HIVphoto

How are HIV and AIDS a human rights issue?

What are HIV and AIDS?

What do the acronyms HIV and AIDS stand for?1

“HIV” stands for human immunodeficiency virus, which is a virus that affects the human immune system. It results in a deterioration of the immune system, causing an individual to become more vulnerable to other infections. “AIDS” stands for acquired immunodeficiency syndrome, which is an advanced stage of HIV defined by the demonstration of certain symptoms, infections, and cancers. An individual with HIV infection may not have developed any of the illnesses that constitute AIDS and the terms should be kept distinct.2 As UNAIDS notes:

The expression HIV/AIDS should be avoided whenever possible because it can cause confusion. Most people with HIV do not have AIDS. The expression ‘HIV/AIDS prevention’ is even more unacceptable because HIV prevention entails correct and consistent condom use, use of sterile injecting equipment, changes in social norms, etc., whereas AIDS prevention entails cotrimoxazole, good nutrition, isoniazid prophylaxis (INH), etc.3

There is currently no cure for AIDS. However, people living with HIV can live healthy and productive lives with antiretroviral therapy.4

How is HIV spread?

HIV can be transmitted through unprotected and close contact with certain body fluids, such as blood, semen, breast milk, and vaginal secretions from infected individuals. However, transmission is not possible through air or water, shaking hands, kissing, saliva, tears, or mosquitoes.5 Common routes of transmission include:

  • Unprotected vaginal or anal sex with an HIV-positive partner. The risk of contracting HIV from sexual encounters increases if the person has other sexually transmitted infections (STIs) and if the male is uncircumcised.6 Unprotected anal sex has a higher risk factor than vaginal sex, and unprotected receptive anal sex has a higher risk factor than unprotected insertive anal sex.7 Transmission can, in some instances with specific conditions, occur through oral sex.
  • Passage from an HIV-positive mother to a child during pregnancy, birth, or breastfeeding.
  • Sharing contaminated equipment used for injection drug use, including needles, syringes, and wash water.
How are HIV and AIDS treated?

Antiretroviral therapy (ART) is “the combination of at least three antiretroviral drugs to maximally suppress the HIV virus and stop the progression of the HIV disease.”8 ART is effective both as life-saving treatment and as protection against HIV AIDS.9 According to the Global Commission on HIV and the Law, “Legal strategies, together with global advocacy and generic [drugs], resulted in a 22-fold increase in ART access between 2001 and 2010.” Nevertheless, coverage remains unequal, and in 2011, just 54% of people indicated for ART in low- and middle-income countries received treatment. Globally, just 28% of children in need of treatment received ART.10 Although there is not yet universal access in many countries, treatment has been successful in extending life expectancy, decreasing HIV transmission,11 and promoting community activism and empowerment around HIV.12 

How is HIV a global epidemic?

The UN General Assembly notes that the HIV epidemic constitutes “an unprecedented human catastrophe inflicting immense suffering on countries, communities and families around the world.”13 More than 30 million people have died of AIDS14 and there are approximately 34.2 million people living with HIV today. Each year, some 2.5 million people become infected with HIV and around 1.7 million people die of AIDS-related causes, mostly in low- and middle-income countries.15 Over 16 million children have been orphaned because of AIDS.16 In the three decades since HIV was first reported, global infection and death rates have declined due to improved access to antiretroviral therapy, which increases life expectancy and reduces the likelihood of transmission. These gains, however, are fragile. HIV and AIDS continue to pose “formidable challenges to the development, progress and stability”17 of human society and must remain a global priority.18

What is the connection between HIV, AIDS, and tuberculosis?

Tuberculosis (TB), a disease caused by the Mycobacterium tuberculosis bacterium that attacks the lungs, is the leading cause of death for people with HIV worldwide.19 HIV compromises the immune system and thus increases the likelihood of TB infection, progression, and relapse. People living with HIV are estimated to have between 20-37 times greater risk of developing TB than those not living with HIV. In 2009, 1.2 million (13%) of the 9.4 million new cases of TB were among people living with HIV, and 400,000 (24%) of the 1.7 million people who died from TB were living with HIV.20 It is estimated that one-third of the 40 million people living with HIV worldwide are co-infected with TB.

Unlike AIDS, however, TB can be cured. Studies show that anti-TB drugs can prolong the lives of people living with HIV by at least two years. Therefore, offering TB tests and treatment to people with HIV—and vice versa—greatly increases the manageability of both diseases; indeed, due in large part to the scale-up of joint HIV and TB services, TB deaths in people living with HIV declined by 10% between 2009 and 2010.21

Inadequate and inconsistent treatment practices, on the other hand, can cause drug-resistant strains of TB. Multi-drug resistant tuberculosis (MDR-TB) is difficult and costly to treat and can be fatal. The emergence of MDR-TB poses a grave threat not only to people with TB, but to overall progress in the global response to HIV and AIDS.

For more information on TB and health and human rights, please see Chapter 3.

How are HIV and AIDS a human rights issue?

Human rights and HIV are inextricably linked. As the Inter-Parliamentary Union’s (IPU) Handbook for Legislators on HIV/AIDS, Law and Human Rights notes:

A lack of respect for human rights fuels the spread, and exacerbates the impact, of the disease. At the same time, HIV undermines progress in the realization of human rights. This link is apparent in the disproportionate incidence and spread of the disease among key populations at higher risk, and particularly those living in poverty. It is also apparent in the fact that the overwhelming burden of the epidemic today is borne by low- and middle-income countries. AIDS and poverty are now mutually reinforcing negative forces in many of these countries.22

Human rights are relevant to the response to HIV in at least three ways. First, lack of human rights protection creates vulnerability to HIV,23 particularly among marginalized and underserved groups such as women, children, and young persons; sex workers; people who use drugs; migrants; men who have sex with men (MSM); transgendered persons; and prisoners.24 The IPU states:

[These groups] are more vulnerable to contracting HIV because they are unable to realize their civil, political, economic, social and cultural rights. For example, individuals who are denied the right to freedom of association and access to information may be precluded from discussing issues related to HIV, participating in AIDS service organizations and self-help groups, and taking other preventive measures to protect themselves from HIV. Women, and particularly young women, are more vulnerable to infection if they lack access to information, education and services necessary to ensure sexual and reproductive health and prevention of infection. The unequal status of women also means that their capacity to negotiate in the context of sexual activity is severely undermined. People living in poverty often are unable to access HIV care and treatment, including antiretrovirals.25

Second, lack of human rights protection fuels stigma, discrimination, and violence against persons living with and affected by HIV.26 These harmful attitudes and practices are rooted in a lack of understanding of HIV, misconceptions about how HIV is transmitted,27 and “fears and prejudices surrounding sex, blood, disease, and death—as well as the perception that HIV is related to ‘deviant’ or ‘immoral’ behaviors such as sex outside marriage, sex between men, and drug use.”28 The IPU notes:

The rights of people living with HIV often are violated because of their presumed or known HIV-positive status, causing them to suffer both the burden of the disease and the consequential loss of other rights. Stigmatization and discrimination may obstruct their access to treatment and may affect their employment, housing and other rights. This, in turn, contributes to the vulnerability of others to infection, since HIV-related stigma and discrimination discourage individuals infected with, and affected by, HIV from contacting health and social services. The result is that those most needing information, education and counselling will not benefit even where such services are available.29

Third, lack of human rights protection impedes effective national responses to HIV.30 Discriminatory, coercive, and punitive approaches to HIV increase vulnerability to infection and worsen the impact of the epidemic on individuals, families, communities and countries.31 Examples include:

    • Ideologically driven restrictions on information about HIV prevention, including safe sex and condom use;
    • Criminalization of groups at higher risk of infection, such as men who have sex with men, persons who inject drugs, and sex workers;
    • Criminalization of “reckless” or “negligent” HIV exposure or transmission;
    • HIV testing without informed consent;
    • Limited access to harm reduction measures, such as needle and syringe programs and opioid substitution therapy;
    • Limited access to opioid medications for palliative care; and
    • HIV-related immigration restrictions on entry, stay, and residence.32 

These measures deter people from coming forward for HIV services and inhibit the ability of organizations to reach vulnerable and at risk groups.33 Human rights are thus necessary to achieving universal access to comprehensive prevention, treatment and care; to meeting the rights and needs of the most vulnerable and worst affected populations; and to ensuring voluntary, informed and evidence-based policies, programs and practices.34 The following are some examples of key human rights issues related to HIV.

HIV disproportionately affects persons living in developing countries and persons living in poverty.

HIV is deeply rooted in social, economic, and gender inequalities.35 The burden of the epidemic is disproportionately carried by persons in developing countries. Sub-Saharan Africa remains the worst-affected region, with 69% of all persons living with HIV and 70% of all HIV-related deaths. The Caribbean region has the highest HIV prevalence outside of sub-Saharan Africa and the number of new HIV infections is increasing in Eastern Europe, Central Asia, North Africa, the Middle East, and parts of Asia and the Pacific.36 The disparate burden of HIV across countries and communities requires “an exceptional and comprehensive global response that takes into account the fact that the spread of HIV is often a consequence and cause of poverty.”37

Poverty creates social and legal environments that increase the risk of infection, sickness, and death. Underlying factors include malnutrition, poor health, barriers to accessing health care and other services, and reduced capacity to participate in HIV prevention and care.38 Poverty increases vulnerability to HIV—even as HIV increases vulnerability to poverty. According to Piot et al.:

AIDS kills people in the prime of their working and parenting lives, with a devastating effect on the lives and livelihoods of affected households. Incomes shrink when employed household members become sick or die, and resources are further depleted by medical and funeral-related costs. The impact on poor households is clearly disproportionate, with many struggling to meet demands for treatment and care…. For example, in India, the financial burden on households living with HIV was 82% of income in the poorest quintile and just over 20% among the richest quintile…. The very poor struggle to afford even heavily subsidized antiretroviral treatment…. Moreover, even if drugs are free, poor families may have insufficient resources to meet basic nutrition needs or the costs of travel to health clinics for care.39

HIV thus imposes the heaviest toll on persons living in poverty, while impeding human development in high-prevalence countries.40 The Joint United Nations Programme on AIDS (UNAIDS) and the UN Office of the High Commissioner for Human Rights (OHCHR) state:

Where human rights are not protected, people are more vulnerable to HIV infection. Where the human rights of HIV-positive people are not protected, they suffer stigma and discrimination, become ill, become unable to support themselves and their families, and if not provided treatment, they die. Where rates of HIV prevalence are high and treatment is lacking, whole communities are devastated by the impact of the virus…. HIV has spread to every country in the world and, in the hardest-hit countries, it is undoing most of the development gains of the past 50 years.41

Stigma, discrimination, and violence violate the human rights of people living with and affected by HIV.

