Wednesday, October 03, 2007

Letter to Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS

September 27, 2007

Dr. Peter Piot
Executive Director
UNAIDS Secretariat
20, Avenue Appia CH-1211
Geneva 27

Dear Mr. Piot,

As China is increasingly in the global spotlight in the lead-up to the 2008 Olympic Games in Beijing, the Chinese government has lost no opportunity to highlight its progressive achievements, including the scaling up of its national response to HIV and AIDS. Recent articles in major journals such as The Lancet and positive assessments on the part of United Nations officials have underscored that China is investing in “best practice” programs of HIV prevention, treatment, care and support much more than was the case only a few years ago. This progress is commendable.

But the scale-up of programs is only half the story of China’s response to HIV and AIDS. The other half is a story of repression of AIDS activists and organizations and violation of the rights of people living with and vulnerable to HIV. These actions are a violation of key principles on HIV and Human Rights which global leaders, including China, agreed to in the UN Political Declaration of June 2006.

We the undersigned appeal to the leaders of the UNAIDS secretariat and its co-sponsor United Nations agencies to join us in speaking publicly about the events and actions noted here, which undermine whatever positive steps there have been in China’s response to the epidemic. United Nations leadership is needed immediately to urge the Chinese government to cease its repression of members of civil society working to fight AIDS and to actively endorse and support a human rights based response to the AIDS epidemic.

A number of recent actions against the AIDS work of legitimate Chinese NGOs and advocates recall China’s early practices of detention and repression of pioneering civil society leaders earlier in China’s epidemic. Among the actions of greatest concern are the following:

• The NGOs Asia Catalyst and China Orchid AIDS Projects had planned an international conference on HIV/AIDS and the law in Guangzhou in early August. On July 26, the organizations were informed that the Guangzhou Public Security Bureau had instructed the managers of the hotel where the conference was to take place to cancel it. On the same day, national security agents detained Li Dan, director of China Orchid AIDS Project and winner of the 2005 Reebok Human Rights Award for 24 hours. The co-sponsors were informed that the combination of AIDS, law and foreigners was “too sensitive” in a time when the year-long countdown to the Olympics was about to begin.

• The China Network of People Living with HIV and AIDS (Beijing), in collaboration with an organization of people living with HIV/AIDS based in Henan, announced it would hold a meeting on August 19-20 with representatives of 30 organizations of people living with HIV from around the province. On August 14, the police in Kaifeng, where the meeting was to take place, told the group to postpone the meeting indefinitely.

• On August 15, after repeated “visits” to the Kaifeng and Ruanjia village offices of China Orchid AIDS Projects, police ordered both offices to be shut down. They said the offices were illegal, though the organization is legally registered with the government and has worked in Henan for many years. They said that if the office was not closed by noon on August 17, personal harm could come to Zhu Zhaohua, the office director. On the day of the closing, police oversaw the removal of the staff and their belongings and told staff to leave the city “for their own personal safety.” Police also shut down a branch office of China Orchid AIDS Projects in Ruanjia village (Henan), and detained and expelled five student volunteers and a professor from Henan. Both offices provided much-needed support and services to children affected by AIDS.

In addition to these actions, NGOs based in and near Beijing have reported that the mandatory detention period for people charged with drug crimes has been extended in Beijing, and HIV outreach activities aimed at sex workers and men who have sex with men in the Beijing metropolitan area face increasing police scrutiny and harassment.

These repressive actions come as international media have reported stepped-up detentions and harassment of civil society representatives identified with pro-democracy and human rights struggles, as well as tighter state controls to ensure that Chinese mass media portray the country in a positive light. All signs point to a period of repression leading up to the Olympic Games that risks undoing whatever progress may have been made in recent years in China’s response to HIV and AIDS.

Courageous civil society action has been crucial to the progress made on HIV and AIDS everywhere in the world. Senior Chinese officials have acknowledged the importance of civil society in fighting AIDS in the past, but the authorities’ fear of public embarrassment during the Olympics threatens to undo this commitment. Leaders and officials of UNAIDS and the co-sponsor agencies must use all available opportunities to ensure that the Beijing Olympic Games do not become the smokescreen behind which AIDS activists in China are attacked and silenced. Public support from the United Nations and others in the international sphere for the life-saving work of AIDS leaders in Chinese civil society is urgently needed. Praise for China’s important AIDS programs must be accompanied by public statements in favour of the human right of civil society representatives to assemble, express themselves freely and continue their life-saving work. In this regard we call on UNAIDS to support the convening of a civil society conference within China in early 2008 on HIV and human rights.

We, the undersigned, will monitor public statements from UNAIDS and its co-sponsors to Chinese authorities on HIV/AIDS and Chinese civil society in the expectation that UN leaders and officials will not let essential civil society voices be silenced in the struggle for human rights and an effective national response to HIV/AIDS.


Accion Ciudadana Contra el SIDA (LACCASO – ACCSI), Venezuela
AIDS and Rights Alliance for Southern Africa (ARASA)
AIDS Law Project
American Anthropological Association, Committee for Human Rights
AP-Rainbow Advocates, Inc.
Asia Catalyst
Asia Pacific Network of people living with HIV/AIDS (APN+)
Asia Pacific Network of Sex Workers (APNSW)
Asian Harm Reduction Network (AHRN)
Association HIVLV, Latvia
Canadian HIV/AIDS Legal Network
Companions on a journey, Sri-lanka
Coordination of Action Research on AIDS & Mobility (CARAM Asia)
Delhi Network of Positive People (DNP+)
Empower India European AIDS Treatment Group (EATG)
Human Rights Watch
IGAT Hope, Papua New Guinea
International Network of People who Use Drugs (INPUD vzw)
International Treatment Preparedness coalition (ITPC)
International Treatment Preparedness coalition in Eastern Europe and Central Asia (ITPCru)
Lawyers Collective, India
Levi Strauss Foundation
Manipur Network of Positive People (MNP+), India
Physicians for Human Rights
Positive Malaysian Treatment Access & Advocacy group (MTAAG+)

Zackie Achmat, Executive director, Treatment Action Campaign
Mark Heywood, Chair, UNAIDS Reference Group on HIV/AIDS and Human Rights
Stephen Lewis, Co-director, AIDS Free-World, and former UN Special Envoy for HIV/AIDS in Africa
Anastasia Agafonova
Snehansu Bhaduri, India
Deirdre Grant
Khartini Slamah
Sergey Kovalevsky
Marhalem Mansor, Kuala Lumpur, Malaysia
Aleksandrs Molokovskis
Luyanda Ngonyama
Vladimir Osin
Shona Schonning
Jamie Uhrig, Chiang Mai, Thailand
Gregory Vergus
Loretta Wong, Hong Kong

Monday, August 06, 2007

The Bush Policy on AIDS

By Joe Amon
Published in
The Huffington Post

July 26, 2007 (New York) - Watching the Presidential candidates debate, the question I'd like to ask is "how many times per page would you make your Surgeon General refer to you in her speeches?" Two weeks ago former Surgeon General Richard Carmona told a Congressional panel that he was ordered to mention President Bush three times on every page of his speeches. I figure any candidate who pledges two or fewer references would be a positive step towards putting US health policy back on track.

And as the Surgeon General made clear, we can certainly use better policies when it comes to our failed response to fight AIDS.

In the US, despite half a million deaths and 1.5 million HIV infections over 26 years, there is still no strategic national plan to eliminate HIV/AIDS domestically. Although we are spending $16 billion per year, the money goes to an ad-hoc array of national, state and local programs with no consistent monitoring, benchmarks or review. This lack of coordination results in inconsistent access to prevention and treatment programs. For example, federal AIDS Drug Assistance Program (ADAP) funding and eligibility guidelines differ by states, so that the program that is the safety net for low income persons ineligible for any other coverage may or may not be available depending on where you live. And as of March of this year there were 571 people on waiting lists for drugs in 4 states. In 2006, 4 people died while on the South Carolina waiting list.

