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WorldWeWant2015 Content
on Thu, January 17, 2013 at 01.27 pm

Lead Theme 2: AIDS, health and development

Details:

The AIDS response has been a pioneer on many fronts – in areas such as inclusive governance, robust accountability systems from the community to the UN General Assembly, strategic investments approaches and the practical imperative of promoting human rights, dignity and equity.

 

1. What are the key factors that account for the significant progress seen in the AIDS response and how can these factors be applied to doing health and development differently? 

2. Can lessons learned accelerate progress towards, for example, universal health coverage, preventing and treating tuberculosis and NCDs, reducing gender-based-violence, and reducing health disparities?

3. How can we ensure that the social determinants of health – including human rights, gender equality and equity– are addressed in the Post-2015 development agenda?

 4. A recent WHO paper argues for 'universal health coverage' as the key health indicator post-2015, with life expectancy as the leading indicator.  Is this a threat or an opportunity (given that rolling out MTCTP and HAART boosts life expectancy) for the international AIDS response?   [Question added by Nicoli Nattrass]

 

Thematic papers:

 


The moderators are:

Gorik Ooms Nicoli Nattrass Mabel Bianco
Gorik Ooms is a human rights lawyer, who worked with Médecins Sans Frontières (MSF) Belgium during most of his professional career. He was a member of the Country Coordination Mechanism for the Global Fund in Mozambique in 2002, and helped starting the first AIDS treatment projects in Mozambique. He was the executive director of MSF Belgium from August 2004 until May 2008. In August 2008, Gorik Ooms joined the Institute of Tropical Medicine, Antwerp, Belgium. In September 2010, he has also been appointed as Adjunct Professor of Law at Georgetown University, Washington DC, USA. Nicoli Nattrass is Professor of Economics and Director of the AIDS and Society Research Unit at the University of Cape Town. She has published widely on the political economy of AIDS policy and antiretroviral treatment. Her latest book is 'The AIDS Conspiracy: Science Fights Back (Columbia University Press, 2012). Mabel Bianco is a feminist and medical doctor, with a Master in Public Health in Epidemiology. She is Founder and President of FEIM: Foundation for Studies and Research on Women since 1989. She is the author of eight books and more than 200 published papers and articles.
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nelson Owusu ntiamoah from
Mon, February 18, 2013 at 06.46 pm

It will be an understatement to point out that global health has significant and transcending position on other agendas that seek to improve the lives of people and the planet globally. Increased and improved access to proven-effective and cost effective health interventions including equitable access to HIV, RMNCH, and Water, Sanitation and Hygiene (WASH) interventions will significantly help the realization of other development agendas. This is why the post MDG agenda must refocus health. The significant landmarks that must inform this refocus on health must be guided by equity and rights of individuals, communities and countries to decide freely what their health priorities are without the hungering for demand and supply spaces created for the advantage of some multinationals at the expense of the scarce aid and foreign exchange of developing countries. It implies making countries take responsibility over what works best for a national scale up through improved mechanisms and capacity to carry out implementation researches; use of indigenous knowledge systems including traditional health practices and medicines that have proven effective for some diseases and advocacy for health systems strengthening through increased investment (both private and public) in health and equitable distribution of health resources to reach the marginalized in countries. Global health Coalitions must be involved in facilitating change in the health sectors of countries through knowledge sharing on best practices. The window of hope for multinationals engaged in global health must be regulated to ensure that health of people is not placed in the market-driven sectors of the global economy for cheap exploitation. Multinationals developing vaccines and other health products for developing countries must also explore possibilities of partnering local pharmaceutical companies to ensure cost effectiveness and safeguard local interests. The significant role of reproductive health, HIV/AIDS and women/children's health having been realized over the previous decades must warrant more global investments in order to reap fully the benefits these health areas bring to the overall development arena.

Anonymous from
Mon, February 4, 2013 at 09.33 pm

arielalfredobazan@yahoo.com.mx.notifico que voy a donar 10% de lo recaudado sobremesa mundial........en trabajos sociales....ariel. abrasos.o investigacion hiv

Anonymous from
Mon, February 4, 2013 at 12.02 pm

The AIDS response is known for the involvement of communities most affected by it (gay men, other MSM, trans women, sex workers, drug users), both in prevention, and in treatment, care and support of those of them already affected. These populations have pushed for advancing the response, although their rights and protection from discrimination and guarantees for equality under the law lag far behind HIV treatment and services. That is why manhy of these populations are underserviced by HIV services, the school system, public housing, judiciary system and access to employment and related services. These health disparities remain for these specific populations, with HIV prevalences 10 to 100 times greater than the general population. This is unequivocal inequity in health access for gay men, MSM, trans women, sex workers and drug users, and should be dealt with in similar ways as women's health is dealt with. But there are social determinants based on lack of legal protection from discrimination, lack of equality under the law, lack of access to education, housing and justice system. These inequalities have to be dealth with and HIV has shown us how to do it for some populations. Now these underserved ones need to be dealt with in similar ways as we have dealth with the women's and girls' agenda to end gender-based violence, gender equality and HIV.
Ban-ki Moon has argued for equality under the law for LGBT and his calls should be dealt with immediately. Similar calls for equality for sex workers and drug users have to be dealt with too.

Anonymous from
Mon, February 4, 2013 at 09.08 am

MDGs and other internationally agreed development goals aspired all us and remain critical to achieve them in the years to come. Since its formulation much progress has been made under MDG 6 to halt and reverse the epidemic in number of countries as reported by UNAIDS in 2012.

Much of the success is due to number of factors, among others, these being:

1. integration the AIDS response with other broader development and health interventions.
2. linking the AIDS movement with broader movements for social justice, rule of law, redistribution of opportunities for an effective AIDS response.
3. global solidarity and shared responsibility for an effective response to the epidemic
4. human centered development and empowering and integrating the voices and aspirations of ALL for an effective multi-sectoral AIDS response.

