Regional Project "Ensuring through Political Advocacy Actions Universal Access to Health and Respect for Human Rights in the Response to HIV in Central America, to Improve the Quality of Life of People with HIV"
Global Fund to Fight AIDS, Tuberculosis and Malaria

*Marked data is mandatory

* Violated Human Right

If you select another, please specify

* Case Type

Collective Case: Interposed by two or more people of a single fact. Individual Case: Interposed by a single person.

Data of the Person Who Registers the Case

* 1. First Name

* 2. Last Name

* 3. Birthdate

* 4. Phone Number

* 5. Cell Phone

* 6. Email

* 7. You are the person with HIV who has been violated the Human Right that is registered?

8. If your answer to the previous question is negative, what is your relationship or relationship with the person with HIV whose human right has been violated?

Data of the Person with HIV who has been violated his Human Right

* 9. Country where the violation was committed?

* 10. First Name

* 11. Last Name

* 12. Social Name

It is the name by which the person is known, but it is not necessarily the one that is registered in your identity document

* 13. Birthdate

* 14. Number Phone

* 15. Cell Phone

* 16. Email

* 17. Document type

* 18. Document Number

* 19. Sex according to legal document

* 20. Identity

* 21. Address

* 22. Zone

* 23. Nationality

24. Details of violation

25. When did the rape occur?

26. What is the name of the institution or place where incident occurred?

27. Please provide us the address of the institution or place where incident occurred

28. Know the name of the person who committed the act?

29. Please provide us the area/department or service station of the person´s who aggravates you

28. You have registered this case on another platform (s)?

29. Mention on which platform (s)

30. He has reported the fact to some authority?

31. Mention the name of the authority

32. Refer to any other important data you want to add.

* 33. You want to be referred?