Εμφάνιση αναρτήσεων με ετικέτα Liberia. Εμφάνιση όλων των αναρτήσεων
Εμφάνιση αναρτήσεων με ετικέτα Liberia. Εμφάνιση όλων των αναρτήσεων

Παρασκευή 31 Ιουλίου 2020

African women: asserting their rights


From Africa Renewal: 

Michelle Bachelet, executive director of UN Women, the world body’s new agency on gender equality issues. 
Michelle Bachelet, executive director of UN Women, the world body’s new agency on gender equality issues.
Photograph: UN Photo / Paulo Filgueiras

As elsewhere in the world, women in Africa are struggling for their fair share of political power and economic opportunity. In recent decades — thanks in great measure to their own organization and energetic efforts — they have made important strides. As Africa shakes off its legacies of autocratic rule, social marginalization and economic disarray, women are staking their claim to participate fully in their continent’s promising future.
But progress has been halting and uneven, and each step forward has been won against difficult obstacles and stubborn resistance. As in many parts of the world, gender inequalities remain deeply entrenched. Women suffer violence and discrimination across the continent. They lack access to decent work and face occupational segregation and wage gaps. They are still too often denied access to education and health care. Few women are represented in key political and economic decision-making positions.
Accelerating women’s empowerment is obviously critical for women themselves. But as the UN’s global agency for women, UN Women, emphasizes, gender equality is more than just a basic human right: “Its achievement has enormous socio-economic ramifications. Empowering women fuels thriving economies, spurring productivity and growth.” When UN Secretary-General Ban Ki-moon launched UN Women in 2010, he observed: “Where women are educated and empowered, economies are more productive and strong. Where women are fully represented, societies are more peaceful and stable.”
Over the years, Africa Renewal has frequently reported on and analyzed many different aspects of the struggles of African women for political, economic and social advancement. This special edition of the magazine – with the generous support of UN Women — brings together a number of those articles, most of them with new and updated material.


The Africa Renewal articles highlight important developments at the summit of political power, such as the adoption by the African Union (AU) of a legally binding protocol to the African Charter on Human and Peoples’ Rights on the rights of women. The AU has also declared the current decade, 2010-2020, as the “African Women’s Decade.” A few countries, such as Angola, Mozambique and South Africa have exceeded the 30 per cent benchmark for women legislators, while Rwanda has the highest percentage in the world. But in all African countries women still have a long way to go.
In some areas gender gaps have narrowed noticeably, as in primary schools, where nearly as many girls as boys are now enrolled. But completion rates remain low, and many girls still are unable to go on to secondary or tertiary education. Meanwhile, health care for women and girls has scarcely improved, while HIV/AIDS continues to exact a deadly toll on Africa’s women.
Repeatedly, the articles in Africa Renewal have noted that it is the hard work and commitment of women at the grassroots that can make the difference: the women farmers, traders, entrepreneurs and activists who struggle day-in and day-out to better their lives and improve the prospects for their families, communities and nations. If Africa is to have a brighter future, gender equality must be achieved. 

African women’s long walk to freedom

Across Africa, women’s movements are now putting more emphasis on decision-making power 
Across Africa, women’s movements are now putting more emphasis on decision-making power.
Photograph: Reuters / Mowliid Ibdi

Africa’s political independence was accompanied by a clarion call to eradicate poverty, illiteracy and disease. Fifty years after the end of colonialism, the question is: To what extent has the promise of that call been realized for African women? There is no doubt that African women’s long walk to freedom has yielded some results, however painfully and slowly.
The African Union (AU) now has a legally binding protocol to the African Charter on Human and Peoples’ Rights on the rights of women. The protocol spells out clearly women’s rights to equality and non-discrimination in a number of areas. It has been ratified by a growing number of African states, can be used in civil law proceedings and is being codified into domestic common law. The AU has also issued a Declaration on Gender Equality in Africa, under which member states are supposed to regularly report on progress.
The protocol and declaration both reflect and reinforce developments at the national level. Many African states have moved to enhance constitutional protections for African women — particularly in the area of women’s rights and equality. And the last two decades have seen the emergence of legislation to address violence against women, including sexual violence.
 
