Human Rights and the AIDS Crisis: The Debate over Resources
Mr. Kenneth Roth, executive director, Human Rights Watch, addressed the
plenary, posing the questions: Can a human rights perspective help us
confront the AIDS crisis? Most important, can human rights help us meet
the urgent challenge of securing the vast resources needed for treatment
and prevention?
Roth did not offer a human rights framework as a panacea to the AIDS
pandemic. He stressed that it would not "magically produce the resources
we need," nor point out which resources should be allocated to HIV/AIDS as
opposed to addressing other societal needs. Rather, he posited that such a
framework requires governments to address the crisis with appropriate
urgency and transparency and facilitates transparency and a participatory
policy process.
Roth paid homage to the work of Jonathan Mann, highlighting that the
new public health challenge is less what should be done to prevent or
treat HIV than where do we find the enormous resources needed? Does the
industrialized world have an obligation to help people from developing
countries, and, if so, what precisely is it? Should obligations arising
from the AIDS pandemic differ from those arising from other public health
crises or from the general need for basic health care?
Roth suggested that international human rights standards can provide a
useful framework for answering these questions. The relevant standards, he
notes, are not those of civil and political rights, but rather those of
economic and social rights. He used the International Covenant on
Economic, Social and Cultural Rights, adopted by the UN General Assembly
in 1966, to develop his argument. (He also pointed out that 142
governments have ratified the covenant; South Africa and the U.S. have
signed but not yet ratified it.)
Roth began to lay out his argument by stating that a government's duty
to respect economic and social rights is far more qualified than the duty
to respect civil and political rights. Governments are expected to uphold
the latter immediately. Moreover, responsibility for doing so lies almost
exclusively with government. In contrast, economic and social rights may
be fulfilled gradually, over time. The covenant states that each
government is asked only to "take steps" to secure these rights and to do
so only "to the maximum of its available resources, with a view to
achieving progressively [their] full realization." And responsibility for
compliance is broader, involving not only the government of the country at
issue, but also the international community, through the duty to provide
"international assistance."
Roth demonstrated how this gradualism and shared responsibility render
it much more difficult to shame a government. He explained that the tool
of public shaming is most effective when there are clear answers to three
basic questions:
- Is there a violation of human rights?
- Who is responsible for the violation?
- What is the remedy?
When answers to all three questions are clear, public shaming can be
powerful.
In the case of HIV/AIDS, one can easily conclude that there is a
violation of human rights, i.e., the right to the highest standard of
health (Article 12 of the above-mentioned covenant). It is difficult,
however, to answer the other two questions. So, Roth asked, how do we move
beyond this impasse? He proposed that the covenant's requirement that
governments "take steps" to secure economic and social rights should mean,
at minimum, that they:
- adopt a plan that is reasonably designed to achieve the right in
question, e.g., the right to adequate AIDS health care
- establish a timetable for implementing the plan
- demonstrate progress toward fulfilling the plan
Although governments will resist these accountability measures, Roth
maintains that they should spur advocacy and public shaming, as should
inadequate plans and timetables and insufficient resources allocated. To
hold all governments--developing and industrialized--accountable, he
proposed a World Conference to Confront the AIDS Crisis. Not another
talking shop, said Roth, but a venue to convene all governments in a
locked room, from which no one leaves until resources adequate to an
emergency are finally committed. This would also provide transparency,
allowing the public to scrutinize government expenditures and priorities.
It also would be a mechanism to engender solidarity.
Roth lambasted the TRIPS agreement of the WTO (the international legal
protocol for protecting patents), saying that "an industrialized
government cannot be said to be 'taking steps' to 'progressively realize'
the right to health when it defends excessive corporate profits over the
right of access to essential, life-saving medicine." To the term "clarify
excessive corporate profits," Roth contrasted "a level of corporate
profits needed to provide basic incentives" with "corporate windfalls."
Acknowledging the enormous challenge of prioritizing among competing
health and HIV/AIDS-specific needs, Roth noted that human rights standards
cannot provide a clear-cut roadmap for determining these priorities. They
can, however, lead to transparency and thus facilitate public debate and
participation.
Roth rounded out his argument by highlighting the noneconomic
dimensions of this process: governments also have a duty to provide public
leadership, political will, and reliable, scientific knowledge. He went on
to state:
We must not be unsparing in our criticism of governments,
like our host government, that shirk that duty, because they violate any
pretence of progressively realizing the right to health in the treatment
of AIDS.
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