Caída en fondos para el VIH deja a 1.2 millones de personas vulnerables

Falling HIV Funds Leaves 1.2 Million Vulnerable

Daily Trust, Nigeria

22/09/2014

By Judd-Leonard Okafor

Continued shortfall in donor funding for HIV/AIDS programme could leave as many as 1.2 million people affected by HIV/AIDS vulnerable as domestic funding from the Nigerian government continues to dwindle.

The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) complained on Monday at the 31st International Candlelight Memorial for HIV/AIDS: “Domestic funding is dwindling and donors that are supporting us are withdrawing.”

Experts estimate up to 80% of HIV/AIDS spending in Nigeria is paid for by donor funding.

“What that means is our government must wake up to their own responsibilities, to place people on treatment,” said Edward Ogenyi, national coordinator of the network.

The President Comprehensive Response Plan unveiled by the Jonathan administration last year sought to bridge gaps in access to HIV/AIDS, including ensuring up to 80 million people know their HIV status. PCRP also plans to enroll some 600,000 on anti-retroviral therapy, which would also be provided to prevent mother-to-child transmission of the virus in at least 244,000 pregnant women.

The plan proposed prevention services for 500,000 most-at-risk population and to activate 2000 new delivery points each for anti-retroviral therapy and prevention of mother-t0-child transmission of HIV.

NEPWHAN said none of the targets to the PCRP had been achieved nearly a year after the plan came into effect.

More than 3 million people living with the virus in Nigeria, and many don’t know their status, and 1.2 million others urgently need treatment, said the network.

The PCRP could bring in up to N262.7 billion in domestic contribution to the national response, but another N198.5 billion is expected in external donor finance to meet total N461.2 billion required for full coverage of anti-HIV programme in the country.

But advocates claim only N8b–a 5.7% shortfall–was appropriated in the first year of PCRP under the subsidy reinvestment programme (SURE-P).

NEPWHAN urged the presidency to “authorize complete release of N8b appropriated for HIV/AIDS under the SURE-P to reduce new AIDS-related deaths in the country” as well as sign the anti-discrimination bill to make “conducive environment for HIV/AIDS response in Nigeria.”

El futuro que queremos

The future we want

Devex News

19/09/2014

#MDGMomentum

By Nana Taona Kuo

We have made great strides on the increased survival and health of women and children since the Millennium Development Goals were launched in 2000.

Thanks to the Global Strategy for Women’s and Children’s Health, the subsequent Every Woman Every Child movement and the work of the many partners around the world, the progress that has been made for women and children has been the success story of the MDGs.

Four years on, more than 300 stakeholders, including 70 governments, have made commitments to advance that strategy. Every Woman Every Child has proven to be a dynamic and innovative multistakeholder partnership that is delivering results.

We are reducing deaths of children under 5 faster than at any time in the past two decades. Each day, 17,000 more children survive, and deaths of mothers have been cut by almost half since 1990.

This is unprecedented progress, but there are still millions of women and children dying every day from treatable and preventable diseases. Now is not the time to take our foot off of the gas. We have the tools and know-how to achieve the health MDGs, and together, we have the opportunity to save 158,000 women and 2.3 million children by the 2015 deadline, laying the groundwork to end preventable maternal and child deaths within a generation.

This vision for achieving the MDGs and beyond is possible with innovative financing and increased political commitment, and accountability for resources and results strongly at the core.

To reach our goals in 2015 and end all preventable maternal and child deaths in a generation, we must also prioritize the primary causes of mortality. For instance, half of maternal and newborn deaths occur during labor or on the day a baby is born. It will only take $1.15 per person to save 3 million women and babies by 2025.

By investing in quality care at the time of birth, the Every Newborn Action Plan outlines how smart integration will maximize our ongoing efforts. Another common plan is around expanding access to affordable, quality commodities. With increased availability and use, the 13 lifesaving commodities identified by the U.N. Commission on Lifesaving Commodities could save 6 million women, newborns and children over five years.

Another key to advancement is meaningful partnership with other development sectors, like water and sanitation, education, women’s empowerment, nutrition, and climate change. Investing in women’s and children’s health positively benefits other development goals and coordination with other sectors must continue to be a tenet of our work — especially in humanitarian settings.

