Those who are better informed should patiently explain why such measures are ineffective, counter-productive and positively harmful in the global struggle against STDs in general and HIV in particular. It is unlikely that a time ever existed when strict quarantine for HIV infection could have worked; if it ever did, that time has long since passed. Global travel spreads HIV to the remotest communities. Testing and screening are expensive and also ineffective in the window period before antibodies show up. Further, these measures may alienate and stigmatize people whose confidence must be won if they are to be open to receiving information and counselling on behaviour change. And behaviour modification is essential for AIDS prevention.

As a judge, I know that it is easy to pass laws or to hand down decisions. It is much harder to change individual behaviour, especially when the social environment is not conducive or even creates obstacles to behaviour change, but this is what must be achieved.

Upholding human dignity

This is where human rights come in. Arising as a global movement only after the Second World War, concern for human rights has since been expressed in the UN Universal Declaration of Human Rights (1948) and the International Covenants on Human Rights (1966). These basic tenets to uphold human dignity include the following rights:

• the right to privacy, now held to extend rights to sexual privacy and one's own sexual orientation
• rights to health care, including preventive health education and self-protection
• rights to shelter and housing
• the right to protection from oppressive laws and policies of the State
• the right to due process in the law
• rights to employment without discrimination
• rights for children to have the basic information necessary for their protection, health and life
• the right of women to dignity of their person
• rights of all persons without distinction to protection against vicious conduct and hate attacks.

When HIV/AIDS first arrived, the period of mandatory screening, quarantine and criminal laws led to confrontation between health officials and human rights advocates. Now, however, many officials, led by the World Health Organization, recognize the AIDS paradox and the need to supplement public and health prevention measures with attention to human rights. We now realize that the right to health is, itself, a basic human right.

Understanding the global principles of human rights helps put strategies to combat HIV/AIDS and other STDs in a context of basic universal principles designed to defend and uphold the human dignity of each individual. Recognizing this, the International Commission of Jurists in Geneva has adopted the human rights of persons living with HIV/AIDS, human rights concerning sexual orientation, and human rights of drug-dependent persons and drug users as items for its programme.

Nearly a century ago, these lessons were taught in the context of syphilis and other STDs, incurable at the time, that had delayed manifestation of symptoms and incompetent drug therapy with serious side effects. We have had to relearn those lessons in the face of HIV/AIDS. HIV/AIDS has at last shone the spotlight of human rights on medical practice and epidemic control.

We must remember that, in many cases, the best policies to attain behaviour modification are those which are addressed to challenging the discrimination and alienation that often stand between the groups vulnerable to HIV/STDs and the necessary educational and behavioural strategies to prevent their spread. A supportive governmental and social environment, combined with the activities of community groups, will help us implement such strategies.

Justice Michael Kirby, President, International Commission of Jurists, c/o High Court of Australia, Canberra 2600, Australia; Tel: 61-2-230-8203; Fax: 61-2-235-1006

These rights are inalienable: individuals cannot arbitrarily be denied their rights and national laws or practices cannot legitimately override fundamental human rights. They belong to every man, woman and child, without distinction.

The rights listed in the Universal Declaration of Human Rights are protected by international texts. These texts impose specific legal obligations on the states that signed them to guarantee the rights named. However, as members of the world community, all states are morally bound to respect the rights recognized in the Declaration, regardless of whether they have ratified international human rights legal instruments or not.

States' obligations go beyond the duty of simply avoiding human rights' violations through their own actions and those of public authorities. They must ensure the provision of a legal and social environment in which individuals can freely and equally enjoy their rights. All individuals, groups and corporations should be aware of their responsibilities to respect the rights and dignity of others, to avoid harm to others and to act in mutual solidarity, with compassion and tolerance.

It is well known that people living with HIV/AIDS (PHAs) have developed successful responses to the epidemic. Yet they are prevented from making such an important contribution where they risk discrimination, physical abuse or imprisonment. As always, violation of one person's rights violates the rights of us all and society as a whole is the loser.

Coercive policies (e.g., mandatory testing, quarantine) both violate human rights and hamper public health objectives. People who fear their rights will be violated are unlikely to seek information and services needed to help protect them from HIV infection, to donate blood or to participate in voluntary HIV testing. It is important to recognize this, since it is sometimes inaccurately argued that it is justifiable to restrict the rights of some individuals in order to introduce strong HIV prevention measures.

The HIV/AIDS epidemic has clearly indicated a relationship between vulnerability to disease and economic or social marginalization. Those who are disadvantaged in fully enjoying their rights - children, prisoners or refugees - are particularly vulnerable to HIV as well. Women are particularly vulnerable as a result of lack of education and employment opportunities, inadequate access to health care and sexual violence and abuse.

Strategies for government action should include:

• inclusion of human rights principles in developing and implementing HIV/AIDS policies and programmes, with the active participation of PHAs
• establishment of appropriate legal and administrative frameworks, including the immediate repeal of coercive or unnecessarily restrictive laws and practices
• the introduction or strengthening of measures prohibiting HIV/AIDS-related discrimination and abuse and the legal protection of privacy
• education and training of government officials, policy-makers, employers, the media and general public to highlight the dangers of prejudice and discrimination and to promote respect for human rights
• legal and political emancipation and empowerment of disadvantaged groups (e.g., women, sex workers and homosexuals), including the repeal of laws that inhibit formation of self-help groups
• increased resource allocation for promoting human rights in relation to HIV/AIDS, including strengthened commitment and action by the international community.

We have a long way to go to ensure respect for human rights in the context of HIV/AIDS. But the initiatives reported in this issue of the Exchange show much is already being done. Hopefully, these examples will encourage others to develop similar measures.