In 2022, thirty-nine million people were living with HIV/AIDS worldwide.[1] In the same calendar year, 630,000 people died of HIV-related illness.[2] Despite an increase in infections, myths persist about HIV, which leads to heavy stigma around the disease.[3] Governments and aid agencies alike have ramped up efforts to combat the epidemic in recent years.[4] The United Nations recognizes the urgency of the HIV epidemic in its Sustainable Development Goals and other health policies, laid out in the UN Charter.[5] The World Health Organization also launched its Global HIV Programme at its most recent assembly in 2022.[6]Both initiatives established the goal of ending HIV by 2030—a harsh deadline that approaches at a daunting rate.[7] In the years leading up to 2030, effective epidemic management will require new strategies that support people and communities, not just their physical health.
Of the nearly forty million people living with HIV today, over two-thirds of them live in Africa.[8] Infection rates are highest in South Africa and other sub-Saharan African countries.[9] The most glaring issue of the HIV epidemic in this region is access to medical care.[10] However, HIV is more than a public health issue.[11] HIV infection often leads to economic hardship for the people of sub-Saharan Africa as well.[12] On an individual level, the disease leads to absences from work and lower productivity.[13] The impact reaches the entire household, particularly children.[14] Access to education decreases among children in HIV-affected households for a variety of reasons.[15] If a parent or guardian dies from the disease, their children are forced to care and provide for their families.[16] In 2011, “[d]eaths of young adults from natural causes (including those from HIV/AIDS) had a negative impact on the growth in income of all households over a five-year period, but especially on those households that were initially modestly well-off.”[17] Impacted families also face increased medical expenses, which harms their ability to pay for basic necessities, let alone their children’s education.[18]
Such devastating, small-scale economic struggle often leads to broader impacts.[19] African economy experts suggest that HIV is starting to affect the economy at large.[20] In sub-Saharan Africa, in particular, HIV is a “disease of poverty”.[21] HIV influences the “decisions concerning schooling, childbearing, finances and unemployment,” of everyone it impacts.[22] According to the UN, “[t]he effect then aggregates, influencing the macroeconomy through impacts on labour markets, and consequently the allocation of resources by governments.”[23] This leads to a vicious cycle of HIV infection, poverty, and crime.[24] Experts posit that infected individuals who are vulnerable to poverty, are more likely to engage in high-risk behavior.[25] Such a phenomenon can exacerbate infection rates and worsen crime rates in countries where HIV infections are most prevalent.[26]
HIV policy often overlooks the social stigma and harsh discrimination that come with an HIV diagnosis.[27] This broaden a pressing public health issue to a crisis of international human rights.[28] Laws that protect against disease-related discrimination are therefore vital to combat HIV.[29] Unfortunately, domestic politics can get in the way as “political shifts worldwide threaten not only HIV funding but also progress toward the globalization of human rights … .”[30] Initial fear of the disease led many governments to stigmatize sex workers, those identifying as LGBTQ+, and other “high-risk” groups.[31] With human rights at the heart of the HIV response, efforts like the 1983 Denver Principles began to define rights for “people with AIDS.”[32] These rights include access “[t]o quality medical treatment and quality service provision without discrimination in any form including sexual orientation, gender, diagnosis, economic status, or race.”[33] Jonathan Mann, the first director of the World Health Organization’s Global Programme on AIDS, encouraged policymakers to account for broader social determinants and structural violence associated with HIV.[34] Mann pioneered utilization of the law “to protect people with the disease from discrimination and exclusion.”[35] As a result, formal resolutions like the 1996 International Guidelines on HIV/AIDS and Human Rights began to emphasize the epidemiological and social nature of the fight against HIV.[36]
Today, access to antiretroviral therapy is widely considered a human right—the right to health.[37] However, infections continue to rise in countries where the government’s human rights commitments are lacking.[38] In 2014, sixty-four percent of countries reported having laws protecting against discrimination based on HIV status.[39] In South Africa, “the promotion of equality and prevention of unfair discrimination are enshrined in the constitution.”[40] Such policy has led to promising humanitarian progress.[41] Nonetheless, such legal protections “mean little to those who are not in a sufficiently secure economic situation to exert those rights.”[42] It is therefore paramount that we continue to advocate for the human rights of people living with HIV on an individual, national, and international level.[43]
The HIV epidemic in sub-Saharan Africa is more than a public health issue. The disease impacts the individual, their family, and society as a whole. International aid is simply not enough to confront the stigma nor put a stop to HIV spread.[44] Infected individuals in sub-Saharan Africa need integrated access to medical care, protection from discrimination, and support for their economic well-being. With less than a decade left before the UN and WHO deadlines, it is imperative that governments and aid agencies stop the spread and start to reconcile the economic human rights impacts the disease has on the people of sub-Saharan Africa.
