Human Rights and Public Health: Dichotomies or Synergies in Developing Countries? Examining the Case of HIV in South Africa

Sen K. and Bonita R. , “Global Health Status: Two Steps Forward, One Step Back,” Lancet, 356 (2000): 577–82; Loewenson R. , “People Centered Science and Globalization: Putting the Public Back into Public Health Policy,” International Journal of Occupation and Environmental Health, 5 (1999): 65–71.

McMichael A.J. and Beaglehole R. , “The Changing Global Context of Public Health,” Lancet, 356 (2000): 495–99; Heggenhoughen K. , “Are the Marginalised the Slag-Heap of Economic Growth and Globalization? Disparity, Health and Human Rights,” Health and Human Rights, 4 (1999): 205–13.

Cosmas C. and Schmidt-Ehry B. , “Human Rights and Health in Developing Countries: Barriers to Community Participation in Public Health in Cameroon,” Health and Human Rights, 1 (1995): 244–54.

Chen L.C. and Berlinguer G. , “Health Equity in a Globalising World,” in Evans T. , eds., Challenging Inequalities in Health: From Ethics to Action (New York: Oxford University Press, 2001): 34–44; Leon D.A. Walt G. , and Gilson L. , “International Perspectives on Health Inequalities and Policy,” British Medical Journal, 322 (2001): 591–94; MacFarlane S. Racelis M. , and Muli-Musiime F. , “Public Health in Developing Countries,” Lancet, 356 (2000): 841–46.

See Loewenson , supra note 1.

World Bank, Better Health in Africa: Experiences and Lessons Learned (Washington, D.C.: World Bank, 1994); Collins C. Green A. , and Hunter D. , “International Experience and Health Sector Reform: The Challenge for Developing Health Systems,” World Hospital Health Services, 30, no. 2 (1994): 20–25; Gilson L. and Mills A. , “Health Sector Reforms in Sub-Saharan Africa: Lessons of the Last 10 Years,” Health Policy, 32 (1995): 215–43; Sen K. and Koivusalo M. , “Health Care Reforms and Developing Countries — A Critical Overview,” International Journal of Health Planning and Management, 13 (1998): 199–215.

Marais H. , South Africa: Limits to Change: The Political Economy of Transformation (London: Zed Press, 1998).

Van den Heever A. and Brijlal V. , “Health Care Financing,” in Baron P. , ed., South African Health Review 1997 (Durban: Health Systems Trust, 1997): 81–89; McIntyre D. , “Equity in Public Sector Health Financing and Expenditure,” in Crisp N. and Ntuli A. , eds., South African Health Review 1999 (Durban: Health Systems Trust, 2000): 27–52.

Budlender D. , “Human Development,” in May J. , ed., Poverty and Inequality in South Africa: Meeting the Challenge (Cape Town: David Philip, 2000): 97–139; Buthelezi G. , Measuring the Move Towards Equity from the Site of Service Delivery: Results for the Nine Provinces (Durban: Heath Systems Trust, 1997); Community Agency for Social Enquiry, Second National Household Survey of Health Inequalities in South Africa (Washington, D.C.: Henry J. Kaiser Foundation, 1999).

See Marais , supra note 7.

See Chen and Berlinguer , supra note 4, at 43.

“Primary Health Care” is the concept proposed by the World Health Organization and adopted in the Alma Ata Declaration in 1978. It flags a set of commitments to an emphasis on prevention rather than treatment, on community participation, on health as a right, and on multisectoral approaches and comprehensive services. It differs from the usage of “primary care,” “basic care,” or “health-care services” delivered at the primary level.

Gostin L. and Mann J.M. , “Towards the Development of a Human Rights Impact Assessment for the Formulation and Evaluation of Public Health Policies,” in Mann J.M. , eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 54–71; International Federation of Red Cross and Red Crescent Societies and the François-Xavier Bagnoud Centre for Health and Human Rights, “The Public Health — Human Rights Dialogue,” in Mann J.M. , eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 46–53; Heyman S.J. and Sell R.L. , “Mandatory Public Health Programmes: To What Standards Should They Be Held?,” Health and Human Rights, 4 (1999): 195–203.

Evans T. , Introduction, in Evans T. , eds., Challenging Inequalities in Health: From Ethics to Action (New York: Oxford University Press, 2001): 3–11.

Leary V.A. , “The Right to Health in International Human Rights Law,” Health and Human Rights, 1 (1994): 24–56; Freeman L. , “Reflection on Emerging Frameworks of Health and Human Rights,” in Mann J.M. , eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 227–52; Mann J.M. , “Health and Human Rights,” in Mann J.M. , eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 7–20.

See Mann , supra note 15.

Constitution of the Republic of South Africa (adopted May 8, 1996, amended October 11, 1996), available at <http://www.polity.org.za/govdocs/constitution/saconst.html>.