Many countries have yet to significantly address the HIV-related human rights abuses of their citizens. As a result, stigma and discrimination remain pervasive; they are the primary drivers of the HIV epidemic and the main obstacles to effective public action. UN Secretary-General Ban Ki-Moon notes:

[Stigma] is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world.42

UNAIDS defines stigma as the process of devaluating an individual based on certain attributes deemed discrediting or unworthy by others. Discrimination, in turn, occurs when stigma is acted on and consists of the actions or behaviors directed against stigmatized individuals.43 In the context of HIV, discrimination can increase vulnerability to infection, particularly among legally and socially marginalized groups such as sex workers, people who use drugs, men who have sex with men, and prisoners. According to UNAIDS and OHCHR:

Discrimination often prevents them from having access to HIV prevention information, modalities (condoms and clean injecting equipment) and services (for sexually transmitted infections and tuberculosis). This, as well as risk-taking behaviour, makes them highly vulnerable to HIV infection.44

At the same time, discrimination can also relate to HIV status itself. People with actual or presumed HIV-positive status may be denied the right to health care, employment, education, and freedom of movement, among other rights.45

For example, all people have the right to decent work and their HIV status should not influence their ability to find and keep employment. Yet people living with HIV often face stigma and discrimination in the workplace.46 This can affect recruitment, salary levels, training opportunities, labor protection, social insurance, welfare, and dismissal.47 The Global Network of People Living with HIV found that up to 45% of survey respondents in Nigeria had lost their jobs or their source of income during the previous 12 months, and up to 27% were refused the opportunity to work as a result of their HIV status.48 To address HIV and AIDs discrimination in the workplace, the International Labour Organization released a recommendation on HIV/AIDs and work in 2001 (“The Code”) and a standard in 2010 to bolster implementation of the Code at the country level.49 The Code guidelines are:50

    • No mandatory HIV testing for workers under any circumstances or for any purpose.
    • No denial of job opportunities for workers with HIV in any area of work.
    • No discrimination of workers such as denial of promotions or shifting job responsibilities.
    • Guaranteed confidentiality with regard to HIV status in the workplace.

Discrimination on account of HIV status can contribute to poverty, poor health, and further marginalization. For example, lack of employment security contributes to worse health outcomes, since employment status can determine access to health care and social benefits.51 When people living with HIV cannot find or keep employment, the loss of income and simultaneous loss of benefits exacerbates poverty and makes adherence to HIV treatment more difficult.

To combat HIV-related stigma manifest in social and legal barriers, countries should enact formal laws that prohibit discrimination on the basis of HIV status for purposes of employment, education, social and health care services, or immigration and asylum applications. The Commission on HIV and the Law reports that of 168 reviewed countries, 123 reported that they had laws that prohibited HIV-related discrimination.52 However, the Office of the High Commission on Human Rights cautions that many of these anti-discrimination laws may not be effective:

When anti-discrimination provisions are in place, they are often not effectively enforced. Fewer than 60 per cent of countries report having a mechanism to record, document and address cases of HIV-related discrimination. In 2010, the vast majority of countries reported that they addressed stigma and discrimination in their national HIV strategies; however, most countries did not have a budget for activities aimed at responding to HIV-related stigma and discrimination.53

Four organizations have partnered54 to document the experiences of people living with HIV-related stigma, discrimination, and rights violations by developing an index called “People Living with HIV Stigma Index.”55 The aim of the index is to “broaden our understanding of the extent and forms of stigma and discrimination faced by people living with HIV in different countries[,]” and to use the data as an advocacy tool.56 This tool is helpful in understanding and documenting the extent to which discrimination and stigma affect the daily lives of persons living with HIV.

The People Living with HIV Stigma Index demonstrates that stigma and discrimination are widespread. Stigma can lead to social ostracism, loss of income or livelihoods, denial of medical services or poor care within the health sector, loss of marriage and childbearing options, violence and depression/loss of hope (internalized stigma).57 Discrimination perpetuates the stigma associated with HIV-positive status and hinders HIV prevention and intervention. HIV-related stigma and discrimination make people afraid to seek information and education about prevention methods, to find out their status, to disclose their status—even to family and sexual partners—and to adhere to treatment schedules.58

HIV education plays an important role in reducing discrimination and stigma. It is also important to ensure that services are delivered in a manner that changes negative social norms at the population level.59 For example, there is some evidence that HIV-associated stigma is decreasing in some communities due to high rates of social exposure to people who are receiving ART.60 Education, outreach, and other mechanisms to reduce social stigma can make people less afraid of HIV, more willing to be tested, to disclose their status, and to seek care when necessary. All these factors contribute to a more open and inclusive environment.61

Gender inequality, gender-based violence, and the low status of women and girls remain three of the principal drivers of HIV.

Women and girls are disproportionately affected by the HIV epidemic. It is estimated that about 75% of all women living with HIV are in sub-Saharan Africa.62 HIV remains the “leading cause of death of women of reproductive age”63 and a leading cause of maternal death.64 In 2011, approximately 1.2 million women and girls were newly infected with HIV.65 Young women between 15 to 24 years of age account for 63% of young people living with HIV and have “infection rates twice as high as among men of the same age.”66 Despite this, “Less than half (46%) of all countries allocate resources for the specific needs of women and girls in their national response to HIV.”67

The manifestation of gender inequality in the HIV epidemic extends beyond infection rates. The International Guidelines on HIV/AIDS and Human Rights notes the extensive impact of gender inequality on the HIV epidemic:

Women’s subordination in the family and in public life is one of the root causes of the rapidly increasing rate of infection among women. Systematic discrimination based on gender also impairs women’s ability to deal with the consequences of their own infection and/or infection in the family, in social, economic and personal terms.68

As the UN Secretary General noted, “Gender inequality affects women’s experience of living with HIV, their ability to cope once infected and their access to HIV and AIDS services, including treatment.”69 Women’s experiences of living with HIV are further influenced by social and economic gender disparities. For example, women are often care givers, which is complicated if the person they care for contracts HIV or they themselves become HIV infected. Their duties as care givers can become significantly more demanding and complex, compounded by additional economic and social burdens. Also, if women lose their partners to HIV, they may face economic insecurity because of discriminatory employment, inheritance, or property laws. Legal and social empowerment, as well as increased education for women, are both important measures to address the manifest gender disparities that exist in the context of HIV.

Gender in the law
Laws and policies can be an important source of empowerment for women in the context of HIV, but they can also be equally discriminatory. Laws can create barriers for women to access health services or HIV treatment itself and to protect themselves from HIV infection. Laws can also harm women by legalizing genital mutilation or denying inheritance and property rights, causing more risk and vulnerability to the social determinants of HIV and its effects.70 For example, the Global Commission noted that, in 2012, 127 countries did not have laws criminalizing marital rape.71

Economic status
Women are at an increased risk of becoming infected with HIV due to unequal access to resources, including land and income-generating opportunities, as well as economic dependence on men. Unequal access to resources and economic dependence on men increase the probability that women and girls will engage in variety of unsafe sexual behaviors, including transaction sex, coerced sex, earlier sexual debut, and multiple sex partners.72 Despite initial concerns that women might face greater barrier to ART access, there is no evidence of socio-economic gradients in ART access, with the exception of distance to the nearest clinic.73 However, a lack of resources can prevent women from accessing necessary health services for prevention, treatment and care.

Gender-based power imbalances in sexual and reproductive decision-making
Gender-based power imbalances in sexual decision-making put women at increased risk to contract HIV and can have grave consequences for women. The majority of HIV transmissions to women occur during heterosexual intercourse, and women are twice more likely than men to acquire HIV from an infected partner during unprotected heterosexual intercourse.74 Gender inequality in sexual relationships can range from women not having power to control their sexual relations both in and out of marriage, women who are married to men for whom having multiple partners is encouraged, the genital mutilation of women, and the early or forced marriage of women. Violence against women also puts women at increased risk for HIV and remains a real threat for women worldwide. Gender-based power imbalances also affect women’s autonomy and independent decision-making on reproductive issues, including methods of protection against HIV during sexual encounters, methods of contraception, testing for HIV, and treatment and care options.

The rights and needs of children under the age of 15 are largely ignored in the response to HIV.

