Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Human Rights

HIV/AIDS and Human Rights

The discipline and practice of health and human rights has owed much of its development to thinking about approaches to HIV, a disease that disproportionately affects people who are marginalized by gender-based subordination, criminalization and social exclusion. The following text, which summarizes some principal ideas about HIV as a health and human rights problem, is taken from the booklet "Human Rights and HIV/AIDS: Now More Than Ever", developed by the Open Society Institute.

In 2006, world leaders committed "to pursuing all necessary effort towards the goal of universal access to comprehensive prevention programs, treatment, care and support by 2010." Yet many of those most in need of HIV services are still the least likely to receive them:

  • Women and girls face widespread discrimination and gender-based violence, including within marriage, that fuel their HIV risk and impede their access to information and services.

  • Children and youth lack unfettered access to HIV information, sexual and life-skills education, and pediatric formulations of HIV medicines.

  • Criminalized populations, such as men who have sex with men, people who use drugs, and sex workers, are driven from HIV services by discrimination and violence, often at the hands of police officers and judges charged with enforcing sodomy, narcotics, and prostitution laws.

In every regional and country consultation on universal access [to HIV services], obstacles such as these have been cited as major barriers to achieving the goal of universal access. Yet in national responses to HIV and AIDS, hardly any political commitment, funding, or programming is dedicated to overcoming them.

Many of those at highest risk of HIV have one thing in common: their status is effectively criminalized by law. Police officers charged with enforcing antidrug, antiprostitution, and antisodomy laws routinely extort bribes and confessions from defenseless people, sometimes committing heinously violent acts against them, including rape and murder. Punitive approaches to drug use, sex work, and homosexuality fuel stigma and hatred against socially marginalized groups, pushing them further into hiding and away from services to prevent, treat, and mitigate the impact of HIV and AIDS.

  • People who use illicit drugs represent the smallest fraction of individuals receiving antiretroviral treatment in many countries, despite accounting for a majority of people living with HIV. Harsh drug laws effectively criminalize the status of being a drug user, leading police officers to extort bribes and confessions from vulnerable groups in order to meet arrest quotas. People who use drugs end up in prison or in a revolving door of ineffective and coercive rehabilitation programs, rarely receiving the services for drug addiction or HIV prevention and treatment they desperately need.

  • Sex workers, whose conduct also attracts criminal penalties under laws prohibiting prostitution, soliciting, pimping, brothel-keeping, and trafficking, often lack access to HIV services due to widespread police abuse. Forcible displacement of sex workers from commercial development areas further interferes with sex workers' access to community-based HIV services. Prejudicial and coercive treatment of sex workers in health facilities deters them from seeking HIV treatment and care. Aggressive efforts to abolish human trafficking often translate into opposition to programs that focus on the health and human rights of sex workers.

  • Men who have sex with men face widespread violence and discrimination around the world, as well as continued criminalization of sodomy in many countries. The continued stereotype of AIDS as a "gay disease" fuels social exclusion against gay men and people living with HIV alike, often driving both populations from mainstream health services. In many jurisdictions, police officers are more likely to ridicule or compound violence against gay men and transgender persons rather than investigate these crimes properly. Politicians in many countries pander to antigay prejudice rather than demonstrating the political will needed to combat HIV among vulnerable groups.

  • Prisoners and detainees in many countries have little or no access to voluntary HIV testing and to treatment even though in most countries people in detention have much higher HIV prevalence than the general population. Prisoners and detainees are often denied access to HIV prevention information and tools, even in places where these are available outside prison. Condoms and sterile syringes are often not provided, despite strong evidence of their effectiveness in preventing HIV without posing a risk to the wider prison population. Segregation of HIV-positive prisoners and detainees, denial of medical release, and failure to take effective action against prison rape are among the many human rights abuses that fuel HIV and worsen the impact of AIDS in prisons and other places of detention throughout the world.

Question for Thought

In 2010, there are many people who argue that HIV has received too much attention and funding as a global health priority and that too much focus on human rights protections has been cumbersome and made HIV strategies unduly "exceptional" compared to standard public health approaches. Do you think the examples about how certain people are affected by HIV or HIV risk are arguments for exceptional approaches? In what sense?