International Guidelines on HIV/AIDS and Human Rights - UNAids

UNAIDSOHCHRCONTENTSForeword 4Glossary 8Introduction 9Background and summary of the <strong>Guidelines</strong> 13I. GUIDELINES FOR STATE ACTION 20A Institutional responsibilities and processes 21B Law review, reform and support services 26C Promotion of a supportive and enabling environment 52II. RECOMMENDATIONS FOR DISSEMINATION ANDIMPLEMENTATION OF THE GUIDELINES ONHIV/AIDS AND HUMAN RIGHTS 69A States 69B United Nations system and regional intergovernmentalbodies 71C Non-governmental organizations 74III. INTERNATIONAL HUMAN RIGHTS OBLIGATIONS AND HIV 77A Human rights standards and the nature of Stateobligations 79B Restrictions and limitations 81C The application of specific human rights in thecontext of the HIV epidemic 832

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsAnnex 1History of the recognition of the importance of human rightsin the context of HIV 105Annex 2List of participants at the Second <strong>International</strong> Consultationon HIV/AIDS and Human Rights 112Annex 3List of participants at the Third <strong>International</strong> Consultationon HIV/AIDS and Human Rights 1143

UNAIDSOHCHRForewordIt has been ten years since the <strong>International</strong> <strong>Guidelines</strong>were adopted by the Second <strong>International</strong> Consultation onHIV/AIDS and Human Rights in 1996. In terms of the fast andever-evolving epidemic, much has happened in this decade, bothgood and bad. Evidence of the effectiveness of a treatment for HIVwas first announced in 1996, which for many changed HIV from asituation of hopelessness to a manageable health condition. But asthe HIV epidemic cast its glaring light on the vast inequity in healthcare across the globe, people living with HIV, among others, beganto demand that something be done about the fact that millions weredying of a treatable condition. In 2001, the Commission on HumanRights adopted a resolution in which it stated that the right to thehighest attainable standard of health includes access to antiretroviraltherapy for HIV. Following this, in 2002, OHCHR and UNAIDSsponsored the Third <strong>International</strong> Consultation on HIV/AIDS andHuman Rights in order to revise Guideline 6 (consolidated into thisreprint) to reflect the human rights dimensions of access to HIVprevention, treatment, care and support.Widespread access to antiretrovirals, as well as to HIVprevention, care and support, remains a major global health andhuman rights emergency for millions in need. Nonetheless, thenumbers of those having such access is rising. In this regard,governments and the international community made commitmentsin 2006 to pursue all necessary efforts towards achieving the goal4

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsof universal access to comprehensive HIV prevention programmes,treatment, care and support by 2010. Other time-bound commitments(including on human rights relating to HIV), have beenmade during the decade in the Millennium Declaration, and inthe Declaration of Commitment adopted by the UN GeneralAssembly Special Session on HIV/AIDS in 2001 and confirmedand expanded by the Political Declaration of the 2006 High LevelMeeting on AIDS at the General Assembly. These commitmentsreflect what works in the response to HIV, as well as much greaterpolitical commitment to the response. Global funding for HIVprogrammes has risen almost 30-fold in the course of the decade.Nevertheless, the situation remains grave, with a doublingof people living with HIV worldwide to over 40 million, withwomen now comprising half of those living with HIV, with youngpeople, particularly young women, having the fastest rates ofinfection, and with some 14 million children having been orphanedby AIDS. HIV prevalence has grown among those groups in societymost marginalized, such as sex workers, drug users and men havingsex with men. Coverage of interventions to educate people aboutHIV; to provide them with HIV prevention commodities, servicesand treatment; to protect them from discrimination and sexualviolence; and to empower them to participate in the response andlive successfully in a world with HIV is unacceptably low in manyplaces in the world.5

UNAIDSOHCHRSince the drafting of the <strong>Guidelines</strong>, the epidemiccontinues to confirm that the relationship between HIV andhuman rights is profound. Vulnerability to HIV infection andto its impact feeds on violations of human rights, includingdiscrimination against women and violations which create andsustain poverty. In turn, HIV begets human rights violations, such asfurther discrimination, and violence. During the decade, the role ofhuman rights in responding to the epidemic and in dealing with itseffects has become evermore clear. The international human rightssystem explicitly recognized HIV status as a prohibited ground ofdiscrimination. At the same time, the impact of HIV highlightedthe inequities and vulnerabilities leading to increased rates ofinfection among women, children, the poor and marginalizedgroups, and thereby contributed to a renewed focus on economic,social and cultural rights. In this regard, the content of the right tohealth has been increasingly defined and now explicitly includesthe availability and accessibility of HIV prevention, treatment, careand support for children and adults. Either through legislationor litigation, many countries have recognized that their peoplehave the right to HIV treatment as a part of their human rights,confirming that economic, social and cultural rights are justiciable.HIV has brought to the fore the difficult issues surrounding thehuman rights of those engaged in illegal activities; and importantlyHIV has hammered home the importance of the right toparticipation of those most affected by the epidemic - people livingwith HIV and those highly vulnerable to infection. Developmentssuch as these have strengthened the principles of the indivisibilityand universality of human rights.6

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsThe <strong>Guidelines</strong> resulted from a request made many yearsago by the Commission on Human Rights which underlined theneed and the imperative to provide guidance to States on how totake concrete steps to protect human rights in the context of HIV.As the epidemic has evolved, the lessons learned from it confirmthat the protection of human rights in the context of HIV reducessuffering, saves lives, protects the public health, and provides for aneffective response to HIV. This is the basis for the joint work ofOHCHR and UNAIDS, the tenth anniversary of which we alsomark in 2006.We urge governments, non-governmental organizations,the United Nations system, and regional bodies to benefit fromand build upon these <strong>Guidelines</strong>, and continue to find ways tooperationalise their commitment to protect human rights in theresponse to HIV.July 2006Louise ArbourUnited NationsHigh Commissionerfor Human RightsPeter PiotExecutive DirectorJoint United Nations Programmeon HIV/AIDS7

UNAIDSOHCHRGlossary of termsAIDSARVARTASOCBOHIVIGONGOPLHIVVCTacquired immunodeficiency syndromeantiretroviralantiretroviral therapyAIDS service organizationcommunity-based organizationhuman immunodeficiency virusintergovernmental organizationnon-governmental organizationpeople living with HIVvoluntary counselling and testing8

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsIntroductionThe <strong>International</strong> <strong>Guidelines</strong> on HIV/AIDS and Human Rightsarose because of various calls for their development in light ofthe need for guidance for Governments and others on how tobest promote, protect and fulfil human rights in the context ofthe HIV epidemic. During the first <strong>International</strong> Consultationon AIDS and Human Rights, organized by the United NationsCentre for Human Rights, in cooperation with the WorldHealth Organization, in Geneva, from 26 to 28 July 1989,participants discussed the possible elaboration of guidelines toassist policymakers and others in complying with internationalhuman rights standards regarding law, administrative practiceand policy. 2 Several years later, in his report to the Commissionat its fifty-first session (E/CN.4/1995/45, para.135), the UnitedNations Secretary-General stated that “the development ofsuch guidelines or principles could provide an internationalframework for discussion of human rights considerationsat the national, regional and international levels in order toarrive at a more comprehensive understanding of the complexrelationship between the public health rationale and the humanrights rationale of HIV/AIDS. In particular, Governmentscould benefit from guidelines that outline clearly how humanrights standards apply in the area of HIV/AIDS and indicateconcrete and specific measures, both in terms of legislation andpractice, that should be undertaken”.The Commission on Human Rights at its fifty-second sessionin its resolution 1996/43 of 19 April 1996 requested that theUnited Nations High Commissioner for Human Rights, inter2Report of an <strong>International</strong> Consultation on AIDS and Human Rights, Geneva, 26 to 28 July1989 (HR/PUB/90/2).9

UNAIDSOHCHRalia, continue the efforts, in cooperation with UNAIDS andnon-governmental organizations, as well as groups of peopleliving with HIV/AIDS, “towards the elaboration of guidelineson promoting and protecting respect for human rights in thecontext of HIV/AIDS.” At the same time, the Commissionrequested that the Secretary-General of the United Nationsprepare for the consideration of the Commission at its fiftythirdsession a report on the above-mentioned guidelines,including the outcome of the second expert consultationon human rights and HIV/AIDS, and on their internationaldissemination.In response to the above requests, the United Nations Centrefor Human Rights and the Joint United Nations Programmeon HIV/AIDS (UNAIDS) convened the Second <strong>International</strong>Consultation on HIV/AIDS and Human Rights in Geneva,from 23 to 25 September 1996. This Consultation broughttogether thirty-five experts in the field of HIV/AIDS andhuman rights, comprising Government officials and staff ofnational AIDS programmes, people living with HIV, humanrights activists, academics, representatives of regional andnational networks on ethics, law, human rights and HIV, andrepresentatives of United Nations bodies and agencies, nongovernmentalorganizations and AIDS service organizations(ASOs). Participants at the Consultation had before themfive background papers that had been commissioned for thepurpose of eliciting specific regional and thematic experiencesand concerns regarding HIV and human rights. Participantsdiscussed the most important human rights principles andconcerns in the context of HIV and AIDS, as well as concretemeasures that States could take to protect HIV-related humanrights. The result was the <strong>International</strong> <strong>Guidelines</strong> on HIV/AIDSand Human Rights. The full text, as adopted by the Second10

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights<strong>International</strong> Consultation, is contained in annex I to thereport of the Secretary-General to the Commission on HumanRights in document E/CN.4/1997/37. The <strong>Guidelines</strong> werepublished in 1998 by OHCHR and UNAIDS.Significant developments have taken place with regard tothe right to health and access to HIV-related prevention,treatment, care and support, including advances in theavailability of diagnostic tests and HIV-related treatments,including antiretroviral therapies. There have been increasedcommitments at the international, regional and domesticlevels towards the full realization of all human rights related toHIV, including improved access to health services for peopleliving with HIV. Key among these are: the Declaration ofCommitment on HIV/AIDS; 3 the Millennium DevelopmentGoals; 4 general comment 14 of the Committee on Economic,Social and Cultural Rights; 5 and the Commission on HumanRights resolutions on the right to the highest attainablestandard of health 6 and access to medication. 7In light of advances in HIV-related treatment and antiretroviralmedication, the current global disparity in access to treatment,as well as political and legal developments since the elaborationof the <strong>Guidelines</strong> in 1996, the High Commissioner for HumanRights and the Executive Director of UNAIDS decided toconvene a Third <strong>International</strong> Consultation on HIV/AIDSand Human Rights on 25-26 July 2002 in Geneva in order to3Declaration of Commitment on HIV/AIDS (‘Global Crisis—Global Action’), GeneralAssembly resolution S-26/2 of 27 June 2001.4United Nations Millennium Declaration, General Assembly resolution 55/2 of 8 September2000.5General comment 14 on the right to the highest attainable standard of health, adopted on11 May 2000 (E/C.12/2000/4).6Commission on Human Rights resolution 2002/31 of 22 April 2002.7Commission on Human Rights resolutions 2002/33 and 2002/32 of 22 April 2002.11

UNAIDSOHCHRupdate Guideline 6. This document consolidates the original<strong>Guidelines</strong> with revised Guideline 6, together with its relatedcommentary and recommendations for implementation.Since their original publication in 1998 and that of revisedGuideline 6 in 2002, the <strong>International</strong> <strong>Guidelines</strong> on HIV/AIDSand Human Rights have provided important guidance toGovernments, international organizations, non-governmentalorganizations and civil society groups on the developmentand implementation of effective national strategies forcombating HIV and AIDS. The Commission on HumanRights has asked States to take all necessary steps to ensurethe respect, protection and fulfilment of HIV-related humanrights as contained in the <strong>Guidelines</strong>, and has urged States toensure that their laws, policies and practices comply with the<strong>Guidelines</strong>. 8 The Secretary-General has submitted reports tothe Commission on steps taken by Governments and UnitedNations organs, programmes and specialized agencies topromote and implement the <strong>Guidelines</strong>. 9Global resolve to halt and reverse the epidemic continues tostrengthen. In the 2005 World Summit Outcome, 10 worldleaders committed to a massive scaling-up of HIV prevention,treatment and care with the aim of coming as close as possibleto the goal of universal access to treatment by 2010 for allwho need it. The political declaration of the 2006 High LevelMeeting on AIDS affirmed and expanded these commitments.8Commission on Human Rights resolutions 1997/33, 1999/49, 2001/51, 2003/47, 2005/84.9E/CN.4/1999/76, E/CN.4/2001/80, E/CN.4/2003/81, E/CN.4/2005/79.10General Assembly resolution 60/1 of 16 September 2005.12

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsBackground and summary of the <strong>Guidelines</strong>1. This document consolidates the <strong>Guidelines</strong> adopted at theSecond <strong>International</strong> Consultation on HIV/AIDS and HumanRights, held in Geneva from 23 to 25 September 1996, andrevised Guideline 6 on access to prevention, treatment, care andsupport adopted at the Third <strong>International</strong> Consultation onHIV/AIDS and Human Rights held in Geneva from 25 to 26July 2002. The purpose of these <strong>Guidelines</strong> is to assist States increating a positive, rights-based response to HIV that is effectivein reducing the transmission and impact of HIV and AIDS andis consistent with human rights and fundamental freedoms.2. The elaboration of such guidelines was first considered bythe 1989 <strong>International</strong> Consultation on AIDS and HumanRights, organized jointly by the then United Nations Centrefor Human Rights and the World Health Organization. 11 TheUnited Nations Commission on Human Rights and its Sub-Commission on Prevention of Discrimination and Protectionof Minorities repeatedly reiterated the need for guidelines. 12Increasingly, the international community recognized the needfor elaborating further how existing human rights principlesapply in the context of HIV and for providing examples ofconcrete activities to be undertaken by States to protect humanrights and public health in the context of HIV.3. The purpose of these <strong>Guidelines</strong> is to assist States in translatinginternational human rights norms into practical observancein the context of HIV. To this end, the <strong>Guidelines</strong> consist11Report of an <strong>International</strong> Consultation on AIDS and Human Rights, Geneva, 26 to 28 July1989 (HR/PUB/90/2).12For reports and resolutions on HIV/AIDS and human rights of the United NationsCommission on Human Rights and its Sub-Commission on Prevention of Discriminationand Protection of Minorities, see footnotes 62-63.13

UNAIDSOHCHRof three parts: first, <strong>Guidelines</strong> for State action comprisingaction-oriented measures to be employed by Governmentsin the areas of law, administrative policy and practice thatwill protect human rights and achieve HIV-related publichealth goals; second, recommendations for dissemination andimplementation of the <strong>Guidelines</strong>; and third, internationalhuman rights obligations and HIV, which describes the humanrights principles underlying a positive response to HIV.4. The <strong>Guidelines</strong> recognize that States bring to the HIVepidemic different economic, social and cultural values,traditions and practices – a diversity which should be celebratedas a rich resource for an effective response to HIV and AIDS.In order to benefit from this diversity, a process of participatoryconsultation and cooperation was undertaken in the draftingof the <strong>Guidelines</strong>, so that the <strong>Guidelines</strong> reflect the experienceof people affected by the epidemic, address relevant needs andincorporate regional perspectives. Furthermore, the <strong>Guidelines</strong>reaffirm that diverse responses can and should be designedwithin the context of universal human rights standards.5. It is intended that the principal users of the <strong>Guidelines</strong> willbe States, in the persons of legislators and Governmentpolicymakers, including officials involved in national AIDSprogrammes and relevant departments and ministries, suchas health, foreign affairs, justice, interior, employment,welfare and education. Other users who will benefit fromthe <strong>Guidelines</strong> include intergovernmental organizations(IGOs), non-governmental organizations (NGOs), networksof persons living with HIV (PLHIV), community-basedorganizations (CBOs), networks on ethics, law, human rightsand HIV and AIDS service organizations (ASOs).14

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsThe broadest possible audience of users of the <strong>Guidelines</strong> willmaximize their impact and make their content a reality.6. The <strong>Guidelines</strong> address many difficult and complex issues,some of which may or may not be relevant to the situation ina particular country. For these reasons, it is essential that the<strong>Guidelines</strong> be taken by critical actors at the national and communitylevel and considered in a process of dialogue involvinga broad spectrum of those most directly affected by the issuesaddressed in the <strong>Guidelines</strong>. Such a consultative process willenable Governments and communities to consider how the<strong>Guidelines</strong> are specifically relevant in their country, assess priorityissues presented by the <strong>Guidelines</strong> and devise effective waysto implement the <strong>Guidelines</strong> in their respective contexts.7. In implementing the <strong>Guidelines</strong>, it should be borne in mindthat achieving international cooperation in solving problemsof an economic, social, cultural or humanitarian character andpromoting and encouraging respect for human rights and forfundamental freedoms for all, is one of the principal objectivesof the United Nations. In this sense, international cooperation,including financial and technical support, is a duty of States inthe context of the HIV epidemic and industrialized countriesare encouraged to act in a spirit of solidarity in assistingdeveloping countries to meet the challenges of implementingthe <strong>Guidelines</strong>.8. HIV continues to spread throughout the world at an alarmingrate. The widespread abuse of human rights and fundamentalfreedoms associated with HIV has emerged in all parts of theworld in the wake of the epidemic. In response to this situationthe experts at the Second <strong>International</strong> Consultation on HIV/AIDS and Human Rights concluded the following:15

UNAIDSOHCHR(a) The protection of human rights is essential to safeguardhuman dignity in the context of HIV and to ensure aneffective, rights-based response to HIV and AIDS. Aneffective response requires the implementation of all humanrights, civil and political, economic, social and cultural, andfundamental freedoms of all people, in accordance withexisting international human rights standards;(b) Public health interests do not conflict with human rights.On the contrary, it has been recognized that when humanrights are protected, fewer people become infected andthose living with HIV and their families can better copewith HIV and AIDS;(c) A rights-based, effective response to the HIV epidemicinvolves establishing appropriate governmental institutionalresponsibilities, implementing law reform and supportservices and promoting a supportive environment forgroups vulnerable to HIV and for those living with HIV;(d) In the context of HIV, international human rights normsand pragmatic public health goals require States to considermeasures that may be considered controversial, particularlyregarding the status of women and children, sex workers,injecting drug users and men having sex with men. It is,however, the responsibility of all States to identify how theycan best meet their human rights obligations and protectpublic health within their specific political, cultural andreligious contexts;(e) Although States have primary responsibility forimplementing strategies that protect human rights andpublic health, United Nations bodies, agencies and16