An estimated 3.4 million children under 15 are living with HIV today. In 2011, 330,000 new children became infected with HIV—91% of whom live in sub-Saharan Africa—and an additional 230,000 children died of AIDS-related causes.75 Children and young people are among the worst affected by HIV due to failures to protect their human rights. The UNAIDS and OHCHR Handbook on HIV and Human Rights for NationalHuman Rights Institutions states:

According to the Convention on the Rights of the Child and its optional protocols, children have many of the rights of adults in addition to particular rights for children that are relevant in relation to HIV and AIDS. Children have the right to freedom from trafficking, prostitution, sexual exploitation and sexual abuse; the right to seek, receive and impart information on HIV; and the right to special protection and assistance if deprived of their family environment. They also have the right to education, the right to health and the right to inherit property. The right to special protection and assistance if deprived of their family environment protects children if they are orphaned by AIDS. And the right of children to be actors in their own development and to express their opinions empowers them to be involved in the design and implementation of HIV-related programmes for children.76

Nevertheless, progress remains unsatisfactory in the prevention, diagnosis, and treatment of HIV in children. Many children affected by HIV experience poverty, homelessness, school drop-out, discrimination, loss of economic and social opportunity, and early death. Countries are not adequately fulfilling their commitments to provide care and support for vulnerable children, including and especially orphans and children living in AIDS-affected families.

Prevention of mother-to-child transmission of HIV
Preventing mother-to-child transmission of HIV (PMTCT) remains a priority in eliminating HIV in children. More than 90% of HIV-positive children are infected through their mother during pregnancy, labor, delivery, and breastfeeding. Without intervention, there is a 20 to 45% chance that a mother will transmit HIV to her baby.77 Moreover, without intervention, half of all infected children will die before their second birthday.78

Lack of universal access to PMTCT services highlights inequities that result from a failure to protect human rights. The prescribed strategy requires administering antiretrovirals (ARTs) to the mother before birth and during labor, administering ARTs to the baby following birth, and undertaking preventative measures to avoid HIV transmission through breast milk. These methods are successfully applied in high-income countries, where mother-to-child transmission is rare.

Women in resource-poor countries, however, often do not have access to PMTCT services.79 Despite concerted efforts to address the issue, in 2011 just 57% of the 1.5 million pregnant women living with HIV in low- and middle-income countries received ARTs to avoid transmission to their child.80 Barriers in resource-poor settings include clinic resources, testing methods, fear and distrust, disclosure and discrimination issues, drug effectiveness, treatment for mothers, feasibility of replacement feeding, and male visits to antenatal clinics. Despite these challenges, effective delivery of PMTCT services has been well documented in resource-limited public health systems.81

Protection, care, and support for children living with or affected by HIV
Many children lack full access to the HIV prevention information, education, and services they are entitled to under international human rights law. They also receive less antiretroviral treatment than adults, with just 28% of those in need receiving treatment,82 and they have limited access to pediatric formulations of HIV medicines.83 Moreover, children are highly vulnerable to the impact of AIDS on their family and community environments. An estimated 17.1 million children under 18 have lost one or both parents to AIDS, with around 14.8 million such orphans in sub-Saharan Africa.84 In some instances, children may be forced to become child heads of their households. Orphans and children living in AIDS-affected households are denied their right to social protection and face higher risks of poverty, abuse, exploitation, discrimination, property-grabbing, school drop-out, and homelessness.85

The rights and needs of young people aged 15 to 24 are largely ignored in the response to HIV.

With 890,000 new infections in 2011, approximately 4.9 million young people are living with HIV—75% of whom are living in sub-Saharan Africa.86 Young women make up 63% of all young people living with HIV globally; however, in sub-Saharan Africa, young women make up 72% of young people living with HIV. Young women in sub-Saharan Africa are eight times more likely to be living with HIV than their male peers.

Young people still are not receiving adequate education on HIV and they face barriers accessing information. Many youth do not receive adequate sex education, and those who do are often misinformed on HIV prevention and HIV transmission. For example, UNAIDS reports: “Only 24% of young women and 36% of young men responded correctly when asked five questions on HIV prevention and HIV transmission, according to the most recent population based surveys in low- and middle-income countries.”87

Young people also face barriers accessing HIV services, including sexual and reproductive health services, HIV treatment, and harm reduction. These barriers include stigma, discrimination, and restrictive laws and policies.88 For example, requiring parental approval to receive HIV testing or treatment can be a significant deterrent for youth, running counter to HIV prevention efforts.

In addition to an inability to realize the right to the highest attainable standard of health, young people living with HIV also often face discrimination in accessing the full range of human rights. For example, UNESCO recently released a publication addressing the barriers and discriminatory practices impeding HIV-positive youth from attending school and getting an education.89 According to the IPU, “Evidence has demonstrated that getting and keeping young people (particularly girls) in school dramatically lowers their vulnerability to HIV.”90

The most vulnerable and worst affected populations often receive the least attention in national responses to HIV.

In most countries, men who have sex with men; people who use drugs; sex workers; and prisoners have a higher prevalence of HIV infection than that of the general population because they engage in behaviors that put them at higher risk of becoming infected, and they are among the most marginalized and discriminated-against populations in society. Punitive approaches to drug use, sex work, and homosexuality fuel stigma and hatred against these populations, pushing them further into hiding and away from services to prevent, treat, and mitigate the impact of HIV. At the same time, the resources devoted to HIV prevention, treatment, and care for these populations are not proportional to the HIV prevalence, which represents “a serious mismanagement of resources and a failure to respect fundamental human rights.”91

Sex workers
UNAIDS defines sex workers as “consenting female, male, and transgender adults and young people over the age of 18 who receive money or goods in exchange for sexual services, either regularly or occasionally.”92 Sex workers are particularly vulnerable to HIV because of their multiple sexual partners and inconsistent condom use,93 discrimination and stigma, criminalization of their work, increased risk of violence, lack of education or information, and barriers to accessing health services. For example, in Rwanda, the prevalence of HIV among female commercial sex workers was 51%, which is 17 times the national average of 3%.94

Criminalization of sex work creates barriers to accessing HIV prevention and treatment services. More than 100 countries criminalize some aspect of sex work, according to the Global Commission on HIV and the Law.95 In many countries, including Kenya, Namibia, Russia, South Africa, and the United States, police confiscate condoms from sex workers or use condoms as a justification for arrest, thereby undermining HIV prevention efforts. These practices criminalize condoms and force sex workers to choose between protecting their health or detention.96

Sex workers are also vulnerable to violence, which also increases their risk of contracting HIV. Some sex workers face threats and violence from clients, managers, and intimate partners that prevent them from enforcing condom use. Street-based sex workers are at particular risk and may be forced to exchange unpaid and unprotected sex with some police officers in order to prevent arrest, harassment, obtain release from prison or not be deported.97

Men who have sex with men
Men who have sex with men are considered a vulnerable or at-risk population for HIV. This is a diverse group that includes men who identify as gay or bisexual, as well heterosexual men who have sex with men. They are particularly vulnerable to HIV because sex between men can involve anal sex, a practice that, when no protection is used, has a higher risk of HIV transmission than unprotected vaginal sex.98

Men who have sex with men are also vulnerable to HIV because of social stigma, discriminatory practices, and criminalization of same-sex conduct. Sex between men is taboo in many cultures and, as a result, HIV prevention campaigns only discuss the risks of heterosexual sex. Some countries deny the existence of homosexuality at all and limit research and funding on the health of this population. There is often little information available about sex between men in these contexts, and this can provide a false impression of limited or no risk.99

The criminalization or punishment of same-sex conduct also creates barriers to accessing healthcare and HIV prevention measures, which also contributes to the underlying determinants of health. The UN Special Rapporteur on the right to health notes:

Various criminal laws exist worldwide that make it an offence for individuals to engage in same-sex conduct, or penalize individuals for their sexual orientation or gender identity. … Other laws also indirectly prohibit or suppress same-sex conduct, such as anti-debauchery statutes and prohibitions on sex work. Many States also regulate extra-marital sexual conduct through criminal or financial sanctions, which affects individuals who identify as heterosexual but intermittently engage in same-sex conduct.100

Further, “Sanctioned punishment by States reinforces existing prejudices, and legitimizes community violence and police brutality directed at affected individuals.”101 The Global Commission on HIV and the Law notes that 78 countries criminalize sexual conduct between same sex partners,102 and it is punishable by death in five of these countries (Iran, Mauritania, Saudi Arabia, Sudan, Yemen, and parts of Nigeria and Somalia).103

Prisoners
Although many prisoners living with HIV contracted their infections before imprisonment, the risk of infection while in prison is high due to high-risk sexual and other behaviors, like sharing needles. High-risk sexual behaviors, including unprotected sex, sexual violence, rape, and coercion, are common in prison and increase prisoners’ vulnerability to HIV.104 Unsafe drug injection, blood exchange, and the use of non-sterile needles/cutting instruments for tattooing are also common and increase HIV vulnerability. Poor prison conditions, including overcrowding, poor food and nutrition, poor security, and lack of health facilities and staff contribute to the spread of HIV and violate prisoners’ human rights.

Some prisons create separate or alternative sections for HIV-positive prisoners, segregating them from the rest of the prison population. In parts of Russia, prisoners are tested for HIV and those who test positive are imprisoned together, but separated from the general prison population. Two states in the United States, Alabama and South Carolina, continue to segregate prisoners living with HIV. The American Civil Liberties Union and the AIDS Project recently filed a lawsuit calling the practice discriminatory.105 Their reports highlight additional human rights violations that are consequences from discriminatory segregation.