Finally, the strength of Every Woman Every Child has been its partnership across government, including South-South collaboration, civil society, U.N. agencies and the private sector.

Every Woman Every Child, with its strong accountability mechanism and focus on innovation, including financing, is a pathfinder for the next development agenda. U.N. Secretary-General Ban Ki-moon continues to make women’s and children’s health one of his top priorities, both because of its moral validity, but also because it is a smart investment.

Together we will achieve our vision of ending preventable maternal and child deaths, making this world more equitable and secure for future generations.

Nana Taona Kuo

Nana Taona Kuo is senior manager of Every Woman Every Child, a U.N. global campaign that hopes to save the lives of 16 million women and children by 2015 by engaging governments, multilaterals, the private sector and civil society to address major health challenges facing women and children around the world. Kuo previously worked for UNAIDS.

La población mundial llegará a 11 billones en el 2100 – con un 70% de probabilidad que siga creciendo

World population to hit 11bn in 2100 – with 70% chance of continuous rise

The Guardian, UK

18/09/2014

Damian Carrington

The world’s population is now odds-on to swell ever-higher for the rest of the century, posing grave challenges for food supplies, healthcare and social cohesion. A ground-breaking analysis released on Thursday shows there is a 70% chance that the number of people on the planet will rise continuously from 7bn today to 11bn in 2100.

The work overturns 20 years of consensus that global population , and the stresses it brings, will peak by 2050 at about 9bn people. “The previous projections said this problem was going to go away so it took the focus off the population issue,” said Prof Adrian Raftery, at the University of Washington, who led the international research team. “There is now a strong argument that population should return to the top of the international agenda. Population is the driver of just about everything else and rapid population growth can exacerbate all kinds of challenges.” Lack of healthcare, poverty, pollution and rising unrest and crime are all problems linked to booming populations, he said.

“Population policy has been abandoned in recent decades. It is barely mentioned in discussions on sustainability or development such as the UN-led sustainable development goals,” said Simon Ross, chief executive of Population Matters , a thinktank supported by naturalist Sir David Attenborough and scientist James Lovelock. “The significance of the new work is that it provides greater certainty. Specifically, it is highly likely that, given current policies, the world population will be between 40-75% larger than today in the lifetime of many of today’s children and will still be growing at that point,” Ross said.

Many widely-accepted analyses of global problems, such as the Intergovernmental Panel on Climate Change’s assessment of global warming, assume a population peak by 2050.

Sub-saharan Africa is set to be by far the fastest growing region, with population rocketing from 1bn today to between 3.5bn and 5bn in 2100. Previously, the fall in fertility rates that began in the 1980s in many African countries was expected to continue but the most recent data shows this has not happened. In countries like Nigeria, the continent’s most populous nation, the decline has stalled completely with the average woman bearing six children. Nigeria’s population is expected to soar from 200m today to 900m by 2100.

The cause of the stalled fertility rate is two-fold, said Raftery: a failure to meet the need for contraception and a continued preference for large families. “The unmet need for contraception – at 25% of women – has not changed in for 20 years,” he said. The preference for large families is linked to lack of female education  which limits women’s life choices, said Raftery. In Nigeria, 28% of girls still do not complete primary education.

Another key factor included for the first time was new data on the HIV/AIDS epidemic showing it is not claiming as many lives as once anticipated. “Twenty years ago the impact on population was absolutely gigantic,” Raftery said. “Now the accessibility of antiretroviral drugs is much greater and the epidemic appeared to have passed its peak and was not quite as bad as was feared.”

The research, conducted by an international team including UN experts, is published in the journal Science  and for the first time uses advanced statistics to place convincing upper and lower limits on future population growth. Previous estimates were based on judgments of future trends made by researchers, a “somewhat vague and subjective” approach, said Raftery. This predicted the world’s population would range somewhere between 7bn and 16bn by 2100. “This interval was so huge to be essentially meaningless and therefore it was ignored,” he said.

But the new research narrows the future range to between 9.6bn and 12.3bn by 2100. This greatly increased certainty – 80% – allowed the researchers to be confident that global population would not peak any time during in the 21st century.

