its support. She mentioned however that people's
attitudes had to change for the fight to be successful.

About thirty persons attended this consultation drawn from the following
groups:

o Grenada Red Cross Society
o Grenada National Council of the Disabled
o Grenada Bus Association
o Grenada Nursing Association
o Her Majesty's Prison
o Grenada Medical Association
o Grenada Bar Association


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Consultant
January 2008
o Ministry of Carriacou and Petite Martinique Affairs
o The Youth Empowerment Foundation of Grenada Inc.
o National Student Council
o Consultants Attached to the National AIDS Directorate
o Clico Insurance
o St. Augustine Medical Services
o Grenada Hotel and Tourism Association
o GrenCHAP
o Hope Pals Foundation
o U.S. Peace Corps, and
o UNDP
This National Consultation generally supported the outcome of the other
stakeholder meetings that were held. Some of the broad
recommendations that were made include:


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Consultant
January 2008
Employment: That there is a need for a broad legislative framework to
provide equal opportunity for employment regardless of sexual
orientation, HIV or disability status;

Confidentiality: Mechanisms should be put in place to provide redress
for breach of confidentiality regarding an individual's HIV status;

Willful infection: Persons who intentionally transmit HIV should be held
liable;

Public Health Act: The words "infectious" and "contagious" as used in
the Public Health Act should be clarified. Secondly, the Act should be
amended to remove Regulation 90 which speaks to the hoisting of a
yellow flag by day and a red lamp at night over a house or hospital which
houses an infected person. This regulation promotes discrimination
towards PLHWA;


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Consultant
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Age of Consent: Age of consent for VCT without parental permission
should be linked to the age of sexual consent. An exception should be
made for cases of sexual abuse; in these cases a social worker will act as
a guardian for the child;

Mandatory testing: Some participants recommended that mandatory
testing be conducted on all pregnant women receiving service through the
public health care system. Additionally, it was recommended that HIV
testing should be part of routine medical examinations;

Prison Act: It was recommended that this Act should be amended to
allow for distribution of condoms within the prison;

Insurance Act: It was recommended that this Act be revised to prevent
discrimination of PLWHA;


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Consultant
January 2008
Police Act. The Act should be amended to accommodate an annual
physical exam, and a protocol for dealing with a police officer who was
diagnosed with HIV while employed with the Royal Grenada Police
Force;

Constitutional review: Future constitutional review should include the
views of vulnerable communities including PLWHA so that their
concerns regarding stigma and discrimination and other issues could be
taken on board; and

Immigration Act: The word "alien" appearing in the Act needs to be
defined to avoid ambiguity.
SECTIONS: INTERNATIONAL GUIDELINES, BEST
PRACTICES AND COMMITMENTS


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Consultant
January 2008
More than 20 years after the first AIDS case was diagnosed, HIV is still
with us. Despite progress in HIV prevention and treatment, this
debilitating, deadly disease continues to be a threat. A vims that many
hoped would be eradicated in the 1980s, has now infected and killed
millions around the world. Faced with the catastrophic impact of HIV
globally and rising rates of infection at home, we are at a turning point in
our fight against HIV.

Do we accept that HIV will be with us always, a chronic debilitating
illness that will continue to steal people's lives, or do we redouble our
efforts to stop the ravages of this preventable disease?

It is believed that we have marginalized the issues regarding persons
living with HIV/AIDS (PLWHA) and the problems that they have to live
with on a daily basis. Yes, we know unemployment or getting fired from
a long time job are early signs of the associated stigma along with people
on the outside or even in homes refusing to be involved with PLWHA or


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Consultant
January 2008
even touch them. We have seen the results of all the misinformation
about HIV/AIDS, the way it is transmitted and what to expect from it.
PLWHA in the Caribbean have the most to deal with as the communities
are small and seemingly every one knows everyone else and so
information is not secret for very long. Persons affected by HIV/AIDS
are almost equally targeted. People in the Caribbean have shown that in
some ways they are open to change in many areas. It is believed
therefore that they could likewise change their approach to people living
with and affected by HIV/AIDS. People's thoughts and approach
towards PLWHA and affected persons are changing.

We as a people must stop making excuses for our approach to HIV/AIDS
and other sexually transmitted disease. We must take privacy issues
seriously and know that when these rights are violated great harm is done
to the affected persons. It has to be drilled into everyone that it is not
okay to divulge someone's confidential information. People have to be
made accountable for their actions in this regard. The privacy issue is a


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January 2008
major hurdle that PLWHA have to deal with from their co-workers, their
neighbors and especially the people in authority; may they be the person
who may be responsible for drawing blood from a patient or suspected
patient, the nurses caring for a patient, the doctor, the doctor's secretary,
pharmacist or laboratory technician. These individuals must know that
they are in a "position of trust" and persons are relying heavily on their
"position of tmsf to protect their privacy.

PLWHA in the Caribbean, on the other hand, must take the time to
educate themselves on the issue of HIV/AIDS, how it affects them, their
rights and responsibilities. Other than discrimination and stigma, many
persons living with HIV/AIDS have no idea of their rights and how they
should be treated or not treated. They must know that although they are
living with HIV/AIDS they are citizens and are entitled to the same
privileges as other citizens. They are sometimes afraid to ask questions
for fear of discrimination and for fear of information being passed along
to the wrong person thereby further leading to stigma and discrimination.


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January 2008
There have been instances where persons who tested positive for
HIV/AIDS in Grenada had that information become public knowledge
without their knowledge or authorization. Indeed in some cases the
information was sent to others including places of business that the tested
person may have dealings with, for example, insurance companies and
employers. Happily, very few such cases are now known to occur.

Grenada is a very small place in comparison with the other Caribbean
countries which place us at an advantage to educate our people and
acquire a modem of control over this epidemic.

It is clear that education is a key component in the fight against stigma
and discrimination and a recommendation of educating people parish by
parish could be an excellent way to proceed. The fight must be the fight
of every person living in Grenada.

Once appropriate educational programmes are put in place we need to


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January 2008
petition the Government to change some of the existing legislations to
reflect the reality of HIV/AIDS. We must look to other countries and
adopt the best practices that have developed in the universal fight against
HIV/AIDS and to make the necessary legislative changes.
Voluntary Counselling and Testing (VCT)

Voluntary Counselling and Testing (VCT) is a critical strategy in
HIV/AIDS prevention and care synergy, providing benefits to those who
test HIV positive and those who test HIV negative. For Voluntary
Counselling and Testing to be effective, high-quality counseling and
testing services must be in place and the community must perceive these


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services to be beneficial. Promoting Voluntary Counselling and Testing
for behavioural change as a prevention strategy alone will have limited
impact without quality services and or referrals for individuals who test
HIV positive. Similarly, counselling an HIV positive individual on ways
to prevent further spread of HIV without addressing the person's
psychological and medical needs will have limited impact.

Voluntary Counselling and Testing is recognized internationally as an
effective and pivotal strategy for both prevention and care. Research in
many countries including Trinidad, provides strong evidence that VCT is
an effective and cost-effective strategy for facilitating behaviour change.
VCT was also identified as an important entry point to care and support.
These findings have raised interest and support for VCT as a valuable
component of comprehensive HIV/AIDS programmes among
international organizations as well as the national AIDS programmes of
many countries and donors.


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The major barrier to VCT is fear of stigma; women in particular can face
violence and loss of security in the form of shelter, food and
relationships. It is particularly important with women to ensure that
testing is performed and results given without breaches in confidentiality.
Other barriers are the lack of available drug therapies, psychological
support and clinical care for individuals who test HIV positive.
Counselling itself is labor intensive and requires training and supervision
to assure high quality.

As an entry point for prevention and care, VCT must be made available
on a much larger scale. The use of simple, rapid HIV tests can decrease
follow-up in VCT Lessons learned from VCT programming to date
include:

o VCT can be offered by government, non-government,
community and private sector;


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o The gold standard for VCT follows a regimen of pretest
counseling, testing, as desired by the client and after informed
consent is provided, and post-test counseling, involving one or
more sessions, depending on the client's needs. Individual risk
assessment, risk reduction planning, and preparing for and
coping with test results are integral components of pre and post-
test counseling;
o A range of innovative service delivery models can be applied,
depending on the context. These include variations on
integration within the existing health facilities, freestanding and
mobile services;
o The model of choice should address cost considerations to
guarantee sustainability of services. Service sustainability
remains a challenge in many settings, especially within non-
integrated sites where initial start-up costs are provided by
external international donors;


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o VCT must be accessible and affordable for those at highest risk
of HIV infection or those suspected to have HIV-related illness.
VCT should be available to the range of clients who may
benefit from knowing their HIV status, including couples,
individuals and young people;
o VCT sites need to be adequately staffed by individuals with
high-quality training in counseling and testing practices;
o VCT site managers must help staff sustain high-quality service
provision, retain skilled staff and prevent burnout among
counselors;
o VCT for couples must be widely encouraged and promoted.
Couples pre- and post-test counseling has significant benefits
for addressing risk assessment and risk reduction planning,
particularly for women. Targeting couples for VCT is also cost
efficient;
o VCT design needs to address service promotion within the
planning and establishment of high-quality VCT services. This


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includes identifying or strengthening other care and support
services, community and hospital referral networks;
o VCT services must to be tailored to the unique epidemiological,
behavioural and socioeconomic context. The designs also can
take into account stigma reduction and demand creation
interventions;
o In scaling-up VCT or developing new VCT sites, a coordinated
response by all stakeholders including partnerships among
donors, government and non-governmental organizations is
crucial to ensure standardization of services in terms of quality
of care and support offered to clients and to avoid duplication
of services within the country;
o Monitoring and evaluation systems must be established from
the onset for both counseling and testing components.
Counselling and testing protocols may vary from one
programme to another based on the goals and objectives of the
programme. Whatever approach is taken, the VCT intervention


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must be evaluated regularly to determine whether it is being
provided in accordance with the predetermined protocol and is
satisfying client needs;
o Innovative approaches to VCT should be responsive to the
specific needs of the country. These include VCT services for
adolescents and integration of VCT practices within antenatal
sites that can employ group pretest information sessions in
settings with high client volume, as part of a comprehensive
strategy for prevention of mother to child transmission;
o VCT is a public health intervention. Government and donors
will need to assume some of the associated costs of VCT to
ensure the widest possible access; and
o The National Policy on HIV/AIDS does list VCT as one of the
health sector responses and I know from my personal
knowledge that persons are continually trained for this
intervention.


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Targeted Intervention:

Grouping technical interventions to meet the needs of individuals,
families, communities and society around specific targeted populations
has been successful.

Evidence increasingly suggests that the most efficient way to reduce the
epidemic's spread is to reduce transmission among those who change
partners most often. Preventing infection among those with the highest
rates of sexual partner change prevents many more subsequent,
secondary infections.

Prevention Concepts

o HIV spreads faster among those with higher risk and greater
vulnerability, for example, sex workers (CSW) and their clients;


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o HIV transmission among lower-risk subpopulations can be
prevented by interrupting transmission among higher-risk
subpopulations and bridge populations; and
o Prevention resources should be directed more strongly to those
with higher risk or vulnerability.

Targeted interventions have led to successful risk reduction and
decreased levels of HIV infection. Some examples;

o A targeted intervention with sex workers in Abidjan, which
combined BCC with condom promotion and STI services, reported
condom use among sex workers with last client increased from 63
percent in 1991 to 91 percent in 1997 (Ghys et al. 1998).
o The Thai 100 percent condom programme has been associated
with an increase in condom use among sex workers from 14
percent to 94 percent (Hanenberg et al. 1994). This programme
created a policy incentive for brothels to insist on condom use by


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Consultant
January 2008
fining brothels whose female sex workers test positive for STIs.
The policy was backed up by legal enforcement of regular STI
screening and treatment, condom provision and a comprehensive
communications campaign.
o In South Africa, condom sales remained low among women at high
risk in a mining community, despite the introduction of a condom
social marketing programme. The women indicated they were
tired of receiving condom messages while other health issues were
ignored. With the introduction of STI services for the women,
condom use began increasing among them (since 2000).

As a result of these targeted interventions, fewer infections have been
observed, not only in the targeted populations themselves, but also in the
bridge and general populations.
To apply the concept of targeted prevention, the subpopulations where
risk behaviour is most concentrated and who are most vulnerable must be


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January 2008
identified on a localized basis. But sex workers and their clients, and
men who have sex with men (MSM), are more likely to predominate, so
targeted populations should be selected based on local data.

An urgent priority, regardless of the state of the epidemic, is to rapidly
expand and deliver prevention and care and support services to the
majority of people at highest risk. Pilot projects have demonstrated the
effectiveness of targeted interventions but, in most cases, coverage of the
high-risk population has been low.

Linking Prevention and Care

As people infected with HIV progress to recurrent illnesses, the services
they need change. Providing comprehensive care across a continuum,
from home and community to institutional services and back, will ensure
that the specific needs of clients and their families are met. Effective
referral systems must develop to ensure that people living with and


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January 2008
affected by HIV/AIDS can benefit from the various community and
institutional-level services available. These services must not only be
developed but must be maintained.

Integration of Targeted Prevention into Other Services and Sectors

HIV/AIDS prevention efforts are more effective when programmes and
activities are integrated into existing large-scale infrastructures that
operate across a range of sectors. Combining delivery of HIV/AIDS
interventions with other sectors, rather than expanding HIV/AIDS
interventions independently, helps reduce costs, improve efficiency and
maintain sustainability. But the potential for integrating HIV/AIDS
programmes into other services, such as education, reproductive health,
family planning or sex education, has not always been exploited fully by
countries (Watts and Kumaranayake 1999). In addition to the public
sector, integration is needed for civil society groups as well, such as trade
unions and youth and women's associations.