Ngwena C. , “Access to Health Care a Fundamental Right: The Scope and Limits of Section 27 of the Constitution,” Journal for Juridical Sciences, 25 (2000): 1–32; Pillay K. , “South Africa's Commitment to Health Rights in the Spotlight,” ESR Review, 2 (2000): 1–4; Sarkin J. , “Health and Human Rights in Post-Apartheid South Africa,” South African Medical Journal, 89 (1999): 1259–63.

Friedman I. , “Poverty, Human Rights and Health,” in Ntuli A. , eds., South African Health Review 2000 (Durban: Health Systems Trust, 2001): 1–12.

Ntsaluba A. and Pillay Y. , “Reconstructing and Developing the Health System — The First 1,000 Days,” South African Medical Journal, 88 (1998): 33–36. The clinic building was one of the first capital development initiatives of the new government aimed at rapidly expanding the network of first contact healthcare facilities in underserved areas.

van Rensburg D. , “Primary Health Care Facilities Survey,” in Ntuli A. , eds., South African Health Review 2000 (Durban: Health Systems Trust, 2001): 3–50.

The Reproductive Rights Alliance and the National Portfolio Committee on Health, Report on the Public Hearings on the Implementation of the Choice on Termination of Pregnancy Act 1996, June 6–8, 2000, available at <http://www.hst.org.za/rra/top/top.pdf>.

Schneider H. and Stein J. , “Implementing AIDS Policy in Post-Apartheid South Africa,” Social Science and Medicine, 52 (2001): 723–31.

Harrison S. and Qose M. , “Health Legislation,” in Ntuli A. , ed., South African Health Review 1998 (Durban: Health Systems Trust, 1999): 17–27.

Baleta A. , “Drug Firms Take South Africa's Government to Court,” Lancet, 367 (2001): 775.

Baleta A. , “Drug Firms Lose Patent Rights Lawsuit Against South Africa's Government,” Lancet, 357 (2001): 1347; Sidley P. , “South African Court Battle Damages Drug Industry's Image,” BMJ, 322 (2001): 635.

See Baleta , supra note 26.

Treatment Action Campaign (TAC), Founding Affidavit (August 21, 2001), filed in Treatment Action Campaign v. Minister of Health, No. 21182/2001 (High Court of South Africa, Transvaal Provincial Division), available at <http://www.tac.org.za/Documents/MTCTCourtCase/ccmfound.rtf>. The Pretoria High Court ruled in favor of TAC in December 2001 and ordered the Department of Health to produce a mother-to-child-transmission prevention plan. The South African government lodged an appeal against the decision, which was recently upheld by the Constitutional Court of South Africa (No. CCT 8/02, July 5, 2002), available at <http://www.tac.org.za/Documents/MTCTCourtCase/ConCourtMOHVsTAC.txt>.

Annas G.J. , “The Impact of Health Policies on Human Rights: AIDS and TB Control,” in Mann J.M. , eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 37–45; United Nations General Assembly, 26th Special Session, Declaration of Commitment on HIV/AIDS, A/Res/S-26/2, June 27, 2001, available at <http://www.unaids.org/UNGASS/>.

Nyazema N.Z. , AIDS and Equity: Civil Rights or Public Health Crisis?, presentation to the Southern African conference on Health Equity, Broederstroom, September 2000.

Channock M. , “Culture and Human Rights: Orientalising, Occidentalising and Authenticity,” in Mamdani M. , ed., Beyond Rights Talk and Culture Talk: Comparative Essays on the Politics of Rights and Culture (Cape Town: David Phillip, 2000): 15–36.

Nhlapo T. , “The Africa Customary Law of Marriage and the Rights Conundrum,” in Mamdani M. , ed., Beyond Rights Talk and Culture Talk: Comparative Essays on the Politics of Rights and Culture (Cape Town: David Phillip, 2000): 136–48, at 144.

Seidel G. , “Confidentiality and HIV Status in Kwazulu-Natal, South Africa: Implications, Resistances and Challenges,” Health Policy and Planning, 11 (1996): 418–27.

See Nhlapo , supra note 32.

Constitution of the Republic of South Africa, supra note 17, at clauses 30 and 31.

Dieng M.A. , “Interface Between Global and Regional Protection and Promotion of Human Rights: An African Perspective,” in Danieli Y. Stamatopoulou E. , and Dias C.J. , eds., The Universal Declaration of Human Rights: Fifty Years and Beyond (Amityville: Baywood Publishing, 1999): 271–82, at 275, quoting the African Charter on Human and Peoples' Rights.

Green E.C. Zokwe B. , and Dupree J.D. , “The Experience of an AIDS Prevention Program Focused on South African Traditional Healers,” Social Science and Medicine, 40 (1995): 503–15.

