In the generalised epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterised in the majority of countries. A cross-sectional anonymous probe of 537 men recruited with non-probability sampling among men who reported ever having had sex with another man in Malawi, Namibia, and Botswana using a structured survey instrument and HIV screening with the OraQuick© rapid test kit. The HIV prevalence among those between the ages of 18 and 23 was 8.3%; 20% among those 24–29; and 35.7% among those older than 30 for an overall prevalence of 17.4%. In multivariate logistic regressions, being older than 25 and not always wearing condoms during sex were significantly associated with being HIV-positive. Human rights abuses were prevalent, with 42.1% reporting at least one abuse. Concurrency of sexual partnerships with partners of both genders may play important roles in HIV spread in these populations. Further epidemiologic and evaluative research is needed.
Values, Policies and Rights
The cultures of indigenous peoples have frequently been ignored when global standards on intellectual property have been set, says a new United Nations report, The State of the World's Indigenous People. It notes that global intellectual property (IP) standards are mainly based on Western legal and economic principles that emphasise private ownership of knowledge and resources. Such principles, it says, 'stand in stark contrast to indigenous worldviews, whereby knowledge is created and owned collectively and the responsibility for the use and transfer of the knowledge is guided by traditional laws and customs.' As a result, IP rules leave 'most indigenous traditional knowledge and folklore vulnerable to appropriation, privatisation, monopolisation and even biopiracy by outsiders,' the report says. Some indigenous peoples believe, the report says, that the World Intellectual Property Organization is 'not an appropriate forum to set standards because it is limited by its mandate to promoting intellectual property rights as the only viable path to protecting traditional knowledge'.
Over the past two decades, legislative and regulatory frameworks have been developed that address links between the environment and health. However, the extent to which these instruments have been streamlined within existing national legislation has not been formally documented and, according to this paper, these instruments are not currently deployed or adequately equipped, notably in Africa. It reveals weaknesses in the international and national regulatory mechanisms and their implementation, and brings to light institutional and operational deficiencies and a dramatic lack of capacity to manage hazardous wastes in an environmentally sound manner. It points to the need for an integrated institutional framework addressing human health and the environment. The Revised International Health Regulations (2005), now being implemented in all African countries, should provide a more cohesive approach to health and environment risk management. Despite the many efforts undertaken by African countries, the level of awareness and understanding of these environmental agreements among country-level policy makers remains limited.
The Kenyan government has created the first ever tribunal to handle legal issues relating to HIV, including discrimination against people living with HIV and protecting the confidentiality of medical records. The new tribunal, under the office of the Attorney General, has the status of a subordinate court, with the right to summon witnesses and take evidence. It will handle issues relating to the transmission of HIV, confidentiality, testing, access to healthcare services, discriminatory acts and policies, and HIV-related research. Networks of people living with HIV have welcomed the formation of the new court. 'Setting up the tribunal is the clearest indication by the government that it is ready to entrench the rights of people living with HIV,' said Nelson Otuoma, chairperson of the Network Empowerment of People Living with AIDS. 'It is, however, important to let people know that the tribunal exists and further educate them on the roles and mandates of it.' Those living with HIV hope the tribunal will be an effective tool in ending discrimination, and groups like Otuoma's are already compiling lists of grievances to present to it.
Confidential documents related to the World Health Organization (WHO) Expert Working Group on Innovative Financing for Research and Development have been leaked to the public, apparently revealing improper participation by the pharmaceutical industry in preparing WHO policy. The documents appear to have come from the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), and include draft reports on innovative financing mechanisms from the working group as well as an analysis by the IFPMA on the reports’ contents. 'IFPMA was not supposed to have working drafts of the expert working group in their possession and they were not given these documents,' said Precious Matsoso, director of Public Health Innovation and Intellectual Property (PHI) at WHO, under whose auspices the expert working group falls. 'It was understood by the working group that its report is intended for the director general and WHO members [only],' she added. Public health advocates reacted strongly to the leaked documents, raising issues of public accountability and transparency in policymaking.
