Launched ahead of World AIDS Day 2017, this Joint United Nations Programme on HIV/AIDS (UNAIDS) report attributes recent rises in access to treatment in part to the courage and determination of people living with HIV demanding and claiming their rights. In addition to sharing recent data and explaining the scope of the right to health, the report gives voice to particular communities that are affected by HIV - including people living with HIV, sex workers, people who use drugs, gay men and other men who have sex with men, transgender people, children (including those living on the street), and adolescents and young people - on what the right to health means to them. Right to Health demonstrates the challenges ahead in efforts to end the AIDS epidemic as a public health threat by 2030, as outlined in the 2016 United Nations Political Declaration on Ending AIDS - while also offering examples of how marginalised communities are responding to issues such as stigma and claiming their right to HIV treatment.
As detailed in the report, references to the right to health are found in international and regional laws, treaties, UN declarations, and national laws and constitutions across the world. The right to health is defined in Article 12 of the International Covenant on Economic, Social and Cultural Rights as the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. This includes the right of everyone, including people living with and affected by HIV, to the prevention and treatment of ill health, to make decisions about one's own health, and to be treated with respect and dignity and without discrimination. Governments have a responsibility and obligation to create the conditions that enable us to enjoy our right to health, a concept that includes the following interrelated and essential elements: access, availability, acceptability, and quality.
People require access to a range of health services, information, and social and economic conditions to realise the right to health. Some of these elements are outlined in the report. For example, information and education must be available to people to enable them to keep themselves and their families healthy and to seek help when they are unwell. Health information and education must be accurate, evidence-informed, unbiased, and non-discriminatory. Health workers must have the information and tools to be able to explain illness, treatment, and the means of prevention to people in a way that they are comfortable with and are able to understand, depending on their age, disability, etc. Health education can take place through different channels (e.g., social media). School-based education, including sexuality education, teaches children about staying healthy and developing respectful relationships based on gender equality and human rights.
UNAIDS observes that people living with or affected HIV have led the way in demonstrating the power of the right to health, but also the power of health to realise wider rights. In seeking and securing access to justice in the courts and creating the space to make their voices heard in political and scientific forums, people living with and affected by HIV have also able to realise their right to fair treatment and their right to participate and contribute to their communities and society. People living with HIV have demanded their right to work in a safe and non-discriminatory environment, to earn a decent wage, and to contribute to the economy. Building on the foundation established by HIV rights-based arguments, people living with disabilities, migrants, and people affected by tuberculosis have been able to make progress in realising their rights, too.
Right to Health features various Q&A conversations with activists, people from different groups who are living with HIV, and leaders of programmes, including communication-centred ones, that are designed to champion rights (e.g., the right to HIV treatment) and to support advocacy. For example, one such conversation is with the PACT, a coalition of more than 80 youth organisations working to end AIDS by 2030. It has been building solidarity across youth organisations to ensure the health, well-being, and human rights of all young people since 2013. The PACT uses strategies such as several online coordination platforms to: strengthen young people's capacity to change the legal and policy frameworks that prevent them from accessing services, advocate for young people's participation in decision-making processes, and mobilise young people and engage decision-makers to increase access to evidence-informed HIV prevention and treatment. Among the many other organisations explored in the report is REDLACTRANS, a network of transgender people from Latin America and the Caribbean using strategies related to political advocacy, social awareness, organisational participation, and strengthening of health, education, justice, and equality.
Various promising practices are explored in the report, as documented in one case about the Canadian Aboriginal AIDS Network, which has been filming indigenous communities to highlight responses to HIV and hepatitis C and to show promising harm reduction practices. One such film showcases how the Eskasoni First Nation, part of the Mi'kmaq community, near Bras d'Or Lake in eastern Cape Breton Island, Canada, took ownership over their own health by talking to youth and elders and launching a poster campaign prior to setting up a needle exchange programme. Also described as "a ray of hope": care for the community by the community. One section examines the role of community health workers at the doorstep. "Community health workers, who come from the communities they serve, are key to reaching people in remote areas, often with few resources, to seek out treatment and care."
In a final conversation, Dainius Puras, United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, explains some key concepts of the right to health. He offers three recommendations: (i) to ensure the meaningful participation of everyone; (ii) to prioritise health promotion and primary care so that health systems are rational, equitable, and do not waste resources on unnecessary interventions; and (iii) to reach zero discrimination in all health care services. "This can be reached if a human rights-based approach is seriously applied."
Southern Africa HIV and AIDS Regional Exchange (SHARE) and UNAIDS press release - both accessed on December 1 2017. Image caption/credit: Ratna, a sex worker and health-care navigator, administering pre-exposure prophylaxis (PrEP) to a young sex worker in Mysore, India. UNAIDS