Putting third first: critical legal issues and HIV/AIDS

On 7 July 2000, before the XIII International AIDS Conference, the Canadian HIV/AIDS Legal Network and the AIDS Law Project, South Africa held a one-day satellite meeting on legal, ethical, and human rights issues in Durban, South Africa. Entitled Putting Third First--Critical Legal Issues and HIV/AIDS, the satellite focused on legal strategies to advance the human rights of those most vulnerable to HIV/AIDS and to discrimination: people in the developing world, and people who, although they live in the industrialized world, suffer from poverty and marginalization and are at high risk of contracting HIV. The satellite grew out of the ongoing partnership between the Canadian HIV/AIDS Legal Network and the AIDS Law Project, South Africa, and was co-hosted by UNAIDS.     

HIV/AIDS in prisons: recent developments

In a report released on 20 November 2002, entitled Action on HIV/AIDS in Prisons: Too Little, Too Late--A Report Card, the Canadian HIV/AIDS Legal Network concluded that despite repeated studies and nearly ten years of recommendations for urgent and pragmatic action, the response of Canadian governments to HIV/AIDS, HCV, and injection drug use in prisons remains inadequate. Only a few weeks later, the House of Commons Special Committee on Non-Medical Use of Drugs released its report, which contained a number of recommendations to the Correctional Service of Canada. Although the Committee avoided talking about needle exchange programs in prisons, it did recommend them! Meanwhile, in Ireland, not even condoms or bleach are provided.     

Draft discussion paper on HIV/AIDS and immigration released

In October 2000, the Canadian HIV/AIDS Legal Network released a 57-page draft discussion paper on HIV/AIDS and immigration, reacting to the announcement that HIV testing may become mandatory for all prospective immigrants to Canada. A final version of the paper will be released in early 2001.     

Health Canada commits to strengthening efforts with respect to injection drug use and HIV/AIDS

On 31 August 2001, over 20 months after the release of the Canadian HIV/AIDS Legal Network's report on Injection Drug Use and HIV/AIDS: Legal and Ethical Issues, Health Canada responded to the report by making a commitment to both "strengthening and expanding efforts with respect to injection drug use."     

The UNGASS Declaration of Commitment on HIV/AIDS: one year later

This article is one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network. It offers a critical assessment of the impact of the UNGASS Declaration of Commitment on national HIV/AIDS strategies and programs in relation to human rights one year after its adoption. The article reviews the process leading up to the Declaration and describes the limitations of the Declaration's explicit and implicit recognition of human rights. It summarizes information provided by countries one year later to the Secretary-General and to UNAIDS on their progress in meeting the goals and targets of the Declaration, particularly with regard to human rights. It comments on what we can learn from this about countries' recognition of the centrality of promoting and protecting human rights. Finally, it suggests ways to monitor more effectively and comprehensively the implementation of a human rights-based response to the HIV/AIDS epidemic.     

Québec: an outbreak of HIV/AIDS-related stigma and discrimination

In the space of a few weeks in January 2004, actions by three different institutions in Québec combined to threaten the human rights of people living with HIV/AIDS, raise the spectre of mandatory HIV testing, and create unnecessary public fears about the spread of HIV infection. In response to what they called "the worst weeks in recent history for people living with HIV/AIDS in Québec," the Canadian HIV/AIDS Legal Network and COCQ-Sida (the Québec coalition of community-based organizations fighting AIDS) called for a province-wide campaign against HIV/AIDS-related stigma and discrimination. A victory was achieved when a Montréal catholic seminary announced that it had backed down from its initial proposal to mandatorily test all applicants for priesthood for HIV, but much more is needed to fight the rapid outbreak of mandatory-testing proposals.     

Global access to treatment: achievements and challenges

As mentioned in the previous issue, this section of the Review addresses issues related to improving access to adequate and affordable care, treatment, and support everywhere. It replaces the section previously called "Patents and Prices." In this issue, we feature a review of achievements and challenges in recent years in opening global access to HIV/AIDS treatments. The article - one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS - describes the developments that recast the debate about access to treatment from one focused on patent entitlements to one focused on the right to health and treatment. It analyzes the role of national and international activism, strategically constructed alliances, and principled leadership in achieving this change. And it discusses continuing obstacles to equitable access to HIV/AIDS treatments for the world's population.     

