A penetrating analysis of the close relationship between public health and human rights, this book makes a compelling case for synergy between the two fields. Using the AIDS pandemic as a lens, the authors demonstrate that health is closely related to human dignity and individual rights--human rights cannot be deemed adequate and comprehensive without ensuring the health of individuals. In the course of their analysis, Gostin and Lazzarini tackle some of the most vexing issues of our time, including the universality of human rights and the counter-claims of cultural relativity. Taking a cue from environmental impact assessment, they propose a human rights impact assessment for examining health policies--a tool that will be invaluable for evaluating real-world public health problems. This volume examines issues--HIV testing, screening, partner notification, isolation, quarantine, and criminalization of persons with HIV/AIDS--within the framework of international human rights law. The authors evaluate the public health implications of a wide range of AIDS policies in developed as well as developing countries. The role of women in society receives special emphasis. Finally, the book presents three case histories significant in the HIV/AIDS pandemic and analyzes them from a human rights perspective. The cases include discrimination and the transmission of HIV and tuberculosis in an occupational health care setting; breast feeding in the least developed countries; and confidentiality and the right of sexual partners to know of potential exposure to HIV. Gostin and Lazzarini have written a book that will be a valuable addition to the libraries of public health practitioners, legal scholars, bioethicists, policy makers, and public rights activists.

Historically, the fields of public health and human rights have remained largely separate. The AIDS pandemic, however, made it clear that a complex relationship exists between the two fields. Women and children have proven to be extremely vulnerable to infection with HIV due to their inability to protect themselves in intimate relationships, their sexual exploitation, and their lack of economic and educational alternatives. On the other hand, coercive government policies aimed at controlling the AIDS pandemic often infringe on the rights of individuals known or suspected of having AIDS, and decrease the effectiveness of public health measures. Protecting and promoting human rights is becoming one of the key means of preserving the health of individuals and populations.; A penetrating analysis of the close relationship between public health and human rights, this book makes a compelling case for synergy between the two fields. Using the AIDS pandemic as a lens, the authors demonstrate that human health cannot be maintained without respect for the dignity and rights of persons, and that human rights cannot be deemed adequate and comprehensive without ensuring the health of individuals and populations. In the course of their analysis, Gostin and Lazzarini tackle some of the most vexing issues of our time, including the universality of human rights and the counter-claims of cultural relativity. Taking a cue from environmental impact assessments, they propose a human rights impact assessment for examining health policies. Such a tool will be invaluable for evaluating real-world public health problems and is bound to become essential for teaching human rights in schools of public health, medicine, government, and law.; The volume critically examines such issues as HIV testing, screening, partner notification, isolation, quarantine, and criminalization of persons with HIV/AIDS, all within the framework of international human rights law. The authors evaluate the public health effects of a wide range of AIDS policies in developed as well as developing countries. The role of women in society receives special emphasis. Finally, the book presents three case histories that are important in the HIV/AIDS pandemic: discrimination and the transmission of HIV and tuberculosis in an occupational health care setting; breast feeding in the least developed countries; and confidentiality and the right of sexual partners to know of potential exposure to HIV. The cases challenge readers with some of the complex questions facing policy-makers, scientists, and public health professionals, and exemplify a method for analysing these problems from a human rights perspective. Gostin and Lazzarini have written a book that will be a valuable addition to the libraries of public health teachers and practitioners, legal scholars, bioethicists, policy makers, and public rights activists.

Law plays essential roles in public health. Law defines health officials' jurisdiction, and specifies how they exercise their authority. It is a tool of public health work used to establish norms for healthy behavior. Policymakers use the law's language of rights, duties and justice in the most important social debates about public health taking place in legislatures, courts and administrative agencies. This article examines the subject and definition of public health, reviews the core functions of public health as they relate to law, identifies challenges confronting communicable disease control, surveys the current landscape of state communicable disease control law, and proposes guidelines for reform of state law to satisfy both legal and public health critiques. The subject of public health. At a minimum the goal of public health is to attain the highest level and widest distribution of physical and mental health that a society reasonably can achieve within the limits of resources available. To effectively combat complex disease threats, the public health approach to disease control must evolve from the microbial, to the behavioral, to the ecological approach. Core functions of public health and the law. Building on the Institute of Medicine's important 1988 study The Future of Public Health, the article identifies the core public health functions necessarily covered by law as: 1) health promotion and disease prevention, 2) assessment, data collection and analysis; 3) provision of medical services; and 4) leadership and policy development. Challenges facing communicable disease control. Health officials must overcome substantial challenges to meet the needs of the public for protection from communicable diseases. These include structural issues such as their limited jurisdiction, popular apathy about public health goals, disease-associated stigma and social hostility that may interfere with effective public health work, and the public's distrust of government health officials. Public health officials must also contend with a crumbling pubic health infrastructure, emergence and re-emergence of old and new disease threats, and changes in the health care environment including managed care and shifting of some disease prevention and surveillance activities from the public to the private sector. Survey of current public health law. Public health law in the United States is ripe for reform. Existing laws often represent multiple layers of provisions from the late 19th and early 20th centuries enacted in response to epidemics of communicable disease. Older statutes do not reflect modern understandings of disease transmission and do not conform to current constitutional or statutory requirements. Proliferation of disease-specific statutes create redundancies in the law that both foster confusion and expend valuable resources. Laws, both old and new, may harbor ambiguities that interfere with public health officials' ability to identify, prevent, and respond to threats to the public's health. State provisions may have weak privacy protection for some types of public health data. Guidelines for reforming public health law. Public health law should: 1) define a broad mission of public health authorities to prevent and control communicable diseases through interventions at the microbial, behavioral and ecological level; 2) be based on uniform provision that apply equally to all communicable diseases, eliminating whenever possible disease-specific statutes; 3) recognize voluntary cooperation as the primary way to obtain compliance with public health measures; 4) base use of compulsory powers on a demonstrated threat of significant risk; 5) provide procedural due process protections; 6) provide a range of options for public health officers including a graded series of alternatives and require use of the least restrictive alternative that will accomplish the public health goal; 7) provide strong privacy protections based on fair information practices, limited disclosure of data, and monitoring of health department practices and substantive justification for data collection.

