HIV, disability and discrimination: making the links in international and domestic human rights law

Similarly, people with disabilities, in particular, women and young people, are at greater risk for sexual abuse or assault, elevating their risk of HIV infection [7,8]. Women, members of ethnic, sexual and other minority communities, youth, and people living in institutions are particularly at risk. It is often incorrectly assumed that people with pre-existing disabilities are not sexually active and are unlikely to use illegal drugs in ways that carry a risk of HIV infection. Thus, HIV education and other prevention efforts focused on reducing transmission through sex or drug use are rarely specifically targeted or made accessible to people with most disabilities [3]. (One notable exception is those with the medical condition of drug dependence.  In a number of jurisdictions, dependence on narcotic or psychotropic drugs is recognized legally as a disability, including for purposes of protection against disability-based discrimination. Obviously, people who use such drugs, especially those who inject and those who do so frequently as a result of addiction, are particularly vulnerable to HIV infection for a host of reasons, including personal and larger structural factors that contribute to the sharing of drug-injection equipment.

A significant proportion of new HIV infections globally is attributed to the epidemic of injection drug use [9]. This, then, is one group of persons with a disability that is already recognized as requiring particular attention for HIV prevention and treatment efforts, given the direct link between the disability of addiction and a high-risk behaviour. In fact, in some quarters, the call for greater, meaningful involvement of people who use drugs in the response to HIV has been expressly framed in the language of the disability rights movement’s demand for the inclusion of people with disabilities [10]).

PLHIV also experience disability related to HIV. As it progresses, HIV disease can result in mental and physical conditions that impair ability. In addition, highly active antiretroviral therapy (HAART) and other treatments, while saving and prolonging the lives of PLHIV, can also cause side effects that can be disabling. In such cases, once HIV or its treatment manifests in impairment of some sort, generic legal protection against discrimination on such grounds as “disability” ought certainly to apply. However, as should be apparent from the “social model” understanding of disability, people with HIV who are asymptomatic may experience discrimination regardless of the fact that HIV does not significantly (or at all) limit their activities, and it is instead the prejudice of others which causes difficulties (e.g., in employment, housing or services), rather than HIV infection itself.

Over the past few years, there has been greater research and attention to the links between HIV and disability, growing attention by policy makers and planners, and growing awareness of the importance of ensuring access to such services. 

More HIV projects with a disability focus are being initiated and more resources are becoming available, although the need continues to far outstrip the response [11-14]. Consider, for example, this recent assessment by the South African National AIDS Council:

There has been a progressive improvement in the inclusion of disability in the national AIDS response, starting with minimal involvement at the beginning of 1992 by the National AIDS Coordinating Committee of South Africa (NACOSA), to full participation in the National Strategic Plan on HIV and AIDS and STI 2007-2011 (NSP 2007-2011).

The NSP 2007-2011 recognises two important aspects. First, that disabled people are a group vulnerable to infection with HIV and bear the impact of AIDS severely. This recognition should lead to mobilisation of resources for disability and prioritising disabled people in the AIDS response.

Second, it recognises the causal relationship between HIV and disability. This raises the need for the disability sector and people living with HIV sector, both represented in the South African National AIDS Council (SANAC), to work collaboratively in developing programmes that respond to the causal relationship. The sectors face similar challenges, such as a struggle for self-representation and the fight for recognition of human rights.

In addition, both sectors have to deal with being regarded as welfare cases, objects of medical mystery deserving of pity and ridicule.” [13] 

However, discussions between the disability rights movement and HIV activists reveal a gap between HIV activism and disability activism. A major factor leading to the lack of cooperation between the two movements is that both PLHIV and people with disabilities are extremely stigmatized and marginalized. Indeed, suffering from the additional burden of stigma of being seen as “disabled” has no doubt been a concern of PLHIV and AIDS rights advocates.

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