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsprogrammes, regional intergovernmental bodies and nongovernmentalorganizations, including networks of peopleliving with HIV, play critical roles in this regard.9. There are many steps that States can take to protect HIV-relatedhuman rights and to achieve public health goals. The 12<strong>Guidelines</strong> elaborated by the Consultations for States to implementan effective, rights-based response are summarized below.GUIDELINE 1: States should establish an effective national frameworkfor their response to HIV which ensures a coordinated, participatory,transparent and accountable approach, integrating HIV policy andprogramme responsibilities across all branches of government.GUIDELINE 2: States should ensure, through political and financialsupport, that community consultation occurs in all phases of HIV policydesign, programme implementation and evaluation and that communityorganizations are enabled to carry out their activities, including in thefield of ethics, law and human rights, effectively.GUIDELINE 3: States should review and reform public health lawsto ensure that they adequately address public health issues raised byHIV, that their provisions applicable to casually transmitted diseases arenot inappropriately applied to HIV and that they are consistent withinternational human rights obligations.GUIDELINE 4: States should review and reform criminal laws andcorrectional systems to ensure that they are consistent with internationalhuman rights obligations and are not misused in the context of HIV ortargeted against vulnerable groups.GUIDELINE 5: States should enact or strengthen anti-discriminationand other protective laws that protect vulnerable groups, people living17

UNAIDSOHCHRwith HIV and people with disabilities from discrimination in boththe public and private sectors, ensure privacy and confidentiality andethics in research involving human subjects, emphasize education andconciliation, and provide for speedy and effective administrative andcivil remedies.GUIDELINE 6 (as revised in 2002): States should enactlegislation to provide for the regulation of HIV-related goods, servicesand information, so as to ensure widespread availability of qualityprevention measures and services, adequate HIV prevention and careinformation, and safe and effective medication at an affordable price.States should also take measures necessary to ensure for all persons,on a sustained and equal basis, the availability and accessibility ofquality goods, services and information for HIV prevention, treatment,care and support, including antiretroviral and other safe and effectivemedicines, diagnostics and related technologies for preventive, curativeand palliative care of HIV and related opportunistic infections andconditions.States should take such measures at both the domestic andinternational levels, with particular attention to vulnerable individualsand populations.GUIDELINE 7: States should implement and support legal supportservices that will educate people affected by HIV about their rights,provide free legal services to enforce those rights, develop expertise onHIV-related legal issues and utilize means of protection in addition tothe courts, such as offices of ministries of justice, ombudspersons, healthcomplaint units and human rights commissions.18

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsGUIDELINE 8: States, in collaboration with and through thecommunity, should promote a supportive and enabling environmentfor women, children and other vulnerable groups by addressingunderlying prejudices and inequalities through community dialogue,specially designed social and health services and support to communitygroups.GUIDELINE 9: States should promote the wide and ongoingdistribution of creative education, training and media programmesexplicitly designed to change attitudes of discrimination andstigmatization associated with HIV to understanding and acceptance.GUIDELINE 10: States should ensure that Government andthe private sector develop codes of conduct regarding HIV issuesthat translate human rights principles into codes of professionalresponsibility and practice, with accompanying mechanisms toimplement and enforce these codes.GUIDELINE 11: States should ensure monitoring and enforcementmechanisms to guarantee the protection of HIV-related humanrights, including those of people living with HIV, their families andcommunities.GUIDELINE 12: States should cooperate through all relevantprogrammes and agencies of the United Nations system, includingUNAIDS, to share knowledge and experience concerning HIVrelatedhuman rights issues and should ensure effective mechanisms toprotect human rights in the context of HIV at international level.19

UNAIDSOHCHRI. <strong>Guidelines</strong> for State action10. Recommended <strong>Guidelines</strong> for implementation by States inorder to promote and protect human rights in the contextof HIV are set out below. These <strong>Guidelines</strong> are firmlyanchored within a framework of existing international humanrights norms and are based on many years of experience inidentifying those strategies that have proven successful inaddressing HIV and AIDS. The normative principles togetherwith practical strategies provide the evidence and ideas forStates to reorient and redesign their policies and programmesto ensure respect for HIV-related rights and to be mosteffective in addressing the epidemic. States should provideadequate political leadership and financial resources to enableimplementation of these strategies.11. The <strong>Guidelines</strong> focus on activities by States in view of theirobligations under international and regional human rightsinstruments. This is not to deny, however, the responsibilitiesof other key actors, such as the private sector, includingprofessional groups such as health-care workers, the media, andreligious communities. These groups also have responsibilitiesnot to engage in discrimination and to implement protectiveand ethical policies and practices.20

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsA. Institutional responsibilities and processesGUIDELINE 1: NATIONAL FRAMEWORK12. States should establish an effective national frameworkfor their response to HIV which ensures acoordinated, participatory, transparent and accountableapproach, integrating HIV policy andprogramme responsibilities, across all branches ofgovernment.13. Depending upon existing institutions, the level of theepidemic and institutional cultures, as well as the need to avoidoverlapping of responsibilities, the following responses shouldbe considered:(a) Formation of an interministerial committee to ensureintegrated development and high-level coordination ofindividual ministerial national action plans and to monitorand implement the additional HIV strategies, as set outbelow. In federal systems, an intergovernmental committeeshould also be established with provincial/state, as well asnational representation. Each ministry should ensure thatHIV and human rights are integrated into all its relevantplans and activities, including:(i) Education;(ii) Law and justice, including police and correctiveservices;(iii) Science and research;(iv) Employment and public service;(v) Welfare, social security and housing;(vi) Immigration, indigenous populations, foreign affairsand development cooperation;21

UNAIDSOHCHR(vii) Health;(viii)Treasury and finance;(ix) Defence, including armed services.(b) Ensuring that an informed and ongoing forum existsfor briefing, policy discussion and law reform to deepenthe level of understanding of the epidemic, in whichall political viewpoints can participate at national andsubnational levels, e.g. by establishing parliamentary orlegislative committees with representation from major andminor political parties.(c) Formation or strengthening of advisory bodies toGovernments on legal and ethical issues, such as alegal and ethical subcommittee of the interministerialcommittee. Representation should consist of professional(public, law and education, science, bio-medical andsocial), religious and community groups, employers’ andworkers’ organizations, NGOs and ASOs, nominees/experts and people living with HIV.(d) Sensitization of the judicial branch of government, in waysconsistent with judicial independence, on the legal, ethicaland human rights issues relative to HIV, including throughjudicial education and the development of judicial materials.(e) Ongoing interaction of government branches withUnited Nations Theme Groups on HIV/AIDS and otherconcerned international and bilateral actors to ensurethat governmental responses to the HIV epidemic willcontinue to make the best use of assistance available fromthe international community. Such interaction should, interalia, reinforce cooperation and assistance to areas related toHIV and human rights.22

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsCommentary on Guideline 114. To be effective, the response to HIV must mobilize keyactors throughout all branches of government and includeall policy areas, since only a combination of well-integratedand coordinated approaches can address the complexities ofthe epidemic. In all sectors, leadership must be developed andmust demonstrate a dedication to HIV-related human rights.Governments should avoid unnecessary politicization of HIVwhich diverts Government energy and divides the communityrather than engendering a sense of solidarity and consensus indealing with the epidemic. Political commitment to dedicateadequate resources to respond to the epidemic within Statesis essential. It is equally important that these resources bechannelled into productive and coordinated strategies. Rolesand lines of responsibility within Government, includinghuman rights issues, should be clarified.15. Most countries already have national AIDS committees.In some countries, there are also subnational committees.However, the persistent lack of coordination in Governmentpolicy and the lack of specific attention to human rightsissues relating to the HIV epidemic suggest a need to considerpossible additional structures or to strengthen and reorientthose that exist to include legal and ethical issues. Severalmodels of coordinating committees and multidisciplinaryadvisory groups exist. 13 Similar coordination is essential withinand between lower levels of government. It is necessary to13A successful example of an interministerial coordinating committee is the National AIDSPrevention and Control Committee chaired by the Prime Minister of Thailand since 1991.Other models are the Federal Parliamentary Liaison Group in Australia, the National AIDSCoordinating Council in Western Samoa, the Philippine National AIDS Council and theNational Commission on AIDS in the United States. Another noteworthy example is theNational Anti-AIDS Committee established by the President of Ukraine as a special Stateauthority.23

UNAIDSOHCHRfocus such coordination not only in creating specialized HIVbodies, but also in securing a place for HIV human rightsissues in existing mainstream forums, such as regular gatheringsof Ministers of, e.g. Health, Justice and Social Welfare. Amultidisciplinary body with professional and communityrepresentation should exist to advise Governments on legaland ethical issues. These bodies at the national level should alsoensure coordination with UNAIDS, its cosponsors and otherinternational agencies (donors, bilateral donors and others) toreinforce cooperation and assistance to areas relating to HIVand human rights.GUIDELINE 2: SUPPORTING COMMUNITYPARTNERSHIP16. States should ensure, through political and financialsupport, that community consultation occurs in allphases of HIV policy design, programme implementationand evaluation and that communityorganizations are enabled to carry out their activities,including in the fields of ethics, law and humanrights, effectively.(a) Community representation should comprise peopleliving with HIV, CBOs, ASOs, human rights NGOsand representatives of vulnerable groups. 14 Formal andregular mechanisms should be established to facilitateongoing dialogue with and input from such communityrepresentatives into HIV-related Government policiesand programmes. This could be established through14See section III, Introduction, for a listing of vulnerable groups.24

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsregular reporting by community representatives to thevarious government, parliamentary and judicial branchesdescribed in Guideline 1, joint workshops with communityrepresentatives on policy, planning and evaluation of Stateresponses and through mechanisms for receiving writtensubmissions from the community.(b) Sufficient Government funding should be allocated in orderto support, sustain and enhance community organizations inareas of core support, capacity-building and implementationof activities, in such areas as HIV-related ethics, humanrights and law. Such activities might involve trainingseminars, workshops, networking, developing promotionaland educational materials, advising clients of their humanand legal rights, referring clients to relevant grievancebodies, collecting data on human rights issues and humanrights advocacy.Commentary on Guideline 217. Community partners have knowledge and experience thatStates need in order to fashion effective State responses. Thisis the case particularly with regard to human rights issues,as community representatives are either directly affected byhuman rights problems or work directly with those who areaffected. States should, therefore, ensure that this knowledgeand experience are included in the development of HIV policy,programmes and evaluation by recognizing the importance ofsuch contributions and creating structural means by which toobtain them.18. The contribution of CBOs, NGOs, ASOs and people livingwith HIV is an essential part of the overall national response tothe epidemic, in such areas as ethics, law and human rights. As25

UNAIDSOHCHRcommunity representatives do not necessarily possess organizationalability or skills for advocacy, lobbying and human rightswork, this contribution should be enhanced by State fundingfor administrative support, capacity-building, human resourcedevelopment and implementation of activities. Collectionof complaints data by CBOs and NGOs is vital to informGovernments and the international community where the mostserious HIV-related human rights problems are occurring andwhat effective action should be implemented in response. 15B. Law review, reform and support servicesGUIDELINE 3: PUBLIC HEALTH LEGISLATION19. States should review and reform public healthlaws to ensure that they adequately address publichealth issues raised by HIV, that their provisionsapplicable to casually transmitted diseases arenot inappropriately applied to HIV and that theyare consistent with international human rightsobligations.20. Public health legislation should include the followingcomponents:(a) Public health law should fund and empower public healthauthorities to provide a comprehensive range of services forthe prevention and treatment of HIV and AIDS, includingrelevant information and education, access to voluntary testingand counselling, STD and sexual and reproductive healthservices for men and women, condoms and drug treatment,15See Guideline 11, paragraph 66.26

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsservices and clean injection materials, as well as adequatetreatment for HIV and AIDS-related illnesses, including painprophylaxis.(b) Apart from surveillance testing and other unlinked testingdone for epidemiological purposes, public health legislationshould ensure that HIV testing of individuals should onlybe performed with the specific informed consent of thatindividual. Exceptions to voluntary testing would needspecific judicial authorization, granted only after dueevaluation of the important considerations involved interms of privacy and liberty.(c) In view of the serious nature of HIV testing and in orderto maximize prevention and care, public health legislationshould ensure, whenever possible, that pre-and post-testcounselling be provided in all cases. With the introductionof home-testing, States should ensure quality control,maximize counselling and referral services for those whouse such tests and establish legal and support services forthose who are the victims of misuse of such tests by others.(d) Public health legislation should ensure that people not besubjected to coercive measures such as isolation, detention orquarantine on the basis of their HIV status. Where the libertyof persons living with HIV is restricted, due process protection(e.g. notice, rights of review/appeal, fixed rather thanindeterminate periods of orders and rights of representation)should be guaranteed.(e) Public health legislation should ensure that HIV andAIDS cases reported to public health authorities forepidemiological purposes are subject to strict rules of dataprotection and confidentiality.27

UNAIDSOHCHR(f) Public health legislation should ensure that informationrelative to the HIV status of an individual be protected fromunauthorized collection, use or disclosure in the healthcareand other settings and that the use of HIV-relatedinformation requires informed consent.(g) Public health legislation should authorize, but not require,that health-care professionals decide, on the basis of eachindividual case and ethical considerations, whether toinform their patients’ sexual partners of the HIV statusof their patient. Such a decision should only be made inaccordance with the following criteria:(i) The HIV-positive person in question has beenthoroughly counselled;(ii) Counselling of the HIV-positive person has failed toachieve appropriate behavioural changes;(iii) The HIV-positive person has refused to notify, orconsent to the notification of his/her partner(s);(iv) A real risk of HIV transmission to the partner(s) exists;(v) The HIV-positive person is given reasonable advancenotice;(vi) The identity of the HIV-positive person is concealedfrom the partner(s), if this is possible in practice; and(vii) Follow-up is provided to ensure support to thoseinvolved, as necessary.(h) Public health legislation should ensure that the blood/tissue/organ supply is free of HIV and other blood-bornediseases.(i) Public health law should require the implementation ofuniversal infection control precautions in health-care andother settings involving exposure to blood and other bodily28

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsfluids. Persons working in these settings must be providedwith the appropriate equipment and training to implementsuch precautions.(j) Public health legislation should require that health-careworkers undergo a minimum of ethics and/or humanrights training in order to be licensed to practise and shouldencourage professional societies of health-care workers todevelop and enforce codes of conduct based on humanrights and ethics, including HIV-related issues such asconfidentiality and the duty to provide treatment.GUIDELINE 4: CRIMINAL LAWS ANDCORRECTIONAL SYSTEMS21. States should review and reform criminal laws andcorrectional systems to ensure that they are consistentwith international human rights obligationsand are not misused in the context of HIV or targetedat vulnerable groups.(a) Criminal and/or public health legislation should notinclude specific offences against the deliberate andintentional transmission of HIV but rather should applygeneral criminal offences to these exceptional cases.Such application should ensure that the elements offoreseeability, intent, causality and consent are clearly andlegally established to support a guilty verdict and/or harsherpenalties.(b) Criminal law prohibiting sexual acts (including adultery,sodomy, fornication and commercial sexual encounters)between consenting adults in private should be reviewed,29

UNAIDSOHCHRwith the aim of repeal. In any event, they should not beallowed to impede provision of HIV prevention and careservices.(c) With regard to adult sex work that involves no victimization,criminal law should be reviewed with the aim of decriminalizing,then legally regulating occupational healthand safety conditions to protect sex workers and theirclients, including support for safe sex during sex work.Criminal law should not impede provision of HIV preventionand care services to sex workers and their clients.Criminal law should ensure that children and adult sexworkers who have been trafficked or otherwise coercedinto sex work are protected from participation in the sexindustry and are not prosecuted for such participation butrather are removed from sex work and provided with medicaland psycho-social support services, including those relatedto HIV.(d) Criminal law should not be an impediment to measurestaken by States to reduce the risk of HIV transmissionamong injecting drug users and to provide HIV-related careand treatment for injecting drug users. Criminal law shouldbe reviewed to consider:the authorization or legalization and promotion ofneedle and syringe exchange programmes;the repeal of laws criminalizing the possession,distribution and dispensing of needles and syringes.(e) Prison authorities should take all necessary measures,including adequate staffing, effective surveillance andappropriate disciplinary measures, to protect prisoners fromrape, sexual violence and coercion. Prison authorities should30

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsalso provide prisoners (and prison staff, as appropriate), withaccess to HIV-related prevention information, education,voluntary testing and counselling, means of prevention(condoms, bleach and clean injection equipment), treatmentand care and voluntary participation in HIV-related clinicaltrials, as well as ensure confidentiality, and should prohibitmandatory testing, segregation and denial of access to prisonfacilities, privileges and release programmes for HIV-positiveprisoners. Compassionate early release of prisoners livingwith AIDS should be considered.GUIDELINE 5: ANTI-DISCRIMINATION ANDPROTECTIVE LAWS22. States should enact or strengthen anti-discriminationand other protective laws that protect vulnerablegroups, people living with HIV and peoplewith disabilities from discrimination in both thepublic and private sectors, that will ensure privacyand confidentiality and ethics in research involvinghuman subjects, emphasize education and conciliationand provide for speedy and effective administrativeand civil remedies.(a) General anti-discrimination laws should be enacted or revisedto cover people living with asymptomatic HIV infection,people living with AIDS and those merely suspectedof HIV or AIDS. Such laws should also protect groups mademore vulnerable to HIV/AIDS due to the discriminationthey face. Disability laws should also be enacted or revisedto include HIV and AIDS in their definition of disability.Such legislation should include the following:31

UNAIDSOHCHR(i) The areas covered should be as broad as possible, includinghealth care, social security, welfare benefits,employment, education, sport, accommodation, clubs,trades unions, qualifying bodies, access to transport andother services;(ii) Direct and indirect discrimination should be covered,as should cases where HIV is only one of several reasonsfor a discriminatory act, and prohibiting HIV vilificationshould also be considered;(iii) Independent, speedy and effective legal and/oradministrative procedures for seeking redress, includingsuch features as fast-tracking for cases where thecomplainant is terminally ill, investigatory powers toaddress systemic cases of discrimination in policies andprocedures, ability to bring cases under pseudonym andrepresentative complaints, including the possibility ofpublic interest organizations bringing cases on behalf ofpeople living with HIV;(iv) Exemptions for superannuation and life insuranceshould only relate to reasonable actuarial data, so thatHIV is not treated differently from analogous medicalconditions.(b) Traditional and customary laws which affect the status andtreatment of various groups of society should be reviewedin the light of anti-discrimination laws. If necessary, legalremedies should be made available, if such laws are misusedand information, education and community mobilizationcampaigns should be conducted to change these laws andattitudes associated with them.(c) General confidentiality and privacy laws should be enacted.HIV-related information on individuals should be includedwithin definitions of personal/medical data subject to32

