Deinstitutionalization,Street Children,and the Coming AIDS Epidemic in the Adolescent Population

The debate about the deinstitutionalization of status offenders has persisted for over a decade. Those in favor of deinstitutionalization maintain that coerced treatment in secure institutions has not proven beneficial to status offenders and locking-up juveniles for noncriminal behavior violates their liberty interests. Those against deinstitutionalization argue it is not possible to treat someone who is not there (runaways) and while juveniles have the same liberty interests as adults, there are occasions for legitimate state restriction of those liberty interests. It is manifest that the advent of AIDS is such an occasion. Deinstitutionalization has allowed thousands upon thousands of juveniles to live on the streets of our cities. These children have no skills, no lawful means of supporting themselves, and thus are at the mercy of those who prey upon the powerless. The lifestyle of these children (high drug usage, prostitution, and promiscuity) places them directly in the path of AIDS. Their exposure and vulnerability to the disease are vast. Street children constitute a large reservoir of AIDS which could be the source of an AIDS epidemic in the overall adolescent population. Society will pay a horrific price unless there is concerted action now by providers of health care and social services to develop a strategy to contain AIDS within the street-child population, and to prevent the spread of AIDS from them to the overall adolescent population.     

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. 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.     

The effect of respondents' just world beliefs and target person's social worth and awareness-of-risk on perceptions of a person with AIDS

The present research examined how individuals' just world beliefs affected their perceptions of a person with AIDS who was depicted as having contracted the HIV virus while either aware or unaware of health risks, and who was defined as either high or low in general social deservingness or worth. Dependent variables included respondents' affective reactions to the person with AIDS, their willingness to allocate resources to him, and their perception of the fairness or the unfairness both of his general plight and that various types of resources be given to him. Results indicated that those who were higher in just world beliefs were more emotionally negative to the other with AIDS, they were less willing to contribute resources to him, and they felt that it was less fair that such resource transfers be required. Similar response patterns were found when the other with AIDS was described as lower in social worth and when he was depicted as having contracted AIDS with full awareness of health risks. Implications of the findings were discussed in terms of how psychological theories of justice might inform health care policy.     

"It's the little things": women, trauma, and strategies for healing

Women recover and heal from traumatic violent experiences in many different ways. This study, which is part of the Franklin County Women and Violence Project, explores the healing experiences of 18 women who have histories of violence, substance abuse, and involvement in the mental health and/or substance abuse treatment system. Ethnographic interviews suggest that while professional intervention can be beneficial, it may not be adequate. In fact, it can be retruamatizing. The means of service delivery and treatment by individuals, service providers and others, may be more important than the actual service. Often women find that caring individuals and a safe environment yield the greatest benefit. It is not so much what people do to help, but how they do it.     

How Brazil outpaced the United States when it came to AIDS: the politics of civic infiltration, reputation, and strategic internationalization

Using a temporal approach dividing the reform process into two periods, this article explains how both Brazil and the United States were slow to respond to AIDS. However, Brazil eventually outpaced the United States in its response due to international rather than democratic pressures. Since the early 1990s, Brazil's success has been attributed to "strategic internationalization": the concomitant acceptance and rejection of global pressure for institutional change and antiretroviral treatment, respectively. The formation of tripartite partnerships among donors, AIDS officials, and nongovernmental organizations has allowed Brazil to avoid foreign aid dependency, while generating ongoing incentives for influential AIDS officials to incessantly pressure Congress for additional funding. Given the heightened international media attention, concern about Brazil's reputation has contributed to a high level of political commitment. By contrast, the United States' more isolationist relationship with the international community, its focus on leading the global financing of AIDS efforts, and the absence of tripartite partnerships have prevented political leaders from adequately responding to the ongoing urban AIDS crisis. Thus, Brazil shows that strategically working with the international health community for domestic rather than international influence is vital for a sustained and effective response to AIDS.     

Correctional Service Canada to undertake Safer Tattooing Practices Initiative

In 1994, the Expert Committee on AIDS and Prisons recommended that tattooing equipment and supplies be authorized for use in federal correctional institutions, and that prisoners who would offer tattooing services to other prisoners be instructed on how to use tattooing equipment safely. Ten years later, Correctional Service Canada (CSC) has finally announced that, as part of a Safer Tattooing Practices Initiative, it will set up safer tattooing pilot projects in six federal prisons in 2004, and evaluate the initiative.     

