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A Person-centered Response to HIV/AIDS

Wed, 01 Aug 2012 00:01:00 -0400

The XIX International AIDS Conference took place in Washington, DC, July 22“27. The meeting occurs biennially, bringing together scientists, experts, and civil society actors in the largest conference on any health or development issue. The official theme of this year’s conference was “Turning the Tide Together.” However, it was the “Condomize!” campaign sponsored by UNFPA and the Condom Project in collaboration with Durex, UNAIDS, and several other organizations that set the predominant tone for the six-day event.

The Conference heralded many remarkable successes in the fight against HIV/AIDS, including an overall decrease in transmission of HIV, improved access to antiretroviral therapy, and a significant reduction in mother-to-child transmission. These advances point to the promise of an evidence-based response to HIV/AIDS and demonstrate the power of human ingenuity in the fight against the disease. However, advancements in science must go hand-in-hand with a culture that affirms the critical importance of responsible choices.

The overwhelming prevalence of the Condomize! campaign palpably undermined the value of building such a culture. With over one million condoms dispensed at the conference and the constant loudspeaker announcements encouraging participants to “Live, Love, Condomize,” it was readily apparent that the message of the International AIDS Conference could be boiled down to one word”condoms. If we are to truly “turn the tide together” we need to do more than ensure that condoms are available in every corner of the world.

Condom promotion is not an effective response in generalized epidemics, like those in Africa, where HIV is spread through heterosexual sex (and not primarily by sex workers, men who have sex with men, and injecting drug users, like it is in the United States and other countries that have concentrated epidemics). Evidence shows that people in long-term relationships do not use condoms consistently, and in many African communities it is a sign of lack of trust if a partner demands condom use. The international AIDS community needs to understand the contexts and cultures in which HIV ravages communities.

It also needs to accept the science behind HIV transmission. When a person is first infected by HIV, his viral loads are extremely high and he is very infectious, yet because there are often no immediate symptoms, he is not aware he has it. If he has multiple concurrent partners”that is, more than one sexual partner around the same time”those partners are at risk of contracting HIV. And if those partners have other partners, those additional partners are exposed to the risk of contracting HIV. Even a monogamous partner is at risk if her partner is not faithful. These concurrent relationships are not uncommon in many parts of Africa, due to migrant labor, transactional sex, and polygamy.

It is therefore critical that people reduce the number of concurrent partners that they have. An emphasis on mutual fidelity works: In Uganda in the 1990s, the famous “zero grazing” and “love faithfully” messages broadcast through all forms of media, by religious leaders, and by the president himself were culturally relevant and effective. Ugandans reduced the number of partners they had, and HIV prevalence declined.

Another necessary form of behavior change is delay of sexual debut. By delaying sexual activity, young people delay their exposure to the virus. This is particularly important for women, who are biologically and behaviorally more susceptible to contracting HIV. This was another component of Uganda’s successful campaign to decrease HIV prevalence.

Both of these prevention strategies are person-centered. They understand the capacity of the person to make responsible decisions, and thus they get at the underlying behavior that puts a person at risk of contracting HIV. A person-centered response to HIV/AIDS also understands the needs of the person who has already contracted HIV, and treatment with antiretroviral drugs (ARVs) is an essential component of this. ARVs keep viral loads down so low that an HIV-positive person has a much longer lifespan than he would otherwise. ARVs are also the key component of preventing transmission of HIV from an HIV-positive mother to her child during pregnancy, childbirth, and breastfeeding.

Unfortunately, attendees of the AIDS Conference did not hear about the importance of evidence-based, risk avoidance prevention strategies. Instead, they were blasted with promotion of condoms and sterile needles, which is the global health policy community’s intervention of choice for injecting drug users.

The body that should be leading the charge for evidence-based and person-centered solutions is UNAIDS, the United Nations body charged with addressing the HIV/AIDS epidemic. Yet UNAIDS documents repeatedly tout harm reduction strategies that do not work in generalized epidemics. Although UNAIDS rightfully promotes ARVs for all infected by HIV, its person-centered approach ends there. UNAIDS does recognize the importance of partner reduction and delay of sexual debut in preventing the transmission of HIV, yet it fails to prioritize these strategies. It is time for UNAIDS to lead with evidence-based and person-centered solutions to end the spread of HIV.

