Health and Human Rights » Sub-Saharan Africa

A Rights-Based Approach to Fighting HIV/AIDS in Ugandan Prisons

OpenForum — Wed, 10 Aug 2011 21:38:49 +0000

Over at Global Pulse, Human Rights Watch researcher Katherine Todrys guest blogs on the HIV epidemic in Uganda’s penitentiaries. Uganda, she explains, has often been presented as a success story in the global fight against HIV/AIDS, and has received over $1 billion from the US for AIDS programs. Many HIV-positive Ugandans have been excluded from these efforts, though, including gay men, drug users, sex workers, and prisoners.

In sub-Saharan African prisons, the prevalence of HIV ranges from twice as high to fifty times as high as levels for the non-imprisoned in the same regions. As part of her research on prison health monitoring for a new Human Rights Watch report, Todrys toured 16 Ugandan prisons and interviewed 164 inmates. Overcrowding, poor ventilation, sex trading, and lack of condoms led to increased infections. Yet despite high rates of transmission, only one of the 223 prisons in Uganda has a medical facility equipped to provide adequate treatment for HIV/AIDS and tuberculosis. Only one-tenth of one percent of PEPFAR funds to Uganda are directed towards prison health.

According to Todrys, “There is a better approach: fund human rights-based approaches, which emphasize government accountability and evidence-based programs—that is, programs that have been shown to work. Pressuring the Ugandan government to end abusive practices that increase HIV transmission, for example, costs very little compared with treating HIV after infection has occurred.”

The abuses that must be addressed include the slow-moving criminal justice system that leads to overcrowding in prisons, the criminalization of men having sex with other men, which leaves all-male prisons devoid of condoms, and forced labor in prisons that worsen the health of those suffering from HIV/AIDS. Ugandan HIV programs must be scaled up to address the massive HIV epidemic in prisons, and Todrys insists that a rights-based approach is the only way to reach this marginalized population.

Photo: Olek Remesz via Wikimedia Commons

Reducing the health gap: A global plan for justice

OpenForum — Wed, 21 Jul 2010 18:22:19 +0000

A child born in sub-Saharan Africa is twenty-five times more likely to die in the first five years of life than one born in the United States. If she lives to child-bearing age, she is a two hundred times more likely to die in labor. Overall, she will die thirty years earlier than the American child. If this health gap is unfair and unacceptable, then how can the international community be galvanized to make a genuine difference?

To answer this question, Lawrence O. Gostin, Faculty Director of the O’Neill Institute at Georgetown University Law Center, proposes an international call to action through the adoption of a Global Plan for Justice (GPJ), a voluntary compact among states and their partners in business, philanthropy, and civil society to redress health inequalities. Under the GPJ, states would devote resources to a Global Health Fund based on their ability to pay — for example, 0.25% of Gross National Income (GNI) per annum — in addition to maintaining current development assistance devoted to programs and activities of their choice. Global Health Fund resources would be allocated based on the health needs of developing countries measured by poverty, morbidity, and premature mortality.

Click here to read the full article: “Redressing the Unconscionable Health Gap: A Global Plan for Justice,” Harvard Law and Policy Review 4 (2010), pp. 271–294.

For an explanation of how the GPJ fits into other innovative Global Health Governance strategies, see http://www.law.georgetown.edu/oneillinstitute/documents/2010-07_Global_Plan_for_Justice.pdf and http://www.acslaw.org/node/16479 (explaining the progression from a Joint Learning Initiative for National and Global Responsibilities for Health, to a Global Plan for Justice, through to a Framework Convention on Global Health). See also, Lawrence O. Gostin, Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health, 96 Geo. L.J. 331 (2008), http://ssrn.com/abstract=1014082, http://scholarship.law.georgetown.edu/ois_papers/1/.

Fighting TB from every angle: New breakthroughs in detection and treatment

OpenForum — Fri, 24 Jul 2009 13:33:31 +0000

Two new studies suggest promising methods of detecting and treating TB despite discouraging reports about the increasing global prevalence of multi-drug resistant tuberculosis (MDR-TB) and extensively-drug-resistant tuberculosis (XDR-TB). The first study underlines the importance of follow-up visits in detecting TB among immigrants and asylum seekers entering the US. While screening is crucial in preventing the spread of TB, identifying TB-infected persons can be difficult; blood or sputum smear testing can take weeks to complete and has only a 50% accuracy rate. Screening of immigrants and asylum seekers is especially important, as the TB rate in foreign-born persons is 9.7 times higher than in US-born persons. Researchers found that follow-up visits with immigrants after their entry into the US were effective in identifying and reducing the number of TB patients in the US.

The World Health Organization estimated 9.27 million cases of TB in 2007, a significant increase from 6.6 million cases in 1990. The majority of these cases are found in the South-East Asia region, which accounts for 34% of all new cases, and sub-Saharan Africa, which has the highest TB mortality rate in the world. People with health conditions that weaken the immune system like HIV infection, substance abuse, or malnutrition are more susceptible to the disease. A recent study showed that one-fourth of all TB-related deaths were in patients who were also HIV-positive.