There is no national plan to address the crisis in the African-American community, which accounts for one half of all new HIV infections, even though blacks are only 12 percent of the US population. Latinos have the second highest AIDS case rate in the nation and Latino adolescents have 3.5 times the case rate of adolescent whites. Yet, current US AIDS efforts regularly ignore the issues which make these groups vulnerable and affect their access to health care, such as housing, education and employment, and focus instead on simplistic strategies like "National HIV testing day" (June 27th).

Surgeon General Carmona testified that as "the nations doctor" he wanted to address sex education, and that scientific studies suggest that the most effective approach to sex education includes a discussion of contraceptives. Yet Dr Carmona stated that he was blocked from doing so by those who "wanted to preach abstinence only". This is not merely a scientific debate - the US spends well over $150 million annually for abstinence-only sex education programs in public schools and since President Bush took office the US has spent more than $2 billion worldwide.

Similarly, despite overwhelming evidence of their efficacy in reducing HIV transmission, federal policy prohibits funding of needle exchange programs. Like abstinence-only, the ban on funding of needle exchange programs has been a triumph of ideology over evidence. At the July 10th hearing, former Surgeon General David Satcher said that while the Clinton administration had discouraged him from issuing a report showing that needle-exchange programs were effective, he had released it anyway.

In Dr Satcher's report, he wrote: "After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs . . . are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs." However, under President Bush, the Office of National Drug Control Policy (ONDCP) has continued to misconstrue evidence in support of needle exchange as an effective strategy for HIV prevention. A recent interview with an ONDCP policy analyst entitled "What's Wrong with Needle Exchange Programs?" claimed that research about the programs' effectiveness in lowering HIV infection had been inconclusive, and that their effect on continued drug use is unknown.

For the fourth year in a row, the President's budget has proposed cutting funding for the Centers for Disease Control and Prevention (CDC). Adjusted for inflation, CDC spending on domestic HIV prevention in 2006 was the lowest since 1993. Not coincidentally the number of new HIV infections in the US is unchanged since 1990. And evidence of politics trumping public health science does not stop at the Office of the Surgeon General. The Department of Health and Human Services (HHS) has increasingly put the Atlanta-based CDC under greater restrictions and scrutiny from political appointees. Staff requests for overseas travel are required to be vetted by political appointees in Washington. A recent internal CDC memo leaked to the Atlanta Journal Constitution complained that such approvals were causing roughly half of CDC overseas posts to be unfilled. And HHS has also routinely gone around CDC to push its ideological agenda. For example, the department funds a website,, targeting adolescents which highlights contraceptive failure rates and gives such helpful tips as this: "Find non-sexual ways to show you care (give a card or a nice comment)."

Under President Bush, the CDC has capitulated to pressures from Washington to censor information about the effectiveness of condoms and to restrict funding to community AIDS organizations not preaching abstinence. At a national conference on sexually transmitted diseases sponsored by the CDC last year, officials bowed to pressure from Congressman Mark Souder and added two pro-abstinence speakers to a panel and removed a scientist whose presentation had been accepted via peer review. The title of the panel - proposed by public health scientists - was changed from "Are Abstinence-Only-Until-Marriage Programs a Threat to Public Health?" to "Public health strategies of Abstinence Programs for Youth".

Surgeon General Carmona was testifying to the House Oversight and Government Reform Committee as part of an effort by Congressman Henry Waxman to examine ways to strengthen the authority and autonomy of the Office of the Surgeon General. It is essential for the credibility of that office, and for the entire Department of Health and Human Services that such reforms take place. For the health of our nation, we should be confident in America's doctor being able to speak openly and honestly.

Monday, July 23, 2007

How, and How Not, to Stop AIDS in Africa

Review by William Easterly of
"The Invisible Cure: Africa, the West, and the Fight Against AIDS" by Helen Epstein

...One of the classic works of journalism of the last couple of decades was Randy Shilts's And the Band Played On
about the sluggish response to AIDS in the 1980s in the United States, which indicted both the Reagan administration and the leaders of the gay community. I still remember the sense of outrage I felt when reading Shilts's book; it struck just the right note, leaving one both horrified about the tragic incompetence of so many and yet also hopeful that someone, somewhere could do things better next time.

Yet after reading Helen Epstein's masterful new book, the response to AIDS in America now looks in retrospect like a model of courage, speed, and efficiency by comparison with the response in Africa. In the US, the government publicized the threat and funded research, the gay community reduced its infection rates by encouraging less risky sexual behavior, the dreaded breakout into the heterosexual population never happened, and AIDS receded to become a disease that, while still tragic, could in most cases be kept under control with expensive new antiretroviral drugs (ARVs)...

Read the whole review in the
New York Review of Books

Friday, July 20, 2007

Sydney AIDS Conference: Scientific Advances Undercut by Rights AbusesAdvances in HIV/AIDS Prevention, Treatment Hinge on Respecting Human Rights

Advances in HIV/AIDS Prevention, Treatment Hinge on Respecting Human Rights

(New York, July 20, 2007) – Scientists and other delegates meeting July 22-25 at the 4th International AIDS Society Conference in Sydney should focus their attention on how human rights abuses against people living with HIV undermine the impact of scientific advances against AIDS, Human Rights Watch said today.

“Research is central to the fight against HIV/AIDS,” said Joe Amon, director of Human Rights Watch’s HIV/AIDS Program and a molecular biologist by training. “But scientific advances will have little impact if people living with HIV continue to be stigmatized and abused.”

Human Rights Watch cited examples from the Asia-Pacific region, where the conference is being held, of children and adolescents living with or at risk of HIV infection being discriminated against, sexually abused and socially marginalized:

· On July 14, police in Kathmandu beat and sexually abuses five Nepalese transgender youths. The officers also strip-searched the youths and examined them for signs of sexual intercourse. Police said that the carrying of condoms by transgender youth was an illegal act.
· On June 4, five HIV-positive children were barred from entering their school in Pampady, India. The students had not attended school since they had been kicked out in December.
· For over a year, hospitals have repeatedly refused to operate on a 5-year-old orphan living with HIV in the southern Chinese city of Guangzhou. Recent newspaper headlines have referred to the child as the “AIDS Boy.”
· In October 2006, Taiwanese officials ruled that residents of a home for people living with HIV/AIDS in Taipei should move out of the local community because they threatened the psychological health of neighbors.
· In January 2006, corrections officers at Buimo prison in Papua New Guinea beat and sexually abused male detainees by forcing them to have anal sex with each other. More than a year later, the officers continue to work at the prison.

Human Rights Watch also called on scientists attending the conference to protest government harassment and intimidation of AIDS activists. Human Rights Watch cited several recent cases from Burma, China and Zambia:

In Burma, authorities detained a leading HIV/AIDS educator between May 21 and July 2. Phyu Phyu Thinn, who has cared for people living with HIV/AIDS in her home, had protested against the lack of access to antiretroviral drugs in government hospitals. She was arrested and imprisoned along with other individuals while praying for the release of political prisoners.
In several cases in China this year, AIDS activists and people living with HIV have been detained: on May 18, two of country’s most prominent HIV/AIDS activists, Hu Jia and Zeng Jinyan, were placed under house arrest and banned from leaving the country; on April 11, about 350 people infected with HIV/AIDS were blocked by police from protesting over ineffective government-supplied drug treatments in Zhengzhou; and on February 1, Dr. Gao Yaojie, an 80-year-old Chinese doctor, was detained by government officials and put under house arrest to prevent her from leaving the country to receive an award for her work on transfusion-related HIV transmission.
In Zambia, Paul Kasonkomona and Clementine Mumba, the chairperson for Treatment Advocacy and Literacy Campaign (TALC), were detained by the police on July 9 as they were demonstrating outside parliament in solidarity with striking healthcare workers.

“While scientists are able to travel freely to Sydney to discuss the international response to AIDS, activists around the world are jailed and harassed for their work against HIV,” said Amon.

