A/HRC/44/46/Add.2 life or be in public spaces. Furthermore, as a result of the social roles that continue to be attributed mainly to women, many women described how physical impairments, sometimes invisible ones like neuropathic pain and loss of sensation, made the performance of house work, childcare and care of other family members increasingly painful. 51. None of the women interviewed mentioned access to justice as a means available to them to address domestic violence, abusive work relations or violations of their right to mental and physical health. This reflects the extreme vulnerability of their social position and their low awareness of their rights and how to claim them. There are two key tools to enforce articles 5 and 12 of the Convention on the Elimination of All Forms of Discrimination against Women and prevent gender-based discrimination against women affected by Hansen’s disease in Brazil. They are general recommendation No. 25 of the Committee on the Elimination of Discrimination against Women, which highlights the importance of an enabling environment that empowers women, and the Committee’s general recommendation No. 19 (1992) on violence against women, which indicates that under general international law and specific human rights covenants, States may be responsible for private acts if they fail to act with due diligence to prevent violations of rights or to investigate and punish acts of violence, and for providing compensation. Children affected by Hansen’s disease 52. As the Special Rapporteur pointed out in a previous report, the outbreak of new cases of Hansen’s disease in children and adolescents points to recent transmission and to the failure of the health-care system to control the disease (A/HRC/41/47, paras. 43–46). Transmission in children under 15 years of age occurs mainly among people living in the same household, which points to a failure of health systems to routinely establish contact surveillance as a standard procedure. 53. In 2017, there was a total of 22,940 new cases of Hansen’s disease in Brazil, of which 1,718 were in children under 15 years of age. In 2017, 54 children were diagnosed with visible and irreversible physical impairments in Brazil and in the past five years, the percentage of children under 15 years of age diagnosed with irreversible damage ranged from 2.9 per cent in 2013 to 4.1 per cent in 2017. 28 Notwithstanding the great concern caused by these figures, the Special Rapporteur welcomes the transparency Brazil has demonstrated in reporting to WHO not only new cases in children, but also new cases in children with irreversible impairments at the time of diagnosis. 54. A child diagnosed with Hansen’s disease is always a matter of great concern. Hansen’s disease can easily develop into a chronic disease that causes serious sensory loss and severely restricts people���s activities and participation in society. During her visit, the Special Rapporteur received reports from civil society organizations and health experts on children affected by Hansen’s disease that point to a shared pattern of socioeconomic vulnerability. In fact, a statistically significant link was found between greater coverage of the Bolsa Família cash transfer programme and a reduction in detection rates of Hansen’s disease. This reinforces the need for strategies that act on the social determinants of Hansen’s disease and protect the families caught up in a cycle of poverty and disease that is difficult to break.29 55. The Special Rapporteur draws attention to the impact of Hansen’s disease at an early stage in life, which is even more serious in the case of children belonging to families living in poverty and extreme poverty. Some of these children face difficulties in making progress at school due to the sometimes physically demanding medical treatment, development of impairments and/or experiences of stigmatization that will result in an endless cycle of poverty and discrimination. 28 29 12 Brazil, Ministry of Health, “Indicadores epidemiológicos e operacionais de hanseníase: Brasil 2000– 2017”; Michelle Christini Araújo Vieira and others, “Leprosy in children under 15 years of age in Brazil: a systematic review of the literature”, PLOS Neglected Tropical Diseases, 2 October 2018. Joilda Silva Nery and others, “Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy”, PLOS Neglected Tropical Diseases, 20 November 2014; Kaio Vinicius Freitas De Andrade and others, “Effect of Brazil’s conditional cash transfer programme on the new case detection rate of leprosy in children under 15 years old”, Leprosy Review, vol. 89, No. 1 (2018).