Impeding access? stigma, individual responsibility and access to post-HIV-exposure prophylaxis (PEP) in South Africa

Medicine and Law

Volumn 30, Issue 2, 2011, Pages 279-294

  Pieterse, Marius ^a  

^a UNIVERSITY OF THE WITWATERSRAND   (South Africa)

Author keywords

HIV AIDS; PEP; Right to Health; Stigma

Indexed keywords

ANTIRETROVIRUS AGENT;

ARTICLE; DISEASE TRANSMISSION; HEALTH CARE DELIVERY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN RIGHTS; LEGAL ASPECT; OCCUPATIONAL EXPOSURE; SEXUAL CRIME; SOCIAL STIGMA; SOUTH AFRICA;

ANTI-RETROVIRAL AGENTS; HEALTH SERVICES ACCESSIBILITY; HIV INFECTIONS; HUMAN RIGHTS; HUMANS; OCCUPATIONAL EXPOSURE; SEX OFFENSES; SOCIAL STIGMA; SOUTH AFRICA;

EID: 80155171842     PISSN: 07231393     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (117)

1. Burris S. Disease stigma in U.S. public health law. Journal of Law, Medicine & Ethics 2002(30); 179: 184.
2. Visser C. Foundering in the seas of human unconcern: AIDS, its metaphors and legal axiology. South African Law Journal 1991(108); 619: 625; 628.
3. Eba PM Stigma[ta]: Aids Review 2007 (2008) 41-42;
4. Pieterse M. The interdependence of rights to health and autonomy in South Africa. South African law Journal 2008(125); 553: 556; 564; 568.
5. Eba op cit 38;
6. Kirby M. The never-ending paradoxes of HIV/AIDS and human rights. African Human Rights Law Journal 2004(4); 163: 167;
7. Gostin LO, Lazzarini Z, Alexander A, Brandt AM, Mayer KH, Silverman DC. HIV testing, counselling and prophylaxis following sexual assault Reproductive Health Matters 1995(3(5));104;
8. Nongogo N. HIV testing and voluntary counselling in the context of stigma. In Viljoen F (ed). Righting Stigma: Exploring a Rights-based Approach to Addressing Stigma. 2005; 94: 97-98; Visser op cit 629-30.
9. Alexander A, Mbali M. Beyond "bitches" and "prostitutes": Folding the materiality of gender and sexuality into rights-based HIV/AIDS interventions. In Viljoen op cit; 50: 51; 53;
10. Gostin et al op cit 104; Kirby op cit 167; Nongogo op cit 98; Visser op cit 629-30.
11. generally, Eba op cit 2; Alexander & Mbali op cit; Nongogo op cit.
12. Bonthuys E. Women's sexuality in the South African Constitutional Court. Feminist Legal Studies 2006(14); 391: 397; 399; 407.
13. For detailed exposition of this argument.
14. Metz T. Respect for persons permits prioritizing treatment for HIV/AIDS. Developing World Bioethics 2008(8(2)); 89: 95-96;
15. Wikler D. Personal and social responsibility for health. In Anand S, Peter F & Sen A (eds). Public Health, Ethics, and Equity. (2004) 109: 109. Neither author supports the argument.
16. Eba op cit 48.
17. Wikler op cit 125.
18. Visser op cit 631.
19. further Stadler J & Delany S. The "healthy brothel": The context of clinical services for sex workers in Hillbrow, South Africa. Culture, Health & Sexuality 2006(8(5)); 451: 452; 458 (in relation to hostility faced by sex workers seeking sexual health services);
20. Gerntholtz L & Richter M. Young women's access to reproductive health-care services in the context of HIV. Agenda 2002(53); 99: 101 (in relation to similar hostility towards sexually active teenage girls).
21. Eba op cit 46-47;
22. Gerntholtz & Richter Op cit 99-100;
23. Kirby op cit 176;
24. Meerkotter A. Comments on the Draft Circular Instruction regarding compensation for occupationally acquired HIV infection and AIDS. Industrial Law Journal 2005(26); 1151: 1154;
25. Stadler & Delaney op cit 452; 458.
26. Wikler op cit 128-129.
27. Metz op cit 99-103;
28. Pieterse op cit 555; 564;
29. Wikler op cit 127.
30. See n 22 below and accompanying text;
