Regulatory aspects of HIV/AIDS in El Salvador and the region

By: Maria Alejandra Tulipano y Natalia Paniagua 

Equality now. That is the slogan that UNAIDS has used for World AIDS Day 2022, which is celebrated on December 1 each year. Forty-one years ago, on December 1, 1981, the first case of AIDS was diagnosed. Since then, 25 million people have died as a result of HIV/AIDS-related health problems, making the disease one of the deadliest epidemics in history. In addition, according to UNAIDS statistics, in 2021 around 38.4 million people around the world were living with HIV.

That is why governments, international organizations and charities around the world have taken action to carry out prevention and awareness campaigns to avoid contracting the HIV virus, which if not treated in time can develop into AIDS and cause serious damage to the immune system. Due to this alarming situation, governments have implemented policies and legislation to combat the deadly disease.

At the international level, the legal framework regarding HIV and AIDS in the world of work includes the 1948 Universal Declaration of Human Rights, which recognizes, protects and guarantees the fundamental rights of all persons, the ILO Code of Practice, Recommendation 200, the Convention on Social and Cultural Rights, and the Convention on Civil and Political Rights. For its part, ILO Convention No. 111 on Discrimination (Employment and Occupation), 1858, in Article 1, paragraph 1, states that: “The term discrimination includes: (a) any distinction, exclusion or preference based on grounds of race, color, sex, religion, political opinion, national extraction or social origin which has the effect of nullifying or impairing equality of opportunity or treatment in employment and occupation; (b) any other distinction, exclusion or preference which has the effect of nullifying or impairing equality of opportunity or treatment in employment or occupation, which may be specified by the member concerned, after consultation with the representative organizations of employers and workers, where such exist and with other appropriate bodies”. Convention 111, paragraph 2, Article 2 states: “Each member for which this Convention is in force undertakes to formulate and carry out a national policy designed to promote, by appropriate methods, conditions in national practice for equality of opportunity and treatment in respect of employment and occupation, with a view to eliminating any discrimination in respect thereof. The issue of HIV and AIDS in the world of work is governed by the adoption of the International Standard “Recommendation No. 200 on HIV and AIDS and the world of work”, which constitutes an unequivocal commitment by ILO constituents (member states and representatives of employers and workers), in close collaboration with associations of people living with HIV and national and international organizations that act as partners, taking advantage of the immense contribution that the world of work can make to ensure universal access to prevention, treatment, care and support services. It in turn builds on the ILO Code of Practice on HIV and AIDS and the World of Work (ILO, 2001).

Within the framework of the Central American Integration System, the COUNCIL OF HEALTH MINISTERS OF CENTRAL AMERICA and the DOMINICAN REPUBLIC adopted Resolution COMISCA 07-2021 on the Regional Strategic Plan (PER) HIV and Regional Strategy for Sustainability in the Response to HIV (ERS) for Central America 2021-2026. The Regional Strategic Plan (PER) HIV 2021-2026 sets the guidelines to work on the alignment of national strategic plans in correspondence to the PER, in order to contribute to the reduction of inequalities to end the HIV epidemic in the Central American region by 2030, taking into account the analysis of emerging scenarios such as COVID-19, to ensure the continuity of care services and prevention interventions in the most vulnerable populations. The regional strategy for sustainability in the response to HIV (ERS) for Central America 2021-2026, has among its objectives to continue with the annual measurement of the index of Sustainability of the Response to HIV, strengthening the analysis of information, which allows decision-making to ensure the appropriate use of available resources, the mobilization of national resources, the inclusion of the private sector and civil society, to achieve the sustainability of the response and the achievement of the goals to end the HIV epidemic by 2030.

It is estimated that 23% of people with HIV in Latin America and the Caribbean are unaware of their infection, and approximately one third are diagnosed late, with advanced immunodeficiency. It is estimated that around 110,000 children and adolescents (aged 0-19 years) around the world died in 2021 from AIDS-related causes, according to UNICEF’s latest global snapshot on children and HIV/AIDS. The same year also saw 310,000 new infections, bringing the total number of young people living with HIV to 2.7 million. UNICEF warns that progress in HIV prevention and treatment for children, adolescents and pregnant women has virtually stagnated over the past three years and that many regions have not yet reached the service coverage they had before the COVID-19 pandemic. This is in addition to the existing and widening gap between children and adults in terms of access to treatment.

Although they make up only 7% of all people living with HIV, children and adolescents accounted for 17% of all AIDS-related deaths and 21% of new HIV infections in 2021. As UNICEF warns, if the causes of unequal access to treatment are not addressed, the eradication of AIDS in children and adolescents will remain a distant dream.

Nevertheless, long-term trends remain positive, according to the UNICEF snapshot. Between 2010 and 2021, new HIV infections declined by 52% among younger children (0-14 years), as well as among adolescents (15-19 years), where they fell by 40%. Similarly, lifetime antiretroviral treatment coverage among pregnant women living with HIV has increased from 46% to 81% in a single decade.

Although the overall number of children living with HIV is declining, the treatment gap between children and adults continues to widen. In countries prioritized by UNICEF in the HIV response, antiretroviral treatment coverage among children was 56% in 2020, although it declined to 54% in 2021. This decline is due to a number of factors, such as the COVID-19 pandemic and other global crises, which have accentuated marginalization and poverty, but it is also a reflection of weak political will and a tepid AIDS response among children. Globally, the percentage of children living with HIV who have access to treatment was even lower, at 52%, a figure that has barely increased in recent years.

