AIDS 2010 Update: Realizing Universal Access to HIV Treatment, Prevention and Care Relies on Protecting and Promoting Human Rights and a Right to Health Framework

AIDS 2010 Update: Realizing Universal Access to HIV Treatment, Prevention and Care Relies on Protecting and Promoting Human Rights and a Right to Health Framework

The AIDS 2010 conference theme “Rights Now, Right Here” was delivered loudly, clearly, and passionately throughout the week in Vienna as delegates discussed the practical and urgent implications for truly gaining universal access to HIV treatment, prevention, and care. Over 10 million HIV positive people are without access to treatment, without universal access, the MDGs will not be achieved by 2015.

Human rights violations are a barrier to learning about the epidemic or receiving critical prevention information. Some HIV positive people are subject to unethical surveillance. Human rights violations contribute to transmission of HIV (such as from rape in prisons or domestic violence) and, in too many countries, being HIV positive is a criminal offense. Stigma, discrimination, and persecution are all huge barriers to HIV testing, care, and support. Universal access to human rights by all is what will lead to universal treatment, prevention, and care, not the reverse. Realizing the full protection of human rights is the first step to enhancing efficiency in these programs. The right to live life free of stigma and discrimination and the right to health care including treatment, prevention, care, and needle exchange and substitution treatment are essential.

Ban Ki Moon reminded delegates of the 2001 UN General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS that emphasized the centrality of human rights for an effective HIV response. President Bill Clinton said in the opening plenary, “health care should be a right for everyone, but isn’t.” The Deputy President of South Africa called for governments to realize the right to health. The new UNAIDS Director, Michel Sidibe, called for full equality for women and girls in UNAIDS’ new “prevention revolution” and an urgent need to address gender-based violence as a critical factor controlling the epidemic. He called for ending discrimination for Men Who Have Sex with Men (MSM), Commercial Sex Workers (CSW) and Injecting Drug Users (IDUs).

Other speakers called for immediate access to treatment, prevention, and care services for migrants, prisoners, and those with Hepatitis C. Stigma and discrimination are still drivers of the epidemic and systemic marginalization of these populations precludes universal access. Without a human rights perspective, access has a limited reach. As the late Dr. Jonathan Mann had said, “fighting stigma and discrimination are as essential fighting the disease itself.” Abuses and discrimination by health workers against HIV positive patients were discussed as were the widespread policies and laws in over 80 countries that criminalize homosexuality and People Living with HIV.

In order for universal access to be achieved as well as MDG 6, universal access needs to truly be universal whereby all who need care can receive it. Many believed that human rights is the vehicle to take us forward toward controlling the epidemic. President Clinton recognized accountability and realization of the right to health as a key factor in achieving access and that governments need to make it happen. Mass mobilization on the national level on the right to health needs to happen to make care that is available and accessible possible. Others said all have a role to play in realizing the right to health, including patients, caregivers, members of civil society and NGOs (including health development implementers such as MSH who are helping governments deliver the right to health), health centers in the private and public sector, businesses and governments. Communities must be included in decision-making and included in planning delivery and evaluating services.

The rights of youth were also a rallying cry—young people are entitled to all human rights despite their diversity and many youth decried the lack of access to information on how to protect themselves.

Meena Seshu, who gave the Jonathan Mann lecture, outlined the struggle for rights of sex workers in India. She described the Sangram Bill of Rights adopted by a community that had a right centered approach that worked in delivering prevention messages and condoms to thousands of sex workers.

Their bill of rights is universal to all:

1. People have the right to be approached with humility and respect.

2. People have the right to say yes or no to things that concern them.

3. People have the right to reject harmful social norms.

4. People have the right to stand up and change the balance of power.

5. People have the right not to be rescued by outsiders who don’t understand them.

6. People have the right to exist how they want to exist.

The Harvard Program on International Health and Human Rights contributed many posters discussing the need for integrating human rights into health systems and the HIV response. They argued that “as increasing attention is being paid to health systems strengthening, efforts are needed to determine how human rights can strengthen health systems. They said: “rights elements relevant to HIV include the legal and policy context, equality, non-discrimination, accountability, and participation. Human rights language appears in descriptions of health systems but explicit incorporation of rights remains lacking. Attention to the overall legal and policy context can identify laws outside the scope of health systems that may facilitate or impede HIV service delivery and can promote participation of PLHIV in decision-making processes, oversight and monitoring of services. “

“Systematic attention to rights as they relate to health systems can improve HIV-related outcomes at individual and population levels. Human rights should be taken into account in health systems frameworks so as to strengthen their operation in ways that enhance HIV prevention, treatment, and care.”

The conference closed with a commitment to achieving universal access and goals for increased improvements in human rights when delegates meet again in Washington, DC in 2012. I hope the discussions on the intersection of public health and human rights continue there as rigorously as they did in Vienna.

Watch Global Health TV's Call for Human Rights in AIDS policy video.

Barbara Ayotte is Director of Strategic Communications at MSH.