Conference delegates should also focus attention on human rights abuses faced by women, and acknowledge that technological advances such as vaccines or vaginal microbicides will have little impact unless they are accompanied by a greater respect for women’s rights. Governments have consistently failed to protect women from the violence that leads to infection or violence targeted against women living with HIV. Human Rights Watch pointed to two examples from India:

· In New Delhi this spring, an HIV-positive woman was beaten to death by her in-laws who feared she would infect the family.
· On September 1, 2006 in Kolkata, an HIV-positive woman was forced to perform an abortion on herself at a state-run hospital. The doctors had refused to treat her because of her HIV status, instructed her as to how to terminate her six-month pregnancy, and forced her to leave the hospital afterwards.

“We can not end the AIDS epidemic solely through science,” said Amon. “Scientific advances and human rights advances must go hand in hand.”

For additional Human Rights Watch reporting on abuses related to HIV/AIDS, and broadcast-quality interviews with AIDS activists, please visit:

Wednesday, July 18, 2007

HRW: Health and Human Rights

Check out Human Rights Watch's new Health and Human Rights webpage!
"It is my aspiration that health will finally be seen not as a blessing to be wished for; but as a human right to be fought for."
—former United Nations Secretary General, Kofi Annan
Promoting and protecting health and respecting, protecting and fulfilling human rights are inextricably linked, and every country in the world is now party to at least one human rights treaty that addresses health-related rights, and the conditions necessary for health. The United Nations Universal Declaration of Human Rights recognizes that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family..".
Governments are obligated to respect, protect and fulfill the “right to health” by taking positive actions that ensure access to high quality health services and by refraining from or preventing negative actions that interfere with health. Human Rights Watch is committed to researching and advocating on behalf of populations that are being denied their right to health.

HIV infection in conflict settings

by Clara Presler
(New York, July 17, 2007)--It has long been believed that conflict fuels HIV infection. High incidence of human rights abuses, including sexual violence, and mass displacement have been shown to heighten the risk of HIV transmission. As UNAIDS stated in
Guidelines for HIV/AIDS Interventions in Conflict Settings, “Sadly, the very conditions that define a complex emergency—conflict, social instability, poverty and powerlessness—are also the conditions that favor the rapid spread of HIV/AIDS and other sexually transmitted infections.”

But the exact relationship between HIV infection and conflict settings is not understood and difficult to track. A recent study by UNHCR, in fact, questions whether or not conflict heightens HIV-infection at all. "
Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review" looks at seven countries affected by conflict and that have data on HIV prevalence over the last 5 years: DRC, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia, and Burundi. The study found that there is insufficient evidence to conclude that populations affected by conflict have a higher prevalence of HIV infection. Among its specific findings was that that 9 out of 12 sets of refugee camps surveyed had lower HIV-prevalence than the host community. In some urban areas affected by conflict, prevalence decreased at similar rates as those unaffected by conflict.

While the study acknowledges some weaknesses of the survey—the restricted nature and quality of the work, the fact that populations once affected by conflict may not have been identified in the surveys due to displacement and/or death, and that traumatized populations may be unwilling to undergo voluntary HVI testing—it offers numerous explanations for its findings. Among these are that mass killings, forced displacement, and hiding can reduce social interactions that expose individuals to HIV. Also, refugees tend to come from rural areas, which often have lower rates of HIV infections.

Another important consideration is that the risks may be balanced: while some modes of transmission may be less prevalent during conflict (e.g. male migration), other modes may be more prevalent (e.g. sexual violence). Also, in post-conflict reconstruction, mobility and transport increase again which, compounded with the recent violence of war, could create an upsurge in infection. Moreover, conflict can, in the long term, damage the government’s ability to carryout education programs around health and limit the delivery of health services.

Press coverage of study: (7/9/07)
Reuters (6/29/07)

Wednesday, July 11, 2007

Civil Society Leaders Announce New Global Call to Stop Cervical Cancer

Thirteen civil society and public health organizations, including World YWCA and Rockefeller Foundation, seek global access to new HPV vaccines and screening
NAIROBI (6 July 2007) – A coalition of leaders at the World YWCA International Women’s Summit in Nairobi today announced the launch of the Global Call to Stop Cervical Cancer, a disease that kills more than a quarter of a million women each year. The Global Call aims to end cervical cancer by mobilizing political support to ensure that every woman and girl has access to newly available life-saving vaccines and new tools for screening and treatment.
“Cervical cancer is entirely preventable, so it is unacceptable that women in developing countries do not have access to new innovations in preventing and treating this disease,” said the Hon. Betty Tett, MP, Chairperson of the Kenya Women Parliamentary Association. “Political leaders must prioritize cervical cancer to ensure that all women, no matter how rich or poor, have access to new medical technologies that can save their lives.”
Cervical cancer, which is caused by the human papillomavirus (HPV), strikes more than 500,000 women every year. Due to extremely limited access to screening and treatment, 80 percent of cervical cancer cases and deaths occur in developing countries, making it the most common cause of cancer-related death for women in these countries. New vaccines which protect against the most dangerous strains of HPV are largely unavailable in the developing world. These vaccines and innovations in HPV screening and treatment for women have the potential end the threat of cervical cancer worldwide.
“Cervical cancer, like HIV and AIDS, affects many women in Africa. African women must therefore play a leading role in prevention efforts,” said Dr. Musimbi Kanyoro, General Secretary of the World YWCA, which is hosting a meeting this week in Nairobi that brings together 1,500 leaders from around the world to discuss issues related to HIV and AIDS. “AIDS activists have taught the world that there is a moral imperative to provide access to prevention and treatment services. We must extend these lessons to cervical cancer.”
Researchers have long recognized a link between HIV and cervical cancer. HIV-positive women are about four times more likely to develop the pre-cancerous lesions that can lead to cervical cancer than HIV-negative women. By launching the Global Call at a conference focused on HIV and AIDS, the organizers hope to encourage HIV activists and cervical cancer activists to learn from one another and share strategies to expand access to prevention and treatment.

“The world cannot afford to wait for new HPV vaccines and screening tests to eventually trickle down from wealthy countries to developing countries where women need these life-saving products,” said Dr. Ariel Pablos-Mendez, a Managing Director at the Rockefeller Foundation. “Cervical cancer is largely preventable, so we must not let women die for want of access to these products. We have an historic opportunity to save lives.”
The Global Call to Stop Cervical Cancer urges governments to prioritize cervical cancer in national development and health budgets, calls on multilateral agencies to ensure accelerated regulatory processes, appeals to international donors to ensure new vaccines and diagnostics are widely available, and calls upon industry to provide adequate supplies of new technologies at radically tiered prices. The Global Call is available online at, and organizations and individuals around the world are invited to sign on to show their support.
Over the coming months, the Global Call will be presented to policymakers at important high-level political events in an effort to demonstrate broad-base support to stop cervical cancer worldwide. The European Commission is organizing a meeting in September to fully engage political leaders in the fight against cervical cancer.
“Far too many women are still dying of cervical cancer,” said Dr. Lieve Fransen, Head of Human and Social Development for the European Commission’s Directorate General for Development. “The public, private and non-profit sectors need to work together to ensure that these new technologies are made available without delay to all women and girls who need them, wherever they live.”
Kenya: Brad Tytel, +254 (0) 73 785 9016,
United States: Victor Zonana, +1 917 497 3939,
Editors note: Thirteen global civil society and public health organizations make up the strategic advisory committee for the Global Call to Stop Cervical Cancer: The World YWCA, The Rockefeller Foundation, PATH, The International Planned Parenthood Federation (IPPF), The International Federation of Gynecology and Obstetrics (FIGO), Family Care International, JHPIEGO, American Cancer Society, The AIDS Vaccine Advocacy Coalition (AVAC), The International AIDS Vaccine Initiative (IAVI), the Medical Women’s International Association (MWIA), the International Union Against Cancer (UICC), Sociedad Latinoamericana y del Caribe de Oncologia Medica (SLACOM). The Global Call is supported by funding from the Rockefeller Foundation and PATH. Global Health Strategies, New York, is the secretariat for this effort.

Friday, June 29, 2007

New Report from UC Berkeley and Johns Hopkins: "The Gathering Storm"

Burma junta faulted for rampant diseases
By Yasmin Anwar, Media Relations 28 June 2007

BERKELEY – As Congress debates extending political and economic sanctions against Burma's military regime, a new report from the University of California, Berkeley, and Johns Hopkins University documents how decades of repressive rule, civil war and poor governance in the Southeast Asian country have contributed to the spread of HIV/AIDS, tuberculosis, malaria and other infectious diseases there.

