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World AIDS Day: Punitive Laws Threaten HIV Progress
Focus on treatment as prevention requires respect for human rights
This year's World AIDS Day theme is "universal access and human rights," tying together goals for universal access to HIV prevention, treatment, and care with recognition that respect for human rights is critical in the global response to AIDS. Achieving universal access to treatment has also been a key theme in debates over the past year around the use of antiretroviral treatment (ART) as a part of comprehensive HIV prevention strategies. Mathematical models have proposed that early initiation of universal antiretroviral treatment combined with HIV prevention programs could lead to the eventual elimination of HIV infection."There is increasing evidence that antiretroviral treatment can be an important part of comprehensive prevention strategies," said Joe Amon, Health and Human Rights director at Human Rights Watch. "But if human rights abuses are unaddressed and punitive laws target people vulnerable to or living with HIV, the potential of treatment as prevention isn't going to be realized."
In many parts of the world, legislation effectively criminalizes populations living with HIV or vulnerable to HIV infection, such as sex workers, drug users, and men who have sex with men. These laws fuel stigma and discrimination, increase barriers to HIV information and treatment, and contribute to the spread of disease, Human Rights Watch said. Elsewhere, laws criminalizing HIV transmission discourage HIV testing, potentially subjecting those who know their HIV status to criminal penalties while exempting those who are unaware of their infection.
In early November, Human Rights Watch released a 10-page critique of a proposed Ugandan HIV/AIDS law, which includes mandatory HIV testing, forced disclosure, and criminal penalties for the "attempted transmission" of HIV to another person. The Ugandan Parliament is also considering a bill that allows for a seven year prison term for any person or organization who supports or promotes lesbian, gay, bisexual, or transgender people's rights. It would jail for up to three years anyone who fails to report a person they suspect of being lesbian or gay. A person living with HIV who has consensual homosexual sex would face the death penalty, regardless of risk of HIV transmission and even if their partner is also HIV-positive.Since 2005, 14 countries in Africa have passed HIV-specific laws that potentially criminalize all sexual behavior among HIV-positive individuals, including those who use condoms, regardless of disclosure and actual risk of transmission. In a number of countries, maternal-to-child HIV transmission is a criminal offense, even where antiretroviral treatment may not be available. In Uganda, the draft legislation exempts HIV transmission before or during birth but allows for the prosecution of women whose infants acquire HIV from breast milk.
"HIV prevention has failed in many countries not because we don't know how to design effective prevention programs, but because governments have been unwilling to implement these programs and ensure that they reach everyone," Amon said. "The potential of HIV treatment in comprehensive prevention programs will be similarly sabotaged if governments continue to pass punitive laws and trample upon human rights."