People who inject drugs
An estimated 15.9 million people worldwide inject drugs, the majority of whom live in middle- and low-income countries.106 Drug-dependent people are frequently subjected to laws, policies and practices that violate their human rights. This increases their vulnerability to HIV and HIV-related risk behaviors, negatively affects the delivery of HIV programs and compromises their health, as well as the health of their communities. As a result, people who inject drugs face a disproportionately high risk of infection and injection drug use accounts for an estimated 10% of total HIV infections.107

The link between human rights abuses experienced by people who use drugs and vulnerability to HIV infection and barriers to accessing is well-documented. Many violations are related to the criminalization of the status of being a drug user, which can result in the imposition of the death sentence for drug offenses, incarceration of drug-dependent people and abusive law enforcement practices (for example, police harassment, arbitrary detention, ill treatment, and torture). Other violations are related to the abusive treatment of people who inject drugs, such as denial of harm-reduction services (including needle and syringe programs and opioid substitution therapy), discriminatory access to antiretroviral therapy, denial of pain relief and palliative care, and coercion in the guise of treatment for drug dependence.108 According to the Now More Than Ever Campaign:

Criminalized populations…are driven from HIV services by discrimination and violence, often at the hands of police officers and judges charged with enforcing sodomy, narcotics and prostitution laws…. People who use drugs end up in prison or in a revolving door of ineffective and coercive rehabilitation programs, rarely receiving the services for drug addiction or HIV prevention and treatment they desperately need.109

To effectively address HIV in people who use drugs, there must be greater understanding of human rights violations as core features of risk environments, as barriers to care, and as social determinants of poor health and development. HIV prevention and treatment efforts must address the specific needs and rights of people who inject drugs and promote access to harm prevention services. According to Jurgens et al.:

Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs. Rights-based responses to HIV and drug use have had good outcomes where they have been implemented, and they should be replicated in other countries.110

For more detailed information on this topic, please see Chapter 4 on harm reduction and human rights.

HIV testing frequently takes place without the full protection of voluntariness, confidentiality, and informed consent.

HIV testing implicates a broad range of ethical and human rights issues, including the rights to health, education, information, privacy, liberty and security of the person, and non-discrimination and equality before the law.111 The 2004 UNAIDS/WHO Policy Statement on HIV Testing notes:

The conditions of the ‘3 Cs’, advocated since the HIV test became available in 1984, continue to be underpinning principles for the conduct of HIV testing of individuals. Such testing of individuals must be confidential, be accompanied by counselling, [and] only be conducted with informed consent, meaning that it is both informed and voluntary.112

Under international human rights law, individuals have a right to information and education, which entitles them to seek, receive, and impart information relating to HIV testing and treatment. They have the right to bodily integrity and to physical privacy, which entitles them to withhold consent to medical treatment and testing. They also have the right to confidentiality of personal information, which entitles them to control the collection, use and disclosure of information relating to their HIV status.113 Jurgens further notes:

The right to be free of discrimination and the right to security of the person, also require that in both HIV testing policy and practice, governments take into account the outcomes of HIV testing for people—including stigma, discrimination, violence and other abuse—and do all that they can to prevent human rights violations associated with this health service.114

Traditionally, there have been three main approaches to HIV testing in clinical settings. Opt-in approaches require patients to affirmatively agree to HIV testing after receiving pretest information. This client-initiated model has been shown to reduce HIV infection and transmission115 while increasing uptake of testing.116 Opt-out approaches, by contrast, require patients to specifically decline HIV testing after receiving pretest information. This provider-initiated model can result in increased testing,117 but voluntariness may be compromised by poorly designed protocols, inadequate information about consent, and power imbalances between patients and providers.118 The third approach, involuntary or mandatory testing,119 involves no patient consent and is often required for populations such as prisoners, military recruits, migrants, and pregnant women. Where HIV testing is required as a precondition for marriage, this also implicates the right to marry and found a family.120 UNAIDS and WHO do not support the mandatory HIV testing of individuals on public health grounds, and require “specific judicial authorization” to perform a mandatory HIV test.”121

In recent years, an international consensus in favor of expanded HIV testing has led to a reevaluation of HIV testing principles. Many in the public health community now advocate for the relaxing or elimination of counseling and informed consent requirements—such as HIV testing outside medical settings, mass HIV screening programs122 and mandatory disclosure of HIV status to sexual partners.123 These ideas are premised on the “right and responsibility” to know one’s HIV serostatus. They are also premised on the 1984 Siracusa Principles on the Limitation and Derogation of Principles, which permit limitations on individual rights “if [public health policies] are sanctioned by law, serve a legitimate public health goal, are necessary to achieve that goal, are no more intrusive or restrictive than necessary, and are non-discriminatory in application.”124

Nevertheless, there is little evidence to suggest that relaxed consent standards meet these rigorous standards, let alone provide adequate safeguards against human rights violations. For example, women are disproportionately affected by coercive and involuntary approaches to HIV testing. According to Amon, studies in sub-Saharan Africa have found between 3.5 percent and 14.6 percent of women report abuse following the disclosure of test results.125 Jurgens further notes that women may be exposed to higher risk of “criminalization in instances of not disclosing to a sexual partner and not using precautions—when it is precisely because women too often lack autonomy in their sexual relations as a result of violence, cultural norms, and/or economic subordination that they may be unable to disclose or to negotiate safer sex.”126

Expanding access to HIV testing must be accompanied by renewed commitment to voluntariness, confidentiality and informed consent, as well as measures to increase access to HIV treatment and to reduce vulnerability to the disease. As Amon notes:

HIV testing in particular—as the entry point for access to anti-retroviral drugs and important services—must be accessible to all. But efforts to expand HIV testing, and to put in place “routine” testing, must not become coercive, must recognize the rights of the individuals being tested, and must provide linkages to both prevention and care.127

Criminalizing HIV transmission and exposure inhibits advances in HIV prevention and treatment.

Criminalization of HIV transmission inhibits advances in HIV prevention and treatment, deters people from being tested or disclosing their status and can negatively impact the underlying social determinants of health. The Global Commission on HIV and the Law found that “[i]n more than 60 countries, it is a crime to expose another person to or transmit HIV” and that “[m]ore than 600 HIV-positive people across 24 countries, including the United States, have been convicted of such crimes.”128 The UN Special Rapporteur on the right to health notes that criminalization has no impact on changing behavior or limiting the spread of HIV. Furthermore, it undermines public health efforts and has a disproportionate impact on vulnerable communities.129 Criminalization also forces individuals to disclose their HIV status, which is a violation of their rights and potentially dangerous to their person. Many individuals, especially women, cannot disclose their status without facing stigma, isolation, or violence.

Migration policies often discriminate on the basis of HIV status and increase vulnerability to HIV.

There are approximately 214 million international migrants and 740 million internal migrants worldwide.130 Migrants are disproportionately vulnerable to HIV. According to the Global Commission on HIV and the Law:

Migration policies—restrictions on entry, stay and residence in a country—split families and isolate people from their peers, friends and known ways. These conditions disempower people, exposing them to exploitation, changing their sexual behaviours and increasing the likelihood of unsafe practices. As a result, migrants face a risk of HIV infection that is as much as 3 times higher than that faced by people with secure homes.

Immigration laws and policies often discriminate on the basis of HIV status. Under international law, it is not permitted to deny an asylum-seeker entry on the basis of their HIV status,131 nor is it possible to detain or restrict the movement of a person on the basis of their HIV status.132 Despite this, some countries still impose mandatory HIV testing for asylum and immigration applications, deny entry based upon HIV status,133 and detain people with HIV indefinitely pending asylum or removal. Noncitizens are also excluded from national health care systems, leaving them without access to medical care and HIV treatment.134 This constitutes a violation of their human rights while also impeding efforts to prevent and address HIV.

Why a human rights response to HIV?

Protection of human rights, both of those vulnerable to infection and those already infected, is not only important for individuals, but also produces positive public health results. National and local responses to HIV will not work without the full engagement and participation of those affected by HIV, particularly people living with HIV. The human rights of women, young people, and children must be protected if they are to avoid infection and withstand the impact of HIV. The human rights of marginalized groups, including people who use drugs, sex workers, prisoners, and gay and bisexual men, must also be respected for the response to HIV to be effective.

When human rights principles guide implementation of local and national responses to HIV, the results are tailored to the needs and realities of those affected. Such principles include non-discrimination, participation, inclusion, transparency, and accountability. Where states provide comprehensive HIV prevention, care, and impact mitigation programs to all those in need—supporting vulnerable populations and allowing the full participation of all those affected in the design and implementation of HIV programs—they are fulfilling their HIV-related human rights obligations and mounting an effective response to HIV.

When human rights inform the content of national responses to HIV, vulnerability to HIV infection diminishes and people living with HIV can live with dignity. In contrast, where human rights are not respected, protected, and promoted, the risk of HIV infection is increased, people living with and affected by HIV suffer from discrimination, and an effective response to the epidemic is often impeded.

What are rights-based interventions and practices in the area of HIV?

The protection of human rights is essential to mounting an effective public health response to HIV and safeguarding human dignity. At the same time, an effective response to HIV requires the realization of all human rights in accordance with international human rights standards. As the IPU states, “A rights-based, effective response to the HIV epidemic involves establishing appropriate government institutional responsibilities, implementing law reform and support services, and promoting a supportive environment for groups vulnerable to HIV and for those living with HIV.”135 Programmatic reforms to address human rights violations must be incorporated in national HIV programs, including measures to combat discrimination and violence against people infected and affected by HIV. Equally, there must be new laws and policies to address the human rights violations that place vulnerable and marginalized populations at risk of HIV. 136

Many of the following interventions and practices are modeled on the OHCHR/UNAIDS International Guidelines on HIV/AIDS and Human Rights. These 12 guidelines—issued in 1998 at the request of what is now the UN Human Rights Council and reissued in 2006137—are an essential resource for governments, policymakers, activists, institutions, and other stakeholders. Since then, UNAIDS has developed a supplemental framework called the 2011 Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses. Together, the International Guidelines and Key Programmes represent several decades of best practice and should be included in all national responses to HIV. The following list provides an overview and is not intended to be comprehensive. For additional recommendations, please refer to both documents, as well the resources listed at the end of this chapter.

