Global HIV/AIDS response, shows human rights is path to success against COVID-19
The global response to the HIV/AIDS epidemic found success when it put human rights at the core of its efforts, a lesson of key importance to our present and future battle against COVID-19.
Twenty years ago in January 2000, for the first time ever, the UN Security Council labelled a health issue—the AIDS crisis—as a threat to international peace and security. The scale of the problem warranted the label—it went beyond the health and economic crises that affected countries faced. Today, COVID-19 has the potential for even worse, catastrophically destabilising effects.
As every country must now tackle the global COVID-19 pandemic, leaders and their citizens are grappling with what constitutes the most effective and appropriate response. The main public health demands of regular handwashing, physical distancing, and observing a lockdown represent almost insurmountable obstacles to poor, vulnerable, and overcrowded communities without access to running water or stable incomes. We are already seeing real time descriptions of desperate situations in many countries. Social and political volatilities are being exposed. Global inequalities are fast coming to the forefront.
So are human rights issues. Emergency responses cannot just involve a temporary derogation from certain human rights (e.g., the right to assembly). Fear and uncertainty is understandable, but adequate responses to the pandemic must engage with a broad range of human rights, including economic and social rights, because the COVID-19 pandemic is already a development issue. If this was not clear before, a new reality has dawned on us. With COVID-19, we now have the clearest evidence possible of the importance of these rights. For example, if states comply with the right to water and sanitation, it may save both their own and the global economy from collapse.
The COVID-19 pandemic is already a development issue.
We are, however, not in completely uncharted territory. We have a well-tested template to guide our public health response. One of the most important things we can do is to apply the hard-earned lessons from the global response to HIV/AIDS, with its many achievements over the last four decades.
And one key lesson stands out. The HIV/AIDS response had human rights, community engagement, and coalition-building at its heart—despite facing much resistance from states to this approach. But it was clear that the traditional and narrow medical approach alone, focusing only on diagnosis and treatment, would not suffice in tackling the HIV pandemic. From these foundations, institutional responses were built to strengthen health systems, with accountability and the goal of universal access as defining features. The human rights approach to HIV/AIDS engaged with the broad pallet of human rights, proving their deep inter-relatedness. This new approach, present already in the 1980s, signified something of a revolution for global health.
As one of the visionaries behind this move, the founder of the WHO Global Program on AIDS Jonathan Mann, explained in 1988:
“I would say that there has always been a human rights dimension to malaria, diarrheal disease, immunization and smallpox. But it was never really understood, it was never really seen and yet with AIDS we see perfectly clearly that if we don’t protect the rights of those who are infected we endanger us all—that the rights of everyone are protected by ensuring that the rights of some are protected.”
There was and is compelling evidence indicating that stigma and discrimination drove people away from prevention and care programmes. Embracing human rights was not just the right thing to do. It made public health interventions more effective and more humane at the same time. It made people living with HIV and demanding a life in dignity central to the response. However, in the late 1990s when the existence of life-saving HIV treatment came into the global equation, it raised new life-or-death questions about the nature of states’ human rights obligations, non-discrimination, and equality. Global gaps in access to treatment were massive and devastating. It spurred a new era of human rights activism to ensure access, and to ensure community engagement. The latter was essential because it allowed the development of treatment literacy—this became a decisive strategy to empower the average layperson to manage complex HIV treatment regimens and reap the benefits of scaling-up, even in resource poor settings, and make it sustainable.
The fact that well over 24 million people today are receiving life-saving HIV treatment is nothing short of remarkable—especially if one remembers the grim reality and outlook two decades ago (although we are still falling well short of universal coverage). However, the new COVID-19 pandemic shows us that we cannot be complacent with such achievements because we have not come far enough in realising the right to health and related human rights. Still, such achievements remind us of the level of ambition and investment needed today and how much is achievable if the political will exists.
Embracing human rights was not just the right thing to do. It made public health interventions more effective and more humane at the same time.
The human rights approach to HIV offered a powerful lens through which to expose stigma, discrimination, prejudice, and other violations, and linked these to the international legal obligations of states. This helped to define actions to address them. In the HIV/AIDS response, this was done with a continued focus on affected communities and key populations, such as LGBTQ persons, sex workers, drug users, people in detention, and others. Many hard battles have been fought over the years just to have these groups recognized in international agreed decisions and declarations. These battles were fought to allow public health evidence to win over discrimination and criminalisation. We need this x-ray quality of human rights to tackle the underlying vulnerabilities that societies face in the battle against COVID-19. These principled achievements from tackling HIV can guide the battle against COVID-19, including by extending protection and services to the homeless, migrants, refugees, and others.
HIV/AIDS revealed itself both as a public health emergency and as a development problem. The way the global HIV/AIDS response organised itself, with human rights values at its core, helped the international community bring the situation back from the brink of societal collapse caused by a combined health, economic, and security crisis. In this context, the HIV response taught us the enduring value and effectiveness of community engagement and human rights. States should renew their commitment to their human rights obligations and engage with communities, both as rights-holders and as partners to build the broadest possible coalitions in the fight against the COVID-19 pandemic.
Many have stated that with this new pandemic, we are entering a very different world. The economic and social impacts are yet untold. However, we can shape this new world. The lesson from the HIV/AIDS response is that dignity, anti-stigma, non-discrimination, treatment literacy, universal access, justice and public health are in themselves worldmaking concepts that can guide our action. We need to define such worldmaking concepts for the COVID-19 era to shape current trajectories for the better.
Steven L. B. Jensen is Senior Researcher at the Danish Institute for Human Rights and their HIV/AIDS expert. He worked for UNAIDS from 2003-2007. He is the author of the prize-winning book The Making of International Human Rights. The 1960s, Decolonization and the Reconstruction of Global Values (Cambridge University Press 2016) and co-editor of Histories of Global Inequality. New Perspectives (Palgrave 2019).