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January 2008
Behaviour Change Communication

Changing individual and community behaviours is an important factor in
Behaviour Change Communication and plays different but related roles
in HIV/AIDS and Sexually Transmitted Infections. Community dialogue
stimulates community and national discussions on the factors that
contribute to HIV/AIDS, such as risk behaviours and the environment
that creates them, and demand for information and for prevention, care
and support services. The following are important:

o Advocacy. Ensures that policy makers and key opinion leaders
stay informed on the epidemic. Advocacy takes place at national
and community levels.
o Provision of information and education. Provides individuals
basic facts in language, visual and media formats they can
understand, and motivates positive behaviour change.


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o stigma. Conveys the issue of stigma and attempts to influence the
social response in all communications as it relates to prevention
and care. This is a particularly critical component of behaviour
change.
o Promotion of services and products. It is important to promote
information on available HIV/AIDS and sexually transmitted
infections programmes and services. Services can include sexually
transmitted infection treatment, voluntary counselling testing,
support groups, PLWHA networks, mother to child transmission,
clinical care and social and economic support.

Consistent messages from a variety of legitimate sources must be
disseminated in an interactive fashion to affect behaviour change.

HIV prevention interventions aim to change individual behaviour, but
community and societal level interventions must also be developed to
change norms and behaviour at the group level. It is critical to support


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and promote behavioural changes at the individual, group, community
and national levels.

Experience has shown that while HIV risk may grow quickly in a
community or country, attitudes favoring prevention and preventive
behaviours are likely to lag far behind. The media can play an important
role in promoting attitudinal changes and popularizing safer behaviours.
When behaviour lag behind knowledge, mass communication can be
used to stimulate dialogue about risk behaviour in the communities,
especially among the youth.

Communication campaigns must be developed using behaviour change
methods that are tailored to address different stages of the epidemic,
since population subgroups, which are the target audiences, may be at
different stages in the behaviour change continuum. Target audiences
must be segmented and behaviour change campaigns developed for each
group. For all of this to be effective, a national behaviour change


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January 2008
campaign must target specific groups with quality messages and
interventions.

The National Policy on HIV/AIDS states quite clearly Government's
intention to continue to use mass media to effect behaviour change. The
intention is not only to use radio, television and newspapers but also,
billboards, posters and leaflets. The policy also takes into consideration
the utilization of the arts to disseminate information. This includes
theatre, poetry, dance and music. I know of one particular theatre group
that has heard the call and has become very involved in the work of the
National AIDS Directorate.

Stigma is a critical issue to be addressed when developing behaviour
change campaigns. Stigma is defined as a mark of shame or discredit on
a person or group. In HIV/AIDS, stigma affects PLWHA, men who have
sex with men (MSM), sex workers and other marginalized groups,
together with persons affected by HIV/AIDS. Stigma often presumes a


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January 2008
negative behaviour on the part of those individuals, stigmatizing others.
This manifests itself in a range of ways, from ignoring the needs of a
person or group to psychologically or physically harming the stigmatized.
The importance of addressing stigma in behaviour change campaigns
transcends questions of compassion and humane treatment for
programmes. Behaviour change programmes that address stigma can
benefit from motivated persons or groups, such as PLWHA, SWs and
MSM, who can work effectively for change as policy advocates and
serve as caregivers and peer educators. This is why it was an important
step for the local MSM group to associate themselves with the
preparation of the UN entitled "Sexuality, Gender, HIV Vulnerability &
Human Rights in Grenada A Shadow Report to the United Nations
Human Rights Committee". While it could be said that the Report itself
have certain inherent flaws, it is in my view, a milestone in addressing
some of the stigma associated with HIV/AIDS.


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Keith H.W. Friday
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January 2008
Condoms

When speaking about condoms, most people only think about the male
condom as a form effective protection against HIV and other sexually
transmitted infections. Access to condoms, whether male or female, is
essential in prevention strategies in the fight against the spread of
HIV/AIDS among the sexually active population at large. Condom use
promotion and therefore their distribution is one of the most effective
HIV prevention interventions. We therefore must ask the following
questions in order to attempt to keep up with the fight against the spread
of HIV/AIDS:

o Is there a national condom social marketing programme?
o Is there a national system for condom logistics and distribution?
o Are condoms available in rural areas?


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January 2008
o Are condoms accessible to those at highest vulnerability and risk
for HIV?
o Are the condoms that are being distributed of a high quality?
o Has the potential for increased coverage of sex acts with the
female condom been assessed?
o Are female condoms available?
o Is there a guaranteed supply of male and female condoms?

There are multiple approaches to marketing and distribution of condoms
to the community. These include free distribution, targeted distribution,
community-based distribution programmes, and dissemination via health
facilities, pharmacies and village stores. The distribution strategy can be
coordinated among the different outlets to achieve maximum availability
of condoms. In Grenada there is great reliance on the health services for
distribution. I must also say that the National AIDS Directorate plays an
important role in condom distribution.


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Keith H.W. Friday
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January 2008
However, it is important to improve the access and availability of
condoms to all communities and vulnerable groups.

People must also be educated on how to use condoms correctly. It cannot
be assumed, as no doubt is now the case, that persons know how to
correctly use condoms. A successful condom promotion programme
should ensure that condoms are used often and consistently and properly
in most high-risk sexual encounters. A condom social marketing
programme that reaches primarily the lower-risk general population may
not have a significant impact on reducing HIV transmission.

The female condom has been the subject of extensive studies in
effectiveness, acceptability, cost-effectiveness, training, and gender
dynamics for the past decade. Study results have been positive. WHO
and UNAIDS have encouraged introducing the female condom as a new
method of preventing pregnancy and HIV infection. The female condom
can be a vital component of reproductive health and HIV/AIDS


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Consultant
January 2008
programmes. It should be introduced strategically to have the strongest,
most cost-effective public health impact. When trying to expand the
response to the epidemic, all potential methods must be used strategically
to increase safer sexual behaviours. While the female condom is available
and are distributed in Grenada, they have not gained the popularity and
level of acceptance of its male counterpart.

The National Policy on HIV/AIDS does not deal in any comprehensive
way with condom distribution and use.

Management of Sexually Transmitted Infections

Management of sexually transmitted infections is a key strategy in HIV
prevention because sexually transmitted infections increase individuals'
susceptibility to HIV and their infectiousness with it. The behaviour that
put individuals at risk for sexually transmitted infections also put them at
risk for HIV. A prevention and care strategy, where prevention messages.


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January 2008
such as condom use, are delivered with quahty, nonjudgmental treatment
services, helps individuals become more receptive to prevention
messages.

Research shows there have been several large-scale interventions that
demonstrate the potential impact of sexual transmitted infection control
on HIV transmission. In this regard we can learn from other countries.
Thailand reduced the incidence of curable sexual transmitted infections
by more than 80 percent in less than five years through a comprehensive
effort that included improved sexually transmitted infection treatment
and targeted promotion of condom use in commercial sex establishments
(100 percent condom policy). During this period, HIV prevalence, which
had been increasing rapidly, began to fall. Through sustained application
of these interventions, Thailand stabilized HIV transmission early and
averted a more extensive epidemic.


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Keith H.W. Friday
Consultant
January 2008
There is also evidence that even more limited sexual transmitted
infections interventions can reduce HIV transmission. In rural Mwanza,
Tanzania, improving the case management of sexually transmitted
infections through the syndromic approach in clinics reduced the
incidence of new HIV infections by 40 percent. But in nearby Rakai,
Uganda, mass antibiotic treatment of the sexually active population at
nine-month intervals resulted in no drop in most curable sexually
transmitted infections or in HIV transmission. Some questions to be kept
in mind are:

o Is there a national policy for sexually transmitted infections case
management?
o Are there communication strategies to promote sexually
transmitted infections services?
o Are services available at the first point of contact?
o Does the majority of the high-risk population have access to
acceptable services, especially youth?


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o Are sexually transmitted infection services available through
informal sector outlets?
o Is there regular screening and presumptive treatment of the most
important core and bridging groups?
o Are treatment medications widely available and affordable?
o Are the relevant drugs on the essential drug list?
o Are institutions and organizations able to train persons in
syndromic management?
o Are there ongoing supplies of treatment drugs within the country?
o Are sexually transmitted infections services linked to counseling
and other HIV/AIDS services?

Blood Safety
Designing strategies and interventions to promote blood safety in
developing countries requires planners and programme managers to


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January 2008
understand the many factors influencing behavioural practices that
present challenges to changes.

Factors to consider include:

o Level of awareness of basic principles and concepts, such as voluntary
blood donation;
o Impact of HIV and hepatitis C vims on donor selection;
o Need for appropriate technology;
o Societal perceptions and behaviour concerning blood donation;
o Political will;
o Organization of blood transfusion services;
o Behaviour change within the delivery system, such as reducing
unnecessary blood transfusions;
o Need for new training methods;
o Need for system-wide health care training; and
o Linking VCT to blood safety.


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A reliable and safe blood supply is still out of reach for many countries.
This is not the case in Grenada. Blood-borne transmission of HIV
accounts for up to 10 percent of HIV infections in countries with limited
resources. The vast majority of these infections can be prevented by:

o reducing unnecessary transfusions by effective clinical use of
blood;
o educating, motivating, recruiting and retaining low-risk blood
donors; and
o screening all donated blood for infectious agents.

Grenada through its National Policy on HIV/AIDS lists as one of
accomplishments "HIV screening of blood donated for transfusion". It is
generally believed that blood used for transfusions is reasonably safe. It
is important that high standards are maintained. It is also important that
blood donors are properly screened and that a system of professional
blood donors does not develop.


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Keith H.W. Friday
Consultant
January 2008
Intravenous Drug Use

Even though intravenous drug use is not considered a problem in
Grenada, it might be wise to keep the problem in mind even if no active
programme is developed. Like any other programme HIV prevention
targeting intravenous drug users is more effective and less costly the
earlier it is implemented, ideally before HIV is introduced into the
population or before it spreads widely.

There is evidence that HIV epidemics among intravenous drug users
slowed and even reversed in developing and developed countries by
implementing specific harm-reduction strategies, including:

o community-based peer outreach;
o increasing access to sterile injecting equipment; and
o increasing access to drug dependence treatment, particularly
methadone (Ball 1998).


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Where effective action has been taken to stem HIV epidemics among
intravenous drug users, no single element has been found to be effective
on its own. Comprehensive programmes based on community
development principles and operating in supportive environments that,
includes access to social welfare and primary health care, including drug
treatment/rehabilitation programmes, are key components of successful
approaches. It has been found that access to sterile needles and syringes
is critical to a successful HIV prevention programme for intravenous
drug users.

Stigma Reduction

o In what ways is stigma hindering effective prevention and care
interventions?
o What role can BCC, VCT and other prevention and care
interventions play in alleviating the impact of stigma?


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o What existing legal, political, human rights and policy contexts are
related to stigma?
o Are policies in place to enhance and protect the rights of PLWHA
and persons affected by HIV/AIDS?
o Has high-profile disclosure occurred within the country?
o Does the hospital and health care setting play a role in perpetuating
stigma?

HIV/AIDS-related stigma continues to inform perceptions and shape the
behaviour of PLWHA, which can hamper prevention interventions.
Developing policies to combat discrimination is crucial to any HIV
prevention programme. Stigma reduction is both a human rights and a
public health issue. Stigma has effects at many different levels:

o Prevention. On the social level, stigma can cause target audiences
to view those with or at risk of HIV/AIDS as the other or them,
perpetuating notions that such an epidemic "could not happen to


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P79_SP00108
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P79_SP00118
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PAGE 1

Mariner,Matthew C M a r i n e r M a t t h e w C | ZW M a r i n e r M


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P40_ST00078 1059 1939
P40_SP00066 1084
P40_ST00079 1099 different 0.87 002800000
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P40_ST00080 1312 197 position.
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P40_ST00081 1533 Section
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P40_ST00082 1725 1927 78
P40_SP00070 1803
P40_ST00083 1823 1931 137 states:
P40_TL00014 1993 1795
P40_ST00084 254 "Whoever- 404000000
P40_SP00071 631 2035 -238
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P82_ST00121 1305 110 Pilot
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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 EXECUTIVE SUMMARY The Grenada National AIDS Programme under the direction of the National AIDS Council (NAC) has been working diligently to educate the public with the aim of achieving its goal of reducing the number of HIV/AIDS cases in Gr enada. Albeit this, persons living with and affected by HIV/AIDS in Grenada have continued to be marginalized and excluded due to stigma and discrimination. It has been recognized and accepted that legal reform together with education is imperative in a ddressing the problem of stigma and discrimination in any country. In light of this, CARICOM Heads of Government recommended that Member States undertake a National Assessment of the legal, ethical and human rights dimension of the laws and policies on HI V/AIDS. The objectives of the assessment were as follows: 1. Promote the incorporation of human rights and non discriminatory practices in policy and legislation, in accordance with international

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 guidelines, best practices and commitments; 2. Increase meaningfu l participation of PLWHA and other vulnerable communities in law and policy reform; 3. Produce a document that sets out the priority areas for law and policy reform. A review of the legislature and the incorporation of views from key stakeholder groups includ ing the NAC, private and public sector officials, and civil society groups formed the basis of the assessment process. The assessment revealed that the majority of laws dealing with health issues were enacted prior to the emergence of HIV/AIDS. Therefore the laws of the State do not specifically make provision for such a disease. The legal review indicated quite clearly that in many cases the methods legislated to are inappropriate to deal with HIV/AIDS. The fact that H IV/AIDS is not mentioned in some of the other laws could