In this letter to Kenya's minister for public health, Human Rights Watch (HRW) has called on the Kenyan government to ensure that human rights are protected during the country's national door-to-door voluntary HIV testing and counselling drive. 'We... urge the inclusion of a strong human rights component into this ambitious testing programme. In particular, we are calling for clear attention to principles of counselling, consent and confidentiality,' it said. HRW noted that large-scale home-based testing would likely result in better access to testing and treatment and give a chance to those who could not afford the transport costs to health facilities or lacked information or the willingness to seek a test. But testing also reached into the family, where many abuses occurred, posing challenges for human rights protection, it added. 'Our research on access to testing and treatment in Kenya has shown that HIV-positive mothers and HIV-positive children frequently suffer stigma and abuse when their status becomes known,' the letter said. 'HIV-positive mothers – among them girls under the age of 18 – sometimes suffer violence, mistreatment, disinheritance and discrimination from their husbands, families-in-law or their own families.'
This paper discusses a number of important policy frameworks for addressing health and environmental challenges, such as the 1992 United Nations Conference on Environment and Development in Rio de Janeiro (also known as the Earth Summit), the Millennium Development Goals (Goals 4, 5 and 6), the Johannesburg Plan of Implementation for the World Summit on Sustainable Development, the Strategic Approach to International Chemicals Management (SAICM) and the New Partnership for Africa’s Development (NEPAD)’s Human Resources Development Initiative, which urges the integration of health and environment policies. In many African countries, national health-sector policies have been developed separate from those on environment. Planning and service delivery also takes place without deliberate integration. For more effective responses to the health and environment challenges facing the continent, this paper urges governments in Africa to mainstream health and environment into national development agendas, and develop the human capacity for assessment, regular monitoring and evaluation of the process.
Twenty-four ex-miners are seeking compensation from Anglo-American after contracting silicosis, an incurable and fatal lung disease. In court papers, the 24 men allege that they contracted silicosis while in the employ of Anglo-American South Africa Ltd. The case is the first of its kind in South Africa. One of Britain’s leading personal injury and human rights law firms, Leigh Day & Co, is consulting for the Legal Resources Centre (LRC), which is representing the plaintiffs. ‘The litigation has two objectives. First, to compensate miners who contracted silicosis on the gold mines, and secondly, to deal with the problem of ex-miners whose health continues to be at risk of bouts of Tuberculosis,’ said Richard Meeran, a lawyer from Leigh Day & Co.
AIDS researchers, scientists and activists have welcomed the changes to South Africa's HIV and AIDS treatment policy, announced by President Jacob Zuma on World AIDS Day. The changes will mean antiretroviral (ARV) treatment can begin earlier for certain vulnerable groups, but stop short of raising the treatment threshold for all HIV-positive patients, as recommended by the World Health Organisation (WHO). Zuma said that from April 2010, all HIV-positive children under the age of one would be eligible for treatment, regardless of their CD4 count. Pregnant women living with HIV, and patients co-infected with tuberculosis (TB), will qualify for ARVs if their CD4 count falls to 350 or less. Pregnant HIV-positive women with higher CD4 counts will be given treatment from the 14th week of pregnancy to prevent mother-to-child transmission. Currently, treatment is only given in the final trimester. Zuma also committed the government to ensuring that all health facilities in the country are equipped to offer HIV counselling, testing and treatment. At present only health facilities accredited as ARV sites by the health department can administer ARVs, which has created bottlenecks and long waiting lists at some hospitals.
This report aims to show that the humanitarian challenge of the twenty-first century demands a step-change in the quantity of resources devoted to saving lives in emergencies and in the quality and nature of humanitarian response. The report recommends that governments, external funders, the United Nations and humanitarian agencies must ensure that humanitarian needs are properly assessed, and that aid is implemented impartially, while donor governments must increase the volume of humanitarian assistance. Governments, international humanitarian agencies and local civil society must recognise the limitations of providing relief and address the underlying causes of human vulnerability. International humanitarian agencies must work much more consistently to build states' capacity to discharge their responsibilities towards their citizens as well as citizens' capacity to demand that their rights are respected. Governments, acting both bilaterally and through multilateral organisations, also have a clear duty to support other states to realise the right to life and security through exerting diplomatic pressure, as well as by offering financial aid and technical assistance.