had been prejudiced do not infer a notion of retrogressivity. According to the judgment, the right
to health is not being violated due to retrogression, because the violation of the international
standard arises from State inaction when implementing the ESCER progressively; that is, from a
failure to implement the right to health effectively. I consider that, if that reasoning were to be
accepted as valid, it would change the nature of the obligation of progressivity into another very
different one which would be the obligation to comply with the implementation of an ESCER, such
as the right to health, within a reasonable time.
II.
GUARANTEES OF NON-REPETITION AND PUBLIC HEALTH POLICIES IN
THIS CASE
11.
In this case, after determining that the State had violated Article 26 of the American
Convention, in relation to Article 1(1) of this instrument, to the detriment of the individuals
named as victims in Annex 2 to the judgment, the Court ordered the State to “implement
mechanisms to supervise and monitor health care services, improve the accessibility, availability
and quality of health care services for people living with HIV, guarantee the provision of
antiretroviral drugs and any other medication required by all those affected, offer the population
HIV diagnostic tests, implement a training program for health system officials, guarantee
adequate medical care for pregnant women living with HIV, and organize a national awarenessraising campaign, in the terms of paragraphs 225 to 230 of this judgment.”24
12.
My first observation in this regard, is that there are two possible interpretations of the
scope of the said measure. One possible interpretation – that I consider would be the most
appropriate for reasons that I will explain in this section – is that the obligation to guarantee the
provision of antiretroviral drugs and other medicines to all those living with HIV should be read in
light of the stipulations made by the Court in paragraphs 225 to 230. There, the obligation to
“design a mechanism to ensure the accessibility, availability and quality of antiretroviral drugs,
diagnostic tests, and health services for the population living with HIV” is inserted within the
broader obligation to “implement effective mechanisms for periodic supervision and monitoring of
its public hospitals to ensure that they are providing comprehensive health care to people living
with HIV.”25 In other words, under this interpretation, the State has an obligation to put in place
measures that consist in implementing information systems and diagnostic mechanisms that allow
it to ensure access to antiretroviral drugs for the whole population. However, a second possible
interpretation is to consider that the obligation to ensure the provision of antiretroviral drugs is an
obligation independent of the one that requires the implementation of mechanisms to monitor
and supervise the health service. That is, it could be interpreted that the Court is placing on the
State the obligation to provide antiretroviral drugs and other prescribed medicines to all those
living with HIV as an obligation of result, regardless of any consideration relating to the
availability of resources or of reasonableness, from a public policy perspective.
13.
In addition, as can be seen, the reparations ordered are not only addressed at redressing
the harm suffered by the victims, but are also aimed at the creation of a public health policy for
all those living with HIV. Even though this practice of ordering diverse administrative or public
policy measures, with an impact that goes beyond the victims of the case in question, is not new
in the Court’s case law, I consider that there are reasons that require, at least, a cautious
approach to this type of measure when rights of a social benefit nature are at stake, such as the
right to health. This is because, as the Constitutional Court of Colombia has stated in other cases,
Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of
August 23, 2018. Series C No. 359, fourteenth operative paragraph.
24
Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of
August 23, 2018. Series C No. 359, paras. 225 to 226.
25
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