Participants of AIDS 2010, the XViII International AIDS Conference, Reveal What’s In Store Regarding Human Rights and the Future of the Pandemic

by Larry Buhl
The International AIDS Conference turns twenty-five this year. With an estimated 25,000 scientists, policy makers, persons living with HIV and others committed to ending the pandemic, AIDS 2010 will look at what efforts have fallen short and share new ways of promoting expanded access to HIV prevention, treatment, care, and support.

The theme of the conference—“Rights Here, Right Now”—will also spur an examination of how promoting and protecting human rights is necessary for a successful and sustainable response to HIV.
Leading up to AIDS 2010 in Vienna, Austria, this July, we asked several conference speakers and participants how human rights and HIV/AIDS are linked and what is the best we can realistically expect before the next conference.

What’s the link between HIV/AIDS and human rights?

Brigitte Schmied
President, Austrian AIDS Society, Local Co-Chair, AIDS 2010
We are now at a turning point where we need to strengthen the global commitment to human rights, as they are a key component of the response to HIV/AIDS. Especially, we need to focus on the difficult situation of people living with HIV and those affected by HIV, like women and young people, gay, lesbian and transgender people, sex workers, and drug users. In the context of HIV, human rights includes the rights to healthcare, access to evidence-based interventions such as harm reduction services, and the right to a life free of stigma and discrimination.

Vuyiseka Dubula
General Secretary of the Treatment Action Campaign, South Africa
When we speak about human rights it is not limited to certain people but we have seen certain groups being victimized as with the recent backlash against people in same-sex relations. This discrimination makes the group difficult to reach and undermines public health efforts to reduce HIV. In the South African context human rights are enshrined in the constitution and our national policy on treatment and prevention recognizes the link between scaling up treatment and reducing new infections to protecting and promoting human rights. The policy has set a number of targets to be met in this area.

Yves Souteyrand
Coordinator of Strategic Information in the World Health Organization HIV/AIDS Department, Geneva, Switzerland
We are living in a world where millions of women, young people and marginalized populations have HIV because their rights have been violated one way or the other. There is strong evidence that HIV transmission is much higher among sex workers, injecting drug users, men-who-have sex-with-men, transgender people, and prisoners. There is also widespread stigma and discrimination against these most-at-risk-populations, which makes it much harder to reach them with appropriate HIV/AIDS prevention, treatment, and care services. Stigma, discrimination, and violence against people living with HIV are unfortunately occurring in many corners of the world and they are serious cases of human rights violations. And there are over fifty countries and areas that don’t allow free entry and travel for people living with HIV, which is another form of human rights violation. HIV can not be overcome as a global problem unless we address human rights linkages with HIV. Successful response to HIV requires respecting the human rights of all people living with or without HIV.

Elaine Abrams, MD
Professor of Pediatrics and Epidemiology at the Columbia University College of Physicians & Surgeons and the Mailman School of Public Health, NYC, USA
Living a healthy life and having access to health services belongs in the spectrum of human rights. Access to health services and vulnerability to disease are intertwined with other human rights, like the empowerment of women, the rights of children, and poverty. As long as you have disadvantaged populations you have chronic disease. Children in particular are horribly neglected and they have no voice. Organizations have to work closer with each other. Health-based organizations are seeing the importance of addressing structural issues, and that is important for addressing a chronic disease like HIV.

Manfred Nowak, PhD
Professor of International Human Rights Protection at University of Vienna and Director of the Ludwig Boltzmann Institute of Human Rights, Austria

People living with HIV are at high risk of discrimination, and this is even more the case when they are in prisons or in police custody. Inmates living with HIV are extremely vulnerable. States also have a duty to ensure that inmates have access to information related to HIV, as well as education and means of protection such as condoms and clean injection equipment. Inmates should also have access to confidential voluntary counseling, testing, and psychological help. In many countries, governments need to address structural issues such as overcrowding and corruption. Prison staffs need to be trained properly to deal with HIV-infected detainees. Drug users in prisons should also be able to receive drug dependence treatment. If possible, I would also recommend drug users be treated in treatment centers, outside of correctional facilities. The vulnerable groups at risk of infection, such as the mentally ill, juveniles and women should be separated from other inmates and given particular attention. These are the main human rights issues related to inmates and HIV/AIDS.
In addition, I have repeatedly expressed my concerns about the international drug policy, which is based more on a criminal law approach than on harm reduction measures in conformity with international human rights law. A significant percentage of persons living with HIV/AIDS are injecting drug users, above all in the Russian Federation and other Eastern European countries. Because of this, harm reduction measures such as substitution, needle or syringe exchange could have a significant impact in reducing HIV transmission.

Christy Abraham
Bangalore, India-based International Head of HIV/AIDS for ActionAid, South Africa
People living with HIV are often denied their rights by policies and programs on education, health, social security and property rights, which leads to exclusion. This political and social exclusion and denial of rights often forces people living with HIV to lead a life of seclusion. This can cause them to develop self-stigma and self-denial. This is due to vulnerable groups not reaching out to available services as they are often unable to accept their status—this means that they deprive themselves of information and access to facilities and medicines. Even if they are able to come to terms with their condition, as a result of being socially excluded, they are unable to earn money to pay for essential medicines.
Similarly, the exclusion and denial of rights and entitlements to poor and marginalized women, sex workers, transgender people, sexuality minorities, urban homeless and migrant populations can lead to poverty, which in turn increases HIV and AIDS vulnerability—particularly for those who are being exploited. This is due to the most vulnerable groups placing their need for basic survival before anything else—buying essential items such as food for their families will come above obtaining primary healthcare for themselves.

