In their introduction to Human Rights and Public Health in the AIDS Pandemic, Larry Gostin and Zita Lazzarini state that this "book is designed to help [concerned] individuals and organizations worldwide to attain ‘literacy’ in human rights and public health." The authors’ "literacy" goal was well met. The language to introduce the reader to the international legal issues that underscore the book is precise without being too scholarly. That precision and the authors’ economy of style help the reader comprehend the nuances of the evolving body of law on the complex dimensions of international human rights. The same topic visited by other authors might have easily missed the mark.

The authors also give us something more–a seven-step matrix which can be used to evaluate public polices and programs to diminish the conflicts that often arise between individual rights and the public good. The conflict between individual rights and the perception of what is truly the public good has had a profound effect on the epidemiology of HIV and on the timely and appropriate care of those infected with the virus.

The history of the pandemic has been shaped by overt and covert discrimination against those with HIV/AIDS, as well as against those perceived to be at increased risk for the disease. Often the discrimination continues to be heightened by a person’s gender, sexual orientation, and inability to survive without assistance.

The history of the pandemic is also a history of discrimination against communities challenged by poverty, hunger, and homelessness. However, as the authors ably point out all discrimination, regardless of how odious it may appear to some, is not necessarily unlawful or unethical. Unless we are fluent in the language of international human rights law, we cannot effectively challenge those types of discrimination prohibited by such laws. Gostin and Lazzarini have provided the reader with tools to gain that fluency.

The authors open their book with an examination of international human rights law applicable to the consequences of the pandemic. They address issues that are too often obfuscated by the multitude of cultural factors that contribute to the increased susceptibility of many caught in the wake of the plague. The right to marry and found a family, and the requisite of free and full consent of both parties to marriage, are human rights that are too often ignored because of discrimination against women in so many cultures, the consequences of which often place women at a disproportionate risk for HIV/AIDS and other life-threatening diseases. The right to education and the right to share in the benefits of science and technological progress also play a significant role in HIV prevention and in the timely and appropriate provision of healthcare to those infected. After a review of these and other rights, the authors lay out challenges to the evolution of human rights doctrine that directly affect the often competing interests of the state and the individual.

The second chapter provides options to harmonize human rights with the true goals of public health. The authors show how to avoid many of the conflicts that often affect the course of the pandemic. Of particular interest are the authors’ comments on the relationship between healthcare and human rights. They discuss how healthcare policy may burden human rights and demonstrate how human rights abuses have affected healthcare.

[This chapter has served as an outline for our upcoming discussions of this topic at IAPAC’s Second International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses.]

The third chapter details the Human Rights Impact Assessment–a seven-step series of evaluations designed to help balance public health benefits with human rights burdens. The seven steps are designed to (1) find the facts; (2) determine if the public health purpose is compelling; (3) evaluate how effectively the policy would achieve the public health purposes; (4) determine whether the public health policy is well-targeted; (5) examine each policy for possible human rights burdens; (6) determine whether the policy is the least restrictive alternative that can achieve the public health objective; and (7) if a coercive measure is truly the most effective and least restrictive alternate, base that measure on the "significant risk" standard and guarantee fair procedures.

With the tools established in the first three chapters, Gostin and Lazzarini illustrate how to integrate public health and human rights into sound AIDS policy and practice. The final chapter provides three case studies applied to the Human Rights Impact Assessment and demonstrate how to achieve an outcome based on a rational balance between public health benefits and human rights burdens. The case studies include (1) the development of policies that address a healthcare worker with HIV infection, (2) creation of public policy on breast-feeding and vertical transmission of HIV, and (3) the duty to inform sexual or needle sharing partners of transmission risk.

There are millions of men, women, and children who might have been spared by HIV if those who had the responsibility to develop sound public health policy in the early days of the pandemic could have read Human Rights and Public Health in the AIDS Pandemic and applied the book’s lessons to the flawed public health polices they often developed, or to the absence of sound public health policy that they had the responsibility to develop. Perhaps millions more lives could be spared in China, India, Eastern Europe, and other nations where the pandemic can still be contained, if government leaders would use this text as a guide in the development of appropriate care to those infected while minimizing any human rights burdens that might occur.

Many of us only encounter the concept of human rights in the sparse media reports of war-related atrocities or of torture of political prisoners by fascist governments. The authors point out that:

The International system to protect human rights grew out of international revulsion at the atrocities committed during WWII. The pre-war international system had focused solely on relations between states; human rights violations that occurred within a country’s borders were generally deemed an ‘internal affair.’

The horrors of the war exposed the vulnerability of the individual in an international system that was based on state sovereignty and demonstrated the gross inadequacy of previous attempts to protect the victims of war. The violations were recognized as a grave threat to international peace and security and ‘were linked in the rhetoric in the war and the plans for the peace.’ One of the first imperatives of the post-war ear was to prevent the recurrence of such egregious affronts to peace and human dignity.

The postwar human rights movement permanently altered the scope of international law. It pierced the veil of national sovereignty and elevated human rights as a matter of national import. The idea that individuals posses inherent rights and freedoms was not new. Recognizing these rights under international law, however, was, as was holding states accountable for violations

As we have recently observed in the failed response of the leaders of the international community to actively bring some of the true criminals of the Bosnian War to justice, the failure of government to enforce human rights by seeking out and punishing the guilty diminishes everyone’s claim to such rights.

Theresienstadt. Hiroshima. Sarajevo. The refusal to provide immigrants with appropriate healthcare. The refusal of affluent governments to provide life-saving drugs to those who will die without them. The failure to develop an effective HIV vaccine. Each of these is related by the common factor of dehumanization. The dehumanization of men, women, and children is always a human rights violation. These are the themes that underscore nearly every issue of the Journal and our association’ s mission.

When I was a child, my parents taught me that anyone whom God graces with any gift has the obligation to use such gifts for the benefit of those who are not so graced. Larry Gostin and Ziat Lazzarini have given us a remarkable gift with Human Rights and Public Health in the AIDS Pandemic. I hope that everyone who reads this book accepts the obligation that comes with the insight into the relationship between appropriate and effective public health policy and human rights in responding to the diverse challenges of the pandemic, and directs some of their energies to the fight against the continued dehumanization of the millions of men, women, and children with HIV and of the millions more at risk of the virus’s terror.