Extreme travel restrictions imposed by the Burmese government have forced Médecins San Frontières (Doctors without Borders) in France and the multinational Global Fund to Fight AIDS, Tuberculosis, and Malaria to pull out of the country, and have severely curtailed the work of the International Committee of the Red Cross, according to the report co-authored by researchers from UC Berkeley's Human Rights Center and The Johns Hopkins Bloomberg School of Public Health.

report was released today (Thursday, June 28), and can be viewed online.

U.S. Senators Dianne Feinstein (D-Calif.) and Mitch McConnell (R-Ky.) introduced a bill on June 15 that would extend the U.S. sanctions, set to expire July 26, against Burma because of continued human rights violations. The sanctions include a ban on imports from Burma and visa restrictions for members of the government.

While 40 percent of Burma's annual spending goes to the military, only 3 percent goes to health care, according to the report. The Burmese military junta spends 40 cents per citizen each year on health care, compared to the government of neighboring Thailand, which spends $61 per citizen a year, the report says.

"Military expenditures should be reallocated to support health care delivery," said Eric Stover, faculty director of UC Berkeley's Human Rights Center. "Burma is not at war with its neighbors, and its security is more profoundly threatened by the rise of drug-resistant malaria and tuberculosis, and by emerging infectious diseases such as avian influenza, than from external military threats."

Stover and fellow researchers from the Human Rights Center and Johns Hopkins launched the project last year to discover the roots of Burma's dire disease epidemics and to determine whether international aid could be delivered in a way that is responsible and effective.

For the report, researchers traveled to the large Burmese city of Yangon, formerly known as Rangoon, and to Burma's borders with China, Thailand, Bangladesh and India. From health clinics in those regions, they gathered data on HIV/AIDS, tuberculosis, malaria and lymphatic filariasis, and interviewed aid officials and health care workers.

The researchers found that the widespread distribution of counterfeit antimalarial drugs, coupled with the rise of drug-resistant malaria and tuberculosis, pose a major health threat to the Burmese people, especially those living in border areas where health care is scarce, if available at all.

Burma has one of the world's highest tuberculosis rates and is home to more than half of Asia's malaria deaths. Those most vulnerable to disease epidemics there are ethnic and religious minorities, displaced farmers, commercial sex workers and intravenous drug users.

Drug trafficking has also played a major role in the spread of HIV/AIDS among intravenous drug users and commercial sex workers, the report says. In addition, aggressive campaigns by the Burmese government and the United Nations Office on Drugs and Crime to eradicate poppy cultivation and heroin production have led to the displacement of tens of thousands of families who have no alternative source of livelihood. Many have relocated to the Thailand border, where communicable diseases are thriving. Meanwhile, methamphetamine production in Burma's border regions is rising.

"Decades of neglect by Burma's military government have turned the country into an incubator of infectious diseases," said Chris Beyrer, a co-author of the report and professor of epidemiology at The Johns Hopkins Bloomberg School of Public Health. "While the health situation deteriorates, the junta continues to limit the ability of international relief organizations to reach those most in need."

In 1990, Burmese voters elected Aung San Suu Kyi, 62, as their democratic leader. But the military rejected the election results and placed her under house arrest, where she has remained for most of the last 17 years. During the 1990s, international relief organizations began responding to Burma's neglect of its citizens' health. By 2004, 41 aid organizations were operating in Burma with a combined budget of about $30 million, and tens of millions of dollars more aimed at fighting infectious diseases, according to the report.

But that changed in 2005 when Burmese government authorities imposed travel restrictions on international organizations. In October 2006, the European Union, along with Australia, Britain, the Netherlands, Norway and Sweden, launched the "Three Diseases Fund" to fight infectious diseases in Burma. Yet the fund, now worth $99.5 million, faces formidable challenges, including the critical task of ensuring that aid reaches Burma's border regions and other areas where infectious diseases are rampant and severe.

The report recommends that:

  • The Burmese government develop a national health care system in which care is distributed effectively, equitably and transparently
  • The Burmese government increase its spending on health and education to confront the country's long-standing health problems, especially the rise of drug-resistant malaria and tuberculosis
  • The Burmese government rescind guidelines issued last year by the country's Ministry of National Planning and Economic Development because these guidelines have restricted organizations such as the International Committee of the Red Cross (ICRC) from providing relief in Burma
  • The Burmese government allow the ICRC to resume visits to political prisoners without the requirement that ICRC doctors be accompanied by members of Burma's Union Solidarity and Development Association or by other junta representatives
  • The Burmese government take immediate steps to halt in eastern Burma the conflicts and human rights violations that are displacing an unprecedented number of people and facilitating the spread of infectious diseases in the region
  • Foreign aid organizations and donors monitor and evaluate how aid to combat infectious diseases in Burma is affecting domestic expenditures on health and education
  • Relevant national and local government agencies, United Nations agencies and non-governmental organizations establish a regional narcotics working group that would assess drug trends in the region and monitor the impact of poppy eradication programs on farming communities
  • These agencies also collaborate more closely, sharing information, to lessen the burden of infectious diseases in Burma and its border regions, and to develop a regional response to the growing problem of counterfeit antimalarial drugs.

Monday, June 18, 2007

Op-ed Trifecta

by Clara Presler

(New York City, June 18, 2007)--Three articles over the weekend cover a range of themes within the AIDS crisis—global aid, government sanctions, clean needle exchange—and converge in their call for increased government responsibility in the global effort to curb the epidemic.

Looking towards the fiscal 2008 appropriations bill, the New York Times calculates that the G8 pledge of $60 billion is actually a “retreat from previous goals”. Past G8 meetings have resulted in a declaration for universal access to treatment; this year, the group set its goal at treating only 5 million individuals in Africa. The editorial calls on the US government to increase its spending: “Congress should set the nation—and, by its example, the world—on course towards universal access to AIDS treatment by 2010.”

Considering whether the US should continue its sanctions against the Burmese military junta for its human rights abuses, or address the deterioration of its citizens’ health—and increase of HIV/AIDS prevalence—with humanitarian aid, the Boston Globe looks at how the Burmese government has spent its own money. While the rulers claim that there is not money to address health care, they have spent extravagant amounts on buildings, weapons, and nuclear agreements. The editorial says enough is enough: “Increases in humanitarian assistance are clearly necessary—but so are increases in political pressure…Now is not the time to reward the generals for their brutality [and] mismanagement…Bush is right to continue sanctions against the generals, and Congress should support this position.”

On the domestic front, the Chicago Tribune looks at a bill in the House of Representatives that would let the people of Washington, DC decide whether to sponsor clean needle programs. At the moment, DC cannot use their own local funds for such programs; no federal funds can go to them either. Such regulations cost money and lives; a sterile syringe costs a quarter, while supporting someone with AIDS costs about $25,000 a year. Numerous scientific institutions have affirmed that needle-exchange programs work without negative consequences. The commentary has a message for Congress—look at the evidence: “Restrictions on the sale and possession of injecting equipment, like the funding bans, make it harder for drug users to take basic self-preservation measures. If you like throwing away money, preventing addicts from getting access to sterile syringes is an excellent strategy. If you like squandering lives, it’s even better.”

Lately, much celebration has been paid to the Bush administration for pledging more money to PEPFAR. These 3 articles look beyond those headlines towards sustainability. Raising the bar, they call for an increase of governmental responsibility. Here are three ways that the US government can begin to meet the bar, both domestically and internationally.

Friday, June 15, 2007

World Bank: Not one approach, but many

The World Bank released a report yesterday entitled The Africa Multi-Country AIDS Program 2000-2006: Results of the World Bank’s Response to a Development Crisis. Advocating locally approapriate approaches to tackling the AIDS epidemic, it says, "the mobilization of empowered 'grassroots' communities, along with delivering condoms and life-saving treatments, are beginning to slow the pace of the continent's epidemic."