What can we expect in the near future?

Carlos Cáceres, MD, PhD
Professor of Public Health at Cayetano Heredia University and Director of the Institute of Studies in Health, Sexuality and Human Development, Peru

I don’t expect any magic bullet in the near future. I just hope that we manage, as a global community, to improve our responses to the epidemic through policies and programs that are well implemented and that are based on both good evidence and solid human rights principles, and that we increasingly understand the HIV crisis as driven by a broader set of social and structural issues that need serious attention, not only for the sake of HIV control, but also to reach better life conditions and more justice for all.

The impact of the HIV epidemic is still large enough to justify organized concerted global action. But there is also increasing consensus on the need to respond to HIV in the context of broader issues including health systems, development, and human rights. Perhaps such a focus will make such investments farther-reaching and more comprehensive in spite of temporary reductions in total amounts invested.

In any event, efforts need to become creative and improve program effectiveness and accountability.
Vuyiseka Dubula: Our primary hope is to achieve universal access. Funders must not backtrack on their commitments and undermine all of the successes of the HIV programs achieved so far. Instead they must continue to support HIV programs to achieve universal access, to reduce new infections, and finally turn the tide on the epidemic.

HIV/TB still remains the number one killer of poor people in Africa, mainly young women in their childbearing years. This undermines our development and population growth. We must always remind the world that HIV is not about numbers of people already on treatment, it’s also about preventing new infections and treating those already infected. HIV is a burden felt at an individual and family level so investing in health is a public good. No economy can prosper if it’s ravaged by illness and high mortality rates.

Brigitte Schmied: 2010 is a pivotal year in the campaign for universal access, not only because of the 2011 deadline, but because the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is holding the third replenishment meeting in New York in October. At this meeting, wealthy nations and other donors will be asked to make three year commitments to ensure the GFATM has sufficient funding to support all high quality funding requests it receives from low-income countries. Adequate funding for the GFATM is crucial as it, along with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is the largest funder of AIDS services globally. Western countries can fulfill their commitment to funding universal access throughout the world, in particular through a strong replenishment of the GFATM in 2010. And Western governments can continue to encourage EECA government leaders to adopt evidence-based interventions such as opioid substitution therapy and needle and syringe exchange services.

Elaine Abrams: My hope is that some international attention will be turned to the needs of women and children with HIV and that is translated to some gains in the field. The WHO issued its new PMTC guidelines in 2009 that covered infant feeding, mother-to-child transmission, and antiretroviral treatment of adults and children. This is a new opportunity for us. It increases the level of attention by international organizations. If all forces come together we might see more lives saved and more women getting lifesaving treatment.

Yves Souteyrand: My hope is that the epidemiology is well used to develop actual policies and programs to stop the spread of the disease. In terms of the overall response, we are entering a new era to find new ways to address the epidemic with much smarter technologies and cost-effective treatments. WHO is announcing a new set of guidelines for HIV treatment and prevention at the XVIII International AIDS Conference, Vienna, Austria. If well implemented and supported, these new approaches and policy directions will help save and prolong lives of millions in HIV-affected communities.

Current economic conditions should not be translated into lowering expectations in responding to the global HIV epidemic. HIV is still the biggest infectious killer in the world, taking chances of prosperity away from many families and communities, particularly in developing countries. There were 33.4 million people living with HIV with 2.7 million new HIV infections and two million AIDS-related deaths in 2008. In 2010, with over four million people receiving life-saving ART, which is a ten-fold increase over five years, we should be encouraged by the progress achieved in the past decade. Cutting HIV/AIDS funding now will bring catastrophic results. We should not lose the fragile gains that resulted from global action but protect them.

Christy Abraham: In 2011 the UN will review the commitments made by 150 countries at the UNGA in June 2001. Here they promised to address the empowerment of women, special assistance for children, and the need for further research and development of a preventative vaccine for HIV/AIDS. ActionAid hopes that at this meeting they will make HIV/AIDS a global priority and start responding effectively. ActionAid’s primary hopes for the next year: legal frameworks are implemented in countries protecting the basic human rights of people living with HIV/AIDS; policies are implemented in favor of women and children affected by AIDS; and free and subsidized lifelong treatment is provided to all those living with HIV/AIDS. We believe that patents should be re-examined so that the production of generic medicines is made more feasible in developing countries.
ActionAid International keeps attention focused on HIV by mobilizing communities and generating pressure on states worldwide to respond locally and globally. Currently about twenty ActionAid countries are working on HIV and AIDS issues in the global south. However, the context in the north is changing because of the financial crisis and HIV is viewed more as a health issue, which can be managed clinically through antiretroviral therapy. If G8 countries do not follow through on their commitments to provide medicine to southern countries, this means that people will be living without these lifesaving drugs.

Larry Buhl wrote about Women ARISE, an international AIDS coalition that fights against gender-based inequities, in the May issue.