The power of a human rights approach
Advocacy arguments have increasingly been grounded in a human rights framework. This draws on both fundamental moral principles and the legal obligations of states to respect, protect and fulfil human rights, including the right to health. These obligations derive from international law, regional human rights agreements and national laws (6). A rights-based approach to HIV/AIDS has propelled social mobilization by civil society groups in a growing number of countries.
In Brazil, the Brazilian Interdisciplinary AIDS Association, founded in 1986, works to defend the rights of people with HIV/AIDS through research, education and policy analysis. In Bolivia, Venezuela and other Latin American countries, civil society organizations have successfully used legal action based on human rights conventions to obtain access to treatment through national health systems (7).
The Treatment Action Campaign in South Africa uses community education and mobilization, mass civil protest, media campaigns, legal mechanisms, and alliances with other nongovernmental organizations and labour groups to defend the rights of people infected with and affected by HIV. Its national fight for access to HIV/AIDS therapy led to the Pan-African Treatment Action Movement, launched in August 2002.
Human rights standards and principles should also guide the planning and implementation of treatment policies and programmes. The human rights approach recognizes that rights are universal and reinforces the value of full participation of all members of society. Such an approach also requires increased accountability of decision-makers and greater equity in health care policies.
Countries have increasingly acknowledged these imperatives. At the 1994 World AIDS Summit in Paris, 42 governments declared that the enhanced involvement of people living with or affected by HIV/AIDS was critical to ethical and effective national responses to the epidemic. This principle of greater involvement is fundamental to the fairness of any policies and programmes concerning HIV/AIDS (8). In 1998, the Office of the United Nations High Commissioner for Human Rights and UNAIDS jointly developed international guidelines on HIV/AIDS and human rights, a tool that applies human rights law and norms to the specific context of HIV/AIDS and identifies what states can and should do in the light of their human rights obligations (9). Commitment to these principles was reinforced in the Declaration of Commitment on HIV/AIDS, adopted at the United Nations General Assembly Special Session on HIV/AIDS in 2001 (10).
Nongovernmental organizations and civil society groups have led the application of human rights standards to the problem of access to medicines for the poor (see Box 3.3). Efforts such as the Access to Essential Medicines Campaign and the Drugs for Neglected Diseases Initiative of Médecins Sans Frontières have focused global attention on the medicines crisis in the developing world and helped drive public debate on the effects of trade and intellectual property rights regulations on poor people’s access to treatments for a wide variety of health problems (11–13).
An international coalition of activists and civil society groups worked with representatives of developing countries before and during the World Trade Organization (WTO) Ministerial Conference in Doha, Qatar, in November 2001. Civil society engagement gave impetus to the Doha Declaration, which formally clarified that the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights “can and should be interpreted and implemented in a manner supportive of WTO members’ right to protect public health and, in particular, to promote access to medicines for all” (14) (see Box 2.5). In April 2002, the United Nations High Commissioner for Human Rights welcomed the Doha Declaration and urged the international community quickly to define ways of enabling all countries to benefit from its provisions (15).