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.     

HIV/AIDS and human rights revisited

In their article, Sofia Gruskin and Daniel Tarantola demonstrate how, as the number of people living with HIV and with AIDS continues to grow in nations with different economies, social structures, and legal systems, HIV/AIDS-related human rights issues are not only becoming more apparent, but also increasingly diverse. In the 1980s, the relationship of HIV/AIDS to human rights was only understood as it involved people with HIV or AIDS and the discrimination to which they were subjected. The concerns included mandatory HIV testing; restrictions on international travel; barriers to employment and housing, access to education, medical care, or health insurance; and the many issues raised by named reporting, partner notification, and confidentiality. Almost 20 years into the epidemic, these issues remain serious and most often have not been resolved. In the 1990s, however, there was increased understanding of the importance of human rights as a factor in determining people's vulnerability to HIV infection and their consequent risk of acquiring HIV infection and their chances of accessing appropriate care and support. And most recently, human rights have also come to be understood to be directly relevant to every element of the risk/vulnerability paradigm. Gruskin and Tarantola identify three situations and three levels of governmental obligations that should be considered when identifying the specific needs and related rights of individuals in the context of HIV/AIDS. They conclude that policymakers, program managers, and service providers must become more comfortable using human rights norms and standards to guide and limit government action in all matters affecting the response to HIV/AIDS; and that those involved in HIV/AIDS advocacy must become more familiar with the practicalities of using international human rights law when they strive to hold governments accountable.     

Legal rights and communicable disease: AIDS, the police power, and individual liberty

The policy debate over AIDS has focused on how to balance the rights of individuals who have the disease against the rights of the public. This paper examines the nature of both sets of rights by analyzing the development of public health law and its dominant visions today. The article argues that while once public health rights implied a vast reserve of community authority and obligation to prevent illness, today the rights of the public and those of individuals are seen as being in opposition. Public health jurisprudence now presupposes that illness is primarily a matter of individual concern. In this view, the science of medicine mediates the relationship between the individual and the public. This understanding of rights protects some of the interests of infected individuals, but is inadequate for addressing many of the major problems raised by the AIDS epidemic, particularly the spread of infection among the uninfected.     

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.     

Barcelona 2002: law, ethics, and human rights. An advocacy and political conference produces a consensus: effective action is urgently required

From the deep sense of frustration about the gap between what is possible and what is actually happening, a clear consensus emerged at the XIV International AIDS Conference that effective action is urgently required. This article is based on a presentation on 12 July 2002, the last day of the conference, by Terje Anderson, the rapporteur for Track G. The article presents a summary of the discussions in Track G on topics such as advocacy strategies, the use of the law, the use of a human rights framework and approach, the role of people living with HIV/AIDS, and the need to mobilize sufficient resources. The article states and then critically examines some of the consensus positions that emerged from the conference--specifically, the goal to have three million people on antiretroviral therapy by 2005; the notion that the debate around prevention versus care is over; and the idea that the key issue is no longer what we do, but how to secure the commitment and the resources to do it. The article states that the fight against HIV/AIDS must be fought on a political plane, and that it is the responsibility of everyone working in AIDS to engage our leaders. The article concludes by asking whether we really have the courage and the perseverance to turn our knowledge and our commitment into action.     

Developments in South African law on HIV/AIDS

South Africa has a powerful legal framework that offers high levels of protection to people living with HIV/AIDS, yet discrimination against people living with HIV/AIDS continues to be widespread in South African society. Court cases decided in 2003 regarding children's issues and health care testify to this ongoing discrimination, and to the potential of the South African legal system to uphold the rights of people living with HIV/AIDS.     

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.     

Measuring legal implementation of the international guidelines on HIV/AIDS and human rights

With over 36 million people now living with the virus and over 21 million people dying of AIDS in the last two decades, HIV/AIDS is a global health and security problem. These shocking figures eclipse the human toll of many wars, and reveal in themselves that human rights are not being respected, protected, or fulfilled, either through negligent omissions or violations. A human rights approach to the epidemic was advocated early by advocates such as Jonathan Mann, who recognized that infections thrived in conditions of inequality. This approach was crystallized in the International Guidelines on HIV/AIDS and Human Rights that were developed at the Second International Consultation in 1996 convened by UNAIDS and the Office of the High Commissioner for Human Rights. The Guidelines cover three main areas: improving governmental responses in terms of multisectoral responsibility and accountability; widespread law reform and legal support services; and supporting increased private sector and community participation in effective responses to the epidemic. This article focuses on the half of the twelve Guidelines that concern rights that are justiciable and amenable to law reform. It highlights the responsibilities of States Parties to human rights treaties, as they bear the principal burden of the obligations to implement.     

AIDS Law Project receives AIDS and human rights award

The AIDS Law Project, the recipient of the 2nd Annual International Award for Action on HIV/AIDS and Human Rights, has been at the forefront of the struggle for human rights for people living with HIV/AIDS in South Africa. It has played a major role in convincing the South African government to implement a national HIV treatment plan.     

Barcelona 2002: law, ethics, and human rights. Toward a more meaningful involvement of people living with HIV/AIDS

All too often, the involvement of people living with HIV/AIDS in AIDS NGOs is tokenistic rather than meaningful. This article, which is based on a presentation by Chistophe Cornu (abstract WeOrG1292), demonstrates that, under the right conditions, the involvement of people living with HIV/AIDS can be beneficial both for the individuals and for the NGOs. The article describes the beneficial impacts of involvement observed in a study conducted in Burkina Faso, Ecuador, India, and Zambia. It also discusses the harmful effects of involvement, for individuals as well as NGOs, identified by study participants. The article concludes with a series of recommendations for NGOs to maximize the benefits of involvement.     