Tax Court allows tax credit for herbs and vitamins, not for massage

In August 2001, the Tax Court of Canada issued its most recent judgment on the tax deductability of expenses for complementary/alternative therapies. The decision in Pagnotta v Canada is significant for people with HIV/AIDS who use such therapies. It also illustrates how provincial and federal laws regulating health-care practitioners and natural health products have a financial impact on the cost of accessing treatment.     

Social junk,social dynamite and the rabble: Persons with AIDS in jail

The issues surrounding AIDS in corrections have forced administrators to develop policy which accurately reflects the realities of the AIDS crisis. Moreover, administrators must base their policy decisions on available research findings, much of which is generated by government agencies and research policy groups. Whereas this research does serve the proper function of guiding policy, it is somewhat removed from the theoretical implications that AIDS has to societal reaction and social class. This article introduces a theoretical framework comprised of Irwin’s (1985) concept of the rabble and Spitzer’s (1975) notes on social junk and social dynamite. In addition to discussing this framework as it relates to social metaphors and social control, the implications to correctional policy are also be presented. The author gratefully acknowledges Marie Mark for her assistance in preparing the final version of this article.     

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.     

Love,fear, and justice: Transforming selves for the new world

Two current models of the self are contrasted. The limitations of these (egocentric autonomous and sociocentric organic) models generate five problems for a comprehensive approach to justice. An alternative model is presented that views the self as an agent who is dependent on others and is motivated by both love for the other and fear for the self. This alternative model has three advantages: The two current models can be derived from it; it resolves the problems created by their limitations; it provides a concrete vision of how we must develop ourselves if we wish to obtain a just world.     

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.     

Vladimir Shapoval: "The CEC Is Destined to Be the Scapegoat"

"The law is harsh, but it is the law"—the well-known ancient Roman saying is entirely suitable as a brief synopsis of the Lb.ua interview with the chairman of the Central Election Commission (CEC), Vladimir Shapoval.

"Any electoral legislation, I emphasize, any, will always be 95 percent the product of political expediency. Always. This way gives them an advantage—so be it." This is how he calmly parried my emotional "How can the advantage of the strong be codified in the law (!), and the weak essentially have no chance? What can you do, how can it be?" "All this ‘whining and crying,’ say, the law is this and that in substance, I do not accept it. The laws were adopted—so we will follow them. You cannot get away from it," he added.

It might seem to someone who does not know Vladimir Nikolaevich that the chief vote-counting official is being clever, "covering up" the "distortions" of the authorities "at the local level." He is in fact speaking frankly. The chairman of the Central Election Commission formed on the eve of the 2007 preterm parliamentary elections by a "coalition"—a retired Constitutional Court of Ukraine (CCU) justice, and a doctor of legal sciences who is an active member of the High Council of Justice (HCJ), he can permit himself that. Shapoval contrives to call things by their names: "How the law is written is another matter. And its parts are written abominably," he states bluntly.

In view of this, my discussion with Shapoval—formally tied to the start of a local elections campaign—went far beyond the bounds of a discussion of the legislation on this topic, and even the specifics of the campaign. The more so as I had already discussed this in detail with CEC Deputy Chairman Andrei Magera. Vladimir Nikolaevich, without concealing his indignation, related just what the HCJ is really afraid of (and it turned out it was not at all, or more precisely not only, what they are portraying it to be). Relying on nine years of experience as a CCU justice, he elucidated the risks of the invalidation of the 2004 constitutional reform by the current Constitutional Court—"only those who have face can lose it." Sketching out the situation in the body politic, he summed up, "If the Party of Regions (PoR) does not win the local elections, many questions will arise."     

Infanticide, physicians, and the law: the "Baby Doe" amendments to the Child Abuse Prevention and Treatment Act

Infanticide, like most other species of homicide, is probably coeval with the human race itself. In modern Western civilization, what were formerly the most powerful incentives to infanticide have virtually disappeared. As with other social problems that affluence has seemed to solve, however, infanticide has reappeared in a new form that seems to have been made possible by affluence itself. This "new infanticide" occurs in a place whose very existence is the result of a tremendously wealthy society's devotion to its most vulnerable and least "useful" members. The modern neonatal intensive care unit, which treats, and often saves, extremely ill newborn children, who during most of history would surely have died, has proven to be a setting where many of the age-old incentives for infanticide have begun to operate again. The "new infanticide" consists of withholding food or needed medical treatment from selected infants who suffer from one or more serious, though treatable, medical problems. The national government has now enacted legislation designed to curtail the practice of infanticide by the medical profession. This paper traces the genesis of that legislation, explores the problem to which it is addressed, and evaluates its prospects for success.     