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted. Operationalizing these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This paper reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels - laws; management of law enforcement agencies; knowledge, attitudes, beliefs and practices of front-line officers; and attitudes and experiences of IDUs - and that such research can be the basis of interventions within law enforcement to enhance IDU health.

A Rapid Policy Assessment and Response (RPAR) intervention was conducted in Szczecin, Poland, to assess the impact of drug policy on the health of drug users in the city and surrounding rural areas. In the RPAR, a team of Polish researchers worked with a Community Action Board (CAB) comprised of law enforcement officials, drug treatment providers, medical officers, NGO leaders, lawyers, judges, and others to collect and analyze laws and policies relevant to health risks in the target populations; existing data on the epidemiological situation and the operation of the criminal justice system; and 3) qualitative interviews with health care providers, lawyers, law enforcement representatives, NGO staff, drug users, sex workers and others who describing how the laws are put into practice. The Szczecin RPAR uncovered evidence of dangerous new drug-use patterns, and significant gaps in the health and drug treatment services available to prevent HIV and other serious health problems among drug users. Key findings include: * Criminalizing drug possession in Poland has not fulfilled its goals in practice * A rise in rural drug use is creating serious unmet needs for prevention, treatment and disease surveillance. * Lack of therapy and HIV prevention methods in prison and difficulties in the social reintegration process * Lack of quality legal services in the criminal and civil justice systems The findings indicate that drug policy in practice does not correspond to the strategies embodied in recent Polish drug legislation, and that urgent action is necessary to prevent serious health problems in rural northwest Poland.

All states have criminal laws that can be used to punish sexual behaviors that pose some risk of HIV transmission; half have HIV-specific laws criminalizing sexual contact by people with HIV unless they abstain from unsafe sex, or disclose their HIV status and obtain consent from their partners. Whether these laws influence behavior is unknown. Illinois and New York exhibit contrasting legal conditions. Illinois has an HIV-specific law explicitly requiring disclosure by HIV+ persons. New York has no HIV-specific law. This study tests the null hypothesis that differences in law and beliefs about the law do not influence condom use in anal or vaginal sex. In this empirical study, 490 people at elevated risk of HIV were interviewed, 248 in Chicago and 242 in New York City. Approximately half in each state were men who have sex with men ("MSM") and half were injecting drug users ("IDUs"). Respondents were classified as MSM if they reported ever having had sex with a man, and as IDUs if they reported having injected drugs at least twice in the last three months. One-hundred sixty two subjects reported known HIV infection (Chicago 58; New York City 104). Three-hundred twenty-eight reported being HIV negative or not knowing their HIV status. Indicators of the law were 1) residence in the state, and 2) belief that it is a crime for a person with HIV to have sex with another person without disclosing his or her serostatus. Using stepwise logistic regression, we examined independent predictors of unprotected sex, adjusting for factors including age, race/ethnicity, disclosure, biological sex at birth, sexual orientation and number of partners. People who lived in a state with a criminal law explicitly regulating sexual behavior of the HIV-infected were little different in their self-reported sexual behavior from people in a state without such a law. People who believed the law required the infected to practice safer sex or disclose their status reported being just as risky in their sexual behavior as those who did not. Our data do not support the proposition that passing a law prohibiting unsafe sex or requiring disclosure of infection influences people's normative beliefs about risky sex. Most people in our study believed that it was wrong to expose others to the virus and right to disclose infection to their sexual partners. These convictions were not influenced by the respondents' beliefs about the law or whether they lived in a state with such a law or not. Because law was not significantly influencing sexual behavior, our results also undermine the claim that such laws drive people with and or at risk of HIV away from health services and interventions. We failed to refute the null hypothesis that criminal law has no influence on sexual risk behavior. Criminal law is not a clearly useful intervention for promoting disclosure by HIV+ people to their sex partners. Given concerns about possible negative effects of criminal law, such as stigmatization or reluctance to cooperate with health authorities, our findings suggest caution in deploying criminal law as a behavior change intervention for seropositives.