In Adjumani district of northern Uganda young people cannot access safe and reliable sexual and reproductive health care. Young people are sexually active and unwanted pregnancy is a common problem. Services must be tailored for young people and health professionals have to be more welcoming and understanding of their needs. Myths and stigma around sexual behavior and prevention should be tackled in an integrated approach.

HIV/AIDS is having an impact on teacher absenteeism in Zambia, which in turn is affecting the quality of education, according to a new World Bank study. 'Teacher Shocks and Student Learning: Evidence from Zambia', found that when teachers were absent as a result of illness, the level of learning was affected.

Officials say that in 2001, there were between 45,000 and 70,000 children under 18 orphaned or rendered vulnerable by HIV/AIDS. Failing proper care of such children, the National High Council Against AIDS (HCNLS) believes the number of minors infected could reach 150,000 in 2010.

Agriculture plays a vital role in the lives of people in developing countries. The sector is a critical source of income as it employs a substantial portion of the population especially in the rural areas. Many developing countries have undertaken import liberalisation in the belief of benefits from freer trade. The results of implementation however have been extremely disappointing. The reform process has neither helped the sector nor improved food security. According to the Food and Agriculture Organisation, there has been " a general trend towards the consolidation of farms as competitive pressures began to build up following trade liberalisation" and this has led to the "displacement and marginalisation of farm labourers, creating hardships that involved typically small farmers and food insecure population groups, and this in a situation where there are few safety nets."

Health Minister Dr Manto Tshabalala-Msimang has for the past three years been promoting an untested diet for people with AIDS-related illnesses, and now believes that it could be an alternative to antiretroviral (ARV) drugs. As the AIDS epidemic intensifies, thousands of sick and desperate people have turned to controversial nutrition nurse Tine van der Maas who advocates that the immune system can be restored through a diet based on garlic, lemons, olive oil and a supplement called Africa’s Solution.

The 192-country World Health Assembly that governs the World Health Organization wholeheartedly adopted the conclusions of the 58-country Ministerial Health Research Summit in Mexico in November 2004, even adding some clauses that amplify the Mexico conclusions. But this came only after several powerful countries chose to have a long, nerve-racking private debate in an informal working group to re-write the Mexico agenda, leaving outsiders - even including WHO staff - biting the nails and guessing what they intended to do.

A local Tanzania pharmaceutical company will begin producing generic anti-retroviral drugs (ARVs) in mid-2006 from a factory in the northern town of Arusha, an official with the firm announced on Monday. "We are optimistic that the locally produced ARVs will be accessible to many HIV/AIDS patients in Tanzania," Ramadhani Madabida, the managing director Tanzania Pharmaceutical Industries (TPI), told IRIN.

A group of HIV positive people in Solwezi, the administrative capital of Zambia's Northwestern province, is helping its members access antiretroviral drugs (ARVs) with the proceeds from its income-generating activities. The hammermill project of the Network for Zambian People Living with HIV/AIDS (NZP+) in Solwezi, about 700 km northwest of the capital, Lusaka, is also making it possible for members to go for viral load testing.

The combination of drought and HIV/AIDS in Southern Africa could put up to seven million people at risk of starvation over the next few months and "threaten to undermine the precious progress" made in HIV/AIDS treatment in the region, U.N. officials said on Wednesday, Toronto's Globe and Mail reports. World Food Programme Executive Director and the U.N. Secretary General's Special Envoy for Southern Africa James Morris, UNAIDS Executive Director Peter Piot, UNICEF Executive Director Ann Veneman and 10 U.N. representatives of countries in the region met on Wednesday in Johannesburg, South Africa, to discuss current HIV/AIDS programs, U.N. reforms and the need to ramp up humanitarian responses to the pandemic.

The UK is crippling sub-Saharan Africa's healthcare system by poaching its staff, UK doctors have warned. With the UK taking over the chair of the G8 in July, there is an ideal opportunity to stop the brain drain from poor to rich countries, they said. The UK should encourage more home-grown doctors and limit the time period that overseas recruits can train and work in the country, they told the Lancet. In 2003, 5,880 UK work permits were approved for health and medical personnel from South Africa, 2,825 from Zimbabwe, 1,510 from Nigeria and 850 from Ghana.