No new classes of TB drugs have been created since the 1960s, and few clinical trials have been conducted using modern regulatory standards. To address this need, research groups are focusing on novel approaches to TB therapeutics. The Global Alliance for TB Drug Development (TB Alliance) recently announced four research partnerships that will explore new methods of treating drug-resistant TB. One of these collaborations, led by Anacor Pharmaceuticals, will provide any new compounds developed to the TB Alliance royalty-free.

Another recent study has found that in an eight week exploratory trial with MDR-TB patients in South Africa, the experimental drug TMC207, in combination with the standard MDR-TB drug cocktail, cleared TB bacterial traces in the sputum of 48% of patients, as compared to 9% of patients given only the standard cocktail. The experimental drug appeared to work faster than standard MDR-TB drugs in clearing TB, possibly because of its unique mechanism of action. Current treatment courses last for at least 18 months because MDR-TB drugs take more time to effectively clear the disease. For example, 81% of MDR-TB patients in Peru treated with DOTS-Plus therapy were cured after four months, versus only 40% after two months. Further proof-of-efficacy studies are being conducted with TMC207 now, and will demonstrate if it is effective as a long-term treatment for various types of TB. If approved, this drug could be a significant advance over current treatments, which can be lengthy and toxic.

Denial of the right to health in Zimbabwe is a crime against humanity

OpenForum — Fri, 08 May 2009 03:36:23 +0000

The non-profit organization, Physicians for Human Rights (PHR), published a report in January of 2009 on the cholera outbreak and related health crises in Zimbabwe. Outlining the outbreak in painful detail, the report suggests that the scope of the disaster, largely due to government mismanagement and neglect on a national scale, constitutes crimes against humanity. PHR thoroughly examined the wide-spread public health crisis in the context of the 28 year rule of Robert Mugabe and urges further investigation and involvement from the international community and possibly the International Criminal Court.

Article 7 (1) (k) of the Rome Statute of the International Criminal Court describes crimes against humanity to include “other inhumane acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health.” Zimbabwe is not a signatory of the Rome Treaty. However PHR asserts that crimes against humanity, as defined by the Rome Treaty, are within the bounds of customary international law. Because Zimbabwe has disregarded the epidemic and openly blocked international aid resulting in the deaths of thousands, PHR believes this constitutes a crime against humanity.

The situation in Zimbabwe dire. During August of 2008, the country saw the beginning of a cholera outbreak that the World Health Organization has categorized as “explosive.” Cholera is easily treated with fluids administered orally or intravenously while the infection runs its course. Without this simple intervention, cholera leaves its victims with severe dehydration that can lead to death. An update published by the World Health Organization on February 20, 2009 listed nearly 80,000 cases and almost 4,000 as recorded by Zimbabwe’s Ministry of Health and Child Welfare (MoHCW). The WHO did provide some encouraging data as it estimated the epidemic peaked in November of 2008.

As PHR detailed, the epidemic spread with unusual vigor because of inadequate or non-functioning sewer and sanitation systems. In December of 2008, the New York Times described a scene of children playing in “streets that flow[ed] with raw sewage.” Further exacerbating the epidemic has been the near complete collapse of the public health system, caused in part by the rapidly declining economic situation. The Zimbabwe dollar is now worthless due to hyperinflation. In January of 2009, the country released a 100 trillion Zimbabwe dollar note that at the time was worth a mere 37 US dollars. Health care workers stopped showing up for work in the fall of 2008 as the monthly salary ceased to cover the cost of transportation to work for a single day. Hospitals lacking essential staff shut their doors. Patients that need treatment either cannot get treatment or must pay hundreds of US dollars in fees for private healthcare.

Despite the recent decline in deaths, there remain significant challenges in protecting the right to health of all citizens of Zimbabwe. There are significant barriers to access to health care including the high cost of private health services and a public health system that has completely collapsed. The nation will continue to be in danger of a resurgence of an outbreak as long as the sanitation and sewer systems remain in ill repair. The high prevalence of HIV and widespread malnutrition makes the population particularly susceptible to infections such as cholera.

Finally, this epidemic has the potential to lead to serious problems, not only for the people of Zimbabwe, but for the entire region. Already neighboring countries have reported an increase in the number of reported cases of cholera as people flee from Zimbabwe to escape political turmoil and seek medical care. Clearly, a drastic intervention is needed to protect the right to health of so many.

Additional Resources:

NYTimes Video: Confronting Rape on Zimbabwe’s Border

NYTimes Op-Ed: Zimbabwe is Dying

UNICEF: Widespread Collapse of Social Services Creates “Twin Disaster” in Zimbabwe

UNICEF: The Tragedy of Zimbabwe’s Cholera Outbreak

The Zimbabwean: Who Controls the Water Determines the Severity of the Cholera