HIV-related stigma and discrimination--the epidemic continues

This article is one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS. It looks at HIV-related stigma and discrimination. The article summarizes the present situation as described in reports from numerous countries throughout the world. It reviews the institutional, non-institutional, and structural dimensions of HIV-related discrimination. It also identifies some essential components of anti-discrimination efforts: legal protection; public, workplace, and health-care programs; community mobilization; and strategizing on the determinants of health.     

Barcelona 2002: law, ethics, and human rights. Advancing research and access to HIV vaccines: a framework for action

In light of the continuing spread of HIV infection and the devastating impact of the disease on lives, communities, and economies, particularly in the developing world, the investment in new treatments, vaccines, and microbicides has clearly been inadequate. Efforts must be intensified to develop effective HIV vaccines and to ensure that they are accessible to people in all parts of the world. This article is a summary of a paper by Sam Avrett presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India. In the article, Avrett calls for immediate action to increase commitment and funding for HIV vaccines, enhance public support and involvement, accelerate vaccine development, and plan for the eventual delivery of the vaccines. The article briefly outlines steps that governments need to take to implement each of these objectives. The article also provides a menu of potential actions for vaccine advocates to consider as they lobby governments.     

Establishing safe injection facilities in Canada: legal and ethical issues

In the face of an ongoing and escalating health crisis among injection drug users in Canada, calls are coming from many quarters to initiate safe injection facilities as a way to reduce overdoses, the spread of bloodborne diseases, and other health and community problems associated with injection drug use. This article summarizes a paper on safe injection facilities released in early 2002 by the Canadian HIV/AIDS Legal Network. The paper contributes to the policy discussion in Canada and sets out why and how the law should support the introduction of safe injection facilities.     

HIV vaccines: current challenges and future directions

Volume seven of the Review will mark the tenth anniversary of the Canadian HIV/AIDS Legal Network with a series of articles that describe past developments and future directions in several areas of policy and law related to HIV/AIDS. The following article is the first of these, discussing current challenges and future directions in the development of and access to HIV vaccines. It argues that governments are under public health, ethical, and legal obligations to develop and provide access to HIV vaccines. It further explains what is required for governments to fulfill their obligations: additional commitment and resources for HIV vaccine development in the context of increased global research and development regarding diseases of the poor; increased support and advocacy for partnerships to develop HIV vaccines; enhanced regulatory capacity in every country to review, approve, and monitor HIV vaccines; and assurance of global supply of, procurement of, delivery of, and access to vaccines in the context of efforts to increase global access to public health measures and technologies.     

Drug policy in Canada--the way forward

This article is one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS. It takes a critical look at Canada's drug policy. Despite calls for a balanced approach focused on reducing drug-related harm, Canada's method of dealing with problems of illicit drug use has remained prohibitionist in nature, and by far the greatest part of federal funding is devoted to supply-reduction initiatives. Considerable changes in policy and law are needed to significantly reduce the harms associated with injection drug use in Canada. These include developing a comprehensive and integrated strategy, exploring alternative legal frameworks, piloting innovative approaches to reducing injection-related harms, and investing in broad social policies that address the determinants of injection drug use.     

HIV vaccines in Canada: legal and ethical issues--an overview

In July 2002 the Legal Network released an overview paper on legal and ethical issues related to an HIV vaccine in Canada. The paper, which is based on a more detailed report prepared in collaboration with the Centre for Bioethics of the Clinical Research Institute of Montréal, calls for the establishment of a Canadian HIV Vaccine Plan.     

