Are rights enough?

We should rethink the relationship between rights and responsibilities. Many have argued for a balance between individual and public rights, calling for compulsory HIV testing or universal screening. Compulsory testing raises serious ethical and rights issues and universal screening, with a provision for informed 'opt-out' to account for a right to consent, assumes that everyone is capable of acting from a position of choice and individual agency. AIDS has demonstrated how millions of women do not have bodily integrity. Moreover, rights and responsibilities are complicated by negative social constructions of AIDS and by the fear, blame and shame that this can produce.

'Responsibilised citizens' - a term coined by Nicolas Rose and Medecins sans Frontiers (MSF) could provide a new way of thinking about this. Responsibilised citizens are people who have a right to health care but they also take control of their own lives, by taking on responsibilities that were previously left to the state. For example, they may play an active role in encouraging high levels of compliance to treatment to reduce the risk that drug resistance will emerge, or they may become involved in preventing irresponsible selling of ARVs. This means that responsibilities need to be negotiated between civil society and health providers, the state, NGOs and others. For anti-retroviral treatment (ART) to work, people will have to be active, empowered citizens rather than passive recipients of services. ART, along with the provision of support and social belonging for PLWHA, is capable of transforming the traumatic experiences of stigmatised illness into new forms of social commitment and active citizenship.