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.     

Barcelona 2002: law, ethics, and human rights. Introducing ARVs in resource-poor settings: challenges and consequences

In most industrialized countries, AIDS mortality has plunged sharply with the advent of antiretroviral therapy. Yet the majority of people living with HIV/AIDS do not have access to modern HIV care, and some experts have argued that introducing such therapy is not a ranking priority. In this article, which is based on a plenary presentation at the XIV International AIDS Conference, Paul Farmer presents the experience of an integrated HIV prevention and care project in rural Haiti, and explores the challenges to national AIDS programs and other bodies in the "least developed" countries as more resources are made available for HIV prevention and care.     

Barcelona 2002: law, ethics, and human rights. HIV/AIDS-related stigma and discrimination: a conceptual framework

Only if we understand where HIV/AIDS-related stigma and discrimination come from, and how they are connected to broader social inequalities and the denial of fundamental human rights, can we develop effective strategies to combat them. This article is a much-condensed version of a keynote presentation given at "Meeting the Stigma Challenge: New Paradigms for Civil Society," a satellite meeting held in Barcelona on 8 July 2002, and sponsored by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The presentation described the conceptual framework underpinning the 2002-2003 World AIDS Campaign, whose theme is "HIV/AIDS-Related Stigma and Discrimination," and whose slogan is "Live and Let Live." In this article, Peter Aggleton provides a conceptual overview of the relationship between the stigma and discrimination associated with HIV and AIDS and the human rights violations that ensue from them, with the goal of demonstrating the interconnectedness of these concerns. He also provides some examples of concrete steps that can be taken to counter the stigma, discrimination, and human rights violations.     

艾滋病立法与国际人权保障

国际社会已经达成共识,认为有效地控制艾滋病与人权保障之间存在着密切关系,而法律则是实现防治艾滋病的一个重要手段。因此,现实和未来都要求各国通过以保障人权为核心的相关立法,充分保护艾滋病病人和艾滋病病毒感染者的各项基本权利,切实调动社会各方面的积极因素来战胜艾滋病,最终维护人类的共同利益,实现社会的可持续发展。对此,在国际人权法的框架下,结合艾滋病的流行特点,国际社会和许多国家近年来制订了不少准则和法律,以阻止艾滋病的进一步传播。     

Nova Scotia renews its HIV/AIDS strategy

On 1 December 2003, after a five-year process of consultation and planning, Nova Scotia embarked on a new HIV/AIDS strategy. It replaces the first strategy, launched a decade earlier. The renewed strategy is meant to promote collaborative action on the determinants of vulnerability to HIV infection and on the capacity of people living with HIV/AIDS to achieve optimal health and quality of life.     

Botswana: Industrial Court tackles HIV testing in the workplace

The Botswana Industrial Court recently decided two cases regarding mandatory HIV testing in the workplace. One case addressed constitutional rights of HIV-infected people, expanding the reach of the Bill of Rights to the private sphere and potentially offering wide protection to people living with HIV/AIDS. Both cases highlight the glaring need for HIV-related legislation in Botswana.     

Survey reveals knowledge and attitudes of Canadians regarding HIV/AIDS

According to a national survey, almost two out of every three Canadians think the federal government should be spending more to fight HIV/AIDS. The survey also found that: (a) although most Canadians know a lot about HIV/AIDS, there are some significant gaps in their knowledge; and (b) although most Canadians think HIV/AIDS is a serious problem, the vast majority do not consider themselves to be at risk for HIV infection. Few Canadians blame people for contracting HIV through sex or drug use, but many Canadians are still uncomfortable associating with people with HIV/AIDS in certain settings.     

Eastern Europe and Central Asia: report identifies human rights gaps

Criminalization and stigmatization of the high-risk behaviours that promote the spread of HIV are fuelling the HIV/AIDS epidemic in Eastern Europe and Central Asia and placing millions of people at risk. This is one of the findings of a report from the United Nations Development Programme released in February 2004. The report, which is the first comprehensive profile of the epidemic in the 28 countries of the region, includes a significant focus on human rights issues.     

Access to treatment as a right to life and health

In some countries in Latin America, in the absence of leadership from governments, activists have had to resort to the courts to obtain access to HIV/AIDS treatments for people with HIV/AIDS. In his presentation to the XIII International AIDS Conference (abstract TuOrE458), Edgar Carrasco, of Acción Ciudadana Contra el Sida (ACCSI), discusses the process that was followed in Venezuela. The presentation describes the very limited access people with HIV/AIDS had to antiretroviral therapies and treatments for opportunistic infections under Venezuela's health and social security systems. It provides details of lawsuits that were launched on behalf of several individuals living with HIV/AIDS, and that resulted in the courts ordering the government to provide treatments for these individuals and, eventually, for all people with HIV/AIDS in Venezuela. The presentation concludes that recourse to the courts is a useful tool for activists and that civil actions launched on behalf of people with HIV/AIDS can serve as an example for people with other chronic diseases.     

Caribbean: Regional support for HIV/AIDS law and policy reform

In this article, David Patterson describes the second regional training workshop on HIV/AIDS, law, ethics, and human rights, which took place in Georgetown, Guyana in November 2003; and a grant from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (the Global Fund) to the Pan Caribbean Partnership against HIV/AIDS (PANCAP). The grant focuses on human rights, prevention, and care and support.