The articulated goals of the World Bank's Multi-Country AIDS Program have been to:
(1) to build strong political and government commitment to responding to HIV;

(2) to create a conducive institutional and resource-appropriate environment in which successful HIV/AIDS interventions could be scaled up to a national level;
(3) to make the HIV/AIDS response local—increasing community participation and ownership in HIV/AIDS interventions by providing financial resources and capacity building; and
(4) to move to a multisectoral approach involving all government sectors, with improved coordination at the national level and decentralization to subnational government structures.

Michel Kazatchkine said of the program, "It (MAP) was a precursor because of its specific objective of supporting civil society, which we know is a key component of the response against HIV/AIDS. In addition, the World Bank is in a privileged position to bring in the fight against HIV/ADS within the frame work of the fight against poverty and the fight for development and for promoting health in development."

Read the report and press release.

Tuesday, June 12, 2007

The Basics on PEPFAR

by Clara Presler
Recent developments on the President's Emergency Plan for AIDS Relief (PEPFAR)
(New York City, June 12, 2007)--In 2003, President Bush introduced the President's Emergency Plan for AIDS Relief (PEPFAR), a plan that allocated $15 billion over 5 years to AIDS relief in 15 countries hardest hit by the epidemic. Last Wednesday, May 30th, Bush announced that he would reauthorize this spending and boost the amount to $30 billion over the next 5 years starting in September 2008.

While PEPFAR has been instrumental in providing treatment to some 1.1 million people since 2003, heavy controversy surrounds the myriad restrictions that are placed on the funds and the specific earmarks. Additionally, increases in the number of people on treatment are being far outstripped by those becoming infected. For example, in sub-Saharan Africa for each 1 person put on treatment in 2005, 5 became infected. This means that, while Bush has doubled the overall funds, per capita spending on HIV-positive individuals will likely remain flat or even decline.

Currently under PEPFAR, 55 percent of funds must go to treatment and 10 percent must go to programs targeting orphans. Twenty percent of the funds go towards for HIV prevention and Congress requires that 33 percent of prevention funds be spent on abstinence-until-marriage programs (the remaining 15 percent goes to palliative care). As a percentage of money spent specifically on prevention of sexual transmission, close to two-thirds is spent on abstinence-only education. This requirement has been shown to divert finds away from other methods of HIV-transmission prevention, for example prevention of maternal-to-child transmission and prevention targeting injecting drug users.

Looking ahead to the next years of PEPFAR, advocacy organizations are working to see that the restrictions on prevention programs will be lifted and replaced by programs that are evidenced-based and fulfill the right to information, and that better respond to the factors making women vulnerable to HIV infection. Such programs include prevention of mother-to-child transmission, comprehensive sex education, and programs addressing property rights and domestic violence.

Another area of advocacy relates to US government policy which does not allow funding for clean needle exchange programs. These are needed in much of Asia and Eastern/Central Europe and specifically in places like Vietnam (a PEPFAR country) where the majority of HIV-transmission occurs through injection drug use. Other groups, including HealthGap and Physicians for Human Rights are pushing for attention to increasing health personnel (training and retention). Jose DeMarco of HealthGAP said, "Fighting AIDS in Africa without addressing the health worker crisis is like treating a massive hemorrhage with a handful of bandaids. PEPFAR must spend money to train and deploy new health workers and pay the providers who are at the heart of any successful AIDS response."

One step towards these goals is the bipartisan PATHWAY Act of 2007 (Protection Against Transmission of HIV for Women and Youth Act of 2007), introduced by Congresswoman Barbara Lee and Congressman Chris Shays that is currently up for consideration. This act would strike the abstinence-only earmark and further require the President and the Office of the Global AIDS Coordinator (OGAC) to establish a comprehensive and integrated HIV prevention strategy to address the vulnerabilities of all women and girls to HIV infection.

Decisions around PEPFAR are moving quickly: just last week, the 5th of June, The House State and Foreign Operations Subcommittee marked up the appropriations bill in a manner that reflects our concerns with US foreign aid, including the recommendation that an option to waive the abstinence-until-marriage earmark be included. The next vote on this will take place this week.


President Bush’s announcement of May 30th
New York Times: Bush Seeks to Double Spending for AIDS Program
Washington Post: Bush to Seek Extension of AIDS Effort

The Government Accountability Office (GAO) April 2006
The Institute of Medicine (IOM) March 2007

Tuesday, May 22, 2007

China: Activist Couple Accused of Endangering State Security

Just months after 79-year-old AIDS activist Dr. Gao Yaoji was detained by Chinese officials and temporarily prohibited from traveling to the US to accept an award, the young Chinese AIDS activists Hu Jia and Zeng Jinyan were arrested on Friday, May 18.

Charged with "harming state security" for their work on behalf of people living with HIV/AIDS, Zeng Jinyan began a blog to document their experiences with the police. Her accounts have captured the world's attention, not least on other blogs.

Below are links to blogs that have followed Hu and Zeng's experiences, along with Human Rights Watch's May 21st press release.

Human Rights In China Blog; My Blue Notes; Talk-Share-Learn

House Arrest, Travel Ban Arbitrarily Imposed on Couple Without Formal Charges

(New York, May 21, 2007) – The Chinese government should immediately lift the house arrest and travel restrictions imposed on Hu Jia and Zeng Jinyan, a prominent husband-and-wife team of human rights activists arrested on Friday, Human Rights Watch said today.

Hu and Zeng, two of China’s most well-known campaigners for the rights of people living with HIV/AIDS, were placed under house arrest and banned from leaving the country on May 18. During a four-hour interrogation at a Beijing police station, police told Hu that the couple was “suspected of harming state security.”

“The Chinese government ought to be grateful to Hu and Zeng for educating and assisting people living with HIV/AIDS, but instead it is punishing them,” said Brad Adams, Asia director at Human Rights Watch. “Their work isn’t a threat to national security, but the government’s attempt to stifle AIDS activists is a threat to public health.”

Minutes before the couple was to board a flight for a two-month trip to Europe, Hu and Zeng were detained by eight police officers – two of whom filmed the proceedings. The police at no point provided any official documents showing the basis for Hu and Zeng’s house arrest and travel ban.

Hu, a human rights activist who has monitored and reported on arrests and harassment of high-profile individuals, spent 214 days under house arrest between August 2006 and March 2007. The couple made a documentary film about their house arrest, “Prisoners of Freedom City,” which records their surveillance by state security and police over that seven-month period.

Last week, Time magazine named Zeng as one of the world’s 100 most influential people. Her

blog documents the routine surveillance and harassment by security forces that China’s activists and dissidents must endure. “I had never expected that the police would restrict me as well as Hu Jia,” Zeng wrote on her blog. “I am already three months pregnant. What is to be feared from me and my child?” She expressed her astonishment that the authorities would subject both her and her husband to house arrest for legally pursuing their rights of free expression and association.

In April, Hu released a transcript of a conversation he had with a prominent human rights lawyer, Gao Zhisheng, in which Gao claimed that he had been forced to “confess” under torture. Gao received a suspended sentence in December for a charge of “subversion” in a trial that fell short of international fair-trial standards.

The house arrest order confines Hu and Zeng to their home in Beijing and severely limits their freedom of movement and association, as well as their ability to contact friends and relatives. “China’s systematic use of house arrest and state security charges against human rights defenders seriously undermines the government’s claims that it respects the rights of its citizens,” said Adams. “The Chinese government should immediately end the practice of house arrest and the use of dubious, politically motivated charges against activists.”

House arrest is just one of the many administrative measures that Chinese authorities can deploy against dissidents and human rights activists without having to formally charge and prosecute them under Chinese law. The Chinese government appears to be increasing its use of house arrest on grounds of loosely defined state security crimes as a means of quelling public expressions of dissent in the run-up to the Beijing 2008 Olympic Games.

Hu stated earlier this year that he was planning to “push the space for freedoms, especially freedom of expression,” in the period leading up to the Beijing Olympics in August 2008. But with a spate of arrests of activists, lawyers and journalists in the past two years, China is moving in the opposite direction. Despite its recent, more forceful response to the AIDS epidemic, the authorities have also repeatedly harassed AIDS activists, most recently detaining 79-year-old Dr. Gao Yaojie in February.