Another population concern is the ageing populations currently seen in Europe and Japan, which raises questions about how working populations will support large numbers of elderly people. But the new research shows the same issue will affect countries whose populations are very young today. Brazil, for example, currently has 8.6 people of working age for every person over 65, but that will fall to 1.5 by 2100, well below the current level in Japan. China and India will face the same issue as Brazil, said Raftery: “The problem of ageing societies will be on them, in population terms, before they know it and their governments should be making plans.”

In separate work, published on Monday , Wolfgang Lutz, director of the Vienna Institute of Demography, highlighted education as crucial in not only reducing birth rates but also enabling people to prosper even while populations are growing fast. In Ghana, for example, women without education have an average of 5.7 children, while women with secondary education have 3.2 and women with tertiary education only 1.5. But he said: “It is not primarily the number of people that’s important in population policy, it’s what they are capable of, their level of education, and their health.”

See graphic: http://www.theguardian.com/environment/2014/sep/18/world-population-new-study-11bn-2100

Jornada de prevención de VIH/SIDA de la Asociación Civil AMAVIDA y la Fundación WayuuTaya

La Asociación Civil AMAVIDA y la Fundación WayuuTaya realizaron una jornada de prevención de VIH/SIDA en SINAMAICA en la Alta Guajira, con las población Indígena AÑU.

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Investigadores de ébola buscan las lecciones del VIH

Ebola responders look to lessons from HIV
The Hill, DC
17/09/2014

By Sarah Ferris

As the Ebola crisis deepens in West Africa, health leaders are taking cues from the international response to another deadly virus that has ravaged the continent — HIV.

Chinua Akukwe, the lead African analyst with the National Academy of Public Administration, told lawmakersWednesday that the U.S. should look at its response to HIV/AIDS over the last decade when mapping out its plan to fight Ebola.

Akukwe said it “jumpstarted the global response to HIV” when the U.S. began pouring money into research and treatment in the early 2000s.

“It allowed multilateral agencies to begin the process of looking at HIV/AIDS from a different perspective. I think this is what we probably need at this time,” Akukwe told members of the House Foreign Affairs subcommittee on Africa and Global Health.

The HIV and Ebola outbreaks have struck different corners of the continent, but both hit quickly and powerfully, straining fragile governments and even more fragile health systems. Both diseases are difficult to treat and come with strong stigmas.

“It’s sort of an inevitable comparison,” said Jen Kates, the vice president and director of global health and HIV policy for the Kaiser Family Foundation. “It’s a common feeling when there’s an outbreak that no one was prepared or expecting it.”

Even some of the people fighting the diseases are the same faces as before.

Anthony Fauci, an infectious disease doctor who has been at the front of the National Institute of Heath’s response to Ebola, was also a lead architect of the Bush-era President’s Emergency Plan For AIDS Relief (PEPFAR).

Fauci, who has appeared in Congress twice over two days to brief lawmakers on Ebola, has also testified at multiple hearings on HIV/AIDS. He became director of the National Institute of Allergy and Infectious Diseases in 1984, just three years after HIV was first identified.

But Kates, who has watched the Ebola epidemic closely over the last six months, said there are also key differences.

Most importantly, she said, is that West African health workers already know that the disease they’re fighting is called Ebola. She said HIV was an unknown disease for years. She added that health workers are better able to identify those infected with Ebola, because they present symptoms quickly.

She said if the international community devotes the resources that it’s promised to control the outbreak, it can prevent the type of decades-long campaign that’s been needed to combat HIV.

“I do think there’s a very small window to get ahead of it. If we do, I don’t think we’re looking at a PEPFAR,” she said.

Akukwe, the head of the African Working Group, also drew comparisons between the decimated West African health infrastructures and those of the countries that have been hit the hardest by HIV. He said international intervention has been imperative in both cases.

“It is not easy for Africans on their own to deal with this problem.” he said. “These are very poor African countries that will never have the capacity to manage some of these outbreaks.”