National Frameworks for HIV Response

Each country’s HIV epidemic has distinctive drivers, vulnerabilities, aggravating factors, and affected populations.138 To address these social and epidemiological complexities, states should establish a national HIV framework that mobilizes key actors and institutions and includes national HIV action plans, strategies, and activities. At the same time, they should ensure the integration of HIV and human rights into all public sectors, including health, education, law and justice, social security and housing, employment and public service and immigration, among others. States should also establish and strengthen national mechanisms for addressing HIV-related legal, ethical, and human rights issues. An effective, well-integrated, and coordinated national framework for HIV response can help harmonize national laws and policy priorities, facilitate stakeholder engagement and ensure the protection of human rights.139

Community Partnership and Consultation

National responses to the epidemic should include consultation and partnership with community representatives in all phases of HIV policy, programs and evaluation. Community representation should comprise people living with HIV, community-based organizations, administrative services organizations, human rights NGOs, and representatives of vulnerable groups, since these individuals and organizations have highly relevant knowledge and experience of HIV and human rights. States should establish formal and regular mechanisms to facilitate ongoing dialogue with community partners. States also ensure they have political and financial support for activities relating to HIV, law, ethics and human rights.140

“Therapeutic Citizenship”, Self-Help, and Empowerment

The experience in some African countries has demonstrated the strengths of “therapeutic citizenship” in promoting access to treatment and improving adherence, particularly in resource-constrained settings. According to Nguyen et al., therapeutic citizenship refers to “the way in which people living with HIV appropriate ART as a set of rights and responsibilities” that is less focused on negotiating biosocial vulnerability than social and institutional relationships.141 Robins describes the efforts of one organization, the Treatment Action Campaign in South Africa:

Whereas public health practitioners report that most of their HIV/AIDS patients wish to retain anonymity and invisibility at all costs, TAC successfully advocates the transformation of the stigma of HIV/AIDS into a “badge of pride.” It is through these activist mediations that it becomes possible for the social reintegration and revitalization of large numbers of isolated and stigmatized HIV/AIDS sufferers into a social movement and a caring community—a HIV/AIDS activist culture.142

These collectivist responses to HIV and treatment have created an empowering experience and resulted in a network of informed activists who are better able to navigate the health system and advise others on how to best negotiate the health care system.143

Public Health Legislation

States should review and reform public health legislation and practices so that they support access to HIV and health services.144 Specifically, legislation should ensure provision of comprehensive HIV prevention and treatment services—such as information and education, voluntary testing and counseling, sexual and reproductive health services, condoms, harm reduction services, drug treatment, antiretroviral therapy, treatment for HIV/AIDs-related illnesses and palliative care.145 Legislation should also ensure that HIV testing is only performed with an individual’s specific, informed consent, provide for pre-test and post-test counseling and protect against unauthorized collection, use or disclosure of information relating to HIV status. No one should be subjected to coercive measures such as isolation, detention or quarantine based on their HIV status.146

Criminal Laws and Correctional Systems

Punitive laws, correctional systems, and denial of access to justice for people infected and affected by HIV are fueling the epidemic.147 States should review and reform criminal legislation, correctional systems and law enforcement practices to ensure they are “consistent with international human rights obligations and are not misused in the context of HIV or targeted at vulnerable groups.”148 The following measures are among those recommended:

      • Decriminalize the transmission of HIV. At most, “criminalization should be considered permissible only in cases involving intentional, malicious transmission.”149
      • Decriminalize homosexuality and decriminalize same-sex relations. This is an important step to reducing the stigma, discrimination and inequality increases the vulnerability of men who have sex with men.
      • Decriminalize sex work and provide support to sex workers. Criminalization exposes sex workers to violence, exploitation and victimization, including from police. Creating safer working environments and ensuring access to health services, advocacy and other forms of support enable sex workers to seek services and protection without fear of criminal penalties.150
      • Reform approaches to drug use and advocate for non-discriminatory treatment of people who inject drugs. 
        Harsh and punitive drug laws exacerbate harms associated with drug use. States should offer harm reduction programs and voluntary, evidence-based treatment.151
      • Review laws, policies, and practices that prevent prisoners from accessing HIV-related services. Prisoners are entitled to the same rights as other individuals, “with the exception of restrictions on liberty directly related to their imprisonment,” and should have access to health information, treatment, care, and support.152

A necessary complement to legislative and criminal justice reform is the sensitization of lawmakers and law enforcement agencies and personnel to the role of law, ethics and human rights in the HIV response. Such programs can “help ensure that individuals living with and vulnerable to HIV can access HIV services and lead full and dignified lives, free from discrimination, violence, extortion, harassment, and arbitrary arrest and detention.”153

Anti-Discrimination and Protective Laws

Enabling legal, social and policy environments are necessary to eliminate HIV-related stigma, discrimination, and violence, to provide legal protections for people affected by HIV, and to promote and protect the human rights in the context of HIV.154 States should therefore enact or strengthen anti-discrimination and other protective laws that protect people living with HIV or members of vulnerable populations from discrimination in both the public and private sectors, ensure privacy and confidentiality and provide access to justice for HIV-related right violations.155 Specific recommendations include, but are not limited to:

    • Explicitly prohibit discrimination against people based on actual or perceived HIV status, covering “health care, social security, welfare benefits, employment, education, sport, accommodation, clubs, trades unions, qualifying bodies, access to transport and other services”;156
    • Abolish mandatory HIV-related registration, testing and forced treatment;
    • Work with guardians of traditional and customary laws for consistency with anti-discrimination principles and provide legal remedies for misuse;157
    • Enact general privacy and confidentiality laws, including the use of HIV-related information;158 and
    • Promote and protect the rights of vulnerable and at-risk populations, including women, children, young persons, men who have sex with men, sex workers, prisoners, and other people in detention settings and people living with HIV.159 

The IPU’s Handbook for Legislators on HIV/AIDS, Law and Human Rights provides a checklist of key components of anti-discrimination legislation, privacy legislation and employment legislation to help stakeholders develop longer-term, strategic plans and programs to address HIV-related stigma and discrimination.160

Universal Access to HIV Prevention, Treatment, Care, and Support

Vast inequities in access to HIV prevention, treatment, care, and support violate a number of human rights—including the right to health, the right to non-discrimination and equality before the law, the right to an adequate standard of living and social security, the right to participation in political and cultural life, and the right to enjoy the benefits of scientific progress.161 States should therefore enact legislation, policies and other measures to ensure universal and equal access to appropriate, affordable and quality HIV-related goods, services and information, “including antiretroviral and other safe and effective medicines, diagnostics and related technologies for preventive, curative and palliative care of HIV and related opportunistic infections and conditions.”162

States should make sufficient resources available to meet the commitments outlined in their national HIV strategies, strengthen their health systems and address health-worker shortages. States should also strive to make HIV medicines more affordable for all. A barrier to access is a global intellectual property (IP) protection regime that hinders the production and distribution of low-cost medicines. The IP regulations enforced by the World Trade Organization’s TRIPS (“The Agreement on Trade Related Aspects of Intellectual Property Rights”) enable pharmaceutical companies to maintain monopolies on drug patents, resulting in higher costs and “catastrophic” outcomes for resource-poor countries unable to afford HIV medicines.163 The IPU recommends the following measures to address the situation:

A number of mechanisms are available to help make HIV medicines more affordable. These include generic competition, local production, differential pricing by research-based and generic pharmaceutical companies, voluntary licensing by innovator to generic companies, high-volume and bulk-purchasing arrangements, elimination of tariffs and taxes on essential medicines, and the use of flexibilities in the international trade and intellectual property rules (through the TRIPS Agreement and other WTO mechanisms) to achieve wider access to affordable generic medicines.

The Global Commission on HIV and the Law thus urges all countries to suspend TRIPS as it relates to essential medicines and adopt a “moratorium on the inclusion of any intellectual property provisions in any international treaty that would limit the ability of countries to retain policy options to reduce the cost of HIV-related treatment.”164

Finally, States should also address barriers to equal access by vulnerable populations, such as poverty, migration, rural location, and discrimination.165 Social protection programs can promote the uptake of HIV services while alleviating the social and economic impacts of HIV.166 According to UNICEF, “HIV sensitive social protection can be grouped into three broad categories of interventions: financial protection through predictable transfers of cash or food for those HIV-affected and most vulnerable; access to affordable quality services including treatment, health, and education services; and policies, legislation and regulation to meet the needs and uphold the rights of the most vulnerable and excluded.”167

Legal Support Services

According to OHCHR, “States should implement and support legal support services that will educate people affected by HIV about their rights, provide free legal services to enforce those rights, develop expertise on HIV-related legal issues and utilize means of protection in addition to the courts, such as offices of Ministries of Justice, ombudspersons, health complaint units and human rights commissions.”168 The provision of HIV-related legal services can facilitate access to justice and redress in cases of HIV-related discrimination or other legal matters, including but not limited to “estate planning; breaches of privacy and confidentiality; illegal action by the police; discrimination in employment, education, housing or social services; and denial of property and inheritance rights.” At the same time, legal literacy programs and campaigns (“Know Your Rights”) teach people about human rights and laws relevant to HIV, enabling them to organize around these rights advocate for their needs.169

Reducing Vulnerability Among Key Groups

Women and Girls
“Gender inequality, gender-based violence, and the low status of women remain three of the principal drivers of HIV.” Addressing the political, social, economic, and sexual subordination of women and girls is therefore critical to reducing their vulnerability to HIV.170 States should enact or strengthen laws to protect women’s equal rights in a broad range of areas, including:

    • Education. Education is instrumental in providing information on HIV itself, but also in empowering women and providing a means for their economic and social independence.
    • Inheritance and Property Ownership. Unequal inheritance and property laws and customs deprive women of the financial and social resources to prevent infection and mitigate the consequences of HIV.171
    • Employment and Compensation. Equal rights to employment and fair compensation provide the opportunity to offset the costs of care associated with HIV or the loss of an income-earning partner or family member.
    • Gender-Based Violence, Domestic Violence, and Spousal Rape. Measures to eliminate violence against women include: enactment of formal laws, like those that criminalize marital rape; policy and program changes; training programs for police and health care providers; increased health and psychological services; and legal recourse for rights violations.
    • Equitable Budgetary Allotment. Only 46% of countries allocate resources for the specific needs of women and girls into HIV programs.172 HIV programs must incorporate women and their needs and countries must demonstrate their commitment through budgetary allotment.
    • Sexual and Reproductive Health Rights. Providing information and access to reproductive services enables women to protect themselves against HIV and mitigate its consequences. Formal educational efforts, as well as health providers and mediators can provide women with information on HIV.