[1] The Global Health Observatory: HIV, WHO, https://www.who.int/data/gho/data/themes/hiv-aids#:~:text=Since%20the%20beginning%20of%20the,at%20the%20end%20of%202022 (last visited Nov. 10, 2023).
[2] Id.
[3] Megan Heneke, Student Note: An Analysis of HIV-Related Law in South Africa: Progressive in Text, Unproductive in Practice, 18 Transnat’l L. & Contemp. Probs. 751, 752 (2009).
[4] See, e.g., The Global HIV/AIDS Epidemic, KFF (Jul 26, 2023) https://www.kff.org/global-health-policy/fact-sheet/the-global-hiv-aids-epidemic.
[5] Global Issues: AIDS, U.N., https://www.un.org/en/global-issues/aids#:~:text=Ending%20AIDS%20by%202030%20is,Nations%20Member%20States%20in%202015 (last visited Nov. 10, 2023).
[6] Global HIV Programme: Strategic Information, WHO, https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information (last visited Nov. 10, 2023).
[7] U.N., supra note 5; WHO, supra note 6.
[8] Nelson Ijumba, Impact of HIV/AIDS on Education and Poverty, U.N. Chron., https://www.un.org/en/chronicle/article/impact-hivaids-education-and-poverty#:~:text=In%20South%20Africa%20alone%2C%20there,found%20elsewhere%20in%20the%20region (last visited Nov. 10, 2023).
[9] Id.
[10] Supra note 3, at 752.
[11] Supra note 3, at 753.
[12] Supra note 8.
[13] Supra note 3, at 753.
[14] Supra note 8.
[15] Id.
[16] Id.
[17] Id.
[18] Id.
[19] Supra note 3, at 753.
[20] Id.
[21] Supra note 8.
[22] Id.
[23] Id.
[24] Id.
[25] Id.
[26] Supra note 3, at 753.
[27] Supra note 3, at 752.
[28] Jamie Enoch & Peter Piot, Human Rights in the Fourth Decade of the HIV/AIDS Response: An Inspiring Legacy and Urgent Imperative, 19 Health & Hum. Rts. J. 117, 117 (Dec. 2017).
[29] Supra note 3, at 752.
[30] Supra note 28, at 117.
[31] Supra note 28, at 118.
[32] The Denver Principles (1983), https://data.unaids.org/pub/externaldocument/2007/gipa1983denverprinciples_en.pdf (last visited Nov. 28, 2023).
[33] Id.
[34] Supra note 28, at 118.
[35] Id.
[36] Id.
[37] Supra note 28, at 119.
[38] Supra note 28, at 120.
[39] Supra note 28, at 119.
[40] Supra note 28, at 120.
[41] Id.
[42] Id.
[43] Id.
[44] G. Taylor, Rolling Out HIV Antiretroviral Therapy in Sub-Saharan Africa: 2003-2017, 44 Can. Communicable Disease Rep. 68, 68-70 (Feb. 1, 2018).
