Efforts to prevent HIV infection are a critical part of States parties’ legal obligation to take steps to realize every person’s human right to the highest attainable standard of health set out in the International Covenant on Economic, Social and Cultural Rights. Effective HIV prevention policy requires looking at the relationships between the epidemiology of HIV transmission, the risk behaviours that are associated with transmission and the structural factors – such as sexual cultural and legal norms, gender inequality, and HIV-related and forms of stigma and discrimination – that fuel the pandemic. Groups and individuals who already suffer from a lack of human rights protection and who are marginalized are often disproportionately affected by HIV/AIDS. According to international instruments such as the International Guidelines on HIV/AIDS and Human Rights and the UN Declaration of Commitment on HIV/AIDS, the promotion and protection of human rights and fundamental freedoms constitutes an essential component of preventing HIV transmission and reducing the impact of HIV/AIDS.
Voluntary informed testing, counselling and access to treatment are crucial elements of an effective rights-based approach to HIV prevention. Increasing the number of people who know their HIV status as well as providing treatment and counselling are essential to preventing transmission, improving care and reinforcing prevention education. To protect people’s rights and to be effective, however, testing should be rooted in human rights principles. It should be voluntary and occur only with specific informed consent; it should include pre- and post-test counselling to promote health and to help prevent onward transmission; and it should be confidential, ensuring people’s privacy and, as such, increasing people’s willingness to be tested and to receive treatment and counselling.
In addition, as recommended in the International Guidelines on HIV/AIDS and Human Rights, states should pass laws to ensure that quality prevention information, services and measures are widely available for all persons, on a sustained and equal basis. This includes ensuring the quality and accessibility of HIV testing technologies and condoms, as well ensuring accurate information is available in the mass media and via other education campaigns. In all measures, governments should pay particular attention to vulnerable individuals and populations.
There is no evidence that criminal law is effective at preventing HIV transmission. Criminalization of HIV transmission and of activities with an increased risk of infection, such as drug use and sex work, may drive people away from effective public health initiatives and create a false sense of security that the law can protect people from HIV infection. However, ensuring widespread, easy, confidential access to information about HIV and its transmission, as well as means of HIV prevention such as safer sex education and condoms (both male and female), is a necessary part of addressing the risks of sexual transmission. Harm reduction initiatives that are effective in reaching people who use illegal drugs, such as supervised injection facilities, needle and syringe programs and opioid substitution therapy, have proven effective in reducing the spread of infectious diseases such as HIV and in protecting and improving the health of this vulnerable population. The marginalization and criminalization of sex workers in many countries means that they routinely face human rights abuses, which exacerbate their risk of HIV infection and undermine prevention efforts. International recognition of sex workers’ rights, including legislative amendments, is therefore also vital to curb the HIV pandemic. More broadly, HIV prevention efforts must also develop legal and policy frameworks that respect, protect and fulfill women’s human rights, and ensure access to services (including reproductive and sexual health services). Gender inequality restricts what women can do to protect themselves from HIV and compounds its impact upon them. Strengthening women’s human rights can help to reduce the subordination and vulnerability that drives the pandemic among them as well as help to prevent mother-to-child transmission. Young people, who are sexually active and also a population at risk through unsafe drug use, need information and services that are accessible in all ways and address their particular needs. Migrants, and specific linguistic, ethnic or religious communities (including indigenous peoples), often face additional barriers to information and services, including additional discrimination, while particular practices or norms within a particular community may make it particular difficult to address sexual or drug-using practices that put community members at risk of HIV infection.