Children
Less than a quarter of children in need of ART receive treatment,173 and children affected by the loss of a caregiver from HIV-related causes are at grave risk of human rights violations. States should therefore reduce the vulnerability of children and to protect their rights through the following measures: laws protecting orphans and other vulnerable children from abuse, violence, exploitation, and discrimination; full implementation of the Convention on the Rights of the Child and its Optional Protocols into national legislation; laws, policies, and practices to prevent mother-to-child transmission and to increase access to affordable HIV treatment for children; and policies and programs to enable children to stay in school.174 Additional measures aimed at the empowerment of children include ensuring access to health information and education; education about the rights of persons, including children, living with HIV; and access to confidential sexual and reproductive health services.175

Young People
Young people aged 15 to 24 represent half of all new HIV infections, and young women are disproportionately vulnerable. States should address the specific needs of this population by ensuring that they have full access to HIV prevention, treatment, care and support, including comprehensive sex and health information and education. Programs should also address HIV-related ignorance, fear, and prejudice by empowering young people to discuss and address the social and cultural issues related to the epidemic, including gender-discrimination, violence, exploitation, and rape. Finally, the IPU recommends ensuring that young people have life skills education “to develop healthy attitudes and the negotiating capacity to make informed, healthy choices about sex, drugs, relationships and other issues.”176

Men Who Have Sex With Men
Men who have sex with men are frequently marginalized by society, and many HIV programs and policies do not address their specific needs. As a result, they experience high rates of infection. Laws and policies should address the stigma and discrimination experienced by men who have sex with men and increase access to HIV prevention and treatment services. Countries should also enact anti-discrimination laws, implement privacy laws for same-sex relations, create measures to prevent violence and permit gay, lesbian and bisexual groups to organize.177

Sex Workers
Sex workers are highly vulnerable to infection and often lack access to HIV services “due to exploitation within the industry, as well as widespread police abuse.”178 OHCHR/UNAIDS recommend that adult sex work that involves no victimization should be decriminalized, and then legally regulated with respect to occupational health and safety conditions. This can protect both sex workers and their clients, including support for safe sex during sex work.179 Additionally, sex workers should be provided full and equal access to HIV prevention, treatment, care, and support services, tailored to their needs and consistent with their fundamental human rights.

People Who Inject Drugs
In many countries, people who use illicit drugs account for the majority of people living with HIV but they are the least likely to receive ART. To reduce the vulnerability of this population and to eliminate one of the key drivers of the HIV epidemic, states should put in place rights-based and evidence-based programs that are effective in reducing the risk behaviours and vulnerability to HIV of people who use drugs, including needle and syringe programs, voluntary drug treatment programs, sensitization of health care providers and law enforcement personnel, equal access to ART and care services, peer education and outreach, and access to legal assistance and legal remedies for rights violations.180

Prisoners
Many prisoners have little or no access to voluntary HIV prevention information and tools or to HIV testing or treatment. States should scale up funding as well as access to access to health services for prisoners, including HIV services. Specific measures to reduce vulnerability include provision of condoms and needles and syringes, as well as criminal justice reform to reduce the number of people in prison—e.g., decriminalizing the status of drug users and limiting pretrial detention.181

Education, Training, and Media

While many countries outlaw discrimination based on HIV, these laws are routinely ignored, unenforced or flouted. According to the Global Commission on HIV and the Law:

To make law real on the ground, the state must education health care workers, legal professionals, employers and trade unionists, and school faculties about their legal responsibilities to guarantee inclusion and equality.182 

The goal of education and training is to inform people living with HIV of their rights, as well to challenge beliefs based on ignorance, fear, prejudice, and moral judgment. States should therefore “promote the wide and ongoing distribution of creative education, training and media programmes explicitly designed to change attitudes of discrimination and stigmatization associated with HIV to understanding and acceptance.”183

Public and Private Sector Standards and Mechanism

OHCHR/UNAIDS recommend that “[s]tates should ensure that Government and the private sector develop codes of conduct regarding HIV issues that translate human rights principles into codes of professional responsibility and practice, with accompanying mechanisms to implement and enforce these codes.”184 This includes training health care providers and other professionals in health care settings on human rights and medical ethics related to HIV. As UNAIDS notes:

Human rights and ethics training for health care providers focus on two objectives. The first is to ensure that health care providers know about their own human rights to health (HIV prevention and treatment, universal precautions, compensation for work-related infection) and to non-discrimination in the context of HIV. The second is to reduce stigmatizing attitudes in health care settings and to provide health care providers with the skills and tools necessary to ensure patients’ rights to informed consent, confidentiality, treatment and non-discrimination.185

Monitoring and Enforcement of Human Rights

OHCHR/UNAIDS recommend that “[s]tates should ensure monitoring and enforcement mechanisms to guarantee HIV-related human rights, including those of people living with HIV, their families and communities.”186 

International Cooperation

OHCHR/UNAIDS recommend that “[s]tates should cooperate through all relevant programmes and agencies of the United Nations system, including UNAIDS, to share knowledge and experience concerning HIV-related human rights issues, and should ensure effective mechanisms to protect human rights in the context of HIV at the international level.”187

 Notes

1 For basic information on HIV/AIDS, please see the following resources: UNAIDS, Fast Facts about HIV. www.unaids.org/en/media/unaids/contentassets/dataimport/pub/factsheet/2008/20080519_fastfacts_hiv_en.pdf; Center for Disease Control, Basic Information about HIV and AIDS. www.cdc.gov/ncphi/disss/nndss/print/aidscurrent.htm; World Health Organization (WHO), HIV/AIDS: Fact Sheet No. 360 (July 2012). www.who.int/mediacentre/factsheets/fs360/en/index.html.

2 UNESCO, UNESCO Guidelines on Language and Content in HIV- and AIDS -Related Materials (October 2006). http://unesdoc.unesco.org/images/0014/001447/144725e.pdf.

4 World Health Organization (WHO), HIV/AIDS: Fact Sheet No. 360 (July 2012). www.who.int/mediacentre/factsheets/fs360/en/index.html.

5 More detailed information on transmission is available from the Center for Disease Control, Basic Information about HIV and AIDS. www.cdc.gov/ncphi/disss/nndss/print/aidscurrent.htm; Center for Disease Control, HIV Transmission. www.cdc.gov/hiv/resources/qa/transmission.htm; and World Health Organization, HIV/AIDS: Fact Sheet No. 360 (July 2012). www.who.int/mediacentre/factsheets/fs360/en/index.html.

6 Canning D, “The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention,” Journal of Economic Perspectives 20 (2006): 121. http://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.20.3.121.

7 Center for Disease Control, “Basic Information about HIV and AIDS.” http://www.cdc.gov/hiv/topics/basic/.

8 WHO, “HIV/AIDS: Antiretroviral Therapy.” www.who.int/hiv/topics/treatment/en/.

9 Ibid.

11 Tanser etl al, “High Coverage of ART Associated with Decline in Risk of HIV Acquisition in Rural KwaZulu-Natal, South Africa,” Science (2013). http://www.sciencemag.org/content/339/6122/966.short; Bor J et al, “Increases in Adult Life Expectancy in Rural South Africa: Valuing the Scale-Up of HIV Treatment,” 339, 961 Science (2013). http://www.sciencemag.org.ezp-prod1.hul.harvard.edu/content/339/6122/961.full.pdf.

12 Robins, S. 2006. “From ‘Rights’ to ‘Ritual’”: AIDS Activism in South Africa.” American Anthropologist 108(2):312-323. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1525/aa.2006.108.2.312/pdf.

13 UN General Assembly, Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS, A/RES/65/277 (June 10, 2011). www.unaids.org/en/media/unaids/contentassets/documents/document/2011/06/20110610_UN_A-RES-65-277_en.pdf.

14 Ibid.

16 UN General Assembly, Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS. A/RES/65/277 (June 10, 2011). www.unaids.org/en/media/unaids/contentassets/documents/document/2011/06/20110610_UN_A-RES-65-277_en.pdf.

17 Ibid.

18 UN Office of the High Commissioner for Human Rights, “HIV/AIDS and Human Rights.” www.ohchr.org/EN/Issues/HIV/Pages/HIVIndex.aspx.

19 The Henry J. Kaiser Family Foundation, US Global Health Policy Fact Sheet: The Global HIV/AIDS Epidemic (July 2012). www.kff.org/hivaids/upload/3030-17.pdf.

20 WHO, “The Three I’s for HIV/TB.” www.who.int/hiv/topics/tb/3is/en/index.html.

21 Kaiser Family Foundation, US Global Health Policy Fact Sheet: The Global HIV/AIDS Epidemic (July 2012). www.kff.org/hivaids/upload/3030-17.pdf.

