NEW YORK (TrustLaw) — Great medical strides have been made in the global fight against HIV/AIDS but they are often undermined by punitive laws and discriminatory local practices that prevent the most vulnerable people from accessing treatment and prevention programmes, a new UN-sponsored study shows.
In 2011, the number of new HIV infections and AIDS-related deaths around the world dropped to their lowest levels since the epidemic peaked in 1997, according to UNAIDS.
The rate of new HIV infections also fell 21 percent between 1997 and 2010 - in large part thanks to greater access to antiretroviral drug therapy, greater use of condoms and a later onset of sexual activity among young people.
Dr Shereen El Feki, vice-chair of the Global Commission on HIV and the Law, which prepared the study, told TrustLaw: "The irony is we're coming to grips in a clinical and scientific respect with the epidemic. But we also have an epidemic of bad laws."
Specifically, laws and practices that criminalise and discriminate against those at the highest risk of HIV infection - particularly men engaging in sex with other men, sex workers, transgender people and injecting drug users - drive people away from the prevention, testing and treatment necessary to combat HIV/AIDS and its spread, the report said.
The Global Commission on HIV and the Law, an independent group of 14 global leaders and experts, conducted more than 1,000 interviews in 140 countries over 18 months to produce its 150-page landmark study, "HIV and the Law: Risks, Rights and Health".
"This report may make a great many people uncomfortable—hopefully uncomfortable enough to take action," Fernando Henrique Cardoso, chair of the commission and former president of Brazil, wrote in his introduction to the report.
In the last three decades, over 30 million people have died of AIDS, 1.8 million in 2010 alone. Currently, 34 million people are living with HIV and 7,400 are newly infected daily, according to the report prepared by the Global Commission on HIV and the Law.
The report found that laws and customs that fail to protect women and girls from gender-based violence and economic and social inequalities increase their vulnerability to HIV infection.
These include laws and practices - like genital mutilation, denial of property and inheritance rights and marital rape - that undermine the ability of women and girls to negotiate safe sex and protect themselves from infection.
When women and girls can't protect themselves, the cost can be particularly high, El Feki said in a telephone interview from London.
"The overwhelming perception is that HIV is a function of illicit activity, somehow it's a function of sin. So, not only is the infection stigmatized, but the infected person as well. That stigma is multiplied when it comes to women," she said.
She noted that only 52 countries have laws against marital rape and that in some countries, including some in the Arab world, health workers can be arrested for providing condoms and condoms can be used as grounds for the arrest of female sex workers.
The study also points to "excessive intellectual property protections that hinder the production of low-cost medicines" and thus further impede access to treatment and prevention that saves lives.
The commission recommends development of an effective intellectual property regime for pharmaceuticals that is consistent with international human rights law and public health needs while still protecting the rights of drug companies.
"Bad laws should not be allowed to stand in the way of effective HIV responses," said a statement by Helen Clark, head of the United Nations Development Programme (UNDP), which supported the research on behalf of UNAIDS.
Among other laws the commission targets for reform and its recommendations:
--In more than 60 countries, it is a crime to expose another person to or transmit HIV, which discourages people from testing and disclosing their status. The commission recommends decriminalizing HIV transmission except in the relatively rare cases where it is intentional.
--Same-sex sexual activity is a crime in 78 countries, including Iran and Yemen which impose the death penalty for sex acts between men. Such laws discourage men from being tested, using preventive measures or seeking treatment. The commission recommends decriminalising consensual same-sex sexual relations.
--More than 100 countries criminalise some aspect of sex work, preventing workers from accessing HIV prevention and care services. The commission recommends decriminalising voluntary sex work. It adds: "Laws against human trafficking must be used to prohibit sexual exploitation, but they must not be used against adults involved in consensual sex work".
--Laws in some countries, such as Cambodia, China, Myanmar, Malaysia and the Philippines criminalise proven "harm reduction" services, such as clean needle programmes, for injecting drug users. The commission recommends decriminalising drug use and harm reduction programmes.