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.     

Chinese scholars call for AIDS rules based on respect for individual rights

In June 2002, the UN Theme Group on HIV/AIDS in China published a comprehensive situation analysis and needs assessment of the HIV/AIDS epidemic in the People's Republic of China (PRC). The report, entitled "HIV/AIDS: China's Titanic Peril", also describes and analyzes current HIV/AIDS legislation and policies. It notes that "laws and regulations that are based on fear and prejudice have contributed to fuelling the epidemic instead of curbing it." The report observes that the targets and goals established in China's five-year Plan of Action (2001-2005) are not consistent with the commitments endorsed in June 2001 at the United Nations General Assembly Special Session on HIV/AIDS. It states that the Plan "continues to present HIV/AIDS as a medical problem, and fails to understand the epidemic as a broader development issue." Even where laws could assist, enforcement remains a huge challenge. For example, in 1998 the National People's Congress passed a law prohibiting commercial blood donations for medical purposes. Nonetheless, the illicit and unregulated blood trade, which has rapidly accelerated the spread of HIV infection in China, has continued. When the alarm was sounded by Dr. Wan Yanhai, coordinator of the AIZHI (AIDS) Action Project, the government response was to arrest him. In the following article, Nick Young, editor of China Development Brief, reviews the findings of three studies commissioned by the United Nations Development Programme (UNDP) on the role of the law in response to HIV/AIDS.     

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.     

Epidemics and agendas: the politics of nightly news coverage of AIDS

We examine why the exponential growth of AIDS cases or the wide-spread professional perception of a health crisis did not move the epidemic more quickly onto the agenda of public problems. One possible explanation focuses on how the national news media's construction of AIDS shaped the meaning of the epidemic for mass and elite audiences. An examination of nightly news coverage by the three major networks from 1982 to 1989 reveals considerable variability and volatility in their coverage. Topic-driven saturation coverage occurred only during three short periods in 1983, 1985, and 1987, when the epidemic seemed likely to affect the "general population". Only at such moments did public opinion shift and discussion and debate in government begin. Otherwise, the typical AIDS story tended less to sensationalize than to reassure, largely because journalists depended upon government officials and high-ranking doctors to present them with evidence of news. Such sources had interests either in avoiding coverage or in pointing toward breakthroughs; more critical sources, especially within the gay movement, had far less access to the news. In concluding, we considered the prospects and pitfalls of the news media's power to shape the public agenda.     

Barcelona 2002: law, ethics, and human rights. The need for harm-reduction approaches in Eastern Europe and the former Soviet Union

In a region where HIV is spread primarily by injection drug use, harm-reduction strategies must be the mainstay of prevention efforts. In her plenary presentation to the XIV International Conference on AIDS on 9 July 2002, Kasia Malinowska-Sempruch asserts that if the world does not turn its attention to the emerging and exploding epidemic in Eastern Europe and the former Soviet Union, the region will suffer the same fate as Africa. The presentation explains that while their economies continue to struggle, the countries in the region have seen their public health systems crumble in the face of the twin health crises of injection drug use and HIV infection. The presentation demonstrates how current repressive laws and practices with respect to drug use serve only to fuel the epidemic. It describes harm-reduction approaches (such as needle exchanges and drug-treatment programs) and provides examples of how NGOs in the region have been attempting to implement such approaches, often with little or no support from governments. Finally, the presentation outlines other measures required to respond to the epidemic in the region, including ensuring that people infected with HIV can access care, treatment, and support services.     

A human rights critique of the United Kingdom's HIV response

The National AIDS Trust (NAT) is the United Kingdom's leading HIV policy and advocacy NGO. NAT is committed to promoting a human rights framework for HIV responses through work with communities, governments, professionals, and the private sector, both within the UK and internationally. In this presentation to the XIII International AIDS Conference (abstract WeOrE524), John Godwin and Saul Walker discuss current human rights issues related to HIV/AIDS in the UK, and NAT's perspective on the International Guidelines on HIV/AIDS and Human Rights as an advocacy tool.     

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.     

