Impeding access? Stigma, individual responsibility and access to post-HIV-exposure prophylaxis (PEP) in South Africa

Opponents of rights-based access to health care services often emphasize individual responsibility for health and well-being, in justifying restrictions on public health care. Where individuals are co-responsible for their ill health, so the argument goes, the public obligation to alleviate their hardship should be limited. This discourse not only denies the socially determined nature of individual behaviour and systemic factors that impact on population health, but also exacerbates the stigmatization of the ill. As such, it is inimical to a human rights approach to health. Unfortunately, it pervades much of health law and policy, especially in relation to HIV/AIDS. This article conducts a human rights analysis of access to postexposure prophylaxis (PEP) treatment for HIV in South Africa. It criticizes the manner in which current South African law and policy in this regard prioritizes access to treatment by persons who display characteristics of'appropriate victimhood', while discouraging access by those regarded as co-responsible for their illness and accordingly as undeserving of treatment. Ultimately, the article advocates for broader and de-stigmatized access to PEP in the public and private health sectors.