Adolescents and the right to health: Eliminating age-related barriers to HIV/AIDS services in Rwanda

Abstract

Under international, regional, and domestic law, adolescents are entitled to measures ensuring the highest attainable standard of health. For HIV/AIDS, this is essential as adolescents lack many social and economic protections and are disproportionately vulnerable to the effects of the disease. In many countries, legal protections do not always ensure access to health care for adolescents, including for HIV/AIDS prevention, treatment, and care. Using Rwanda as an example, this article identifies gaps, policy barriers, and inconsistencies in legal protection that can create age-related barriers to HIV/AIDS services and care. One of the most pressing challenges is defining an age of majority for access to prevention measures, such as condoms, testing and treatment, and social support. Occasionally drawing on examples of existing and proposed laws in other African countries, Rwanda and other countries may strengthen their commitment to adolescents' rights and eliminate barriers to prevention, family planning, testing and disclosure, treatment, and support. Among the improvements, Rwanda and other countries must align its age of consent with the actual behavior of adolescents and ensure privacy to adolescents regarding family planning, HIV testing, disclosure, care, and treatment.

Keywords:

• HIV/AIDS
• adolescents
• age of majority
• Rwanda
• barriers to care

Notes

1. Additional human rights instruments that Rwanda has ratified or acceded to which touch on the rights of the child include the Optional Protocols to the CRC on Sex Trafficking and Armed Conflict, the International Covenant on Economic, Social and Cultural Rights (1976), the International Covenant on Civil and Political Rights, the Convention on the Elimination of all Forms of Discrimination against Women, the African Charter on Human and People's Rights and Protocol, the Protocol on the Rights of Women in Africa, and the UN Convention on the Rights of Persons with Disabilities.

2. The CRC Committee recommends access to free or low-cost contraceptives for children (United Nations, 2003a).

3. These concerns have been raised by Rwandan youth. (See, e.g., National AIDS Control Commission, Rwanda, 2007), which recommended integrating into law a provision to give children the right to be tested.

4. Reports of confidentiality breaches by health workers are not unheard of. (See, e.g., National Institute of Statistics, 2008; Rwebangira & Tungaraza, 2003)

5. See, for example, Kenya: “[A]ll HTC services Kenya should be conducted with the best interests of the clients/patient. HTC should never be coercive or mandatory. Three core principles—consent, confidentiality, and counselling—otherwise known as the ‘3Cs’, are central to HTC in Kenya,” (Ministry of Public Health and Sanitation, Kenya, 2008).

6. Many of the sources cited to in this article refer to “children” as individuals below the age of 15, as consistent with the official UN definition. Unless otherwise noted, however, this article will refer to “children” as individuals below the age of 18, as consistent with the legal definition contained in the UNCRC. For purposes of discussion, “adolescents” will refer to individuals aged 10 to 19 and “adolescents” will refer to individuals aged 14 to 24.

7. Inconsistent metrics highlight the need to standardize the definition of “child” to better measure barriers to accessing CSS. To measure infected children, “child” is defined as ages 0 to 14. (UNICEF, 2009). However, to measure children orphaned by HIV/AIDS, “child” is sometimes defined as ages 0 to 17. (Rwanda National Strategic Plan on HIV/AIDS, 2009).

8. 10% of all Rwandan households are headed by children. (See Mirza, 2006).

9. Because Rwandan law is silent on the issue of OVC's legal access to health services, such children remain vulnerable despite the government's willingness to pay health insurance fees (Sloth-Nielsen, 2008, p. 281).