In 2001, 189 member states of the United Nations arrived at a global consensus on a comprehensive framework to achieve the Millennium Development Goal of halting and reversing the HIV epidemic by 2015. The consensus assumed a shared partnership between government, civil society and the private sector.

This commitment on HIV and AIDS (termed the UNGASS Declaration) was further elaborated on and reaffirmed at both the 2005 World Summit and the 2006 United Nations High Level meeting on HIV and AIDS, with a specific focus on Universal Access by 2010 for all those who needed treatment, care and prevention services.

At the core of this commitment was the idea that all persons who needed access had a right to fair, equitable and reliable access to HIV-related services in the areas of treatment, care and prevention, regardless of status, gender, orientation and any other defining consideration.

The resolution sought to reaffirm that the full realisation of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV and AIDS pandemic. It specifically noted that to mount a comprehensive response, we must overcome any legal, regulatory, trade and other barriers that block access to prevention, treatment, care and support; commit adequate resources; promote and protect all human rights and fundamental freedoms for all. In short, the underlying principle of the respective commitments was that recognition of and respect for basic human rights was essential to the scaling up and achievement of universal access.

December 23, 2009 marked five years since the first articulation of the Universal Access theme and now is an opportune time to question how far Jamaica has come in fulfilling the commitments made in respective declarations toward Universal Access? To what extent has the issue of rights affected our progress?

Jamaica's response has been mixed. While progress has been made on a number of fronts such as in the areas of access to antiretroviral therapy (ART), prevention of mother-to-child transmission (PTCMT) there are still many challenges to be overcome and many barriers to ensuring full universal access as envisaged by the various commitments and declarations.

This is particularly the case where legislative action is needed to support the achievement of some of the targets set. Also, while there has been increased knowledge of Voluntary Counselling and Testing (VCT) services, there are still concerns about the quality of services and the entitlements inherent in the voluntary counselling and testing protocols.

The rights dimension

The Jamaica National HIV/AIDS Policy recognises the issue of human rights as being fundamental to the HIV response. Indeed, it calls for the promotion and protection of human rights. It also identified the need for legislative reform in support of this thrust. While this recognition exists in principle the practice has a far way to go.

To begin with, there is need within the national strategy for a clearer statement on the groups which are most at risk of discrimination and marginalisation. Additionally, in setting its universal targets in 2006, only one of 10 targets was set in the area of human rights indicating the challenge in moving the idea of universal access to this arena. Efforts to make access to health care a fundamental right have been unsuccessful and there exists a need for legislation to protect the rights of vulnerable groups. Indeed, a number of laws which criminalise activities among risk groups serve to limit access by these groups by virtue of the potential discriminatory effects.

If we are to achieve universal access through a supportive human rights environment, then the journey must be embraced by all. The private sector must ensure that within its ambit, it seeks to support the full recognition of the rights of persons infected and affected by HIV and support their access to treatment, care and prevention services. Civil society, which has been instrumental in the push towards a rights-based approach to scaling up access, must become united in its effort, increase vigilance and hold both the government and the private sector accountable to their partnership in the response.

There is a long way to go to universal access services for all and access to services by all. Time is definitely not on our side, so action must be rapid and the society must begin to move towards ensuring that the rights-based approach articulated in the various commitments becomes a reality sooner rather than later or we risk reversing some of the gains we have made to this point.

As we seek to enshrine a Charter of Rights, this should be used as an opportunity for us to build supportive legislative and institutional arrangements to make good on the commitment to universal access as outlined in the 2005 declaration. This will require government to take a proactive stance in recognising the rights of all groups in society as fundamental to reducing their vulnerability to HIV and AIDS and to ensuring that they can access the needed services without fear of discrimination or retribution.

Ivan Cruickshank is a community activist working with at-risk populations and persons infected with and affected by HIV and AIDS.

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