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 actually be beneficial. The review however, showed that many of the laws of Grenada need to be amended to deal specifically with the problems of HIV/AIDS related stigma and discrimination. TABLE O F CONTENTS Section 1 Introduction 5 Section 2 Objectives of Assessment 7 Section 3 Review of the Laws 8 Section 4 Consultations 22 Secti on 5 International Guidelines, Best Practices and Commitments 30

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Section 6 Conclusion 46 Section 7 Recommendations 50 References 52 Appendix 53

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 ACKNOWLEDGEMENTS I would like to acknowledge with thanks the assistance given to my by Mrs. Carolyn Alexis Thomas, Director, National AIDS Directorate; Mrs. Dianne Roberts, Project Coordinator and my wife, Thourla.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 I thank all the persons who mad e comments which contributed to this report.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 SECTION 1: INTRODUCTION

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The continuing increase of HIV/AIDS in the Caribbean has prompted CARICOM Heads of Government to recommend that Member States undertake a National Assessment of the legal, ethical and human rights dimensions of the laws and policies on HIV/AIDS. This would involve the joint efforts of all sectors of the country including Government and non government organizations. The Grenada National AIDS Programme under the di rection of the National AIDS Council (NAC) has been working diligently to educate the public with the aim of achieving its goal of reducing the numb er of HIV/AIDS cases in Grenada. Regardless of the many tremendous efforts to educate the public, persons li ving with HIV/AIDS in Grenada have continued to be marginalized and excluded due to stigma and discrimination. It has been recognized and accepted that legal reform together with education is imperative in addressing the problem of stigma and discriminati on in any country.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 1. A growing concern for the number of human rights abuse and discriminatory treatment emerging from the advent of the HIV/AIDS pandemic. 2. Emerging public health situatio ns and concerns that are not adequately addressed by existing laws and policies. 3. The participation and involvement of many local, regional and international organizations in the fight against HIV/AIDS has increased the need for a comprehensible legal an d political framework within which they should be encouraged to function. 4. The creation of common standards to which all practitioners can subscribe. The action plan formulated by CARICOM, for the implementation of

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Priority Area 1 accords with a rights b ased approach to combat the HIV/AIDS pandemic involving: 1. Emphasis on capacity building. 2. Greater involvement of persons living with HIV/AIDS (PLWHA) in all decisions affecting them. 3. A multi sectoral approach to ensure effective consultation and wi der participation. 4. Appropriate priority setting and fast tracking of issues particularly those specific to the national context. With a relatively small population, the number of new cases reported is on the rise and must be of great concern. Preventi on, treatment and care are critical. The unavailability and high cost of medication and employer provided benefits are but some factors that hamper the fight against

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 HIV/AIDS. Until the stigma is broken down and persons infected with and affected by HIV/ AIDS are certain that they would not be discriminated against or if discriminated against actions can be taken, fighting the HIV/AIDS pandemic in the Caribbean would not be easy. Additionally, keeping credible data on Sexually Transmitted Infections, part icularly HIV/AIDS would be next to data collected. There is also the lack of cooperation in the area of contact tracing and partner referrals for counseling and treatment. Thi s hinders the efficiency of HIV/AIDS surveillance and makes it difficult to determine the extent of exposure. The issue of confidentially is also a major concern. People who may require HIV testing are hesitant, for fear that their identity might be know n, thereby exposing them to prejudice, discrimination, rejection and loss of employment.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 What can we do to break or remove the stigma and discrimination? SECTION 2: OBJECTIVES OF ASSESSMENT To collect background information on the status and c ontents of law, policies and practices impacting on PLWHA, vulnerable groups and other affected communities in the following areas but not limited to: o Public Health Legislation

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Criminal Laws and Prison Laws o Anti Discrimination Laws o Privacy and Confidentia lity Laws o Employment, Social Security and Insurance Laws o Consumer Protection and Housing Laws To assess the changes needed in priority areas identified above to achieve therein the incorporation of human rights and non discrimination practices in national policy and legislation in keeping with international guidelines, best practices and commitments, so as to strengthen national capacity to reduce the spread of HIV/AIDS.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 SECTION 3: REVIEW OF THE LAWS

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 THE CONSTITUTION OF GRENADA The Constitution is the supreme law of Grenada; its provisions are entrenched and cannot be changed without strict and onerous procedures being followed. Chapter one (1) of the Constitution entitles every person in Grenada to certain fundamental rights and fr eedoms and it protects those rights. Among those rights are the protection of right to life, protection of right to personal liberty, protection from inhumane treatment, protection from deprivation of property, protection of freedom of movement and protec tion from discrimination. Many of these fundamental rights and freedoms could be used to deal with violations of the human rights of PLWHA and persons affected by HIV/AIDS. Section sixteen (16) of the Constitution gives to every person who alleges that a ny of their fundamental rights and freedoms have been, is being or is likely to be contravened the right to apply to the High Court for redress.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The problem here, however, is that these are rights guaranteed between the State and its citizens. These rights could therefore only be enforced against the State. While a citizen could seek redress for a breach of his/her fundamental rights and freedoms brought about by action of the State he/she cannot likewise complain about breaches inflicted by his/her fellow citizens. PUBLIC HEALTH ACT, CAP 263 The Public Health Act, (Cap.263) is the law that regulates the public health of Grenada. It is a very old law passed on the 2 nd November, 1925. It has had very few amendments since that time. Needless t o say it was around way before the existence of HIV/AIDS and has not been modified to take this disease into consideration. This Act sets up a Sanitary Authority with the Chief Medical Officer as its Chairman. This Act also makes provision for the appoin tment of Public

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Health Inspectors. Sections 8 16 deals with the operation of bake houses. Section 8 makes it unlawful for anyone suffering from an infectious disease to be employed to work in a bake house. There is a requirement for persons to get a med ical certificate stating that he/she is free from such diseases. The certificate is to be kept by the owner or manager of the establishment for a period of twelve months. The medical examination is to be undergone every year in the months of June and Dec ember by anyone cooking in a bake house. appearing in PART II of the Public Health Act where infectious diseases or tuberculosis, syphilis, erysipelas, lupus, yaws, itch or any open or was not known to medical science when these laws were passed in 1925 the ordinary meanin

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 World Health Organisation by pathogenic micro organism, such as bacteria, viruses, parasites or fungi; [and] can be spread, directly or indirectly HIV/AIDS is caused by a virus and therefore the part dealing with bake houses would incorporate HIV/AIDS as an infectious disease since the legisl ation. We could cross reference (Part II) of this Act with (Part IV). Part IV, the In s small pox, chicken pox, alastrim, leprosy, poliomyelitis, yellow fever, cholera, diphtheria, membranous group, the disease known as scarlatina or scarlet fever, and fevers known by any of the following names: typhus, enteric group, typhoid and para typho id, relapsing, and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 includes any other infectious disease to which this part has been This definition is specific and definitely does not include HIV/ADIS nor any other infectious disease not speci fically mentioned in the definition. regulations made by the Minister. Part V of the Public Health Act is headed Epidemic and Endemic Diseases Section 59 gives to the Sanitary Authority the power to make regulations for the treatment of persons effected with any epidemic, endemic or infectious disease, and for the prevention of such disease and more particularly for the isolation and detention of persons suffering from s

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 and it could be successfully argued that the ordinary dictionary meanings of those words apply. In such a case HIV/AIDS could be included. It is instrumental al so to look at the Public Health Regulations made under the Public Health Act. Regulation 6 seeks to extend the definition of tuberculosis, infantile paralysis, cerobro spinal meningitis, Spanish This extended definition is restricted to Part IV of the Act. It follows, therefore, that whenever the term infectious diseases is used in the regulations, unless that regulation is tied to Part IV of the Act, the term would be given its ordinary dictionary meaning and the disease HIV/AIDS could be captured.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Of note are regulations 87 100 which deals with Epidemic, Endemic and ical officer the duty of visiting without delay, any person who he is aware or suspects of suffering from an infectious disease and reporting the facts immediately to the Chief Medical Officer. The house where an infected person resides could be isolated and the police notified to enforce strict observance to the isolation. Regulation 90 gives to the Sanitary Authority the power to remove the affected person to a hospital. The regulation also makes provision for the hoisting of a yellow flag by day and a red lamp at night over an isolated house or hospital and notices posted in the vicinity and with the local press warning all persons against communicating in any way with persons within such hospital or house. While we have not had widespread use of the se regulations in relation to HIV/AIDS we must be aware that they exist and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 ensure that their application is not extended. We have had cases of infected persons being isolated within hospitals especially when HIV/AIDS first came to light. Regulation 111 to 118 deals with the interment of persons dying of an infectious disease. These regulations give directions as to where such bodies could be buried, the depth of the grave and the type of grave. Importantly, regulation 116 speaks to prompt burial direct who has died from an infectious or contagious disease shall remain unburied THE POLICE ACT, CAP. 244 Section 16 of the Police Act (Cap.244.) sets out the qualifications of persons for appointment to the Police Force. A candidate is required to pass a Regulation 5 of the Police Regulation puts it slightly differently. It states that

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 by a Medical Officer appointed by the Chief Medical Officer for the purpose, to be in good health, of sound constitution and fitted both physically and mentally to perform the duties of a police In either case it is clear that a candidate mu st undergo medical examination before he is admitted to the police force. It is ironic, however, that the Act and the Regulations makes no provision for the continuing health status of a police officer. THE QUARANTINE ACT, CAP. 271 Grenada s Quarantine Act is dated 1 st December, 1947. This is long before the known introduction of HIV/AIDS. The Act was geared to deal with the known infectious diseases of that time. Quite frankly, this law has not been used recently. This Act however, sets up a Quarant ine Authority which has the power to quarantine persons arriving or leaving Grenada by means of

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 ship or aircraft. This Act gives to a Health Officer the authority to isolate any person suffering or suspected to be suffering from any infectious disease un til in the opinion of the Health Officer that person is free from infection or though not free from infection he does not pose undue danger to public health. disease and include o pen pulmonary tuberculosis but does not include venereal disease. Since HIV/AIDS is an infectious disease, it is conceivable that this legislation could be used to isolate persons infected with HIV/AIDS arriving or leaving Grenada by ships or aircraft. THE HOSPITALS ACT, CAP 135 This Act provides for the detention of a patient suffering from a contagious

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 infectious disease by the chief medical officer. Section 17 reads as follows: So long as any patient in a hospital continues to suffer from a conta gious or infectious disease, it shall be lawful for the chief medical officer of a hospital to detain such person therein for such time as may in his judgment be necessary for the purpose of securing the public against the spread of such contagious or i nfectious disease, and for such purpose to take all reasonable measures to restrain such person within bounds and to prevent Section 18 goes on to give to any medical officer of the hospital, any police officer or sanitary officer the auth ority to pursue and apprehend any person detained under the authority of section 17 who have absconded without having been discharged. THE PRISIONS ACT, CAP 254

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Section 26 of the Prisons Act, (Cap. 254) gives to the Commissioner the authority, if he rec eives a certificate from a medical officer stating that a prisoner is suffering from a communicable disease, to direct the removal of that prisoner to a hospital until the medical officer in charge of the hospital certifies that the prisoner has ceased to require treatment at that hospital. is not defined and it is unclear whether HIV/AIDS fits into this expression. It may be said that this provision is helpful in that it authoriz es the Commission to seek medical assistance for a prison inmate; it does not go on to protect the medical records of the prisoner. Section 51(2) gives to the Minister the power to make regulations governing the medical examination, measuring, photograp hing, taking of fingerprints One could argue that the Minister could under this provision make

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 regulations protecting the medical records of the prisoners. This however has not been done. THE REGISTRATION OF BIRTHS A ND DEATHS ACT, CAP. 280 Though as the name implies, this Act deals with the registration of births and deaths, we are particularly concerned here with the registration of deaths. Section 39 makes provision for a medical practitioner to furnish a certifica te of death setting out the cause of death of each person that dies. This is important having regard to the prior discussions regarding the Public Health Act. If the cause of death of a person is given as HIV/AIDS related, for example, and that disease is interpreted as an infectious disease under the Public Health Act, that burial would have to take place within twelve hours. THE IMMIGRATION ACT, CAP. 145

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The Immigration Act gives to an immigration officer the authority to admit aliens into Grenada. Sec tion 4 (I) of that Act states that an immigration officer, shall not give permission to an alien to enter Grenada if the alien is a practitioner to be suffering from a contagio us or infectious disease which person suffering from a contagious or infectious disease ought not to be given permission to enter Grenada. The Act goes on in section 8, to give to an immigration officer the authority to grant a temporary permit to sick persons to enter Grenada. Section 8 states grant a permit for a alien suffering from a contagious or inf ectious disease to remain in Grenada temporarily for the purpose of treatment, subject to such conditions as the medical practitioner may deem necessary for the protection

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 These provisions could be used to keep persons infected with HI V/AIDS from entering the State or only allowing them to enter specifically for the purpose of receiving treatment. Since HIV is not spread through casual contact it is clear that these restrictions do not protect the public from this particular virus. Th ese provisions therefore should never be used to keep out persons infected with HIV/AIDS. THE INSURANCE ACT, CAP. 150 It is common knowledge that insurance companies require a medical examination before they offer persons life insurance policies. The re sults of these medical examinations are not protected under this Act. If a person is found to be infected with HIV/AIDS or any other ailment they are either denied coverage or the premium is weighted to such an extent that the effect is the same.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 What if the person is infected with some disease after the insurance policy is in existence? Section 89 of the Act seeks to deal with such a situation. It relating to insurance shall o perate to except an insurance company from liability under the policy or to reduce the liability of the company under the policy on the ground of any matter relating to the state of health of the person whose life is insured, other than the ground of the p roposer s having, when making the proposal or there after and before the making of the contract, either, (a) made an untrue statement of his knowledge and belief as regards the matter, or (b) failed to disclose to the company something known or believed by THE NATIONAL INSURANCE (Benefits) REGULATIONS, CAP. 205

