HIV and the Law

via the Global Commission on HIV and the Law

The end of the global AIDS epidemic is within our reach. This will only be possible if science and action are accompanied by a tangible commitment to respecting human dignity and ending injustice.

Law prohibits or permits specific behaviours, and in so doing, it shapes politics, economics and society. The law can be a human good that makes a material diff erence in people’s lives. It is therefore not surprising that law has the power to bridge the gap between vulnerability and resilience to HIV.

We came together as a group of individuals from diverse backgrounds, experiences and continents to examine the role of the law in eff ective HIV responses. What we share is our abiding commitment to public health and social justice. We have listened with humility to hundreds of accounts describing the eff ects of law on HIV. In many instances, we have been overwhelmed by how archaic, insensitive laws are violating human rights, challenging rational public health responses and eroding social fabric. At other times, we have been moved by those who demonstrate courage and conviction to protect those most vulnerable in
our societies.

Many would say that the law can be complex and challenging and is best left alone. Our experience during this Commission has shown us a very different perspective. We have been encouraged by how frank and constructive dialogue on controversial issues can sometimes quickly lead to progressive law reform, the eff ective defence of legislation or better enforcement of existing laws. Even in environments where formal legal change is a slow and arduous process, we have witnessed countries taking action to strengthen access to justice and challenge stigma and discrimination.

Click here for the full report.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

Ethical Concerns Raised: Human Experimention Without Subject's Consent

viaNature.com by Matthew Walter

The injections came without warning or explanation. As a low-ranking soldier in the Guatemalan army in 1948, Federico Ramos was preparing for weekend leave one Friday when he was ordered to report to a clinic run by US doctors.

Ramos walked to the medical station, where he was given an injection in his right arm and told to return for another after his leave. As compensation, Ramos's commanding officer gave him a few coins to spend on prostitutes. The same thing happened several times during the early months of Ramos's two years of military service. He believes that the doctors were deliberately infecting him with venereal disease.

Now 87 years old, Ramos says that he has suffered for most of his life from the effects of those injections. After leaving the army, he returned to his family's remote village, on a steep mountain slope northeast of Guatemala City. Even today, Las Escaleras has no electricity or easy access to medical attention. It wasn't until he was 40, nearly two decades after the injections, that Ramos saw a doctor and was diagnosed with syphilis and gonorrhoea. He couldn't pay for medication.

“For a lack of resources, I was here, trying to cure myself,” says Ramos. “Thanks to God, I would feel some relief one year, but it would come back.” Over the decades, he has endured bouts of pain and bleeding while urinating, and he passed the infection onto his wife and his children, he told Nature last month in an interview at his home.

Ramos's son, Benjamin, says that he has endured lifelong symptoms, such as irritation in his genitals, and that his sister was born with cankers on her head, which led to hair loss. Ramos and his children blame the United States for their decades of suffering from venereal disease. “This was an American experiment to see if it caused harm to human beings,” says Benjamin.

Ramos is one of a handful of survivors from US experiments on ways to control sexually transmitted diseases (STDs) that ran in semi-secrecy in Guatemala from July 1946 to December 1948. US government researchers and their Guatemalan colleagues experimented without consent on more than 5,000 Guatemalan soldiers, prisoners, people with psychiatric disorders, orphans and prostitutes. The investigators exposed 1,308 adults to syphilis, gonorrhoea or chancroid, in some cases using prostitutes to infect prisoners and soldiers. After the experiments were uncovered in 2010, Ramos and others sued the US government, and US President Barack Obama issued a formal apology. Obama also asked a panel of bioethics advisers to investigate, and to determine whether current standards adequately protect participants in clinical research supported by the US government.

When details of the Guatemalan experiments came to light, US health officials condemned them as 'repugnant' and 'abhorrent'. Last September, the Presidential Commission for the Study of Bioethical Issues went further, concluding in its report1, that “the Guatemala experiments involved unconscionable violations of ethics, even as judged against the researchers' own understanding of the practices and requirements of medical ethics of the day”

Read the Rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

The Treatment Action Campaign (TAC) Shapes AIDS Policy in South Africa

via The Guardian, by Pierre de Vos

"The TAC case thus illustrates how social and economic rights can be used by civil society groups to mobilise public support for a worthy cause – even before a court is asked to adjudicate on what will often be very complex legal and moral issues – and that it can enhance democratic engagement and participation."

Shortly after Thabo Mbeki, the former South African president, began his flirtation with Aids dissidence in 2000, the Treatment Action Campaign (TAC) was created to respond to the HIV crisis in the country and the government's reluctance to deal with it.

Although closely aligned with the ANC government, the TAC engaged politically and launched various court challenges to force a change of heart on the part of the government and, ultimately, in order to ensure that every HIV-positive person who could not afford it was provided with antiretroviral (ARV) medicine by the state.