Constitutional challenge to "medical inadmissibility" provisions in the Immigration Act

In a case with significant implications for people living with HIV/AIDS who wish to immigrate to Canada, in January 2002 a woman with multiple sclerosis launched a constitutional challenge to the "medical inadmissibility" provisions in the Immigration Act. The provisions state that any would-be immigrant may be denied permission to immigrate "if their admission would cause or might reasonably be expected to cause excessive demands on health or social services."     

Sexual Entitlement: Rights and AIDS,The Early Years*

While traditionally social scientists saw politics as an independent force acting on law, today it seems appropriate to also view law as an agent in the construction of political identities, aspirations and tactics. Here, the AIDS epidemic illuminates this relationship. Soon after AIDS was identified, the cities of San Francisco and San Diego moved to close the gay baths as breeding grounds for the disease. The struggle over that policy reveals how law enters into the debates within the homosexual community, and at least partially constitutes individual identity in that community.     

Child Neglect and "Unfit" Mothers:

The state's reaction to pregnant mothers who use drugs today has major continuities with the Progressive Era's response to mothers accused of child neglect. The child savers in both historical eras have imposed their class, ethnic and racial biases upon poor, immigrant and African-American women. These child savers imposed a gender ideology of maternal care on mothers, labelling those mothers who did not conform to their cultural ideal, "unfit" mothers in need of state control. In the modem era, physicians collude with prosecutors and social workers to prosecute and medicalize pregnant mothers who use drugs through the use of mandatory reporting laws together with drug tests, often resulting in the removal of their children from their homes. Historical comparison provides us with insight into how processes of engendering state power have disempowered mothers.     

Gender, sexuality, and HIV/AIDS: the what, the why, and the how

The focus of Geeta Rao Gupta's plenary presentation of 12 July 2000 at the XIII International AIDS Conference is on the what, why, and how of gender, sexuality, and HIV/AIDS. Dr Rao Gupta discusses the factors associated with women's vulnerability to HIV; and the ways in which unequal power balance in gender relations increases not only women's, but also men's, vulnerability to HIV-despite, or rather because of, their greater power. She then addresses the question of how one is to overcome the seemingly insurmountable barriers of gender and sexual inequality. How can we change the cultural norms that create damaging, even fatal, gender disparities and roles? According to Dr Rao Gupta, an important first step is to recognize, understand, and publicly discuss the ways in which the power imbalance in gender and sexuality fuels the epidemic. She provides examples of sensitive, transformative, and empowering approaches to gender and sexuality and concludes that, in the final analysis, reducing the imbalance in power between women and men requires policies that are designed to empower women--policies that aim to decrease the gender gap in education, improve women's access to economic resources, increase women's political participation, and protect women from violence.     

“Experts by Experience”: The Involvement of Service Users and Families in Designing and Implementing Innovations in Family Justice

Drawing on international research, policy, and practice, this article explores what is meant by service user involvement, how it has developed, and how it has been implemented across different areas of practice. Using examples from across the health and social care fields, it reflects on how the learning from other areas of practice in which service user involvement has been successful may be applied to the family justice field. The arguments presented highlight the value of taking a bottom‐up approach in designing and implementing innovations in family justice, which would embrace the views of family members, including children, as ‘service users.’ It is important, however, to balance both the challenges and the opportunities offered by involving those who are ‘experts by experience’ in the family justice processes, in order to lead to improved services and experiences.     

Ontario court recognizes constitutional equality rights of people "in receipt of social assistance"

On 13 May 2002, the Ontario Court of Appeal released its unanimous decision in the Falkiner case, which declared the definition of "spouse" in Ontario's social assistance legislation to be unconstitutional because it discriminates on the basis of sex, marital status, and receipt of social assistance. The case is significant for people living with HIV/AIDS, given that a high proportion live on social assistance and thus face discrimination.