Elyssa Koren, J.D., is the Director of Advocacy at the World Youth Alliance. Meghan Grizzle, J.D., is the Research and Policy Specialist at the World Youth Alliance.

RESOURCES

World Youth Alliance HIV/AIDS White Paper

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Rio+20: Where Do We Go From Here?

Wed, 04 Jul 2012 00:04:00 -0400

On June 20-22, the United Nations Conference on Sustainable Development took place in Rio de Janeiro, Brazil. The conference, known as Rio+20, signified the end of months of negotiations at the UN in New York and then a hectic week of negotiations in Rio before the conference. In the end, the delegates were not able to agree on a complete document, so the Brazilian government stepped in and presented its own version. The outcome document, called the Future We Want, is 53 pages and 283 paragraphs of governments’ political commitments on everything from oceans to food to cities to gender equality.

During the pre-conference negotiations in Rio, much of the debate was on the inclusion of “reproductive rights” in the document. Pro-life groups rightly praised the Brazilian government’s decision to exclude this phrase from the outcome document, since it is widely known that “reproductive rights” is code for abortion. This omission, among others, inspired the Women’s Major Group to express its outrage and to call the document a complete failure, and the utter despair of abortion advocates should be encouraging to pro-lifers.

So, after Rio+20, where do we go? All eyes are now on the future development of the Sustainable Development Goals (SDGs). The Future We Want sets up a mechanism for the introduction of goals that will piggyback on the Millennium Development Goals (MDGs), which expire in 2015. The MDGs, which present targets for the achievement of priorities such as maternal health, education, poverty eradication, and environmental sustainability, will not be achieved by 2015. Thus, at the General Assembly in September, a 30-person committee will begin to assess and enumerate SDGs.

The next battle is thus determining what these new goals will be. It is certain that abortion activists like International Planned Parenthood Federation will push for the inclusion of universal recognition of reproductive rights and universal access to contraception in the list of SDGs. This inclusion would be an affirmation of the idea that population reduction is critical for the success of developing nations that cannot sustain their growing populations. The misguided reasoning is that a smaller population leads to more economic opportunities and more available jobs. This dangerous premise has inspired population control policies and practices and human rights violations in China, India, Vietnam, and Cambodia, among other countries.

This does not reflect the reality that it is poverty, not populations, that is the real culprit in failures to achieve sustainable development. It also ignores the innovation and problem-solving capacities of people, the first principle of the Rio Declaration from the 1992 Earth Summit. The new SDGs then must focus on lifting people out of poverty and fostering the exercise of their creativity. Some critical areas for SDGs are:

Health: Healthy people can focus their efforts on positive pursuits and do not drain countries’ resources. In many developing countries, there is still a need for even the most basic health care. Medical infrastructure, like hospitals and technology, will provide more people with better access to health care. Maternal health care, including prenatal and postnatal care and emergency obstetric care, is also critical because mothers are central figures in every family and community, as caretakers, providers, and teachers.

Education: Education empowers people to develop and realize their creative potential. Many people around the world, particularly girls, do not even have guaranteed access to primary schooling. This disadvantages them from accessing the ideas and developing the skills necessary for positive participation in a society.

Youth: A society that is invested in its youth is a society that is invested in its future. Unfortunately, discussions about youth at the United Nations are inevitably accompanied by the promotion of sexual rights. Youth are not simply sexual beings; they have very real concerns about education, employment access, and skill development that must be addressed by the SDGs.

Good governance: No effort to achieve sustainable development can succeed in a society that operates under corruption and bribery. Good governance means the establishment of the rule of law and the recognition and promotion of political rights, economic freedom, and private property which allow people to pursue their interests.

Cultivation of cultural capital: Cultural capital is the highest form of capital in a society. It is the ideas, beliefs, values, and knowledge that attach meaning to events and make up the mindset that informs each person’s actions. It is culture that informs how each person uses all other forms of capital, such as natural resources, tools, and institutions.