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsprotection and should prohibit the unauthorized use and/or publication of HIV-related information on individuals.Privacy legislation should enable an individual to see hisor her own records and to request amendments to ensurethat such information is accurate, relevant, complete andup to date. An independent agency should be establishedto redress breaches of confidentiality. Provision should bemade for professional bodies to discipline cases of breachesof confidentiality as professional misconduct under codes ofconduct discussed below. 16 Unreasonable invasion of privacyby the media could also be included as a component ofprofessional codes governing journalists. People living withHIV should be authorized to demand that their identityand privacy be protected in legal proceedings in whichinformation on these matters will be raised.(d) Laws, regulations and collective agreements should beenacted or reached so as to guarantee the followingworkplace rights:(i) A national policy on HIV and the workplace agreedupon in a tripartite body;(ii) Freedom from HIV screening for employment,promotion, training or benefits;(iii) Confidentiality regarding all medical information,including HIV status;(iv) Employment security for workers living with HIVuntil they are no longer able to work, includingreasonable alternative working arrangements;(v) Defined safe practices for first aid and adequatelyequipped first-aid kits;16See Guideline 10, paragraphs 64-65.33

UNAIDSOHCHR(vi) Protection for social security and other benefits forworkers living with HIV, including life insurance,pension, health insurance, termination and deathbenefits;(vii) Adequate health care accessible in or near theworkplace;(viii) Adequate supplies of condoms available free toworkers at the workplace;(ix) Workers’ participation in decision-making onworkplace issues related to HIV and AIDS;(x) Access to information and education programmes onHIV, as well as to relevant counselling and appropriatereferral;(xi) Protection from stigmatization and discrimination bycolleagues, unions, employers and clients;(xii) Appropriate inclusion in workers’ compensation legislationof the occupational transmission of HIV (e.g.needle stick injuries), addressing such matters as thelong latency period of infection, testing, counsellingand confidentiality.(e) Protective laws governing the legal and ethical protectionof human participation in research, including HIV-relatedresearch, should be enacted or strengthened in relation to:(i) Non-discriminatory selection of participants, e.g.women, children, minorities;(ii) Informed consent;(iii) Confidentiality of personal information;(iv) Equitable access to information and benefits emanatingfrom research;(v) Counselling, protection from discrimination, health andsupport services provided during and after participation;34

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights(vi) The establishment of local and/or national ethical reviewcommittees to ensure independent and ongoingethical review, with participation by members of thecommunity affected, of the research project;(vii) Approval for use of safe and efficacious pharmaceuticals,vaccines and medical devices.(f) Anti-discrimination and protective laws should be enactedto reduce human rights violations against women in thecontext of HIV, so as to reduce vulnerability of women toinfection by HIV and to the impact of HIV and AIDS. Moreparticularly, laws should be reviewed and reformed to ensureequality of women regarding property and marital relationsand access to employment and economic opportunity,so that discriminatory limitations are removed on rights toown and inherit property, enter into contracts and marriage,obtain credit and finance, initiate separation or divorce, equitablyshare assets upon divorce or separation, and retaincustody of children. Laws should also be enacted to ensurewomen’s reproductive and sexual rights, including the rightof independent access to reproductive and STD health informationand services and means of contraception, includingsafe and legal abortion and the freedom to choose amongthese, the right to determine number and spacing of children,the right to demand safer sex practices and the rightto legal protection from sexual violence, outside and insidemarriage, including legal provisions for marital rape. Theage of consent to sex and marriage should be consistent formales and females and the right of women and girls to refusemarriage and sexual relations should be protected by law.The HIV status of a parent or child should not be treatedany differently from any other analogous medical conditionin making decisions regarding custody, fostering or adoption.35

UNAIDSOHCHR(g) Anti-discrimination and protective laws should be enactedto reduce human rights violations against children inthe context of HIV, so as to reduce the vulnerability ofchildren to infection by HIV and to the impact of HIVand AIDS. Such laws should provide for children’s accessto HIV-related information, education and means ofprevention inside and outside school, govern children’saccess to voluntary testing with consent by the child,in line with the evolving capacities of the child, or bythe parent or appointed guardian, as appropriate, shouldprotect children against mandatory testing, particularlyif orphaned by AIDS, and provide for other formsof protection in the context of orphans, includinginheritance and/or support. Such legislation should alsoprotect children against sexual abuse, provide for theirrehabilitation if abused and ensure that they are consideredvictims of wrongful behaviour, not subject to penaltiesthemselves. Protection in the context of disability lawsshould also be ensured for children.(h) Anti-discrimination and protective laws should beenacted to reduce human rights violations against menhaving sex with men, including in the context of HIV,in order, inter alia, to reduce the vulnerability of menwho have sex with men to infection by HIV and to theimpact of HIV and AIDS. These measures should includeproviding penalties for vilification of people who engagein same-sex relationships, giving legal recognition tosame-sex marriages and/or relationships and governingsuch relationships with consistent property, divorce andinheritance provisions. The age of consent to sex andmarriage should be consistent for heterosexual andhomosexual relationships. Laws and police practices36

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsrelating to assaults against men who have sex withmen should be reviewed to ensure that adequate legalprotection is given in these situations.(i) Laws and regulations that provide for restrictions onthe movement or association of members of vulnerablegroups 17 in the context of HIV should be removed in bothlaw (decriminalized) and law enforcement.(j) Public health, criminal and anti-discrimination legislationshould prohibit mandatory HIV-testing of targeted groups,including vulnerable groups. 18GUIDELINE 6: ACCESS TO PREVENTION,TREATMENT, CARE AND SUPPORT (revised)23. States should enact legislation to provide for theregulation of HIV-related goods, services andinformation, so as to ensure widespread availabilityof quality prevention measures and services,adequate HIV prevention and care information, andsafe and effective medication at an affordable price.24. States should also take measures necessary to ensurefor all persons, on a sustained and equal basis,the availability and accessibility of quality goods,services and information for HIV/AIDS prevention,treatment, care and support, including antiretroviraland other safe and effective medicines, diagnostics17See section III, Introduction, for a listing of vulnerable groups.18In addition to vulnerable groups, specific employment groups should also be protectedfrom such targeted testing, e.g. truck drivers, sailors, hospitality/tourist industry workersand the military.37

UNAIDSOHCHRand related technologies for preventive, curativeand palliative care of HIV and related opportunisticinfections and conditions.25. States should take such measures at both thedomestic and international levels, with particularattention to vulnerable individuals and populations.Commentary on Guideline 626. Prevention, treatment, care and support are mutually reinforcingelements and a continuum of an effective response to HIV.They must be integrated into a comprehensive approach, anda multifaceted response is needed. Comprehensive treatment,care and support include antiretroviral and other medicines,diagnostics and related technologies for the care of HIV andAIDS, related opportunistic infections and other conditions,good nutrition, and social, spiritual and psychological support,as well as family, community and home-based care. HIVpreventiontechnologies include condoms, lubricants, sterileinjection equipment, antiretroviral medicines (e.g. to preventmother-to-child transmission or as post-exposure prophylaxis)and, once developed, safe and effective microbicides andvaccines. Based on human rights principles, universal accessrequires that these goods, services and information not onlybe available, acceptable and of good quality, but also withinphysical reach and affordable for all.Recommendations for implementation of Guideline 627. States should develop and implement national plans toprogressively realize universal access to comprehensive38

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightstreatment, care and support for all persons living with HIV,as well as universal access to a full range of goods, servicesand information for HIV prevention. National plans shouldbe developed in consultation with non-governmentalorganizations to ensure the active participation of people livingwith HIV and vulnerable groups.28. Universal access to HIV prevention, treatment, care andsupport is necessary to respect, protect and fulfil human rightsrelated to health, including the right to enjoy the highestattainable standard of health. Universal access will be achievedprogressively over time. However, States have an immediateobligation to take steps, and to move as quickly and effectivelyas possible, towards realizing access for all to HIV prevention,treatment, care and support at both the domestic and globallevels. This requires, among other things, setting benchmarksand targets for measuring progress. 1929. Access to HIV-related information, goods and services isaffected by a range of social, economic, cultural, politicaland legal factors. States should review and, where necessary,amend or adopt laws, policies, programmes and plans to realizeuniversal and equal access to medicines, diagnostics and relatedtechnologies, taking these factors into account. As one example,duties, customs laws and value-added taxes may hinder accessto medicines, diagnostics and related technologies at affordableprices. Such laws should be revised so as to maximize access.States should ensure that national laws, policies, programmes19For example, States could make use of the indicators developed by UNAIDS for measuringfollow-up on the United Nations General Assembly’s 2001 Declaration of Commitment onHIV/AIDS, in particular the National Composite Policy Index, which assesses a country’sprogress in developing laws, policies and strategies to address HIV and AIDS at thenational level in relation to prevention, treatment, care and support, as well as specifichuman rights issues.39

UNAIDSOHCHRand plans affecting access to HIV-related goods, services orinformation are consistent with international human rightsnorms, principles and standards. States should consider theexperience and expertise of other States, and consult withpeople living with HIV, non-governmental organizations, anddomestic and international health organizations with relevantexpertise.30. States should also ensure that their laws, policies, programmesand practices do not exclude, stigmatize or discriminate againstpeople living with HIV or their families, either on the basis oftheir HIV status or on other grounds contrary to internationalor domestic human rights norms, with respect to their entitlementor access to health-care goods, services and information. 2031. States’ legislation, policies, programmes, plans and practicesshould include positive measures to address factors that hinderthe equal access of vulnerable individuals and populations toprevention, treatment, care and support, such as poverty, migration,rural location or discrimination of various kinds. 21 Thesefactors may have a cumulative effect. For example, children(particularly girls) and women may be the last to receive accesseven if treatment is otherwise available in their communities.20See also Guideline 5, above, regarding protections against discrimination, including inareas such as health care, social security, welfare benefits and other services.21Depending on legal, social and economic conditions, which may vary widely within countriesand across regions, individuals and groups that may be vulnerable to discrimination andmarginalization include women, children, those living in poverty, indigenous people(s), gaymen and other men who have sex with men, migrants, refugees and internally displacedpersons, people with disabilities, prisoners and other detained persons, sex workers, transgenderpeople, people who use illegal drugs, and racial, religious, ethnic, linguistic or otherminorities. See also: Guideline 3, paragraph 20 (j), and Guideline 10, paragraph 64 (a), onmeasures to address discrimination in the provision of health care; Guideline 4, paragraph21 (e), on the specific issue of access to HIV-related prevention, treatment and care for prisoners;and Guideline 8, paragraphs 60 (b) and 60 (j), regarding specific attention to theneeds of vulnerable groups.40

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights32. States should recognize, affirm and strengthen the involvementof communities as part of comprehensive HIV prevention,treatment, care and support, while also complying with theirown obligations to take steps in the public sector to respect,protect and fulfil human rights related to health. Mechanismsshould be developed to enable affected communities to accessresources to assist families who have lost income earners toAIDS. Particular attention must be paid to gender inequalities,with respect to access to care in the community for womenand girls, as well as the burdens that delivering care at thecommunity level may impose on them.33. To assist caregivers and, where relevant, employers and insurers,States should ensure the availability, use and implementation ofsound, scientifically up-to-date guidelines for prevention, treatment,care and support to people living with HIV in respectof available health-care goods, services and information. Statesshould develop mechanisms to monitor and improve, as necessary,the availability, use and implementation of these guidelines.34. Legislation, policies and programmes should take into accountthe fact that persons living with HIV may recurrently and progressivelyexperience ill-health and greater health-care needs,which should be accommodated accordingly within benefitschemes in both the public and private sectors. States shouldwork with employers, and employers’ and workers’ organizations,to adopt or adapt benefit schemes, where necessary, toensure universal and equal access to benefits for workers livingwith HIV. Particular attention must also be paid to ensuringaccess to health care for individuals outside the formal employmentsector, who lack work-related health-care benefits. 2222See also Guideline 5, paragraph 22 (d), and the Code of practice on HIV/AIDS and theworld of work, adopted in 2001 by the <strong>International</strong> Labour Organization.41

UNAIDSOHCHR35. States should ensure that domestic legislation provides forprompt and effective remedies in cases in which a person livingwith HIV is denied or not provided access to treatment, careand support. States should also ensure due process of law sothat the merits of such complaints can be independently andimpartially assessed. At the international level, States shouldstrengthen existing mechanisms, and develop new mechanismswhere they do not currently exist, enabling persons living withHIV/AIDS to seek prompt, effective redress for breaches ofStates’ international legal obligations to respect, protect andfulfil rights related to health.36. States should ensure the quality assurance and control of HIVrelatedproducts. States should ensure, through legislative andother measures (e.g. functional systems for pre-marketingapproval and post-marketing surveillance), that medicines,diagnostics and related technologies are safe and effective.37. States should take legislative and other measures to ensure thatmedicines are supplied in adequate quantities and in a timelyfashion, and with accurate, current and accessible informationregarding their use. For example, consumer protection laws orother relevant legislation should be enacted or strengthenedto prevent fraudulent claims regarding the safety and efficacyof drugs, vaccines and medical devices, including thoserelating to HIV.38. Laws and/or regulations should be enacted to ensure thequality and availability of HIV tests and counselling. If hometests and/or rapid HIV test kits are permitted on the market,they should be strictly regulated to ensure quality and accuracy.The consequences of loss of epidemiological information, thelack of accompanying counselling and the risk of unauthorized42

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsuse, such as for employment or immigration, should alsobe addressed. Legal and social support services should beestablished to protect individuals from any abuses arising fromHIV testing. States should also ensure supervision of the qualityof delivery of voluntary counselling and testing (VCT) services.39. Legal quality control of condoms should be enforced, andcompliance with the <strong>International</strong> Condom Standard shouldbe monitored in practice. Restrictions on the availability ofpreventive measures, such as condoms, bleach, clean needlesand syringes, should be repealed. Widespread provision of thesepreventive measures through various means, including vendingmachines in appropriate locations, should be considered, inlight of the greater effectiveness provided by the increasedaccessibility and anonymity afforded by this method ofdistribution. Condom promotion initiatives should be coupledwith HIV information campaigns for optimal impact.40. Laws and/or regulations should be enacted to enablewidespread provision of information about HIV through themass media. This information should be aimed at the generalpublic, as well as at various vulnerable groups that may havedifficulty in accessing information. HIV information should beeffective for its designated audience and not be inappropriatelysubject to censorship or other broadcasting standards,particularly as this will have the effect of damaging access toinformation vital to life, health and human dignity.41. In order to improve prevention and therapeutic options relatedto HIV, States should increase funds allocated to the publicsector for researching, developing and promoting therapies andtechnologies for the prevention, treatment, care and supportof HIV and AIDS and related infections and conditions. The43

UNAIDSOHCHRprivate sector should also be encouraged to undertake suchresearch and development and to make the resulting optionswidely and promptly available at prices affordable to those whoneed them.42. States and the private sector should pay special attention tosupporting research and development that address the healthneeds of developing countries. In recognition of the humanright to share in scientific advancement and its benefits,States should adopt laws and policies, at the domestic andinternational levels, ensuring that the outcomes of research anddevelopment are of national and global benefit, with particularattention to the needs of people in developing countries andpeople who are poor or otherwise marginalized.43. States should integrate HIV prevention, treatment, care andsupport into all aspects of their planning for development,including in poverty eradication strategies, national budgetallocations and sectoral development plans. In so doing, Statesshould have particular regard, at a minimum, for internationallyagreed targets in addressing HIV. 2344. States should increase their national budget allocations formeasures promoting secure and sustainable access to affordableHIV prevention, treatment, care and support, at both thedomestic and international levels. States should, among othersteps, make contributions, in proportion to their resources,to mechanisms such as the Global Fund to Fight AIDS,Tuberculosis and Malaria. Developed countries should makeconcrete commitments of increased official development23Examples include the Millennium Development Goals agreed in 2000 by the UnitedNations General Assembly, and the specific HIV/AIDS-related goals agreed in the UnitedNations General Assembly’s Declaration of Commitment on HIV/AIDS in 2001.44

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsassistance that will move them without delay towards meetinginternational targets to which they have agreed, payingparticular attention to assistance in realizing access to healthcaregoods, services and information. 2445. States should ensure that international and bilateral mechanismsfor financing responses to HIV/AIDS provide funds forprevention, treatment, care and support, including the purchaseof antiretroviral and other medicines, diagnostics and relatedtechnologies. States should support and implement policiesmaximizing the benefit of donor assistance, including policiesensuring that such resources are used to purchase genericmedicines, diagnostics and related technologies, where these aremore economical.46. States’ international and bilateral financing mechanisms shouldalso provide funding for strengthening health-care systems, forimproving the capacity and working conditions of health-carepersonnel and the effectiveness of supply systems, for financingplans and referral mechanisms to provide access to prevention,treatment, care and support, and for family, community andhome-based care.47. States should collaborate with non-governmental organizations,intergovernmental organizations, and United Nationsbodies, agencies and programmes in creating, maintainingand expanding international, publicly accessible sources ofinformation on the sources, quality and worldwide prices24For example, in their 2001 Declaration of Commitment on HIV/AIDS, all United NationsMember States urged developed countries that have not done so to meet, as soon aspossible, the long-standing target of dedicating 0.7% of their gross national product tooverall official development assistance and earmarking 0.15–0.20% of their gross nationalproduct as official development assistance for least developed countries. States formallyreiterated this call in the outcome document of the 2002 <strong>International</strong> Conference onFinancing for Development (Monterrey, Mexico).45

UNAIDSOHCHRof medicines, diagnostics and related technologies for thepreventive, curative and palliative care of HIV and AIDS andrelated opportunistic infections and conditions. 2548. Creditor countries and international financing institutionsshould implement debt relief for developing countries morequickly and extensively, and should ensure that resourcesprovided for this purpose do not detract from those madeavailable for official development assistance. Developingcountries should use the resources freed up by debt relief (aswell as other sources of development finance) in a manner thatfully takes into account their obligations to respect, protectand fulfil rights related to health. States should, among otherthings, dedicate an appropriate proportion of such resources, inthe light of domestic conditions, priorities and internationallyagreed commitments, to HIV prevention, treatment, care andsupport.49. States should support and cooperate with internationalmechanisms for monitoring and reporting on the measuresthey have taken for progressively realizing access tocomprehensive HIV prevention, treatment, care and support,including antiretroviral and other medicines, diagnostics andrelated technologies. States should include relevant informationin their reports to bodies monitoring their progress incomplying with their international legal obligations. The datain these reports should be disaggregated in a manner thathelps identify and remedy possible disparities in access to25For example, UNICEF, UNAIDS, WHO and the non-governmental organization MédecinsSans Frontières jointly produce and update a publication identifying sources and pricesof selected drugs and diagnostics used in providing care and treatment to people livingwith HIV. Similarly, in 2001 the World Health Organization initiated an ongoing project thatproduces and maintains a list of HIV/AIDS drugs and diagnostics, and their suppliers, whomeet WHO quality standards.46