Anonymous from
Mon, February 4, 2013 at 08.08 am

“Universal health coverage”, while broad as an indicator, will nevertheless provide opportunities for advocating strong engagement on HIV.

Given the major impact of untreated HIV on life expectancy at a population level, particularly in countries with generalised epidemics, addressing HIV and ensuring access to treatment will necessarily feature as a key tool in responses seeking to improve life expectancy.

Focus on achieving universal coverage will also require stronger engagement of civil society partners, as a means to achieve coverage amongst populations and groups which are harder to access.

Focussing on the potential positive impacts of prioritising HIV as a means of increasing life expectancy will need to be a central part of advocacy efforts seeking to ensure that HIV receives the attention it requires in the post-2015 era. HIV must be seen as a central part of efforts to achieve universal health coverage and improved life expectancy, rather than an optional priority, competing with other priorities.

Anonymous from
Sun, February 3, 2013 at 11.51 pm

Strong UNAIDS leadership as lead advocate for the global AIDS response has been acheived through the mobilization of critical stakholders including national leadership, governments, private sector, CSOs including PLHIV among others. Mobilizing national and global stakeholders for Health and other development sectors will be critical for the acheivement of post 2015 development agenda.

The use of global AIDS reports, UNGASS and universal access reporting have increased government action to international committments and enhance greater accountability and reporting ont he national AIDS responses. These reporting mechanisms must be adapted for main and sub-themes/ priorities of the post 2015 development agenda

The use of the mult-sectoral approach has made it possible for other non-health sectors to contribute to acheiving universal access to HIV prevention, treatment, care and support. Adapting the multi-sectoral approach will be critical in addressing the determinants of health and other developmental challenges

Global and national AIDS response has provided opportunities for strengthening the health systems in many countries. interventions that reduces gender violence and women and girls vulnerability to HIV, eliminate mother to child transmission and save mothers life, eliminating stigma and descrimination, promoting universal accessment to HIV prevention, treatment, care and support services provides great opportunities for addreessing health inequities and enhances the quality and delivery of health services as clearly demonstrated by the Global Fund and PEPFAR.

Subsumining HIV into health could have devastating consequence. The possiblity that HIV will be overcrowded by other health priorities is highly possible. In spite of the possibile benefits to be derived, such as better integration of services, increased coverage of HIV coverage under national health insurance and other social protection initiatives. It is desirable that the relationship between HIV and Health remains parellel but complementry rather than competitive.

Anonymous from
Sun, February 3, 2013 at 10.39 pm

Responding to the HIV epidemic has led to unprecedented engagement and discussion around health, human rights, and development. This health and human rights approach to the HIV response should inform other work on global health and sustainable development issues. Furthermore, HIV activism helped pioneer innovative approaches to global health governance, fighting for principles of inclusion and accountability. Intensified efforts to address HIV will lead to achievements of other health goals, from strengthening health and community systems, to improving sexual and reproductive health rights, to advancing preventive and behaviorial health, to ensuring the right to health for all.
Furthermore, development investment under MDG 6 has led to the strengthening and promotion of health and human rights. Global efforts against HIV and other health issues have catalyzed the global investments in development, community organizing, and improved service delivery. Global HIV and other health efforts advance new collaborative models involving providers, communities, advocates, governments, and funders. Finally, global HIV and other health efforts spur innovation and effectiveness in linking across multiple sectors of health and human rights
Despite these advances, more engagement by communities, especially key affected populations, is needed in decision making processes and in the HIV response more broadly to deliver more sustainable progress and results. Moreover, further development investment is needed to battle the HIV epidemic, including spurring more country-level investment, attention and resourcing of human rights, creation of enabling legal environment to facilitate effective HIV responses (e.g. greater improvement in laws, decriminalization of sodomy, sex work, criminalization of HIV exposure/transmission). By ensuring the prioritization of the HIV response with the post-2015 MDG, the ensuing development investments will create a structure in which there is more equality, non-discrimination and access to health and human rights, and a world with a more effective HIV response.
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Anonymous from
Sun, February 3, 2013 at 07.59 pm

Nous avons vraiment besoin d'être plus investi dans la liaison et l'intégration du VIH et de santé sexuelle et reproductive (SSR). Lorsque les services sont intégrés, ils répondent mieux à un large éventail de besoins. Il est temps de s'éloigner de l'objectif vertical sur la maladie et à la place se propager à travers les ressources du système de santé afin d'assurer une lutte plus efficace contre la maladie.
Nous devons allez davantage vers la promotion de la "couverture universelle" sans distinction de zone géographique en abandonnant de faire un choix à partir d'un critère de priorisation qui risque de nous fausser dans l'avenir.
En matière d'IEC/CCC, l'insuffisance des témoignages des PVVIH, le manque de preuve tangible de l’existence de la maladie, la diffusion trop fréquente des messages contre la discrimination des PVVIH (exemple: le VIH ne se transmet pas par..........) donnent un effet négatif à la lutte contre cette maladie

Anonymous from
Sun, February 3, 2013 at 11.49 am

HIV is one of the most compelling health responses in the history of human development. What can we learn from this, and how can we translate that learning into a broader health and development framework? The HIV response has catalyzed a new form of activism around health which comprises 1) the centrality and leadership of the people most affected by the epidemic; 2) the non-negotiability of gender equality and human rights as essential to successful health outcomes; and 3) multi-sectoral partnerships and governance models.

HIV remains unfinished business and there is still much to be done: over 33 million people are still living with HIV worldwide and all of these people will need treatment over the course of the rest of their lifetimes; 7 million people are currently in need of anti-retroviral treatment and still not accessing it; this presents as fundamental a problem to our economies and societies as it ever did; and, there is now clear evidence that intimate partner violence doubles the chances of a woman acquiring HIV, and that one in three women will be beaten, coerced into sex or abused in her lifetime. So how can the lessons from the HIV response be applied to the post-MDG paradigm?

HIV forms an important two-way link in a series of interlocking and mutually reinforcing chains and building blocks, which not only serve to address and mitigate the impacts of the HIV epidemic, but also position HIV as a key element of achieving other health, development, and social justice goals.