The TAC ran a brilliant and strategically astute campaign to mobilise the public, trade union organisations and other civil society groups behind its cause. Its trump card in this campaign was section 27(1) of the constitution , which states that everyone has the right to have access to healthcare services, including reproductive healthcare.

Like other social and economic rights contained in the South African bill of rights – including the right of access to housing, sufficient food and water; and social security – the right to healthcare is not absolute. It requires the state only to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

At the time of the drafting of the bill, some politicians and academics opposed the inclusion of these rights, arguing that it would not be possible for judges to enforce these claims as they would be required to make policy choices best left to the democratically elected branches of government. But given the vast discrepancies in wealth – often based on race – caused by apartheid and the fact that many citizens did not have access to basic services at the dawn of democracy, the drafters of the constitution believed that it was imperative to include not only traditional civil and political rights in the constitution, but also justiciable social and economic rights. Otherwise the very legitimacy of the constitutional enterprise would be at risk.

South Africa's constitutional court at first dealt cautiously with the interpretation and application of these rights, making it clear that it would not be feasible to interpret the rights in a way that provided individual claimants with a right to demand specific goods and services from the state.

The court was in a difficult position as it had to respect the separation of powers doctrine and could not dictate to the government how to allocate its budgets. At the same time it was required to ensure that the social and economic rights did not remain rights on paper alone, but were interpreted in a way that signalled their enforceability.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Notes from India: Concerns and Challenges Around PrEP

At present, India has approximately 2.4 million people living with HIV out of its total population of approximately 1,210 million people (a prevalence of 0.03%). In 2009, close to 1.2 million people were newly infected. According to a recent United Nations report, there has been a 50 percent decline in the number of new HIV infections in the country over the last decade.

India has made significant strides in tackling HIV/AIDS in recent years, with the government’s efforts actively being supported by the Bill & Melinda Gates Foundation, the World Bank, and the United States Agency for International Development. Many Indian NGOs work to provide care facilities, ARV medicines and education for people living with HIV. There has also been consistent work towards spreading awareness, from communicating key messages though concerts, radio shows, and TV spots with famous Bollywood stars to innovative initiatives such as promoting condom use through kite flying during popular festivals.

However, much remains to be done. “Most importantly, the government needs to step in because we need better laws – laws that will enable behavior change and help us fight HIV effectively. There are some draconian laws that stigmatize sex workers and intravenous drug users, making life very unsafe for them. MSM community building is nearly impossible due to the hostile environment. Sex education also needs to be made legally mandatory in the school system. These steps would help bring about real change,” says Anjali Gopalan, Executive Director of NAZ India, a Mapping Pathways partner organization.

How is India responding to pre-exposure prophylaxis (PrEP)? Says Anjali, “My sense is that many people are still very uncomfortable and not quite able to figure out why we’re talking about PrEP in the Indian context. Many senior people in the field feel the focus needs to be on TLC+.” There could be a few reasons for this view. First, India is a low-prevalence country, and people in the HIV prevention field believe this makes it very different from places like South Africa where the prevalence among the general population is very high. Second, there have been great difficulties in procuring ARV drugs for people living with HIV recently. “There are massive stockouts – the government is saying they don’t have the money to buy more drugs – we’re trying to move drugs from centers where they are less utilized to others where they are needed more. There is a lot of concern in the country, especially with global funding not available right now,” explains Anjali.

When it comes to PrEP, the common view in India (and elsewhere) appears to be that to take away dwindling funding and hard-to-get ARV drugs from HIV-positive people and directing them toward HIV-negative people is not a realistic or justifiable step. Of course, others are quick to point out that it is not a case of either/or – PrEP is simply one more new tool with which to prevent HIV infections. The public health community is still in the phase of gathering data on PrEP and figuring out the best possible way to utilize this new option in a variety of regions with different target populations.

Cultural differences may also play a part. For instance, homosexuality is still largely taboo in India and drug users are commonly seen as people who “knowingly put themselves at risk”. Discordant couples face a similar issue: No-one sees a problem with giving ARV drugs to people who are infected. But some doctors and social workers have indicated an aversion to giving drugs to those who are not infected on the assumption that they may indulge in high-risk behavior.

There are other significant questions for India, and for other countries contemplating whether they will implement PrEP or not: How does one ensure compliance among people who are healthy?  How does one ensure that side-effects, if any, are taken care of? How would one follow up? Will private practitioners be involved? India is still grappling with basic infrastructural and supply-chain issues, which makes these extremely important concerns.

“The Mapping Pathways team is trying to help answer these very questions,” says Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago, chair of IRMA (International Rectal Microbicide Advocates), and a member of the Mapping Pathways team. “It’s time to gather all of this new data that’s pouring in and make sense of it, see how it can be applied in real scenarios. PrEP might make sense for some communities and situations, and it might not for others. Our end goal is to give decision-makers all the information they need to make informed decisions.”


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]