Human Rights and HIV/AIDS“An important aspectof HIV/AIDS policy isto ensure theprotection of the humanrights of those who arevulnerable and alsothose who are infected.Appropriate workplacepolicies that ensureawareness, access tohealth services, nondiscriminationat theworkplace and care andsupport for thoseinfected go a long wayin mitigating the impactof HIV/AIDS”.Atal Bihari Vajpayee,Indian Prime Minister, atthe launch of the IndianBusiness Trust forHIV/AIDS, New Delhi,September 2001Chapter 4Human Rights and HIV/AIDS4.1 IntroductionThis chapter looks at the necessity of usinga human rights approach in the fightagainst HIV/AIDS. It argues that theepidemic can be combated effectively onthe one hand only with an enabling legalenvironment, and on the other, societalacceptance through sustained sensitisationand the elimination of stigma anddiscrimination.Many of the key strategies against HIV—especially those dealing with behaviourchange among vulnerable groups—require a set of legal and statutory changesthat make it feasible for PLWHA to have agreater voice in decisions affecting theirown lives, without fear of beingstigmatised and discriminated against.Treating HIV prevention as a corecomponent of the policy frameworkof human development can helpaccomplish this task, since the objectiveof a ‘caring society’ is common tothe concerns of human rights andAIDS activists.4.1.1 Understanding humanrights within a humandevelopment frameworkHuman rights are now widely acceptedas being central to any community ornation’s effective response to HIV/AIDS.This has been acknowledged both ininternational documents and nationalresponses. 1 It is important, then, to assessthe role and importance of a human rightsframework in responding to HIV/AIDS.Human rights are inherent in andinalienable to every individual. They renderthe government and the larger societyaccountable to the citizen. Every individualhas a right to live with freedom and dignityand ‘citizens’ are the ‘duty holders’obligated to respect, protect and addressthis fundamental need. Human rights arenot given or bestowed upon people byindividual governments or society butare earned by virtue of being born `human’.As Justice J.S. Verma, former chairpersonof India’s National Human RightsCommission so aptly put it, “dignity is theentitlement of all as long as life exists.” 2HDR 2000 defines human rights as “therights possessed by all persons, by virtueof their common humanity, to live a life offreedom and dignity. They give peoplemoral claims on the behaviour ofindividuals and in the design of socialarrangements–and are universal,inalienable and indivisible.” The value of ahuman rights approach lies not only inprinciples such as state accountability andpopular participation, but also in thenormative potential of rights to alleviateinjustice, inequality and poverty. 3<strong>Regional</strong> Human Development <strong>Report</strong>HIV/AIDS and Development in South <strong>Asia</strong> 2003 73
Human Rights and HIV/AIDSThe internationalresponse toHIV/AIDS has beencharacterised bytwo diametricallyopposed publichealth approaches:the isolationistapproach and theintegrationistapproach.The conceptual framework of humandevelopment places people at the centreas empowered beings. It embodies arights-based approach to developmentthat could serve as the appropriate frameof reference for integrating the humanrights concerns in the struggle against HIV.Principles of GIPA are, therefore, intrinsicto the human development approach.“The protection of human rights isessential to safeguard human dignity inthe context of HIV/AIDS and to ensurean effective, rights-based response toHIV/AIDS. An effective response requiresthe implementation of all human rights,civil and political, economic, social andcultural, and fundamental freedoms of allpeople, in accordance with existinginternational human rights standards…”. 4Addressing the epidemic within a humanrights framework involves a strongemphasis on acceptance and nondiscriminationof populations perceivedto be more vulnerable to HIV. The lastdecade has witnessed the increasingconcentration of the epidemic in thedeveloping world where the responseneeds to not only protect individual rightsand privacy, but must also deal with widerdevelopmental concerns like poverty,gender and inequality. Such an approachwill encompass the InternationalCovenant on Economic and Social Rights,the Convention on the Elimination of AllForms of Discrimination Against Women(CEDAW) and the Convention on Rightsof the Child (CRC). In sum, it will capturethe spirit of the Universal Declaration ofHuman Rights, which talks about povertybeing the greatest denial of human rights.4.1.2 Relevance and importanceof human rights to HIV/AIDSIt has been argued that protecting therights of those affected and at risk is thebest public health strategy to cope withan epidemic. A rights-based approachrecognises vulnerability to the epidemicnot just in terms of individual behaviourbut also the social, cultural and economicconditions that lead to this vulnerability.It also recognises that the vulnerability ofwomen, children, migrant workers, menwho have sex with men, injecting drugusers and sex workers can be reducedthrough the protection of their humanrights. It is only when the stigma anddiscrimination faced by PLWHA iseliminated, that they can be empoweredto take control of their lives. Protection ofhuman rights helps to create a supportiveenvironment, encouraging PLWHA toaccess the various health and HIV/AIDSrelatedsocial services and, consequently,stimulating behaviour change. Thisposition has been vindicated by theexperiences of several countries. 5The international response to HIV/AIDShas been characterised by twodiametrically opposed public healthapproaches-the isolationist approachand the integrationist approach. Theisolationist response proposes three basicstrategies for HIV/AIDS prevention:compulsory and universal HIV screening,the disclosure of the HIV status of thosetesting positive and their isolation fromlarger society through discriminatorypractices. The integrationist strategy, onthe other hand, proposes voluntarytesting following informed consent, thenon-disclosure of a person’s HIV-positivestatus and the equitable treatment ofPLWHA in healthcare, employment andall other facets of life.Integrationist policies were based on thefundamental human rights of individualsto self-autonomy, privacy and equality.The basis of this philosophy was that,in the long term, voluntary testing,confidentiality and non-discriminationwould encourage people to come out andaccess health services. This, in turn, would74<strong>Regional</strong> Human Development <strong>Report</strong>HIV/AIDS and Development in South <strong>Asia</strong> 2003