Report on the Global HIV/AIDS epidemic

What makes people vulnerable?

What makes people vulnerable?
Individuals do not live and make decisions in a vacuum. After years of focusing on
personal choices about lifestyles, by the early 1990s AIDS prevention programmes
were giving renewed attention to the social and economic context of people's daily
lives - the context that shapes sexual and drug-related behaviour.
Many factors and forces exist that restrict people's autonomy and leave them particularly
exposed to HIV infection, or vulnerable to needless suffering once they are infected.
Intolerance of racial, religious or sexual minorities; discrimination against people with
known or suspected HIV infection; lower status of women; abuse of power by older or
wealthier individuals; scarcity of HIV counselling and testing facilities and of condoms;
lack of care and support for those infected or affected; poverty or trafficking that leads
to prostitution; domestic violence and rape; military conflict and labour migration which
split up families - the list is a long one and varies from place to place. Recognition of the
factors that fuel the HIV epidemic prompted the development of new programmes for
reducing vulnerability - in the civil, political, economic, social and cultural arenas - that
would work in synergy with the more traditional prevention approaches aimed at diminishing risk-taking behaviour.
Many factors in vulnerability - the root causes of the epidemic - can best be understood
within the universal principles of human rights. Vulnerability to AIDS is often engendered
by a lack of respect for the rights of women and children, the right to information and
education, freedom of expression and association, the rights to liberty and security, freedom from inhuman or degrading treatment, and the right to privacy and confidentiality.
Where human rights such as these are compromised, individuals at risk of HIV infection
may be prevented or discouraged from obtaining the necessary information, goods and
services for self-protection. Where people with AIDS risk rejection and discrimination,
those who suspect they have HIV may avoid getting tested and taking precautionary
measures with their partners, for fear of revealing their infection; they may even avoid
seeking health care. Promoting human rights and tolerance is thus important in fighting
AIDS as well as in its own right.
Paradoxically, some usually positive features can also fuel a country's HIV epidemic,
such as a good road network which enables people from low- and high-prevalence areas
to travel and mix more freely. It is important to anticipate such unintended impacts so as
to take them fully into account in national development and AIDS prevention plans.

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