“With the Olympics on the horizon, Beijing should know that its actions are being closely watched by the rest of the world,” Adams said. “Is the house arrest of two internationally known activists really the image that China wants to project to the world?”

More information about Hu Jia and Zeng Jinyan:

TIME: 100 Most influential people

Enemy of the State: Guardian Unlimited

China: Activist Couple Accused of Endangering State Security: Reuters

2 Activists Are Under House Arrest and Barred From Leaving China: New York Times

More information about AIDS activists in China
China: House Arrests Stifle HIV/AIDS Petitions
Restrictions on AIDS Activists in China
Hold Beijing to Account for its AIDS Coverup
Chinese AIDS Activist Honored Despite Ongoing Detention
By Choking Information, China Worsens AIDS Crisis

Tuesday, May 15, 2007

Curb HIV infection rates in Texas prisons

May 10, 2007 in the Statesman

"The Bible people come to the prisons once a month. Let the condom people come in once a month. The purpose is the same — to save lives." Last month, Texas State Representative Garnet Coleman (D-Houston) spoke these words to the House Committee on Corrections in support of his bill permitting community organizations to distribute condoms in Texas prisons.

In the United States, more than two-thirds of all new HIV infections occur among minorities. And because of the increasing imprisonment of drug users, and the disproportionate incarceration of minorities, the number of people with HIV or AIDS behind bars in the U.S. is more than three times higher than in the general population. Although most inmates acquire the infection outside of prison, some transmission occurs inside.

Coleman is concerned about the health of inmates, but he explained to the committee that much of the impetus for this bill arises out of the high rates of HIV infection among Latina and African American women. In Texas, some 12 percent of the population is African American. Yet among those living with HIV about 38 percent are African American. African American and Hispanic women combined represent 78 percent of women living with HIV in Texas. Coleman told the committee that making condoms available might lower the HIV transmission rate in prison and, in turn, lower the infection rate in the community as the inmates return home.

Coleman is right about the alarming rates of HIV infection in minority communities. And he's right that condom distribution will decrease transmission in prisons. Distributing condoms is a low-cost, practical public health measure that needs to be more widely implemented in U.S. prisons and jails. New York City, Washington, D.C., San Francisco and Los Angeles are some of the cities already distributing condoms in their jails, and the distribution of condoms to inmates has been endorsed by the National Commission on Correctional Health Care and the American Public Health Association.

However, sexual transmission is not the only way HIV is spread in prisons. Injection drug use and unsafe tattoos contribute to transmission, and strictly supervised programs providing prisoners with methadone, bleach, and clean needles have proven both effective, and safe, in such countries as Switzerland, Spain and Germany.

But it's important to note that minority women are not primarily at risk because of HIV transmission in prisons. Unemployment, housing discrimination, the lack of access to quality prevention and medical services, and the on-going stigma which surrounds HIV all fuel the epidemic.

And that's why Coleman's second bill on HIV in prisons is ineffective, and ultimately counterproductive. The bill would mandate HIV testing of all inmates and segregate those found to be HIV positive. These policies are not necessary, nor do they respect the civil rights of inmates. Informed consent is a cornerstone of legal and ethical medical testing requirements, and inmates, while losing certain rights to liberty, do not leave all of their rights at the jailhouse door.

Voluntary HIV counseling and testing can increase knowledge and impact HIV-related behaviors more than mandatory programs. The segregation of inmates with HIV perpetuates stigma, isolation and discrimination, undermining efforts to address the epidemic both in prison and out.

Despite the U.S. government's pledge in 2001 to cut the number of new HIV infections in half by 2005, more than forty thousand people in the U.S. continue to become infected with HIV each year. Much of what has stopped us from fulfilling that pledge is a willingness to cling to ideology rather than recognize reality. Rather than just inviting "condom people" into its prisons, Texas needs to implement public health programs that expand HIV information and services both inside and outside prisons, and respect the rights and the dignity of everyone living with HIV.

Joe Amon and Megan McLemore, Human Rights Watch

Monday, May 14, 2007

Woman AIDS activist nominated for Nobel Peace Prize

This week Patricia Perez became the first HIV-positive woman to be nominated for a Nobel Peace Prize. An activist from Argentina, she is the regional representative of the International Community of Women Living with HIV/AIDS in Latin America (ICW Latina). Her nomination was announced in Mexico City.

In the last three years, the prevalence of HIV among Latin American women has risen considerably. According to the United Nations Population Fund (UNFPA), three years ago there were seven or eight men with HIV/AIDS in Latin America for every woman with the virus. But today the ratio is three to one.

Since she was diagnosed in 1986, Patricia Perez has been a powerful voice in Latin America, an advocate for the rights of women living with HIV/AIDS in her region.

More about Patricia Perez:

ICW Latina

IPS: HIV-Positive Women Activists in Latin America Stand Tall

HIV Infection Rates Among Women in Latin America and the Caribbean Continue to Increase

Interview with Patricia Pérez, Candidata al Premio Nobel de la Paz (Spanish)

Monday, May 07, 2007

Debate: Global Public Health

The Challenge of Global Health by Laurie Garrett, Foriegn Affairs, January/February 2007
Thanks to a recent extraordinary rise in public and private giving, today more money is being directed toward the world's poor and sick than ever before. But unless these efforts start tackling public health in general instead of narrow, disease-specific problems -- and unless the brain drain from the developing world can be stopped -- poor countries could be pushed even further into trouble, in yet another tale of well-intended foreign meddling gone awry...

Nancy Aossey, International Medical Corps
To the Editor:
As head of an organization that has struggled for over two decades with the challenges Laurie Garrett raises ("The Challenge of Global Health," January/ February 2007), I know that making a lasting impact on the health of the world's poor is fraught with difficulties. No issue is more pressing than the work-force crisis in local health sectors, because it ultimately erodes the very same local structures that are essential for sustainable progress....

Joe Amon, HIV/AIDS Program, Human Rights Watch
To the Editor:
Laurie Garrett makes it painfully clear how shortsighted and dysfunctional our response to the global health crisis has been to date.
Garrett correctly points out that it will take more than money to make an impact on global public health, and she correctly states that unless we start tackling public health in general instead of narrow, disease-specific problems, we may end up worse off. But while her diagnosis is on target, her prescription misses the mark, because she misses the most basic factors underlying not only successful health infrastructures but also successful prevention programs and a successful health industry: good governance and a respect for human rights...

Susan L. Erikson, Global Health Affairs, University of Denver
To the Editor:
I have been following with great interest Foreign Affairs' discussion about Laurie Garrett's article on global health. But I am struck by the irony that a distinguished journal of foreign relations has completely missed such an important point: today's global health lacuna is political. We simply do not have people who are knowledgeable and experienced enough in foreign policy engaging in the politics of global health...

Tuesday, April 24, 2007

Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector

Last week the United Nations, UNAIDS, and WHO launched a new report focusing on access to treatment for people living with HIV/AIDS in low and middle income countries. The findings were mixed: although treatment in these countries increased 54 percent over 2005, coverage in general is patchy and inadequate. And the UN's stated goal of achieving universal access by 2010 is now only 3 years away.

Indeed, the numbers reflecting need are alarming. The report, appropriately named Towards Universal Access, shows that:

  • last year only 11 percent of HIV-positive pregnant women were receiving treatment to prevent transmission to their children;
  • only 15 percent of children in need of treatment had access to it;
  • there are 5 million people in low- and middle- income countries who still need treatment.

The report pitches a few recommendations to overcome these statistics. Some examples:

  • More attention to mothers and children;
  • More attention injecting drug users, an emerging problem in Africa;
  • Control of sexually transmitted diseases to prevent HIV transmission.

Toward Universal Access also lingered on the cost of drugs; the report comes at a time of heated debate between Abbott Laboratories and Thailand’s Ministry of Health. In early 2007, Thailand issued a compulsory license for Kaletra, prohibiting its patent. Abbott tried to assuage the government by offering Kaletra at a reduced price. When Thailand maintained its compulsory license, Abbott retaliated by offering a different version of the drug, Aluvia, to other developing countries at a reduced price. Just yesterday and after much criticism, Abbott changed its stance and agreed to offer Aluvia in Thailand at a reduced price, approximately $1000/person/year.

