OpenForum – a blog by the Health and Human Rights community

During his speech on World AIDS Day, South African President Jacob Zuma promised to ramp up HIV/AIDS prevention and treatment programs for children and high-risk groups. The new plan calls for treating all HIV-infected babies in a country whose child mortality rate has risen since 1990. “Our message is simple,” President Zuma said, “we have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.”

President Zuma’s commitments set a new ideological standard in South Africa that breaks from previous conceptions of the disease. Former President Thabo Mbeki received widespread criticism for his ideas about the nature and treatment of the epidemic. He is often noted as a denialist of the viral cause of AIDS and the effectiveness of antiretroviral treatment. A Harvard University study reported in The New York Times found that more than 330,000 premature deaths could have been prevented if Mbeki’s administration had backed the provision of antiretroviral drugs to AIDS patients.

Despite Mbeki’s misguided stance, that Jacob Zuma reversed his predecessor’s rhetoric on HIV/AIDS came as somewhat of a surprise. A husband to three wives – an acceptable facet of his Zulu heritage but a risk factor for contracting HIV – and the defendant in a 2006 criminal case for the rape of an HIV-positive friend, he is an improbable leader in the AIDS movement.

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Photo © Gemma Longman

Many prisoners living with HIV are denied access to adequate antiretroviral drugs, leaving them susceptible to opportunistic infections. Recently, prisoners have increasingly demanded HIV treatment. In 2006, South African inmates launched a hunger strike, demanding that the government provide antiretroviral (ARV) treatment for infected prisoners. In response, Judge Thumba Pillay of the High Court ordered the Department of Correctional Services to adopt a comprehensive HIV/AIDS plan for prisons throughout South Africa. The ruling mandated that prisoners be provided access not only to ARVs but also to health facilities, regular counseling, and adequate nutrition. Unfortunately, this integrated ideal has yet to be translated into practical implementation.

Three years later, inmates at the Westville Correctional Centre, where the hunger strike occurred, and lobbyists from the South Africa-based Treatment Action Campaign (TAC) continue to push for full compliance with the judicial decree. In a recent Plus News article, prisoners remarked on the uneven results of the court order, stating that while ARVs are now more available, the prison support services remain inadequate. Successful ARV treatment therapies depend upon consistent drug regimens and good nutrition, but unsanitary conditions, food shortages, and overcrowding make it difficult for prisoners to benefit fully from the drugs.

According to the United Nations Human Rights Committee, prisoners should have access to medical care equivalent to that available in the community without discrimination on the grounds of their legal status. As the World Health Organization points out in its report Effectiveness of Interventions to Address HIV in Prisons, institutions like the Westville Correctional Centre represent key points of contact with millions of individuals living with or at high risk of HIV infection. This population, normally largely out of the reach of community medical systems, can greatly benefit from care, support, and education. Most inmates will eventually be released, and a comprehensive HIV protocol in prisons can help spread awareness to the larger community.

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Photo by The Humanitarian and Development Partnership Team

Access to an adequate amount of clean water is an integral part of maintaining good health. Unfortunately for the residents of Phiri, Soweto — a low-income community in Johannesburg developed and relegated to black Africans during Apartheid — a ruling made by the South Africa Constitutional Court in a high-profile right-to-water case may limit access to this valuable resource.

The case pitted five impoverished residents of Phiri (the “applicants”) against the City of Johannesburg, Johannesburg Water, and the national Minister for Water Affairs and Forestry (the “respondents”) in a dispute about water provision policies and the installation of a pre-payment water meter system in Phiri. Before consideration by the Constitutional Court, this case had been decided in favor of the Phiri residents by two lower courts. Then on October 8, 2009, the Constitutional Court overturned these earlier decisions and ruled in favor of the respondents — the City, Johannesburg Water, and the Minister. If the poor want water, they will have to pay.

The applicants, all of whom are poor residents of Phiri, brought this case against the City, Johannesburg Water, and the Minister to challenge the adequacy of Johannesburg’s Free Basic Water policy, which allows only 6000 free liters of water per household monthly, or 25 liters per person per day for a household of 8. Households vary in size, but informal settlements sometimes adjoin these houses and share the household’s water stand. (This was the experience of the first applicant, Mrs Lindiwe Mazibuko, who shared a water stand with 19 other “household” members, thus limiting severely each person’s monthly water supply.) They also disputed the legality of installing a pre-paid water meter system in Phiri as part of a water sustainability program known as Operation Gcina’manzi (“to save water”).

Operation Gcina’manzi was implemented as a means to regulate water distribution more closely, decrease non-payment for water in Soweto, and raise money to repair corroded pipelines. After residents use up the monthly allowance of free water, they are required to purchase water from meters that automatically shut off if the consumer cannot afford to pay. The applicants contended that the provision of only 6 free kiloliters of water per month under this system violates section 27 of the Constitution, which provides that “everyone has the right to have access to sufficient water” and that “the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.” Read more

In 1995, after producing a successful weekly TV program about apartheid in South Africa against all odds, we broadcast an edition of a new series that explored revolutionary ideas about human rights, such as those then being formulated by a visionary at Harvard named Jonathan Mann. In our show, called Rights & Wrongs: Human Rights Television, Dr. Mann laid out in typically brilliant fashion the crystal-clear thinking behind his vision of human rights – and in particular, his then (and still) controversial notion that health and human rights are inextricably linked, that access to quality health care is a self-evident, inalienable right shared by all human beings, as recognized by the Universal Declaration of Human Rights, adopted without dissent by the entire United Nations sixty years ago. Read more