Findings from the 2011 Virtual Consultation (see womeneurope.net, HLM June2011 tab) toward the High Level Meeting on AIDS identified 10 key building blocks:
1. Meaningful involvement of women and girls living with and affected by HIV
2. Solidarity with and between women and girls living with and affected HIV in all their diversity
3. Achieve safety for all women and girls
4. Accelerate gender equality
5. Integrate services, especially sexual and reproductive health and HIV
6. Affirm the sexual and reproductive health and rights of women living with HIV to receive comprehensive peri-natal care and to have children free of HIV
7. Making women-centred HIV prevention technologies a reality
8. Advance comprehensive sexuality education
9. Invest in care and caregivers
10. Fund an HIV response and a development agenda that works for women and girls in all of their diversity

Anonymous from
Sun, February 3, 2013 at 11.34 am

Universal Health Coverage is a powerful political project and a promising means to reach a better level of health, and it is interesting to discuss how the unfinished agenda of the targets set in the MDG 6 can be articulated with the emergence of UHC in the post-2015 framework, to identify economic and epidemiologic pre-requisites, outcomes indicators, safeguards to make sure that the most vulnerable and stigmatized populations are fully integrated in national health systems.

But this is only a part of the conversation; in the meanwhile there is still much to be said on what the HIV/AIDS experience has brought to health and development.

One of the points that has not been said on this forum so far is that it is the very verticality of the fight against HIV/AIDS, TB and malaria that has been key in its success: in the mobilization of patients and civil society; in the creation of specific funding and governance mechanisms at global level; in the development of innovative procurement chains and care techniques on the ground; in making quality medicines financially accessible for a large number of pathologies; in creating and setting up innovative ways to finance health and development.

Our analysis as patients’ organizations and actors of the civil society is that the fight against HIV/AIDS has led to a unique dynamic in the story of development, where the global response to pandemics stands at the cutting edge of global health strengthening.

We believe that the momentum around the fight against pandemics has to be more than ever reinforced, so that we, actors of the struggle for an AIDS, TB and malaria-free generation, keep on leading the way towards achieving the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Patrick Brenny from
Sun, February 3, 2013 at 10.36 am

A key sucess of the AIDS response is that it has come, first and foremost, from the advocacy efforts of many affected communities and groups, without which the global response to AIDS may never have taken off. The critical challenge is translating that community ownership and advocacy -- as well as governmental accountability to their citizens and their needs -- into all of the various local situations where this transformation is still sorely needed.

Anonymous from
Sat, February 2, 2013 at 07.02 pm

The following factors have helped in AIDS response
- Joint Advocacy teams; these include Governments, CSOs and Donor partners.
- Resource mobilisation
- Use of Public Private Partnership
The above factors can be incorporated in health and development by involving stakeholders in planning process. Appropriate use of public private partnership is a developmental key in any sector. Also, creation of resource mobilisation centers will strengthen logistic chain approach.
Of course, lessons learnt can accelerate progress provided decision-makers put those things into consideration. I wish we have a situation where CSOs will be more of pressure groups on government to enforce social determinants in Post-2015 agenda.
Finally, Universal Health Coverage is an opportunity to allow more people to have access to health care. Let the rich begin to insure the health of the poor!

DORA BIYELA from
Sat, February 2, 2013 at 02.37 pm

I am glad to have to add a voice to the matter though mine might be slightly different. my main concern is the youth and at what alarming rate they are contraction the HIV virus everyday. I am a writer that is passionate about the issues of that affect the youths on a day to day basis, issues such as HIV, peer pressure among the many. my biggest dream is to have to see that HIV messages to the youths are transmitted in a form of literature. Here in Zambia, we practically do not have adequate information that is written down specifically for the youths. We must realize that we have a generation of youths that are fun filled and will not just pick up any dual looking book and read. we need to give them something that is not only going to educate and inform but entertain them as well, something they are going to relate to directing so that it should leave them with a question only them can answer.
Another issue is on PMTCT. I really appreciate all the efforts that the concerned stakeholders are putting in to ensure that we have an HIV free generation, BRAVO to them, my worry is that, why pump so much money in protecting a child in the mothers womb, protect them during birth and the first two weeks of their lives only to let them loose thereafter to contract the virus? these are the same people that these organizations com e and start spending money on in providing them with ARVs. What am i saying, we need to bridge the gap, we need to come up with an on going thing and as for me, literature is the only way and the inclusion of HIV| AIDS be included in the school curriculum like the way Maths is.

Guiselly Flores from
Fri, February 1, 2013 at 11.58 pm

Para mi un factor clave es una respuesta multisectorial realmente efectiva, en nuestro país, la respuesta al sida ha sido enmarcada básicamente en Salud. No podemos hablar de desarrollo, salud y VIH si no tomamos en cuenta todos los factores que influyen por ejemplo los niños y niñas huérfanas del SIDA, cómo podemos hablar de desarrollo y sida? si no incluimos esta agenda abandonada por casi todos los países en Latino américa. Nuestros hijos e hijas están abandonados viviendo en un mundo de pobreza y pobreza extrema en un entorno totalmente desfavorable: sin educación y expuestos a muchas vulnerabilidades: hambre, explotación sexual, estigma, drogas, alcohol, delincuencia. Incluir en las agendas las necesidades de los niños y niñas huérfanas por el sida es básico-

Anonymous from
Fri, February 1, 2013 at 08.41 pm

1- Access to Treatment is a priority . Issue of medicines patent rights should be tackled and access to essential medicines ( generics) should be granted.

2 - Prevention efforts have developed along past years, but we still see high incidents even in the most conservative communities. Directing our attention to structural factors affecting HIV transmission is a must and should go hand in hand with well targeted prevention programmes. Evidence show that awareness alone doesn't achieve significant behavior change.

