Although we might not always consider it, a well developed and appropriate legal framework is a very necessary component in the fight against HIV/AIDS. On September 12, 2007, the authors of the report Legal Aspects for HIV and AIDS: A Guide for Policy and Law Reform came together at the World Bank Headquarters in Washington, DC, to present and discuss the role of law in the fight against this devastating pandemic.
Debrework Zewdie, Director of the Global HIV/AIDS Program at the Bank, introduced the event. Joy Phumaphi, Vice President of the Human Development Network, gave the opening remarks, noting some of the legal challenges and dilemmas surrounding HIV/AIDS. Among the issues she mentioned was the pressure certain countries face to introduce routine testing, health workers who get infected while on the job, and the forceful testing of people within risk groups.
Laurence Gostin, Associate Dean and Professor of Global Health Law at Georgetown University, outlined the four reasons why law is of critical importance in the fight against HIV/AIDS. First, he explained that good law allows for good public health, ensuring that public health authorities have the tools they need to enact truly effective prevention and public health programs. Because drugs are costly and a vaccine doesn’t exist, he said, prevention is still key, and law can play an important role. Secondly, he pointed out that treatment and vaccinations are a matter of international law as well as national. He mentioned the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) as a piece of international law that is a good blend of protection of intellectual property (necessary to incentivize innovation) while ensuring full access to medications. Gostin also stated the law’s importance in the avoidance of social risk, in particular the importance of appropriate privacy and antidiscrimination laws, which are thoroughly covered in the report. Finally, law can dismantle legal barriers in many countries that criminalize HIV/AIDS and discriminate against sex workers or injection drug users who could have otherwise had access to preventative treatment.
Gostin finished by stressing how due to deep injustice and global inequalities, the burden of the pandemic falls on the worlds poorest who already suffer so much injustice. Because of this, he said, there is an ethical mandate to create enlightened laws, funding, and technical and financial assistance to ensure that everything possible is done to relieve the burden. Gostin stated that the best way to deal with this is a dual scale of justice and human rights, including the right to health.
Lance Gable, Assistant Professor of Law at Wayne State University, made three general observations. First, he stated that there is a lot of evidence that a good legal framework can be a real benefit to supporting legal rights of those infected with HIV/AIDS. Secondly, that these legal tools can occur in many forms, and can happen at many local, national, and international levels. Lastly, that law is an important component of the discussion, but not in itself sufficient, to effect change—enforcing laws is equally important. In relation to these statements, he pointed out that the report includes sections examining legal issues that affect specific groups, such as women and children.
James Hodge, Associate Professor at Johns Hopkins University Bloomberg School of Public Health and Director of the Centers of Law and Public Health at both Johns Hopkins and Georgetown University, was the next presenter. He stressed the two major strengths of the book: the wide breadth and the fact that it is a truly global text. In particular, he pointed out the book’s ability to quickly and succinctly identify the critical themes of conflict and contrast. He focused on a few specific chapters, such as one on disclosure versus exposure, which highlighted the rights to privacy of people living with HIV and AIDS in contrast with the rights of others to know of risks of potential contraction. Also, he mentioned a chapter on the attempt to criminalize homosexuality. Finally, he mentioned that the book also covers the issue of when and how to equitably share the benefits of HIV/AIDS research.
Katharina Gamharter, Legal Associate in the Environmentally and Socially Sustainable Development and International Law Practice Group of the Bank’s Legal Vice Presidency, was the next presenter. She spoke about her contribution to the book, which deals with trade and intellectual property rules and their impact on access to medicines. She mentioned that the book addresses issues such as the legality of generic medicines as alternatives to patented antiretroviral medications. These issues, she said, have not lost any timeliness even though they have been debated for a long time. She stressed that the aim of the book is not to give all the legal details on the matters, but a very practical and concise overview of what a certain issue entails on the legal side, and then beyond this, to provide the tools (for example, Web sites, books) that will enable the practitioner to find the answers.
Rudolf Van Puymbroeck, formerly Lead Counsel for Public Health and HIV/AIDS in the Legal Advisory Services Group of the World Bank’s Legal Vice Presidency, was the last author to present. He spoke about the chapter dealing with the Bank’s procurement rules. This, he said, deals mainly with the issue of registration, why it is important, and the capacity of national drug regulatory authorities to make this registration meaningful. In addition, the chapter covers the Bank’s procurement methods and the exceptions made to allow borrowers to take advantage of prices made possible by the Clinton Foundation.
In the question and answer session, audience members asked the panel a number of questions, among which was a question about the role of legal activism and civil society, and whether it is recognized as an important path to law reform. Also, there were questions about the dumping of expired drugs and the international effort to combat this. Audience members also asked about countries’ efforts to start reforming laws and what are the best measures and policies to do so given existing capacity constraints.
Zewdie made closing remarks for the event, noting the importance of the report and that she will make sure partner countries dealing with these issues will have it and use it.
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