In an ideal world, the SDG committee will consider these priorities when determining the new SDGs. In a realistic world, the battle will be to remind the committee that creativity of humanity is the Earth’s greatest resource.

Meghan Grizzle is Research and Policy Specialist at the World Youth Alliance. She graduated from Harvard College in 2007 with a Bachelor’s and a Master’s in Linguistics and from Harvard Law School in 2011.

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Reproductive Health, Reasserted

Wed, 16 May 2012 00:01:00 -0400

“Reproductive health” and “family planning” are not poisonous terms. As the World Youth Alliance’s white paper on reproductive health demonstrates, international law is clear. No international human rights treaty includes abortion as a component of reproductive health. The first and primary international consensus document to define reproductive health, the Programme of Action of the International Conference on Population and Development (ICPD), does not include abortion in the definition. As a document of political will, rather than a legally binding treaty, it reflects the commitments of States to addressing population opportunities and challenges.

Although the ICPD Programme of Action includes abortion as a component of reproductive health care (Paragraph 7.6) and reproductive health services (Paragraph 13.14(b)), in each of these instances, abortion is only included as specified in Paragraph 8.25. That paragraph limits the inclusion of abortion only where it is legal, and thus does not require abortion where it is not already legal. It emphasizes that each State’s abortion laws are its own prerogative, not the international community’s. It also states that abortion should not be promoted as a means of family planning, a point on which every United Nations Member State agrees. Further references to abortion throughout the Programme of Action cast it as undesirable.

It is important to make distinctions in language and terminology when attempting to understand or participate in UN negotiations. “Reproductive health,” the topic of the World Youth Alliance white paper, is different from the terms “reproductive health care,” “reproductive health services,” and “reproductive rights.” These terms should be understood separately, as they have different meanings. Reproductive health should not be rejected altogether because of conflation with the other terms.

During the negotiations for the 45th Session of the Commission on Population and Development , held this April, at least 24 consistently pro-life Member States clearly articulated that they accept the term “reproductive health services,” as long as it is accompanied by a specific reference to the ICPD Programme of Action. At no point in the negotiations did any of these pro-life Member States object to the terms “reproductive health” and “family planning.”

The failure to produce an outcome document at the 56th Commission on the Status of Women in March was due to opposition to sexual and reproductive rights language, in addition to ambiguous ideas such as comprehensive sexuality education. The repeated inclusion of contraception”in the place of family planning”also contributed to the lack of consensus. The delegates did not battle over the concept of reproductive health, as it is an accepted term.

The consequences of an improper understanding of reproductive health are serious. Treaty-monitoring bodies (TMBs), which monitor the implementation of treaties, such as the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), have pressured countries to legalize abortion or loosen abortion restrictions under the reproductive health framework. The answer to this pressure is to educate States Parties to treaties that abortion is not a component of any treaty and to empower them to reject the non-binding recommendations of TMBs, not to run away from the concept of reproductive health. NGOs that relentlessly assert abortion as part of reproductive health”powerhouses such as International Planned Parenthood Federation and Ipas among them”do not have lawmaking capacities.

The response to these NGOs is to assert the true definition, which has the support of law. Even better, programs and policies that emphasize real reproductive health”empowerment of women through knowledge-based education about their bodies”need to be available to countries so that they do not reluctantly accept the slim pickings that IPPF has on offer. And in response to pressure from the EU, the United States, Scandinavian countries, and other proponents of the false understanding of reproductive health, it is clear that small and developing countries are able to defend their position on reproductive health. This was made evident at this March’s Commission on the Status of the Women, when they refused to succumb to dirty political tactics and prevented those governments from asserting their false understanding of reproductive health.

The term “reproductive health” is here to stay in the global health policy arena. By using the term, States can influence what happens at the United Nations. States cannot afford to be irrelevant in negotiations.

Meghan Grizzle is Research and Policy Specialist at the World Youth Alliance. She graduated from Harvard College in 2007 with a Bachelor’s and a Master’s in Linguistics and from Harvard Law School in 2011.