重大突发公共卫生事件中防疫用品市场管制理路

作为一种公共干预,管制通常是对经济事件或市场失灵的特殊回应。重大突发公共卫生事件中防疫用品市场管制基础在于防疫用品的公共性和外部性。管制必须于法有据,这就需要以相应的管制立法为前提。为有效化解法律稳定性与重大突发公共卫生事件应对所要求的及时性、灵活性的矛盾,政府需要着眼于供给和需求两端,立足防疫用品生产、销售、消费三个环节,依据相关立法遵循法定程序,出台相应的管制政策。     

Police and HIV/AIDS: The risk, the reality, the response

Risk and fear have been examined empirically and theoretically in the policing literature. To date, however, there has been minimal effort to examine these concepts in the context of HIV/AIDS. Since the HIV/AIDS epidemic was first detected nearly 20 years ago, relatively little attention has been given to the complex issues it presents for police officers. The following discussion draws from both the policing and epidemiological literatures to examine police officers’ fear and risk of occupational HIV transmission and individual and departmental responses to this fear. Important elements of educational programs and policies are also addressed.     

Psychiatric patients and AIDS: the forensic clinician perspective

A survey was completed by American Academy of Forensic Sciences (AAFS) Psychiatry and Behavioral Science members regarding their opinions on acquired immunodeficiency syndrome, (AIDS)-related issues. A considerable range of opinions was found, probably reflecting such differences in society. There was general agreement that psychiatric hospitals should not be allowed to refuse AIDS patients and that education about AIDS is useful for psychiatric patients. There was also support for notifying the public health department, known sexual contacts, and hospital staff about human-immunodeficiency virus (HIV)-seropositive patients.     

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.     

Thou Shalt Not Flip Flop: Senators’ Religious Affiliations and Issue Position Consistency

Is there a relationship between legislators’ religious affiliations and the consistency of their voting records? Building on the theory of “the personal roots of representation,” we argue that a legislator's likelihood of switching positions depends on whether the issue is central to their personal values. We evaluate this claim using a data set including senators’ religious affiliations and “culture war” votes from 1976 to 2004 and find that different religious groups vary in their voting consistency on issues such as abortion, public prayer, and gay and lesbian rights.     

Human bites and the risk of human immunodeficiency virus transmission.

The risk of human immunodeficiency virus (HIV) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the United States, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of HIV and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, HIV and AIDS, HIV in saliva, and case examples was performed to examine the current opinion regarding the transmission of HIV via this route. A bite from an HIV-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.     

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.     

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.     

Report on complementary/alternative health care and HIV/AIDS

In 2001, the Canadian HIV/AIDS Legal Network published a lengthy report on Complementary/Alternative Health Care and HIV/AIDS: Legal, Ethical & Policy Issues in Regulation. The document is the first in a series of papers to be produced by the Legal Network on priority legal and ethical issues related to HIV/AIDS care, treatment, and support. The article below summarizes the contents of the report.     

Commons committee recommends significant increase in funding for AIDS strategy

A House of Commons committee says that current funding for the Canadian Strategy on HIV/AIDS should be more than doubled. It calls for designated funding for inmates and First Nations and Inuit peoples, and for HIV vaccine research. Finally, it says that more federal government departments need to become involved in the response to AIDS.     

Parliamentarians take the initiative on HIV/AIDS

In 1999 UNAIDS and the Inter-Parliamentary Union jointly published the Handbook for Legislators on HIV/AIDS, Law and Human Rights. This section describes initiatives taken by parliamentarians to promote legal and policy responses to the HIV/AIDS epidemic which respect human rights.     

Rural HIV: Brief interventions for felony probationers

HIV/AIDS in Southern rural America has been described as an epidemic. Furthermore, the HIV prevalence rate among criminal justice populations is higher than the general population in both rural and urban areas. One segment of the criminal justice population, felony probationers, has not been targeted for HIV/AIDS interventions and little is known about rural HIV risk behaviors. Probation is an appropriate setting for examining HIV interventions because rural participants can be easily identified and contacted. Thus, the purpose of this paper is to describe an HIV intervention for Southern rural probationers and to profile participants (N=800) on their demographics and risk behaviors by degree of criminality. Results suggest that HIV interventions are needed to target rural probationers, especially those with extensive arrest histories since they engage in high-risk behaviors, including illicit substance use and unprotected sex. This project is supported by grant #R01DA11580 from the National Institute on Drug Abuse. The opinions expressed are those of the authors.     

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.