In the last 25 years, it has been shown time and again that HIV programs are most effective when based on people’s voluntary, informed, and open engagement with evidence- based health services. Such services should inform and educate people about HIV, support them to adopt healthy behaviors, and offer them a variety of proven prevention and care options that acknowledge the realities of their lives and allow them to choose what is most effective. However, recent trends toward coercive and “one size fits all” approaches have placed proven HIV and AIDS services in unprecedented jeopardy.
- In many countries that have fought hard to establish access to comprehensive services to prevent sexual transmission of HIV, pressure by foreign donors, religious conservatives, and other ideological forces has resulted in restrictions on information that emphasizes safer sex and condom use. This has resulted in young people being denied life-saving information about HIV transmission; young women being denied access to reproductive health information and services; and men and women being denied access to condoms and comprehensive HIV information.
- In many countries, governments are resorting to coercive methods of HIV prevention such as criminalization of “reckless” or “negligent” HIV exposure and/or transmission, and mass HIV testing without informed consent. Such policies have the potential to promote stigma against people living with HIV and to deter people from coming forward for needed health services.
- Despite the risk to both sex workers and clients posed by unprotected commercial sex, in many countries police confiscate condoms from sex workers and use them as evidence of illegal prostitution. Recently, many organizations working with sex workers have been denied funding unless they adopt an explicit policy “opposing” prostitution—a requirement that restricts freedom of expression and undermines efforts to work respectfully with sex workers to prevent HIV and provide care and treatment to sex workers.
- Pressure on the United Nations and many governments has weakened official support for needle and syringe programs, one of the most proven methods of preventing HIV among people who inject drugs. Needle and syringe programs and methadone substitution therapy remain restricted by law or policy in many countries, despite incontrovertible evidence of their effectiveness. Even where these programs are legal, people who use drugs may fear using these programs because of the risk of arrest for possession of drug paraphernalia or controlled substances.
- Access to opioid pain medication for palliative care remains out of reach to most people who need it worldwide. Despite some progress, countries hard-hit by HIV and AIDS still fail to strike the appropriate balance between controlling illicit morphine use and making morphine available for medical purposes. Restrictions on importing and prescribing morphine persist, due in large part to exaggerated fears of morphine’s addictiveness and the failure of governments to educate doctors and other health workers about the importance of morphine to palliative care for AIDS and other life-limiting illnesses.