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True Reproductive Health

Fri, 17 Feb 2012 01:13:00 -0500

‘Reproductive health’ is the subject of numerous international conferences, United Nations meetings, agency reports, and NGO papers, yet the meaning of the term can vary widely”and very consequentially. Clarity about reproductive health is increasingly necessary as United Nations Member States seek to honor the Millennium Development Goals, one component of which is achieving universal access to reproductive health. This requires clarity about exactly what reproductive health is.

A newly issued World Youth Alliance white paper that I authored seeks to set the record straight. It begins by looking at the Programme of Action, the consensus document resulting from the 1994 International Conference on Population and Development, the first United Nations conference to define reproductive health. Although not legally binding, the Programme of Action’s definitions of terms such as ‘reproductive health,’ ‘reproductive health care,’ and ‘reproductive health services’ are instructive because the document is a declaration of political will, meaning that States who approved it are committed to carrying out its objectives; further, it is the most cited document on reproductive health in global health policy discussions. Delegates at the ICPD consciously did not include abortion as a component of reproductive health, expressly reserving changes in abortion policy to individual States and local governments. Follow-up commissions to the ICPD, in addition to the Fourth World Conference on Women in Beijing in 1995 and its own follow-up commissions, have not elaborated on the definition of reproductive health provided in the Programme of Action, and States have continued to express their understanding that abortion is not a part of reproductive health.

The white paper objectively investigates international law, examining what human rights treaties actually say”and do not say”on the topic. Only one treaty even mentions reproductive health, and none establishes a right to reproductive health. The paper further explains that treaty-monitoring bodies, such as the Human Rights Committee, do not have the authority to create new rights not enumerated in international treaties. Nor do they have the authority to bind States with their concluding observations.

Materials from various UN agencies and NGOs like the Center for Reproductive Rights and the International Planned Parenthood Federation often assert without basis that abortion is the primary aspect of reproductive health and that there is an international right to reproductive health. But promoters of abortion as a necessary component of reproductive health do not acknowledge the actual definition of reproductive health agreed on in Cairo in 1994, even though they are ready and willing to cite the Programme of Action’s call for an international right to reproductive health. Those who identify an international right to abortion do not quote actual provisions of international treaties but instead make tenuous connections between right-to-life treaty provisions and abortion; after all, “safe” abortion guarantees the right to life of all women. They cite treaty-monitoring bodies as if their word were law. Unfortunately, the constant repetition that abortion is necessary for reproductive health has had some effect, leading some to give “soft law” more weight than it is due.

These distortions demonstrate the need for white papers in global health policy discussions. A white paper simultaneously educates readers and advocates for a particular position. Misinformation and disinformation are rampant in global health discussions, and white papers provide an opportunity for clarification. Developing countries are often the intended audience, given that they have limited resources in policy battles. A white paper gives them a straightforward analysis of the law, exposing the gaps left by other organizations and agencies.

The white paper thus becomes an important tool for developing countries in maintaining their ground at the United Nations and in other international negotiations. These countries are sometimes threatened by their more powerful counterparts”including the United States”with the withholding of foreign aid if they do not implement new policies and programs that match the agenda of the Western world. If they are equipped at the negotiating table with accurate information about the law, they are better equipped to maintain their positions.

Of course, it is possible for white papers to mislead. Proponents of non-existent human rights often make assertions without citing any sources, an omission that should alert the reader to the likely falsity of the claim. A good white paper is well sourced, and readers must be discriminating about the authority of the sources, though unfortunately, certain organizations are so visible that people think whatever they say must be true. The World Youth Alliance’s reproductive health white paper is helpful in this regard, identifying where organizations and agencies have made unfounded claims about international law.

White papers are needed to clarify confusion about some of the most salient topics in global health policy discussions, including family planning, maternal health, and HIV/AIDS. If countries are educated about where international law stands on these issues and are provided with evidenced-based information, they will be able to develop their own”and therefore appropriate and more likely effective”health policies without bowing to pressure from the bullies of international policy.

Meghan Grizzle is Research and Policy Specialist at the World Youth Alliance. She graduated from Harvard College in 2007 with a Bachelor’s and a Master’s in Linguistics and from Harvard Law School in 2011.

RESOURCES

Meghan Grizzle, World Youth Alliance White Paper on Reproductive Health

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