3- HIV can no longer be a stand alone vertical programme. Integrating efforts addressing HIV in health systems strenghthening agenda is a must. The HIV response must be seen as a lantern guiding efforts to strenghthen health systems and grant universal access to health as a wholistic goal

Anonymous from
Fri, February 1, 2013 at 04.00 pm

1.Successful AIDS responses have involved comprehensive prevention, treatment, care and support, taking account of social determinants of health. HIV is an STI, with implications for many other sexual and reproductive health (SRH) problems, and HIV prevention and treatment must be closely linked to comprehensive SRH care. In general, health cannot be ensured without ensuring sexual and reproductive health and rights (SRHR).
2.The MDGs have shown that sensitive issues have not gone away by being marginalised. Opposition to SRHR has grown, and it is more crucial than ever to endorse all SRHR, including sexual rights (Beijing, 1995 Para. 96) and women’s right to safe abortion. Moreover, all health-related goals, including those addressing population dynamics, must respect, protect and fulfil human rights (Rio+20, Paras. 145/146).
3.Lessons learned from the MDG framework need more time to evolve into recommendations. MDG indicators and targets and imbalances in funding heavily influenced which issues were prioritised. Public health imperatives were sometimes ignored and successes distorted. Equity and health disparities were not addressed. These mistakes must not be repeated. Measurement requires a public health and human rights approach, which needs new thinking.
4.We are in broad agreement with the WHO discussion paper’s analysis on positioning health in the post-2015 agenda, and particularly that: “…promoting a long list of competing health goals will be counterproductive. The alternative is to build the case that health… is influenced by as well as contributing to policies across a wide range of sectors. The challenge then becomes one of deciding how “health” in this broad sense can be characterized…”.
5.We disagree that “universal health coverage”, as defined and outlined in WHO’s paper, is acceptable as the basis of a health goal for the future. Health services alone are not enough, and the financing issues are fraught with difficulty and must be confronted. We have shown in SRHR that the right to health, equity, access, reduction of disparities, and the external determinants are all undermined by private ownership of services, private financing and private control (RHM journal 2009-2012). It is crucial to address where financing should come from, who has responsibility for health systems, and public vs private ownership, control and provision of health care. We support strengthening of public health systems above all else.

Dossè SOSSOUGA from
Fri, February 1, 2013 at 04.57 pm

Vous savez, le racisme, la discrimination raciale, la xénophobie étant toujours là, nous ne pouvons pas parler de succès. La prévention du VIH ne doit pas négliger la migration des peuples.

Gorik Ooms from
Fri, February 1, 2013 at 11.29 am

And hello again,

I don’t know why this system keeps changing my name in Gery, but anyhow… There’s another suggestion I would like you to consider.

There is an agreement in principle, to create a Green Climate Fund that would raise and distribute $100 billion per year. http://www.environmentmagazine.org/Archives/Back%20Issues/2011/May-June%...

If this is a compensation by rich countries to poor countries, not only for the harm done by climate change, but also for the much lower carbon emissions by poorer countries, can we argue that this money should also be used for health? (We’re talking about a fund that should be 30 times bigger than the Global Fund to fight AIDS, Tuberculosis and Malaria.)

Or should we bring the Financial Transaction Tax to the MDG negotiation tables?
Gorik

Gorik Ooms from
Fri, February 1, 2013 at 11.16 am

Hi everyone,

For our final days of discussion, I would like more people to express their opinion about the process about defining the ‘new’ MDGs (keeping in mind that this discussion is part of that process).

I would like you to comment on three options that have been expressed here, and to express your position.

1. The process about defining the new MDGs is a threat to the global AIDS response. We will be forced to lower our demands and expectations, for example with regards to AIDS treatment regimens. Perhaps we should not participate, or perhaps we should make it very clear that we’re not accepting what seems to emerge from this process so far.

2. The process about defining the new MDGs is irrelevant to the global AIDS response. What really matters is activism, not what WHO or other UN institutes are preparing for us.

3. The process about defining the new MDGs is an opportunity for the global AIDS response. We can share our principles and working methods, and raise the bar for health in general.

What do you think?

Gorik

Anonymous from
Fri, February 1, 2013 at 03.14 pm

On question 2:
Will there be some sort of validation moment of the first phase of the process?

On question 3:
In my opinion the other health MDGs have more to gain from this process than HIV/AIDS. On condition the success factors of the past drive around HIV are adopted/built on (focus on effectiveness, concrete and measurable results, population impact, political drive and commitments) and not rejected or sidelined in favor of politically correct development jargon, where process, partnerships, technicalities and vague composite indicators prevail. Make it about practical and real change for people.
In that respect I definitely understand that UHC has a rather poor mobilisation power for many people...

Anonymous from
Fri, February 1, 2013 at 03.11 pm

On question 1 & 2:
It is tempting to consider this entire complex process as time consuming and distracting from the real priorities. Unfortunately we know this type of large scale consultations are often more a 'tick the box' exercise, to validate the inclusiveness of the process, not so much change the content of the output. This one seems particularly prone to fragmentation and lobbying from specific interest groups.
However, it is one opportunity among others to bring important priorities across. It is important though to make sure it doesn't stop here and that this formal process under tight direction/staging does not paralyse or block off other possibilities.

The main input in the current process should be about unfinished business under the current MDGs. Sufficient space and energy should be going to the same MDGs as pre-2015. The work is not done and this should remain high on the agenda post 2015. Progress made during the MDG period should be supported and maintained, not punished by shifting to other priorities.
And of course pushing back on 'conservative voices' in development circles is important; a return to pre-MDG thinking on development should be avoided.

Anonymous from
Thu, January 31, 2013 at 08.24 pm

Integration of maternal, sexual and reproductive health services with HIV prevention and treatment is an effective mechanism for addressing the AIDS epidemic. This requires ensuring that women have access to a "one-stop shop" for essential services, thus maximizing the impact of the valuable time and resources they spend seeking out these services. Also required is the assurance of stigma-free, quality, and affordable services.
--On behalf of Women Deliver

Anonymous from
Thu, January 31, 2013 at 05.19 pm

Possitive factors: a good program, alliance between actors, well funded an evaluated.

