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Conclusion

The response to the HIV/AIDS epidemic by governments and multilateral agencies must recognize and respect human rights. In parts of the world today, the lack of an adequate response to the epidemic—whether due to denial of the existence or extent of the epidemic, misappropriation of resources, or hostility to those individuals infected or those populations most at-risk of infection—represents a basic violation of the right to health. In other countries, HIV education, prevention, and treatment programs are inaccurate or inequitable.

All individuals, including those most marginalized, must enjoy access to accurate information about HIV/AIDS and have equal access to HIV/AIDS programs. HIV testing in particular—as the entry point for access to anti-retroviral drugs and important services—must be accessible to all. But efforts to expand HIV testing, and to put in place “routine” testing, must not become coercive, must recognize the rights of the individuals being tested, and must provide linkages to both prevention and care.

Across the globe, people who test positive for HIV have been denied employment, fired from their jobs, kicked out of hospitals, denied both HIV specific and general medical treatment, harassed and assaulted by community members who find out their status, and sometimes even killed. Because human rights abuses fuel the HIV epidemic, HIV/AIDS programs must explicitly address, and find ways to mitigate, these abuses.

Combating the rights abuses that put vulnerable populations at risk of HIV is essential to turning around the AIDS crisis. Concrete policy measures are urgently needed and can have immediate and long-term impact. New laws can be put in place, or enforced if they already exist, to protect women’s equal rights in the areas of inheritance, sexual violence, domestic violence and spousal rape, marriage, division of property upon divorce, land use and ownership, and access to housing and social services.

Programmatic reforms, designed to address human rights violations, should ensure that national HIV/AIDS programs include measures to combat discrimination and violence against people living with HIV/AIDS, with particular attention to marginalized populations. Efforts should also be made to provide human rights training for judges, police, and other officials; improve data collection relating to police abuse and domestic violence, women’s property rights, and sexual abuse of girls; ensure that anti-retroviral drug distribution systems recognize the challenges marginalized populations face in accessing treatment; and ensure that HIV test results and other patient information is kept confidential. Public education campaigns on the human rights of people living with HIV/AIDS in local languages and using appropriate media should be intensified.

It is sometimes suggested that paying attention to human rights is somehow so costly and time consuming that it should really be considered optional during a public health crisis. However, there is no reason that public health and human rights be considered in opposition to one another. In responding to the global HIV/AIDS epidemic, only programs that start with a basic respect for individuals, and their rights, will be successful. Those programs which adopt strategies in the name of efficiency or ideology and which fail to respect human rights will ultimately fail.

Joseph Amon directs the HIV/AIDS Program at Human Rights Watch.

¹ U.N. Joint Progamme on HIV/AIDS (UNAIDS), AIDS Epidemic Update: December 2005 (Geneva: United Nations, 2005), http://www.unaids.org/epi2005/doc/EPIupdate2005_html_en/epi05_00_en.htm#TopOfPage (retrieved November 21, 2005).

² Jonathan Mann, who headed the first Global Programme on HIV/AIDS at the World Health Organization (WHO), recognized early in the epidemic the importance of linking HIV/AIDS and human rights, especially to ensure that those at risk would not be stigmatized in using services. See Jonathan M. Mann, "Human rights and AIDS: The future of the pandemic," in Jonathan M. Mann, Sofia Gruskin, Michael A. Grodin, and George J. Annas, eds., Health and Human Rights: A Reader (New York and London: Routledge, 1999).

³ HIV can be transmitted from an HIV-infected mother to her child during pregnancy, labor, and delivery, or through breastfeeding. The administration of antiretroviral drugs to HIV-infected pregnant women and to her infant shortly after birth greatly reduces the risk of mother-to-child HIV transmission.

⁴ United Nations General Assembly, “Declaration of Commitment on HIV/AIDS,” June 27, 2001.

⁵ U.S Global AIDS Act, 22 U.S.C. §§ 7672(b)(3), 7673(a); see also Office of the United States Global AIDS Coordinator, “The President’s Emergency Plan for AIDS Relief. U.S. Five Year Global HIV/AIDS Strategy,” February 2004.

⁶ For further information about U.S.-funded abstinence-only-until-marriage programs, see Human Rights Watch, “The Less they Know, the Better: Abstinence-only HIV/AIDS Programs in Uganda,” vol. 17, no. 4(A), March 2005; Human Rights Watch, “Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States: Texas: A Case Study,” vol. 14, no. 5(G), September 2002.

