Over the course of the HIV/AIDS epidemic, too little has been done to change laws and practices that violate human rights, putting individuals at risk of infection and disease and impeding access to HIV information and services for those who need it most. Changing these laws is not only a moral imperative, but is also key to the sustained success of prevention, testing, and treatment programs.
In sub-Saharan Africa, for example, nearly 60 percent of individuals living with HIV infection are women. This disproportionate burden is due less to a specific biologic susceptibility to infection, and more to their lack of basic human rights. Women and girls are put at risk by economic vulnerability resulting from discrimination and lack of legal protections; sexual violence, including in institutions such as schools, prisons, and workplaces; domestic violence, including marital rape; violations of property and inheritance rights; and, in some countries, harmful traditional practices such as exorbitant bride price, widow inheritance, and even ritual sexual cleansing. Governments, which have an obligation to stop such violations and abusive practices, too often tolerate them.
Responding to the HIV/AIDS epidemic requires addressing such vulnerabilities directly, not indirectly through general education campaigns or HIV testing. In Zimbabwe, an estimated 700,000 people lost their homes, livelihood, or both when, in May 2005, the government unleashed Operation Murambatsvina (Cleanse the Filth), a campaign of forcible evictions and demolitions in urban areas throughout the country. Six months into the crisis, hundreds of thousands of people remained displaced throughout the country. Among other things, the massive displacement disrupted access to life-saving therapies for individuals with HIV and TB, encouraging the emergence of multi-drug resistant strains, and it created the conditionsdisplacement, destitution, lack of legal protectionswhich are known to spur the epidemic. This was recognized by UNAIDS representatives when, in November 2005, they cautioned that recent declines in HIV prevalence in Zimbabwe could start rising again if underlying vulnerabilities, which contribute to unsafe sexual behaviour and fuel the epidemic, are not sufficiently addressed. Such vulnerabilities include gender inequality, poverty and population mobility.20
Stigmatizing attitudes and discrimination by health care providers continue to hinder access to HIV testing and treatment in many places. In other places, violence, or the fear of violence, prevents many people from obtaining HIV/AIDS testing and treatment. In Uganda, despite long-standing and well run programs, service providers have reported that women come to them secretly, fearing that their husbands will beat them if they seek HIV testing or medical attention. Jane Nabulya, a Ugandan woman, said that she secretly tested for HIV in 1999 when she found out her husband had AIDS. She explained: I was scared to tell him that I had tested HIV-positive. He used to say [of] the woman who gives him AIDS, I will chop off her feet. I have never told him.21