I left Mexico City absolutely inspired by the amazing international student advocacy I saw. From Y-Peer’s efforts to use celebrities as messengers for AIDS education campaigns to YouthRise harm reduction advocacy efforts for IDUs, students are at the leading edge of the movement. I was especially moved by a Peruvian student group’s video on comprehensive sex education. The Peruvian group runs a peer education program for middle school aged kids about human rights and sex education. I was struck by how sophisticated, simple and hard hitting their message is: Access to information is a human right, and access to comprehensive sex education is a human right they must demand from the governemnt and educators. I didn’t even know what human rights were until college!
And speaking of human rights, I saw a huge potential for the Student Program’s Health and Human Rights Education (HHREd) curriculum at the conference. Each time I mentioned the PHR Student Program’s HHREd curriculum to students and faculty that I met in Mexico City, they were really enthusiastic. They all noted that traditional medical ethics does not prepare health profefssional students for the complex situations they will deal with as a professional. Many said that learning to look at the world through a human rights lens helps one to be a better advocate.
I couldn’t have said it better myself and am excited to continue to build our HHREd program and help students to be stronger advocates.
At the International AIDS Conference in Mexico, HIV-related travel restrictions in a handful of countries worldwide—including the US—drew sharp criticism from participating officials and civil society. I had the good fortune of attending many of the related sessions to learn and participate in the growing international momentum for HIV-related travel restrictions to be reversed.
In the early 1980s, many countries established travel restrictions, out of ignorance and fear, to prevent the virus from entering their borders. Today, we know that HIV positive travelers do not pose a threat to public health because HIV cannot be transmitted through casual contact (through the air, or from common vehicles such as food or water). At least 67 countries still have some form of HIV-specific travel restrictions, thirteen of which ban people living with HIV from entering for any reason or length of time (including Armenia, Brunei, China, Iraq, Qatar, South Korea, Libya, Moldova, Oman, the Russian Federation, Saudi Arabia, Sudan and United States). Travel restrictions usually take the form of a law that requires people to indicate their HIV-free status before entering or remaining in a country. Some countries require people to undergo an HIV test whereas others require an “HIV-free” certificate or simply ask that people declare their HIV status. Many receiving countries require that the testing be done, at the expense of the traveler, in the country of origin.
Such requirements not only discriminate by hindering HIV-positive people from travel to certain countries and affecting their work, livelihood and human rights—such requirements also perpetuate stigma and discrimination that lead people to hide their status and not seek the care they need. Assuming that people living with HIV will act irresponsibly is also highly prejudicial.
The World Health Organization, UNAIDS, and the United Nations Office of the High Commissioner for Human Rights, oppose the use of HIV-related travel restrictions. UNAIDS in fact, has set up a new international task team to heighten attention to the issue of HIV-related travel restrictions on international and national agendas and move towards their elimination.
In the US, Congresswoman Barbara Lee has been championing the issue for many years—getting the US Congress to reauthorize PEPFAR with a provision included to remove the current statutory ban on travel for people living with HIV/AIDS. During the conference, PHR thanked the Congresswoman for her leadership on global AIDS and human rights (pictured right).
Even though the US action to repeal the HIV entry ban is in keeping with international momentum, the Administration still lists HIV on the list of “communicable diseases of public health significance” that automatically preclude a person from entering the United States—and this must change in order to truly end the discriminatory travel ban. Here in the US, PHR is mobilizing health professionals to contact their Representative to co-sign a letter urging the White House to completely abolish the discriminatory travel ban.
Please take action by contacting your Representative.
In the age of globalization, and in the setting of dramatic improvements in HIV care and treatment, HIV-travel restrictions are archaic and highly inappropriate. Repealing the discriminatory travel ban is the right thing to do and it is long overdue.
During the campaign to bring affordable HIV treatment to people all over the world, South Africa’s Treatment Access Campaign volunteers spontaneously adapted the songs that united people during the fall of apartheid to the struggle that was keeping people in Africa from accessing HIV treatment. On July 10, in the halls of Mexico City’s Centro Banamex, the PHR Health Action AIDS team was part of yet another spontaneous rewriting of these songs. This time, instead of singing “We want AZT, we want Nevarapine,” we were singing about the global need for health workers.
We were part of a rally to raise awareness about the global health worker shortage that is curbing attempts to treat and prevent HIV across Sub-Saharan Africa. Organized by the Treatment Action Campaign, Medecins sans Frontieres, Health GAP, and PHR, this rally drew hundreds of supporters from the conference who marched through the Exhibition Hall, the conference center, and the Media Center singing, chanting, and speaking to the pain and suffering of people living with HIV in Sub-Saharan Africa who lack access to health workers. Holding signs stating “Where is my nurse?” and “Stop poaching our health care workers,” the rally brought together health workers from around the world with the organizations who support them to send a message to global development partners that the time to for action to solve the health workforce crisis is long overdue.