⁷ U.S. Global AIDS Act, 22 U.S.C. § 7631(e, f) (2003); see also Letter from Human Rights Watch, et al., to President Bush opposing mandatory “anti-prostitution pledge,” May 18, 2005, http://hrw.org/campaigns/hivaids/hiv-aids-letter/; Rebecca Schleifer, “United States: Funding Restrictions Threaten Sex Workers’ Rights,” HIV/AIDS Policy and Law Review, vol. 10, no. 2, August 2005.

⁸ Two separate lawsuits have been filed in U.S. courts challenging the “anti-prostitution pledge” requirements as violating fundamental rights to health and to free expression. See Rebecca Schleifer, “Challenges filed to U.S. Anti-AIDS Law Anti-prostitution Pledge Requirement,” HIV/AIDS Policy and Law Review (forthcoming) (describing cases); “Prostitution Loyalty Oath,” http://www.genderhealth.org/loyaltyoathsuit.php (website links to court pleadings filed in cases).

⁹ See Human Rights Watch, “Injecting Reason: Human Rights And HIV Prevention For Injection Drug Users; California: A Case Study,” vol. 15, no. 2(G), September 2003.

¹⁰ See studies cited in “Injecting Reason,” pp. 10-17.

¹¹ See, e.g., World Health Organization, Joint United Nations Program on HIV/AIDS, and United Nations Office on Drugs and Crime, “Policy Brief: Provision of Sterile Injecting Equipment to Reduce HIV Transmission” (2004); Joint United Nations Program on HIV/AIDS, “Intensifying HIV prevention: UNAIDS policy position paper,” August 2005, p. 23; U.S. National Institutes of Health, Interventions to Prevent HIV Risk Behaviors: Consensus Development Statement, February 11-13, 1997; Institute of Medicine of National Academy of Sciences, No Time to Lose: Getting More from HIV Prevention (2001).

¹² Transnational Institute, “The United Nations and Harm Reduction – Revisited: An unauthorized report on the outcomes of the 48^th CND session,” Drug Policy Briefing No. 13, April 2005.

¹³ Ibid.; see also, Letter from Antonio Maria Costa, Executive Director, United Nations Office on Drugs and Crime, to Robert B. Charles, Assistant Secretary, International Narcotics and Law Enforcement Affairs, U.S. Department of State, November 11, 2004.

¹⁴ See, e.g., Jole Baglole, “Vancouver Drug Facilities Draw Ire of U.S. Officials,” Wall Street Journal, April 1, 2003.

¹⁵ “Lesotho launches groundbreaking HIV campaign on World AIDS Day,” WHO website: http://www.who.int/mediacentre/news/releases/2005/pr64/en/index.html (retrieved December 1, 2005).

¹⁶ See: The Voluntary HIV-1 Counseling and Testing Efficacy Study Group, "Efficacy of VCT in individuals and couples in Kenya, Tanzania, and Trinidad: A Randomised Trial," The Lancet, vol. 356, July 8, 2000, pp 103-112; M.H. Merson, J.M. Dayton, K. O’Reilly, “Effectiveness of HIV prevention interventions in developing countries,” AIDS, September 2000, vol. 14, supp. 2, pp. S68-84; and C.A. Liechty, “The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access,” Current HIV/AIDS Report, December 2004, vol. 1(4), pp. 181-5.

¹⁷ See, e.g., Kevin De Cock et al., “A serostatus-based approach to HIV/AIDS prevention and care in Africa. The Lancet, vol., 367 (2003), pp. 1847–49; Kevin De Cock, et al., “Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century,” The Lancet, vol. 360 (2002), pp. 67-72.

¹⁸ Lesotho Ministry of Health and Social Welfare (STI, HIV & AIDS Directorate and Partners), “‘Know Your Status’ Campaign Operational Plan 2006-7; Gateway to comprehensive HIV prevention, treatment, care and support; Universal Access to HIV Testing and Counseling,” December 1, 2005.

¹⁹ This figure refers to the total budget for Strategic objective 7: “Strengthen post-test services for both HIV positive and HIV negative people” as specified in Lesotho Ministry of Health and Social Welfare (STI, HIV & AIDS Directorate and Partners), “‘Know Your Status’ Campaign Operational Plan 2006-7; Gateway to comprehensive HIV prevention, treatment, care and support; Universal Access to HIV Testing and Counseling,” December 1, 2005.

²⁰ UNAIDS, “HIV rates decline in Zimbabwe,” November 21, 2005, http://www.unaids.org.zw/default.htm (retrieved November 21, 2005).

²¹ Human Rights Watch, “Just Die Quietly: Domestic Violence And Women’s Vulnerability to HIV In Uganda,” August 2003, vol. 15, no.15(A), p. 29.