31. Wikler op cit 110;
32. Pieterse op cit 564-565; 572.
33. Burris op cit 184-185.
34. In, respectively, sections 10, 9 and 27 of the 1996 Constitution.
35. WHO. Joint WHO/ILO Guidelines on Post-Exposure Prophylaxis (PEP) to Prevent HIV Infection. 2007; 1.
36. WHO. Joint WHO/ILO Guidelines on Post-Exposure Prophylaxis (PEP) to Prevent HIV Infection. 2007;2.
37. WHO. Joint WHO/ILO Guidelines on Post-Exposure Prophylaxis (PEP) to Prevent HIV Infection. 2007; 2-3.
38. Centre for Aids Development, Research and Education (CADRE). Rape and Post-Exposure Prophylaxis in South Africa: A Review. 2003; 5-6
39. Roehrs S. Half-hearted HIV-related services for victims. In Artz L & Smythe D. Should We Consent? Rape Law Reform in South Africa. 2008; 175: 177-178.
40. WHO op cit 2; 5;
41. Roehrs op cit 178.
42. PEP is further significantly more cost-effective than life-long anti-retroviral treatment.Ibid.
43. WHO op cit 9.
44. WHO op cit 5.
45. UN Committee on Economic, Social and Cultural Rights. General Comment No 14:
46. The Right to the Highest Attainable Standard of Health (Article 12 of the International Covenant on Economic, Social and Cultural Rights. 2000; paras 12; 16-18.
47. WHO op cit 1; 3;
48. CADRE op cit 7; 24.
49. In terms of s 36 of the Constitution, the right may further be limited by a law of general application to the extent that the limitation is reasonable and justifiable in an open and democratic society based on human dignity, equality and freedom'. Note.
50. CADRE op cit 14;
51. De Vos P. So much to do, so little done: The right of access to anti-retroviral drugs post-Grootboom. Law, Democracy & Development 2003(7); 83: 89;
52. McQuoid-Mason D., Dhai A., & Moodley J., Rape survivors and the right to emergency medical treatment to prevent HIV infection. South African Medical Journal 2003(93(1)); 41: 41-43.
53. On the ambit and scope of the right in s 27(3) of the Constitution.
54. Soobramoney v Minister of Health, KwaZulu Natal 1998 (1) SA 765 (CC) paras 13; 17-21; 38; 51;
55. Pieterse M. Enforcing the right not to be refused emergency medical treatment: Towards appropriate relief Stellenbosch Law Review 2007(18); 75: 80-81.
56. De Vos op cit 93;
57. Roehrs op cit 178.
58. On the South African government's AIDS-denialist-fuelled stance in relation to ARVS in the late 1990s.
59. further Forman L. Ensuring reasonable health: Health rights, the judiciary and South African HIV/AIDS policy. Journal of Law, Medicine & Ethics 2005(33); 711: 717;
60. Heywood M. Preventing mother-to-child HIV transmission in South Africa: Background, strategies and outcomes of the Treatment Action Campaign case against the Minister of Health. South African Journal on Human Rights 2003(19); 278: 281-285;
61. Nattrass N. The Moral Economy of AIDS in South Africa. 2004; 47-55.
62. Department of Health. Policy Guideline on HIV and Aids and Sexually Transmitted Diseases in the Workplace. 2000;
63. De Vos op cit 92.
64. Minister of Health v Treatment Action Campaign 2002 (5) SA 721 (CC).
65. The TAC successfully challenged the government's restrictive PMTCT policy, according to which the drug Nevirapine could only be accessed for PMTCT at limited, designated "research and training' sites, for being in breach of the right of access to health care services in s 27 of the Constitution. The Constitutional Court held that the State's ostensible "concerns' over the drug's safety and efficacy were scientifically unfounded and that the policy was unreasonable (and, hence, unconstitutional) due to its rigidity. The government was ordered to remove restrictions on the public sector availability of Nevirapine for PMTCT and to enable access thereto in all instances where it was medically indicated and where the capacity to administer it existed. Note.
