Society and Welfare

Human Rights and HIV/AIDS

All too often HIV/AIDS is seen as a public health issue, an issue for medical research or economics. The need to see HIV/AIDS as a human rights issue is often overlooked – especially by governments in their rush to control the epidemic. If the global fight against the disease is to be successful, HIV/AIDS needs to be seen through the prism of human rights and in particular the right to freedom of expression, association, information and health. It is generally agreed that without these rights and the subsequent society that is built around them there is little hope of bringing an end to the disease and providing adequate help and treatment for its sufferers. For a country to stem the increase of HIV/AIDs, it needs the input of civil society as well as an informed and open press and public, non-discriminatory policies for patients, transparent health care policies and supportive initiatives towards high-risk groups in society such as drug users. Without these and with continued recourse to restrictive and authoritarian policies there will be no sustained or long-term improvement.

In China, as in many countries around the world, HIV sufferers face discrimination in the workplace, in hospitals and more generally in society. Discrimination and ignorance is not unique to China by any means – what is more unique is the wall of secrecy and denial that, until recently, surrounded state policy on HIV/AIDS It is only recently that this wall has begun to topple. Fear and discrimination is common to many countries, but the lack of basic human rights like freedom of association and expression in China means that many HIV positive Chinese people have very little room to lobby for reform or legal right to form independent support groups or call for access to treatment. It has only been in the past few years that such groups have been allowed to exist and their leaders not persecuted or harassed. Despite this improved openness however some activists who cross the line are still being arrested for divulging “state secrets” or when they cooperate with western media. International experts and the UN have all stressed that community and NGO involvement is crucial in the fight against AIDS – a message the Chinese authorities are only just beginning to accept.

The complete absence of independent trade unions in the workplace has for the most part contributed to the failure of a progressive union position on HIV/AIDS . The official ACFT failed to pressure the government to adopt a more conciliatory and positive role. The lack of independent trade unionists has helped enforced the stereotypes of HIV/AIDS patients in the workplace and among management and encouraged a hostile attitude to HIV positive workers – one that is proving very difficult to shake off. A recent survey conducted by the United Nations Development Programme in Sichuan Province showed that 88 per cent of those surveyed thought that people living with HIV/AIDS should not have contact of any form with other people.

This view is enforced by many discriminatory and abusive practices in various regions against HIV positive people being employed in the service industry or in childcare. In many places there are restrictions or outright bans on the marriage of people with STDs including HIV. (although the recent marriages of several highly publicised couples in some provinces signals a possible relaxation of these restrictions.) Reports have also emerged of the denial of education to HIV children and the children of AIDS patients. Only now is the government paying serious attention to the plight of the many children orphaned through AIDS who are unable to continue schooling because of costs – the support of such children has been led by community organisations. HIV positive people and AIDS patients are often forced out of their homes after it has become open knowledge that they are sick with HIV/AIDs. Many are then unable to find work.

However perhaps the most restrictive form of discrimination in China has been the inclusion of HIV/AIDS in the national law on infectious diseases which allowed for the forcible isolation for treatment of HIV positive people and AIDS patients, allowing police to enforce quarantine and detention. It was only in the April 2004 NPC Congress that a draft amendment to the law was passed which downgraded HIV and took away the right of the security forces to forcibly detain HIV sufferers. This amendment would bring Chinese law into line with UN recommendations banning the use of quarantine of HIV people and help to curtail the stigma and discrimination against sufferers. However, despite this welcome move, Chinese law still allows for the forcible detention of drug users, further excluding them from the wider community and discouraging them from seeking treatment for HIV/AIDS. In the past few years however local initiatives, with new input from the growing NGO community, are increasingly beginning to stress the need for inclusion of such high-risk groups and a more effective form of drug rehabilitation and treatment.

Human rights NGOs have long documented and criticised the compulsory HIV testing that is carried out in many places (often as a sign of “improvement” in the fight against AIDS) and the subsequent lack of safeguards guarding the confidentiality of results. In many cases, people entering hospital for routine operations are not even told they have been tested for HIV/AIDs until they receive their medical bills. Once diagnosed many patients find themselves rejected by their family, refused care or unable to afford what care is available to them.

In terms of economic, social and cultural rights, the most glaring abuse, other than widespread discriminatory restriction on everyday living, is that of the right to the progressive realisation of the highest attainable standard of physical and mental health to be enjoyed equally. In China, many AIDs patients instead face an absence of medical care and discrimination in treatment.

The state health care system built up after 1949 has crumbled in the past 20 or so years and is now failing over 100 million people, predominately rural citizens but also the urban poor and migrants. Nationwide, only some 20 percent of rural counties have basic universal medical care. The rush towards privatisation and the lack of central government support for rural and local health care has led many places to depend on the sale of medicines and services to such an extent that the Ministry of Health survey suggests that up to 70 percent of all patients who should have been hospitalised failed to seek or receive treatment simply because they could not afford it.

The ease of transmission of SARS, the immediate economic losses it created (especially in the service industry) and the spotlight SARS placed on the disastrous state of China’s health care system led almost immediately to a huge increase in funding for rural health care and in particular, in funding for SARS related projects. However, while welcomed, the investment in treating and preventing SARS has not been matched by a corresponding rise in investment in the treatment of HIV/AIDS. Despite this however, the promises of massive funding from the UN Global Fund and from the central government has led many to believe that recent efforts are serious and that initiatives began in the past few years such as the China CARES programme are just the beginning of a concerted effort to stem the disease and provide proper medical care for AIDS patients, including vital access to anti-retroviral drugs.