This concession has the potential to embolden other developing countries to take advantage of the compulsory license option of the
TRIPS agreement and obtain second-line ARVs at a more affordable price.

As Toward Univeral Access states:

“With some exceptions in certain low-income countries the average prices paid for second-line regimens remain unaffordably high in low- and middle-income countries, where few or no prequalified generic alternatives are available.”

It further points out that access to second-line drugs in developing countries is completely disproportional to their financial abilities:

“…An average price of US$ 1600 per person per year is paid by South Africa for tenofovir + abacavir + lopinavir/ritonavir, whereas El Salvador pays US$ 7613 per person per year for the same regimen.”

The Abbott Laboratories/Thailand story was a small victory towards increasing access. But, as Lancet pointed out last week, it was achieved only after advocacy groups heavily pressured the WHO to be more aggressive with Abbott. Reliance on case-by-case advocacy efforts is not sufficient, either to convince pharmaceuticals to lower their prices or to empower governments to take advantage of their right to provide generic drugs.

To this end, Towards Universal Access issues a warning:

“Unless prices for second-line regimens fall significantly, countries will soon be confronted with budgetary constraints that may put treatment programmes at risk. It is vital to achieve further reductions in the prices of second-line drugs and to obtain more second-line generic alternatives.

Lancet offers a first step: "WHO can do more. Developing a robust plan on access to second-line drugs in collaboration with its partners...would be a good start. Such a move would show that WHO is serious about defending the interests of patients with HIV/AIDS."

Wednesday, April 18, 2007

World Bank: New Policies Backslide on Family Planning

Continued Support for Access to Contraceptives, Safe Abortion Crucial to Development

(New York, April 16, 2007) – By failing to explicitly support continued access to family planning and contraception, new World Bank policies, as drafted, would undermine a key strategy in the fight against global poverty, Human Rights Watch said in a letter to the bank’s board of directors.

“Women’s lack of control over their own fertility keeps millions of them mired in poverty,” said LaShawn R. Jefferson, women’s rights director at Human Rights Watch. “If the World Bank is serious about ending poverty, it needs to enhance women’s ability to make independent choices about having children.”

Traditionally, the World Bank has supported broad reproductive health programs as part of its population policy, but recent developments at the bank raise concerns about its continued support for this strategy. Last week, World Bank staff told reporters that the bank’s managing director, Juan José Daboub, ordered them to remove all references to family planning in a country package requested by Madagascar. Paul Wolfowitz, the president of the World Bank, subsequently denied that the bank was changing its policy on reproductive health, but did not affirm the bank’s support for access to contraception and comprehensive sex education.

A draft World Bank strategy paper on health and population leaked in early April recognizes that population growth is a significant challenge to developing countries’ ability to provide access to basic services. But unlike earlier documents, including the World Bank’s World Development Report of 2007, the draft fails to make explicit reference to the need for access to sex education and contraceptives. This omission would allow for the kind of measures taken on the Madagascar country package. The bank’s board of directors will reportedly review the strategy paper on April 17 and 18.

“The bank’s draft strategy paper fails to give people the key tools they need to participate actively and as equal partners in society,” said Joseph Amon, director of Human Rights Watch’s HIV/AIDS and human rights program. “This week, the World Bank’s board of directors must correct that omission.”

Monday, April 09, 2007

WHO speaks out on health security on World Health Day

"Invest in health, build a safer future", the WHO said in a new publication honoring this World Health Day, April 7th. In the face of rising temperatures and globalization, the international health organization looks to the increasing threats to health. The publication outlines its primary focus areas:

  1. Emerging diseases;
  2. Economic stability’s effect on mobility of people and goods, and consequently diseases;
  3. Humanitarian emergencies, for example Hurricane Katrina;
  4. Biological and chemical terror threats;
  5. Climate change;
  6. HIV/AIDS;
  7. Building health security;
  8. Strengthening health systems.

The WHO continued, saying, after the Security Council met to discuss HIV/AIDS in 2000, “public health was no longer seen as irrelevant to security or as its by-product; it had become its essential ingredient.”

The call was echoed by many around the world. Dattatreya Bant, a professor of community medicine at Karnataka Institute of Medical Sciences explained the specific links between health security and health to the Times of India: "They include sudden shocks to health and economies from emerging diseases, like SARS (severe acute respiratory syndrome) and avian influenza, humanitarian emergencies, bio-terrorism and other acute health risks."

Bant also commented on the challenges to health common across the world: "The shortage of safe drinking water and its impact on health and security after hurricane Katrina in USA, and the tsunami in Asia, clearly demonstrate the importance of advance preparation and the ability to respond quickly."

An editorial in The Rising Nepal commented, “As defined by the WHO, health is a state of complete physical, mental and social wellbeing, and not merely an absence of diseases or infirmity”. It went on to emphasize the commitment that is necessary to achieving this wellbeing:

“There are political and institutional obstacles to optimally utilizing these trained human resources in their actual field of interest and expertise…There is no doubt that an effective public health workforce is extremely important to improving the health system …It is increasingly realized that this requires a substantial commitment to a new and creative approach from all countries and donor agencies.”

Tuesday, April 03, 2007

“Shackles” or “budget allocations”?

On March 30, the Institute of Medicine released a report called, “PEPFAR Implementation: Progress and Promise” which evaluates the initiative’s progress over the last three years. The interpretations of this report have been as mixed as those of the controversial initiative itself:

The New York Times focused on the IOM’s assertion that the fight against AIDS is “hampered” by certain restrictions in the plan, in particular:

  1. the requirement that 33 percent of all prevention money be spent on teaching abstinence (and nearly 60% of all money for the prevention of sexual transmission)
  2. that the FDA must approve AIDS drugs already approved by the WHO
  3. that the program cannot sponsor clean needle exchange programs using taxpayers’ money.
    The article stresses IOM’s call for a more sustainable approach and less emergency response, and ends with the critical fact that at the half-way point of PEPFAR, the program has not met its goals.

The Boston Globe also focused on the obstacles to the US effort to fight AIDS, citing the funding restrictions and the report’s call for greater emphasis on prevention.

The Washington Post took a more positive slant, referring heavily to the reports statements that the program has made a “strong head start” and PEPFAR’s success at treating pregnant women, but also cites the report’s call for less prescriptive budgeting.

So does the IOM’s report “please almost everyone” as the Washington Post says?

Mark Dybul, who oversees the implementation of PEPFAR, was thrilled, welcoming the report as “an endorsement of our program”. In response to the critique on the prevention programs he said “There is no abstinence-only provision. I wish people would stop calling it that. It’s abstinence until marriage.”

According to the New York Times Dybul also disagreed with the report that PEPFAR should pay for clean needle programs. “Needle exchange just continues the condition” Dr. Dybul said. This, of course, contradicts with the Institute of Medicine’s recent review of the effectiveness of needle exchange, and the endorsement of needle exchange programs by the AMA, APHA, the American Academy of Pediatrics and numerous other groups.

While many PEPFAR critics were glad the report highlighted a need for a less “cookie cutter” approach to HIV prevention, tailoring responses to the epidemiology and emphasizing evidence-based approaches, others felt the report pitted prevention against treatment. Gregg Gonsalves said “If one needed more evidence that the pendulum has swung away from access to treatment and back towards the pre-2000 conventional wisdom that poor people can't be and shouldn't be treated with ARVs, the New York Times article today on PEPFAR just confirms” it.

The news coverage also gave little coverage of one of the major findings of the report – that more attention must be paid to factors making women and girls more vulnerable to HIV infection, and that PEPFAR must invest greater in efforts to improve their legal, economic, educational and social status. "We are making the overall recommendation to find ways to empower girls and women and to protect them from sexual harassment and sexual violence," the panel's chairman, Jaime Sepulveda of the University of California at San Francisco, told reporters.

