The response to HIV from Human Rights and the UN Strategy 90-90-90

• Professor Miguel A Ramiro Avilés,  Associate Professor of Legal Philosophy, Chair ‘Disability, Chronic Condition and Access to Rights’ initiative (DECADE-UAH) at the University of Alcalá, Madrid

Since the beginning of the HIV epidemic, the response to HIV has been dominated by the medical-rehabilitation model, which focused, on one hand, on public health requirements to prevent the spread of infection and, on the other, on the protection of individual health to reduce the morbidity and mortality of infected people. The achievements, at least in the high-income countries, have been remarkable because in the fourth decade of HIV it has become a chronic disease, which responds to antiretroviral treatment in a cost-efficient manner, increasing the life expectancy of the people with HIV. This response must be complemented with the response based on the rights of people with HIV because since the beginning of the epidemic, legal normative measures were adopted that have limited their rights and freedoms and that have generated differentiated treatments. Currently, providing only pharmacological treatment is only a relative success if people with HIV cannot enjoy their rights and freedoms on equal terms. In 2014 the United Nations introduced their Strategy 90-90-90. The intention of this strategy is to diagnose 90% of all HIV-positive persons, also to  provide antiretroviral therapy (ART) for 90% of persons diagnosed, and achieve viral suppression for 90% of those persons treated by 2020. This paper argues that the Strategy should incorporate a Fourth 90 that takes into account the social and legal determinants of health in people with HIV. Given the new scientific evidence about U=U, limitations and differential treatments are no longer legitimate.  

This paper explores the importance of a Fourth 90 by examining the current approaches taken to persons with HIV and how a Fourth 90 along with other measures may make a substantial difference in the future. It discusses cases concerning access to public safety bodies (police) and the provision of health services by people with HIV (healthcare workers) and compares and contrast the different approaches taken  in the UK and Spain. It explores the different relationship that HIV and disability have in the UK and Spain which may determine a greater social inclusion of people with HIV. It draws upon these cases to and explores the factors which support the case for the Fourth 90.