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.     

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. 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.     

Effectiveness of hotline, advocacy, counseling, and shelter services for victims of domestic violence: a statewide evaluation

The authors report the results of an evaluation of services provided by 54 Illinois domestic violence agencies. In collaboration with the University of Illinois at Chicago evaluation team, domestic violence advocates identified services to be evaluated, specified desired outcomes of those services, and participated in developing measures of those outcomes in both English and Spanish. With in the limitations of the study, outcomes were positive in all four program areas: hotline, counseling, advocacy, and shelter. The authors then discuss implications for evaluation of domestic violence programs that maintain victim safety as a guiding principle.     

Coexistence, conflict, and cooperation: public policies toward medical devices

Medical devices include thousands of products, many of which have greatly contributed to the quality of health care. As devices have proliferated, so have public policies that affect them. The federal government intervened to promote three fundamental values: safety by federal regulation, innovation through federal funding of research and development, and access by providing services under Medicare. The policies generally coexisted without conflict. However, two recent developments--the advent of cost containment and the expansion of the tort liability system--present a potentially disruptive influence on these policies, and threaten to undermine the values they serve. Because cost restraints are inevitable and the tort system provides consumer protection, the challenge for policymakers is to reconcile them with the values of safety, innovation, and access. The proposals presented here seek to promote coordination to protect those values without imposing unacceptable costs on the health care system.     

Penal austerity: Perceived utility, desert, and public attitudes toward prison amenities

Several states have reduced or eliminated a variety of amenities for prisoners. It is unclear, however, whether the general public supports making prisons harsher and more austere. Using a sample of 200 citizens from central Florida, the present study finds less support for prison austerity than commonly assumed. In addition, these preferences are linked to particular correctional goals, especially concerns about utility and desert.     

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.     

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).     

The Philippines: HIV/AIDS, condoms, and human rights

Influential leaders are increasingly attacking condoms through HIV-prevention programs that focus on sexual abstinence and marital fidelity. In May 2004 Human Rights Watch (HRW) released a report that examines the impact of these policies in the Philippines, the largest Roman Catholic country in Asia and a major recipient of US HIV/AIDS funding.     

The measurement of concern about victims: Empathy,victim advocacy and the Victim Concern Scale (VCS)

Purpose . In a series of studies, the authors developed the Victim Concern Scale (VCS) to assess levels of concern for diverse types of crime victims. The goal was to derive a psychometrically sound instrument and to assess victim concern in relation to other crime‐related attitudes and victim advocacy endorsements. Methods . Through several scale iterations, participant responses to the VCS were examined. Participants also completed measures of empathy and provided judgments about specific victim/crime scenarios. In addition, in two large samples (college [N = 276] and community [N = 478]), victim concern was compared with other attitudes, attributions and participant demographics. Results . Participants readily distinguished among different victims. Four factors emerged from the VCS. Raters endorsed the highest levels of concern for victims of violent crimes and the lowest level for ‘culpable’ victims. Women and older respondents showed higher levels of concern across all categories of victims. Both victim concern and emotional empathy influenced advocacy responses to victimization. Victim concern was unrelated to such traits and attitudes as authoritarianism, political ideology or punishment goals; moreover, a high level of concern for victims did not preclude endorsement of rehabilitative goals for offenders. Conclusions . The VCS appears to be a valid instrument for assessing levels of concern for victims. It differs meaningfully from measures of general empathy. The VCS could be used to assess differential attitudes across demographic groups or as a measure of change following exposure to educational or other persuasive intervention.