EDITORIAL : THE GLOBE AND MAIL, CANADA

A sobering defence of the HIV-afflicted

A United Nations-sponsored report on HIV and the law, released this week, is at once a thorough and sobering survey of the international landscape and, for the most part, a sensible, sensitive and humane set of recommendations for preserving and enhancing the legal and human rights of the 34 million persons currently living with HIV and the roughly 7,500 who join their ranks each day.

Two years in the making, the 146-page report by the Global Commission on HIV and the Law – former Canadian ambassador to the UN Stephen Lewis was one of the 14 commissioners – draws its 80-plus recommendations largely from the experiences of individuals and organizations in 140 countries.

Staunchly against “punitive laws, discriminatory and brutal policing and the denial of access to justice,” HIV and the Law: Risks, Rights and Health correctly calls for the worldwide decriminalization of voluntary sex work and consensual same-sex sexual practices. It further urges the repeal of “punitive conditions” such as the federal ban in the United States on funding needle and syringe exchanges.

Some recommendations raise as many questions as they answer, such as one that calls for decrimilalization of the possession of small amounts of all drugs for personal use – a very radical step.

And where the report seems to go astray in its laudable concern for the rights of persons living with HIV is in the realm of disclosure. It labels as “counterproductive” laws that “criminalize HIV transmission, exposure or non-disclosure of HIV status.” Like other advocates for the HIV-positive, the report describes the infection as “preventable” and “remediable,” even as it acknowledges that in 2010 alone almost 2 million persons worldwide died of HIV-related causes. To many, especially in the affluent West, HIV is now considered “a manageable chronic condition.” Yet more than three decades after its onset, it remains incurable and continues to pose a “significant risk of serious bodily harm,” as Canada’s Supreme Court observed in 1998.

It’s the responsibility of those who knowingly have the condition to inform potential sexual partners of their status, regardless of how many condoms are at hand or the potency of the antiretrovirals they’re taking. Nevertheless, even if it goes too far in places, the report is for the most part a needed statement in defence of those whose rights and protections are often lacking.

Ontario’s doctors should be at the negotiating table, not in the courtroom

Last week, the union representing Ontario’s Catholic teachers demonstrated the merits of engaging with that province’s government as it seeks to bring its finances under control – negotiating a deal that replaced one cost-cutting proposal with another that its membership might find more palatable. That should serve as a lesson for the association representing the province’s doctors.

When negotiations with the Ontario Medical Association broke down this spring, Premier Dalton McGuinty’s deficit-plagued government imposed through regulation a round of fee cuts aimed at meeting immediate fiscal targets. Now, the OMA has launched a constitutional challenge aimed at overturning them, mostly on the basis that the government did not negotiate in good faith. That’s likely to be an uphill legal battle, given that the OMA is not a certified union. But the OMA’s president, Doug Weir, argues that the association has nothing to lose, since the government couldn’t treat it any more harshly than it already has.

In fact, doctors stand to lose a great deal more. Ontario is expected to be in the red until at least 2017, and doctors’ fees account for roughly 10 per cent of the province’s total program spending. So this spring’s cost-cutting measures, targeted heavily at a few specialist groups, were only the first round. If the OMA were to adopt a more constructive approach and return to the table, it could at least help shape future funding decisions. If not, the government will unilaterally impose further measures.

This involves more than just haggling over numbers. The province has little choice in the years ahead but to make structural reforms to the way health care is delivered. To get those reforms right, Ontario will need the engagement of doctors, who after all know the system better than anyone else.

To some extent, it’s incumbent on Mr. McGuinty – who allowed wages to skyrocket during better times, and is now abruptly trying to make up for it – to extend olive branches as he tries to sort through the country’s biggest fiscal challenge. But those who benefited from generous settlements in the past need to accept new realities, and make the best of them. Lawyering up is not the answer.