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsprevention, treatment, care and support, and should use existing,or develop new, evaluation tools such as indicators or auditsto measure implementation. States should actively involvenon-governmental organizations, including those representingpeople living with HIV/AIDS and vulnerable groups, inpreparing such reports and in acting on the observations andrecommendations received from such monitoring bodies. 2650. States should pursue and implement international andregional cooperation aimed at transferring to developingcountries technologies and expertise for HIV prevention,treatment, care and support. States should support cooperationbetween developing countries in this regard, and shouldjoin international organizations in providing and supportingtechnical assistance aimed at realizing access to HIV prevention,treatment, care and support.51. In their conduct in international forums and negotiations, Statesshould take due account of international norms, principles andstandards relating to human rights. In particular, they shouldtake account of their obligations to respect, protect and fulfilrights related to health, as well as of their commitments toprovide international assistance and cooperation. 27 States shouldalso avoid taking measures that would undermine access toHIV prevention, treatment, care and support, including accessto antiretroviral and other medicines, diagnostics and relatedtechnologies, either domestically or in other countries, andshould ensure that medicine is never used as a tool for politicalpressure. Particular attention must be paid by all States to theneeds and situations of developing countries.26See also Guideline 11, for further guidance on State monitoring and enforcement ofhuman rights.47

UNAIDSOHCHR52. States should, in light of their human rights obligations, ensurethat bilateral, regional and international agreements, such asthose dealing with intellectual property, do not impede accessto HIV prevention, treatment, care and support, includingaccess to antiretroviral and other medicines, diagnostics andrelated technologies.53. States should ensure that, in interpreting and implementinginternational agreements, domestic legislation incorporatesto the fullest extent any safeguards and flexibilities thereinthat may be used to promote and ensure access to HIVprevention, treatment, care and support for all, including accessto medicines, diagnostics and related technologies. Statesshould make use of these safeguards to the extent necessary tosatisfy their domestic and international obligations in relationto human rights. States should review their internationalagreements (including on trade and investment) to ensurethat these are consistent with treaties, legislation and policiesdesigned to promote and protect all human rights and, wherethose agreements impede access to prevention, treatment, careand support, should amend them as necessary.GUIDELINE 7: LEGAL SUPPORT SERVICES54. States should implement and support legal supportservices that will educate people affected by HIVabout their rights, provide free legal services toenforce those rights, develop expertise on HIV-relatedlegal issues and utilize means of protection inaddition to the courts, such as offices of Ministriesof Justice, ombudspersons, health complaint unitsand human rights commissions.48

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights55. States should consider the following features in establishingsuch services:(a) State support for legal aid systems specializing in HIVcasework, possibly involving community legal aid centresand/or legal service services based in ASOs;(b) State support or inducements (e.g. tax reduction) to privatesector law firms to provide free pro bono services to peopleliving with HIV in areas such as anti-discriminationand disability, health-care rights (informed consentand confidentiality), property (wills, inheritance) andemployment law;(c) State support for programmes to educate, raise awarenessand build self-esteem among people living with HIVconcerning their rights and/or to empower them todraft and disseminate their own charters/declarations oflegal and human rights; State support for production anddissemination of HIV legal rights brochures, resourcepersonnel directories, handbooks, 28 practice manuals, studenttexts, model curricula for law courses and continuinglegal education and newsletters to encourage informationexchange and networking should also be provided. Suchpublications could report on case law, legislative reforms,national enforcement and monitoring systems for humanrights abuses;27See also Guideline 11, paragraph 66 (e), regarding promotion of HIV-related human rightsin international forums and ensuring their integration into the policies and programmes ofinternational organizations.28See J. Godwin (et al.), Australian HIV/AIDS Legal Guide, (2nd edition), Federation Press,Sydney, 1993; Lambda Legal Defense and Education Fund Inc., AIDS Legal Guide: AProfessional Resource on AIDS-related Legal Issues and Discrimination, New York.49

UNAIDSOHCHR(d) State support for HIV legal services and protectionthrough a variety of offices, such as Ministries of Justice,procurator and other legal offices, health complaint units,ombudspersons and human rights commissions.Commentary on <strong>Guidelines</strong> 3 to 756. Since laws regulate conduct between the State and theindividual and between individuals, they provide an essentialframework for the observance of human rights, including HIVrelatedhuman rights. The efficacy of this framework for theprotection of human rights depends on the strength of the legalsystem in a given society and on the access of its citizens to thesystem. However, many legal systems worldwide are not strongenough, nor do marginalized populations have access to them.57. Nevertheless, the role of law in the response to HIV mayalso be overemphasized and provide a vehicle for coerciveand abusive policies. Although law may have an educativeand normative role and may provide an important supportiveframework for human rights protection and HIV programmes,it cannot be relied upon as the only means by which toeducate, change attitudes, achieve behavioural change orprotect people’s rights. <strong>Guidelines</strong> 3 to 7 above are, therefore,meant to encourage the enactment of meaningful and positivelegislation, to describe the basic legal components necessary toprovide support for the protection of HIV-related human rightsand effective HIV prevention and care programmes and to besupplemented by all other <strong>Guidelines</strong> set out in this document.58. <strong>Guidelines</strong> 3 to 6 encourage law and law reform which wouldbring national HIV-related laws into conformity with internationaland regional human rights standards. Although the contentof the strategies primarily addresses formal law, law reform50

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsshould also encompass traditional and customary laws. The processof HIV law review and reform should be incorporated intothe State’s general activities regarding the observance of humanrights norms and be integrated into the national AIDS response,whilst involving the affected communities, ensuring that existinglegislation does not act as an impediment to HIV preventionand care programmes (for the general population, as wellas for vulnerable groups) and protecting individuals against discriminationby both Government actors and private individualsor institutions. It is recognized that some of the recommendationsfor law and law reform, particularly those concerning thestatus of women, drug use, sex work and the status of men havingsex with men, might be controversial in particular national,cultural and religious contexts. However, these <strong>Guidelines</strong> arerecommendations to States: they are based on existing internationalhuman rights standards and designed to achieve a pragmaticapproach to public health goals relative to HIV. It is theobligation of States to establish how they can best meet theirinternational human rights obligations and protect the publichealth within their political, cultural and religious contexts. TheOffice of the United Nations High Commissioner for HumanRights, UNAIDS, its relevant co-sponsors and other UnitedNations bodies and agencies, such as the <strong>International</strong> LabourOrganization, can offer Governments technical assistance in theprocess of law review and reform.59. Guideline 7 urges that States (and the private sector) encourageand support specialist and generalist legal services to enablepeople living with HIV and affected communities to enforcetheir human and legal rights through the use of such services.Information and research resources on legal and human rightsissues should also be made available. Such services should alsoaddress the issue of reducing the vulnerability to infection with-51

UNAIDSOHCHRin and the impact of HIV on vulnerable groups. The locationand format of the information (e.g. plain and understandablelanguage) provided via such services should render it accessibleto members of these groups. Models exist in many countries. 29C. Promotion of a supportive and enablingenvironmentGUIDELINE 8: WOMEN, CHILDREN AND OTHERVULNERABLE GROUPS 3060. States should, in collaboration with and throughthe community, promote a supportive and enablingenvironment for women, children and other vulnerablegroups by addressing underlying prejudicesand inequalities through community dialogue, speciallydesigned social and health services and supportto community groups.29Models include the Group for Life (Grupo Pela Vidda) in Rio de Janeiro, Brazil, which offersfree legal services, brochures, bulletins, telephone hotline and media campaigns. Legalrights brochures have been produced in the United Kingdom by the Terrence Higgins Trustand Immunity’s Legal Centre (D. Taylor (ed.), HIV, You and the Law). Resource directorieshave been produced in the United States by the American Bar Association (Directory ofLegal Resources for People with AIDS & HIV, AIDS Coordination Project, Washington, D.C.,1991) and the Gay Men’s Health Crisis (M. Holtzman (ed.), Legal Services Referral Directoryfor People with AIDS, New York, 1991). Several other organizations in the United Stateshave produced practitioners’ or volunteers’ training manuals, such as the Whitman-WalkerClinic (Washington, D.C.), the AIDS Project (Los Angeles), the National Lawyers Guild, StateAIDS Legal Services Organization (San Francisco) and the American Civil Liberties Union(William Rubenstein, Ruth Eisenberg and Lawrence Gostin, The Rights of Persons Livingwith HIV/AIDS (Southern Illinois Press, Carbondale, Illinois, 1996)). A manual for paralegalsis being prepared in South Africa by the Pietermaritzburg branch of Lawyers for HumanRights with the assistance of the AIDS Law Project and with training coordination beingprovided by the AIDS Legal Network. Other resources include benchbooks for judges (A.R.Rubenfield (ed.), AIDS Benchbook, National Judicial College, American Bar Association,Reno, Nevada, January 1991), the Southern Africa AIDS Information Dissemination Serviceand newsletters such as the Canadian HIV/AIDS Policy and Law Newsletter and Australia’sLegal Link (see also AIDS/STD Health Promotion Exchange, Royal Tropical Institute, theNetherlands).30See section III, Introduction, for a listing of vulnerable groups.52

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights(a) States should support the establishment and sustainability ofcommunity associations comprising members of differentvulnerable groups for peer education, empowerment, positivebehavioural change and social support.(b) States should support the development of adequate, accessibleand effective HIV-related prevention and care education,information and services by and for vulnerable communitiesand should actively involve such communities inthe design and implementation of these programmes.(c) States should support the establishment of national andlocal forums to examine the impact of the HIV epidemicon women. They should be multisectoral to includeGovernment, professional, religious and community representationand leadership and examine issues such as:(i) The role of women at home and in public life;(ii) The sexual and reproductive rights of women andmen, including women’s ability to negotiate safer sexand make reproductive choices;(iii) Strategies for increasing educational and economicopportunities for women;(iv) Sensitizing service deliverers and improving health careand social support services for women; and(v) The impact of religious and cultural traditions onwomen.(d) States should implement the Cairo Programme of Actionof the <strong>International</strong> Conference on Population andDevelopment 31 and the Beijing Declaration and Platformfor Action of the Fourth World Conference on Women.Primary health services, programmes and information31A/CONF.171/13, chap. I, resolution 1, annex.53

UNAIDSOHCHRcampaigns in particular should include a gender perspective.Violence against women, harmful traditional practices,sexual abuse, exploitation, early marriage and femalegenital mutilation, should be eliminated. Positive measures,including formal and informal education programmes,increased work opportunities and support services, shouldbe established.(e) States should support women’s organizations to incorporateHIV and human rights issues into their programming.(f) States should ensure that all women and girls of child-bearingage have access to accurate and comprehensive informationand counselling on the prevention of HIV transmissionand the risk of vertical transmission of HIV, as well as accessto the available resources to minimize that risk, or to proceedwith childbirth, if they so choose.(g) States should ensure the access of children and adolescentsto adequate health information and education, includinginformation related to HIV prevention and care, inside andoutside school, which is tailored appropriately to age leveland capacity and enables them to deal positively and responsiblywith their sexuality. Such information should takeinto account the rights of the child to access to information,privacy, confidentiality, respect and informed consent andmeans of prevention, as well as the responsibilities, rightsand duties of parents. Efforts to educate children about theirrights should include the rights of persons, including children,living with HIV.(h) States should ensure that children and adolescents haveadequate access to confidential sexual and reproductivehealth services, including HIV information, counselling,54

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightstesting and prevention measures such as condoms, and tosocial support services if affected by HIV. The provisionof these services to children/adolescents should reflectthe appropriate balance between the rights of the child/adolescent to be involved in decision-making according tohis or her evolving capabilities and the rights and duties ofparents/guardians for the health and well-being of the child.(i) States should ensure that persons employed to child careagencies, including adoption and foster-care homes, receivetraining in the area of HIV-related children’s issues in orderto deal effectively with the special needs of HIV-affectedchildren including protection from mandatory testing,discrimination and abandonment.(j) States should support the implementation of specially designedand targeted HIV prevention and care programmesfor those who have less access to mainstream programmesdue to language, poverty, social or legal or physical marginalization,e.g. minorities, migrants, indigenous peoples,refugees and internally displaced persons, people with disabilities,prisoners, sex workers, men having sex with menand injecting drug users.Commentary on Guideline 861. States should take measures to reduce the vulnerability,stigmatization and discrimination that surround HIV andpromote a supportive and enabling environment by addressingunderlying prejudices and inequalities within societies and asocial environment conducive to positive behaviour change.An essential part of this enabling environment involvesthe empowerment of women, youth and other vulnerablegroups to deal with HIV by taking measures to improve55

UNAIDSOHCHRtheir social and legal status, involving them in the design andimplementation of programmes and assisting them to mobilizetheir communities. The vulnerability of some groups is due totheir limited access to resources, information, education andlack of autonomy. Special programmes and measures should bedesigned to increase access. In many countries, communitybasedorganizations and NGOs have already begun the processof creating a supportive and enabling environment in theirresponse to the HIV epidemic. Governments must recognizethese efforts and lend moral, legal, financial and politicalsupport to strengthen them.GUIDELINE 9: CHANGING DISCRIMINATORYATTITUDES THROUGH EDUCATION, TRAININGAND THE MEDIA62. States should promote the wide and ongoing distributionof creative education, training and mediaprogrammes explicitly designed to change attitudesof discrimination and stigmatization associatedwith HIV to understanding and acceptance.(a) States should support appropriate entities, such as mediagroups, NGOs and networks of people living with HIV,to devise and distribute programming to promote respectfor the rights and dignity of people living with HIVand members of vulnerable groups, using a broad rangeof media (film, theatre, television, radio, print, dramaticpresentations, personal testimonies, Internet, pictures,bus posters). Such programming should not compoundstereotypes about these groups but instead dispel mythsand assumptions about them by depicting them as friends,56

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsrelatives, colleagues, neighbours and partners. Reassuranceconcerning the modes of transmission of the virus and thesafety of everyday social contact should be reinforced.(b) States should encourage educational institutions (primaryand secondary schools, universities and other technical ortertiary colleges, adult and continuing education), as well astrades unions and workplaces to include HIV and humanrights/non-discrimination issues in relevant curricula, suchas human relationships, citizenship/social studies, legalstudies, health care, law enforcement, family life and/or sexeducation, and welfare/counselling.(c) States should support HIV-related human rights/ethicstraining/workshops for Government officials, the police,prison staff, politicians, as well as village, community andreligious leaders and professionals.(d) States should encourage the media and advertisingindustries to be sensitive to HIV and human rightsissues and to reduce sensationalism in reporting and theinappropriate use of stereotypes, especially in relation todisadvantaged and vulnerable groups. A training approach ofthis kind should include the production of useful resources,such as handbooks containing appropriate terminology,which would serve to eliminate use of stigmatizinglanguage; and a professional code of behaviour in order toensure respect for confidentiality and privacy.(e) States should support targeted training, peer education andinformation exchange for people living with HIV staffand volunteers of CBOs and ASOs as well as for leadersof vulnerable groups as a means of raising their awarenessof human rights and of the means to enforce these rights.57

UNAIDSOHCHRConversely, education and training should be provided onHIV-specific human rights issues to those working on otherhuman rights issues.(f) States should support the use of alternative efforts suchas radio programmes or facilitated group discussionsto overcome access problems for individuals who arelocated in remote or rural areas, are illiterate, homeless ormarginalized and without access to television, films andvideos and specific ethnic minority languages.Commentary on Guideline 963. The use of formal standards and their implementationthrough Government process and law alone cannot changethe negative attitudes and prejudices surrounding HIV intorespect for human rights. Public programming explicitlydesigned to reduce the existing stigma has been shown tohelp create a supportive environment which is more tolerantand understanding. 32 The reach of such programming shouldbe a mixture of general and focused programmes usingvarious media, including creative and dramatic presentations,compelling ongoing information campaigns for toleranceand inclusion and interactive educational workshops andseminars. The goal should be to challenge beliefs based onignorance, prejudices and punitive attitudes by appealing tohuman compassion and identifying with visible individuals.Programming based on fear can be counter-productive byengendering discrimination through panic.32Professor R. Feachem, Valuing the Past, Investing in the Future: Evaluation of the NationalHIV/AIDS Strategy 1993-4 to 1995-6, Commonwealth Department of Human Services andHealth, September 1995, Canberra, pp. 190-192.58

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsGUIDELINE 10: DEVELOPMENT OF PUBLICAND PRIVATE SECTOR STANDARDS ANDMECHANISMS FOR IMPLEMENTING THESESTANDARDS64. States should ensure that Government and theprivate sector develop codes of conduct regardingHIV issues that translate human rights principlesinto codes of professional responsibility andpractice, with accompanying mechanisms toimplement and enforce these codes.(a) States should require or encourage professional groups,particularly health-care professionals, and other privatesector industries (e.g. law, insurance) to develop andenforce their own codes of conduct addressing humanrights issues in the context of HIV. Relevant issues wouldinclude confidentiality, informed consent to testing, theduty to treat, the duty to ensure safe workplaces, reducingvulnerability and discrimination and practical remedies forbreaches/misconduct.(b) States should require that individual government departmentsdevise clear guidelines on the extent to which theirpolicies and practices reflect HIV-related human rightsnorms and their enforcement in formal legislation andregulations, at all levels of service delivery. Coordinationof these standards should occur in the national frameworkdescribed in Guideline 1 and be publicly available, afterinvolvement of community and professional groups inthe process.59

UNAIDSOHCHR(c) States should develop or promote multisectoralmechanisms to ensure accountability. This involves theequal participation of all concerned (i.e. Governmentagencies, industry representatives, professional associations,NGOs, consumers, service providers and service users).The common goal should be to raise standards of service,strengthen linkages and communication and assure the freeflow of information.Commentary on Guideline 1065. The development of standards in and by the public and privatesectors is important. First, they translate human rights principlesinto practice from an insider’s perspective and reflect moreclosely the community’s concerns. Second, they are likelyto be more pragmatic and acceptable to the sector involved.Third, they are more likely to be “owned” and implemented ifdeveloped by the sector itself. Finally, they might have a moreimmediate impact than legislation.GUIDELINE 11: STATE MONITORING ANDENFORCEMENT OF HUMAN RIGHTS66. States should ensure monitoring and enforcementmechanisms to guarantee HIV-related humanrights, including those of people living with HIV,their families and communities.(a) States should collect information on human rights andHIV and, using this information as a basis for policy andprogramme development and reform, report on HIVrelatedhuman rights issues to the relevant United Nations60