Campbell C. and Williams B. , “Beyond the Biomedical and Behavioral: Towards an Integrated Approach to HIV Prevention in the Southern African Mining Industry,” Social Science and Medicine, 48 (1999): 1625–39; Campbell C. and Williams B. , “Mines, Migrancy and HIV in South Africa — Managing the Epidemic,” South African Medical Journal, 86 (1996): 1249–51.

See Nyazema , supra note 30.

Note that a Provincial Minister in South Africa is more accurately titled a Member of the Executive Committee.

Mkhize Z.L. , Minister of Health, XIIIth International AIDS Conference, Durban, South Africa, July 11, 2000, cited in Garbus L. , “Debate on Treatment to Prevent Mother-to-Child Transmission without Treatment for the Mother,” XIII International AIDS Conference Report #3 (July 11, 2000), available at <http://hivinsite.ucsf.edu/InSite.jsp?doc=3098.0711>.

See id.

McCoy D. , “Back to Basics for Health Care,” Editorial, Mail and Guardian, May 4, 2001.

Strachan D. , “Thabo Mbeki Is Right in His Stance on Anti-AIDS Drugs,” Cape Times, July 7, 2001.

Mamdani M. , Introduction, in Mamdani M. , ed., Beyond Rights Talk and Culture Talk: Comparative Essays on the Politics of Rights and Culture (Cape Town: David Philip, 2000): 1–13.

Heywood M. and Altman D. , “Confronting AIDS: Human Rights, Law and Social Transformation,” Health and Human Rights, 5 (2000): 149–79, at 150.

Farmer P. , Infection and Inequalities: The Modern Plagues (Berkeley: University of California Press, 1999).

Wall S. , “Epidemiology for Prevention,” International Journal of Epidemiology, 24 (1995): 655–64.

Varkey S.J. and Fonn S. , “Termination of Pregnancy,” in Crisp N. and Ntuli A. , eds., South African Health Review 1999 (Durban: Health Systems Trust, 2000): 81–89.

Cameron E. , “The Deafening Silence of AIDS,” Health and Human Rights, 5 (2000): 7–24.

Cohen J. , “South Africa: AIDS Researchers Decry Mbeki's Views on HIV,” Science, 288 (2000): 590–91; Coste P. , “Mbeki's Aids Stance Leaves Scientists in a Daze,” Mail and Guardian, April 19, 2000.

Department of Health, Position of the South African Government on Access to Pharmaceuticals, Press Release, Pretoria, July 11, 2000; Sidley P. , “South Africa Will Not Pay for Antiretroviral Therapy,” British Medical Journal, 322 (2001): 1441.

See McCoy , supra note 43.

Tarantola D. , “The Shifting HIV/AIDS Paradigm: Twenty Years and Counting,” Health and Human Rights, 5 (2001): 1–6.

Farmer P. , “Community-Based Approaches to HIV Treatment in Resource-Poor Settings,” Lancet, 358 (2001): 404–09.

Marseille E. , “Cost-Effectiveness of Single-Dose Nevirapine Regimen for Mothers and Babies to Decrease Vertical HIV-1 Transmission in Sub-Saharan Africa,” Lancet, 354 (1999): 803–09. See McCoy , supra note 43.

Skordis J. and Nattras N. , What Is Affordable: The Political Economy of Policy on the Transmission of HIV/AIDS from Mother to Child in South Africa, paper presented to the AIDS in Context Conference, University of Witwatersrand, Johannesburg, April 2001; Soderlund N. , “Prevention of Vertical Transmission of HIV: Analysis of Cost Effectiveness of Options Available in South Africa,” British Medical Journal, 318 (1999): 1650–56; Wilkinson D. Floyd K. , and Gilks C.F. , “National and Provincial Estimated Costs and Cost Effectiveness of a Program to Reduce Mother-to-Child HIV Transmission in South Africa,” South African Medical Journal, 90 (2000): 794–97; Marseille E. Kahn J.G. , and Saba J. , “Cost-Effectiveness of Antiviral Drug Therapy to Reduce Mother-to-Child HIV Transmission in Sub-Saharan Africa,” AIDS, 12 (1998): 939–48; Marseille E. , supra note 57.

The DALY is a measure developed as a comprehensive indicator to assess the burden of disease and injury. See Murray C.J. Lopez A.D. , and Jamison D.T. , “The Global Burden of Disease in 1990: Summary Results, Sensitivity Analysis and Future Directions,” Bulletin of the World Health Organization, 72 (1994): 495–509.

Wilkinson Floyd , and Gilks , supra note 58.