Anonymous from
Thu, January 31, 2013 at 10.58 am

Following on from the comments made by Barbara and Kingsley, amongst others, IDLO recently analysed how lessons from HIV and other health MDGs could contribute to health in the Post-2015 development agenda - both in terms of ensuring health remains intrinsic to the new development agenda and ensuring valuable lessons are utilised.

We considered that there was a valuable lesson in how the HIV sector has engaged a broad range of development partners. Framing HIV as a broad development challenge, rather than just a health issue, allowed the engagement of a broad range of multi-sectoral partners, including development agencies and civil society organizations. This approach, which included the creation of a joint UN program on HIV outside of WHO, has been hugely successful in engaging multiple stakeholders, raising funds, and coordinating global policy development on HIV. In the post-2015 context, such an approach to priority health issues will require States, WHO and UN and other international development agencies and civil society organizations to work together in new ways. WHO must become a facilitator and catalyst of a global response, welcoming other development partners, and not limit its role to technical guidance and support.

We thought another key lesson from HIV was that addressing discrimination is essential to achieving health goals. Discrimination in the healthcare settings has meant the denial of appropriate prevention, treatment and care services to people living with HIV and vulnerable groups. It also has resulted in practices such as the coercive sterilization of women with disabilities or women living with HIV. Such discrimination increases vulnerability to illness, through reduced economic opportunity or exposure to violence, and undermines public health goals. Appropriate legal frameworks that prohibit discrimination, and affordable and accessible quality legal services, are required. These frameworks must also consider the different impact of discrimination and proposed remedies on men and boys, and women and girls. The post-2015 development agenda on health should include also strengthen measures to address discrimination.

Our full analysis is at: http://www.idlo.int/english/WhatWeDo/Programs/Health/Pages/Details.aspx?...

Gorik Ooms from
Thu, January 31, 2013 at 07.57 am

Two tweets from Richard Horton (The Lancet) yesterday:
“Today, I spoke with someone close to the post-2015 development process. He reports that Universal Health Coverage has serious opposition.”
“He says UHC has limited-to-no political support from influential heads of state. They want something meaningful. Something the public gets.”
Would the public get ‘AIDS free generation’?

Howard Katzman from
Thu, January 31, 2013 at 03.31 pm

“He says UHC has limited-to-no political support from influential heads of state. They want something meaningful. Something the public gets.”

Huh? The public does not understand Universal Health Coverage? I wonder...

Mabel Bianco from
Wed, January 30, 2013 at 10.56 pm

Thanks to new comments . Of course to include HIV in the access to health is not to invisibilzle , by contrary is to reinforce and ensure in all cases is incorporate , so we need to be sure in the acess to health are specify all the issues we need as the universal access to ARV. About access to all people this is a great challenge because in many countries homophobia and criminalization of behaviours and sexual identiies unable persons to go to Health services. So we need to ensure this laws and norms are change because if not only through the health services we cann't ensure access to universal access for HIV. What kind of laws and norms you consider necessary to change and what do you know about success stories? Lets share someone

Dossè SOSSOUGA from
Fri, February 1, 2013 at 03.38 pm

Le VIH est un phénomène qui n'a pas de frontière. Tous les programme jusqu'alors ne tiennent pas compte des phénomènes migratoires. Nous au niveau de l'ONG: Amis des Etrangers au Togo, on y a pensé . Il s'agit du programme SIDA sans FRONTIERE. La lutte doit être générale avant de vaincre le phénomène

Anonymous from
Wed, January 30, 2013 at 07.01 pm

A minimum package of health care is definitely needed and its composition should be determined by its effectiveness, its beneficial impact on the health of people. Not on its cost or its affordability.


Affordability by who, anyway? Can we -as a world- not afford and make sure that ARV treatment is provided to those in need, now that this treatment has been proved not only highly cost-effective in saving lives, but also in reducing morbidity and transmission of the virus?
Why compromise and re-instate the old economic order in thinking about global health? How this might help us to progress, I fail to see.
This entire discussion on the post MDG seems to lead us further away from where we want to get to: an effective response to the real health needs of people and better health for more people. Is this really what this consultation is about: a way to make people accept that the MDG drive is now over and that we have to return to business as usual, lowering ambitions for change and accepting a deadly status quo? I hope not.

Anonymous from
Wed, January 30, 2013 at 07.00 pm

It comes as quite a shock to me that people in the conversation - including the moderators- suggest that there would be a need for compromises in the choice of ARV regimens in order to fit within the available national health budgets. This is not the beginning of the end, but in my opinion already quite some way down the sliding slope towards accepting second rate care as inevitable for people in poor communities. It might suggest people have very short memories what the situation was like before AIDS treatment was made available in low income countries. Those communities most affected by HIV had the least access to lifesaving treatment. It was exactly the fatal acceptance of the paradigma of so-called financial sustainability that turned a blind eye to those suffering most. If anything, the Millennium Development Goals and in particular the goals in the fight against HIV, are about international solidarity in the face of disease and ill health. This shift allowed to break through the vicious circle of local/national economics deciding on who would live or die.
Certainly today, in light of what we know has been achieved and can be further achieved in HIV treatment roll out through new strategies and tools, the idea that countries' economic situation would be sufficient argument to downgrade quality and provide ARV with much more secondary effects and less adherence is more disconcerting. It would not only be unjust, it is also very unclever, even shortsighted. We know that below standard treatment creates extra burden for patients, communities and health systems in the form of secondary effects, more need for expensive care, more loss-to-follow up, more resistance and need for more expensive drugs etc. I would argue low income countries cannot afford to use less effective ARV regimens.
In terms of the discussion on what world we want post 2015, we should not return to the old adagio of doing the best with what we have. We know this leads to pitting diseases and patients against each other and serving all of them short. That approach deals only with distributing the gaps, the lack of effective care, not with making sure we close the gaps. This approach proved very ineffective in making any progress in terms of health results, we have experienced that pre-2000.

