Kenyan human rights activists have filed an appeal for the release of two men imprisoned for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August 2010, the two men have been held in police remand in Kapsabet for ‘posing a risk to the health of the wider community’. Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. According to Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya, the two men have not been isolated, posing a health risk to other inmates. He warned that the arrests could act as a deterrent to patients needing treatment. ‘This is a negative consequence of the government's action’, he added, denouncing criminalisation of the disease. ‘Counselling of those on treatment will have better outcomes,’ he noted.
Values, Policies and Rights
The Botswana government has passed an amendment to its Employment Act that will bring an end to dismissal based on an individual's sexual orientation or HIV status, but rights groups believe the legislation needs to go further. Civil society organizations in Botswana welcomed the move but said legislation to protect the rights of people living with HIV in the workplace was necessary. The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) noted that ‘tolerance and acceptance of sexual minorities will ensure universal access to prevention, treatment, care and support - crucial for Botswana to achieve its ... goal of zero new HIV infections by 2016’. Gadzani Mhotsha, Secretary General of the Botswana Federation of Trade Unions (BFTU) warned that the legislation was not comprehensive enough in dealing with the serious issues of HIV at the workplace and called for comprehensive legislation, not piecemeal amendments. BONELA also added that a specific HIV Employment Act should be passed that attends to matters of reasonable accommodation for those who are HIV-positive, ensuring they have a safe and supportive environment to access treatment, care and support. Civil society has also called on the government to enact laws prohibiting private sector employers from testing potential employees for HIV and subsequently disqualifying them on the basis of an HIV-positive status.
The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data, according to this paper. The paper drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. It concludes that guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. It was unclear if the overall decrease in gunshot homicides applies to women in relationships. In view of the general role guns play in violence against women, the paper urges the government to keep gun control high on the legislative agenda.
Christiana Figueres, newly appointed executive secretary of the United Nations (UN) Framework Convention on Climate Change (UNFCCC), has voiced the UN’s position on the state of climate change negotiations and said that there is a constructive atmosphere and a growing sense of urgency among governments about climate change mitigation. At Cancun, Mexico, where the sixteenth Conference of the Parties will be held from 29 November–10 December 2010, governments need to go from the politically possible to the politically irreversible, she said. During the last meeting in Bonn, Germany, in June 2010, Figueres said that countries decided that the ‘text before them is now a negotiation text,’ and a ‘party text,’ which shows serious commitment, she said. In addition, comments were heard from ‘very important countries’ that their confidence and trust in the negotiation process was restored, which was not the case at the end of the 2009 conference at Copenhagen. Figueres said that she was expecting governments attending the Cancun meeting to make decisions on the relevant financing mechanism and technology for fighting global climate change, on how to push forward reduction of emissions from deforestation, on adaptation, and on monitoring, she said. At Cancun, four or five decisions could be taken to establish the operational entities that would be the basis for the next chapter of the climate regime.
According to this study, there have been few studies on domestic violence and women in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. The study examined the association between physical intimate partner violence and physical health outcomes and behaviours among South African women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the study assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1,229 married and cohabiting women. It found the prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance. The study recommends that public health programmes in South Africa should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health behaviours is needed to inform the design of such programming.
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma, according to this article. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximise their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, the article argues that opt-out testing may be an effective and ethically acceptable policy response to Africa’s HIV epidemic.
In preparation for the Millennium Development Goal (MDG) Summit, held from 20-22 September 2010, in New York, Women in Development Europe (WIDE) launched the new campaign ‘Mobilising for Gender Justice Beyond the MDGs’ to advance gender and social justice for all. WIDE’s view on the MDGs framework is that it offers too narrow and minimalist a focus for measuring development or the advancement of gender equality and women´s rights. WIDE considers that the MDGs’ shortcoming is that the indicators exclude the structural nature of poverty as well as the structural nature of gender inequality. WIDE is inviting participation in the ‘Gender Justice Beyond the MDG Campaign’ to share analysis, opinions, activities and proposals, news, processes, expectations and outcomes of the summit.
The African Union (AU) Summit in Kampala August 2010 adopted an action plan for the improvement of maternal, infant and child health and development and made a commitment to spending 15% of national budgets in an effort to reach the Millennium Development Goals in this area. An AU task force will track progress to ensure implementation. On the partnership for the eradication of mother-child transmission of HIV (PMTCT), the Assembly invited all Member States to intensify efforts relating to antiretroviral treatment and PMTCT and to extend such efforts to primary health centres. The Assembly underscored the need for programmes for the total eradication of PMTCT and called for all African actors concerned to act immediately to make eradication a realisable outcome. An initiative on agriculture and food security was also launched. Economic growth, job creation and investment are the preferred focus for the Africa-Europe Summit in November and the next AU Summit in 2011 will focus on the Pan-African Governance Architecture.
The Kenyan government is drafting new regulations to stop fraudulent herbalists claiming to be able to treat diseases, including HIV, from practising. Anybody found selling untested herbal products will face legal action for ‘endangering people's lives,’ said Jayesh Pandit, head of pharmacovigilance at the Pharmacy and Poisons Board. The Pharmacy and Poisons Board has registered 300 legitimate herbalists, but thousands more are practising outside the law, often selling useless or even harmful products to desperate patients. According to the World Health Organization, up to 80% of Africans use traditional medicine. The government is planning to introduce a ‘Traditional Medicines Practitioners Bill’, which will regulate the use of herbal medicines and define the punishment to be handed down to herbalists practising illegally.
In his address to the Eighteenth International AIDS Conference in Vienna, Mark Heywood of the Treatment Action Campaign (TAC) has warned that South Africa’s campaign to test 15 million people for HIV in one year risks being implemented in a way that undermines people’s human rights. Incidents of coercive testing have been recorded but the lack of effective monitoring procedures means that it’s impossible to know whether those incidents are widespread or not. The testing campaign is a means to an end, and not of value in itself, he said. Unless the campaign delivers on its promise to link newly diagnosed people into treatment services, then the means to achieve this end will be unjustifiable. He noted human rights concerns about a lack of monitoring of ‘adverse events’, such as whether a person who is diagnosed with HIV then suffers discrimination, suffers violence or gains access to treatment. Incidents of refusing HIV-positive patients access to health services have been recorded by the TAC in South Africa. Heywood said it was unclear whether such incidents were rare or widespread, but that any violations of basic principles should be taken seriously.