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 These Regulation made under the National Insurance Act makes provision for sickness benefits. Regulation 3 provides that an insured person who is incapable of work a s a result of some specific disease, bodily or mental disability shall be granted a sickness benefit. This provision deems an insured person incapable of work if he/she is required to be absent because he/she is under observation by reason of being a carr ier or having been in contact with a case of infectious disease. This is interesting as it authorized the payment of a benefit to someone who, having been exposed to an infectious disease is under observation. THE RENT RESTRICTION ACT, 287 One of the c onstant complaints is that landlords try to evict tenants from premises once they learn of that tenant s health status. While the Rent Restriction Act does not deal specifically with persons suffering from illness,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 it seeks to protect persons from unjusti fied eviction. Section 24 makes it an offence for any person to deprive a tenant unlawfully of premises or attempt to do so. The section also makes it illegal for any person with intent to cause a tenant either to give up occupation of premises or to re frain from exercising any right in respect of the premises. If the landlord does acts calculated to interfere with the peace and comfort of the tenant he commits an offence. For example, if the landlord turns off the water in order to evict the tenants, he commits an offence. A person found guilty under this section of such an offence is liable to a fine two thousand dollars or imprisonment of one year. A Magistrate also has the power to reinstate the tenant in a case where he was actually illegally evi cted. This Act therefore, does offer some protection to a tenant from abuse by his landlord. THE EMPLOYMENT ACT, 1999

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The Employment Act, 1999, was passed to set out the legal rights and responsibilities of employees and employers. One of the things th at the Act seek to do is to prohibit discrimination with respect to recruitment, training, promotion, terms and conditions of employment, termination of employment or other matters arising out of the employment relationship. The Act actually lists grounds on which an The Act lists disability but one would have to stretch the definition of disability Conceivable therefore, an employer would not offend this section if he fails to employ a person based only on the person s HIV status. Section 74 of the Act clearly prohibits the dismissal of an employee unless

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 there is a valid re ason for doing so. That section goes on to state grounds that do not amount to valid reasons for dismissal. Listed as grounds that do not amount to valid reasons for dismissal are a person s race, colour, national extraction, social origin, religion, po litical opinion, sex, marital status, family responsibility or disability. Here again the question is whether a person s positive HIV status could be viewed as a disability thereby preventing its use by an employer. This remains an open question. An emp loyee s temporary absence from work because of sickness cannot be used as a ground for dismissal. Could an employer demand that the employees take an HIV test as a condition of continued employment? The Act does not give an employer that right. This matte r was taken to court in Botswana. In Diau v. Botswana Building Society (BBS), Case No IC 50/2003, Industrial Court, an employee refused to take a HIV test and was dismissed. The Court ordered her reinstatement and awarded her compensation.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The Act in sec tion 80 also gives an employee the right to terminate the contract of employment where the employer s conduct has made it unreasonable to expect the employee to continue his/her employment. In such a case the employee is deemed to have been unfairly dismi ssed. If therefore a person is forced out of a job by the action of his/her employer that person could bring an action against that employer. The aggrieved person would complain to the Labor Commissioner. If or when the Labor Commissioner fails to settl e the matter, it is referred to the Minister. If the Minister then fails, the matter is referred to the Arbitration Tribunal. Where the Arbitration Tribunal finds for the employee they can order the reinstatement of the employee or the reengagement of th e employee to a position compatible to that in which that employee was engage prior to his dismissal. They could also make an award of compensation in such a situation.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 THE EDUCATION ACT, 2002 Section 14 of the Education Act, 2002, confers the right on all persons in Grenada to receive an education appropriate to his or her needs. Section 15 mandates the Chief Education Officer to provide an education programme for every person of compulsory school age who resides in means any age from five years to sixteen years inclusive. The Act however, by section 22(3) places on a parent of a child who is under the age of eighteen, the duty to make known to the principal of the school, information of any medical or other conditio n that the child has. This that this information could be of great importance, especially in an

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 emergency. Of great concern however, is what is done with the information once it is collected. Section 23, impose on every principal the obligation to establish and maintain a student record for each student. This section also gives to the student, the parent and sponsor of the student, the right to examine the record. A sponsor is defined by the Act to mean a person or body paying the fees and or maintenance expenses of a student at an educational institute, student is on a scholarship, the donor is entitle d to view that student s record It might be argued that while the sponsor is entitled to the student school performance records. The Act h owever does not distinguish between the two. The Act in section 23 goes on to make it an offence for anyone to disclose information from a student s record in contravention of the Act.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 THE CRIMINAL CODE, CAP. 1 (1994 Continuous Revised Edition) Sectio n 137(29) makes prostitution illegal in certain circumstances. It states not exceeding twenty It would seem that this section is aimed at the person who operates on the streets and not one who operates within premises. It could be said therefore that the prostitute within a brothel is not committing a crime under the Criminal Code. When one looks at the fine attached to this offence the offence seems almost innocuous. While this may be so the stigma attaches ever so forcefully to the sex worker who operates in this way or indeed any other way. The law in this area assumes that a person engaged in sex work would be female and while it deals with is silent with respect to someone who procures a male to do the same.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The position of the person who procures a sex worker to ply h er trade, in Whoever (a) procures any female under twenty one years of age to have unlawful with any other perso n; (b) procures any female to become, either within or without Her (c) procures any female to leave this State, with intent that she may become an inmate of a brothel elsewhere; (d) procures any female to leave her usual place of abode in this State with intent that she may, for the purposes of prostitution, become an

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Section 190 criminalizes th e holding of a woman against her will in a brothel or in any premises so that she may be unlawfully and carnally known by any man. The penalty in this case is two years imprisonment. Some countries have actually legalized sex work. What this does is to bring the sex worker within the protective fold of the law thereby making it possible for these persons to come forward and take advantage of the services provided within the health care system. Although the law was clearly designed to punish to a greate r extent the person who facilitates a woman in the commercial sex business the society places much more stigma on the shoulders of the sex worker. It is important to note that the laws of Grenada refers to sex worker as a female and does not recognize th e male who is involved in sex work. Therefore this issue

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 must be incorporated into any future amendments. The Criminal Code also deals in some fashion with homosexuality. I put it this way because of the way the section is worded. Section 431 states: If any two persons are guilty of unnatural connexion These provisions marginalize both of these groups and make it unlikely that would come forward to seek any kind of assistance. These pr ovisions need to be looked at for possible reform. connexion persons it also contemplates a situation of unnatural carnal knowledge by force. Section 183 states that, whoever is convicted of un natural carnal knowledge of any person,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 with force or without the consent of the person, shall be liable to Women are also considered a vulnerable group. T his is so because in many instances they are exploited sexually by men. The Criminal Code in section 177 makes rape a criminal offence punishable by fifteen years female of any age definition it is clear that only females could be raped. Section 179 makes it an offence for anyone to have sexual intercourse with a female under sixteen years of age, whether with or without her consen t. Sections 183A, 183B and 183C added the crime of incest to the Criminal Code. Quite significantly however, the law does not make any provisions for the protection of boys as it relates to sexual matters.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Another vulnerable group of women consist of tho se who have a mental incapacitated. Some of these women are taken advantage of sexually and so the law tries to protect them. Section 181 provides that, whoever unlawfully and carnally knows any idiotic or imbecile female, whether with or without her con sent, under circumstances which do not amount to rape, but which prove that the accused person knew, at the time of the commission of the offence, that the female was an idiot or imbecile, shall be liable to imprisonment for two It is also to be n oted that while at one time it was believed that a husband could not be guilty of committing rape against his wife, case law now makes it clear that he could. (R [1992] 1AC 147) Although there is this legal protection, on many occasions women do not

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 com e forward after being raped because of the process that they go through both psychologically and by the legal system. The problem starts with the medical examination after the incident. In many cases people accuse the women of inviting the attack, either by putting themselves in the wrong situation, wearing clothes that are too revealing or leading the men on. Once the matter reaches to court the matter becomes very public as in many cases the trial proceeds in an open court. There is no formal require ment requirement that the evidence of rape must be corroborated. This means that there must be independent evidence supporting the allegation of rape. (Ensor [1989] 1 WLR 497) issue in the case. All these things combine to make it difficult for women to come forward with an allegation of rape. Indeed, in many cases they keep the incident to themselves and do not come forward f or treatment. The

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 effect of this on the possible spread of HIV/AIDS is clear. This whole area of the law needs review. The law ought to be changed to o the discretion of the particular judge. THE CHILD PROTECTION ACT, 1998 This Act is designed to protect children at risk. It sets up an Authority and gives that Authority the capacity to apply to a court for an order of protection with respect to a chil d who is in need of protection. The Act considers a child to be at risk, inter alia, where that child has been sexually molested or exploited where the parent knows or should know and fails to protect that child. Also, a child is considered at risk, in c ircumstances where the child is in substantial risk for that type of abuse. In making an order of protection, the court may order (a) that the child be

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 placed with or returned to a parent, subject to the supervision of the Authority for a period of at lea st three and not more than twelve months; (b) that the child be made a ward of the Authority and be placed in a child care home or foster home for a period not exceeding twelve months; or (c) a combination of (a) and (b). This Act also gives to the Author ity the responsibility to establish and approve child care homes. Among some of the things that the Authority must do is to appoint a doctor for each child care home. The doctor has the responsibility to compile a medical record of each child in the home. Section 25 mandates the person in charge of a home to inform the Chairperson of the Authority and the Minister of any infectious disease contracted by a child. The parents of the child must also be informed. This Act also makes provision for foster pare nts. It is important to note that the Act specifically prohibits single men from being a foster parent.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 SECTION 4 CONSULTATIONS

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Consultations were held with the following: 1. Prisoners and prison Officer, 2. The National Youth Counci l, 3. Persons living with HIV/AIDS, 4. Caregiver of Persons living with HIV/AIDS, 5. The Grenada Chambers of Industry and Commerce/GEF, 6. Public sector representatives, 7. Staff Nurses at the General Hospital, 8. Grenada Nursing Association, 9. Public s ector workers and general Public in Carriacou and Petit Martinique, 10. Grenada Red Cross Society, 11. The Hotel and Tourism Association, 12. The Grenada National Council of the Disabled, 13. 14. Grenada Bus Association,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 15. GNOW (through the National Assessment Team), 1 16. Grenada Coalition on the Rights of the Child (through the National Assessment Team), 17. Grenada Trade Union Council (through a brief submitted to the Consultant). The consultation turned out to be very in teresting and enlightening. There was general consensus that there was stigma and discrimination against persons living with HIV/AIDS and also their families. The groups felt that the question of quarantine of persons with HIV/AIDS is not acceptable. Th ere is however, no known case of any person in Grenada having been quarantined under the Quarantine Act because of his HIV status. With regards to employment all the groups believes that it is wrong to 1 The National Assessment Team is a multi stakeholder committee that provides strategic guidance to the National HIV/AIDS Assessment Process.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 discriminate against a fellow worker who is infected with HIV/AIDS. Only one person in Carriacou expressed the view that she would not work with someone if she knows that the person is HIV positive. It was also expressed by another person in the business sector his business would not employ someone if it wa s known that that person was HIV positive. This was said to be a purely business decision as it was felt that that infected person would eventually become a burden to the company if and when they developed AIDS. This particular employer drew a parallel w ith employing a pregnant woman. The pregnant woman, it was said; after she had her baby would have to be paid while another person had to be employed to do her job during her maternity leave. Thus the company would have to pay two persons for doing the s ame job. This employer however said that if an existing employee was discovered to be HIV positive that person would not be dismissed but be given all the support possible including medication. There was consensus that the ILO Code of Practice for HIV/AI DS be adopted.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 All the groups expressed the view that in order to conquer stigma and discrimination, education was a key factor. They believed that educating persons on the issues relating to HIV/AIDS should begin at the primary level. It was learnt that at the moment there is in the general school curriculum a course dealing with family life and health issues. T his could be an avenue through which HIV/AIDS information is disseminated. At present, parents have the option to indicate whether their chi ldren should take the class. The groups believed that these classes should be mandatory. There were great discussions in all the groups about the distribution of condoms both to the general population and to prisoners. There was general consensus that condoms should be distributed to the general public, the question was, how? It was concluded that one method of condom distribution should be through vending machines in

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 where perso ns, especially young persons, could go to get information on all matters including health. These areas too could serve as distribution points for condoms. The Health Centers and other institutions should continue to serve as distribution points. Distrib ution of condoms to prisoners was felt to be more problematic. The prison authorities believe that the distribution of condoms in the prison would be an admission that homosexuality exists in the prison and that this might also be condoning homosexuality. Some prisoners, however, admitted that homosexuality exists in the prison. Also, we must remember that homosexuality is a criminal act in Grenada. Many persons felt that the distribution of condoms in the prison would be encouraging an unlawful act. I t is interesting to note, however, that some of the prisoners themselves opposed the changing of the Criminal law to decriminalize homosexuality.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The consultation shows generally that while many people would support the distribution of condoms in the pri son for health reasons, there is general opposition to repealing the laws against homosexuality. Although research conducted by the NAD suggests otherwise. It could be Vulnerability Nations Human Rights Committee. This Report was submitted to the UN as a shadow report by GrenCHAP, Hope Pals Foundation and the Grenada Human Rights Desk et al. The Report focuses on the laws relati ng to homosexuality and commercial sex work and advocates for a repeal of those laws on human rights grounds. This report has already generated some debate especially on the subject of homosexuality. A major area discussed was that of confidentially. The discussions revealed that in many cases a person s HIV status was revealed to the general public through some source where confidentiality should have