Reuter H. , Affidavit (November 2001), filed in Treatment Action Campaign v. Minister of Health, No. 21182/2001 (High Court of South Africa, Transvaal Provincial Division), available at <http://www.tac.org.za/Documents/MTCTCourtCase/affidavit/reuteraffidavit.txt>.

Meerkotter A. , Mother-to-Child-Transmission of HIV: A Guide for Health Workers and HIV/AIDS Trainers, in Richter M. and Reuter H. , eds. (Treatment Action Campaign/AIDS Law Project, 2001).

Frontières Médicins Sans , Long-Term Strategy Needed to Treat AIDS in Poor Countries, Press Release (April 3, 2000); Loewenson R. and Whiteside A. , United Nations Development Programme, HIV/AIDS: Implications for Poverty Reduction (New York: United Nations Development Programme, 2001), available at <http://www.undp.org/dpa/frontpagearchive/2001/june/22june001/hiv-aids.pdf>.

See Department of Health, supra note 52.

See Gostin and Mann , supra note 13; International Federation of Red Cross and Red Crescent Societies and the François-Xavier Bagnoud Centre for Health and Human Rights, supra note 13; Heyman and Sell , supra note 13.

See International Federation of Red Cross and Red Crescent Societies and the François-Xavier Bagnoud Centre for Health and Human Rights, supra note 13.

See Pillay , supra note 18; Ngwena , supra note 18; Sarkin , supra note 18.

Beckerman K.P. , “Mothers, Orphans and Prevention of Paediatric AIDS,” Lancet, 359 (2002): 1168–69.

World Health Organization Technical Consultation on Behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV, New Data on the Prevention of Mother-to-Child Transmission of HIV and Their Policy Implications: Conclusions and Recommendations, WHO/RHR/01.28, January 15, 2001, available at <http://www.unaids.org/publications/documents/mtct/MTCT_Consultation_Report.doc>; Dabis F. , “Prevention of Mother-to-Child Transmission of HIV in Developing Countries: Recommendations for Practice. The Ghent International Working Group on Mother-to-Child Transmission of HIV,” Health Policy and Planning, 15 (2000): 34–42; Brocklehurst P. and Volmink J. , “Antiretrovirals for Reducing the Risk of Mother-to-Child Transmission of HIV Infection” (Cochrane Review), The Cochrane Library, 3 (Oxford: Update Software Ltd., 2002).

See Beckerman , supra note 68.

Newell M.L. , “Prevention of Mother-to-Child Transmission of HIV: Challenges for the Current Decade,” Bulletin of the World Health Organization, 79 (2001): 1138–44.

For example, see Daponte A. Guidozzi F. , and Marineanu A. , “Maternal Mortality in a Tertiary Center after Introduction of Free Antenatal Care,” International Journal of Gynaecology and Obstetrics, 71 (2000): 127–33.; Ebrahim S. Daponte A. , and Guidozzi F. , “The Impact of Free Antenatal Care on Perinatal Mortality,” International Journal of Gynaecology and Obstetrics, 71 (2000): 205–07; McCoy D. , Free Health Care for Pregnant Women and Children Under Six in South Africa: An Impact Assessment (Durban: Health Systems Trust, 1996); Westaway M.S. , “Monitoring Utilization, Quality & Effectiveness of Free Antenatal Care in an Informal Settlement in Gauteng,” Curationis, 21 (1998): 57–59; Wilkinson D. Sach M.E. , and Karim Abdool S.S. , “Examination of Attendance Patterns Before and After Introduction of South Africa's Policy of Free Health Care for Children Aged Under 6 Years and Pregnant Women,” British Medical Journal, 314 (1997): 940–41.

Ioannidas J.P. , “Perinatal Transmission of Human Immunodeficiency Virus Type 1 by Pregnant Women with RNA Viral Loads < 1000 Copies/ml,” Journal of Infectious Diseases, 183 (2000): 539–45; See Beckerman , supra note 68.

See Annas , supra note 29.

Truth and Reconciliation Commission, Truth and Reconciliation Commission Report (Cape Town: Juta, 1998).

See Tarantola , supra note 55.

See Heywood and Altman , supra note 46.

Mamdani M. , Citizen and Subject: Contemporary Africa and the Legacy of Late Colonialism (Princeton: Princeton University Press, 1996).

South African Department of Health, HIV/AIDS & STD Strategic Plan for South Africa 2000–2005 (Pretoria: Department of Health, 2000).

Heads of State and Government of the Organisation of African Unity (OAU), Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, OAU/SPS/ABUJA/3, April 27, 2001, available at <http://www.unaids.org/decabuja%5Fen.doc>; UNAIDS, The African Consensus and Plan of Action: Leadership to Overcome HIV/AIDS, December 7, 2000, available at <http://www.unaids.org/whatsnew/adf/files/adf_consensus.doc>. See also United Nations General Assembly, supra note 29.