Political representation

These developments have been accompanied by improvements in African women’s political representation. The AU adopted, from its inception, a 50 per cent quota for women’s representation, which is reflected in the composition of the AU Commission.
Again, this standard reflects and reinforces efforts to enhance women’s representation at the national level. Angola, Mozambique and South Africa have exceeded the 30 per cent benchmark for their legislatures. Rwanda made history in 2008 when 56 per cent of legislators elected to parliament were women, the highest in the world. A few countries, including Nigeria, have seen women assume non-traditional ministerial portfolios, in defence and finance, for example. And Liberia also made history (“herstory”) by becoming the first African country to elect into office a female head of state, Ellen Johnson-Sirleaf.
Progress is evident, particularly in countries that have electoral systems based on or incorporating proportional representation. However, enhanced women’s representation has been harder to achieve in first-past-the-post electoral systems.
Even where there has been progress, the question is whether increased representation of women is catalyzing action by the executives and legislatures in favour of gender equality. That question arises because the battle for women’s representation is not only demographic (with political representation as an end) but also for gender equality (with political representation as a means).
Put another way, there has been a shift in the focus and strategy of the African women’s movement over the last two decades, from emphasizing capacity-building to improve African women’s access to resources to emphasizing decision making to enhance African women’s control over resources. This shift was made possible by real gains resulting from the capacity-building approach.
 
Education, poverty, health

These gains are most evident in African women’s education. Girls and boys are now at par with respect to primary school enrolment. Efforts to get girls into school have been accompanied by efforts to keep them in school and to promote role models by developing gender-responsive curricula. Gender gaps are also narrowing in secondary education. The real challenge now lies at the university level, both in the enrolment figures and in curricula to benefit young women. So much for the “illiteracy” element of the African independence clarion call.
Gains for women are harder to see in that call’s “poverty” element, however. It is true that since independence investments in micro-credit and micro-enterprises for women have improved their individual livelihoods — and therefore those of their families. Since African women have proved that they are good lending risks, micro-credit is now being offered not just by development and micro-finance institutions, but also by commercial financial institutions.
Yet there was a critique of such investments, especially in the decade of the 1980s when governments withdrew from social service delivery as a result of structural adjustment programmes. Under those circumstances, such investments essentially enabled redistribution among the impoverished, rather than at a larger level from the rich to the poor.
The end of that era thus saw a new focus on gender budgeting: looking at where national budget allocations and expenditures could enhance women’s status in the economy. Unsurprisingly, this approach has led African governments back towards public investments in social services.
It is now agreed, for example, that the benchmark for public investments in health in Africa is 15 per cent. The African women’s movement has called in particular for more to be directed towards reproductive and sexual health and rights. These areas are of critical concern to women, given the impact of HIV/AIDS, maternal mortality and violence against women, particularly in conflict areas. They are also of concern since African women’s continued lack of autonomy and choice over reproduction and sexuality lie at the heart of so much suffering. So much for the “disease” element of the independence call.
 
Where next?

Where to over the next 50 years, then? In light of the experience so far, the African women’s movement will be focusing not just on political representation, but also on the meaning of that representation for advancing gender equality and women’s human rights. And given recent retreats in Africa (such as the rise of the constitutional coup and “negotiated democracy”), the women’s movement will also be focusing on democracy, peace and security more broadly — that is, on the nature of the political system itself and not just on the means of getting into that system.
Economically, women will continue to focus on the macro-level, but in a deeper sense. What has emerged from gender budgeting efforts is the need to actually track budgetary expenditures, not just getting information about allocations.
It is also necessary to concentrate on the macro-economic framework for fiscal and monetary policies, especially in the context of stabilization programmes in response to the recent economic shocks. Previously that framework was assumed to be gender-neutral, but it clearly can have gendered consequences. This problem must be addressed to ensure that Africa’s growth will enhance women’s livelihoods.
Finally, the women’s movement will be focusing on reproductive and sexual health and rights. The battle over choice (including over gender identity and sexual orientation) is now an open one in many African countries. It is no longer couched politely in demographic or health terms.
The upsurge of conservative identity politics (in both ethnic and religious terms) is fuelling conflict on the continent. It constrains and dangerously limits women’s human rights, including reproductive and sexual rights. Such notions are not harmless — they have grave consequences for women’s autonomy, choice and bodily integrity. They therefore must be challenged.
African women’s long walk to freedom has only just begun.  

