HIV now: why human rights matter more than ever
Corresponding author: Chris Beyrer, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Received 19 November 2013; Accepted 19 November 2013; Published 10 December 2013
Copyright: © 2013 Beyrer C; licensee International AIDS Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License ( http://creativecommons.org/licenses/by/3.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Beyrer C. Journal of the International AIDS Society 2013, 16 :18968
http://www.jiasociety.org/index.php/jias/article/view/18968 | http://dx.doi.org/10.7448/IAS.16.1.18968
We are living in an extraordinary moment in the HIV response. Advances in science, implementation, community
engagement and political support have led to unprecedented optimism and measurable declines in new forms
of HIV infections in many communities, populations and affected countries. There is growing realization
that through strategic use of the prevention, treatment and care advances we now have in hand, the
fourth decade of the AIDS pandemic could be where we finally achieve meaningful and sustained
reductions in new HIV infections, close to full life expectancy for those living with the
virus, and integration of HIV into health services, which could be beneficial to both
HIV programmes and strapped health systems. We are learning how to use the powerful
insight that effective early HIV treatment is a potent HIV-preventive
intervention for sero-discordant couples and may have preventive
impacts at community and population levels. And we have new and
combined prevention tools and technologies (and more in the
research and development pipeline), which could markedly
increase prevention choices and offer real promise in protecting those most in need of prevention.
For many, this bright moment has come too late. By the end of 2013, AIDS will have claimed more than
35 million human lives and affected countless more. We must not lose our urgency or flag in this key
stage of our shared struggle against this virus.
What could hold us back? What could give HIV, again, the edge over humanity's best efforts to control
spread and maintain the health and well-being of those living with HIV? While antiretroviral drug
resistance is a real concern and adherence to safer behaviours, condom use and prevention
technologies are on-going challenges, these can and are being addressed and overcome.
The epidemiologic data suggest that much more fundamental issues are at play where
HIV rates are rising, not falling, and where countries are facing expanding
epidemics. Stigma, discrimination, human rights abuses and the
criminalization of people and communities, including people
who use drugs, sexual and gender minorities and sex
workers, continue to constitute our greatest barriers to control of the pandemic. Failed policies and
flawed politics are at the heart of our collective failures in the HIV response. This must change,
not simply because the realization of the rights and dignity we all share as human beings is
fundamental to all of our lives, but because the limitations on these basic rights and
freedoms continue to aid and abet the HIV pandemic.
HIV rates continue to rise across the vast eastern Europe and central Asian region, driven by policy
failures in the provision of sterile injecting equipment, political refusals to provide evidence-based
drug treatment (such as methadone and buprenorphine) and harsh punitive polices and practices toward
sex workers and gay, bisexual and other men who have sex with men. In many of these states,
including the largest, the Russian Federation, recent policies have become so repressive
that it is becoming difficult to even assess the spread of HIV as new
anti-homosexuality propaganda laws make it challenging to reach men in need of services.
The most impressive gains against the virus have arguably been made in the severe epidemics in east
and southern Africa, where behaviour change and condom usage, prevention of mother-to-child
transmission, male circumcision and, arguably, expanded treatment access have together
shown real traction against HIV spread. But even where HIV rates have declined
among reproductive aged adults, limitations on essential services continue
for many - again, driven by exclusion and discrimination of those deemed
unworthy. Sex workers are denied PMTCT services in Tanzania. African
gay men with sexually transmitted infections cannot find providers
who will treat them in safety and dignity. In too many
countries, people who inject drugs find that their substance use history is used to deny them HIV
treatment. Transgender persons are excluded from care, particularly transgender women, who are
the most disproportionately burdened of any community at risk. And persons in detention and
prison worldwide continue to suffer from lack of access to essential services.
These exclusions are violations of the right to health and to dignity and,
because untreated HIV infection is fatal, of the right to life itself.
This is morally unacceptable and scientifically indefensible.
If we cannot begin to provide essential services to those who need them most, HIV will win. And compassion
will lose. Humanity will lose. Because we will have let bigotry prevail - and let our Achilles heel,
discrimination, undermine the magnificent achievements we have made in the HIV response.
UN Secretary - General Ban Ki-moon spoke about the need for inclusion and about the universality of human
rights for sexual and gender minorities on Human Rights Day in 2012:
The very first article of the Universal Declaration of Human Rights proclaims that, 'All human beings are
born free and equal in dignity and rights.' All human beings - not some, not most, but all. No
one gets to decide who is entitled to human rights and who is not. Let me say this loud
and clear: lesbian, gay, bisexual, and transgender people are entitled to the same
rights as everyone else. They, too, are born free and equal.
The road to full inclusion of those in need will not be easy. Indeed, we are currently seeing dangerous
signs of increasing discrimination, as in Russia, Uganda, Cameroon and numerous other countries - but
this is an essential struggle for the next phase of the HIV response. The great TB researcher,
George Comstock, used to say: "TB anywhere is TB everywhere." He meant that TB could not be
controlled if all who needed treatment were not reached. On Human Rights Day, we must
recognize that HIV anywhere is HIV everywhere. And we must commit to all in need.
No exceptions. That is what human dignity demands.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
The author declares no competing interests.
This is an original contribution by the author who conceived and wrote the paper.
This work is licensed under a Creative Commons Attribution 3.0 License.
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