La agenda de desarrollo post-2015 protagoniza la sexagésimo novena sesión de la Asamblea General

Post-2015 development agenda takes centre stage as General Assembly’s 69th session opens

UN News Centre

16/09/2014

16 September 2014 – The United Nations General Assembly opened its 69th annual session today with the body’s new President declaring that it would be a historic opportunity to formulate a post-2015 development agenda that is transformative, brings tangible results in fighting poverty, and leads to improving lives of all people.

“As I stand in this newly opened magnificent Assembly Hall, I cannot help but think that we are here at the dawn of a new day. Let us approach this pivotal 69th session with a sense of urgency, hope and greater cooperation,” said the General Assembly President Sam Kahamba Kutesa in his opening address to the 193-Member States body.

Mr. Kutesa, of Uganda, declared the theme of this year’s general debate “Delivering on and implementing a Transformative Post-2015 Development Agenda” and said the framework must strive to eradicate poverty and hunger and promote sustained and inclusive economic growth.

Next week, scores of heads of State and Government will take to the very same podium in the annual general debate, which will run from Wednesday, 24 September, through Wednesday, 1 October, to deliberate the world’s most pressing issues.

“The list is as lengthy as it is daunting- poverty and hunger; persistent unemployment; violent armed conflicts; faltering education systems; climate change and rising sea-levels; and inadequate infrastructure,” Mr. Kutesa said.

Just in recent months, health systems in West Africa have been overwhelmed by an unprecedented Ebola outbreak, while new challenges to peace and security have emerged with alarming frequency. Extremism is spreading and acts of terrorism are spreading in Iraq and Syria.

“The General Assembly remains the pre-eminent forum for global debate and cooperation amongst Member States,” he said, calling on countries to harness opportunities and to find solutions to the challenges confronting humanity.

“It is evident that the 69th session will be very busy,” Mr. Kutesa said, explaining that in addition to dealing with the normal work of its six main Committees – which deal with specific issues, such as the UN budget, human rights, disarmament, and economic and financial matters – the Assembly we will be preoccupied with negotiations on the post-2015 development agenda.

Calling the coming year a “momentous” one for the UN, Mr. Kutesa said he looked forward to commemorating the 70th anniversary of the Organization’s founding, as well 15 years since the adoption of the Millennium Declaration and 10 years since the 2005 World Summit. It will be critical to craft a new development agenda to succeed the landmark Millennium Development Goals (MDGs), set to expire in 2015.

“It is our responsibility to ensure that adequate means for implementing the agenda, in terms of finances, technology development and transfer and capacity-building are mobilized,” he said.

This will require strengthened global partnership and enhanced cooperation between and amongst Member States, the private sector and civil society. It will also require a fair trading regime and promotion of investment.

One of the thematic debates Mr. Kutesa has planned for the session will focus on implementing the new development agenda and on how to mobilize resources. And the second debate, to be held in March 2015, will focus on “advancing gender equality and the empowerment of women in the post-2015 development agenda.”

“As highlighted in the outcome document of Rio+20 (UN Conference on Sustainable Development), although progress in gender equality has been made in some areas, the potential of women to engage in, contribute to and benefit from sustainable development has not yet been fully realized.”

A third thematic debate will address strengthening cooperation between the United Nations and regional organizations. Mr. Kutesa said he also intends to convene, in June 2015, a high-level event on combating climate change, calling it “one of the defining global challenges of our time.”

“To preserve plant Earth for ourselves and succeeding generations, the international community has an obligation to address the effects of climate change, which threaten humankind’s very existence,” he said.

Echoing the momentous nature of this annual debate, Secretary General Ban Ki-moon called the 69th session of the General Assembly the “most consequential in a generation – and for a generation.”

“There is plenty of reason to be uneasy over the state of the world. But there is also plenty of reason for hope,” Mr. Ban said emphasizing the need to accelerate progress on Millennium Development Goals and establish a development agenda that can wipe out extreme poverty over the next 15 years.

The world must rally together to move ahead on climate change, advance the rights of the world’s indigenous peoples, improve the health of women and girls, take on Ebola and address an array of peace and security challenges.

