An estimated 25,000 participants will soon gather in Vienna for the XVIII International AIDS Conference (AIDS 2010) under the banner of Rights Here, Right Now, declaring the fundamental importance of protecting and promoting human rights as a prerequisite to a successful response to HIV. This year also marks the deadline world leaders set for attaining universal access to HIV prevention, treatment, care, and support. Just as the lack of financial resources has been a major barrier toward achieving this goal, human rights violations and the absence of legal protections have also significantly hindered progress.
Vienna was selected as the site for AIDS 2010 in large part because of its proximity to Eastern Europe and Central Asia (EECA), home to the world’s fastest-growing HIV epidemic, and a region where the role of human rights violations in fueling the epidemic is clearly evident. People who inject drugs, sex workers, women, people in detention, and men who have sex with men (MSM) all bear the brunt of discriminatory policies and programs that too often deny them access to the HIV services they need. People who inject drugs represent more than 80 percent of HIV cases in EECA, but only 14 percent of those receiving antiretrovirals. Harm Reduction Developments 2008: Countries with Injection-Driven HIV Epidemics (2008). Recent field assessments in five EECA countries also found that women who use drugs face gender-specific barriers to accessing harm-reduction and drug-treatment services. Women, Harm Reduction, and HIV: Key Findings from Azerbaijan, Georgia, Kyrgyzstan, Russia, and Ukraine (2009). Turning its back on those at greatest risk for infection, the Russian government refuses to support a network of successful HIV prevention and harm-reduction programs known as the GLOBUS Project, which has averted an estimated 37,000 HIV infections. Meanwhile, the “war on drugs” has had little appreciable effect on demand, while criminalizing addiction.
AIDS 2010 is an opportunity to examine not only the region’s significant human rights challenges, but also the impact of programs and policies in the region that are rooted in a human rights framework. Ukraine, for example, is making major efforts to scale up opioid substitution therapy (OST) to reach 20,000 people by 2013, and in Kyrgyzstan a nationwide scale-up of OST, including pilot OST in prisons, is underway. Russia’s own dramatic scale-up of HIV treatment is also a model for other countries.
Of course, the role of human rights violations in the spread and devastation of HIV go well beyond EECA, circling the entire globe. As a result of their political, social, economic, and sexual subordination, women now account for almost half of all HIV infections globally and the majority of infections in sub-Saharan Africa. Many women living with HIV face discrimination, stigma, and violence on a daily basis. Ralf Jürgens and Jonathan Cohen, Human Rights and HIV: Now More than Ever (2009). Inadequate access to reproductive health services remains a major barrier to HIV prevention among women. And, although efficient methods to prevent vertical transmission exist, children are still being born with HIV.
The effort to further criminalize homosexuality in Uganda is among the most recent and public examples of the very real threats to MSM and other sexual minorities in countries around the world—threats that criminalize their sexuality and place them at increased risk for HIV, making it less likely that they will seek treatment and care.
Despite the recent change in U.S. law, the still-common restrictions on the freedom of movement and residence of people living with HIV around the world perpetuate stigma and discrimination, running counter to all scientific evidence and sound public health practice. ( See www.hivrestrictions.org.)
More than 650 organizations and networks around the world have endorsed the joint statement Human Rights and HIV: Now More than Ever, which states: “In every regional and country consultation on universal access, 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.” This situation must change. With all eyes upon Vienna, AIDS 2010 will expand awareness of the human rights impediments to universal access and identify strategies to generate the commitment, funding, and programming to overcome them.
All people living with HIV and those at risk for infection have the right to dignity and self-determination. They have the right to equal access to health care and lifesaving prevention and treatment programs, and the right to HIV interventions based on evidence rather than ideology.
The role of human rights violations in the HIV epidemic is well documented, as are the remedies. Our collective efforts must now be focused on building the political and societal will to ensure that human rights are a central tenet of the response to HIV. It is our profound hope that AIDS 2010 will prove a pivotal moment in such efforts.
Julio Montaner is the chair of AIDS 2010 and director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. Brigitte Schmied is local conference co-chair and president of the Austrian AIDS Society in Vienna.