6. In the judgment, the Court concluded that the State had violated the principle of progressivity contained in Article 26 of the American Convention, in relation to Article 1(1) of this instrument, as a result of the State’s failure to act to protect the right to health of people living with HIV in Guatemala, despite the existence of an international obligation and State regulations.22 It asserted that the progressive dimension of the ESCER, while allowing a certain gradualness for their realization based on the legislative characteristics and available resources of each State, also included a sense of progress that called for an effective and continuing improvement of the rights, so that social inequalities were remedied and the inclusion of vulnerable groups facilitated. 23 In the analysis of the case, the Court noted that, despite having a series of laws and public policies for the medical care of people with HIV in force before 2004, Guatemala had only provided direct medical care to a limited number of people, which did not include 48 of the 49 victims in this case.24 This State inactivity, prior to 2004, in the face of the HIV epidemic, resulted in the State’s international responsibility for the violation of the principle of progressivity in relation to health protection. 7. The judgment refers specifically to the State’s failure to comply with its obligation to act, in the sense mentioned in the case of Acevedo Buendía. The central thesis of the majority opinion in Cuscul Pivaral is that, although the State enjoys a certain leeway to comply with its obligations of progressivity in the area of ESCER, this cannot be interpreted as a blank cheque in order not to adopt any measure of protection, or to adopt measures that are so limited in scope that they leave vulnerable people unprotected, and at risk of suffering serious violations of their integrity or their life. This is the situation of people living with HIV, who are clearly at risk of contracting opportunistic diseases and, therefore, suffering violations of their personal integrity or their life, and it is on this basis that, in this case, the State of Guatemala has been convicted of State inaction as regards effective protection prior to 2004. In Cuscul Pivaral the Court did not identify the existence of measures that had been retrogressive in the protection of people living with HIV in Guatemala. Indeed, it recognized the existence of a series of laws, government plans, and budgetary increases, above all after 2004, aimed at ensuring adequate health care. However, despite their existence after 2004, they failed to ensure this right effectively. 25 8. That said, the criteria expressed in the judgment, in addition to its value in relation to care for people living with HIV in Guatemala, open an important door so that, in future, the Commission and the victims’ representatives may submit arguments to the Inter-American Court concerning either State inactivity as regards protection of the ESCER, or the existence of retrogressive measures in their protection that can be attributed to the State. However, this must be done respecting the methodological challenges involved in evaluating State affect disadvantaged or marginalized people or groups, and (d) that they respect at least the basic obligations of the social right in question and that they are applicable to the specific group of people concerned. Mutatis mutandis, CESCR, General Comment No. 22 on the right to sexual and reproductive health (article 12 of the International Covenant on Economic, Social and Cultural Rights). E/C.12/GC/22, May 2, 2016, para. 38 and General Comment No. 23 on the right to just and favourable conditions of work (article 7 of the International Covenant on Economic, Social and Cultural Rights). E/C.12/GC/23, April 27, 2016, para. 53. 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. 148. 22 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. 146. 23 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. 119. 24 Cf. Case of Cuscul Pivaral et al. v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of August 23, 2018. Series C No. 359, paras. 41 to 54. 25 4