Expressing serious concern over “a rising tide of intolerance – of societies closing in on themselves – of groups eager to exploit differences and wage campaigns of hate,” Mr. Ban said the General Assembly’s nature is to stand as the “ultimate rebuke to that distorted and venomous view.”

A pesar de la negación, la mortalidad infantil y el hambre persisten en países en vía de desarrollo. Reporte de la ONU

Despite Declines, Child Mortality and Hunger Persist in Developing Nations, U.N. Reports

The New York Times

16/09/2014

By RICK GLADSTONE and SOMINI SENGUPTASEPT

The United Nations on Tuesday reported significant declines in the rates of child mortality and hunger, but said those two scourges of the developing world stubbornly persist in parts of Africa and South Asia despite major health care advances and sharply higher global food production.

The trends, detailed in two annual reports by United Nations agencies, were presented before the General Assembly meetings of world leaders, where the Millennium Development Goals, a United Nations list of aspirations to meet the needs of the world’s poorest, are an important discussion theme.

While one of those goals — halving the number of hungry people by 2015 — seems within reach, the goal of reducing child mortality by two-thirds is years behind, the reports showed.

The child mortality report, a collaboration of Unicef, other United Nations agencies and the World Bank, showed that the mortality rate for children younger than 5, the most vulnerable age group, had dropped by nearly half between 1990 and 2013. Nearly all of the countries with the highest mortality rates are in Africa, the report said, and two countries that are among the world’s most populous — India and Nigeria — account for nearly one-third of all deaths among children younger than 5.

Child mortality rates are scrutinized because they can be barometers of other problems and are considered a telling indicator of a country’s quality of life.

The report showed that the global mortality rate fell to 46 deaths per 1,000 live births last year, from 90 per 1,000 births in 1990. It also showed that the gap in mortality rates between the richest and poorest households has fallen in all regions over most of the past two decades, except for sub-Saharan Africa, which remains the riskiest region for a young child.

The report attributed much of the progress to broad interventions over the years against leading infectious diseases in some of the most impoverished regions, including immunizations and the use of insecticide-treated mosquito nets, as well as improvements in health care for expectant mothers and in battling the effects of diarrhea and other dehydrating maladies that pose acute risks to the young.

“There has been dramatic and accelerating progress in reducing mortality among children, and the data prove that success is possible even for poorly resourced countries,” Dr. Mickey Chopra, the head of global health programs for Unicef, said in a statement about the report’s conclusions.

Despite the advances, the report said, 223 million children worldwide died before their fifth birthday between 1990 and 2013, a total that the report called “staggering.”

In 2013, 6.3 million children younger than 5 died, 200,000 fewer than the year before, the report said. Nonetheless, that is still about 17,000 child deaths a day, largely attributable to preventable causes that include insufficient nutrition; complications during pregnancy, labor and delivery; pneumonia; diarrhea; and malaria.

While sub-Saharan Africa has reduced the under-5 mortality rate by 48 percent since 1990, the report said, the region still has the world’s highest rate — 92 deaths per 1,000 live births, nearly 15 times the average in the most affluent countries.

Put another way, the report said, children born in Angola, which has the world’s highest rate — 167 deaths per 1,000 live births — are 84 times more likely to die before they turn 5 than children born in Luxembourg, which has the lowest rate of two per 1,000.

The hunger report, a collaboration of the Food and Agriculture Organization, World Food Program and International Fund for Agricultural Development, said more than 800 million people worldwide do not get enough to eat.

Feeding the world is no longer a question of growing more food. The Food and Agriculture Organization says the world produces twice the amount of food that the population needs. The report called for “targeted policy interventions such as strengthening safety nets and other social protection.”

Hunger has declined slowly over the last few decades: 11.3 percent of the world’s population was clinically undernourished in the 2012-14 period, down from 18.7 percent in the 1990-92 period. But it keeps its hold on a handful of countries. Chad, the Central African Republic and Ethiopia have some of the highest rates of undernourished people. A relatively large percentage of the population remains hungry across South Asia.

And in Iraq, the share of hungry people has soared: Nearly one in four Iraqis are undernourished, according to the report, up from 7.9 percent of the population in the 1990-92 period.

The report defined hunger as having “insufficient food for an active and healthy life.”