This recommendation led many activists to call for passage of the PATHWAY bill re-introduced by Congresswoman Barbara Lee (D-CA) and Congressman Christopher Shays (R-CT) on March 27. The bill would require all HIV prevention programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) to address violence against women and would eliminate the earmark for abstinence-until-marriage programs (Read more).

Tuesday, March 27, 2007

HIV/AIDS in Honduras

Honduras is one of the poorest countries in Latin America and one of the hardest hit by HIV/AIDS. The adult prevalence rate is estimated at 1.5 percent. Only Belize, with a prevalence of 2.5 percent, has a higher prevalence in all of North, Central, or South America, according to UNAIDS.

I would like to highlight a couple places that are hard at work to curb the epidemic and improve the lives of Hondurans living with HIV and AIDS.

In 1995, Siempre Unidos ("Always United") formed as the first self-help group for persons living with HIV/AIDS in Honduras. Its scope expanded over the years and it now follows the mission of providing life-saving outpatient medical treatment, social support, and education to people living with HIV/AIDS in Honduras. It receives help from the Global Fund, the Episcopal Church, and the Honduran government and now provides free anti-retroviral treatment to hundreds of people living with AIDS in San Pedro Sula. It continues to hold support group meeting once a week for over 100 people and also provides employment opportunities for HIV-positive women at its sewing factory, SiempreSol.

Fundacion Llaves began in 1999 to assist people living with HIV/AIDS in Honduras who were unable to obtain adequate information about their condition. Upon realizing that most of the information in Honduras pertained to prevention, Fundacion Llaves’ primary mission became to disseminate information for people living with HIV/AIDS—about health, the treatment options, and human rights. To this end, Fundacion Llaves reaches out to the press, the government, and the community to raise awareness. They publish a magazine called “Llaves” and a weekly radio program “Aprende del VIH/SIDA y Gana” (Learn about HIV/AIDS and Gain). With only 8 people, the organization has made significant gains for Hondurans living with HIV/AIDS.

Wednesday, March 21, 2007

HIV Testing and Reproductive Choice – How Did The Rights-Based Approach Play Out?

While this reflection is of the International AIDS Conference in Toronto - the tough questions it raises remain as pertinent (and largely unanswered) today as they were 6 months ago.

Published on (

By Maria de Bruyn
Created Aug 28 2006 - 8:20am
Any reflections on the XVI International Conference on AIDS are necessarily subjective, as each person reporting attended different sessions, had different goals and talked to different people at different times. Nevertheless, taking the various perspectives into account can give us a more comprehensive view of what transpired in Toronto.
Advocates for women’s and rights issues can rightly take pride in having focused at least some attention on topics that were relatively neglected, such as female-controlled (at least to some extent!) barrier methods (female condoms, microbicides, diaphragms and cervical caps) and violence against women.
One hot topic that was debated in formal and informal sessions was the current push by national and international agencies to have as many people tested for HIV as possible. Most people agree that knowing one’s HIV status can have many benefits, not the least of which is enabling a person to seek appropriate treatment in a timely manner (assuming that affordable treatment is available within a reasonable distance from their place of residence, of course). What concerns those who question the speed with which testing initiatives are being expanded is whether this public-health measure will be based on respect for individual human rights.
Some worry that routine offers of HIV tests by health-care providers may easily turn into routine imposition of HIV tests for patients who are not knowledgeable or confident enough to ask about the benefits and risks associated with tests. (And just think about it – how often have you asked your physician all the questions you had about a medical exam, procedure or prescription? Have you never felt just a little intimidated or reluctant to challenge or question what your doctor says? I know that it’s happened to me and my well-to-do, highly educated, empowered female friends; women raised to be subordinate will have even more problems with this.)
The growing shortage of health-care workers in many areas means that health systems don’t have adequate staffing levels to ensure that patients can give informed consent or receive counseling. Inadequate infrastructure can mean that confidentiality is not ensured as no separate spaces are available where people can receive test results in privacy. Or people’s confidentiality is breached later when they can only access antiretroviral therapy (ART) at offices labeled “AIDS Services,” “ART for adults” and “ART for children.” When women are asked to take HIV tests during labor and delivery, they will often be in a ward with others – how can protocols ensure that their consent is informed and private? And how well can they consider benefits and risks at such a time?
At two different sessions on testing and counseling, speakers highlighted the increased numbers of people tested through Botswana’s provider-initiated testing system. However, it was only in response to an audience member’s question that one scientist admitted they were only now starting to consider evaluations that might also assess client satisfaction, access to ART and possible negative impacts subsequent to testing.
The ATHENA Network and International Community of Women Living with HIV/AIDS (ICW), with assistance from the Center for Health and Gender Equity (CHANGE), organized a press conference to highlight the need to examine testing from a gender perspective. For example, the experiences of ICW members point to the fact that “Testing services often do not address the stigma, discrimination and related violence, and loss of livelihood that many women face if their status becomes known. This makes seeking treatment and care a devastating prospect for many.”
The questions raised about the push for testing were good and necessary. What we need to hear about as soon as possible, however, is how the challenges to human rights-based testing and counseling are being tackled. Just a few examples (there are more!). Many physicians are coming to Africa from other countries to help deal with the health-care worker shortage (e.g., from Cuba). How well can doctors who don’t speak local languages ensure that people are able to give informed consent for a test? A study coordinated by Ipas on meeting HIV-positive women’s health needs recommends that women living with HIV be paid as counselors, instead of having them supplement health services as volunteers. Health-care workers in Argentina confirmed that HIV-positive counselors can offer superior services – how many testing programs are taking this approach? How do testing protocols take into account follow-up of people who tested positive (e.g., in accessing ART if needed or in providing treatment and support for mothers and children)?
Regarding reproductive choice: in 1992, when ICW was founded, the network published 12 statements on what was needed to improve the situation of women living with HIV/AIDS; one of those statements was: “The right to be respected and supported in our choices about reproduction, including the right to have, or not to have, children.” In the 2002 Barcelona Bill of Rights, ICW and other organizations stated that a fundamental right for women and girls around the world is “to sexual and reproductive health 1 services, including access to safe abortion without coercion.” So is reproductive choice receiving attention at the AIDS conference?
Some state that it was scarcely addressed; that is certainly true, for example, in comparison to prevention of perinatal transmission. But a few small steps forward have been made if we consider that the topic was virtually ignored in the past. About 20 poster and CD-ROM abstracts included the topic of pregnancy termination or integration/linking of HIV/STI and abortion services; several called for access to safe abortion services or noted how current laws create obstacles for women.
Of course, many people will not read the abstracts and did not see the posters. So was the topic visible otherwise? The T-shirts given away to participants in the Women’s March and Rally (the first to be officially endorsed by an AIDS conference) featured the Barcelona Bill of Rights, including access to safe abortion. Buttons distributed by the ATHENA Network and Blueprint Coalition asked for “sexual rights, reproductive choice and healthy motherhood.” And in an opening plenary speech on the first day of the conference, Louise Binder highlighted the need for women to have access to safe abortion for all indications permitted by law. Now we need to ensure that the 2008 International AIDS Conference includes at least one oral abstract, round-table or panel discussion session on reproductive choice with discussion of issues such as antenatal care for women who choose to become pregnant after knowing their status, access to safe abortion and integration/linkage of postabortion care services into HIV/AIDS information and services, coercive abortion/sterilization as human rights violations, and the possibility of adoption for HIV-positive parents.
One final observation: Louise’s plenary was the final one on 14 August and previous speakers had exceeded their allotted time. This resulted in many delegates leaving the session to go to the next one; considerable numbers of women also left the room before hearing the presentation on women and HIV/AIDS. When her presentation went a bit long, the chair of the session (a woman!) cut off her microphone. To her credit, however, Louise stood her ground, refused to budge and was supported by remaining delegates so that eventually her microphone was turned back on and she could finish. The most insulting thing about this was the chair’s admonition that Louise had to conclude because the next session was about to start and included “important people – Bill Clinton and Bill Gates.” Now what does that say to us about women having a fully recognized and meaningful place at the table??
Some references:
ATHENA Network: 2
ICW press release on testing: 3Ipas study: 4
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