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The world’s response to HIV three decades ago can be summed up in one word: Shameful. At worst, people living with HIV were, inexplicably, chained to their beds, detained, turned away from medical facilities, criminalised and deported.
At best, they lost their jobs, were kicked out of schools and denied access to basic services. We responded to a virus by humiliating, stigmatising and punishing those infected. Our response to the virus was as painful, and sometimes as deadly, as the virus itself.
Fortunately, impressive strides have been made in the fight against HIV.
In the past few years major scientific advances have been made and the number of new HIV infections, particularly among children, has been slowly declining, fewer people are dying from Aids-related causes, nearly half of those people eligible for antiretroviral treatment, including in low- and middle-income countries, are now receiving it, and treatment has become the new engine for prevention.
HIV is no longer the certain death sentence it once was.
And yet the stigma and discrimination faced by HIV-positive people remains high, in every region of the world. Even today, we continue to focus on punitive approaches to HIV such as the criminalisation of HIV transmission, non-disclosure and exposure.
Entry restrictions against and deportation of HIV-positive non-nationals at borders are still far too common, particularly in the more affluent countries. The most vulnerable communities, the ones that least enjoy their fundamental human rights, also remain disproportionately more vulnerable to HIV infection – and this is no coincidence.
The face of HIV has always been the face of our failure to protect human rights. One of the key drivers of Aids has always been, and remains, this failure to ensure human rights protection for marginalised communities, including prisoners, sex workers, drug users, people with disabilities, migrants, refugees and asylum seekers. Homophobia, gender discrimination, racial profiling and violence against women have further impeded efforts to effectively manage and contain the spread of HIV.
The theme of this year’s International Aids Conference in Washington DC later this month is Turning the Tide Together. It is indeed now time to turn the tide. The human rights violations that have characterised the spread of HIV – and in many cases also the fight against HIV – must be curbed.
It is time to build on the gains of the past few years to create a sustainable global response to an epidemic that still challenges us. Taking a human rights perspective on the issue is essential.
The starting point is the recognition of all people as equal in the enjoyment of their human rights. Vulnerable populations that are most at risk must not only be included in national responses to HIV, they must also be given the opportunity to participate in making the policies that will affect them.
Human rights norms must accompany public health considerations to ensure that our laws, policies and programmes do not increase vulnerability to HIV or result in further human rights violations. Broad laws and policies in many countries that criminalise non-intentional HIV transmission, exposure and non-disclosure, target specific groups for mandatory HIV testing, and restrict travel of individuals based on HIV status alone, are examples of such alarmist and misguided policies.
Advances in the right direction have been made, one of which – the lifting of travel restrictions – has enabled the US to host the Aids conference this year, after 22 years.
But much remains to be done. Even in the US, where laws are on the books to protect and promote the human rights of HIV-positive people, the extent to which they are respected and enforced is not clear.
More resources certainly need to be channelled into ensuring access to good-quality lifesaving antiretroviral treatment and to human rights programmes, including awareness raising, training of health care providers and law enforcement officials, access to justice for HIV-positive individuals, fighting stigma and educating young people about safe sex.
Funding the fight against Aids in this holistic fashion is not only necessary, it is also a human rights legal obligation.
The economic crisis cannot be an excuse for diminishing our investment in the response to Aids.
This would result in a reversal in the gains made so far.
This is not a time for complacency. UNAids has as its goal Zero new infections, zero Aids-related deaths and zero discrimination.
At this Aids conference – a gathering of high-level government officials, civil society, the international community and, importantly, people living with HIV – it is essential to drive home the point that in order to succeed, human rights must inform and motivate our response.
l Navi Pillay is the UN high commissioner for human rights.