While the report said the world was on target to meet the Millennium Development goal of halving hunger levels, natural disasters and conflict had blunted progress in the countries of sub-Saharan Africa and the Middle East.

See related: http://www.theguardian.com/global-development/2014/sep/16/infant-child-deaths-un-estimates

Brote de ébola: La ONU pide $1 billón para combatir el virus

Ebola outbreak: UN calls for $1bn to fight virus

BBC News

16/09/2014

More than $1bn (£618m) is needed to fight the West Africa Ebola outbreak, which is a health crisis “unparalleled in modern times”, UN officials say.

The spread of the disease means the funds needed to fight the outbreak have increased ten-fold in the past month, the UN’s Ebola co-ordinator said.

Ebola has killed 2,461 people this year, about half of those infected, the World Health Organization said.

There has been criticism of the slow international response to the epidemic.

The outbreak began in Guinea before spreading to its neighbours Sierra Leone and Liberia.

Nigeria and Senegal have reported some cases, but seem to have contained the transmission of the virus.

‘Massive surge needed’

“We requested about $100m a month ago and now it is $1bn, so our ask has gone up 10 times in a month,” the UN’s Ebola co-ordinator, David Nabarro, told a briefing in Geneva.

“Because of the way the outbreak is advancing, the level of surge we need to do is unprecedented, it is massive.”

At the same briefing, World Health Organization (WHO) deputy head Bruce Aylward announced the latest Ebola case figures.

The virus has infected at least 4,985 people so far, with about half of those infected dying.

“Quite frankly, ladies and gentlemen, this health crisis we’re facing is unparalleled in modern times. We don’t know where the numbers are going on this,” he said.

West Africa Ebola casualties

Up to 13 September 2,461 Ebola deaths – probable, confirmed and suspected

1,296 Liberia

595 Guinea

562 Sierra Leone

8 Nigeria

Source: WHO

When the WHO had said it needed the capacity to manage 20,000 cases two weeks ago “that seemed like a lot”, Dr Aylward said.

“That does not seem like a lot today,” he added.

US President Barack Obama is expected to announce plans to send 3,000 American troops to Liberia, one of countries worst affected by the outbreak, to help fight the virus.

Officials say the troops will build 17 health care centres, each with 100 beds, deliver health care kits to hundreds of thousands of homes and help train 500 health workers a week.

Infected ‘turned away’

Medical charity Medecins Sans Frontieres (MSF) called on other countries to follow the US lead as the response to outbreak continued to fall “dangerously behind”.

At the Ebola briefing, MSF president Joanne Liu said there needed to be “co-ordinated response, organised and executed under clear chain of command”.

“The window of opportunity to contain this outbreak is closing,” she said. “We need more countries to stand up, we need greater deployment, and we need it now.”

Guinea’s Red Cross health workers wearing protective suits prepare to carry the body of a victim of Ebola at the NGO Medecin Sans Frontieres Ebola treatment centre near the hospital Donka in Conakry, 14 September 2014 The WHO says the most urgent immediate need is more medical staff

Sick people in the Liberian capital were banging on the doors of MSF Ebola care centres desperate for a safe place in which to be isolated, she said.

“Tragically, our teams must turn them away; we simply do not have enough capacity for them,” Dr Liu said.

“Highly infectious people are forced to return home, only to infect others and continue the spread of this deadly virus. All for a lack of international response.”

Earlier on Tuesday, the WHO welcomed China’s pledge to send a mobile laboratory team to Sierra Leone, which will include epidemiologists, clinicians and nurses.

“The most urgent immediate need in the Ebola response is for more medical staff,” WHO head Margaret Chan said in the statement.

Ebola virus

Symptoms include high fever, bleeding and central nervous system damage

Spread by body fluids, such as blood and saliva

Current outbreak has mortality rate of about 55%

Incubation period is two to 21 days

There is no proven vaccine or cure

Criminalización de Personas LGBT y aquellos que viven con VIH amenaza el progreso contra el SIDA

Criminalization of LGBT People and Those Living With HIV Threatens Global Progress Against AIDS

The Huffington Post

10/09/2014

Kenneth H. Mayer, M.D.

