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Letter from international health and human rights experts to Mbeki and Zuma on the need for a human rights approach to TB

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Dear President Mbeki and ANC President Zuma,

On the 3rd of July at the South African National Tuberculosis (TB) Conference in Durban, Mr. Thami Mseleku, Director General of the Department of Health, stated publicly that: “human rights are not relevant to the considerations of health policy in a developmental state”. As international health and human rights experts, we are extremely disturbed that someone holding such a central post with responsibility for health in South Africa would express such sentiment and display such a fundamental misunderstanding about human rights as a critical foundation of the health response in developing countries. The realization and protection of human rights is fundamental to reducing people’s vulnerability to infection, disease and mortality, as well as to reduce morbidity and other negative consequences of disease, e.g. discrimination, loss of employment and social support, wrongful imprisonment. 

His statement comes more than two years after world leaders – including the South African government – officially reaffirmed their commitment to the full realization of human rights and fundamental freedoms as an essential element of the global response to HIV/AIDS. Mr. Mseleku’s comments were made as a direct criticism of a presentation by Mr. Mark Heywood, Deputy Chairperson of the South African National AIDS Council, which clearly outlined the legal obligation of the South African government to implement an effective, reasonable and rights-based response to health needs in the country. As you know, the human rights to life, dignity, equality and privacy, as well as the rights to acces  to food, water, housing, healthcare and social security are guaranteed under the South African Constitution, and all organs of the state are obliged to respect, protect, promote and fulfil those rights. In addition, South Africa is a signatory to many international conventions and covenants on human rights, which address socio-economic rights, including the right to health. 

The success and sustainability of any health policy or programme in any country is, to a large extent, dependent on its consideration of the human rights of all the people it affects: patients, health care workers and the general public. This is particularly true for both TB and HIV, which disproportionately affect poor, marginalized and vulnerable populations, whose civil, social and economic rights are often in jeopardy before they are struck by these diseases. Neglecting the State’s duty to ensure the realization of human rights not only renders such populations more susceptible to these epidemics and their effects, but also impedes their access to essential interventions. For instance: 

  • Poor people often live in substandard and crowded housing without proper ventilation which promotes the spread of TB;
  • The nutritional status of poor people can affect their susceptibility to active TB disease;
  • Women and girls face widespread discrimination and gender-based violence, including domestic violence, that fuels their HIV risk and impedes their access to vital health information and services;
  • Children and youth lack unfettered access to HIV and TB information, sexual and life-skills education, and pediatric formulations of HIV medicines;
  • Marginalized populations, such as people who use drugs and sex workers, are driven from HIV and TB services by discrimination and violence, often at the hands of police officers and judges charged with enforcing narcotics and prostitution laws;
  • People living with HIV continue to face discrimination and violence, losing their jobs and homes and being rejected by their families and community.
  • Incarceration of TB patients against their will and under conditions that do not respect their human rightS can drive people with TB away from health services and expose other patients and health care workers to TB nosocomial transmission.

We call upon Thami Mseleku to reconsider his comment that human rights are not relevant to the considerations of health policy in a developmental state. In particular, to the extent that he was asserting that this view is or should be reflected in South African health policy, we would call on you to publicly affirm that both government and ANC policy reject such an approach. 

We are also calling upon you both to reaffirm South Africa’s commitment to human rights, not only in health, but across the spectrum of the work of your government and your party. Free and fair elections are one measure of a democratic, progressive state. The promotion and fulfilment of people’s civil, political, social and economic rights is the highest goal to which political leaders of all parties should aspire.

Yours truly,

Joe Amon PhD MSPH
Director, Health and Human Rights Program
Human Rights Watch

Chris Beyrer, MD, MPH
Director of the Center for Public Health and Human Rights
Johns Hopkins University

Michaela Clayton LLB
AIDS and Rights Alliance for Southern Africa

Richard Elliott LLB, LLM
Executive Director
Canadian HIV/AIDS Legal Network

Adriaan van Es MD
International Federation of Health and Human Rights Organisations

Ryan Goodman
Rita E. Hauser Professor of Human Rights and Humanitarian Law
Director, Human Rights Program
Harvard Law School

Sofia Gruskin JD, MIA
Associate Professor in Health and Human Rights
Director, Program on International Health and Human Rights
Harvard School of Public Health

Ralf Jurgens LLM, Dr.Jur
Consultant, HIV/AIDS, health, policy and human rights

Jim Yong Kim, MD, PhD
Division of Global Health Equity
Brigham and Women's Hospital
Department of Global Health and Social Medicine
Harvard Medical School
François Xavier Bagnoud Center for Health and Human Rights
Harvard School of Public Health

Stephen Lewis
Co-Director AIDS-Free World

Alice M. Miller, JD
Senior Scholar, Thelton E. Henderson Center for Social Justice
UC Berkeley School of Law

Richard Parker, PhD
Professor of Sociomedical Sciences, Columbia University
President, Associação Brasileira Interdisciplinar de AIDS (ABIA)
Co-Chair, Sexuality Policy Watch (SPW)

Mindy Jane Roseman, JD, PhD
Academic Director, Human Rights Program
Lecturer on Law
Harvard Law School

Meena Saraswathi Seshu

Christine Stegling
Botswana Network on Ethics, Law and HIV/AIDS

Tripti Tandon, MA, LLB
Senior Technical and Policy Advisor
Lawyers Collective HIV/AIDS Unit

Daniel Tarantola MD
Professor of Health and Human Rights
The University of New South Wales

Alicia Ely Yamin, JD MPH
Joseph H. Flom Fellow on Global Health and Human Rights
Harvard Law School

Wan Yanhai, MD
Beijing Aizhixing Institute



In their

In their 1997 reports on the tuberculosis epidemic and on anti-tuberculosis drug resistance in the world, the WHO paints a bleak picture of the global failure of health service providers to deal with the burden of tuberculosis. In the 216 reporting member countries of the WHO, representing a total population of 5,72 billion, there were an estimated 7,4 million new cases of tuberculosis in 1995. This represents a rate of 130 cases among every 100 000 persons.

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Tuberculosis is spread

Tuberculosis is spread through the air, when people who have the disease cough, sneeze, or spit. One–third of the world's current population has been infected with M. tuberculosis, and new infections occur at a rate of one per second.

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