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					UN Pacific Regional High Level Consultation:
  HIV & the Law - Panel 1 Public Health
       Heritage Auckland Hotel, NZ
               13 April 2007


              Australian Capital Territory
            Human Rights & Discrimination
                    Commissioner:
                  Dr Helen Watchirs
          Human rights & HIV
Lack of protection fuels epidemic
• Discrimination increases impact: PLWHs,
  family/associates, presumed HIV+ - further
  burdens if lose job, health care, housing, services
• Creates or further deepens vulnerability: eg
  refugees, racial minorities, women, children - less
  able to protect selves by prevention measures/info
• Hinders effective civil society response - NGOs
  silenced, groups criminalised, individuals hide,
              HR obligations
• International Guidelines HIV/AIDS & Human
  Rights & UN Declaration of Commitment (2001)
• Obligations to respect, protect, fulfil HR
• Breaches can be by action/inaction of government
• Not just rhetoric: realise in laws, policies,
  programs at local & national levels – or reverse
  development gains (eg life expectancy 47yrs)
• UN HR treaties – mechanisms for accountability,
  eg reporting, complaints
• Asia Pacific no regional HR regime
  What is a human rights approach ?
• Recognises dignity and value of all humans
• Social vulnerability & disproportionate impact:
  individual risk behaviour not always chosen –
  social constraints if poor & stigmatised
• Informing & capacity building – know rights and
  responsibilities: individuals & service
  providers/government
• Bad law fearful barrier: drive people underground
  - hard to reach: trust - counsel, support, test, treat
     Old public health approach
• Strong & authoritative legal powers control social
  environment, eg vaccinations – relationship govt
  (public majority) & individual
• Punitive like plague/leper focus poor as vectors:
  notify, quarantine, detain, isolate (vs care/support)
• Forced & secret testing – lack informed consent
• Clinical/medical model can be conservative &
  paternalistic, but ethics (eg Dr/patient relationship)
  can be consistent with HR
• population health – effective interventions, eg
  blood/organ donation screening
              HIV is different
• Majority of 40m unaware that HIV+ - ten years
  generally before serious illness
• HIV no vaccine & not curable like some STIs -
  forced drug treatment, so non-infectious
• ARVs treatments – access inequitable
• Transmission not casual (eg droplet) - modes
  mainly sexual, but also, non-sterile needles or
  medical goods, mother-to-child, tattoo/scarify
• Epidemic not just medical problem – needs whole
  of government response (law only part of it)
• Testing antibodies ‘window period’- confirm
• Public health & human rights complement/conflict
              ‘Knee jerk’ laws
• 1986-1993: Cuba mandatory testing/tracing
   quarantine sanatoriums - change ‘ambulatory care’
• Late 1980s Australia - old PH law applicable
  - NSW lack confidentiality protections - patients
   give false names (not use coded data). Tasmania
   & Bavaria – move jurisdictions
  - WA/SA ban HIV+ from public transport,
   boarding houses & cheese factories
• Less testing if fear identification & discrimination,
   eg insurance (NY, Denver, Illinois 1990)
• Ban marriage HIV+ - move jurisdictions, de facto
• Ban sex education- research: delay sexual activity
              Best practice laws
• Anti-discrimination agency to handle & resolve
  complaints, systemic review – include HIV status
  & unequal status (gender, sexuality) eg Australia,
  NZ, US, HK
• Privacy protection agency to handle & resolve
  complaints, systemic review, eg Canada
• Complaints agencies accessible, simple
  procedures, free/cheap, quick (cf courts)
• Effective public health laws – quality,
  confidential, accessible, comprehensive &
  regulated health services (prevention, treatment,
  education, voluntary testing, counselling, condom
  distribution, & legal Needle Syringe Exchanges)
Relevant human rights principles
• International Covenant on Civil & Political Rights
  (‘ICCPR’) - rights to life; equality before the law;
  information & expression; protection of family &
  children; privacy; liberty & security of person; fair
  trial; participation; minorities; freedom of
  movement; assembly & association; freedom from
  inhumane treat/punishment; & non-discrimination
• International Covenant on Civil & Political Rights
  (‘ICCPR’): rights to health; adequate standard of
  living; education; work; benefit scientific progress
• ILO Code of Practice
            Useful Resources
• UN OHCHR/UNAIDS - International Guidelines
   HIV/AIDS and Human Rights (1996)
• UNAIDS/IPU Handbook (1999)
• UK All Party Parliamentary Group
• UNAIDS, WHO & UNDP websites
NGOs
- IACSO/FXB (Harvard) guides
- Canadian HIV/AIDS Legal Network – model laws
- AIDS Legal Network (South Africa)
- HR Watch, Amnesty International, Civil Liberties

				
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