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 been paramount. This problem has prevented many persons from presenting themselves for HIV testing It was revealed in Carriacou that persons refused to be tested because when tested the results were known by the public before they were known by the tested person. Persons had several suggestions to deal with this problem. It was suggested that all in formation dealing with testing should be individually coded to protect the person s identity. It was also suggested that the old practise of public officers signing an oath of confidentiality, be revived. Any officer drastic measures taken against him. Interestingly, a suggestion that came from one group was that where there was a breach of confidentiality, say in an office, and the culprit could not be detected, measures should be in place to punish everyone in that office. This it was felt would create a system of self policing. One person felt strongly that in some cases confidentially actually

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 worked against infected persons. It was explained that an agency was giving help to the general public but wanted to inc lude HIV infected persons in an anonymous way. That agency sought information on HIV infected persons but was denied the information on the ground of confidentiality. These are cases it was suggested where not sharing the information might actually hurt the persons everyone was trying to help. There is no doubt that co operation between agencies on matters like these is paramount. The nurses believe that coding should be extended to prescriptions in order to protect persons from stigma and discrimina tion. They however have concerns because they believe that the full information of a patient s medical history ought to be made available to the caregivers so that the treatment of the patient is not compromised. Also of concern for many of the nurses wa s the issue of confidentiality in situations where an infected person continues to engage in risky sexual

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 behaviour without the knowledge of their sex partner. There is a case where an HIV infected woman continues to have children. There is authority to suggest that in cases like these the interest of the community becomes paramount and it is permissible for the unsuspecting partner to be at risk of HIV infection as a result of informatio n gained through a confidential relationship (R v. Cuerrier ). The Public Health Act requires that anyone intending to sell food to the While the Act does not name HIV as one of the factors to be taken into consideration, the discussions reveal that it is routinely done. One but was convinced that she would not be successful because of her status. This clearly ind icates the mindset of some PLWHA who routinely shy away from situations for fear of rejection and discrimination.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The Grenada Hotel and Tourism Association believes that while an HIV p ermit one should be. This is so especially for some classes of employees. Chefs, they said are prone to cut themselves and an infected chef could be a danger. Many persons indicated that in order to get a life insurance policy they were required by the i nsurance companies to do an HIV test. The results of the test in many cases are given either to the insurance agent or directly to the insurance company, without the concurrence of the person tested. This was seen as a major breach. The problem apparent ly goes further. One PLWHA indicated that when an insurance company with whom she had an existing insurance policy revoked. Revocation of a life insurance policy under such circumsta nces is clearly illegal. However, she was not aware of this until after the

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 limitation period for bringing an action against the insurance company had expired. This clearly shows that while there is a general need for educating the public on HIV/AIDS, it is equally important to educate PLWHA about their rights and responsibilities. The issue of testing young persons was also discussed. This is important because there are young persons who would like to be tested without the consent of a parent or guardi an. There is consensus that a child needs the permission of a parent before he could to be tested. The question is, at what age is a child free to be tested without parental consent? The law in Grenada has several age limits up to which parental permis sion is required. The age of majority is twenty one (21), the age at which someone could be married without parental consent is twenty one (21), the voting age is eighteen (18) and the age of sexual consent is sixteen (16). Many persons hold the view tha t the age at which a child should be

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 tested without parental consent ought to be synchronized with the age of sexual consent. Other persons, however, express the view that the age of sexual consent is too low and ought to be increased. Some persons also held the view that there ought to be no age at which a child needed parental consent to be able to be tested. It was felt that there may be many reasons why a child does not want to obtain parental consent. It may be that the child is being sexually abu sed in the home and while the Child Protection Act does offer some protection it might not be the appropriate method to be used at that time. The idea is that all persons at risk should have the right to get tested. The consensus is that mandatory testi ng ought not to be done under any condition. However, one group felt very strongly that there should be mandatory testing of the whole population at least every two years. This vol untary decision.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 It was however reported that all pregnant woman were tested with or without their consent. It would appear that pregnant women are not even asked to give their consent to being tested for HIV/AIDS. Some groups supported mandatory testin g of pregnant mothers. Some nurses also felt that all persons who are undergoing any medical procedure involving blood or body fluids should be tested. There was consensus however that health practitioners should at all time use the universal infection control precautions. It was discovered that in many cases the universal infection control precautions were only used to deal with infectious cases. This in itself promotes stigma and discrimination as it advertises to all and sundry the nature of the pat universal infection control precautions should be used at all times. The lack of these measures also exposed persons to infection in cases where they ought not to be.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 What about willful transmission of HIV? Most people felt that the re should be a law against willful transmission of the virus in cases where it could be proven that a person knowingly engaged in acts that intentionally transmitted the virus to another. To be noted is the Canadian case of R v. Cuerrier where the Supreme Court held that where sexual activity posed a significant risk of serious bodily harm there was a duty on an HIV positive person to disclose his/her status. Failure to do so would invalidate any consent to sexual intercourse thereby making the act an ass ault. An interesting recommendation emanated from the consultations, it was suggested that a health ombudsman be appointed. This ombudsman would receive and deal with complaints regarding health issues. It was felt that the ombudsman should deal with co mplaints relating to health issues and not be restricted to HIV/AIDS issues. A National Consultation was also held to discuss the issues. This

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 national consultation was addressed by the Minister of Health, Hon. Ann David Antoine who is the Chair of the National AIDS Council. She HIV/AIDS. She shared with the meeting the tangible ways in which attitudes had to change for th e fight to be successful. About thirty persons attended this consultation drawn from the following groups: o Grenada Red Cross Society o Grenada National Council of the Disabled o Grenada Bus Association o Grenada Nursing Association o o Gren ada Medical Association o Grenada Bar Association

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Ministry of Carriacou and Petite Martinique Affairs o The Youth Empowerment Foundation of Grenada Inc. o National Student Council o Consultants Attached to the National AIDS Directorate o Clico Insurance o St. Augusti ne Medical Services o Grenada Hotel and Tourism Association o GrenCHAP o Hope Pals Foundation o U.S. Peace Corps, and o UNDP. This National Consultation generally supported the outcome of the other stakeholder meetings that were held. Some of the broad recommenda tions that were made include:

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Employment: That there is a need for a broad legislative framework to provide equal opportunity for employment regardless of sexual orientation, HIV or disability status; Confidentiality: Mechanisms should be put in place t o provide redress Willful infection: Persons who intentionally transmit HIV should be held liable; Public Health Act : the Public Healt h Act should be clarified. Secondly, the Act should be amended to remove Regulation 90 which speaks to the hoisting of a yellow flag by day and a red lamp at night over a house or hospital which houses an infected person. This regulation promotes discrim ination towards PLHWA;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Age of Consent: Age of consent for VCT without parental permission should be linked to the age of sexual consent. An exception should be made for cases of sexual abuse; in these cases a social worker will act as a guardian for the child; Mandatory testing: Some participants recommended that mandatory testing be conducted on all pregnant women receiving service through the public health care system. Additionally, it was recommended that HIV testing should be part of routine medical examinations; Prison Act: It was recommended that this Act should be amended to allow for distribution of condoms within the prison; Insurance Act: It was recommended that this Act be revised to prevent discrimination of PLWHA;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Police Act : The Act sho uld be amended to accommodate an annual physical exam, and a protocol for dealing with a police officer who was diagnosed with HIV while employed with the Royal Grenada Police Force; Constitutional review: Future constitutional review should include the v iews of vulnerable communities including PLWHA so that their concerns regarding stigma and discrimination and other issues could be taken on board; and Immigration Act : defined to avoid ambiguity. SECTI ON 5: INTERNATIONAL GUIDELINES, BEST PRACTICES AND COMMITMENTS

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 More than 20 years after the first AIDS case was diagnosed, HIV is still with us. Despite progress in HIV prevention and treatment, this debilitating, deadly disease continues to be a threat. A virus that many hoped would be eradicated in the 1980s, has now infected and killed millions around the world. Faced with the catastrophic impact of HIV globally and rising rates of infection at home, we are at a turning point in our fight against HIV. Do we accept that HIV will be with us always, a chronic debilitating illness that will continue to steal people's lives, or do we redouble our efforts to stop the ravages of this preventable disease? It is believed that we have marginalized the issues rega rding persons living with HIV/AIDS (PLWHA) and the problems that they have to live with on a daily basis. Yes, we know unemployment or getting fired from a long time job are early signs of the associated stigma along with people on the outside or even in homes refusing to be involved with PLWHA or

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 even touch them. We have seen the results of all the misinformation about HIV/AIDS, the way it is transmitted and what to expect from it. PLWHA in the Caribbean have the most to deal with as the communities are small and seemingly every one knows everyone else and so information is not secret for very long. Persons affected by HIV/AIDS are almost equally targeted. People in the Caribbean have shown that in some ways they are open to change in many areas. It is believed therefore that they could likewise change their approach to people living towards PLWHA and affected persons are changing. We as a people must stop making excuses for our approach to HIV/AIDS and other sexually transmitted disease. We must take privacy issues seriously and know that when these rights are violated great harm is done to the affected persons. It has to be drilled into everyone that it is not onfidential information. People have to be made accountable for their actions in this regard. The privacy issue is a

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 major hurdle that PLWHA have to deal with from their co workers, their neighbors and especially the people in authority; may they be the person who may be responsible for drawing blood from a patient or suspected pharmacist or laboratory technician. These individuals must know that PLWHA in the Caribbean, on the other hand, must take the time to educate themselves on the issue of HIV/AIDS, how it affects them, their rights and responsibilitie s. Other than discrimination and stigma, many persons living with HIV/AIDS have no idea of their rights and how they should be treated or not treated. They must know that although they are living with HIV/AIDS they are citizens and are entitled to the sa me privileges as other citizens. They are sometimes afraid to ask questions for fear of discrimination and for fear of information being passed along to the wrong person thereby further leading to stigma and discrimination.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 There have been instances where persons who tested positive for HIV/AIDS in Grenada had that information become public knowledge without their knowledge or authorization. Indeed in some cases the information was sent to others including places of business that the tested person may hav e dealings with, for example, insurance companies and employers. Happily, very few such cases are now known to occur. Grenada is a very small place in comparison with the other Caribbean countries which place us at an advantage to educate our people and a cquire a modem of control over this epidemic. It is clear that education is a key component in the fight against stigma and discrimination and a recommendation of educating people parish by parish could be an excellent way to proceed. The fight must be t he fight of every person living in Grenada. Once appropriate educational programmes are put in place we need to

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 petition the Government to change some of the existing legislations to reflect the reality of HIV/AIDS. We must look to other countries and ado pt the best practices that have developed in the universal fight against HIV/AIDS and to make the necessary legislative changes. Voluntary Counselling and Testing (VCT) Voluntary Counselling and Testing (VCT) is a critical strategy in HIV/AIDS preventi on and care synergy, providing benefits to those who test HIV positive and those who test HIV negative. For Voluntary Counselling and Testing to be effective, high quality counseling and testing services must be in place and the community must perceive th ese

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 services to be beneficial. Promoting Voluntary Counselling and Testing for behavioural change as a prevention strategy alone will have limited impact without quality services and or referrals for individuals who test HIV positive. Similarly, counsell ing an HIV positive individual on ways to prevent further spread of HIV without addressing the person's psychological and medical needs will have limited impact. Voluntary Counselling and Testing is recognized internationally as an effective and pivotal strategy for both prevention and care. Research in many countries including Trinidad, provides strong evidence that VCT is an effective and cost effective strategy for facilitating behaviour change. VCT was also identified as an important entry point to care and support. These findings have raised interest and support for VCT as a valuable component of comprehensive HIV/AIDS programmes among international organizations as well as the national AIDS pro grammes of many countries and donors.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The major barrier to VCT is fear of stigma; women in particular can face violence and loss of security in the form of shelter, food and relationships. It is particularly important with women to ensure that testing is performed and results given without breaches in confidentiality. Other barriers are the lack of available drug therapies, psychological support and clinical care for individuals who test HIV positive. Counselling itself is labor intensive and requires trai ning and supervision to assure high quality. As an entry point for prevention and care, VCT must be made available on a much larger scale. The use of simple, rapid HIV tests can decrease follow up in VCT. Lessons learned from VCT programming to date incl ude: o VCT can be offered by government, non government, community and private sector;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o The gold standard for VCT follows a regimen of pretest counseling, testing, as desired by the client and after informed consent is provided, and post test counseling, inv olving one or more sessions, depending on the client's needs. Individual risk assessment, risk reduction planning, and preparing for and coping with test results are integral components of pre and post test counseling; o A range of innovative service delive ry models can be applied depending on the context. These include variations on integration within the existing health facilities, freestanding and mobile services; o The model of choice should address cost considerations to guarantee sustainability of serv ices. Service sustainability remains a challenge in many settings, especially within non integrated sites where initial start up costs are provided by external international donors;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o VCT must be accessible and affordable for those at highest risk of HIV i nfection or those suspected to have HIV related illness. VCT should be available to the range of clients who may benefit from knowing their HIV status, including couples, individuals and young people; o VCT sites need to be adequately staffed by individuals with high quality training in counseling and testing practices; o VCT site managers must help staff sustain high quality service provision, retain skilled staff and prevent burnout among counselors; o VCT for couples must be widely encouraged and promoted. Co uples pre and post test counseling has significant benefits for addressing risk assessment and risk reduction planning, particularly for women. Targeting couples for VCT is also cost efficient ; o VCT design needs to address service promotion within the plan ning and establishment of high quality VCT services. This