22 Inter-Parliamentary Union (IPU), Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007), www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

23 UNAIDS and the UN Office for the High Commissioner for Human Rights, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

24 Ibid. See also Piot P, Greener R, Russell S, “Squaring the Circle: AIDS, Poverty, and Human Development,” PLOS Medicine 4, no. 10 (2007): e314. www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040314, and World Health Organization, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, Progress Report 2010 (2010). http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf.

25 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

26 Ibid.

27 UNAIDS, HIV – Related Stigma, Discrimination, and Human Rights Violations: Case Studies of Successful Program (April 2005). http://data.unaids.org/publications/irc-pub06/jc999-humrightsviol_en.pdf.

28 Open Society Institute, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org.

29 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

30 Ibid.

31 UNAIDS, Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses (2012). http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/Key_Human_Rights_Programmes_en_May2012.pdf.

32 Ibid.

33 Ibid. See also Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007), www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

34 Open Society Foundations, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org.vs3.korax.net/downloads/nmte_20090923_0.pdf.

35 Piot P, Greener R, Russell S, “Squaring the Circle: AIDS, Poverty, and Human Development,” PLOS Medicine 4, no. 10 (2007): e314. www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040314

37 UN General Assembly, Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS, A/RES/65/277 (Jun. 10, 2011). www.unaids.org/en/media/unaids/contentassets/documents/document/2011/06/20110610_UN_A-RES-65-277_en.pdf.

38 Ibid. See also Drimie S, “The Impact of HIV/AIDS on rural households and land issues in Southern and Eastern Africa,” Background Paper, (Food and Agricultural Organization, Sub-Regional Office for Southern and Eastern Africa, 2002). ftp://ftp.fao.org/docrep/nonfao/ad696e/ad696e00.pdf.

39 Piot P, Greener R, Russell S, “Squaring the Circle: AIDS, Poverty, and Human Development,” PLOS Medicine 4, no. 10 (2007): e314. www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040314

40 Drimie S, “The Impact of HIV/AIDS on rural households and land issues in Southern and Eastern Africa,” Background Paper, (Food and Agricultural Organization, Sub-Regional Office for Southern and Eastern Africa, 2002). ftp://ftp.fao.org/docrep/nonfao/ad696e/ad696e00.pdf.

41 UNAIDS and UN Office of the High Commissioner for Human Rights (OHCHR), Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

42 Ki-Moon B, The Stigma Factor, The Washington Times, (Aug. 6, 2008). www.washingtontimes.com/news/2008/aug/06/the-stigma-factor/.

43 UNAIDS, HIV – Related Stigma, Discrimination, and Human Rights Violations: Case Studies of Successful Program (April 2005). http://data.unaids.org/publications/irc-pub06/jc999-humrightsviol_en.pdf

44 UNAIDS and the UN Office of the High Commissioner for Human Rights, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

45 Ibid

46 Global Network of People Living with HIV (GNP+), Stigma and Discrimination at Work: Findings from the People Living with HIV Stigma Index, Evidence Brief, (2012). www.gnpplus.net/images/stories/Rights_and_stigma/SI_WorkBriefing_Online.pdf.

47 National Center for AIDS/STD Control and Prevention, China CDC & International Labour Office for China and Mongolia, HIV and AIDS Related Employment Discrimination in China. www.ilo.org/wcmsp5/groups/public/—asia/—ro-bangkok/—sro-bangkok/documents/publication/wcms_150386.pdf.

48 International Labour Organization (ILO), HIV still a major obstacle to employment security (July 24, 2012). www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_185826/lang–en/index.htm.

49 International Labour Organization, Recommendation concerning HIV and AIDS and the World of Work (No. 200) (2010), www.ilo.org/aids/WCMS_142706/lang–en/index.htm. Available in many languages. See also, ILO, Code of Practice on HIV/AIDS and the World of Work, www.ilo.org/aids/Publications/WCMS_113783/lang–en/index.htm.

50 National Center for AIDS/STD Control and Prevention, China CDC & International Labour Office for China and Mongolia, HIV and AIDS Related Employment Discrimination in China. www.ilo.org/wcmsp5/groups/public/—asia/—ro-bangkok/—sro-bangkok/documents/publication/wcms_150386.pdf.

51 Rueda SI, “Labour Force Participation and health-related quality of life in people living with HIV”, AIDS Behavior 16, no. 8 (2012):2350-60.
www.ncbi.nlm.nih.gov/pubmed/22814570.

52 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf. The Global Commission on HIV and the Law is an independent body, convened by UNDP on behalf of the program Coordinating Board of the Joint United Nations program on HIV/AIDS (UNAIDS).

53 United Nations High Commissioner for Human Rights, The protection of human rights in the context of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), A/HRC/19/37 (Dec. 14, 2011).
http://www2.ohchr.org/english/bodies/hrcouncil/docs/19session/A.HRC.19.37_en.pdf.

54 The Global Network of People Living with HIV/AIDS (GNP+); The International Community of Women Living with HIV/AIDS (ICW); The International Planned Parenthood Federation (IPPF); and The Joint United Nations Programme on HIV/AIDS (UNAIDS).

55 The People Living with HIV Stigma Index. www.stigmaindex.org/.

56 The People Living with HIV Stigma Index, “User Guide.” www.stigmaindex.org/9/aims-of-the-index/aims-of-the-index.html.

57 AVERT, “HIV and AIDS Stigma and Discrimination.” www.avert.org/hiv-aids-stigma.htm#contentTable1; UNAIDS, Non-discrimination in HIV responses (2010). www.unaids.org/en/media/unaids/contentassets/documents/priorities/20100526_non_discrimination_in_hiv_en.pdf.

58 UNAIDS and OHCHR, Handbook on HIV and Human Rights for National Human Rights Institutions (2007).
http://data.unaids.org/pub/Report/2007/ jc1367-handbookhiv_en.pdf.

59 See, e.g., England R, “The Writing is on the wall for UNAIDS,” BMJ 336, no. 7652(2008). http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pmc/articles/PMC2375992/; Jewkes R, “Beyond Stigma: social responses to HIV in South Africa,” The Lancet 368, no. 9534 (August 2006).
http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0140673606691307.

60 Bor J et al, Social exposure to an antiretroviral treatment programme in rural KwaZulu‐Natal, (Africa Centre and University of Kwazulu-Natal, 2011).

61 AVERT, “HIV and AIDS Stigma and Discrimination.” www.avert.org/hiv-aids-stigma.htm#contentTable1.

62 AVERT, “Women, HIV and AIDS.” www.avert.org/women-hiv-aids.htm#contentTable0.

64 Fried S et al, “Integrating interventions on maternal mortality and morbidity and HIV: A human rights-based framework and approach,” Health and Human Rights 14, no. 2 (2012). www.hhrjournal.org/index.php/hhr/article/view/512/776.

67 UNAIDS, Report on the global AIDS epidemic 2010 (2010). www.unaids.org/globalreport/global_report.htm.

68 UN Office of the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights: 2006 Consolidated Version (2006): 110. www.ohchr.org/Documents/Issues/HIV/ConsolidatedGuidelinesHIV.pdf.

69 UN Commission on the Status of Women, Report of the Secretary General on women, the girl child and HIV and AIDS, E/CN.6/2011/7 (Dec. 3, 2010): 2. www.un.org/womenwatch/daw/csw/csw55/documentation.htm.

70 World Bank, Protecting Women’s Land and Property Rights in the Context of AIDS. http://siteresources.worldbank.org/INTGENAGRLIVSOUBOOK/Resources/AfricaIAP.pdf.

71 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

72 What Works for Women and Girls, Promoting Women’s Employment, Income and Livelihood Opportunities. www.whatworksforwomen.org/chapters/21-Strengthening-the-Enabling-Environment/sections/63-Promoting-Womens-Employment-Income-and-Livelihood-Opportunities.

73 Cooke et al, “Population uptake of antiretroviral treatment through primary care in rural South Africa,” BMC Public Health 10 (2010). http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pmc/articles/PMC3091553/pdf/1471-2458-10-585.pdf.

74 AVERT, “Women, HIV and AIDS.” www.avert.org/women-hiv-aids.htm#contentTable0.

76 UNAIDS and the UN Office of the High Commissioner for Human Rights, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

77 AVERT, “Preventing Mother-to-child Transmission (PMTCT) in Practice.” www.avert.org/pmtct-hiv.htm.

79 AVERT, “Preventing Mother-to-child Transmission (PMTCT) in Practice.” www.avert.org/pmtct-hiv.htm.

81 See, AVERT, “Preventing Mother-to-child Transmission (PMTCT) in Practice.” www.avert.org/pmtct-hiv.htm.

83 Open Society Foundations, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org; UNAIDS and OHCHR, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

84 UNICEF, “Childinfo: Monitoring the Situation of Children and Women.” www.childinfo.org/hiv_aids.html.

85 Open Society Foundations, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org; UNAIDS and OHCHR, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

87 Ibid.

88 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

89 UNESCO and the Global Network of People Living with HIV, Positive Learning: Meeting the needs of young people living with HIV (YPLHIV) in the education sector. http://unesdoc.unesco.org/images/0021/002164/216485E.pdf.

90 Inter-Parliamentary Union (IPU), Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007), www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

91 UNAIDS, quoted in Open Society Institute, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org.vs3.korax.net/downloads/nmte_20090923_0.pdf.

93 AVERT, “Sex Workers and HIV Protection.” www.avert.org/sex-workers.htm.

94 IRIN News, Rwanda: Criminalization of sex work hinders HIV prevention efforts (Nov. 17, 2011). www.irinnews.org/Report/94231/RWANDA-Criminalization-of-sex-work-hinders-HIV-prevention-efforts.