As Eric explains, AIDS activists and global health experts at the International AIDS Conference were unified in their recognition of the need to strengthen health systems and address the health workforce shortage. But, the resources are not yet flowing to address the gap between the health workforce needed to meet critical health goals such as Universal Access to HIV treatment or the Millenium Development Goals and the existing health workforce. We have had some successes—including the inclusion of training 140,000 new health workers as part of the United States Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008—but the funding available still falls well short of being adequate to address the global shortages.
And so, in partnership with health workers across the globe, we will continue to sing, to speak out, and to rally until the funding and the support follows.
In a sea of 25,000 faces, it can be hard to make 2 stand out—but in Mexico City, Health Action AIDS and our partners were able to do just that for Drs. Kamiar and Arash Alaei. The team passed out 6000 postcards, 1000 buttons, 4000 stickers, collected thousands of signatures for the petition, liaised with key NGO partners like Amnesty and HRW as well as with people from across the globe interested in taking action to free the doctors. Three plenary speakers discussed their case, and press from around the world, including VOA and AFP, covered the story. Margaret Salmon, a close friend and colleague of Kamiar, gave an incredibly moving speech about them at a session during which Arash was mean to present, and had Kamiar and Arash’s photos in empty chairs that were then projected onto a screen 2 stories tall—a stunning indictment of the Iranian government for detaining the physicians without due process.
As of today, we have over 3000 petition signatures from more than 80 countries—with more coming in every day—urging the Iranian government to respect the brother’s human rights and release them. There has been little news from Iran in the past few weeks, but the coalition continues to work to bring pressure on the Iranian government and spread the word about this urgent colleagues at risk case.
You too can help. Check out IranFreeTheDocs.org for up to date information and to take action today.
What a difference four years makes. The health workforce crisis in developing countries, especially sub-Saharan Africa, has moved from marginal to mainstream at the International AIDS Conferences. In 2004, PHR released our report on the brain drain of health professionals out of Africa at the Bangkok International AIDS Conference. I remember going to one major session where one speaker spent perhaps one minute (maybe two) addressing the health workforce crisis. There were also a few posters of relevance. The health workforce was on the agenda, but barely.
The 2006 Toronto International AIDS Conference saw a big change. A packed session was devoted to the health workforce. Activists held up empty white coats while President Clinton spoke, calling for more nurses. Several closing ceremony speakers—Stephen Lewis and the then Acting Director General of WHO—highlighted the health workforce crisis as one of the issues that had to be addressed in order to achieve universal access to HIV treatment, prevention, care and support.
In Mexico City, issues of health workforce and health systems had a number of major sessions of its own. If not for all the meetings and other things that come up during the conference, I would have filled quite a portion of my schedule here with health workforce related sessions. Health workforce and health systems are big enough here that a one session, Asia Russell of Health GAP, a close ally of PHR, could fairly say—as she did—that the rallying cry of this International AIDS Conference, the mark it will make, is that we must scale up AIDS service using an approach that significantly contributes to broader health system strengthening.
These sessions have had two major themes. One is the connection between AIDS and health systems strengthening. What impact is the AIDS response having on health systems—especially the health workforce—and what can be done to ensure that AIDS funding is used to have a broader impact on funding. The second is task-shifting, delegating tasks that more intensely trained health workers (like doctors or nurses) would previously perform to less intensely trained professionals (like community health workers).
I see a common thread to these areas—lack of funding. Several AIDS and health systems sessions are partially driven by questions of whether AIDS is harming countries’ ability to address other diseases, such as by drawing health workers from maternal health programming to AIDS programming. There are real issues here about how to ensure AIDS programs do not inadvertently have such an impact. But the root of the potential conflict is adequate funding in AIDS and the health workforce. With adequate funding available for AIDS and the workforce, there would room for the needed investments in both areas. But with inadequate funding, money for one area may mean less for the other.
Similarly, the focus on task-shifting partially reflects inadequate funding. Again task-shifting is an important issue in its own right, and this is an important strategy for scaling up AIDS—and other health—programs. But why so much focus on task-shifting compared to other strategies, like health worker education and retention? Because training community health workers (and hopefully compensating them fairly) is less expensive than training and retaining doctors and nurses.
The major investments needed in the health workforce received minimal attention in Mexico City. There won’t be successful and sustained scale-up for universal access without this investment. Nor will the world ever achieve universal access without building health systems that are based in human rights—an issue that received a little attention in Mexico City (including through PHR’s new guide on the right to health and health workforce planning), but far too little.
I’m sure that the health workforce will be on the agenda again at the next International AIDS Conference in Vienna in 2010. When it is, I hope that we are able to look back of the time between Mexico City and Vienna and reflect on how the landscape has changed, with far greater funding for the health workforce—and for fighting AIDS—and with health workforces and health systems that are rooted in human rights.
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