Legal changes are crucial to fight HIV, says new report

BMJ 2012; 345 doi: (Published 09 July 2012) Cite this as: BMJ 2012;345:e4687
  1. Bob Roehr
  1. 1Washington, DC

Structural changes in law and public policy around the world could almost halve the incidence of HIV, lowering it from 2.1 million to 1.2 million new infections a year, says a new report.1

“Punitive laws and human rights abuses are costing lives, wasting money, and stifling the global AIDS response,” said the Global Commission on HIV and the Law in its report, released on Monday 9 July. The commission is an independent body created by the United Nations’ joint programme on HIV and AIDS (UNAIDS) and the UN Development Programme.

The report calls for an end to laws that criminalise the transmission of HIV, which currently exist in more than 60 countries, including Canada, 37 of the 50 US states, and 27 countries in Africa.

“Such laws do not increase safer sex practices. Instead they discourage people from getting tested or treated, in fear of being prosecuted for passing HIV to lovers or children,” it says.

Discriminative practices against girls and women, from genital mutilation to denial of property rights, “produce profound gender inequality,” the report says. “Domestic violence also robs women and girls of personal power” and undermines their ability to cope with the risks of HIV infection and to deal with its aftermath.

The report applauds the 2009 decision by the High Court in Delhi to decriminalise homosexual acts in India. But many countries continue to aggressively prosecute sex workers and men who have sex with men, a key risk group for ongoing HIV transmission in every country.

A harm reduction approach to illicit drug use that takes a medical rather than a legal prohibitionist approach has been proved to greatly reduce the incidence of HIV among drug misusers. The report’s recommendations reflect those made by the Global Commission on Drug Policy in a report issued late last month.2

The commission wrote: “Fear of arrest drives key populations underground, away from HIV and harm reduction programs. Incarceration and compulsory detention exposes detainees to sexual assault and unsafe injection practices, while condoms are contraband and harm reduction measures (including antiretroviral medicines) are denied.”

The broad scope of legal reform should be to decriminalise private and consensual adult sexual behaviours, prosecute the perpetrators of sexual violence, and treat citizens and migrants equally, the report adds.

It says that the central role of excessive intellectual property protection, characterised by strict patent laws, is “exacerbating the lack of access to HIV treatment and other essential medicines.” It urges the promotion of innovations that serve the medical needs of poor people rather than the profit desires of drug manufacturers.

“Bad laws should not be allowed to stand in the way of effective HIV responses,” said the administrator of the UN Development Programme, Helen Clark.

“This report is a powerful tool for HIV and human rights advocacy,” said George Ayala, executive director of the Global Forum on MSM (men who have sex with men) and HIV, a coalition of advocacy groups. “Legislators can no longer feign ignorance of the consequences of their actions,” he added. “The document presents a clear road map that cuts through taboo issues and outlines a legal environment that both promotes public health and upholds human rights.”


Cite this as: BMJ 2012;345:e4687


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