obligation to ensure access to essential health services, guaranteeing good quality and efficient medical care, and to promote the improvement of the health of the population as a whole.”7 In addition, the Court recalled that the dual scope of the economic, social, cultural and environmental rights (hereinafter “the ESCER”), and of the right to health, contained in Article 26 of the American Convention, may result in obligations that are enforceable immediately or in obligations of a progressive nature. 8 3. In this case, and in relation to the obligations of immediate enforceability, the judgment concluded that the Court found it proved that, prior to 2004, the presumed victims “had not received any kind of State medical treatment or that such treatment was ineffective to treat their condition as people living with HIV.” 9 Consequently, it asserted that the State was responsible for “violating the obligation to ensure the right to health, pursuant to Article 26 of the American Convention, in relation to Article 1(1) of this instrument, of the 49 people named as victims in Annex 2 to this judgment.”10 In addition, the Court’s judgment concluded that, “since the irregular, inadequate or total lack of access to antiretroviral drugs, the lack of access to periodic CD4 counts, and viral load, phenotype and genotype testing, the inadequate or total lack of social support, and the impossibility of access to the health centers for financial reasons or the location of the homes of some of the presumed victims has been proved, the State failed to comply with its obligation to guarantee the right to health because its omissions are incompatible with the elements of the availability, accessibility and quality of health care.”11 4. In addition to declaring the violation of Article 26 for the said reasons, the Court concluded that the State was responsible for the violation of the rights to life and to personal integrity recognized in Articles 4 and 5 of the American Convention. In this regard, the Court verified diverse omissions in the medical care provided to the presumed victims who had died and considered that the State had failed to comply with its obligation to ensure antiretroviral therapy, perform the necessary diagnostic tests for the care and treatment of HIV and opportunistic infections, and provide social support. 12 Accordingly, the Court found it proved that a causal nexus existed between the State’s omissions in relation to the medical treatment and the cause of death of the presumed victims, when death had been caused by an opportunistic infection, and therefore concluded that the State was responsible for violating the obligation to ensure the right to life contained in Article 4(1) of the Convention. 13 Furthermore, it found that 46 presumed victims have suffered adverse physical and mental effects as a result of their condition as people living with HIV and noted the existence of a causal nexus between the lack of adequate medical treatment for the presumed victims and the physical and mental effects they suffered as people Case of Poblete Vilches et al. v. Chile. Merits, reparations and costs. Judgment of March 8, 2018. Series C No. 349, para. 118, and Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 105. 7 Cf. Case of Poblete Vilches et al. v. Chile. Merits, reparations and costs. Judgment of March 8, 2018. Series C No. 349, para. 104, and judgment, para. 98. 8 Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 119. 9 Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 119. 10 Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 126. 11 Cf. Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 158. 12 Cf. Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, para. 159. 13 2