Medical Research Director, Fenway Health, and Co-Chair of The Fenway Institute

When Uganda President Yoweri Museveni visited the White House during the U.S.-Africa Leaders Summit last month, a high court had just overturned his country’s widely reviled “Anti-Homosexuality Law” which penalized “aggravated homosexuality” with life in prison, and criminalized the provision of services and support to gay people, threatening progress in that country’s long battle against HIV.
The elimination of the law, which President Barack Obama had warned Museveni would “complicate” the relationship between their two countries, allowed Museveni to focus on the summit, centered around growth, economic development, and the theme of “investing in the next generation.” In many sub-Saharan African countries, no greater threat to growth exists than the impact of HIV on human resources, development and income.

The irony is that by then, Museveni had apparently decided to sign the “HIV Prevention and Control Act,” a new setback to Uganda’s HIV fight. The law criminalizes HIV transmission and “attempted” transmission; forces involuntary testing on survivors of sexual assault, all pregnant women, and anyone who “unreasonably” withholds consent for testing; and encourages medical providers to divulge patients’ HIV status. In addition to promising a further erosion of human rights in Uganda, the law provides a powerful disincentive for Ugandans to risk criminal culpability by getting tested for HIV, or seek medical care at all. United States Global AIDS Coordinator Ambassador Deborah Birx, who leads the President’s Emergency Plan for AIDS Relief (PEPFAR), Uganda’s longtime partner and funder in fighting its HIV epidemic , called on the government of Uganda to reject the bill when the parliament passed it in May.

While Museveni’s signature on the law, revealed only after the Washington summit, is dated July 31, 2014, reports say it was backdated, making it likely he signed the law after posting a photo to Twitter of himself between President Barack and First Lady Michelle Obama. Either way, he signed it within a few days of meeting with U.S. leaders to discuss ways to foster growth and opportunity in Africa, while being aware that his support for such legislation was in conflict with the goals of PEPFAR, and the U.S. Government.

The latest law raises questions of how many opportunities have been squandered, not just during the week of the U.S.-Africa Leaders’ summit but also during the last decade of the global HIV response, to communicate the importance of human rights and sound public health approaches to “investing in the next generation.” Museveni was representing a country with grave human rights abuses enshrined in law. Nigerian President Goodluck Jonathan, who signed his country’s anti-homosexuality law earlier this year, also attended. Other leaders represented countries that already had HIV criminalization laws, as well as laws abusing the rights of gay people, women, ethnic minorities, immigrants, and migrants, and other important populations to reach if these countries hope to have lasting success in controlling their national HIV epidemics.

To communicate the link between health and human rights, however, the United States has to set a credible example. The ability to do that is challenged by HIV criminalization laws on the books of at least 33 states in this country. It also is challenged by an inconsistency. President Obama rightly issued sanctions in response to Uganda’s Anti-Homosexuality Law, and those may have factored into the nullification of that law. However, PEPFAR had by then been funding activities for a decade at the Inter-Religious Council of Uganda, an organization that urged the signing of the Anti-Homosexuality Law, and then celebrated when it was signed. When their funding ended in the wake of the new law, the group’s leaders claimed surprise that their stance was held against them, apparently still unaware that homophobic abuse ran counter to the mission they had been enlisted to carry out.

A decade-long public health partnership between the U.S. and African countries should have clarified, by words, actions and example, that human rights are critical to success in stopping the spread of HIV/AIDS throughout the world, particularly in those countries hardest hit by the epidemic. Any new public health partnerships must make this a priority.

Kenneth Mayer, MD is founder, Co-Chair, and Medical Research Director of The Fenway Institute, the research, training and health policy division of Fenway Health, an ambulatory facility caring for HIV-infected patients. He is also a professor at Harvard Medical School and the Harvard School of Public Health; attending physician at Beth Israel Deaconess Medical Center in Boston where he serves as director of HIV Prevention Research; and serves as co-chair of the Infectious Diseases Society of America’s Center for Global Health Policy that focuses on the U.S. response to HIV and TB globally.