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightstreaty bodies as part of their reporting obligations underhuman rights treaties.(b) States should establish HIV focal points in relevantgovernment branches, including national AIDSprogrammes, police and correctional departments, thejudiciary, Government health and social service providersand the military, for monitoring HIV-related humanrights abuses and facilitating access to these branchesfor disadvantaged and vulnerable groups. Performanceindicators or benchmarks showing specific compliance withhuman rights standards should be developed for relevantpolicies and programmes.(c) States should provide political, material and humanresources support to ASOs and CBOs for capacity-buildingin human rights standards development and monitoring.States should provide human rights NGOs with support forcapacity-building in HIV-related human rights standardsand monitoring.(d) States should support the creation of independent nationalinstitutions for the promotion and protection of humanrights, including HIV-related rights, such as human rightscommissions and ombudspersons and/or appoint HIVombudspersons to existing or independent human rightsagencies, national legal bodies and law reform commissions.(e) States should promote HIV-related human rights in internationalforums and ensure that they are integrated intothe policies and programmes of international organizations,including United Nations human rights bodies, aswell as in other agencies of the United Nations system.61

UNAIDSOHCHRFurthermore, States should provide intergovernmentalorganizations with the material and human resources requiredto work effectively in this field.Commentary on Guideline 1167. Standard-setting and promotion of HIV-related human rightsstandards alone are insufficient to address human rights abusesin the context of HIV. Effective mechanisms must be establishedat the national and community levels to monitor andenforce HIV-related human rights. Governments should seethis as part of their national responsibility to address HIV. Theexistence of monitoring mechanisms should be publicized, particularlyamong networks of people living with HIV, in orderto maximize their use and impact. Monitoring is necessary tocollect information, formulate and revise policy, and establishpriorities for change and benchmarks for performance measurement.Monitoring should be both positive and negative,i.e. reporting on good practice to provide models for others toemulate, as well as identifying abuses. The non-governmentalsector can provide an important means of monitoring humanrights abuses, if resourced to do so, since it frequently hascloser contact with the affected communities. Formal grievancebodies may be too bureaucratic and their procedures too timeconsumingand stressful to attract a representative sample ofcomplaints. Training is necessary for community participants todevelop skills so as to be able to analyse and report findings ata level of quality which is credible for States and internationalhuman rights bodies.62

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsGUIDELINE 12: INTERNATIONALCOOPERATION68. States should cooperate through all relevant programmesand agencies of the United Nations system,including UNAIDS, to share knowledge andexperience concerning HIV-related human rightsissues, and should ensure effective mechanisms toprotect human rights in the context of HIV at theinternational level.(a) The Commission on Human Rights should take note ofthe present <strong>Guidelines</strong> and of the report on the Second<strong>International</strong> Consultation on HIV/AIDS and HumanRights and request States to carefully consider and implementthe <strong>Guidelines</strong> in their national, subnational and localresponses to HIV and human rights.(b) The Commission on Human Rights should request humanrights treaty bodies, special rapporteurs and representativesand its working groups to take note of the <strong>Guidelines</strong> andinclude in their activities and reports all issues arising underthe <strong>Guidelines</strong> relevant to their mandates.(c) The Commission on Human Rights should requestUNAIDS, its co-sponsors (UNDP, UNESCO, UNFPA,UNICEF, WHO and the World Bank 33 ) and other relevantUnited Nations bodies and agencies to integrate thepromotion of the <strong>Guidelines</strong> throughout their activities.33Since the issuing of the <strong>Guidelines</strong> in 1998, the number of UNAIDS co-sponsors has grownto include the <strong>International</strong> Labour Organization (ILO), the United Nations Office on Drugsand Crime (UNODC), the World Food Programme (WFP) and the United Nations HighCommissioner for Refugees (UNHCR).63

UNAIDSOHCHR(d) The Commission on Human Rights should appointa special rapporteur on human rights and HIV/AIDSwith the mandate, inter alia, to encourage and monitorimplementation of the <strong>Guidelines</strong> by States, as well as theirpromotion by the United Nations system, including humanrights bodies, where applicable.(e) The Commission on Human Rights should encouragethe Office of the United Nations High Commissioner forHuman Rights to ensure that the <strong>Guidelines</strong> are disseminatedthroughout that Office and are incorporated intoall its human rights activities and programmes, particularlythose involving technical cooperation, monitoring andsupport to human rights bodies and organs.(f) States, in the framework of their periodic reportingobligations to United Nations treaty monitoring bodiesand under regional conventions, should report on theirimplementation of the <strong>Guidelines</strong> and other relevant HIVrelatedhuman rights concerns arising under the varioustreaties.(g) States should ensure, at the country level, that theircooperation with UNAIDS Theme Groups includespromotion and implementation of the <strong>Guidelines</strong>, includingthe mobilization of sufficient political and financial supportfor such implementation.(h) States should work in collaboration with UNAIDS,the Office of the United Nations High Commissionerfor Human Rights and non-governmental and otherorganizations working in the field of human rights andHIV to:64

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights(i) Support translation of the <strong>Guidelines</strong> into national andminority languages;(ii) Create a widely accessible mechanism for communicationand coordination for sharing information on the<strong>Guidelines</strong> and HIV-related human rights;(iii) Support the development of a resource directory oninternational declarations/ treaties, as well as policystatements and reports on HIV and human rights,to strengthen support for the implementation of the<strong>Guidelines</strong>;(iv) Support multicultural education and advocacy projectson HIV and human rights, including educating humanrights groups with regard to HIV and educating HIVand vulnerable groups in human rights issues andstrategies for monitoring and protecting human rightsin the context of HIV, using the <strong>Guidelines</strong> as aneducational tool;(v) Support the creation of a mechanism to allow existinghuman rights organizations and HIV organizationsto work together strategically to promote and protectthe human rights of people living with HIV and thosevulnerable to infection, through implementation of the<strong>Guidelines</strong>;(vi) Support the creation of a mechanism to monitor andpublicize human rights abuses in the context of HIV;(vii) Support the development of a mechanism to mobilizegrass-roots responses to HIV-related human rightsconcerns and implementation of the <strong>Guidelines</strong>,including exchange programmes and training amongdifferent communities, both within and across regions;(viii)Advocate that religious and traditional leaders take upHIV-related human rights concerns and become partof the implementation of the <strong>Guidelines</strong>;65

UNAIDSOHCHR(ix) Support the development of a manual that wouldassist human rights and AIDS service organizations inadvocating the implementation of the <strong>Guidelines</strong>;(x) Support the identification and funding of NGOs andASOs at country level to coordinate a national NGOresponse to promote the <strong>Guidelines</strong>;(xi) Support, through technical and financial assistance,national and regional NGO networking initiativeson ethics, law and human rights to enable themto disseminate the <strong>Guidelines</strong> and advocate theirimplementation.(i) States, through regional human rights mechanisms, shouldpromote the dissemination and implementation of the<strong>Guidelines</strong> and their integration into the work of thesebodies.Commentary on Guideline 1269. The United Nations bodies, agencies and programmescomprise some of the most effective and powerful forumsthrough which States can exchange information and expertiseon HIV-related human rights issues and build support amongthemselves to implement a rights-based response to HIV. States,in their work with and governance of these bodies, can usethese bodies as tools for promoting the <strong>Guidelines</strong>. States must,however, both encourage and enable these bodies throughpolitical and financial support, to take effective and sustainedaction in terms of promoting the <strong>Guidelines</strong> and must respondpositively to the work done by these bodies with steps taken atthe national level.66

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsConclusion70. States are urged to implement these <strong>Guidelines</strong> in order toensure respect for the human rights of those affected by HIVand to ensure an effective and inclusive public health responseto HIV. These <strong>Guidelines</strong> are based on experience gained frombest practices which have proven to be effective over the last15 years. By implementing these <strong>Guidelines</strong>, States are able toavoid negative and coercive policies and practices which havehad a devastating impact on people’s lives and on national HIVprogrammes.71. The practical aspects of protecting HIV-related human rightsare more likely to be addressed if there is leadership on thisissue in the executive and legislative arms of government and ifmultisectoral structures are established and maintained. Vital toany policy development and implementation is the involvementof affected communities, together with relevant professionalsand religious and community leaders, as equal partners in theprocess.72. As national legislation provides a critical framework forthe protection of HIV-related human rights, many of the<strong>Guidelines</strong> relate to the need for law reform. Another majorinstrument of social change is the provision of a supportiveand enabling environment within which to conduct HIVrelatedprevention, care and support activities. Part of thisenabling environment can be obtained by changing attitudesthrough general and targeted education, public informationand education campaigns which deal with HIV-relatedrights, tolerance and inclusion. Another part of this enablingenvironment involves the empowerment of women andvulnerable groups to deal with HIV by taking measures to67

UNAIDSOHCHRimprove their social and legal status and to assist them inmobilizing their communities.73. HIV and AIDS continue to challenge our societies in manyways. It is incumbent on States, communities and individualsto address extremely difficult and pervasive societal issueswhich have always been present in our societies, and to identifysolutions thereto. With the advent of HIV, we can no longerafford to evade these issues because to do so threatens the livesof millions of men, women and children. These issues relateto the roles of women and men, the status of marginalizedor illegal groups, the obligations of States concerning healthexpenditure and the role of law in achieving public healthgoals, the content of privacy between individuals and betweenindividuals and their Governments, the responsibility andability of people to protect themselves and others, as well asthe relationship between human rights, health and life. These<strong>Guidelines</strong> are means for giving guidance on these difficultmatters – guidance which has evolved from the internationalhuman rights regime and from the courageous and inspiringwork of millions the world over who have demonstrated thatprotecting the human rights of people means protecting theirhealth, lives and happiness in a world with HIV.68

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsII. Recommendations for disseminationand implementation of the <strong>Guidelines</strong>on HIV/AIDS and Human Rights74. At the Second <strong>International</strong> Consultation on HIV/AIDSand Human Rights, the participants considered strategies fordissemination and implementation of the <strong>Guidelines</strong>. It wasconsidered that there are three groups of key actors who,jointly and separately, are critical to the implementation of the<strong>Guidelines</strong>, namely States, the United Nations system, regionalintergovernmental organizations and non-governmentaland community-based organizations. Recommendations formeasures that these actors are encouraged to take in orderto ensure that the <strong>Guidelines</strong> are widely disseminated andeffectively implemented are set out below.A. States75. States, at the highest level of Government (Head of State,Prime Minister and/or relevant ministers), should promulgatethe <strong>Guidelines</strong> and ensure that the political weight of theGovernment is behind the dissemination and implementationof the <strong>Guidelines</strong> throughout all branches of the executive,legislature and judiciary.76. States, at the highest level of Government, should assignappropriate governmental bodies/staff the responsibilityto devise and implement a strategy for dissemination andimplementation of the <strong>Guidelines</strong> and establish periodicmonitoring of this strategy through, for example, reports to the69

UNAIDSOHCHRExecutive Office and public hearings. States should establishwithin the executive branch a staff member(s) responsible forthis strategy.77. States should disseminate the <strong>Guidelines</strong>, endorsed by theexecutive, to relevant national bodies, such as interministerialand parliamentary committees on HIV and national AIDSprogrammes, as well as to provincial and local-level bodies.78. States, through these bodies, should give formal considerationto the <strong>Guidelines</strong> in order to identify ways to build them intoexisting activities and prioritize necessary new activities andpolicy review. States should also organize consensus workshopswith the participation of non-governmental organizations,community-based organizations and AIDS service organizations(ASOs), networks of people living with HIV, networks onethics, law, human rights and HIV, United Nations ThemeGroups on HIV/AIDS, as well as political and religious groups:(a) To discuss the relevance of the <strong>Guidelines</strong> to the localsituation, to identify obstacles and needs, to proposeinterventions and solutions, and to achieve consensus for theadoption of the <strong>Guidelines</strong>;(b) To elaborate national, provincial and local plans of action forimplementation and monitoring of the <strong>Guidelines</strong> withinthe local context;(c) To mobilize and ensure the commitment of relevantgovernmental officials to apply the <strong>Guidelines</strong> as a workingtool to be integrated into their individual workplans.79. States, at national, subnational and local levels, should establishmechanisms to receive, process and refer issues, claims and70

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsinformation in relation to the <strong>Guidelines</strong> and to the humanrights issues raised therein. States should create focal pointsto monitor the implementation of the <strong>Guidelines</strong> in relevantgovernment departments.80. States, in ways consistent with judicial independence, shoulddisseminate the <strong>Guidelines</strong> widely throughout the judicialsystem and use them in the development of jurisprudence,conduct of court cases involving HIV-related matters and HIVrelatedtraining/continuing education of judicial officers.81. States should disseminate the <strong>Guidelines</strong> throughoutthe legislative branch of government and particularly toparliamentary committees involved in the formulation ofpolicy and legislation relevant to the issues raised in the<strong>Guidelines</strong>. Such committees should assess the <strong>Guidelines</strong> toidentify priority areas for action and a longer-term strategy toensure that relevant policy and law are in conformity with the<strong>Guidelines</strong>.B. United Nations system and regional intergovernmentalbodies82. The United Nations Secretary-General should submit the<strong>Guidelines</strong> to the Commission on Human Rights as part ofthe report on the Second <strong>International</strong> Consultation on HIV/AIDS and Human Rights.83. The Secretary-General should transmit the <strong>Guidelines</strong> to headsof State:(a) Recommending that the document be distributednationally through the appropriate channels;71

UNAIDSOHCHR(b) Offering, within the mandates of UNAIDS and theOffice of the United Nations High Commissioner forHuman Rights, technical cooperation in facilitating theimplementation of the <strong>Guidelines</strong>;(c) Requesting that compliance with the <strong>Guidelines</strong> beincluded in national reports to existing human rights treatybodies;(d) Reminding Governments of the responsibility to upholdinternational human rights standards in promotingcompliance with the <strong>Guidelines</strong>.84. The Secretary-General should transmit the <strong>Guidelines</strong> tothe heads of all relevant United Nations bodies and agencies,requesting that they be widely disseminated throughout therelevant programmes and activities of the bodies and agencies.The Secretary-General should request that all relevant UnitedNations bodies and agencies consider their activities andprogrammes on HIV in the light of the provisions of the<strong>Guidelines</strong> and support the implementation of the <strong>Guidelines</strong>at national level.85. The Commission on Human Rights and the Sub-Commissionon Prevention of Discrimination and Protection of Minorities,as well as all human rights treaty bodies, should consider anddiscuss the <strong>Guidelines</strong> with a view to incorporating relevantaspects of the <strong>Guidelines</strong> into their respective mandates.Human rights treaty bodies, in particular, should integrate the<strong>Guidelines</strong>, as relevant, in their respective reporting guidelines,questions to States and when developing recommendations andgeneral comments on related subjects.86. The Commission on Human Rights should appoint a specialrapporteur on human rights and HIV with the mandate,72

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsinter alia, to encourage and monitor implementation ofthe <strong>Guidelines</strong> by States, as well as their promotion by theUnited Nations system, including human rights bodies, whereapplicable.87. The Office of the United Nations High Commissionerfor Human Rights should ensure that the <strong>Guidelines</strong> aredisseminated throughout that Office and incorporated intoits activities and programmes, particularly those involvingsupport for the United Nations human rights bodies, technicalassistance and monitoring. This should be coordinated by astaff member with exclusive responsibility for the <strong>Guidelines</strong>.Similarly, the United Nations Division for the Advancementof Women should ensure the full integration of the <strong>Guidelines</strong>into the work of the Committee on the Elimination ofDiscrimination against Women.88. UNAIDS should transmit the <strong>Guidelines</strong> throughout thesystem – to co-sponsors of the UNAIDS ProgrammeCoordinating Board, United Nations Theme Groups on HIV/AIDS, UNAIDS staff, including country programme advisersand focal points – and should ensure that the <strong>Guidelines</strong>become a framework for action for the work of the UnitedNations Theme Groups on HIV/AIDS and UNAIDS staff;Theme Groups should use the <strong>Guidelines</strong> to assess the HIVrelatedhuman rights, legal and ethical situation at country leveland to elaborate the best means for supporting implementationof the <strong>Guidelines</strong> at that level.89. Regional bodies (such as the Inter-American Commissionon Human Rights, the Organization of American States, theAfrican Commission on Human and Peoples’ Rights, theOrganization of African Unity, the European Commissionon Human Rights, the European Commission, the Council73

UNAIDSOHCHRof Europe, the Association of South-East Asian Nations,etc.) should receive the <strong>Guidelines</strong> and make them availableto the largest possible number of members and relevantdivisions with a view to assessing how their activities mightbe made consistent with the <strong>Guidelines</strong> and promote theirimplementation.90. Specialized agencies and other concerned bodies (such asthe <strong>International</strong> Labour Organization, the <strong>International</strong>Organization for Migration, the Office of the United NationsHigh Commissioner for Refugees, the United NationsResearch Institute for Social Development and the WorldTrade Organization) should receive the <strong>Guidelines</strong> andtransmit them widely among members and throughout theirprogrammes with a view to assessing how their activities canbe made consistent with the <strong>Guidelines</strong> and promote theirimplementation.C. Non-governmental organizations 3491. NGOs should implement the <strong>Guidelines</strong> within a broadframework of communication in terms of HIV and humanrights, including the establishment of ongoing communicationbetween the HIV community and the human rightscommunity by:(a) Establishing contacts at the international, regional and locallevels between networks of ASOs, human rights NGOs, andpeople living with HIV.34Including AIDS service organizations, community-based organizations, regional andnational networks on ethics, law, human rights and HIV and networks of people living withHIV. These networks comprise not only non-governmental and AIDS service organizationsbut also professionals (e.g. lawyers, health-care workers, social workers), people livingwith HIV, academics, research institutions and other concerned citizens. The networks areimportant voices for mobilizing change and protecting human rights.74

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights(b) Developing mechanism(s) for ongoing communicationand dissemination and implementation of the <strong>Guidelines</strong>,such as a bulletin board and/or home page on the Internetallowing for input and exchange of information on humanrights and HIV and database linkages between groupsworking on human rights and HIV;(c) Networking with human rights NGOs at meetings ofUnited Nations human rights bodies;(d) Promoting discussion of the <strong>Guidelines</strong> in their newslettersand other publications, as well as through other media;(e) Developing an action-oriented and accessible version(s) ofthe <strong>Guidelines</strong>;(f) Developing a strategy and process for the disseminationof the <strong>Guidelines</strong> and seeking funding and technicalcooperation in that regard.92. Non-governmental organizations at the regional level should:(a) Establish or use existing focal points to disseminate the<strong>Guidelines</strong>, with popularization and/or training;(b) Establish a regional “technical group” to introduce the<strong>Guidelines</strong> to the region;(c) Use the <strong>Guidelines</strong> as a tool for advocacy, interpretation,monitoring abuse and establishing best practices;(d) Prepare regular reports on the implementation of the<strong>Guidelines</strong> to human rights bodies (human rights treatybodies and United Nations extra-conventional factfindingmechanisms, such as special rapporteurs and75

