Legal rights, human rights and AIDS: the first decade. Report from South Africa 2.

A broad range of coercive measures has been considered internationally and applied in some countries in the interest of controlling the spread of HIV. Although a couple such measures are on the books in South Africa, they have never been invoked and will soon be officially repealed. There is, however, a problem in South Africa with the violation by health care workers, employers, and others of individuals' rights to dignity, privacy, and autonomy. The exaggerated and undue fear that doctors and other health workers have of being infected by patients with HIV has led to widespread and gross human rights abuses in clinical management and treatment. Abuses include the refusal of treatment, testing patients for HIV without their informed or any consent, insisting upon HIV testing devoid of diagnostic or therapeutic justification, and widespread breaches of confidentiality. Persons with AIDS and HIV are also denied access to their fair share of national resources. This latter phenomenon is likely to become the principal form of human rights abuse, with racism and class differences exacerbating the problem. The practice is proliferating and takes many forms including pre-employment HIV testing; exclusionary discrimination in insurance; discrimination between HIV and other life-threatening conditions in corporate medical, pension, and provident funds; and the discriminatory denial of fair and adequate health care to people with HIV or AIDS. Discrimination of all kinds, however, retards preventive efforts. Public health therefore demands the recognition and enforcement of individual human rights and that structures of discrimination be eliminated. Human rights protection may, by limiting the effect of discrimination, play a significant part in fighting the epidemic. Protective measures could include enacting legislation to prohibit pre-employment testing, legislation to regulate the provision of insurance and to prohibit or regulate pre-insurance HIV testing and the wholesale refusal of AIDS-related coverage, and more broadly drafted legislation to prohibit public enterprises from discriminating against persons on the basis of HIV or AIDS and to enshrine the principle of nondiscrimination.