Learning from the Past: Confronting Legal, Social, and Structural Barriers to the HIV Response

Luisa Cabal is chief of human rights and law at UNAIDS, the Joint United Nations Programme on HIV/AIDS.

Patrick Eba is senior human rights and law adviser at UNAIDS, the Joint United Nations Programme on HIV/AIDS.


The first special issue on HIV and human rights published by this journal in 1998 highlighted emerging concerns that structural, legal, and social barriers were at the core of vulnerability to HIV.[1] It called attention to the specific challenges and human rights violations faced by women, gay men and men who have sex with men, people who use drugs, and persons with disabilities, and stressed the need to address these challenges.[2] Nearly 20 years later, significant transformations and progress have occurred in the global AIDS epidemic and our response to it. In 1998, less than 500,000 people worldwide had access to antiretroviral therapy. Today, 21 million people receive highly active antiretroviral therapy, the majority of whom live in low- and middle-income countries.[3]We now have better understanding of the epidemic, and of the approaches and tools for successful HIV prevention, testing, treatment, and care.

However, many of the human rights, social, and structural barriers described in the 1998 special issue continue to hinder the HIV response. The historic achievement in expanding access to treatment has not been matched with the commensurate commitment and courage to tackle the underlying determinants that continue to fuel the epidemic among the most marginalized.

This December 2017 special section offers critical observations on the past, present, and future of human rights in the response to HIV, and in efforts to realize better health for all within the Sustainable Development Goals agenda. The history of the HIV response is marked by hard-fought victories of inclusion, human rights, and accountability. Across the world, there is increased recognition that legal, social, and structural barriers to the response must be addressed. However, this recognition often does not translate into action by governments and other duty-bearers. As Jamie Enoch and Peter Piot (the former executive director of UNAIDS) note, there is no “guaranteed march to progress” on the human rights of people living with HIV and key populations, especially in a global climate of indifference, hostility, and contestation of human rights.

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