The HIV/AIDS crisis continues to dominate the global health and human rights agenda.

For the late Dr. Jonathan Mann, founder of Doctors of the World, the HIV/AIDS pandemic exemplified the fundamental link between health crises and human rights violations. He recognized that "discrimination, marginalization, stigmatization, and, more generally, a lack of respect for the human rights and dignity of individuals and groups heighten their vulnerability to becoming exposed to HIV/AIDS." Doctors of the World has found in all of our work that poverty, civil unrest, political repression, involuntary migration, and social inequality on the basis of race, gender, or ethnicity result in serious health consequences. Moreover, HIV/AIDS is itself characterized by social discrimination and stigma, fear of which inhibits people from learning their HIV/AIDS status, from seeking treatment, and from preventing the spread of the disease to others. Nowhere are the human rights issues surrounding HIV more apparent than in the former Soviet Union. Previously characterized by very low prevalence rates, the region now faces an extremely steep increase in the number of new infections. For example, in the Russian Federation new cases of HIV have increased from 420,000 at the end of 1999 to over one million in 2001 (UNAIDS), the fastest rate of increase in the world. Between 50 to 90 percent of new HIV infections throughout the region since 1995 are among injection drug users (IDUs).

Within Russia and the Newly Independent States (NIS), IDUs are significantly marginalized, often criminalized, and substantially denied full access to treatment in the governmental health structure. The marginalized status of IDUs combined with their distrust of authority and the stigma associated with injecting drug use make them a particularly vulnerable and often inaccessible population. For injection drug users, the most common interaction with the government is through the criminal justice system. IDUs who are HIV-positive are further stigmatized and even less likely to receive adequate medical treatment. IDUs have limited access to treatment and prevention services through governmental programs.

Doctors of the World is working to develop HIV programming that will address the stigma and marginalization IDUs experience and provide effective treatment and secondary prevention for people living with HIV. Combining harm-reduction theory with the growing knowledge of treatment and prevention for opportunistic infections among IDUs, our efforts are building sustainable mechanisms to prolong life and reduce HIV transmission.

Doctors of the World has a deep commitment to fighting HIV/AIDS and addressing the attendant human rights issues. The broad range of our workÑsupporting better medical care for HIV-infected prisoners in the United States, developing prevention strategies for street youth in Russia, training lay healthcare providers in South Africa, and developing HIV/AIDS treatment programs for injection drug users in the former Soviet UnionÑdemonstrates the impact that medical professionals and volunteers can have in improving human rights protection for marginalized populations. Working together, human rights advocates and healthcare professionals can greatly advance the prevention and treatment of HIV/AIDS around the world.

Robert Kushen is the Executive Director of Doctors of the World. He is a human rights lawyer with over 13 years of experience in public sector legal, human rights, and health activities. Before coming to Doctors of the World, he served as Deputy Director of the Open Society Institute, an operating foundation focusing on human rights issues. He also served as an attorney in the US State Department's Office of the Legal Adviser.