Cómo priorizar las Metas de la ONU

How to Prioritize U.N. Goals (Op-ed)

The New York Times

10/09/2014

By ABHIJIT BANERJEE and VARAD PANDE

Cambridge, Mass. — In France, children grow up hearing the story of the 100 times good cake: A cat and a dog preparing a cake start from the idea that if the cake has 100 delicious ingredients, it will be “100 times good.” So they make a cake with strawberries and cream, garlic and pepper (and throw in a mouse and some bones for good measure) — with predictable consequences.

Diplomats are facing a “100 times good” temptation as they work to establish new United Nations global objectives for development, known as Sustainable Development Goals, that will help set an overarching narrative for the world’s progress for the next 15 years.

The diplomats from 70 countries made up an Open Working Group, which recently submitted its proposal. A diplomat from a small Pacific island that faces imminent inundation might, understandably, have focused on the elimination of fossil-fuel subsidies, while one from China or India might have stressed the transfer of environmentally sound technologies to developing countries on favorable terms. By themselves, these are both worthy causes, but a result of accommodating these divergent priorities is a list with 17 goals and 169 targets as metrics for measuring progress toward those goals — a sort of “169 times good cake.”

The previous Millennium Development Goals, established in 2000 with a target date of 2015, set only eight broad goals — like universal primary education, gender equality and environmental sustainability — as priorities for global resources, and just 19 targets.

The power of the original millennium goals came from their very clear prioritization of a small number of measurable objectives. The idea was to present to the world a specific vision that said, “This much at least we should be able to offer every human being.” By emphasizing the sheer modesty of what was being proposed, it made it hard for nation states to ignore the global project.

What is needed now is a clear, concise set of objectives. Without them, the entire project is in very real danger of failing. If nations can simply ignore the imperatives on the grounds that they are too many, too grandiose and too far out of touch with countries’ limited resources and ability to effect change, the development goals will just be another pious hope in the long list of United Nations-sponsored fantasies.

We have some experience of just how difficult choosing priorities can be. We were both involved in the High-Level Panel for the Post-2015 Development Agenda, a group set up by the secretary general that worked in parallel to the Open Working Group. We submitted our report  — which will be combined with the Open Working Group’s — in May last year, and despite our attempts to discipline ourselves ruthlessly, we ended up with 12 goals and 54 targets.

Choices have to be made. Some are easier than others: For example, “Devise and implement policies to promote sustainable tourism” (Target 8.9 in the diplomats’ proposal), laudable as it is as an objective, cannot possibly lay the same claim to our attention as infant mortality or mass illiteracy.

The list of targets could also be shortened by focusing on outcomes and leaving out process or input measures (the current version has both). This has the added advantage of allowing countries to use their limited resources as they see fit. For example, we think it is much better to have a quantitative target for children’s learning (e.g., by 2030, X percent of children should be reading or doing math at their grade level) than to require them to “increase by X percent the supply of qualified teachers” (Target 4.c in the working group proposal), especially given the lack of evidence that teacher training as currently delivered has much effect on children’s learning.

Moreover, the goals and targets should be as specific, measurable and actionable as possible. For example, Target 12.2 in the proposal asks countries to “by 2030 achieve sustainable management and efficient use of natural resources.” Who would argue with that, but what does it actually require countries to do other than to say amen?

Finally, our report indicated some issues that apply to many goals. Inequality was one. The idea was that for a range of goals, countries would have to measure and report the outcomes — for example, infant mortality — for the poorest X percent (say, 20 percent) of the population, in addition to the average.

This is where we find a lot of the historically disadvantaged populations (the Roma in Europe, “scheduled tribes,” as the indigenous people in India are known, African-Americans) and help bring some attention to subpopulations without focusing on ethnicity directly.

It also makes it harder for countries to concentrate just on people close to the poverty line and ignore those far below and points to overlooked communities in the richest countries.

The United Nations General Assembly has its work cut out. It must balance ambition with practicality. It must devise a tight agenda for the world to collectively strive toward — and remember that more ingredients do not always make the best cake.

Abhijit Banerjee  is the international professor of economics at M.I.T.

Varad Pande  is a sustainability science fellow at the Harvard Kennedy School.

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