The African Union (AU) Summit in Kampala August 2010 adopted an action plan for the improvement of maternal, infant and child health and development and made a commitment to spending 15% of national budgets in an effort to reach the Millennium Development Goals in this area. An AU task force will track progress to ensure implementation. On the partnership for the eradication of mother-child transmission of HIV (PMTCT), the Assembly invited all Member States to intensify efforts relating to antiretroviral treatment and PMTCT and to extend such efforts to primary health centres. The Assembly underscored the need for programmes for the total eradication of PMTCT and called for all African actors concerned to act immediately to make eradication a realisable outcome. An initiative on agriculture and food security was also launched. Economic growth, job creation and investment are the preferred focus for the Africa-Europe Summit in November and the next AU Summit in 2011 will focus on the Pan-African Governance Architecture.
Values, Policies and Rights
The Kenyan government is drafting new regulations to stop fraudulent herbalists claiming to be able to treat diseases, including HIV, from practising. Anybody found selling untested herbal products will face legal action for ‘endangering people's lives,’ said Jayesh Pandit, head of pharmacovigilance at the Pharmacy and Poisons Board. The Pharmacy and Poisons Board has registered 300 legitimate herbalists, but thousands more are practising outside the law, often selling useless or even harmful products to desperate patients. According to the World Health Organization, up to 80% of Africans use traditional medicine. The government is planning to introduce a ‘Traditional Medicines Practitioners Bill’, which will regulate the use of herbal medicines and define the punishment to be handed down to herbalists practising illegally.
In his address to the Eighteenth International AIDS Conference in Vienna, Mark Heywood of the Treatment Action Campaign (TAC) has warned that South Africa’s campaign to test 15 million people for HIV in one year risks being implemented in a way that undermines people’s human rights. Incidents of coercive testing have been recorded but the lack of effective monitoring procedures means that it’s impossible to know whether those incidents are widespread or not. The testing campaign is a means to an end, and not of value in itself, he said. Unless the campaign delivers on its promise to link newly diagnosed people into treatment services, then the means to achieve this end will be unjustifiable. He noted human rights concerns about a lack of monitoring of ‘adverse events’, such as whether a person who is diagnosed with HIV then suffers discrimination, suffers violence or gains access to treatment. Incidents of refusing HIV-positive patients access to health services have been recorded by the TAC in South Africa. Heywood said it was unclear whether such incidents were rare or widespread, but that any violations of basic principles should be taken seriously.
The AIDS 2010 conference theme emphasises the central importance of protecting and promoting human rights as a prerequisite to a successful response to HIV. The right to dignity and self-determination for key affected populations, to equal access to health care and life-saving prevention and treatment programmes, and the right to evidence-based interventions based on evidence rather than ideology are all incorporated in this urgent demand for action. Rights Here, Rights Now, a campaign launched by the International Lesbian, Gay, Bisexual, Trans and Intersex Association, emphasises that concrete human rights measures need to be in place to protect those most vulnerable to and affected by HIV, especially women and girls, people who use drugs, migrants, prisoners, sex workers, men who have sex with men and transgender persons.
This book is a collection of 16 critical essays by leading scholars and practitioners in the field of sexual and reproductive health and rights. Each author analyses the legacy of the International Conference on Population and Development (ICPD) from a different perspective or focuses on a particular topic. They examine strengths, weaknesses and whether and how the ICPD mandate can still be used to improve sexual and reproductive health. Given the complexities and challenges of implementing and continuing to take forward the ICPD agenda after more than fifteen years, the undertaking in this volume is laudable. The essays all contain some dimension that should be of interest to a variety of readers. Some provide historical background which might otherwise be forgotten. Several other authors point out that the absence of reproductive health in the initial targets for the Millennium Development Goals was a serious setback. While the target of ‘universal access to reproductive health’ has since been added, one of the essays, ‘Mobilising resources for reproductive health’, points out that a strong evidence base is needed to demonstrate that poor reproductive health outcomes do, in fact, undermine the chances of the poor to escape poverty.