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 includes identifying or strengthening other care and support services, community and hospital referral networks; o VCT services must to be tailored to the unique epidemiological, behavioural and soc ioeconomic context. The designs also can take into account stigma reduction and demand creation interventions; o In scaling up VCT or developing new VCT sites, a coordinated response by all stakeholders including partnerships among donors, government and non governmental organizations is crucial to ensure standardization of services in terms of quality of care and support offered to clients and to avoid duplication of services within the country; o Monitoring and evaluation systems must be established fro m the onset for both counseling and testing components. Counselling and testing protocols may vary from one programme to another based on the goals and objectives of the programme. Whatever approach is taken, the VCT intervention

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 must be evaluated regula rly to determine whether it is being provided in accordance with the predetermined protocol and is satisfying client needs; o Innovative approaches to VCT should be responsive to the specific needs of the country. These include VCT services for adolescents and integration of VCT practices within antenatal sites that can employ group pretest information sessions in settings with high client volume, as part of a comprehensive strategy for prevention of mother to child transmission; o VCT is a public health inte rvention Government and donors will need to assume some of the associated costs of VCT to ensure the widest possible access; and o The National Policy on HIV/AIDS does list VCT as one of the health sector responses and I know from my personal knowledge tha t persons are continually trained for this intervention.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Targeted Intervention: Grouping technical interventions to meet the needs of individuals, families, communities and society around specific targeted populations has been successful. Evidence increa singly suggests that the most efficient way to reduce the epidemic's spread is to reduce transmission among those who change partners most often. Preventing infection among those with the highest rates of sexual partner change prevents many more subsequen t, secondary infections. Prevention Concepts o HIV spreads faster among those with higher risk and greater vulnerability, for example, sex workers (CSW) and their clients;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o HIV transmission among lower risk subpopulations can be prevented by interrupting tra nsmission among higher risk subpopulations and bridge populations; and o Prevention resources should be directed more strongly to those with higher risk or vulnerability. Targeted interventions have led to successful risk reduction and decreased levels of HIV infection. Some examples; o A targeted intervention with sex workers in Abidjan, which combined BCC with condom promotion and STI services, reported condom use among sex workers with last client increased from 63 percent in 1991 to 91 percent in 1997 ( Ghys et al. 1998). o The Thai 100 percent condom programme has been associated with an increase in condom use among sex workers from 14 percent to 94 percent (Hanenberg et al. 1994). This programme created a policy incentive for brothels to insist on condom use by

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 fining brothels whose female sex workers test positive for STIs. The policy was backed up by legal enforcement of regular STI screening and treatment, condom provision and a comprehensive communications campaign. o In South Africa, condom sales rem ained low among women at high risk in a mining community, despite the introduction of a condom social marketing programme. The women indicated they were tired of receiving condom messages while other health issues were ignored. With the introduction of ST I services for the women, condom use began increasing among them (since 2000). As a result of these targeted interventions, fewer infections have been observed, not only in the targeted populations themselves, but also in the bridge and general population s. To apply the concept of targeted prevention, the subpopulations where risk behaviour is most concentrated and who are most vulnerable must be

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 identified on a localized basis. But sex workers and their clients, and men who have sex with men (MSM), are more likely to predominate, so targeted populations should be selected based on local data. An urgent priority, regardless of the state of the epidemic, is to rapidly expand and deliver prevention and care and support services to the majority of people at highest risk. Pilot projects have demonstrated the effectiveness of targeted interventions but, in most cases, coverage of the high risk population has been low. Linking Prevention and Care As pe ople infected with HIV progress to recurrent illnesses, the services they need change. Providing comprehensive care across a continuum, from home and community to institutional services and back, will ensure that the specific needs of clients and their fa milies are met. Effective referral systems must develop to ensure that people living with and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 affected by HIV/AIDS can benefit from the various community and institutional level services available. These services must not only be developed but must be ma intained. Integration of Targeted Prevention into Other Services and Sectors HIV/AIDS prevention efforts are more effective when programmes and activities are integrated into existing large scale infrastructures that operate across a range of sectors. Com bining delivery of HIV/AIDS interventions with other sectors, rather than expanding HIV/AIDS interventions independently, helps reduce costs, improve efficiency and maintain sustainability. But the potential for integrating HIV/AIDS programmes into other services, such as education, reproductive health, family planning or sex education, has not always been exploited fully by countries (Watts and Kumaranayake 1999). In addition to the public sector, integration is needed for civil society groups as well, s uch as trade unions and youth and women's associations.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Behaviour Change Communication Changing individual and community behaviours is an important factor in Behaviour Change Communication and plays different but related roles in HIV/AIDS and Sexually Tra nsmitted Infections. Community dialogue stimulates community and national discussions on the factors that contribute to HIV/AIDS, such as risk behaviours and the environment that creates them, and demand for information and for prevention, care and suppor t services. The following are important: o Advocacy Ensures that policy makers and key opinion leaders stay informed on the epidemic. Advocacy takes place at national and community levels. o Provision of information and education Provides individuals ba sic facts in language, visual and media formats they can understand, and motivates positive behaviour change.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Stigma Conveys the issue of stigma and attempts to influence the social response in all communications as it relates to prevention and care. Thi s is a particularly critical component of behaviour change. o Promotion of services and products It is important to promote information on available HIV/AIDS and sexually transmitted infections programmes and services. Services can include sexually transm itted infection treatment, voluntary counselling testing, support groups, PLWHA networks, mother to child transmission, clinical care and social and economic support. Consistent messages from a vari ety of legitimate sources must be disseminated in an interactive fashion to affect behaviour change. HIV prevention interventions aim to change individual behaviour, but community and societal level interventions must also be developed to change norms and behaviour at the group level. It is critical to support

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 and promote behavioural changes at the individual, group, community and national levels. Experience has shown that while HIV risk may grow quickly in a community or country, attitudes favoring prev ention and preventive behaviours are likely to lag far behind. The media can play an important role in promoting attitudinal changes and popularizing safer behaviours. When behaviour lag behind knowledge, mass communication can be used to stimulate dialog ue about risk behaviour in the communities, especially among the youth. Communication campaigns must be developed using behaviour change methods that are tailored to address different stages of the epidemic, since population subgroups, which are the target audiences, may be at different stages in the behaviour change continuum. Target audiences must be segmented and behaviour change campaigns developed for each group. For all of this to be effective, a national behaviour change

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 campaign must target specif ic groups with quality messages and interventions. intention to continue to use mass media to effect behaviour change. The intention is not only to use radio, television and newspapers but also, billboards, posters and leaflets. The policy also takes into consideration the utilization of the arts to disseminate information. This includes theatre, poetry, dance and music. I know of one particular theatre group that has heard the call and h as become very involved in the work of the National AIDS Directorate. Stigma is a critical issue to be addressed when developing behaviour change campaigns. Stigma is defined as a mark of shame or discredit on a person or group. In HIV/AIDS, stigma affe cts PLWHA, men who have sex with men (MSM), sex workers and other marginalized groups, together with persons affected by HIV/AIDS. Stigma often presumes a

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 negative behaviour on the part of those individuals, stigmatizing others. This manifests itself in a range of ways, from ignoring the needs of a person or group to psychologically or physically harming the stigmatized. The importance of addressing stigma in behaviour change campaigns transcends questions of compassion and humane treatment for programme s. Behaviour change programmes that address stigma can benefit from motivated persons or groups, such as PLWHA, SWs and MSM, who can work effectively for change as policy advocates and serve as caregivers and peer educators. This is why it was an importa nt step for the local MSM group to associate themselves with the Human Rights in Grenada A Shadow Report to the United Nations e Report itself have certain inherent flaws, it is in my view, a milestone in addressing some of the stigma associated with HIV/AIDS.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Condoms When speaking about condoms, most people only think about the male condom as a form effective protection agai nst HIV and other sexually transmitted infections. Access to condoms, whether male or female, is essential in prevention strategies in the fight against the spread of HIV/AIDS among the sexually active population at large. Condom use promotion and theref ore their distribution is one of the most effective HIV prevention interventions. We therefore must ask the following questions in order to attempt to keep up with the fight against the spread of HIV/AIDS: o Is there a national condom social marketing pro gramme? o Is there a national system for condom logistics and distribution? o Are condoms available in rural areas?

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Are condoms accessible to those at highest vulnerability and risk for HIV? o Are the condoms that are being distributed of a high quality? o Ha s the potential for increased coverage of sex acts with the female condom been assessed? o Are female condoms available? o Is there a guaranteed supply of male and female condoms? There are multiple approaches to marketing and distribution of condoms to the community. These include free distribution, targeted distribution, community based distribution programmes, and dissemination via health facilities, pharmacies and village stores. The distribution strategy can be coordinated among the different outlets t o achieve maximum availability of condoms. In Grenada there is great reliance on the health services for distribution. I must also say that the National AIDS Directorate plays an important role in condom distribution.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 However, it is important to improve the access and availability of condoms to all communities and vulnerable groups. People must also be educated on how to use condoms correctly. It cannot be assumed, as no doubt is now the case, that persons know how to correctly use condoms. A successful condom promotion programme should ensure that condoms are used often and consistently and properly in most high risk sexual encounters. A condom social marketing programme that reaches primarily the lower risk general population may not have a significan t impact on reducing HIV transmission. The female condom has been the subject of extensive studies in effectiveness, acceptability, cost effectiveness, training, and gender dynamics for the past decade. Study results have been positive. WHO and UNAIDS hav e encouraged introducing the female condom as a new method of preventing pregnancy and HIV infection. The female condom can be a vital component of reproductive health and HIV/AIDS

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 programmes. It should be introduced strategically to have the strongest, most cost effective public health impact. When trying to expand the response to the epidemic, all potential methods must be used strategically to increase safer sexual behaviours. While the female condom is available and are distributed in Grenada, they h ave not gained the popularity and level of acceptance of its male counterpart. The National Policy on HIV/AIDS does not deal in any comprehensive way with condom distribution and use. Management of Sexually Transmitted Infections Management of sexually tr ansmitted infections is a key strategy in HIV prevention because sexually transmitted infections increase individuals' susceptibility to HIV and their infectiousness with it. The behaviour that put individuals at risk for sexually transmitted infections a lso put them at risk for HIV. A prevention and care strategy, where prevention messages,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 such as condom use, are delivered with quality, nonjudgmental treatment services, helps individuals become more receptive to prevention messages. Research shows there have been several large scale interventions that demonstrate the potential impact of sexual transmitted infection control on HIV transmission. In this regard we can learn from other countries. Thailand reduced the incidence of curable sexual transmitted infections by more than 80 percent in less than five years through a comprehensive effort that included improved sexually transmitted infection treatment and targeted promotion of condom use in commercial sex establishments (100 percent condom policy). Du ring this period, HIV prevalence, which had been increasing rapidly, began to fall. Through sustained application of these interventions, Thailand stabilized HIV transmission early and averted a more extensive epidemic.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 There is also evidence that even mor e limited sexual transmitted infections interventions can reduce HIV transmission. In rural Mwanza, Tanzania, improving the case management of sexually transmitted infections through the syndromic approach in clinics reduced the incidence of new HIV infec tions by 40 percent. But in nearby Rakai, Uganda, mass antibiotic treatment of the sexually active population at nine month intervals resulted in no drop in most curable sexually transmitted infections or in HIV transmission. Some questions to be kept in mind are: o Is there a national policy for sexually transmitted infections case management? o Are there communication strategies to promote sexually transmitted infections services? o Are services available at the first point of contact? o Does the majority of the high risk population have access to acceptable services, especially youth?

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Are sexually transmitted infection services available through informal sector outlets? o Is there regular screening and presumptive treatment of the most important core and brid ging groups? o Are treatment medications widely available and affordable? o Are the relevant drugs on the essential drug list? o Are institutions and organizations able to train persons in syndromic management? o Are there ongoing supplies of treatment drugs w ithin the country? o Are sexually transmitted infections services linked to counseling and other HIV/AIDS services? Blood Safety Designing strategies and interventions to promote blood safety in developing countries requires planners and programme managers to

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 understand the many factors influencing behavioural practices that present challenges to changes. Factors to consider include: o Level of awareness of basic principles and concepts, such as voluntary blood donation; o Impact of HIV and hepatitis C virus on donor selection; o Need for appropriate technology; o Societal perceptions and behaviour concerning blood donation; o Political will; o Organization of blood transfusion services; o Behaviour change within the delivery system, such as reducing unnecessary bl ood transfusions; o Need for new training methods; o Need for system wide health care training; and o Linking VCT to blood safety.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 A reliable and safe blood supply is still out of reach for many countries. This is not the case in Grenada. Blood borne transmi ssion of HIV accounts for up to 10 percent of HIV infections in countries with limited resources. The vast majority of these infections can be prevented by: o reducing unnecessary transfusions by effective clinical use of blood; o educating, motivating, recru iting and retaining low risk blood donors; and o screening all donated blood for infectious agents. Grenada through its National Policy on HIV/AIDS lists as one of generally believed t hat blood used for transfusions is reasonably safe. It is important that high standards are maintained. It is also important that blood donors are properly screened and that a system of professional blood donors does not develop.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Intravenous Drug Use Eve n though intravenous drug use is not considered a problem in Grenada, it might be wise to keep the problem in mind even if no active programme is developed. Like any other programme HIV prevention targeting intravenous drug users is more effective and les s costly the earlier it is implemented, ideally before HIV is introduced into the population or before it spreads widely. There is evidence that HIV epidemics among intravenous drug users slowed and even reversed in developing and developed countries by i mplementing specific harm reduction strategies, including: o community based peer outreach; o increasing access to sterile injecting equipment; and o increasing access to drug dependence treatment, particularly methadone (Ball 1998).