66. De Vos op cit 92-93;
67. Roehrs op cit 178.
68. regs 7-9 and Annexure A of the General Regulations Made in terms of the Medical Schemes Act 131 of 1998 GN R 1262 of 20 October 1999 (as updated).
69. Further Hassim A, Heywood M & Berger J Health & Democracy. 2007; 378.
70. CareWorks medical insurance's 'PEPcare' product, advertised as part of a comprehensive HIV/AIDS care package at http://www.careworks.co.za/pepcare.php.
71. On the inequities of the South African dual health system and efforts to reduce these,
72. Hassim, Heywood & Berger op cit 162-198.
73. Department of Health. HIV & AIDS STI Strategic Plan for South Africa 2007-2011. 2007; 70-72; 75.
74. Reg 2 of the Criminal Law (Sexual Offenses and Related matters) Regulations GN R.561 in GG 31076 of 22 May 2008.
75. National Instruction 3/2008 Sexual Offenses, issued in terms of GN 865 in GG 31330 of 15 August 2008. See instructions 10(2); 10(5)(a); 11(2)(b).
76. Available online at http://www.doh.gov.za/aids/docs/rape-protocol.html.
77. Issued in terms of GN 223 in GG 31957 of 6 March 2009.
78. Note 36 above guidelines 1.2; 2.1; 3.6; note 37 above directives 3(a)-(b); 4; 11.
79. Roehrs op cit 181.
80. CADRE op cit 13; 15;
81. Roehrs op cit 182.
82. WHO op cit 5.
83. Roehrs op cit 182;
84. Artz L & Roehrs S. Criminal Law (Sexual and Related Matters) Amendment Act (No 32 of 2007): Emerging issues for the health sector. CME - SA Journal of CPD Oct 2009(27); 484: 486.
85. CADRE op cit 25;
86. De Vos op cit 94;
87. McQuoid-Mason, Dhai & Moodley op cit 42-43;
88. Roehrs op cit 179; 182.
89. Roehrs op cit 182.
90. Roehrs op cit 192-193.
91. Roehrs S. Privacy, HIV/AIDS and public health interventions. South African Law Journal 2009(126); 360: 394-397.
92. Section 36(1)(a)-(e) of the 1996 Constitution.
93. De Vos op cit 92.
94. CADRE op cit 1-2; 33.
95. For a related argument,
96. De Vos op cit 93.
97. That such irrational' distinctions fall afoul of the right to equality in s 9(1) of the 1996 Constitution was held by the South African Constitutional Court in, for instance, Prinsloo v Van der Linde 1997 (3) SA 1012 (CC) para 25; Harksen v Lane 1998 (1) SA 300 (CC) para 53 and Jooste v Score Supermarkets 1999 (2) SA 1 (CC). Note.
98. Section 38(1)(a) of Act 32 of 2007.
99. CADRE op cit 13; 15;
100. Roehrs op cit (n 18) 182; 193-194.
101. Gray A & Jack C. Health Legislation and Policy. SA Health Review 2008; 31: 38.
102. In relation to sex workers,
103. Stadler & Delaney op cit 453.
104. While the provisions of the Act are gender neutral, men often have difficulty with being believed when they complain of having been raped and accordingly tend not to do so.
105. Pantazis A & Bonthuys E. Gender and sexual orientation. In Bonthuys E & Albertyn C (eds). Gender, Law & Justice. 2007; 120: 152;
106. Singh D. Male rape: A real crime with real victims. Acta Criminologica 2004(17(1)); 129: 132.
107. On perceptions of male sexuality as barrier to HIV-related treatment, see further Kirby op cit 179.
108. Gostin et al op cit 104.
109. For critical discussion of this discourse in South African court judgments dealing with other aspects of HIV/AIDS.
110. Klug H. Five years on: How relevant is the Constitution to the new South Africa?. Vermont Law Review 2002(26); 803: 817;
111. Pieterse op cit 568-569.
112. Wikler op cit 131.
113. Wikler op cit 115-116; 122;
114. Pieterse op cit (n 2) 568.
115. CADRE op cit 24.
116. Wikler op cit 130-131.
117. WHO op cit 5-6.