AIDS Alert International

UNAIDS guidelines update includes expanded agenda

Changes occur with sixth guideline

Recent changes made to the "HIV/AIDS and Human Rights International Guidelines" include recommendations that hold governments accountable for developing policies that will improve HIV treatment and care. Among the new recommendations, made by the Office of High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS are some of the more controversial issues facing the international AIDS community. For example, one change to guideline six recommends that states enact laws to enable HIV/ AIDS information to be spread through the mass media and to ensure this information is not subject to censorship. Another item recommends that states ensure that intellectual property agreements do not impede access to HIV/AIDS prevention and treatment.

Providing governments a framework

The guidelines also instruct creditor countries and international funding institutions to implement debt relief for developing countries and that developing nations use a proportion of the resources freed up by debt relief to provide HIV/AIDS prevention and treatment services.

"The purpose of the guidelines is to give practical guidance, as well as to provide a framework to governments to redesign their policies and programs within HIV/AIDS human rights," says Miriam Maluwa, LLB, LLM, law and human rights advisor in the Office of the Director of the Department of Social Mobilisation and Information for UNAIDS in Geneva.

The entire guideline six is new because a lot has changed worldwide in the six years since the initial guidelines were developed, Maluwa notes. "There has been quite a noticeable strengthening on international human rights law relating to HIV/AIDS," Maluwa says. "A number of key human rights mechanisms have made pronouncements or given legal interpretative value on how the right to health can be realized in the context of HIV," she adds. Before the recent revision, guideline six focused largely on the regulation of goods, services, and information. Now there’s a greater focus on defining what states’ obligations are under guideline six, Maluwa explains.

Many countries already have policies and regulations that follow the points made under the revised guidelines, especially those pertaining to the recommendation that states ensure their laws and policies do not exclude, stigmatize, or discriminate against people living with HIV/AIDS with regard to access to health care services, she says.

Some progress is seen

There also has been some progress made in ensuring that legislation provides prompt and effective remedies in cases in which a person living with HIV/AIDS is denied access to health care treatment, Maluwa says. "We’ve seen HIV/AIDS related litigation of people discriminated against," she says. "The judicial structure, courts, and tribunals have led to regress granted to those who have a complaint."

For example, HIV/AIDS litigation has been under way in South Africa, India, Venezuela, and Costa Rica, Maluwa says. Also, some countries, including Uganda, Thailand, and the Philippines, have strong community engagement policies as part of their HIV prevention and treatment programs, as is recommended in the revised guideline, she adds. However, there are a number of areas that most nations have not addressed. Maluwa offers these observations on several of the more controversial recommendations:

• Debt relief

"Generally, we, as an institution, have been advancing debt relief as an approach to ensure that resources allocated to HIV/AIDS are increased," Maluwa says. "And we’re doing it in the context of ensuring that countries that are benefiting from debt-relief programs," she says. UNAIDS has been trying to make certain that elements of the poverty reduction plans of debt-relief initiatives include components of HIV/ AIDS, she adds.

• Intellectual property laws

"Issues of intellectual property laws and HIV treatment and the dynamism of how they work varies a lot from country to country," Maluwa says. For example, Brazil has been able to guarantee universal and free access to antiretroviral medications since 1996 through a number of strategies that include ensuring the production of generic drugs within the country, Maluwa says. "Brazil has struck the balance between increasing access of antiretrovirals without intellectual property law being an impediment to that, and they have produced quite good results between 1996 and 2000," she adds. "Brazil’s hospital admissions have dropped by 80%, and AIDS mortality rates have fallen by 50% because of this guaranteeing of free access to HIV medications."

Some other countries, including Venezuela, Costa Rica, and Kenya are currently developing agreements to increase access to HIV medications, Maluwa says. "They are looking at what legal framework would best advance that on a national level," she points out.

Censorship issues

• HIV information censorship

"I can’t cite countries as examples of this censorship, but certainly the relationship between censorship of information and the failure to advance HIV programs, particularly prevention, is quite obvious," Maluwa says. "Any kind of censorship on issues related to sexuality or sexual terminology makes it very difficult to implement prevention programs because you can’t talk about how to prevent without talking about how it is sexually transmitted and how to put a condom on the penis," she says. "So one can see quite easily a correlation between censorship and failure to advance prevention."

• Providing universal access to HIV treatment

The first point of guideline six, which is about how states should develop and implement a national plan to progressively realize universal access to comprehensive treatment, care, and support for HIV patients, is a new component of the guidelines. It remains to be seen how well that is implemented around the world, Maluwa says. "That would be quite a move if we see that guideline effective in a number of countries," she says. "Very few countries have provided international access, so if we saw a system where 50% of the countries in the world have national plans on treatment that would be a massive contribution to ensuring equitable HIV-related care."