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Where effective action h as been taken to stem HIV epidemics among intravenous drug users no single element has been found to be effective on its own. Comprehensive programmes based on community development principles and operating in supportive environments that, includes access to social welfare and primary health care, including drug treatment/rehabilitation programmes, are key components of successful approaches. It has been found that access to sterile needles and syringes is critical to a successful HIV prevention programme for intravenous drug users Stigma Reduction o In what ways is stigma hindering effective prevention and care interventions? o What role can BCC, VCT and other prevention and care interventions play in alleviating the impact of stigma?

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o What existing legal, political, human rights and policy contexts are related to stigma? o Are policies in place to enhance and protect the rights of PLWHA and persons affected by HIV/AIDS? o Has high profile disclosure occurred within the country? o Does the hospital and health c are setting play a role in perpetuating stigma? HIV/AIDS related stigma continues to inform perceptions and shape the behaviour of PLWHA, which can hamper prevention interventions. Developing policies to combat discrimination is crucial to any HIV preventi on programme. Stigma reduction is both a human rights and a public health issue. Stigma has effects at many different levels: o Prevention On the social level, stigma can cause target audiences to view those with or at risk of HIV/AIDS as the other or th em,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 programmes can result in audiences rejecting AIDS prevention messages when stigma is not addressed. On the individual level, ignoring stigma can cause people to de cide not to seek VCT or other medical care. o Quality of care Stigma can perpetuate negative practices among health care providers, such as secrecy, neglect and poor treatment of PLWHA. A behavioural change campaign aimed at increasing demand for a facilit y's services might not be effective, due in part to poor quality of care encountered by PLWHA. o Policy It is important to address stigma to facilitate enforcement of existing laws and end discriminatory laws and practices. Psychosocial Support Ongoing c ounseling helps individuals to accept their HIV status and develop a positive attitude. It can facilitate information sharing with partners or close family members who may also participate in counseling.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Disclosure, however, is still a very difficult proc ess as many persons felt that they would be stigmatized once their status was known. Psychosocial support can be provided at clinics, schools or community support groups. Caregivers also need psychosocial support. Caring for someone with a serious chronic illness is a physical and emotional challenge, even for the most dedicated caregiver. This is particularly true for nurses, counselors and caregivers in the home who provide the bulk of care for PLWHA. These caregivers also need support to help them do th eir jobs well, avoid "burnout" and keep going, free of HIV infection. Home based Care Home based care is defined as any care given to PLWHA in the home or community environment. This can involve people at different stages, for example, people who are chr onically ill at an early stage or those at the terminal stage of illness. Care can be provided by family caregivers,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 trained volunteers or health and social/support care providers. Home based care has emerged, in many countries over the past decade, as a valuable strategy to alleviate the strain on hospitals, families and communities, and provide PLWHA with a better quality of life. Home based care models generally take two forms, hospital/clinic based outreach and community based programmes Programmes can benefit by developing both hospital and community based components. These services are intended to provide comprehensive care for persons in the home and reduce the need for hospital admission. Home based care is an intervention strategy that aims to relieve the burden of an already stretched health care system. For PLWHA, there are clear psychological benefits to home care. It is a trusted environment and it provides opportunity for discussing care and prevention with the entire family. Home based care volunteers are often respected in the community and can mobilize communities for prevention and care.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 It is important to recognize that at the center of all HIV/AIDS work is the individual and the family. Individual and family needs are not limited to one category of intervention; they require prevention programming care and support, and strategies to mitigate the impact of the epidemic. All interventions must be integrated into existing health and social services systems and structures. While hom e care has many benefits, it often can be limited because it is time and resource intensive. As a result, home care programmes and family caregivers may not be supported fully. Outreach workers may be challenged to meet patients needs as caseloads escala te, reducing the frequency and duration of visits. Other difficulties include travel costs and travel time. Outreach work is demanding and workers require appropriate training and support. In some areas, trained community volunteers have been used exten sively as a link between family caregivers and outreach staff. For the family, caring for the PLWHA can be challenging. Because of the fact that home care may not be fully

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 funded, individuals may be cared for in overcrowded and impoverished conditions. This raises important issues regarding the potential to expand home care services. Alternatives to home care, such as hospice care or day care centers, have not been explored in many countries. Some faith based organizations can also play a vital role in providing care to PLWHA. SECTION 6: CONCLUSION When the majority of laws dealing with health issues were enacted in Grenada, HIV/AIDS was unknown. The laws of Grenada, therefore, do not specifically make provision for such a disease. It does not mea n, however,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 that HIV/AIDS issues cannot be brought within the scope of some of the laws. Take, for example, the Public Health Act and the Quarantine Act are used without the re striction of a definition. As previously stated, those sections would be interpreted using the ordinary dictionary meaning of the said terms as a result of which HIV/AIDS is likely to be included. The review of the laws of Grenada indicates quite clearly that in many cases are inappropriate to deal with HIV/AIDS. The fact that HIV/AIDS is not specifically mentioned in some of the other laws could actually be beneficial. This review however, shows that many of the laws of Grenada need to be amended to deal specifically in many cases with the problem of stigma and discrimination arising out of the issue of HIV/AIDS.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The public consultations showed that the issue of stigma and discrimination relatin g to HIV/AIDS was a very real one. While it is important to remove such stigma and discrimination through the legislative process, it is probably more important to deal with the problem through education. The whole issue of stigma and discrimination rela ting to HIV/AIDS is a major one for Government and the society as a whole. The human rights abuses meted out to both persons infected and affected by HIV/AIDS are well documented and need not be rehashed. Suffice it to say that stringent anti discriminat ion laws need to be put in place to protect HIV infected and affected persons from human rights abuses at the hands of fellow citizens. The provisions of all the human rights conventions that Grenada has become a party to should be incorporated into the do mestic law.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Our response to HIV must be based on key common values. These values identify what is important to all stakeholders involved and they serve as a basis for identifying, assessing and implementing the strategies required. We must as a peop le recognize that every person, regardless of sexual orientation, race, culture, gender or risk behaviour, is important and should enjoy the same fundamental human rights. Not one life is expendable. As a caring, compassionate society, we must take extra ordinary steps to protect the rights of the most vulnerable and address social inequities. This must be Charter of Rights could be developed so that the issues are clear to every o reproduced in the Appendix. The populations most affected by HIV/AIDS have diverse and unique needs that must be recognized and reflected in all programmes and services. It is important th erefore to make provisions for vulnerable groups because it is

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 these groups that are likely to go underground and not seek out the programmes and services provided, and included in these vulnerable groups are women, children, sex workers and MSM. Our child ren are particularly vulnerable and while the Child Protection Act is a step in the right direction and does give some protection to children, the question is, does it go far enough? Many of our children fall prey to sexual exploitation which in some case s does not amount to rape and are of such a nature that the criminal law is not geared to deal with them. For example, pornography involving children is not dealt with directly by our laws. This needs to be addressed. Grenada has become a party to the U N Convention on the Rights of the Child thereby undertaking to protect children from all forms of sexual exploitation and sexual abuse. However, many of the provisions of the Convention are not incorporated in our domestic laws. The result of this is tha t some of the rights provided for by the Convention are not enforceable through our laws. Government needs to ensure that all the

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 rights expressed in the Convention are expressly provided for in our domestic law. All people living with and vulnerable to HIV must have equitable access to high quality programmes and services relating to their care, treatment and wellbeing. It is important that all of the agencies that fund and provide HIV services must collaborate to meet the complex needs of PLWHA and peo ple affected by HIV and achieve common goals. We already got an idea of what the lack of this coordination can do and who are likely to be hurt by it. Lives are at stake and resources must be used wisely. The fight against any disease that affects and st igmatizes a small number of marginalized people takes committed people who are able to define the issues and convince the public that these issues deserve attention and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 persuade policy makers to make decisions that safeguard the rights of those infected an d affected. Leadership is needed not only within the community but within the government. It is therefore comforting to note that this initiative came out of a CARICOM Heads of Government decision which shows leadership and commitment at the highest level It is important that people living with HIV/AIDS be empowered and given the opportunity to participate in a meaningful way in identifying their unique needs and in planning, delivering and evaluating programmes and services that affect them. The respons e to the challenges of the disease will be more effective when the communities most affected are fully engaged in promoting their own health and wellbeing, and all services are client centered.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 When people infected with an illness are able to participate actively in their own care and treatment, and work with their peers to influence the policies and programmes that affect their lives, they generally report higher levels of satisfaction with their care, less stress, better quality of life, and improved hea lth. Their experiences contribute valuable knowledge and skills to the health care system, and enhance its ability to connect with others in their community. In spite of this, the capacity of people living with HIV and populations at risk to promote thei r own well being, to direct policies and services, and to assist in preventing HIV has been neither well utilized nor fully developed. To improve opportunities for peer led initiatives, we must acknowledge the contribution of people living with and vulner able to HIV and provide more opportunities for them to participate in a meaningful way in developing and implementing policies, programmes and services. Because so many people with HIV face other health issues, it is essential for HIV programmes to be inte grated with other health services. Further, so many of the factors that contribute to the spread of HIV, such as housing,

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 poverty and violence, lie outside the direct influence of the health care system, it is essential for health services to develop effe ctive partnerships with the other systems that shape our social environment, including social and housing services, the criminal justice system and correctional services. A holistic approach must be taken to deal with HIV/AIDS. The Caribbean region is cite d as one of the most affected regions in relation to HIV/AIDS. This is a whole Caribbean issue and requires a whole Caribbean response.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 SECTION 7: RECOMMENDATIONS o Constitutional amendment to include discrimination on the ground of sexual orie ntation; o Legislation recognizing male involvement in sex work; o Legislation giving similar protection to young boys as is presently given to young girls; o Amendment to the law giving young persons the right to be tested at age 16 without the consent of a par ent thereby equating the law in this

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 area with that of sexual consent; o General legislation enforcing confidentiality by health workers and others which takes into consideration situations in which information could be divulged in the inte rest of the protected person or for some other reason; o Provision of free medication for PLWHA and other persons who, whether through rape or other cause, were exposed or suspected to have been exposed to HIV; o Legislation outlawing all forms of discriminati on and provision of redress against persons who discriminate; o Legislation making provision for all the rights expressed in the Convention on the Rights of the Child; o Counseling for all PLWHA their families and all persons affected by HIV/AIDS; o Amendment to Prison Act specifying who shall have access to o Amendment to the Public Health Act taking into consideration

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 HIV/AIDS, its transmission and treatment; o Amendment to the Quarantine Act taking into consideration HIV/AIDS, its tran smission and treatment; o Amendment to the Immigration Act removing the possibility of a status; o Amendment to the Police Act to provide for treatment and care of police officers who contract HIV; and also job security for those police officers who are living with HIV; o Amendment to the Employment Act preventing mandatory HIV testing of employees and specifically providing that the health status of an employee cannot be used by an employer as a factor to dismiss an employee; o Review of the Criminal Code as it relates to unlawful connexion between consenting adults with a view to de criminalization, especially in light of the recommended Constitutional amendment; o Review of the law of evidence as i t relates to rape cases especially

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 making it mandatory that cases involving rape and indecent assault be o Review of the law of evidence as it relates to rape cases taking into consideration the corroboration requirement; o Legislation prov iding for the offence of willful transmission of HIV o General strategy to empower women so that they could negotiate safe sex; o Legal Support for PLWHA and their families; o Job security for PLWHA and their families; o Massive education campaign on HIV/AIDS, prevention, treatment, care and the related stigma and discrimination; o Greater involvement of PLWHA in all decisions affecting them; o Behaviour change communication by the media and others; o Condom, both m ale and female promotion and availability to the population at large; o Management of all sexually transmitted infections;

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 o Prevention of mother to child transmission; o Provision of a safe blood supply; o Home based care of PLWHA; o Nutrition Programmes for PLWHA; o Income generation programmes for PLWHA and their families; o Comprehensive HIV prevention and care programmes; and o Post exposure prophylaxis as a general response to rape.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 REFERENCES 1. Lance Gable, Katharina Gamharter Lawrence O. Gostin, Jame s G. Hodge, jr. and 2. Rudolf V. Van Puymbroeck, Legal Aspects of HIV/AIDS A Guide for Policy and Law Reform, The World Bank, 2007. 3. Richard Elliott, After Cuerrier: Canadian Criminal Law and the Non Disclosure of HIV Positive Status, Canadian HIV/AIDS Legal Network, 2002. 4. Courting Rights: Case Studies in Litigating the Human Rights of People Living with HIV, UNAIDS Best Practice Collection, 2006.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 5. The Federal Initiative to Address HIV/AIDS in Canada, the Public Health Agency of Canada, 2003. 6. HIV Infection Reporting, Centers for Disease Control, 2007. 7. Uniting the World against AIDS, UNAIDS Website, 2007. 8. HIV/AIDS and Young People in Jamaica, UNICEF, 2005. 9. Communities Knowledge Sharing and Collaboration Worldwide, th e Development Gateway Foundation, 2007. 10. 11. An ILO code of practice on HIV/AIDS and the world of work, The International Labour Office, Geneva, 2001. 11. Jacqueline Sealey Burke, Protecting Children Affected by AID S in the

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Caribbean Recommendations for Legal Reform in Grenada, 2006. 1 3. Gaietry Pargass, Regional Guidelines for a Human Rights Referral and Response System to Violations Against Persons Living with HIV/AIDS (PLWHA), 2007. APPENDIX Copy of Namibia n HIV/AIDS Charter of Rights NAMIBIAN HIV/AIDS CHARTER OF RIGHTS Preamble