Meanwhile, coverage among all adults living with HIV (76%) exceeded that of children by more than 20 percentage points. The gap is even wider among children and pregnant women living with HIV (81%). The percentage of children aged 0-4 years living with HIV who are not receiving antiretroviral treatment has increased worryingly over the past seven years. It reached 72% in 2021, a figure similar to 2012.

Numerous regions, including West and Central Africa, Eastern and Southern Africa, Latin America and the Caribbean, Asia and the Pacific, the Middle East and North Africa, also saw a decline in treatment coverage among pregnant and breastfeeding women during 2020. In 2021, Asia and the Pacific and Middle East and North Africa saw further declines. With the exception of West and Central Africa, which continues to have the highest incidence of mother-to-child transmission, none of the above regions have returned to the coverage levels achieved in 2019. These shocks put the lives of newborns at greater risk. In 2021, more than 75,000 new infections occurred in children due to undiagnosed and untreated pregnant women.

At the end of the 1990s and the beginning of the new millennium, one of the clearest manifestations of the political commitment of the countries of the Central American region to the fight against HIV/AIDS has been the approval of the different special laws on AIDS by the Legislative Assemblies. The fundamental pillar of these laws is the protection and defense of the human rights of people living with HIV/AIDS as well as access to comprehensive care and ARV treatment.

Each and every one of the laws makes explicit reference to the right of people living with HIV/AIDS to access comprehensive care services. Until a few years ago, no country included the provision of ARVs in its basic package of care. However, although in the last two or three years the provision of treatment has begun, only a small percentage of those patients who need it receive it due, among other reasons, to its high cost. In the region, there is a clear commitment to increase coverage and joint efforts continue with the private and public sectors to reduce the assistance gap and facilitate access to appropriate treatment.

Special HIV/AIDS Laws in Force in the Central American Region

Country Name of Law Number of Articles on Comprehensive Care

Guatemala General law for the fight against the Acquired Immunodeficiency Virus-AIDS and the promotion and defense of human rights in the face of HIV/AIDS.

Decree No. 27-2000 Number 35.

El Salvador Law for the prevention and control of the infection caused by the Human Immunodeficiency Virus Decree No 588 24-10-2001 Number 11.

Honduras Special Law on HIV/AIDS Decree No 147-99 No. 1,2 47,48,49,53,57

Nicaragua Law for the promotion, protection and defense of Human Rights in the face of AIDS. Law No 238 (14.10.96) Numero 19

Costa Rica General Law on HIV/AIDS Law No. 7771 (20.04.98) No. 7

Panama General Law on Sexually Transmitted Infections, Human Immunodeficiency Virus and AIDS. Law No 3 (05.01.00) Number 21, 22, 23, 24, 25 and 33. Chapter III

In the case of El Salvador, on October 24, 2001, the Legislative Assembly issued the Law on Prevention and Control of the Infection Caused by the Human Immunodeficiency Virus, which was repealed with the aim of issuing a more updated law in order to respond comprehensively and efficiently to the evolution of the virus worldwide, issuing on December 14, 2016 the Law on Prevention and Control of the Infection Caused by the Human Immunodeficiency Virus. Said Law aims to ensure the health of Salvadorans, seeking prevention, promotion, protection and comprehensive care and control of the infection caused by HIV; through the implementation of inter-institutional coordination strategies. The Salvadoran Law applies to all public and autonomous institutions, as well as to natural and legal private persons that carry out prevention actions in relation to HIV infection; through the same Law, HIV carriers are granted the following rights: non-discrimination, access to information on HIV, information on HIV diagnosis, access to testing for the diagnosis of HIV infection, access to comprehensive care and access to counseling and guidance.

In addition, by means of the aforementioned Law, comprehensive care centers are created, which the State, in coordination with public and private organizations, will promote and support. The law also establishes obligations, such as the obligation to be informed about HIV prevention methods, the duty of health personnel to communicate measures and actions to sensitize people with HIV regarding the ethical responsibility to disclose their serological status to their partners for their own safety, and the prohibition to donate organs, blood and other human tissues. The law mandated the establishment of a comprehensive care policy through the Ministry of Health and created the National Commission Against HIV.

Likewise, in July 2022, the Ministry of Health issued the National Multisectoral Strategic Plan for HIV and STIs 2022-2026, in accordance with the UNAIDS Global AIDS Strategy 2021-2026, with the objective of putting an end to this disease. From the Central American regional perspective, in December 2021 the presidents of the Central American Integration System (SICA) endorsed the Strategy for the sustainability of Central America and the Dominican Republic’s progress towards universal access to HIV prevention, care, treatment, and support. Despite all these efforts, new data from UNAIDS show that unfortunately due to the COVID-19 pandemic, progress against HIV has declined over the past two years as resources have been reduced, putting millions of lives at risk.

In this sense, each employer must contemplate in its respective occupational risk prevention management program: “The establishment of complementary programs on alcohol and drug consumption, prevention of sexually transmitted infections, HIV/AIDS, mental health and reproductive health”. This is regulated in Article 8, numeral 7, of the General Law on Risk Prevention in the Workplace.

We are called as a Central American region to be part and promoters of a renewed social and political commitment to reach the most vulnerable, strategic partnerships and resources to expand programs, we can eradicate AIDS in children, adolescents and women if we all join efforts in research, prevention and proper treatment of HIV AIDS, without stereotypes or biases.