Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa. The authors located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services. Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
Values, Policies and Rights
The Angola National Nurses Association in Lubango, southern Huila Province, created an Ethics Commission with a view to making the services rendered in this sector more humanised. The spokesman of ANEA, Rufino Kulamba, who was speaking at the International Nurses Day commemorations, said that the commission will be tasked with supervising the nursing activity. He stressed that the idea is to make professionals in this area have a better and better relationship with patients, as well as bring about professional improvements in this sector. He also explained that the commission will facilitate the filing of complaints against nurses who violate the principles of professional ethics.
This paper explores litigation as a mechanism for the realization of the economic, social and cultural. Though it is often the last resort after all advocacy methods have been rendered futile, it is argued to draw government to the drawing board remembering the obligations in the international human rights instrument that it bonds itself for proper economic and social development. By its self, litigation may not yield the desired result but if backed up by strong advocacy the results are far more reaching.
With the development community, governments, policymakers, researchers and international organisations hard at work on the Sustainable Development Goals (SDGs), this report analyses the background of identifying development goals.
In two years, the uncompleted tasks of the Millennium Development Goals will be merged with the agenda articulated in the 2012 United Nations Conference on Sustainable Development. This process will seek to integrate economic development (including the elimination of extreme poverty), social inclusion, environmental sustainability, and good governance into a combined sustainable development agenda. The first phase of consultation for the post-2015 Sustainable Development Goals reached completion in the May 2013 report to the Secretary-General of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. Health did well out of the Millennium Development Goal (MDG) process, but the global context and framing of the new agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, four strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak—and listen—to the whole sustainable development agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, the authors assert that we need to construct goals that will be truly “universal”, that will engage every nation—a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal Sustainable Development Goals.
WHO has published a draft proposal for a set Framework and set of policies to address its engagement with Non Sate Actors (NSAs). Member States are being invited to discuss these proposals at WHO’s HQ in Geneva on 27th and 28th March. Public Interest NGOs are not invited. IBFAN has been following the process closely and reports finding serious flaws, inconsistencies and contradictions in the proposals. Despite the many statements of WHO’s Director General, Margaret Chan, that WHO’s policies, norms and standards setting processes should be protected from commercial influence, if the new proposals were to be adopted, the corporate influence would increase. IBFAN fears that this would compromise WHO’s integrity, independence and its ability to fulfil its mandate. In particular, the proposals introduce a new risky element, allowing Official Relations status, with all its related privileges, for International Business Associations. Up to now, if businesses wanted to attend governing body meetings in order to lobby Member States delegations, they could wear a public badge, or, if they wanted to speak, inveigle their way onto government delegations. Some, over the years have slipped through WHO’s admission procedures, pretending to be NGOs. The new proposals open the door wide to participation by any business member of these Associations, except tobacco or arms companies. This would, in effect, legitimize businesses lobbying role at WHO’s global policy-setting meetings - the very thing that WHO alleges that it is trying to avoid. In addition to turning WHO governing bodies meetings into multi-stakeholder public-private gatherings, the proposals would also allow businesses greater engagement at programme level, through agreed 3-year plans with WHO. Lida Lhotska, IBFAN NGO Liaison to WHO says: “If these new policy proposals are adopted, IBFAN fears that WHO will be unable to lead and support Member States in taking the bold decisions necessary to tackle global health challenges. For example, irresponsible marketing is a major underlying cause of Non Communicable Diseases (NCDs). In tackling NCDs, acknowledged to be a major threat to public health, will WHO prefer to engage in partnerships with corporations, who would prefer campaigns for promoting ‘slightly better for you products’– or will WHO help Member States bring in legally-binding controls that truly protect right to health of their citizens?”
CEDAW, the Committee on the Elimination of Discrimination against Women, at its recently concluded session, issued a statement (attached) on sexual and reproductive health and rights, which is its contribution to the ICPD@20 review process. The Committee reminds us that it "has observed that failure of a State party to provide services and the criminalisation of some services that only women require is a violation of women's reproductive rights and constitutes discrimination against them." It States that: "the provision of, inter alia, safe abortion and post abortion care; maternity care; timely diagnosis and treatment of sexually transmitted diseases (including HIV), breast and reproductive cancers, and infertility; as well as access to accurate and comprehensive information about sexuality and reproduction, are all part of the right to sexual and reproductive health" and that "every State can and should do more to ensure the full respect, protection and fulfilment of sexual and reproductive rights, in line with human rights obligations."
WHO is launching a public consultation on its draft guideline on sugars intake. When finalized, the guideline will provide countries with recommendations on limiting the consumption of sugars to reduce public health problems like obesity and dental caries (commonly referred to as tooth decay). Comments on the draft guideline will be accepted via the WHO web site from 5 through 31 March 2014. Anyone who wishes to comment must submit a declaration of interests. An expert peer-review process will happen over the same period. Once the peer-review and public consultation are completed, all comments will be reviewed, the draft guidelines will be revised if necessary and cleared by WHO’s Guidelines Review Committee before being finalized.
On 11th March 2014, the legality of the Anti Homosexuality Act was challenged in Constitutional Court by an unprecedented coalition of petitioners and an Injunction against enforcement sought. The petition was filed under the auspices of the Civil Society Coalition on Human Rights and Constitutional Law, a coalition of 50 indigenous civil society organisations that advocates for non-discrimination in Uganda. The petition argues that the Anti Homosexuality Act violates Ugandans’ Constitutionally guaranteed right to: privacy, to be free from discrimination, dignity, to be free from cruel, inhuman and degrading treatment, to the freedoms of expression, thought, assembly and association; to the presumption of innocence, and to the right to civic participation.
The complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the fetus to term and abandon the infant at birth. The author conducted research into perceptions of abortion in urban Botswana in order to understand the social and cultural obstacles to women’s reproductive autonomy, focusing particularly on attitudes to terminating a pregnancy. She carried out 21 interviews with female and male urban adult Batswana. The findings however, suggest that socio-cultural factors, not punitive laws, present the greatest barriers to women seeking to terminate an unwanted pregnancy. It is argued that these factors must be addressed so that effective local solutions to unsafe abortion can be generated.