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Recognizing that people living with HIV/AIDS continue to face discrimination and prejudice which preclude them from access to services and benefits. And further recognizing that a rights based approach to HIV/AIDS which outlaws discrimination on the basis of HIV status is central to an effective public health response to HIV/AIDS. And further recognizing that people living with HIV/AIDS should be involved at all levels of decisi on making regarding the design and implementation of HIV/AIDS programmes and policies. And further recognizing that people living with HIV/AIDS should be empowered and empower themselves to effectively participate in decision making processes. And furthe r recognizing that the responsibility to effectively prevent the

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 transmission of HIV is not limited to people living with HIV/AIDS but rests on Namibian society as a whole, and that all persons should empower themselves through education and information to gain knowledge about sexually transmitted diseases including HIV/AIDS, that will protect others and minimize the risk of HIV infection and re infection. And further recognizing that an effective response to the AIDS epidemic requires commitment at a poli tical level to implement an effective HIV/AIDS prevention strategy; prevent discrimination and stigmatization on the basis of HIV status; promote openness and transparency regarding the disease; and provide adequate information that will enable every perso n to make informed choices and to take responsibility for his or her own choices. NOW THEREFORE this Charter sets out those basic rights which all people enjoy or should enjoy and which should not be denied to persons affected by HIV or AIDS, as well as c ertain duties.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 1. Equal protection of the law and equal access to public and private facilities and benefits HIV status cannot be considered as a ground on which to deprive any person of his or her basic human rights. Respect for the inherent dignity of all persons and the right to equal protection of the law requires that persons living with HIV/AIDS should have equal access to public and private services, benefits and opportunities. HIV testing should not be required as a precondition for such acces s. Public measures should be adopted to protect persons living with HIV/AIDS, including children and adolescents, from discrimination in employment, housing, education, childcare and custody and the provision of medical, social and welfare services.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 2. Liberty, autonomy, security of the person and freedom of movement All persons, including persons living with HIV/AIDS, have the same rights to liberty, autonomy, security of the person and freedom of movement in Namibia and should have the same rights between countries. Namibian HIV AIDS Charter of Rights 2 Segregation, isolation or quarantine of persons in prisons, schools, hospitals or elsewhere, merely on the grounds of HIV/AIDS is unjustified and should therefore not be permitted. Persons li ving with HIV/AIDS are entitled to autonomy in decisions regarding marriage and reproductive health. Adequate counselling information and education in this regard should be made

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 available to all persons to enable them to make informed decisions. 3. Pr ivacy and confidentiality Confidentiality in the context of the AIDS pandemic is a concept that is widely misunderstood and is often quite incorrectly labeled as a veil of secrecy that undermines efforts to control the spread of HIV. In the context of HI V/AIDS, confidentiality means that health care workers are ethically and legally required to keep all patient information to illness or treatment can only be given to another person with the It is crucial to distinguish between the promotion of open discussion about HIV/AIDS and nondiscrimination at a community and society level on the one hand, and the need for confidentiality on the other.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Both of these contribute positiv ely to the public health interest in reducing transmission and in providing care and support. Therefore: Persons living with HIV/AIDS have the right to confidentiality and privacy regarding their health and HIV status. This right endures after death. Information about HIV status may not be disclosed to a third party without the consent of the person with HIV/AIDS, unless legally required. The sharing of information regarding HIV status by the person living with HIV with others remains a matter of in dividual choice. However, this practice should be encouraged through appropriate counselling education and the creation of a supportive environment and appropriate services to those affected by this disclosure. It should be explained to patients that in order to optimize treatment and care it may be necessary to disclose personal health

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 information to other health care workers, but that this will only be done with the prior consent of the patient. 4. Counselling and testing Voluntary and confidenti al counselling and testing for HIV should be encouraged. The establishment of affordable and accessible voluntary confidential counselling and testing facilities is essential. These facilities should provide quality pre and post test and ongoing counse lling by qualified and competent counsellors Testing should be done only with informed consent. 5. Partner notification and reporting Health care workers and counsellors are obliged to maintain

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Dis closure by a health sexual partner at risk in accordance with the following criteria: Namibian HIV AIDS Charter of Rights 3 The HIV positive person in question has been thoroughly counselled as to the need for partner notification. The HIV positive person has refused to notify or consent to the notification of his/her partner(s). A real risk of transmission to the partner(s) exists.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The HIV positive person is given reasonable advance notice of the intention to notify. Follow up is provided to ensure support to those involved, as necessary. Reporting of HIV positive results to any health information system should take place on an anonymous basis. Reporting of HIV positive results should be undertaken for the sole purpose of gathering epidemiological data to facilitate the management of the HIV/AIDS epidemic. 6. Gender

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 All females and males are potentially at risk of HIV in fection and are affected by HIV/AIDS. Disproportionate numbers of women and girl children are infected with HIV. The predominantly subordinate position of women and girl children in society makes them especially vulnerable to the risk of HIV infection. This is exacerbated by the high prevalence of domestic violence against and sexual abuse of women and girl children. Therefore: The empowerment of women should be promoted through appropriate programmes aimed at raising the status of women and eliminati ng adverse social, economic and cultural factors that put responsibility in relation to the prevention of transmission. Women and men should be equal partners in decision making and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 matters of family planning and reproductive health. This includes the right to demand and to take appropriate precautionary measures to prevent transmission of HIV. Appropriate counseling and information regarding transmission of HIV should be made avai lable to persons living with HIV/AIDS who wish to exercise the right to marry and/or found a family. Women with HIV should have access to adequate information to enable them to make informed decisions regarding their reproductive health. 7. Children, adolescents and HIV/AIDS Children and adolescents enjoy the same rights as adults in respect of access to information, privacy, confidentiality, respect, informed consent and means of prevention.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Quality health care, information and education should b e made available to all children and adolescents, including those living with HIV/AIDS. This should include information relating to HIV/AIDS and STD prevention and care, inside and outside school, which is tailored appropriately to age level and capacity and enables them to deal positively and responsibly with their sexuality and rights. Children and adolescents should be ensured adequate access to user friendly, confidential sexual and reproductive health services These services should include informa tion on HIV/ AIDS and STDs, sexual health advice, counseling, HIV testing and prevention measures including free access to condoms and social support services. The provision of these services to children/adolescents should reflect an appropriate balance be tween the rights of the child or adolescent to be involved in decision making according to his or her evolving capabilities and the rights and duties of parents or guardians

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 for the health and well being of the child. Namibian HIV AIDS Charter of Rights 4 8. Supportive and enabling environment for vulnerable groups infected and affected by HIV/AIDS A supportive and enabling environment for vulnerable groups should be promoted by identifying and addressing underlying prejudices and inequalities through advocacy, community dialogue, policy formulation and implementation, specially designed social and health services and support to community groups. Associations comprising members of different vulnerable groups should be established and supported for pu rposes of peer education, empowerment, positive behavioural change and social support.

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 The development of adequate accessible and effective HIV/AIDS related prevention and care, education, information and services by and for vulnerable groups should be supported. Such groups should actively be involved in the design and implementation of these services. 9. Children orphaned by AIDS Children orphaned by AIDS, regardless of their HIV status, who have lost one or both of their parents due to HIV/AIDS, are entitled to love and care, and a nurturing environment that would enable them to realise their full potential. The rights of the child should be respected therefore children orphaned by AIDS should not be discriminated against. It is recognised th at children orphaned by AIDS should be cared for and

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 supported within their communities and that all decisions should be made in their best interests. Information on services, grants and benefits for children orphaned by AIDS should be made freely avail able. People employed in childcare agencies as well as informal and formal adoptive and foster care parents and persons providing services to children should receive training in order to deal effectively with the special needs of HIV affected children, including psycho social support and protection from mandatory testing, discrimination, abuse and abandonment. 10. Prisoners Prisoners should not be discriminated against on the basis of their HIV status. No compulsory HIV testing of prisoners should be

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 carried out. Prisoners living with HIV/AIDS should not be isolated or quarantined. Prisoners living with HIV/AIDS are entitled to special care equal to that afforded to other prisoners with serious illnesses. Prisoners should be provided with info rmation on HIV/AIDS and preventative measures, such as condoms, as well as with adequate counselling facilities. Information regarding the HIV status of a prisoner in the possession of the prison authorities should not be disclosed to any third party without the informed consent of the prisoner. 11. Adequate standard of living All persons, including those living with HIV/AIDS, have the same right to a standard of living adequate for the health and well being of

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 themselves and their families, includi ng food, clothing, housing and medical care and necessary social services. Namibian HIV AIDS Charter of Rights 5 12. Access to education Persons living with HIV/AIDS should have equal access on a non discriminatory basis to institutions of primary, sec ondary and tertiary education, as well as to scholarship schemes. 13. Access to appropriate information and sex education Culturally appropriate formal and non formal education programmes and information on HIV/AIDS should be accessible on a continuous basis to all, to enable people to make informed decisions about their life and sexual practices. Education should also promote

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 respect, tolerance and non discrimination in relation to persons living with HIV/AIDS. Appropriate information regarding par ent to child transmission, breastfeeding, treatment, nutrition, change of lifestyle and safer sex should be freely available. 14. Access to health care and appropriate treatment HIV status should not be considered as a ground for depriving any person of their right to the highest attainable standard of physical and mental health. To this end, persons living with HIV/AIDS should have access on a non discriminatory basis to adequate health care and appropriate and affordable treatment and drugs so that persons living with HIV/AIDS can live as long and as successfully as possible. Ethical guidelines and codes of conduct for health care workers

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 and counsellors should be implemented and reinforced to guarantee the rights to privacy, confidentiality and d ignity of persons living with HIV/AIDS. These guidelines and codes of conduct should require health care workers and counsellors to treat any person living with HIV/AIDS without discrimination. Community efforts to provide home based care to people who are living with HIV/AIDS should be supported. Caregivers should be properly trained to render effective care and counselling. Women with HIV who are pregnant should have access to adequate information regarding mother to child transmission and to afford able treatment to reduce the risk of mother to child transmission. Rape survivors should have access to adequate information about HIV/AIDS and to affordable and timely prophylactic treatment. 15. Research and clinical trials

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Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Persons living with HIV/ AIDS should have access to clinical trials conducted only in terms of acceptable research protocols, which adequately protect the rights of research subjects prior to, during and after the trials. The results should be made available to the community fo r timely and appropriate action. 16. Employment Discrimination on the basis of HIV status in access to and continued employment, conditions of employment and employment benefits is contrary to the provisions of the Labour Act. Therefore:

PAGE 143

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Namibian HIV A IDS Charter of Rights 6 People living with HIV/AIDS have the right to work, and should not be excluded from employment solely on the basis of their HIV status. Both employers and employees have a mutual responsibility to prevent discrimination on the basis of HIV status in the workplace. There should be no compulsory testing for HIV in the workplace. Voluntary testing for HIV on the request of the employee should be done by a suitably qualified person in a health facility with the informed consent of the employee in accordance with normal medical ethical rules and with pre and post test counselling. Persons living with HIV/AIDS have the legal right to confidentiality regarding their HIV status in any aspect of their

PAGE 144

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 employment. An employee is u nder no obligation to inform his or her employer of his or her HIV status. Employees living with HIV/AIDS should continue to work under normal conditions in their current employment for as long as they are medically fit to do so. When on medical grounds they are unable to continue with normal employment, the normal rules regarding incapacity should apply. Employers, in consultation with employees, should develop and implement appropriate workplace policies on HIV/AIDS. Employers should provide a sa fe and healthy working environment for employees, including the provision of the necessary equipment and information, as well as the implementation of universal precautions to prevent transmission of HIV in the workplace.

PAGE 145

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 Where an employee accidentally contracts HIV in the course and scope of his or her employment, he or she shall be entitled to 17. Insurance and medical aid Persons living with HIV/AIDS and those suspected of being at risk of having HIV or AIDS should be prot ected from arbitrary discrimination in insurance and medical aid. Insurers and medical aid administrators should explain to the insured or medical aid member what influence HIV/AIDS would have on the validity and effect of the contract of insurance or med ical aid. If HIV testing is required for life insurance or medical aid, the insurer or medical aid administrator should provide access to adequate pre and post test counselling. The insurer or medical aid administrator requiring the test should ensure that the results are

PAGE 146

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 treated with confidentiality. Insurers and medical aid administrators should continue to explore, in consultation with people living with HIV/AIDS, the development of new products that would provide appropriate cover for people livi ng with HIV/AIDS. Insurers and medical aid administrators should be encouraged to play an effective role in HIV/AIDS prevention and education campaigns. Media Media programmes should be designed to challenge attitudes of discrimination and stigmatiz ation associated with HIV/AIDS. The media and the advertising industry should be sensitive to

PAGE 147

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 HIV/AIDS and human rights issues and should reduce sensationalism in reporting and the inappropriate use of language and stereotypes, especially in relation to disadvantaged and vulnerable groups. Namibian HIV AIDS Charter of Rights 7 The public has the right to balanced and informed coverage, information and education on HIV/AIDS, STDs and related issues. HIV/AIDS media programmes should be designed to b e accessible to all people, including those with audio visual disabilities. 19. Cultural and traditional practices It is recognised that some cultural and traditional practices militate against effective preventive action and place people, especially women and young people, at risk of HIV infection. These practices

PAGE 148

Coat of arms and other images and logos have been removed for posting on the Interne t due to file size constraints. National HIV/AIDS Assessment Law, Ethics and Human Rights Project Grenada Review of the Laws of Grenada, Carriacou and Petite Martinique for implications of discrimination and breach of human rights Keith H.W. Friday Consultant January 2008 and traditions should be identified and steps should be taken to address them by way of formal and non formal education and/or legislation. Traditional Authorities should play an importa nt role in HIV/AIDS prevention strategies. Traditional healers and traditional birth attendants should be provided with appropriate education and information about HIV/AIDS and its transmission. Dialogue and collaboration between traditional and non tra ditional health providers.


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