L. Muthoni Wanyeki is a former executive director of the Kenya Human Rights Commission.

 

Κυριακή 24 Μαΐου 2020

News from Africa




PanAfrikaniki
 

Παρασκευή 23 Αυγούστου 2019

Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon

www.ncbi.nlm.nih.gov

Abstract

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3–6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030.
 
Introduction

The goal to end AIDS as a public health threat by 2030 [] was the underpinning theme of the 10th International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-Limited Settings (2016 INTEREST Conference) held in Yaoundé, Cameroon, 3–6 May 2016. The meeting attracted 369 active delegates from 34 countries of which 22 were in Africa (Cameroon, South Africa, Nigeria, Cote D’Ivoire, Kenya, Uganda, Zambia, Zimbabwe, Botswana, Ghana, Senegal, Tanzania, Benin, Burkina Faso, Congo, Gabon, Guinea, Liberia, Malawi, Namibia, Rwanda and Swaziland). Spirited plenary debates on the UNAIDS 90-90-90 (90-90-90 refers to the targets of 90% of people living with HIV knowing their serostatus, 90% of those who know they are HIV-positive being on antiretroviral treatment [ART] and 90% of those on ART achieving viral suppression. This translates into 73% of all people living with HIV being virally suppressed) treatment cascade goal for 2020 [] and on antiretroviral pre-exposure prophylaxis (PrEP) took place. There were presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens [].
In addition to oral, mini-oral and poster presentations, early morning Joep Lange research career guidance sessions saw mid-career and senior investigators explain how they got started on a research career and give advice on how to get funded, choose a mentor and get published. Parallel research grantspersonship sessions were presented by ANRS (France Recherche Nord & Sud Sidahepatites); Fogarty International Center, US National Institutes of Health; and EDCTP (European & Developing Countries Clinical Trials Partnership).
 
HIV in Cameroon

Cameroon’s Minister of Public Health, André Mama Fouda, opened the conference. Dr JB Elat, Permanent Secretary of the National AIDS Programme, presented an overview of HIV in Cameroon. HIV prevalence in 2011 was 4.3%, with urban populations and women disproportionately affected: 5.6% of women versus 2.9% of men. Compared to the general population, men who have sex with men (MSM) have 8–14× higher (24–44%), truck drivers have 5× higher (16%) and female sex workers (FSW) have 6× higher (36%) HIV prevalence. Clients of FSW account for 36% of new HIV infections annually. After Cameroon’s ART programme began in 2000, HIV prevalence fell by 20% between 2004 and 2011 from 5.5% to 4.3%. Prenatal consultations for prevention of mother-to-child transmission (PMTCT) increased steadily from 2009, with attendance reaching 74% in 2015. Between 2005 and 2015, the number of people on ART increased 10-fold and approximately 7,000 children now receive ART. In 2015, 882,639 Cameroonians were tested for HIV. Cameroon aims to increase access to HIV testing and treatment services, reduce stigma, strengthen supply chains, tailor HIV prevention for key populations and build civil society capacity. Poor retention in care remains a weak link in Cameroon’s progress towards 90-90-90 [].
 
Achieving 90-90-90

Passionate debate presenting opposing viewpoints on 90-90-90 saw pessimists emphasize factors preventing achievement of the Fast-Track Initiative targets: insufficient resources (human, infrastructure, financial), inability to reach all people living with HIV (PLHIV) and retain them in care, risk of emerging drug resistance and international donor fatigue. Optimists highlighted the 17 million PLHIV on ART globally, opportunities to halt the HIV epidemic now and examples of countries close to achieving 73% viral suppression targets. Although achieving 90-90-90 is judged desirable, during the debate more conference participants became convinced the proposed time frame is too short.