UNAIDSOHCHRrepresentatives, as well as regional commissions) and otherrelevant international agencies;(e) Bring cases of HIV-related discrimination and otherviolations of human rights in the context of HIVto regional human rights judicial and quasi-judicialmechanisms.93. In order to advocate the <strong>Guidelines</strong>, NGOs at the nationallevel should obtain consensus on their acceptance andestablish a joint strategy with governmental and nongovernmentalpartners as a baseline for monitoring the<strong>Guidelines</strong>, through the following actions:(a) hold national NGO strategy meetings on the <strong>Guidelines</strong>that include human rights NGOs (including women’sorganizations and prisoners’ rights organization), ASOs,community-based organizations, networks on ethics, law,human rights and HIV and networks of people living withHIV;(b) Hold meetings with national governmental human rightsbodies;(c) Hold meetings with national Government (relevantministries), legislative and the judiciary;(d) Establish or use existing national focal points to gatherinformation and develop systems of information exchangeon HIV and human rights, including the <strong>Guidelines</strong>.76

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsIII. <strong>International</strong> human rightsobligations and HIVIntroduction: HIV, human rights and public health94. Several years of experience in addressing the HIV epidemichave confirmed that the promotion and protection of humanrights constitute an essential component in preventingtransmission of HIV and reducing the impact of HIV andAIDS. The protection and promotion of human rights arenecessary both to the protection of the inherent dignityof persons affected by HIV and to the achievement of thepublic health goals of reducing vulnerability to HIV infection,lessening the adverse impact of HIV and AIDS on thoseaffected and empowering individuals and communities torespond to HIV.95. In general, human rights and public health share the commonobjective to promote and to protect the rights and well-beingof all individuals. From the human rights perspective, thiscan best be accomplished by promoting and protecting therights and dignity of everyone, with special emphasis on thosewho are discriminated against or whose rights are otherwiseinterfered with. Similarly, public health objectives can best beaccomplished by promoting health for all, with special emphasison those who are vulnerable to threats to their physical,mental or social well-being. Thus, health and human rightscomplement and mutually reinforce each other in any context.They also complement and mutually reinforce each other inthe context of HIV.77

UNAIDSOHCHR96. One aspect of the interdependence of human rights and publichealth is demonstrated by studies showing that HIV preventionand care programmes with coercive or punitive features resultin reduced participation and increased alienation of those at riskof infection. 35 In particular, people will not seek HIV-relatedcounselling, testing, treatment and support if this would meanfacing discrimination, lack of confidentiality and other negativeconsequences. Therefore, it is evident that coercive publichealth measures drive away the people most in need of suchservices and fail to achieve their public health goals of preventionthrough behavioural change, care and health support.97. Another aspect of the linkage between the protection of humanrights and effective HIV programmes is apparent in thefact that the incidence or spread of HIV is disproportionatelyhigh among some populations. Depending on the nature of theepidemic and the legal, social and economic conditions in eachcountry, groups that may be disproportionately affected includewomen, children, those living in poverty, minorities, indigenouspeople, migrants, refugees and internally displaced persons,people with disabilities, prisoners, sex workers, men having sexwith men and injecting drug users-that is to say groups whoalready suffer from a lack of human rights protection and fromdiscrimination and/or are marginalized by their legal status.Lack of human rights protection disempowers these groups toavoid infection and to cope with HIV, if affected by it. 3698. Furthermore, there is growing international consensus thata broadly based, inclusive response, involving people living35J. Dwyer, “Legislating AIDS Away: The Limited Role of Legal Persuasion in Minimizing theSpread of HIV”, in 9 Journal of Contemporary Health Law and Policy 167 (1993).36For the purposes of these <strong>Guidelines</strong>, these groups will be referred to as “vulnerable”groups although it is recognized that the degree and source of vulnerability of thesegroups vary widely within countries and across regions.78

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightswith HIV in all its aspects, is a main feature of successful HIVprogrammes. Another essential component of comprehensiveresponse is the facilitation and creation of a supportive legal andethical environment which is protective of human rights. Thisrequires measures to ensure that Governments, communitiesand individuals respect human rights and human dignity andact in a spirit of tolerance, compassion and solidarity.99. One essential lesson learned from the HIV epidemic is thatuniversally recognized human rights standards should guidepolicymakers in formulating the direction and content of HIVrelatedpolicy and form an integral part of all aspects of nationaland local responses to HIV.A. Human rights standards and the nature of Stateobligations100. The Vienna Declaration and Programme of Action, adoptedat the World Conference on Human Rights in June 1993, 37affirmed that all human rights are universal, indivisible,interdependent and interrelated. While the significance ofnational and regional particularities and various historical,cultural and religious backgrounds must be borne in mind,States have the duty, regardless of their political, economicand cultural systems, to promote and protect universal humanrights standards and fundamental freedoms.101. A human rights approach to HIV is, therefore, based on theseState obligations with regard to human rights protection.HIV demonstrates the indivisibility of human rights since therealization of economic, social and cultural rights, as well as37A/CONF.157/24 (Part I), chap. III.79

UNAIDSOHCHRcivil and political rights, is essential to an effective response.Furthermore, a rights-based approach to HIV is grounded inconcepts of human dignity and equality which can be foundin all cultures and traditions.102. The key human rights principles which are essential toeffective State responses to HIV are to be found in existinginternational instruments, such as the Universal Declarationof Human Rights, the <strong>International</strong> Covenants on Economic,Social and Cultural Rights and on Civil and PoliticalRights, the <strong>International</strong> Convention on the Eliminationof All Forms of Racial Discrimination, the Conventionon the Elimination of All Forms of Discrimination againstWomen, the Convention against Torture and Other Cruel,Inhuman or Degrading Treatment or Punishment and theConvention on the Rights of the Child. Regional instruments,namely the American Convention on Human Rights, theEuropean Convention for the Protection of Human Rightsand Fundamental Freedoms and the African Charter onHuman and Peoples’ Rights also enshrine State obligationsapplicable to HIV. In addition, a number of conventions andrecommendations of the <strong>International</strong> Labour Organizationare particularly relevant to the problem of HIV, such as ILOinstruments concerning discrimination in employmentand occupation, termination of employment, protection ofworkers’ privacy, and safety and health at work. Among thehuman rights principles relevant to HIV/AIDS are, inter alia:The right to non-discrimination, equal protection andequality before the law;The right to life;The right to the highest attainable standard of physical andmental health;80

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsThe right to liberty and security of person;The right to freedom of movement;The right to seek and enjoy asylum;The right to privacy;The right to freedom of opinion and expression and theright to freely receive and impart information;The right to freedom of association;The right to work;The right to marry and to found a family;The right to equal access to education;The right to an adequate standard of living;The right to social security, assistance and welfare;The right to share in scientific advancement and its benefits;The right to participate in public and cultural life;The right to be free from torture and cruel, inhuman ordegrading treatment or punishment.103. Particular attention should be paid to human rights of childrenand women.B. Restrictions and limitations104. Under international human rights law, States may imposerestrictions on some rights, in narrowly defined circumstances,if such restrictions are necessary to achieve overriding goals,such as public health, the rights of others, morality, publicorder, the general welfare in a democratic society and nationalsecurity. Some rights are non-derogable and cannot berestricted under any circumstances. 38 In order for restrictions38These include the right to life, freedom from torture, freedom from enslavement or servitude,protection from imprisonment for debt, freedom from retroactive penal laws, theright to recognition as a person before the law and the right to freedom of thought, conscienceand religion.81

UNAIDSOHCHRon human rights to be legitimate, the State must establish thatthe restriction is:(a) Provided for and carried out in accordance with the law,i.e. according to specific legislation which is accessible,clear and precise, so that it is reasonably foreseeable thatindividuals will regulate their conduct accordingly;(b) Based on a legitimate interest, as defined in the provisionsguaranteeing the rights;(c) Proportional to that interest and constituting the leastintrusive and least restrictive measure available andactually achieving that interest in a democratic society, i.e.established in a decision-making process consistent with therule of law. 39105. Public health is most often cited by States as a basis forrestricting human rights in the context of HIV. Many suchrestrictions, however, infringe on the principle of nondiscrimination,for example when HIV status is used asthe basis for differential treatment with regard to access toeducation, employment, health care, travel, social security,housing and asylum. The right to privacy is known tohave been restricted through mandatory testing and thepublication of HIV status and the right to liberty of person isviolated when HIV is used to justify deprivation of liberty orsegregation. Although such measures may be effective in thecase of diseases which are contagious by casual contact andsusceptible to cure, they are ineffective with regard to HIVsince HIV is not casually transmitted. In addition, such coercivemeasures are not the least restrictive measures possible and39P. Sieghart, AIDS and Human Rights: A UK Perspective, British Medical AssociationFoundation for AIDS, London, 1989, pp. 12-25.82

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsare often imposed discriminatorily against already vulnerablegroups. Finally, and as stated above, these coercive measuresdrive people away from prevention and care programmes,thereby limiting the effectiveness of public health outreach. Apublic health exception is, therefore, seldom a legitimate basisfor restrictions on human rights in the context of HIV.C. The application of specific human rights in thecontext of the HIV epidemic106. Examples of the application of specific human rights to HIVare illustrated below. These rights should not be consideredin isolation but as interdependent rights supporting the<strong>Guidelines</strong> elaborated in this document. In the applicationof these rights, the significance of national and regionalparticularities and various historical, cultural and religiousbackgrounds must be taken into consideration. It remains theduty of States, however, to promote and protect all humanrights within their cultural contexts.1. NON-DISCRIMINATION AND EQUALITYBEFORE THE LAW107. <strong>International</strong> human rights law guarantees the right to equalprotection before the law and freedom from discriminationon any ground such as race, colour, sex, language, religion,political or other opinion, national or social origin, property,birth or other status. Discrimination on any of these grounds isnot only wrong in itself but also creates and sustains conditionsleading to societal vulnerability to infection by HIV, includinglack of access to an enabling environment that will promotebehavioural change and enable people to cope with HIV.Groups suffering from discrimination, which also disables83

UNAIDSOHCHRthem in the context of HIV, are women, children, those livingin poverty, minorities, indigenous people, migrants, refugeesand internally displaced persons, people with disabilities,prisoners, sex workers, men having sex with men and injectingdrug users. Responses by States to the epidemic shouldinclude the implementation of laws and policies to eliminatesystemic discrimination, including where it occurs againstthese groups.108. The Commission on Human Rights has confirmed that “otherstatus” in non-discrimination provisions is to be interpretedto include health status, including HIV/AIDS. 40 This meansthat States should not discriminate against people living withHIV or members of groups perceived to be at risk of infectionon the basis of their actual or presumed HIV status. 41109. The Human Rights Committee has confirmed that the rightto equal protection of the law prohibits discrimination in lawor in practice in any fields regulated and protected by publicauthorities and that a difference in treatment is not necessarilydiscriminatory if it is based on reasonable and objectivecriteria. The prohibition against discrimination thus requiresStates to review and, if necessary, repeal or amend their laws,policies and practices to proscribe differential treatment whichis based on arbitrary HIV-related criteria. 4240See, inter alia, Commission on Human Rights resolutions 1995/44 of 3 March 1995 and1996/43 of 19 April 1996.41Other groups singled out for discriminatory measures in the context of HIV, such asmandatory screening, are the military, the police, peacekeeping forces, pregnant women,hospital patients, tourists, performers, people with haemophilia, tuberculosis or sexuallytransmitted diseases (STDs), truck drivers and scholarship-holders. Their partners, families,friends and care providers may also be subject to discrimination based on presumed HIVstatus.42Human Rights Committee, General Comment No. 18 (37). Official Records of the GeneralAssembly, Forty-fifth Session, Supplement No. 40 (A/45/40), vol. I, annex VI A.84

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights2. HUMAN RIGHTS OF WOMEN110. Discrimination against women, de facto and de jure, rendersthem disproportionately vulnerable to HIV and AIDS.Women’s subordination in the family and in public life is oneof the root causes of the rapidly increasing rate of infectionamong women. Systematic discrimination based on genderalso impairs women’s ability to deal with the consequences oftheir own infection and/or infection in the family, in social,economic and personal terms. 43111. With regard to prevention of infection, the rights of womenand girls to the highest attainable standard of physical andmental health, to education, to freedom of expression, tofreely receive and impart information, should be applied toinclude equal access to HIV-related information, education,means of prevention and health services. However, evenwhen such information and services are available, women andgirls are often unable to negotiate safer sex or to avoid HIVrelatedconsequences of the sexual practices of their husbandsor partners as a result of social and sexual subordination,economic dependence on a relationship and cultural attitudes.The protection of the sexual and reproductive rights ofwomen and girls is, therefore, critical. This includes the rightsof women to have control over and to decide freely andresponsibly, free of coercion, discrimination and violence,on matters related to their sexuality, including sexual andreproductive health. 44 Measures for the elimination of sexual43See report of the Expert Group Meeting on Women and HIV/AIDS and the Role ofNational Machinery for the Advancement of Women, convened by the Division for theAdvancement of Women, Vienna, 24-28 September 1990 (EGM/AIDS/1990/1).44Beijing Declaration and Platform for Action, Fourth World Conference on Women, Beijing,4/5 September 1995 (A/CONF.177/20).85

UNAIDSOHCHRviolence and coercion against women in the family andin public life not only protect women from human rightsviolations but also from HIV infection that may result fromsuch violations.112. Violence against women in all its forms during peacetimeand in conflict situations increases their vulnerability to HIVinfection. Such violence includes, inter alia, sexual violence,rape (marital and other) and other forms of coerced sex, aswell as traditional practices affecting the health of women andchildren. States have an obligation to protect women fromsexual violence in both public and private life.113. Furthermore, in order to empower women to leaverelationships or employment which threaten them withHIV infection and to cope if they or their family membersare infected with HIV, States should ensure women’s rightsto, inter alia, legal capacity and equality within the family, inmatters such as divorce, inheritance, child custody, propertyand employment rights, in particular, equal remunerationof men and women for work of equal value, equal access toresponsible positions, measures to reduce conflicts betweenprofessional and family responsibilities and protection againstsexual harassment at the workplace. Women should also beenabled to enjoy equal access to economic resources, includingcredit, an adequate standard of living, participation in publicand political life and to benefits of scientific and technologicalprogress so as to minimize risk of HIV infection.114. HIV prevention and care for women are often underminedby pervasive misconceptions about HIV transmission andepidemiology. There is a tendency to stigmatize women as“vectors of disease”, irrespective of the source of infection. As86

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsa consequence, women who are or are perceived to be HIVpositiveface violence and discrimination in both public andin private life. Sex workers often face mandatory testing withno support for prevention activities to encourage or requiretheir clients to wear condoms and with little or no access tohealth-care services. Many HIV programmes targeting womenare focused on pregnant women but these programmes oftenemphasize coercive measures directed towards the risk oftransmitting HIV to the foetus, such as mandatory pre- andpost-natal testing followed by coerced abortion or sterilization.Such programmes seldom empower women to preventperinatal transmission by prenatal prevention education and anavailable choice of health services and overlook the care needsof women.115. The Convention on the Elimination of All Forms ofDiscrimination against Women obliges States parties to addressall aspects of gender-based discrimination in law, policy andpractice. States are also required to take appropriate measuresto modify social and cultural patterns which are based onideas of superiority/inferiority and stereotyped roles formen and women. The Committee on the Elimination ofDiscrimination against Women (CEDAW), which monitorsthe Convention has underscored the link between women’sreproductive role, their subordinate social position and theirincreased vulnerability to HIV infection. 4545CEDAW, general recommendation No. 15 (ninth session, 1990). Official Records of theGeneral Assembly, Forty-fifth Session, Supplement No. 38 (A/45/38), chap. IV.87

UNAIDSOHCHR3. HUMAN RIGHTS OF CHILDREN116. The rights of children are protected by all international humanrights instruments and, in particular, under the Conventionon the Rights of the Child, which establishes an internationaldefinition of the child as “every human being below the ageof eighteen years unless under the law applicable to the child,majority is attained earlier” (art. 1). The Convention reaffirmsthat children are entitled to many of the rights that protectadults (e.g. the rights to life, non-discrimination, integrity ofthe person, liberty and security, privacy, asylum, expression,association and assembly, education and health), in addition toparticular rights for children established by the Convention.117. Many of these rights are relevant to HIV prevention, careand support for children, such as freedom from trafficking,prostitution, sexual exploitation and sexual abuse since sexualviolence against children, among other things, increases theirvulnerability to HIV. The freedom to seek, receive and impartinformation and ideas of all kinds and the right to educationprovide children with the right to give and receive all HIVrelatedinformation needed to avoid infection and to copewith their status, if infected. The right to special protectionand assistance if deprived of his or her family environment,including alternative care and protection in adoption, inparticular protects children if they are orphaned by HIV. Theright of disabled children to a full and decent life and to specialcare and the rights to abolition of traditional practices whichare prejudicial to the health of children, such as early marriage,female genital mutilation, denial of equal sustenance andinheritance for girls are also highly relevant in the context ofHIV. Under the Convention, the right to non-discriminationand privacy for children living with HIV and finally the rights88

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsof children to be actors in their own development and toexpress opinions and have them taken into account in makingdecisions about their lives should empower children to beinvolved in the design and implementation of HIV-relatedprogrammes for children.4. RIGHT TO MARRY AND TO FOUND A FAMILY ANDPROTECTION OF THE FAMILY118. The right to marry and to found a family encompasses theright of “men and women of full age, without any limitationdue to race, nationality or religion,…to marry and to found afamily”, to be “entitled to equal rights as to marriage, duringmarriage and at its dissolution” and to protection by societyand the State of the family as “the natural and fundamentalgroup unit of society”. 46 Therefore, it is clear that the right ofpeople living with HIV is infringed by mandatory pre-maritaltesting and/or the requirement of “AIDS-free certificates” asa precondition for the grant of marriage licences under Statelaws. 47 Secondly, forced abortions or sterilization of HIVinfectedwomen violates the human right to found a family, aswell as the right to liberty and integrity of the person. Womenshould be provided with accurate information about the riskof perinatal transmission to support them in making voluntary,informed choices about reproduction. 48 Thirdly, measuresto ensure the equal rights of women within the family are46Article 16 of the Universal Declaration of Human Rights.47People living with HIV should be able to marry and engage in sexual relations whose naturedoes not impose a risk of infection on their partners. People living with HIV, like all peoplewho know or suspect that they are HIV-positive, have a responsibility to practise abstinenceor safer sex in order not to expose others to infection.48The chances of an HIV-infected woman giving birth to an HIV-positive baby is approximately1 in 3. This rate may be significantly reduced if the woman is able to undergo pre-andpost-natal treatment with antiretrovirals. Since extremely difficult and complex ethical andpersonal decisions are involved, the choice to have a child should be left to the woman,with input from her partner, if possible.89