The global movement to reduce the price of medicines and expand access to antiretroviral Therapy (ART) continues to gather momentum. In sub-Saharan Africa, the region with the highest number of people living with AIDS, millions of dollars are being directed at this cause through governments as well as through the global fund to fight AIDS, tuberculosis and malaria. Ensuring access to treatment is a human right. It is important that attempts to provide a comprehensive response to the HIV epidemic, including access to drugs, are fully supported. However, there are a number of inadequately acknowledged pitfalls associated with the push to rapidly expand access to ART in this region. Unless the push to expand access to ART is placed within the context of comprehensive health systems development, it may fail to achieve the desired aim of reducing AIDS-related mortality.

As Senior Public Health Adviser you will among other things assist the Provincial Health Directorate in advising within public health planning, monitoring, quality development and other parts of the Health Sector Programme. You will collaborate closely with the provincial Chief Medical Officer in the elaboration and implementation of new health initiatives. You have an academic medical degree, preferably combined with a postgraduate degree in public health planning and/or -administration. You must be ready for changing environments in which fluency in English and interest in learning Portuguese is required.

The Land Center for Human Rights (LCHR) is calling for a 'New Egypt' where everyone carries the responsibility - and should prioritise - the protection of children rights and their future. The aim of this workshop is to raise awareness on children's rights, particularly in Egypt . For more information, please e-mail: [email protected] or see www.lchr-eg.org

‘'Do you think I can go for an HIV test and be accepted?” Zitha scoffs at the suggestion. Disabled, and also a single mother, the 44-year-old swears her fear of discrimination is no idle assumption. Rather, it is based on her experience at a test centre she visited last year. ''The attitude was horrible,'' she says. Such fear of condemnation and disapproval is rooted in society's tendency to scowl at evidence of the disabled person's sexuality. Its effect renders disclosure largely unthinkable for those who may test HIV positive.

A year after the Malawian government launched its HIV/AIDS treatment programme, the numbers of people awaiting treatment are stretching hospitals to their limits. In May 2004 the government began providing free antiretroviral (ARV) medication at public health facilities, hoping to reach 44,000 people living with the virus by June 2005.

Toronto's Globe and Mail on Tuesday examined the "unexpected" rise in Swaziland's estimated HIV prevalence rate from 38.6% in 2002 to 42.6% in 2004 - the highest rate in the world - despite "massive efforts to stop the spread of the disease." African AIDS advocates said the results of the latest HIV sentinel survey conducted in 2004 among women at prenatal clinics are "shocking and devastating," according to the Globe and Mail.

Rape by soldiers has long been a crime under national military codes, but international law has only recently come to recognize its use as a tool of war. This responsive approach succeeded in bringing rape from a prohibition in national military codes, to the categorization of rape as a form of torture, and finally recognizing rape as an independent crime under international law. While this advancement in the law cannot be minimized, it is critical at this time, and in response to ongoing circumstances, to review the legal parameters of the crime of rape and re-evaluate its efficacy.

More than 98 percent of children in five districts in Uganda reported experiencing physical or emotional violence in a study conducted by Save the Children Uganda. 75.8 percent reported experiencing sexual violence, and 74.4 percent reported experiencing economic violence. "For each form of violence, a significant percentage of children reported experiencing the violence at least once a week or more," the report said.

The Botswana Federation of Trade Unions (BFTU) and the Public Service Workers Association (PWSA) are to embark on a series of demonstrations this weekend to press the government for labour legislation to protect workers from general victimisation, unfair dismissals and discrimination on the grounds of their HIV/AIDS status. According to the unions, the demonstrations will begin on Saturday and end on 4 June, when a petition will be handed over to President Festus Mogae.

Current economic policies mean that those not able to join the global marketplace are considered disposable, or as the World Bank has previously termed it, the “unintended and regrettable consequences” of adjustment policies. Recent commitments to improve Africa's situation within this context provide reasons for both optimism and pessimism ahead of a G8 summit in July, which will show whether leaders of the industrialized world are serious about improving the health of all Africans.

