A human rights-based approach to mitigating the extent and effects of the AIDS epidemic, and promoting universal access to HIV services is critical. Although there has been notable progress in many areas, punitive laws, policies, practices, stigma and discrimination continue to undermine the achievement of universal access targets including access to prevention for those who need it and the MDGs related to the right to health.
PAHO Director participation at the XVIII International AIDS Conference, the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are, evaluate recent scientific developments and lessons learned, and collectively chart a course forward.
Given the 2010 deadline for universal access set by world leaders, AIDS 2010 is a major push for expanded access to HIV prevention, treatment, care and support.
XVIII International HIV/AIDS ConferenceThe AIDS 2010 programme presents new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV.
How we can effectively scale up evidence-informed and human rights-based laws, policies and programmes in support of a ‘prevention revolution’ to break the trajectory of the epidemic. Panelists from governments, civil society and the UN presents their views on whether we have used human rights analysis effectively to move forward in achieving Universal Access to prevention, treatment, and care and support services.
Dr. Mirta Roses Periago,
Director of the Pan American Health Organization (PAHO/WHO)
Speech at the UNAIDS Satellite Session
" Human Rights-based approach to HIV Prevention: Mission Impossible?"
Vienna, Austria. 18 July 2010
Global Village Session.
from left: Mirta Roses, PAHO Director and
Tripti Tandon, Lawyers Collective in India; at ‘Human Rights-based approach to HIV Prevention: Mission Impossible’
18 July 2010.
Credit: UNAIDS/Anna Rauchenberger)
It can safely be said that a critical and perhaps initial step towards Universal Access has been taken by rights-holders who by claiming their human right to the enjoyment of the highest attainable standard of health -“right to health” - which includes obligations and measures to guarantee prevention, treatment and care - have succeeded in making this human right and other related human rights a reality to themselves and to many others. Those claims have been strongly supported by international and regional Human Rights treaty bodies, committees and special rapporteurs by requesting duty-bearers (mainly Governments) to honor the international treaties and agreements their countries have subscribed to. Whether by strong conviction or as a result of resources interposed before human rights 'duty-bearers’ the response is in many instances supportive of and conducive to the achievements of the Universal Access targets.
This has been the experience in many countries of the Region of the Americas through “precautionary measures” or “emergency measures” interposed by the Inter-American Commission on human rights, they seek to guarantee availability of treatments and therefore to guarantee fundamental rights to persons living with HIV such as the right to life, the right to personal integrity and the right to equal protection under the law, among others. The scale up process is active when the equation of awareness and exercise of Human Rights by rights-holders and commitment by duty bearers is balanced. Hence, the halting of the HIV epidemic entails knowledge sharing and awareness, through the educational processes on Human Rights treaties, principles and standards for all stakeholders, including the private sector.
PAHO has supported educational activities of health authorities, judges, legislators, ombudspersons and members of civil society on Human Rights which have resulted in the expansion in offering and utilization of voluntary testing and counseling, access to condoms, and positive prevention actions.
It is important to mention that prevention, treatment and care without discrimination are intrinsic elements of the right to health enshrined in the constitution of the World Health Organization and also in several international and regional human rights treaties such as the Covenant on Economic, Social and Cultural Rights and the Protocol of San Salvador, just to mention a few.
In 2004, during the Extraordinary Summit of the Americas in Monterrey, Mexico, the heads of state expressed their commitment to expand access to treatment. They also commit to face stigma, discrimination and fear which are factors that deter people from gaining access to health and other social services. This in turn, may prove critical for prevention, early diagnosis and prevention of re-infection and other co-infections which again, are situations which not only can affect negatively the right to health of individuals, but also their right to life and personal integrity. The Declaration from that summit did not use the word “rights” in the context of HIV prevention and care, but it is obvious that by claiming the need to face and address stigma and discrimination there is a clear focus on Human Rights principles such as human dignity, attention to the most disenfranchised, and equality and equity in access.
