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.
The AIDS Conference has been very busy with harm reduction sessions. I met a lot of new people and reconnected with people I knew from when I ran a needle exchange program. So many regions and so many perspectives were represented. Adeeba Kamazulzaman, a physician from Malaysia, talked about Substance Abuse and Harm Reduction in the Tuesday plenary session – and made a personal appeal for the release of her close colleagues Drs. Arash and Kamiar Alaei who are detained by the Iranian government. There were great presentations and discussions around research, human rights and harm reduction. Caitlin Padgett of YouthRISE participated in many panels and events to increase the focus on youth with the harm reduction movement, and Stijn Gossens of INPUD stressed the importance of including drug users in all harm reduction discussions and strategizing.
A march to recognize that womens rights are essential to fight the AIDS Pandemic. The signs saying “Todos las mujeres, todos los derechos” mean “all women, all rights.”
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