The first 90: HIV testing

More than 150 million HIV tests are conducted in low- and middle-income countries annually and although the goal of diagnosing 90% of PLHIV is achievable, testing must be performed with 100% accuracy because of the profound consequences of misdiagnosis at both the individual and population level []. Outreach programmes are necessary for marginalized, stigmatized, often criminalized and hard to reach key populations. Community-based testing can reach healthy people early in their infection and link them to care []. Identifying all HIV+ children and adolescents requires case-finding approaches for chronic HIV survivors, intensified facility-based testing and decentralized and simplified HIV testing at point of care [].

The second 90: ART

The World Health Organization recommends ART be offered immediately to everyone diagnosed with HIV infection, regardless of their CD4+ T-cell count measuring immune status []. Globally, 17 million people (46% of PLHIV) are on ART []. Voluntary licensing is enabling generic companies to provide antiretroviral (ARV) drugs in effective, well tolerated, and quality-assured individual or combination formulations for 100–130 USD per year. Voluntary licensing of drugs such as dolutegravir and tenofovir alafenamide may reduce this cost to 60 USD/year; however, more efficacy and safety data in pregnant women and HIV–TB-coinfected patients are needed []. Robust supply chains are essential to prevent stock-outs and ensure continuity of ART. Fulfilling high-income countries’ commitment to spend 0.7% of gross national income on overseas development assistance [] can assist resource-limited countries but increasing domestic health-care funding in sub-Saharan Africa to reach the Abuja target of 15% of annual government expenditures being devoted to health will reduce donor dependency and facilitate sustainable programmes []. Building on the global success of generic ART, generic versions of drugs for tuberculosis, cancer and hepatitis B and C could facilitate drug access for people in resource-limited settings around the world at very affordable prices.

The third 90: viral suppression

Tracking viral suppression requires rapid scale-up of viral load monitoring, necessitating improved efficiencies in sample collection, transportation and laboratory performance; timely transmission of results to clinics and patients; and rapid appropriate action []. Treatment retention in Africa at 36 months is estimated at only 65% []. Poor adherence leads to drug resistance [], requiring effective interventions, including mHealth and group delivery, to support retention in care and adherence. Innovations must be anchored in a comprehensive understanding of the multiple barriers facing people on ART, including adolescents who have important retention and adherence challenges.
The WHO recommends that ART scale-up be accompanied by high-quality HIV drug resistance surveillance, achieved by investing in human and laboratory resources, innovative and efficient technical approaches, robust supply chains and quality assurance measures. Political and community commitment is needed to overcome limited laboratory capacity in sub-Saharan Africa and support studies identifying suitable ARV options. These include the ultra-deep pyrosequencing work showing that protease inhibitors and mara-viroc are likely to be effective in young Cameroonian children (the author of this abstract received the Joep Lange award for the top-scoring abstract by an African scientist at the 10th INTEREST Conference) [], as are protease inhibitors in Ugandan children [].
 
HIV prevention

More than 10 million voluntary medical male circumcisions (VMMC) have been performed, with high adult MC prevalence countries moving to establish sustainable VMMC HIV prevention programmes focused on early infant and early adolescent MC [].
PrEP with ARV drugs has achieved regulatory approval in South Africa and Kenya, following WHO guidance recommending PrEP when HIV incidence is 3% or more []. Follow-on studies and demonstration projects of oral PrEP among serodiscordant couples and MSM have shown higher adherence than in trial settings, possibly because people know that they are taking an effective product []. Novel products and delivery options under investigation include injectables that would be taken every 2 to 3 months, vaginal gel and ring formulations, and monoclonal antibodies. PrEP works for anyone experiencing a high risk of HIV exposure during a specific time of his or her life. A debate on whether Africa was ready for PrEP persuaded some who were sure it was ready to wonder whether regulatory, logistical, equity and other issues had all been adequately addressed. Importantly, PrEP implementation requires intensified investment in HIV testing strategies across Africa, which would result in the increased knowledge of serostatus that can improve entry into the 90-90-90 treatment cascade.
 
