Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment

• Published in: Journal of the International AIDS Society Vol. 16; no. 1; pp. 18000 - n/a
• Main Authors: Gruskin, Sofia, Ferguson, Laura, Alfven, Tobias, Rugg, Deborah, Peersman, Greet
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.01.2013; John Wiley & Sons, Inc
• Subjects: Acquired immune deficiency syndrome; AIDS; AIDS education; Care and treatment; Civil society; Councils; Criminalization; Disease prevention; Female; Health aspects; Health Policy; Health services; Health Services Accessibility; Health Services Administration; HIV; HIV infection; HIV Infections - diagnosis; HIV Infections - prevention & control; HIV Infections - therapy; Homosexuality, Male; Human immunodeficiency virus; Human Rights; Humans; Jurisprudence; key populations; law; Male; Management; Medicin och hälsovetenskap; Personal information; policy; Prevention; Progress reports; Sex industry; Sex Workers; Sexually transmitted diseases; Social aspects; Social policy; STD; structural barriers; Substance Abuse, Intravenous; Transgender persons; United States; New York; Bangladesh; Burundi; El Salvador; United States > US; Senegal; Mexico; Paraguay; key populations; law; HIV; structural barriers; human rights; AIDS; policy
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.16.1.18000

Introduction Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results Seventy‐eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV‐related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV‐related services deserve greater attention. Conclusions Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.