Barcelona 2002: law, ethics, and human rights. Using the law to improve access to treatments

The XIII International AIDS Conference in Durban, South Africa in July 2000 focused worldwide attention on the problem of accessing treatments in developing countries. In the interim, thanks to the work of activists - from demonstrations to court cases, and from acts of public courage by people living with HIV/AIDS to ongoing lobbying of politicians and trade negotiators - some very significant developments have occurred. But the reality is that the vast majority of people living with HIV/AIDS still lack access to affordable, quality medicines. This article, a summary of a paper presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India, explores three approaches for improving access. In the first part, Richard Elliott provides an overview of the state of the right to health as embodied in international human rights law; comments on the experience to date in litigating claims to the right to health; and identifies potential strategies activists can adopt to advance recognition of the right to health. In the second part, Sharan Parmar and Vivek Divan describe price-control and drug-financing mechanisms used by industrialized countries to increase the affordability of medicines; and discuss how some of these mechanisms could be adapted for use in developing countries. Finally, Jonathan Berger describes the use of litigation in the courts by the Treatment Action Campaign in South Africa.     

Africa: regional workshop held on HIV/AIDS and the right to health

In October 2003, the AIDS and Rights Alliance of Southern African (ARASA) and the Zambia AIDS Law Research and Advocacy Network (ZARAN) held a regional workshop on HIV/AIDS and the Right to Health: Challenges and Opportunities, at Kafue Gorge, Zambia.     

Legal and ethical issues in microbicides research and development in Canada

The Canadian AIDS Society (CAS) recently completed a report entitled Microbicides Development and Delivery in Canada: Legal, Ethical and Human Rights Issues. The report builds on Canadian and international experience and was written in consultation with Canadian community and international experts. It is available on the CAS website (www.cdnaids.ca) and from the Canadian HIV/AIDS Information Centre (www.aidssida.cpha.ca) as of September 2004. In this article the report's author, Anna Alexandrova, argues that Canada needs to develop a microbicides development and delivery strategy that addresses research and development issues, outlines possible roles for meaningful community participation, and provides guidelines on funding, promotion, licensing, and distribution.     

HIV treatments, vaccines, and microbicides: toward coordinated advocacy

In November 2003, the Canadian HIV/AIDS Legal Network convened a meeting in Montréal of global experts working in the fields of treatments, vaccines, and microbicides. The meeting was historic in that it was the first occasion on which advocates from the three fields had the opportunity to meet and exchange views on policy priorities. In this article, John Godwin provides a summary of the background paper produced for that meeting and of the key outcomes of the meeting. The article describes the reasons why developing a joint advocacy agenda has emerged as a priority for advocacy organizations from the three fields, despite their differing histories and the fact that they have often been positioned as competitors rather than collaborators. The role of a human rights approach in informing joint advocacy and the relevance of the prevention-care-treatment continuum are considered. The article then examines possible areas for joint advocacy, including funding, clinical trials, public private partnerships, tax credits, liability issues, equity pricing, bulk procurement, regulatory issues, manufacture, delivery, and national plans. The article concludes by noting upcoming opportunities for joint advocacy efforts, and outlining the next steps to be taken by the Legal Network to support coordinated advocacy.     

Barcelona 2002: law, ethics, and human rights. HIV testing for peacekeeping forces: legal and human rights issues

In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the XIV International AIDS Conference (abstract TuOrG1173), reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights-based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel.     

Compulsory HIV testing after an occupational exposure

In December 2001, the Ontario legislature passed Bill 105, authorizing a Medical Officer of Health to order blood testing of a source person in the event that emergency service workers and "good Samaritans" (as well as other categories of people) may have been exposed to a communicable disease. Similar legislation (Bill C-217) is before a committee of the House of Commons. This article discusses the value of information about the health status of the source person, Bill C-217 and Bill 105, current public health guidelines, recent Canadian research, and the conclusions of Backgrounder prepared by the Canadian HIV/AIDS Legal Network.     

Canada: new report on HIV,HCV, and women prisoners

In March, 2003, the Prisoners' HIV/AIDS Support Action Network (PASAN) released Unlocking Our Futures: A National Study on Women, Prisons, HIV and Hepatitis C, a qualitative, evaluative study investigating the perceptions and lived experiences of federally incarcerated women regarding HIV/AIDS and hepatitis C (HCV).