Given that the vast majority of infections occur during events of unprotected sex, there is an ongoing discussion on how sexuality and sexual health relate to Human Rights. Even the term “sexual rights” has been coined to refer to that relationship and to define the informed and autonomous capacity to live one’s sexuality in a healthy and responsible manner. The notion refers also to the aspirational goal of individuals, families and communities to live in and create environments in which people can fully live their sexualities in a healthy and responsible manner. We will have then to underline, and this has been the position of the Committee on Economic, Social and Cultural Rights of the United nations, that the right to the enjoyment of the highest attainable standard of sexual health is another aspect of the broader “right to health”, governments, specialized agencies, the private sector and civil society “as duty bearers” have a responsibility and the measures to implement regarding “sexual health” in a manner consistent with human rights law obligations.
With certain frequency there are groups and populations whose sexual attractions, desires, identities, and behaviors are considered undesirable and the members of these groups not only live their sexual lives clandestinely with fear and shame, but also avoid actions intended to improve their health out of fear of being further stigmatized and mistreated. Again, these apparent “social and cultural situations” have a profound effect in the exercise of the right to the enjoyment of the highest attainable standard of health and other related human rights such as the right to live free from violence and the right to equal protection under the law. Fear can lead to stigmatization and stigmatization can lead to mistreatment and even loss not only of health, but even life, which is a basic human right: the right to life.
These groups and populations were explicitly discussed at the Meeting of Ministers of Health and Education held in Mexico City on August 1st, 2008 and they became a center topic when discussing their location at the center of the epidemic in the Region. An outcome of the meeting was the Mexico City Ministerial Declaration “Educating to Prevent” in which they, as duty-bearers, ministers commit to implement strategies to guaranteeing the rights to education, health and other related human rights for all children, adolescents and youth in an environment free of violence, stigma and discrimination. Furthermore, they expressed their commitment to ensure that comprehensive sexuality education, recognized an added factor to prevent HIV, must include topics related to sexual orientations and identities and promote respect for differences rejecting any form of discrimination.
The groups and populations that are disproportionately affected by the epidemic do require special attention not only because of their greater risk of exposure to infection but also because of their increased vulnerability fueled by disdain attitudes, marginalization, bullying, harassment, and covert and overt violence. This is why PAHO is emphasizing at all levels that the highest attainable standard of health will not be possible without the exercise of basic human rights and fundamental freedoms.
At the same time, only when societies exercise all their human rights and freedoms, the enjoyment of health becomes a reality. This is the reality also in the HIV context. In regions, sub-regions and localities with concentrated epidemics these persons are the ones that must be the main beneficiaries of prevention and care interventions as part of their right to health which entails specific measures to be implemented by governments. Therefore, there should be clarity about the public health rationale behind the special emphasis on the most at risk groups and populations or MARPs and the appropriate tools to address them. Yet, at the same time there must be a clear strategy to deal with Human Rights issues, especially protection of human rights that may and will hamper the prevention and care actions. We are in the process of developing the necessary tools to work with men who have sex with men, with female sex workers, with transgender persons, and with drug users. Nevertheless, we are convinced that these tools may not be useful unless they are supported by sensitization and education activities on Human Rights.
The Pan American Health Organization is also supporting Member States with tools to address homophobia and discrimination in the health sector Within the health sector each provider and member of a team becomes a duty-bearer that must ensure not only the highest level of care and access to state of the art prevention but also respect to dignity and regard for diversity.
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The Global Village of AIDS 2010 was the setting of a UNAIDS satellite session on HIV prevention and human rights where participants discussed how evidence-informed and rights-based laws, policies and programmes can be scaled-up in support of a ‘prevention revolution’ to break the trajectory of the epidemic.
Panelists highlighted some enduring failures to recognise and protect human rights in the context of prevention, as well as examples of successful prevention responses employing a human rights-based approach. Notwithstanding some key challenges, the unanimous view of the diverse expert panel was that such an approach to prevention is not mission impossible if current opportunities to put human rights at the centre of the prevention revolution are seized. Indeed, it was felt that there can be no ‘revolution’ of the prevention response without human rights.
Panelists emphasized that a prevention revolution must be grounded in human rights if there is to be a significant and sustainable improvement in the prevention response, noting that the experiences shared confirmed that success in prevention can only be achieved in legal and social environments that advance human rights, gender equality and social justice.