Public Health and Human Rights: Evidence-Based Approaches

The words HIV or AIDS do not appear in the title of this book, and at first glance, this book appears to be about something else. On the contrary, it is about HIV and much more.

Beyrer and Pizer examine public health policy and its necessary convergence with human rights. The authors remind us that population health must be addressed in context with human rights to develop public health programs that improve outcomes.

Using a case study format, various authors put public health into context in a series of chapters discussing such topics as genocide, illicit drugs, prostitution, and trafficking of women. They cite numerous examples of how the narrower approach to public health that does not address human rights issues for individuals and populations is not enough.

For example, the case study of HIV transmission through contaminated blood products in China is a sober reminder of how much damage bad public health policy can do. In this case, there was a total disconnect between public health policy and human rights. Patients receiving transfusions of blood and blood products were put at risk for HIV infection because of the lack of safe blood screening policies. Moreover, the scientist who alerted the public and public health authorities to the problem, and also the author of the case study, was jailed for posting HIV-related information on the Internet.

If you are saying that this could not happen in the United States, read on. In the chapter on prison health, Julie Mair takes us into the world of men’s prisons in the United States. The subject is rape, which she feels is too often tolerated by prison administrators. The conundrum here is that sex is against the rules and condoms are considered “contraband” in most correctional settings. From the public health/human rights perspective, Mair sees it differently. She makes the point that prisons serve as incubators of infectious diseases that have an impact on communities when prisoners are released. She pushes the envelope further in her review of corrections systems in other parts of the world that actually offer harm reduction strategies, such as providing inmates with condoms and clean injection equipment.

Obviously, the two above-mentioned problems have no easy solutions. On the other hand, the China case study reminds us of the importance of scientific freedom and the freedom of speech. Suppressing vital health information is clearly not in anyone’s best interest, unless you happen to be responsible for the disconnect between public health and humans rights in the first place; in this case, it was the provincial government that turned its back on blood safety.

In the section on public health policy, authors take an evidence-based approach to make their cases. Even with the evidence at hand, shifts in public health policy do not come easily. The hot-button issue of HIV prevention and drug policy worldwide illustrates this. In the chapter on injection drug use and HIV policy, the authors state that in most cultures, injection drug users are considered to be “less than human,” and the approach to their health issues is usually punitive. The more enlightened approach offered by the harm reduction model recognizes the need for drug treatment and support. Without addressing certain fundamental human rights issues, the problem of injection drug use will only go underground. It won’t go away. The chapter then discusses the struggle to adopt the harm reduction model worldwide as an HIV prevention strategy in injection drug users.

The same is true of prostitution. Regardless of the view that people take of sex workers, they are not going away. One case study offers an example of Brazil’s refusal of a $40 million HIV-prevention grant from the United States because of a requirement that countries accepting funding must sign a pledge condemning prostitution. Their response was that condemning prostitution not only fueled the stigma surrounding HIV but also was in conflict with the country’s position on access to HIV care for all. End of discussion? Not quite. The chapter goes on to discuss how Brazil’s program of HIV care is grounded in universal health care for all.

The message of this book is clear. Human rights violations have a negative impact on health. The problems are many, and the evidence to support solutions is still emerging. In the meantime, a rights-based analysis of our public health policies is a requirement of the times in which we live.

William M. Valenti, MD
University of Rochester School of Medicine and Dentistry
Rochester, NY