Anonymous from
Wed, January 30, 2013 at 03.42 pm

An interesting conversation... About including access to HIV/AIDS treatment under a universal health access goal. I think the AIDS response should be bold and say yes, it should be included. Not because we want to detract from other priorities, but because these goals (such as the MDGs) are ideals and we must not short change ideals.
A universal health goal should include access to all essential medicines. This is especially important in the campaign for minority rights and for most affected populations. If we only prioritize health issues that affect the majority of the population we are saying that people of certain habits and identities don't deserve treatment - which is against the human rights norms of the AIDS response.
While I recognize that many countries/donors chose not to adequately invest in health and so don't have the resources to achieve universal access to all medications - we can only convenience them to invest more with ambitious. goals. So yes, ART should be included in a universal health goal, as should insulin for diabetes, malaria medications, rehydration salts, cancer treatments, etc.

Anonymous from
Wed, January 30, 2013 at 03.05 pm

http://www.worldwewant2015.org/node/282631

Here is the report from the global thematic consultation on addressing inequalities. This report highlights the need to include LGBTI into international development goals. As this community is often outside of legal, health and social systems they are not accessing the care, treatment and support they need while at the same time being most vulnerable. Not only should the LGBTI community be included in health development goals but the different needs between these groups needs to be considered to ensure they are each receiving the proper health services they need. Civil society organizations from the LGBTI and HIV communities have done amazing work in changing the attitudes in some countries today. One way to continue this progress in those countries who still discriminate against LGBTIs and those living with HIV is to involve religious leaders who can point out that including these groups in your community will not only make them less susceptible to new infections but can help us achieve our greater goal of ending AIDS.

Anonymous from
Fri, February 1, 2013 at 03.14 am

I want to reply only to your proposal to involve religious leaders, in those countries who still discriminate against LGBTIs and those living with HIV that, you claim, can help us to achieve our greater goal of ending AIDS. As an HIV+ gay man, I say that religious leaders are, at this point in our history, have been among the greatest enemies of ending AIDS in this generation.

Unfortunately, Islamic religious leaders continue to advocate the persecution of gay men and limit women's equality. Many Sub-Saharan countries, have come to be excessively influenced by American fundamentalist Christians ministers who are advocating for more, not less, legal punishment for gay persons. And until very recently, the Vatican actively opposed the use of condoms to prevent the spread of HIV.

While there are some exceptions, such as South Africa's Archbishop Tutu, I simply do not believe that most religious leaders buy into any kind of equity for women, gay men or other MSM or for all PLHIV.

If religious persons want to be involved with the process of determination the post-2015 development goals, they are free to do so as individuals. But we cannot let our discussions be hijacked by religious leaders as most have not demonstrated any leadership on the issue of human rights for women, for gay men and other MSM or for PLWHIV .

Anonymous from
Wed, January 30, 2013 at 02.54 pm

http://www.worldwewant2015.org/node/282631

I recently read the summary report from the global thematic consultation on addressing inequalities and noticed many cross-secting areas where LGBTI rights intersect with their rights to treatment, care and support. LGBTI need to be integrated into international development goals, including health and HIV goals. Not only should there not be discrimination in their ability to access health service but health care needs should address the specific needs of each of these groups. Cultures are changing which has been lead by the strong civil society organizations from the LGBTI and AIDS communities. Religious leaders should be further engaged to show that the LGBTI community needs to be included in the legal, health and social systems and that their inclusion will help us not only reduce possible transmissions of HIV but to achieve an AIDS free generation.

These are just my thoughts... what do you think?

Nicoli Nattrass from
Wed, January 30, 2013 at 02.08 pm

SUMMARY

Thanks to all who have contributed.

Since Gorik’s summary on 23 Jan, several commentators opened up the discussion by commenting on the importance of involving affected communities in the design and implementation of HIV prevention and treatment programs, and how such involvement can contribute to the promotion of universal health care. The conversation then broadened to consider how a universal health care agenda could build on, and take forward, the international AIDS agenda. The question was asked how we could ensure that antiretroviral treatment was part of a basic universal health care package and it was suggested that this might not be possible in countries where budgets were constrained and prioritising other health concerns could save more lives. People also mentioned the specific problems that HIV-positive migrants face, the need to remain aware of the broader socio-economic and structural drivers of HIV infection, and how understandings of health and illness are socially constructed. The potential to achieve efficiency gains by focusing on sexually transmitted infections and reproductive health services in a linked way was also mentioned – as was the importance of community involvement. As Nathan Geffen commented in his post from South Africa, unless we can sustain good activism at country level, UN/WHO policy statements about universal health care will have no real meaning.

Anonymous from
Wed, January 30, 2013 at 01.59 am

There really needs to be more invested into linking and integrating HIV and sexual and reproductive health (SRH) services. When services are fully integrated they are better able to meet a wide range of needs. It is time to move away from the vertical focus on disease and instead spread resources across the health system to ensure optimal prevention, treatment and management of diseases.
If a young woman living in poverty finally manages to scrape together enough money for a bus fare to visit a health clinic because she has recently had unprotected sex and is worried she is pregnant, it is preferential that the clinic she visits is not only capable of offering a pregnancy test but can also provide VCCT and information about living with HIV should she be positive. If she were to be referred elsewhere for this service she may not go if she does not have the money for transport, if it is too far, or if she has responsibilities at home she needs to tend to. An important opportunity would have been missed of being able to inform this young woman about HIV; treatment options if she is positive or methods of prevention in the future is she is not. What is she is pregnant but does not receive information about mother-to-child transmission of HIV?
The international development community needs to recognise the importance of investing in sexual and reproductive health and rights overall. Recognise that HIV is a sexual and reproductive health issue and that advancing sexual and reproductive health and rights will have a significant impact on reducing new infections of HIV.