The aim of this paper is to examine young women's motivations to exchange sex for gifts or money, the way in which they negotiate transactional sex throughout their relationships, and the implications of these negotiations for the HIV epidemic. An ethnographic research design was used, with information collected primarily using participant observation and in-depth interviews in a rural community in North Western Tanzania. The qualitative approach was complemented by an assisted self-completion questionnaire. The study found that transactional sex underlay most non-marital relationships and was not, per se, perceived as immoral. However, women's motivations varied, for instance: escaping intense poverty, seeking beauty products or accumulating business capital. There was also strong pressure from peers to engage in transactional sex, in particular to consume like others and avoid ridicule for inadequate remuneration. Young women actively used their sexuality as an economic resource, often entering into relationships primarily for economic gain. In conclusion, transactional sex is likely to increase the risk of HIV by providing a dynamic for partner change, making more affluent, higher-risk men more desirable, and creating further barriers to condom use. Behavioural interventions should directly address how embedded transactional sex is in sexual culture.
The United Nations (UN) General Assembly has declared access to safe, clean drinking water and sanitation to be a ‘'human right' in this resolution, which more than 40 countries (including the United States) didn't support. The text is non-binding. The resolution expresses deep concern that, despite the fact that the Millennium Development Goal (MDGs) adopted by world leaders in 2000 call for the proportion of people without access to safe drinking water and basic sanitation to be cut in half by 2015, an estimated 884 million people still lack access to safe drinking water and more than 2.6 billion people do not have access to basic sanitation. In the resolution, the Assembly calls on UN ‘member states and international organisations to offer funding, technology and other resources to help poorer countries scale up their efforts to provide clean, accessible and affordable drinking water and sanitation for everyone’. Additionally, the resolution backs the UN Human Rights Council recommendation that the UN independent expert on the issue of human rights obligations related to access to safe drinking water and sanitation must report annually to the General Assembly. This annual report will focus predominantly on the principle challenges of achieving the right to safe and clean drinking water and sanitation, as well as progress towards the relevant MDGs.
This joint statement from a range of international development organisations argues that regular, predictable social transfers (cash or in kind) from governments to communities can reduce child poverty and vulnerability by helping to ensure children get access to basic social services. Social insurance offers access to health care for children, as well as services to support communities to reach all households and individuals, including children. The statement propose steps that governments and international development partners can take to further social protection in the interests of children, such as ensuring that existing social protection policies and programmes are child-sensitive and setting priorities and sequence policy development and implementation to progressively realise a basic social protection package that is accessible to all those in need. The statement calls for governments and donors to seek to improve fiscal space and increase available resources for child-sensitive social protection programmes, while making broader efforts to build awareness, political will, capacity and intersectoral coordination. Adequate investment is required, and links should be built between transfers and social services to ensure the reach, effectiveness and impact of social protection. At the same time, ongoing research, monitoring and evaluation are needed to better understand effective programme design and implementation, as well as how child-sensitive approaches can benefit the wider community and national development.
For years, there has been silence at the global level about the disproportionate impact that HIV and AIDS have on men who have sex with men (MSM). This silence has led to unabated epidemics and especially weak HIV prevention programming at national levels for MSM across the globe. This policy brief aims to provide universal guidelines for HIV and AIDS services that target MSM. It also discusses the legal context in Africa, where sex between members of the same sex is illegal in most countries, explaining how criminalising homosexuality heightens the risk for HIV transmission and drives those most at need away from prevention, care, treatment, and support services. The brief points to consensus among HIV behavioral researchers and practitioners that combination approaches to prevention, sustained over time and tailored to the specific local needs of MSM, should be adopted to effectively address HIV prevalence and incidence among MSM. These approaches should combine and integrate biomedical and behavioral strategies with community-level and structural approaches. The brief provides some important core principles of practice that can serve as broad guidelines in the design, implementation, and evaluation of targeted HIV prevention programmes and paradigms within MSM communities worldwide.
The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas: leadership and governance for health, health services delivery, human resources for health, health financing, health information systems, health technologies, community ownership and participation, partnerships for health development and research for health. This paper describes a framework constructed for implementing the necessary activities in each of these priority areas, and proposes recommendations for consideration by World Health Organization Member States in the development of their own country frameworks. In conclusion, countries are expected to use this Framework, adapted to their own specific situations, by taking into account the progress made and the efforts needed for better and more equitable health outcomes. The Regional Committee is requested to endorse the Framework and urges Member States to put in place monitoring frameworks that feed into the national and regional observatories. Partners are expected to support countries in a harmonised and predictable manner that reduces fragmentation during the implementation of the Ouagadougou Declaration. It is expected that the implementation of the Ouagadougou Declaration by countries will contribute in accelerating progress towards the achievement of the Millennium Development Goals, and reduce the inequities and social injustices that lead to large segments of the population remaining without access to essential health services.