At what point does help become harm? And at what point can funders use their clout to stop harm?
Those are questions facing health and human rights donors giving aid to countries where the people at the highest risk of disease are further threatened by government laws and policies that sanction their detention, forced labor, beatings and torture. For several years, it has been a question facing the Global Fund to Fight AIDS Tuberculosis and Malaria, and other HIV response funders, including PEPFAR, that give program support for HIV prevention and treatment in Viet Nam’s compulsory drug treatment centers where “drug treatment” consists of “labor therapy” that includes hours of mandatory physical toil — unpaid, or at token pay then docked for expenses — in cashew processing, garment manufacturing, coffee farming, or construction. These conditions were documented in Human Rights Watch’s 2011 The Rehab Archipelago Forced Labor and Other Abuses in Drug Detention Centers in Southern Vietnam, which recommended that donors examine their funding and the programs they support to ensure they are not supporting international human rights law violations, “including prohibitions on arbitrary detention, forced labor, torture and cruel, inhuman or degrading treatment. Programs supported by the President’s Emergency Plan For AIDS Relief to provide staff training for addiction counseling, as well as by the Global Fund to provide HIV and TB testing and treatment, are described in the report.
Today the Global Fund released a statement reiterating the charity’s commitment to human rights, and announcing that the $85 million grant signed in May with Viet Nam’s Ministry of Health includes a stipulation that requires the government to identify and allow an independent international organization to monitor conditions at the country’s compulsory drug detention centers. The Fund has also been “closely working with its Vietnamese counterparts to ensure a sensible timeframe” to close the centers, the statement says.
The stipulation is a step in the right direction, said Joe Amon, director of Health and Human rights at HRW. Before and since the release of Rehab Archipelago, Amon has called on donors to use their clout to hold governments responsible for discrimination and abuse of populations that include people living with HIV, as well as those in “rehabilitation centers” for sex workers and drug users. He coauthored an International Journal of Drug Policy piece published earlier this month noting that agencies and organizations have taken a less passive approach to the centers in recent years, expressing concerns and calling for their closure. Following reports of abuses in drug detention centers, the Global Fund refined its policy, in 2010-2011, the article noted, limiting support “to services that provide direct ‘support,treatment and prevention of HIV and TB,’ eliminating support for capacity building efforts and activities not considered ‘“life-saving.'” Still, the article noted, “specific mechanisms for ensuring that governments abide by this restriction were not publicly identified.”
How human rights abuses will be monitored in a country where the government doesn’t allow independent organizations to work unhindered remains a question, Amon said today. “There are a lot of people who hope there’s progress being made in Viet Nam,” he said. “But the restrictions make it hard to know.”
A longer term approach would help, he added, with strategies to move funding away from detention centers, and to support the release from them of the people who need medical care.