Mabel Bianco from
Wed, January 30, 2013 at 12.44 pm

Nielsen gracias por tu aporte. Es cierto que necesitamos integrar la respuesta de los servicios de salud sexual y reproductiva con el VIH, es cierto que los programas verticales no son eficientes o sea son mas costosos porque duplican personal y recursos y ademas tienen menor impactoen terminos de salud , no solo son menos efectivos en terminos costo efectividad sino que tambien son un inconveniente para las personas que consulta. El ejemplo de la mujer embarazada que consigue pagar el pasaje opara consurrir al centro de salud u hospital y la mandan de un consultorio al otro es muy calro. Pero como mantenemos / aseguramos que se ateinden las necesidades especificas como el Tratamiento ARV ?? el dilema es como integramos sin perder el objetivo de acceso universal a tratamiento en VIH?? esperamos comentarios y aportes

Anonymous from
Mon, January 28, 2013 at 06.15 pm

Barbara talked about early wisdom of civil society leaders! Ideally, the self-coordinating and self-regulating nature of the civil society continue to make invaluable contribution to the AIDS response. It's one form of allowing mutually reciprocative and natural social cohesiveness, accountability and responsibility to communal welfare. Lay communities across social divides develop and self-regulate naturally without much ado. They spend much time on action than on processes, and/or lip service. They are always concerned about outcome and impact, than mere deliverables like comprehensive reports, and capacity building workshops. They are mobilised towards issues and what each one can contribute, regardless of who they are. Widows have acted, grandparents have done the same, young people make their contribution, to mention but a few. There are issues and needs for each of these groups in the response upon which they mobilised themselves. Several of such lessons are important to the health agenda.

Anonymous from
Mon, January 28, 2013 at 09.47 am

It's complex: On the one hand healthy life-expectancy as the key measure is consistent with implementing big interventions that work (e.g. ARVs, TB treatment, probably sewage and water systems etc), which is great. On the other, this is probably going to result in long-delayed discussions at country level that further delay action, with vested interests of not-nice people possibly dominating. Also, don't over-estimate ease of measuring life-expectancy.

Whatever the UN/WHO decides though, is secondary to there being good quality activists in poor countries who campaign for interventions that will make a difference. Without that the fundamental changes to health-care systems and delivery of good thinks like ARVs, malaria treatment, clean water etc are much harder to achieve. If we can sustain good activism, then the UN/WHO grand policy statements can have real meaning.

Gorik Ooms from
Mon, January 28, 2013 at 07.40 pm

Thanks, Nathan. When you write "whatever the UN/WHO decides though, is secondary to there being good quality activists", do you mean that the present MDG on AIDS, TB and Malaria didn't make any difference? And that, therefore, whatever comes after the MDGs won't be that important?

Well, I certainly get the impression that a lot of energy is being used on discussing the new MDGs, but also had the impression that the 'old' ones had been quite useful.

What do others think?

Gorik Ooms from
Sun, January 27, 2013 at 08.54 pm

Hi everyone,

Thanks for your participation, active or passive. (We will consider all 700 viewers who did not leave a comment as people who agree with everything that has been discussed so far. :-))

As far as I can tell, nobody objects to the idea that the goal of universal health coverage could include and encompass the goals of the global fight against AIDS. Howard provides an illustration of how universal health coverage could help to reduce the number of people needing AIDS treatment, via better control of sexually transmitted infections.

So we seem to know what we want: universal health coverage, including and encompassing the older target of “universal access to treatment for HIV/AIDS for all those who need it”. (See: http://www.un.org/millenniumgoals/aids.shtml). And universal health coverage as we want it should adopt some features of the global fight against AIDS: rooted in human rights, giving affected people and communities a decisive voice, and so on.

But how do get what we want? Universal access to treatment for HIV/AIDS was promised by 2010, and we’re not there yet in 2013, and we won’t be there in 2015. The commitment of the international community seems to be evaporating under the sunrays of the global financial crisis.

Should we advocate for an AIDS-free generation by 2030, as one of the next Millennium Development Goals? Several countries already made a commitment to aiming for an AIDS-free generation, so why not include it in the next Millennium Development Goals? It would not be contradictory to universal health coverage (unless some people have a concept of universal health coverage in mind that does not include universal access to AIDS treatment).

Another idea: should we link the Sustainable Development Goals and the next Millennium Development Goals, into a single global social contract or compact? The wealthier countries of this world seem very keen on obtaining binding commitments from poorer countries on environmental goals – like reducing carbon emissions. But the wealthier countries seem very reluctant to accept binding commitments for the social goals – like ensuring essential health care and education to all humans. Would it help if we proposed to link these issues: no mutual commitments on carbon emissions without mutual commitments on efforts to uphold human dignity?

Take care,

Gorik

Anonymous from
Mon, January 28, 2013 at 06.49 pm

Dear Gery,
I've a very strong feeling that a more inclusive approach is adopted than getting stuck in the traditional pathogenic ideology to health. This is the time for inductive positivism, epidemiological and other approaches to know. Denying the role of socially constructed practices doesn't take away the fact that they are practiced. I saw a doctor that suffered from AIDS but believed that it was witchcraft. We've seen professionals of all categories subscribing to superstitious practices. We've seen practitioners that don't value the contribution of beneficiaries. It's not about instruction and compliance. We should seek informed adherence through constructive engagement.

Anonymous from
Sun, January 27, 2013 at 10.39 am

HIV/AIDS, HEALTH and Development:
Simple approach to tackle these factors:
1- Affected individuals / communities should be involve and participate in HIV awareness campaign, shearing true life experience.
2- Funding for HIV awareness and treatment should not be reserved alone to Government to handle. For a result based financing, funding can be made available directly to NGOs from the donor agencies in line with a monitoring system to achieve targeted result.
3- Health issues should not only be left to Medical Doctors alone. The resultant effect is the people visit the hospital when the case is too late to handle by doctors. There should be a involvement of NGO to take health lecture, campaign and awareness, providing preventives measures to people at the grassroots level to promote health and longevity. This is what our Ngo (www.basichealthfoundation.org) have embarked for over a time now.
4- In health development: Health clubs should be established in School. A Forum where young people gather occasionally to discuss issues concerning total health, nutrition, hygiene, HIV/AIDS, First aid measures and other related health issues.
5- In health development and HIV/AIDs, there should be a global input and intervention strategy to carry every one along and possible a global agenda to enable developing countries to participate and measure up.