95 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

96 Open Society Foundations, Criminalizing Condoms: How Policing Practices Put Sex Workers And Hiv Services At Risk In Kenya, Namibia, Russia, South Africa, The United States, And Zimbabwe (July 2012). www.Soros.Org/Reports/Criminalizing-Condoms.

97 WHO, Violence Against Women and HIV/AIDS: Critical Intersection., www.who.int/gender/documents/sexworkers.pdf.

98 Avert, “HIV, AIDS, and Men who have sex with men.” www.avert.org/men-sex-men.htm.

99 Semugoma P, Nemande S, Baral SD, “The irony of homophobia in Africa,” 380, no. 9839 The Lancet (July 2012).

100 Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/14/20 (Apr. 27, 2010). http://www2.ohchr.org/english/bodies/hrcouncil/14session/reports.htm. Report is on the right to health and criminalization of same-sex conduct and sexual orientation, sex-work and HIV transmission.

101 Ibid.

102 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

103 AVERT, “HIV, AIDS, and Men who have sex with men.” www.avert.org/men-sex-men.htm.

104 WHO, Effectiveness of Interventions to Address HIV in Prisons (2007). http://whqlibdoc.who.int/publications/2007/9789241596190_eng.pdf.

105 For the copy of the legal documents, news reports, and blog posts on the case, please see American Civil Liberties Union, Henderson et al. v. Thomas et al., www.aclu.org/hiv-aids-prisoners-rights/henderson-et-al-v-thomas-et-al.

106 Mathers B et al., “The global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review,” Lancet 372, no. 9651 (2008): 1733–1745.

107 World Health Organization, HIV/AIDS: Injecting Drug Use, http://www.who.int/hiv/topics/idu/en/index.html.

108 Jurgens et al, “People who use drugs, HIV, and human rights”, Lancet 376 (2010): 475-485.

109 Open Society Foundations, 10 Reasons Why Human Rights Should Occupy the Centre of the Global AIDS Struggle (2009). www.hivhumanrightsnow.org.

110 Jurgens et al, “People who use drugs, HIV, and human rights,” Lancet 376 (2010): 475-485.

111 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

112 UNAIDS and WHO, “UNAIDS/WHO policy statement on HIV testing” (2004). www.who.int/hiv/pub/vct/statement/en/.

113 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

114 Jurgens R, Increasing Access to HIV Testing and Counseling While Respecting Human Rights (Open Society Institute, 2007). www.opensocietyfoundations.org/publications/increasing-access-hiv-testing-and-counseling-while-respecting-human-rights-background.

115 Amon J, “Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights,” in Sudarshan N, ed., HIV/AIDS, Health Care and Human Rights Approaches (Amicus Books, Jan. 2009).

116 Ibid.

117 WHO, Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities (2007). www.who.int/hiv/pub/guidelines/9789241595568_en.pdf

118 Amon J, “Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights,” in Sudarshan N, ed., HIV/AIDS, Health Care and Human Rights Approaches (Amicus Books, Jan. 2009). See also Jurgens R, Increasing Access to HIV Testing and Counseling While Respecting Human Rights (Open Society Institute, 2007). www.opensocietyfoundations.org/publications/increasing-access-hiv-testing-and-counseling-while-respecting-human-rights-background.

119 Involuntary measures are those undertaken against the individual’s will. Mandatory or compulsory measures are also undertaken against the individual’s will and may also be required by law.

120 Open Society Foundations, Mandatory Pre-Marital HIV Testing: An Overview (2010). http://www.soros.org/sites/default/files/mandatory-premarital-hiv-testing-20100513.pdf.

121 Amon J, “Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights,” in Sudarshan N, ed., HIV/AIDS, Health Care and Human Rights Approaches (Amicus Books, Jan. 2009).

122 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf. Also see Jurgens R, Increasing Access to HIV Testing and Counseling While Respecting Human Rights (Open Society Foundations, 2007). www.opensocietyfoundations.org/publications/increasing-access-hiv-testing-and-counseling-while-respecting-human-rights-background.

123 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

124 Amon J, “Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights,” in Sudarshan N, ed., HIV/AIDS, Health Care and Human Rights Approaches (Amicus Books, Jan. 2009).

125 Ibid.

126 Ibid.

127 Jurgens R, Increasing Access to HIV Testing and Counseling While Respecting Human Rights (Open Society Institute, 2007). www.opensocietyfoundations.org/publications/increasing-access-hiv-testing-and-counseling-while-respecting-human-rights-background.

128 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

129 UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/14/20 (Apr. 27, 2010).

130 Institute of Medicine (IOM), World Migration Report 2011 (2011): 49. http://publications.iom.int/bookstore/free/WMR2011_English.pdf.

131 UN Office of the High Commissioner of Human Rights, 10 Key Points on HIV/AIDS and the Protection of Refugees, IDPs and Other Persons of Concern. www.ohchr.org/Documents/Issues/HIV/SummaryHIV.pdf; UNAIDS, Denying Entry, Stay and Residence Due to HIV Status: Ten Things You Need to Know. www.unaids.org/en/media/unaids/contentassets/dataimport/pub/basedocument/2009/jc1738_entry_denied_en.pdf.

132 Ibid.

133 International AIDS Society (IAS), HIV-specific entry and residence restrictions, IAS Policy Paper (2009). www.iasociety.org/Web/WebContent/File/ias_policy%20paper.pdf. List of countries with restrictions are provided in the Annex.

134 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012): 60-61. http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

135 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

136 Amon J, “Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights,” in Sudarshan N, ed., HIV/AIDS, Health Care and Human Rights Approaches (Amicus Books, Jan. 2009).

137 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

138 Ibid.

139 UN Office of the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

140 Ibid.

141 Robins, S. 2006. “From ‘Rights’ to ‘Ritual’”: AIDS Activism in South Africa.” American Anthropologist 108(2):312-323. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1525/aa.2006.108.2.312/pdf; Nguyen VK, “Chapter 17: Trial Communities: HIV and Therapeutic Citizenship in West Africa,” Evidence, Ethos and Experience: The Anthropology and History of Medical Research in Africa, Geissler WP and Molyneux C, eds., (Berghahn Books, 2011).

142 Robins, S. 2006. “From ‘Rights’ to ‘Ritual’”: AIDS Activism in South Africa.” American Anthropologist 108(2):312-323. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1525/aa.2006.108.2.312/pdf.

143 Robins, S. 2006. “From ‘Rights’ to ‘Ritual’”: AIDS Activism in South Africa.” American Anthropologist 108(2):312-323. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1525/aa.2006.108.2.312/pdf; Nguyen VK, “Chapter 17: Trial Communities: HIV and Therapeutic Citizenship in West Africa,” Evidence, Ethos and Experience: The Anthropology and History of Medical Research in Africa, Geissler WP and Molyneux C, eds., (Berghahn Books, 2011).

144 UNAIDS, Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses (2012). http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/Key_Human_Rights_Programmes_en_May2012.pdf.

145 UN Office of the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines.

146 Ibid.

147 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

148 UN Office of the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

149 UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/14/20 (Apr. 27, 2010). http://www2.ohchr.org/english/bodies/hrcouncil/14session/reports.htm.

151 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

152 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

153 UNAIDS, Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses (2012). http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/Key_Human_Rights_Programmes_en_May2012.pdf.

154 See 2011 Political Declaration

155 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

156 Ibid.

157 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf. See also Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

158 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

159 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

160 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

161 UNAIDS and UN Office of the High Commissioner for Human, Handbook on HIV and Human Rights for National Human Rights Institutions (2007). http://data.unaids.org/pub/Report/2007/jc1367-handbookhiv_en.pdf.

162 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

163 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

164 Ibid.

165 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

166 Nolan A, Social Protection in the Context of HIV and AIDS (OECD, 2009), www.oecd.org/development/povertyreduction/43280854.pdf.

167 UNICEF, Enhancing Social Protection for HIV Prevention, Treatment, Care & Support –The State of Evidence (2010). www.unicef.org/aids/files/Social_Protection_Brief_LowresOct2010.pdf.

168 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

169 UNAIDS, Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses (2012). http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/Key_Human_Rights_Programmes_en_May2012.pdf.

170 Ibid.

171 Strickland R, To Have and To Hold: Women’s Property and Inheritance Rights in the Context of HIV/AIDS in Sub-Sahara Africa (International Center for Research on Women, June 2004). www.icrw.org/files/publications/To-Have-and-To-Hold-Womens-Property-and-Inheritance-Rights-in-the-Context-of-HIV-AIDS-in-Sub-Saharan-Africa.pdf.

172 UNAIDS, Report on the global AIDS epidemic 2010 (2010) www.unaids.org/globalreport/global_report.htm.

173 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

174 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

175 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

176 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

177 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

178 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

179 UN Office of the High Commissioner for Human and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

180 Inter-Parliamentary Union, Handbook for Parliamentarians on HIV/AIDS, Law and Human Rights (2007). http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/manual/2007/20071128_ipu_handbook_en.pdf.

181 Ibid.

182 Global Commission on HIV and the Law, Risks, Rights and Health (July 2012). http://www.hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-EN.pdf.

183 UN Office for the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

184 Ibid.

185 UNAIDS, Key Programmes to Reduce Stigma and Discrimination and Increase Access to Justice in National HIV Responses (2012). http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/Key_Human_Rights_Programmes_en_May2012.pdf.

186 UN Office for the High Commissioner for Human Rights and UNAIDS, International Guidelines on HIV/AIDS and Human Rights (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

187 Ibid.