In Zambia, a woman named Chileshe is dying of AIDS. She was infected by her now dead husband, who once worked in a textile plant along with thousands of others but lost his job when Zambia opened its borders to cheap, second-hand clothing. Resorting to work as a street vendor, he would get drunk and trade money for sex - often with women whose own husbands were somewhere else working, or dead, and who desperately needed money for their children. Desperation, she thought, is what makes this disease move so swiftly; she recalls that a woman from the former Zaire passing through her village once said that the true meaning of SIDA, the French acronym for AIDS, was “Salaire Insuffisant Depuis des Années” (Schoepf, 1998).

Chileshe’s is one of four stories we used in a report that has just been published by Canada’s Centre for Social Justice (Labonte, Schrecker & Sen Gupta, 2005b) to dramatize the health impacts of transnational economic integration (‘globalization’). It is a composite, like the stories used in the World Bank’s 1995 ‘World Development Report’. The Centre for Social Justice report, which grew out of a contribution to the first ‘Global Health Watch Report’ (forthcoming in July at directly challenges the elite religion of neoliberal, market-oriented economic policy, as promoted by agencies like the World Bank and the International Monetary Fund. Drawing on an extensive research base, we describe the causal pathways that link globalization to unequal and deteriorating health outcomes by way of increasing inequalities in access to the social determinants of health, and policies that tilt the economic playing field even more steeply toward the rich countries.

Sometimes, the impact is straightforward, as when public spending cutbacks combined with onerous debt repayment terms mean that governments opt for “cost recovery” in health care or water and sanitation. This process played a role in Chileshe’s story. As part of a structural adjustment program attached to loans from the International Monetary Fund, Zambia imposed user fees, cut health staff and reduced the salaries of those who remained – just at a time when the AIDS epidemic was surging out of control.

In other cases, the causal pathways operate less directly, by reducing economic insecurity and magnifying inequalities. The same adjustment program required Zambia to open its borders to second-hand clothing in 1992. Its domestic clothing manufacturers, valuable though they were as providers of employment, could not compete with imports of used clothing with zero production costs. Within eight years, Zambia’s clothing and textile industry all but disappeared, along with 30,000 jobs; large numbers of previously employed Zambian workers were thrust into the informal, ill-paid and untaxed underground economy. The World Bank called these “unintended and regrettable consequences” of the adjustment process (Jeter, 2002). For classical economists, the market was working as it should: consumers get more and cheaper stuff, and inefficient producers are driven out of business. For the losers and the left-behind, the consequences can be deadly. Zambia’s required privatization of state enterprises eliminated a further source of revenues that might have been used to support social programs, such as education and health care.

The Zambian government is trying to undo some of this damage. But like many other governments, it is hampered by the rich world’s failure to cancel more of the developing world’s crippling debt, or to provide it with the resources it needs to sustain its peoples’ health. Writing about another African country, journalist Ken Wiwa noted: “You’d need the mathematical dexterity of a forensic accountant to explain why Nigeria borrowed $5 billion, paid back $16 billion, and still owes $32 billion” (Wiwa, 2004).

Not until 1996 did the rich world respond collectively with the so-called Heavily Indebted Poor Countries or HIPC initiative. This has freed up more money for health and education. But much of the HIPC countries’ debt will remain unpaid and uncancelled at the conclusion of the initiative, most of the world’s poor live in countries that are not eligible for HIPC and the price of debt relief is often more privatization and trade liberalization, now dressed up in the rhetoric of poverty reduction strategies.

Development assistance is by no means a panacea. At the same time, a wealth of experience now exists on how to make aid work for basic needs, if the political will is there on the part of donor and recipient countries. The most authoritative estimate is that meeting the Millennium Development Goals’ 2015 targets, most of which are health-related, would require an additional $60 – $120 billion a year in aid from the industrialized to the developing world. This would represent a doubling or tripling of current aid flows, but hardly a formidable sacrifice: less than the cost of 57 Big Macs per Canadian per year, or 43 Big Macs per German per year (Schrecker, Labonte & Sen Gupta, 2005a). The cost would also be a fraction of what the United States spends on its armed forces, or of the value of the tax breaks that the richest Americans and Canadians have received in recent years.