Howard Katzman from
Fri, January 25, 2013 at 06.07 pm

The WHO proposal to base the post-2015 development goals on health is interesting. The MDGs were based upon economic development, which is a limited framework to describe the human condition. Many issues, AIDS being a significant one, become a force fit.

Structural violence - poverty and unjust socio-political and economic institutions, etc. - becomes reflected in life expectancy (Galtung 1969). Reflecting on life expectancy, not just on medical issues but health issues, becomes an interesting measure on the development of the human condition.

With regard to Gorik's fear that AIDS treatment might become neglected because of cost, I would like to propose a different approach to AIDS prevention. Some of the overlooked risk factors for the spread of HIV is "a sexually transmitted infection, such as syphilis, genital herpes, chlamydia, gonorrhea, bacterial vaginosis, or trichomoniasis" (NIAID "HIV Risk Factors"). Various studies have shown that certain STIs increase the possibility of becoming infected with HIV (Cameron 1989, Iatif 1989, Gray 2001, Kapiga 2002). These factors may explain the selectivity of how HIV spreads in specific populations.

This would lead to a focus on diagnosing and controlling STIs, a less expensive goal. Combine this with gender issues that limit women's opportunities forcing them to become sex workers to survive and feed their children, along with economic structures that force men to abandon their families for much of the year in pursuit of work. Each of these factors reflect the ways in which society is structured.

Instead of blaming the victims for being irresponsible and having unsafe sex, we could instead blame societies for neglecting primary healthcare, preventing opportunities for women and allowing economies that force the breakup of families. This shows the relationship between health of the individual and the health of the society and the prevention of the spread of HIV.

Anonymous from
Fri, January 25, 2013 at 08.21 am

A rights-based approach to addressing migration-related HIV dynamics in the post-2015 development agenda
Social, economic and political factors in countries of origin, transit and destination influence the risk of HIV infection of migrants. These factors include separation from spouses, families, social and cultural norms, and being exposed to substandard living and exploitative working conditions which can contribute to stress and isolation, and may increase unsafe sexual behaviour and practices, such as multiple concurrent sexual partners without the use of condoms.
The risk of HIV infection is increased by various barriers that migrants face to accessing HIV prevention, care, support and treatment due to the marginalization that stems from migration status and language barriers, amongst others. Some countries exclude migrants from entry or stay based on their HIV status, or target migrants with discriminatory HIV policies, especially in countries with high level of anti-migrant sentiments fuelled by economic downturns. This not only violates international law, but further aggravates social exclusion of migrants, discourages migrants from seeking care, delays early diagnosis and treatment and impedes the achievement of global health and development goals.
Many migrants living with HIV are confronted with a double stigma of being a migrant and infected with HIV. Migrants frequently do not know their HIV status and tend to get diagnosed with the virus at a much later stage than the general population as a result of their marginalization and precarious migration status. The post-2015 development framework needs a rights-based approach to HIV, including indicators that measure the health needs of migrants and their access to specific HIV services. States need to ensure universal access to HIV prevention, treatment, care and support, as outlined in the 2008 World Health Assembly Resolution on the Health of Migrants and in the Political Declaration on HIV and AIDS (2011), in which the member states of the United Nations General Assembly committed inter alia “to address, according to national legislation, the vulnerabilities to HIV experienced by migrant and mobile populations and support their access to HIV prevention, treatment, care and support” (para. 84).
For further information: mhddpt@iom.int and cschultz@iom.int.

Anonymous from
Mon, January 28, 2013 at 03.29 pm

La migration et les problèmes de santé est un grand défit à relever. L'ONG ADET a prévu un projet dénommé SOS- Santé Etrangers au Togo .

Nicoli Nattrass from
Thu, January 24, 2013 at 08.32 pm

In his latest post Gorik raises the issue of Universal Health Coverage. He asks whether antiretroviral treatment should be part of the basic package of care, even in cases where prioritising other diseases is more cost-effective.

This is an important question given our topic: AIDS, health and development. We know that giving people access to antiretroviral treatment is developmental and helps fight the HIV epidemic. But it may nevertheless be the case (especially in poor countries with low HIV prevalence rates) that putting the money into other diseases is even more developmental, and could save even more lives. What then?

One option is to mobilise around the issue and insist that AIDS treatment is prioritised. But this runs the danger of losing the moral high ground as we look like we are selfishly taking resources away from less organised (and probably poorer) people.

Another option is to work with other constituencies to ensure that the health care system is adequately resourced – for all diseases, including HIV – and to advocate for higher taxation if necessary. But this is unlikely to be achieved in the short-term. We thus might have to compromise in order to retain credibility and support from other constituencies, for example, by accepting cheaper, albeit less efficient ARV regimens.

This would be a retreat, for sure. But it may be the kind of strategic retreat necessary to build domestic alliances – even as we continue to pressure the donor countries to allocate more resources to low-income countries for AIDS treatment.

Responses?

Gorik Ooms from
Thu, January 24, 2013 at 06.52 pm

So, the WHO paper on Universal Health Coverage mentions that universal health coverage “is not about a fixed minimum package, it is about making progress on several fronts”. How do we avoid that in some countries, governments decide that AIDS treatment is not a priority, because it is not ‘efficient’ – too expensive per life year saved – or because other diseases are more prevalent? How do we make sure that AIDS treatment is in the minimum package, if there is no minimum package? How do we make sure that “making progress on several fronts” does not result in regress on the AIDS front to finance progress on another health front?

Mabel Bianco from
Thu, January 24, 2013 at 01.02 pm

How to transfer the HIV experience to the Global Health ? This is a question we need to address and specially we need to elaborate alliances with other groups? Which ones you have any experience? lets us know.

Anonymous from
Sat, January 26, 2013 at 07.32 am

now start to zero

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