UNAIDSOHCHRnecessary to enable women to negotiate safe sex with theirhusbands/ partners or be able to leave the relationship if theycannot assert their rights (see also “Human rights of women”above). Finally, recognition of the family as the fundamentalunit of society is undermined by policies which have theeffect of denying family unity. In the case of migrants, manyStates do not allow migrants to be accompanied by familymembers, and the resulting isolation can increase vulnerabilityto HIV infection. In the case of refugees, mandatory testingas a precondition of asylum can result in HIV-positive familymembers being denied asylum while the rest of the family isgranted asylum.5. RIGHT TO PRIVACY119. Article 17 of the <strong>International</strong> Covenant on Civil and PoliticalRights provides that “No one shall be subjected to arbitraryor unlawful interference with his privacy, family, home orcorrespondence, nor to unlawful attacks on his honour andreputation. Everyone has the right to the protection of thelaw against such interference or attacks”. The right to privacyencompasses obligations to respect physical privacy, includingthe obligation to seek informed consent to HIV testingand privacy of information, including the need to respectconfidentiality of all information relating to a person’s HIVstatus.120. The individual’s interest in his/her privacy is particularlycompelling in the context of HIV, firstly, in view of theinvasive character of a mandatory HIV test and, secondly,by reason of the stigma and discrimination attached to theloss of privacy and confidentiality if HIV status is disclosed.The community has an interest in maintaining privacy so90

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsthat people will feel safe and comfortable in using publichealth measures, such as HIV prevention and care services.The interest in public health does not justify mandatory HIVtesting or registration, except in cases of blood/organ/tissuedonations where the human product, rather than the person, istested before use on another person. All information on HIVsero-status obtained during the testing of donated blood ortissue must also be kept strictly confidential.121. The duty of States to protect the right to privacy, therefore,includes the obligation to guarantee that adequate safeguardsare in place to ensure that no testing occurs without informedconsent, that confidentiality is protected, particularly in healthand social welfare settings, and that information on HIV statusis not disclosed to third parties without the consent of theindividual. In this context, States must also ensure that HIVrelatedpersonal information is protected in the reporting andcompilation of epidemiological data and that individuals areprotected from arbitrary interference with their privacy in thecontext of media investigation and reporting.122. In societies and cultures where traditions place greateremphasis on the community, patients may more readilyauthorize the sharing of confidential information with theirfamily or community. In such circumstances, disclosure to thefamily or community may be for the benefit of the personconcerned and such shared confidentiality may not breach theduty to maintain confidentiality.123. The Human Rights Committee has found that the right toprivacy under article 17 of the <strong>International</strong> Covenant onCivil and Political Rights is violated by laws which criminalizeprivate homosexual acts between consenting adults. The91

UNAIDSOHCHRCommittee noted that “… the criminalization of homosexualpractices cannot be considered a reasonable means orproportionate measure to achieve the aim of preventing thespread of HIV/AIDS…by driving underground many of thepeople at risk of infection…[it] would appear to run counter to the implementationof effective education programmes in respect of theHIV/AIDS prevention”. 49124. The Committee also noted that the term “sex” in article 26of the Covenant which prohibits discrimination on variousgrounds includes “sexual orientation”. In many countries,there exist laws which render criminal particular sexual relationshipsor acts between consenting adults, such as adultery,fornication, oral sex and sodomy. Such criminalization notonly interferes with the right to privacy but it also impedesHIV/AIDS education and prevention work.6. RIGHT TO ENJOY THE BENEFITS OF SCIENTIFICPROGRESS AND ITS APPLICATIONS125. The right to enjoy the benefits of scientific progress and itsapplications is important in the context of HIV in view of therapid and continuing advances regarding testing, treatmenttherapies and the development of a vaccine. More basicscientific advances which are relevant to HIV concern thesafety of the blood supply from HIV infection and the useof universal precautions which prevent the transmission ofHIV in various settings, including that of health care. In thisconnection, however, developing countries experience severeresource constraints which limit not only the availability of49Human Rights Committee, Communication No. 488/1991, Nicholas Toonan v. Australia (viewsadopted on 31 March 1994, fiftieth session). Official Records of the General Assembly, FortyninthSession, Supplement No. 40 (A/49/40), vol. II, annex IX EE, para. 8.5.92

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightssuch scientific benefits but also the availability of basic painprophylaxis and antibiotics for the treatment of HIV-relatedconditions. Furthermore, disadvantaged and/or marginalizedgroups within societies may have no or limited access toavailable HIV-related treatments or to participation in clinicaland vaccine development trials. Of deep concern is the needto share equitably among States and among all groups withinStates basic drugs and treatment, as well as the more expensiveand complicated treatment therapies, where possible.7. RIGHT TO LIBERTY OF MOVEMENT126. The right to liberty of movement encompasses the rights ofeveryone lawfully within a territory of a State to liberty ofmovement within that State and the freedom to choose his/her residence, as well as the rights of nationals to enter andleave their own country. Similarly, an alien lawfully within aState can only be expelled by a legal decision with due processprotection.127. There is no public health rationale for restricting liberty ofmovement or choice of residence on the grounds of HIVstatus. According to current international health regulations,the only disease which requires a certificate for internationaltravel is yellow fever. 50 Therefore, any restrictions on theserights based on suspected or real HIV status alone, includingHIV screening of international travellers, are discriminatoryand cannot be justified by public health concerns.128. Where States prohibit people living with HIV from longertermresidency due to concerns about economic costs, Statesshould not single out HIV/AIDS, as opposed to comparable50WHO <strong>International</strong> Health Regulations (1969).93

UNAIDSOHCHRconditions, for such treatment and should establish that suchcosts would indeed be incurred in the case of the individualalien seeking residency. In considering entry applications,humanitarian concerns, such as family reunification and theneed for asylum, should outweigh economic considerations.8. RIGHT TO SEEK AND ENJOY ASYLUM129. Everyone has the right to seek and enjoy asylum frompersecution in other countries. Under the 1951 Conventionrelating to the Status of Refugees and under customaryinternational law, States cannot, in accordance with theprinciple of non-refoulement, return a refugee to a countrywhere she or he faces persecution. Thus, States may not returna refugee to persecution on the basis of his or her HIV status.Furthermore, where the treatment of people living with HIVcan be said to amount to persecution, it can provide a basis forqualifying for refugee status.130. The United Nations High Commissioner for Refugees issuedpolicy guidelines in March 1988 which state that refugees andasylum seekers should not be targeted for special measuresregarding HIV infection and that there is no justification forscreening being used to exclude HIV-positive individuals frombeing granted asylum. 51131. The Human Rights Committee has confirmed that the rightto equal protection of the law prohibits discrimination in lawor in practice in any fields regulated and protected by publicauthorities. 52 These would include travel regulations, entryrequirements, immigration and asylum procedures. Therefore,51UNHCR Health Policy on AIDS, 15 February 1988 (UNHCR/IDM).52Human Rights Committee, general comment No. 18 (37), op. cit.94

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsalthough there is no right of aliens to enter a foreigncountry or to be granted asylum in any particular country,discrimination on the grounds of HIV status in the context oftravel regulations, entry requirements, immigration and asylumprocedures would violate the right to equality before the law.9. RIGHT TO LIBERTY AND SECURITY OF PERSON132. Article 9 of the <strong>International</strong> Covenant on Civil and PoliticalRights provides that “Everyone has the right to liberty andsecurity of person. No one shall be subjected to arbitrary arrestor detention. No one shall be deprived of his liberty except onsuch grounds and in accordance with such procedures as areestablished by law”.133. The right to liberty and security of person should, therefore,never be arbitrarily interfered with, based merely on HIVstatus by using measures such as quarantine, detention inspecial colonies, or isolation. There is no public healthjustification for such deprivation of liberty. Indeed, it has beenshown that public health interests are served by integratingpeople living with HIV within communities and benefitingfrom their participation in economic and public life.134. In exceptional cases involving objective judgments concerningdeliberate and dangerous behaviour, restrictions on liberty maybe imposed. Such exceptional cases should be handled underordinary provisions of public health, or criminal laws, withappropriate due process protection.135. Compulsory HIV testing can constitute a deprivation ofliberty and a violation of the right to security of person. Thiscoercive measure is often utilized with regard to groups least95

UNAIDSOHCHRable to protect themselves because they are within the ambitof Government institutions or the criminal law, e.g. soldiers,prisoners, sex workers, injecting drug users and men who havesex with men. There is no public health justification for suchcompulsory HIV testing. Respect for the right to physicalintegrity requires that testing be voluntary and that no testingbe carried out without informed consent10. RIGHT TO EDUCATION136. Article 26 of the Universal Declaration of Human Rights statesin part that “Everyone has the right to education. …Educationshall be directed to the full development of the human personalityand to the strengthening of respect for human rights andfundamental freedoms. It shall promote understanding, toleranceand friendship…”. This right includes three broad componentswhich apply in the context of HIV/AIDS. Firstly, bothchildren and adults have the right to receive HIV-related education,particularly regarding prevention and care. Access to educationconcerning HIV is an essential life-saving component ofeffective prevention and care programmes. It is the State’s obligationto ensure, in every cultural and religious tradition, thatappropriate means are found so that effective HIV informationis included in educational programmes inside and outsideschools. The provision of education and information to childrenshould not be considered as promoting early sexual experimentation;rather, as studies indicate, it delays sexual activity. 53137. Secondly, States should ensure that both children and adultsliving with HIV are not discriminatorily denied access to53M. Alexander, “Information and Education Laws”, in Dr. Jayasuriya (ed.) HIV, Law, Ethics andHuman Rights, UNDP, New Delhi, 1995, p. 54. Impact of HIV and sexual health educationon the sexual behaviour of young people: a review update, UNAIDS, 1997.96

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightseducation, including access to schools, universities, scholarshipsand international education or subject to restrictions becauseof their HIV status. There is no public health rationale forsuch measures since there is no risk of transmitting HIVcasually in educational settings. Thirdly, States should, througheducation, promote understanding, respect, tolerance and nondiscriminationin relation to persons living with HIV.11. FREEDOM OF EXPRESSION AND INFORMATION138. Article 19 of the <strong>International</strong> Covenant on Civil and PoliticalRights states in part that “Everyone shall have the right tohold opinions without interference. …Everyone shall havethe right to freedom of expression; this right shall includethe freedom to seek, receive and impart information andideas of all kinds…”. This right, therefore, includes the rightto seek, receive and impart HIV-related prevention and careinformation. Educational material which may necessarilyinvolve detailed information about transmission risks and maytarget groups engaged in illegal behaviour, such as injectingdrug use and sexual activity between the same sexes, whereapplicable, should not be wrongfully subject to censorshipor obscenity laws or laws making those imparting theinformation liable for “aiding and abetting” criminal offences.States are obliged to ensure that appropriate and effectiveinformation on methods to prevent HIV transmission isdeveloped and disseminated for use in different multiculturalcontexts and religious traditions. The media should berespectful of human rights and dignity, specifically the right toprivacy, and use appropriate language when reporting on HIV.Media reporting on HIV should be accurate, factual, sensitiveand avoid stereotyping and stigmatization.97

UNAIDSOHCHR12. FREEDOM OF ASSEMBLY AND ASSOCIATION139. Article 20 of the Universal Declaration of Human Rightsprovides that “Everyone has the right to freedom of peacefulassembly and association”. This right has been frequentlydenied to non-governmental organizations working in thefield of human rights, AIDS service organizations (ASOs) andcommunity-based organizations (CBOs), with applications forregistration being refused as a result of their perceived criticismof Governments or of the focus of some of their activities, e.g.sex work. In general, non-governmental organizations andtheir members involved in the field of human rights shouldenjoy the rights and freedoms recognized in human rightsinstruments and the protection of national law. In the contextof HIV/AIDS, the freedom of assembly and association withothers is essential to the formation of HIV-related advocacy,lobby and self-help groups to represent interests and meet theneeds of various groups affected by HIV, including peopleliving with HIV. Public health and an effective response toHIV are undermined by obstructing interaction and dialoguewith and among such groups, other social actors, civil societyand Government.140. Furthermore, persons living with HIV should be protectedagainst direct or indirect discrimination based on HIV statusin their admission to organizations of employers or tradeunions, continuation as members and participation in theiractivities, in conformity with ILO instruments on freedomof association and collective bargaining. At the same time,workers’ and employers’ organizations can be important factorsin raising awareness on issues connected with HIV and indealing with its consequences in the workplace.98

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights13. RIGHT TO PARTICIPATION IN POLITICAL ANDCULTURAL LIFE141. Realization of the right to take part in the conduct ofpublic affairs, 54 as well as in cultural life, 55 is essential toguaranteeing participation by those most affected by HIVin the development and implementation of HIV-relatedpolicies and programmes. These human rights are reinforcedby the principles of participatory democracy; this assumes theinvolvement of people living with HIV and their families,women, children and groups vulnerable to HIV in designingand implementing programmes that will be most effectiveby being tailored to the specific needs of these groups. It isessential that people living with HIV remain fully integratedin the political, economic, social and cultural aspects ofcommunity life.142. People living with HIV have the right to their culturalidentity and to various forms of creativity, both as a meansof artistic expression and as a therapeutic activity. Increasingrecognition has been given to the expression of creativity as apopular medium for imparting HIV information, combatingintolerance, and as a therapeutic form of solidarity.14. RIGHT TO THE HIGHEST ATTAINABLE STANDARD OFPHYSICAL AND MENTAL HEALTH143. The right to the highest attainable standard of physical andmental health comprises, inter alia, “the prevention, treatmentand control of epidemic…diseases” and “the creation ofconditions which would assure to all medical service andmedical attention in the event of sickness”. 5654Article 25 of the <strong>International</strong> Covenant on Civil and Political Rights.55Article 15 of the <strong>International</strong> Covenant on Economic, Social and Cultural Rights.56Article 12 of the <strong>International</strong> Covenant on Economic, Social and Cultural Rights.99

UNAIDSOHCHR144. In order to meet these obligations in the context of HIV,States should ensure the provision of appropriate HIVrelatedinformation, education and support, including accessto services for sexually transmitted diseases, to the means ofprevention (such as condoms and clean injection equipment)and to voluntary and confidential testing with pre-and posttestcounselling, in order to enable individuals to protectthemselves and others from infection. States should alsoensure a safe blood supply and implementation of “universalprecautions” to prevent transmission in settings such ashospitals, doctors’ offices, dental practices and acupunctureclinics, as well as informal settings, such as during home births.145.States should also ensure access to adequate treatment anddrugs, within the overall context of their public healthpolicies, so that people living with HIV can live as long andas successfully as possible. People living with HIV shouldalso have access to clinical trials and should be free tochoose amongst all available drugs and therapies, includingalternative therapies. <strong>International</strong> support is essential fromboth the public and private sectors, for developing countriesfor increased access to health care and treatment, drugs andequipment. In this context, States should ensure that neitherexpired drugs nor other invalid materials are supplied.146. States may have to take special measures to ensure that allgroups in society, particularly marginalized groups, haveequal access to HIV-related prevention, care and treatmentservices. The human rights obligations of States to preventdiscrimination and to assure medical service and medicalattention for everyone in the event of sickness require States toensure that no one is discriminated against in the health-caresetting on the basis of their HIV status.100

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights15. RIGHT TO AN ADEQUATE STANDARD OF LIVING ANDSOCIAL SECURITY SERVICES147. Article 25 of the Universal Declaration of Human Rightsstates that “Everyone has the right to a standard of livingadequate for the health and well-being of himself and hisfamily, including food, clothing, housing and medical care andnecessary social services, and the right to security in the eventof unemployment, sickness, disability, widowhood, old age orother lack of livelihood in circumstances beyond his control”.Enjoyment of the right to an adequate standard of living isessential to reduce vulnerability to the risk and consequencesof HIV infection. It is particularly relevant to meeting theneeds of people living with HIV/AIDS, and/or their families,who have become impoverished by HIV/AIDS as a resultof increased morbidity due to AIDS and/or discriminationwhich can result in unemployment, homelessness and poverty.If States introduce priority ranking for such services forresource allocation purposes, then PLHAs and persons withcomparable conditions and disabilities should qualify forpreferential treatment due to their dire circumstances.148. States should take steps to ensure that people living with HIVare not discriminatorily denied an adequate standard of livingand/or social security and support services on the basis of theirhealth status.16. RIGHT TO WORK149. “Everyone has the right to work…[and] to just and favourableconditions of work”. 57 The right to work entails the rightof every person to access to employment without any57Article 23, of the Universal Declaration of Human Rights.101

UNAIDSOHCHRprecondition except the necessary occupational qualifications.This right is violated when an applicant or employee isrequired to undergo mandatory testing for HIV and is refusedemployment or dismissed or refused access to employeebenefits on the grounds of a positive result. States shouldensure that persons with living with HIV are allowed towork as long as they can carry out the functions of the job.Thereafter, as with any other illness, people living with HIVshould be provided with reasonable accommodation to beable to continue working as long as possible and, when nolonger able to work, be given equal access to existing sicknessand disability schemes. The applicant or employee shouldnot be required to disclose his or her HIV status to theemployer nor in connection with his or her access to workers’compensation, pension benefits and health insurance schemes.States’ obligations to prevent all forms of discrimination in theworkplace, including on the grounds of HIV, should extend tothe private sector.150. As part of favourable conditions of work, all employees havethe right to safe and healthy working conditions. “In the vastmajority of occupations and occupational settings, work doesnot involve a risk of acquiring or transmitting HIV betweenworkers, from worker to client, or from client to worker.” 58However, where a possibility of transmission does exist in theworkplace, such as in health-care settings, States should takemeasures to minimize the risk of transmission. In particular,workers in the health sector must be properly trained in universalprecautions for the avoidance of transmission of infectionand be supplied with the means to implement such procedures.58Consultation on AIDS and the Workplace (World Health Organization, in association withthe <strong>International</strong> Labour Organization), Geneva, 1988, sect. II, “Introduction”.102