Reasons exist for optimism. Both the UN Millennium Project, which generated the cost estimates we have quoted, and the UK Commission for Africa were emphatic about the need for more development assistance and more effective ways of using it. In the words of the UN Millennium Project, “Even if we don’t know everything about such challenges, we know enough to achieve the [Millennium Development] Goals. Moreover, the necessary interventions are utterly affordable” (UN Millennium Project, 2005). Partly because the British government has placed African development high on the agenda, this July’s G8 Summit may represent a turning point for population health in Africa, and elsewhere in the developing world.

A minimal “health equity agenda” for the Summit (Labonte & Schrecker, 2005) includes not only clear timetables for aid increases tied to comprehensive strategies for improving population health, but also expanded debt cancellation, acceptance of development-friendly trade policies such as special and differential treatment (SDT), and explicit acknowledgment that human rights – including the right to health – take precedence over trade and financial liberalization. In addition, because of the importance of capital flight in undermining African economies, the G8 must quickly ratify the United Nations Convention Against Corruption (which would provide for repatriation of assets illegally shifted offshore) and pressure other industrialized countries, as well as offshore financial centres, to do the same. To the credit of the UK Commission on Africa, it was emphatic on these points.

Unfortunately, reasons also exist for pessimism. The Millennium Project and the UK Commission were less emphatic in acknowledging the need for fundamental redesign of the international economic order. Canada’s finance minister, who was a member of the UK Commission, is making breathless speeches about how Africa needs “a strong indigenous private sector to create jobs” and must “improve the business and investment climate … building entrepreneurial and marketing skills, domestic capacity and improving access to finance” (Goodale, 2005). This language suggests a development policy triage in which people not strong, young, or lucky enough to make it into the entry levels of the global marketplace (like Kenya’s call centres; see Lacey, 2005), or predatory enough to establish business alliances with foreign corporations, are considered disposable. In the discourse of growth through entrepreneurship those Africans who are already seropositive, or at highest risk for HIV infection because of their economic vulnerability, become invisible.

By the end of the July Summit we will have a much better sense of whether the industrialized world is serious about improving the health of all Africans, or whether the best it can come up with is selective and targeted policies that represent only incremental departures from a past posture of ‘Fatal Indifference’(Labonte et al., 2004).

* Ronald Labonte ([email protected]) and Ted Schrecker ([email protected]) are, respectively, Canada Research Chair and Senior Policy Researcher at the Institute of Population Health, University of Ottawa, Canada. ‘Health for Some: Death, Disease and Disparity in a Globalizing Era’ by
Ronald Labonte, Ted Schrecker and Amit Sen Gupta is available from
[email protected]

References

Goodale R (2005). Comments at UK Commission for Africa presentation, Washington, DC, April 19; transcribed from audio webcast at http://www.nuffieldtrust.org.uk/policy_themes/docs/g8book.pdf .

Labonte R, Schrecker T, Sen Gupta A (2005a). A global health equity agenda for the G8 summit. BMJ 350:533-536.

Labonte R, Schrecker T, Sen Gupta A (2005b). Health for Some: Death, Disease and Disparity in a Globalizing Era Toronto: Centre for Social Justice, 2005; http://www.socialjustice.org/pdfs/HealthforSome.pdf

Labonte R, Schrecker T, Sanders D, Meeus W (2004). Fatal Indifference: The G8, Africa and Global Health. Cape Town: University of Cape Town Press/IDRC Books.

Lacey M (2005). Accents of Africa: a new outsourcing frontier. The New York Times, 2 February.

Schoepf BG (1998). Inscribing the body politic: AIDS in Africa. In: Lock M, Kaufert P, eds. Pragmatic women and body politics. Cambridge, Cambridge University Press.

UK Commission for Africa (2005). Our Common Interest. London: the Commission, March; http://www.commissionforafrica.org/english/report/introduction.html

UN Millennium Project (2005). Investing in Development: A Practical Plan to Achieve the Millennium Development Goals. London: Earthscan; 2005; http://unmp.forumone.com/eng_full_report/TF1mainreportComplete-highres.pdf .

Wiwa K (2004). Money for nothing - and the debt is for free. The [Toronto] Globe and Mail, 22 May:A19.