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights17. FREEDOM FROM CRUEL, INHUMAN OR DEGRADINGTREATMENT OR PUNISHMENT151. The right to freedom from cruel, inhuman or degradingtreatment or punishment can arise in a variety of ways in thecontext of HIV, for example in the treatment of prisoners.152. Imprisonment is punishment by deprivation of liberty butshould not result in the loss of human rights or dignity. Inparticular, the State, through prison authorities, owes a duty ofcare to prisoners, including the duty to protect the rights tolife and to health of all persons in custody. Denial to prisonersof access to HIV-related information, education and meansof prevention (bleach, condoms, clean injection equipment),voluntary testing and counselling, confidentiality and HIVrelatedhealth care and access to and voluntary participation intreatment trials, could constitute cruel, inhuman or degradingtreatment or punishment. The duty of care also comprisesa duty to combat prison rape and other forms of sexualvictimization that may result, inter alia, in HIV transmission.153. Thus, all prisoners engaging in dangerous behaviour, includingrape and sexual coercion, should be subject to disciplinebased on their behaviour, without reference to their HIVstatus. There is no public health or security justification formandatory HIV testing of prisoners, nor for denying inmatesliving with HIV access to all activities available to the rest ofthe prison population. Furthermore, the only justificationfor segregation of people living with HIV from the prisonpopulation would be for the health of themselves. Prisonerswith terminal diseases, including AIDS, should be consideredfor early release and given proper treatment outside prison.103

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsANNEX IHistory of the recognition of the importance ofhuman rights in the context of HIV1. The World Health Organization (WHO) held an <strong>International</strong>Consultation on Health Legislation and Ethics in the Fields ofHIV/AIDS in April 1988 at Oslo. It advocated bringing downbarriers between people who were infected and those whowere not infected and placing actual barriers (e.g. condoms)between individuals and the virus. On 13 May 1988, theWorld Health Assembly passed resolution WHA41.24 entitled“Avoidance of discrimination in relation to HIV-infectedpeople and people with AIDS”, which underlined how vitalrespect for human rights was for the success of national AIDSprevention and control programmes and urged member Statesto avoid discriminatory action in the provision of services,employment and travel. In July 1989, the first internationalconsultation on AIDS and human rights was organized by thethen United Nations Centre for Human Rights, in cooperationwith the World Health Organization/GPA. The report of theconsultation highlighted the human rights issues raised inthe context of HIV/AIDS and proposed the elaboration ofguidelines. Resolution WHA45.35 of 14 May 1992 recognizedthat there is no public health rationale for measures whicharbitrarily limit individual rights, such as mandatory screening.In 1990, the World Health Organization conducted regionalworkshops on the legal and ethical aspects of HIV/AIDS atSeoul, Brazzaville and New Delhi. The first of these workshopsdeveloped guidelines to evaluate current and elaborate105

UNAIDSOHCHRfuture legal measures for the control of HIV to be used as acheck-list by countries considering legal policy issues. 59 InNovember 1991, the WHO Regional Office for Europe andthe <strong>International</strong> Association of Rights and Humanity held aPan-European Consultation on HIV/AIDS in the Contextof Public Health and Human Rights in Prague, whichconsidered the Rights and Humanity Declaration and Charterand developed a consensus statement (the Prague Statement).Three further consultations on HIV, law and law reform wereconvened during 1995 by the WHO Regional Office forEurope, for countries in Eastern Europe and Central Asia.2. The United Nations Development Programme held Inter-Country Consultations on Ethics, Law and HIV in Cebu(Philippines) in May 1993 and in Dakar, in June 1994. 60Both of these consultations produced consensus documentsreaffirming a commitment to voluntarism, ethics and thehuman rights of those affected (the Cebu Statement of Beliefand the Dakar Declaration). UNDP also held RegionalTraining Workshops on HIV Law and Law Reform in Asia andthe Pacific at Colombo, Beijing and Nadi (Fiji) in 1995.3. Law reform programmes focusing on human rights havebeen ongoing in countries such as Australia, Canada, theUnited States, South Africa and in the Latin American region,together with networks of legal advocates, practitioners andactivists at governmental and community levels. One concreteachievement of such groups has been the successful lobbyingfor general anti-discrimination legislation at national and locallevels which defines disability broadly and sensitively enough to59See WHO document RS/90/GE/11(KOR).60R. Glick (ed.), Inter-Country Consultation on Ethics, Law and HIV (Cebu), New Delhi, India,1995; UNDP, Inter-Country Consultation on Ethics, Law and HIV, Dakar, Senegal, 1995.106

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rightsexplicitly include HIV/AIDS. Such civil legislation exists in theUnited States, the United Kingdom, Australia, New Zealandand Hong Kong. In France, such a definition is contained inthe Penal Code. Some countries have constitutional guaranteesof human rights with practical enforcement mechanisms, suchas the Canadian Charter of Rights.4. The United Nations General Assembly, in its resolutions45/187 of 21 December 1990 and 46/203 of 20 December1991, emphasized the need to counter discrimination andto respect human rights and recognized that discriminatorymeasures drove HIV/AIDS underground, making it moredifficult to combat, rather than stopping its spread. The SpecialRapporteur of the United Nations Sub-Commission onPrevention of Discrimination and Protection of Minorities ondiscrimination against HIV-infected people and people livingwith AIDS presented a series of reports to the Sub-Commissionbetween 1990 and 1993. 61 The Special Rapporteur’s reportshighlighted the need for education programmes to createa genuine climate of respect for human rights in order toeradicate discriminatory practices which are contrary tointernational law. The right to health can only be implementedby advising people of the means of prevention and the SpecialRapporteur made specific reference to the vulnerable situationof women and children in the spread of HIV. Since 1989, theSub-Commission, at its annual sessions, has adopted resolutionson discrimination against people living with HIV. 6261E/CN.4/Sub.2/1990/9, E/CN.4/Sub.2/1991/10, E/CN.4/Sub.2/1992/10 and E/CN.4/Sub.2/1993/9.62Sub-Commission resolutions and decisions 1989/17, 1990/118, 1991/109, 1992/108,1993/31, 1994/29, 1995/21, 1996/33, 1997/40.107

UNAIDSOHCHR5. The United Nations Commission on Human Rights, atits annual sessions since 1990, has also adopted numerousresolutions on human rights and HIV which, inter alia, confirmthat discrimination on the basis of HIV/AIDS status, actual orpresumed, is prohibited by existing international human rightsstandards and clarify that the term “or other status” used in thenon-discrimination clauses of such texts “should be interpretedto include health status, such as HIV/AIDS”. 636. There have also been prestigious academic international studiesof HIV and human rights: these include the work of the latePaul Sieghart for the British Medical Association Foundationfor AIDS; 64 the François-Xavier Bagnoud Center for Healthand Human Rights, Harvard School of Public Health; 65 the<strong>International</strong> Federation of Red Cross and Red CrescentSocieties; the National Advisory Committee on AIDS inCanada; 66 the Pan-American Health Organization (PAHO); 67the Swiss Institute of Comparative Law; 68 by the Danish Centreon Human Rights 69 and by the Georgetown/Johns HopkinsUniversity Program in Law and Public Health. 7063Commission on Human Rights resolutions 1990/65, 1992/56, 1993/53, 1994/49, 1995/44and 1996/43. Relevant reports of the Secretary-General submitted to the Commission onHuman Rights are E/CN.4/1995/45 and E/CN.4/1996/44 and E/CN.4/1997/37.64P. Sieghart, op. cit.65<strong>International</strong> Federation of the Red Cross and Red Crescent Societies, AIDS, Health andHuman Rights: An Explanatory Manual, Geneva, 1995. See, in particular, p. 43 on the Four-Step Impact Assessment of Public Health and Human Rights.66HIV and Human Rights in Canada, submitted to the Minister of National Health andWelfare, January 1992.67PAHO, Ethics and Law in the Study of AIDS, Scientific Publication No. 530, Washington,D.C., 1992.68Swiss Institute of Comparative Law (Lausanne), Comparative Study on Discrimination ofPersons Infected with HIV or Suffering from AIDS, Council of Europe, Steering Committeefor Human Rights, CDDH (92) 14 Rev. Bil., Strasbourg, September 1992.69Danish Centre on Human Rights, AIDS and Human Rights, Akademisk Forlag, Copenhagen,1988.70L. Gostin and Z. Lazzarini, Public Health and Human Rights in the HIV Pandemic, OxfordUniversity Press, 1997.108

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights7. Numerous charters and declarations which specificallyor generally recognize the human rights of people livingwith HIV have been adopted at national and internationalconferences and meetings, including the following:London Declaration on AIDS Prevention, World Summit ofMinisters of Health, 28 January 1988;Paris Declaration on Women, Children and AIDS, 30 March1989;Recommendation on the Ethical Issues of HIV Infectionin the Health Care and Social Settings, Committee ofMinisters of the Council of Europe, Strasbourg, October1989 (Rec. 89/14);Council of Europe, Committee of Ministers,Recommendation R(87) 25 to member States concerninga common European public health policy to fight AIDS,Strasbourg, 1987;European Union, European Parliament and CouncilDecisions on “Europe Against AIDS” programme (includingdec. 91/317/EEC and dec. 1279/95/EC);Declaration of Basic Rights of Persons with HIV/AIDS,Organizing Committee of the Latin American Networkof Community-Based Non-Governmental OrganizationsFighting AIDS, November 1989;Declaration of the Rights of the People with HIV andAIDS, United Kingdom, 1991;Australian Declaration of the Rights of People with HIV/AIDS, National Association of People Living with HIV/AIDS, 1991;Prague Statement, Pan-European Consultation on HIV/AIDS in the Context of Public Health and Human Rights,November 1991;109

UNAIDSOHCHRRights and Humanity Declaration and Charter on HIVand AIDS, United Nations Commission on Human Rights,1992; 71 South African AIDS Consortium Charter of Rightson AIDS and HIV, 1 December 1992;Cebu Statement of Belief, UNDP Inter-CountryConsultations on Ethics, Law and HIV, the Philippines, May1993;Dakar Declaration, UNDP Inter-Country Consultations onEthics, Law and HIV, Senegal, July 1994;Phnom Penh Declaration on Women and Human Rightsand the Challenge of HIV/AIDS, Cambodia, November1994;Paris Declaration, World AIDS Summit, Paris, 1 December1994;Malaysian AIDS Charter: Shared Rights, SharedResponsibilities, 1995;Chiang Mai Proposal on Human Rights and Policy forPeople with HIV/AIDS, submitted to the Royal ThaiGovernment, September 1995;Asia-Pacific Council of AIDS Service Organization'sCompact on Human Rights, September 1995;Montréal Manifesto of the Universal Rights and Needs ofPeople Living with HIV Disease;Copenhagen Declaration on Social Development andProgramme of Action of the World Summit for SocialDevelopment, March 1995;New Delhi Declaration and Action Plan on HIV/AIDS,Interdisciplinary <strong>International</strong> Conference: AIDS, Law andHumanity, December 1995.71E/CN.4/1992/82, annex.110

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human Rights8. The formulation of the present <strong>Guidelines</strong> is a culminationof these international, regional and national activities andan attempt to draw on the best features of the documentsdescribed above, whilst also focusing on strategic action plans toimplement them. It has been noted that, although some positivemeasures at the national level to promote and protect humanrights in the context of HIV/AIDS are in place, a dramatic gapexists between professed policy and implementation on theground. 72 It is hoped that these <strong>Guidelines</strong>, as a practical toolfor States in designing, coordinating and implementing theirnational HIV policies and strategies, will assist in closing the gapbetween principles and practice and be instrumental in creatinga rights-based and effective response to HIV.72See E/CN.4/1995/45 and E/CN.4/1996/44.111

UNAIDSOHCHRANNEX IIChairList of participants of the Second <strong>International</strong>Consultation on HIV/AIDS and Human RightsGeneva, 23-25 September 1996Michael KirbyJudge of the High Court of Australia, CanberraParticipantsAisha Bhatti [Rights and Humanity, London] ■ Edgar Carrasco[Acción Ciudadana contra el SIDA (ACCSI), Caracas] ■ DavidChipanta [Network of African People living with HIV/AIDS(NAP+), Lusaka] ■ Isabelle Defeu [<strong>International</strong> Communityof Women Living with HIV/AIDS (ICW+), London]■ Lawrence Gostin [Georgetown University, Law Center,Washington] ■ Anand Grover [Lawyers Collective, Bombay]■ Meskerem Grunitzki-Bekele [National AIDS Programme,Lomé] ■ Julia Hausermann [Rights and Humanity, London]■ Mark Heywood [AIDS Law Project, Centre for AppliedLegal Studies, University of Witwatersrand, Witwatersrand]■ Babes Igancio [ALTERLAW, Manila] ■ Ralph Jurgens[Canadian HIV/AIDS Legal Network, Montréal] ■ YuriKobyshcha [National Anti-AIDS Committee, Kiev] ■ JoanneMariner [Human Rights Watch, New York] ■ Shaun Mellors[Global Network of People Living with HIV/AIDS (GNP+),Amsterdam] ■ Ken Morrison [<strong>International</strong> Council of AIDSService Organisations (ICASO), Vancouver] ■ Galina Musat[Asociatia Romana Anti-SIDA (ARAS), Bucharest] ■ SylviaPanebianco [Consejo Nacional de Prevención y Control del112

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsSIDA (CONASIDA), Mexico City] ■ Alissar Rady [NationalAIDS Programme, Beirut] ■ Eric Sawyer [HIV/AIDS HumanRights Project, New York] ■ Aurea Celeste Silva Abbade[Grupo de Apoio a Prevencao a AIDS, Sao Paolo] ■ DonnaSullivan [François-Xavier Bagnoud Center for Healthand Human Rights, Boston/New York] ■ El Hadj (As) Sy[AFRICASO, Dakar] ■ Helen Watchirs [Australian Attorney-General’s Department, Barton] ■ Martin Vazquez Acuña[RED-LAC, Buenos Aires]ObserversJane Connors [Division for the Advancement of Women,United Nations Headquarters] ■ Sev Fluss [World HealthOrganization, Geneva] ■ Angela Krehbiel [NGO LiaisonOffice, United Nations Office at Geneva] ■ Lesley Miller[United Nations Children’s Fund (UNICEF), Geneva] ■ DavidPatterson [United Nations Development Programme (UNDP),New York] ■ Mari Sasaki [United Nations Population Fund(UNFPA), Geneva] ■ Frank Steketee [Council of Europe,Strasbourg] ■ Janusz Symonides [United Nations Scientific,Cultural and Educational Organization (UNESCO), Paris]■ Benjamin Weil [United Nations Development Programme(UNDP), Dakar]OthersGeneviève Jourdan [Women’s <strong>International</strong> League for Peaceand Freedom, Geneva] ■ James Sloan [<strong>International</strong> Servicefor Human Rights, Geneva] ■ Jacek Tyszko [PermanentMission of Poland to the United Nations Office at Geneva]113

UNAIDSOHCHRANNEX IIIChairList of participants of the Third <strong>International</strong>Consultation on HIV/AIDS and Human RightsGeneva, 25-26 July 2002Michael KirbyJudge of the High Court of Australia, CanberraParticipantsJavier Luis Hourcade Bellocq [Red Latinoamericana dePersonas Viviendo con el VIH/SIDA RED LA+, Buenos Aires]■ Pascale Boulet [Médecins Sans Frontières, Paris] ■ RichardBurzynski [<strong>International</strong> Council of AIDS Service Organization,Toronto] ■ Edwin Cameron [Judge of the Supreme Court ofAppeal, Bloemfontein] ■ Edgar Carrasco [Acción CiudadanaContra el SIDA (ACCSI) and Latin America and the CaribbeanAIDS Service Organization, Caracas] ■ Joanne Csete [HumanRights Watch, New York] ■ Mandeep Dhaliwal [<strong>International</strong>HIV/AIDS Alliance, London] ■ Vivek Divan [LawyersCollective, New Delhi] ■ Richard Elliott [Canadian HIV/AIDS Legal Network, Montréal] ■ Michaela Figueira [AIDSLaw Unit, Legal Assistance Centre, Windhoek] ■ CharlesGilks [World Health Organization, Geneva] ■ Sofia Gruskin[François-Xavier Bagnoud Center for Health and HumanRights, Harvard School for Public Health, Boston] ■ MarkHeywood [Treatment Action Campaign (TAC), Centrefor Applied Legal Studies, University of the Witwatersrand,Witwatersrand] ■ Ralf Jürgens [Canadian HIV/AIDS Legal114

<strong>International</strong> <strong>Guidelines</strong>on HIV/AIDS and Human RightsNetwork, Montréal] ■ Esther Mayambala Kisaakye [UgandaNetwork on Human Rights, Ethics and Law, Kampala] ■ FelixMorka [Social and Economic Rights Action Centre, Lagos]■ Helen Watchirs [Research School of Social Sciences,Australian National University, Canberra] ■ Bretton Wong[Asia Pacific Network of People Living with HIV/AIDS(APN+), Singapore]115

The Office of the High Commissioner for Human Rights (OHCHR), a department of the United Nations Secretariat,is guided in its work by the mandate provided by the General Assembly in resolution 48/141, the Charter of theUnited Nations, the Universal Declaration of Human Rights and subsequent human rights instruments, the 1993Vienna Declaration and Programme of Action, and the 2005 World Summit Outcome Document. Operationally,OHCHR works with governments, legislatures, courts, national institutions, civil society, regional and internationalorganizations, and the United Nations system to develop and strengthen capacity, particularly at the nationallevel, for the protection of human rights in accordance with international norms. Institutionally, OHCHR iscommitted to strengthening the United Nations human rights programme and to providing it with the highestquality support. OHCHR is committed to working closely with its United Nations partners to ensure that humanrights form the bedrock of the work of the United Nations.The Joint United Nations Programme on HIV/AIDS (UNAIDS) brings together ten UN agencies in a commoneffort to fight the epidemic: the Office of the United Nations High Commissioner for Refugees (UNHCR), theUnited Nations Children’s Fund (UNICEF), the World Food Programme (WFP), the United Nations DevelopmentProgramme (UNDP), the United Nations Population Fund (UNFPA), the United Nations Office on Drugs andCrime (UNODC), the <strong>International</strong> Labour Organization (ILO), the United Nations Educational, Scientific andCultural Organization (UNESCO), the World Health Organization (WHO), and the World Bank.UNAIDS, as a cosponsored programme, unites the responses to the epidemic of its ten cosponsoringorganizations and supplements these efforts with special initiatives. Its purpose is to lead and assist anexpansion of the international response to HIV/AIDS on all fronts. UNAIDS works with a broad range ofpartners – governmental and nongovernmental, business, scientific and lay – to share knowledge, skills andbest practices across boundaries.Produced with environment-friendly materials

UNITED NATIONSUNAIDS20 AVENUE APPIACH-1211 GENEVA 27SWITZERLANDTel: (+41) 22 791 36 66Fax: (+41) 22 791 41 87e-mail: bestpractice@unaids.orgwww.unaids.orgOHCHRPALAIS DES NATIONSCH-1211 GENEVA 10SWITZERLANDTel: (+41) 22 917 9000Fax: (+41) 22 917 9008publications@ohchr.orgwww.ohchr.org