Vaccine and cure

The search for a vaccine, following the promising results of RV 144 [], includes active and passive approaches to HIV prevention. Clade-specific trials in South Africa and elsewhere are part of the pox-protein public-private partnership (P5) evaluating pox-protein candidates. Hypothesis-generating Phase IIb trials are underway of passive immunisation strategies involving monoclonal antibodies using trivalent and tetravalent vectors to obtain broader coverage against HIV []. Research to understand differences in viral reservoirs with implications for cure strategies has found that Ugandans without HIV infection have increased immune activation and lymph node pathology that resembles early HIV infection among patients in Minnesota, USA []. If they acquire HIV in an environment where life-long exposure to various pathogens already predisposes them to high levels of T-cell activation, they may develop a larger HIV reservoir leading to persistent immune activation, subsequent lymph node fibrosis and reduced immune reconstitution. Pre-existing T-cell activation thus may account for population differences in responsiveness to immune therapy strategies, with fibrosis limiting diffusion of therapeutic agents into lymph nodes where the virus replicates.
 
Key populations

Success in bringing down HIV prevalence among sex workers in Rwanda, Burkina Faso, Kenya and Namibia highlights data gaps on successful interventions among men involved in sex work, regular partners of female sex workers and girls under 18 years who receive money or goods in exchange for sexual services. Exciting new developments include studies of PrEP use, integration of HIV and sexual and reproductive health services, and use of mobile technology, social media and biometric measures to assist in studying mobile sex work populations. Striking data on the use of heroin, tramadol and other opioids have led to the African Union Plan of Action on Drug Control that recognizes the burden of HIV and hepatitis C among people who inject drugs in Africa. Political barriers to holistic harm reduction remain for illicit drugs and for alcohol, a psychoactive substance with dependence-producing properties that has been strongly linked to HIV risk in Africa and around the world []. MSM have high HIV risks and continue to be criminalized in many African countries, making it difficult to reach them with services. In eight African countries, between 25 and 65% of these men aged 18–19 years are meeting male sexual partners online [], suggesting that social media and mobile platforms could help increase their access to HIV prevention and treatment.
 
Emerging pathogens – lessons learned for and from HIV

The Ebola epidemic of 2014–2015 and epidemics of re-emerging pathogens, such as Zika and Lassa Fever, have shown that high-quality studies can run alongside the outbreak response, but health-care systems must be strengthened now before more epidemics occur. Designing and running Ebola clinical trials proved challenging in Guinea, Liberia and Sierra Leone. In Guinea, a ‘ring vaccination’ trial design was used to evaluate a vaccine candidate, with real-time modifications to take account of the rapidly changing epidemic and logistical issues []. The impact of favipiravir on Ebola virus disease was evaluated in a single arm, proof-of-concept trial that found it well-tolerated but could not draw firm conclusions about efficacy []. Ideally, outbreaks of emerging and re-emerging pathogens should be anticipated and potential drugs and vaccines for them investigated on an ongoing basis so that efficacy trials can be initiated quickly when an outbreak occurs. Engaging stakeholders, including community stakeholders, at all stages of a clinical trial contributes to robust trial design, facilitates trial conduct by addressing rumours and enhancing participant retention, and helps ensure ownership of the results for action []. Addressing ethical issues is key to ensuring that studies are conducted ethically, communities support them and post-trial legacies are assured []. Robust public health infrastructure, appropriate legislation and community involvement were key in containing an Ebola outbreak of 20 cases in Nigeria and subsequent health-care system investments have upgraded disease surveillance, research infrastructure and treatment facilities [].
 
Conclusions

Although ART coverage in sub-Saharan Africa increased from 24% in 2010 to 54% in 2015, reaching a regional total of 10.3 million people [], late diagnosis of HIV infection, loss to follow-up and poor ART adherence contributed to 790,000 people dying of AIDS-related causes in 2014. New adult HIV infections remain a concern: 25% are adolescent girls and young women and more than 20% are from key populations. An estimated 25.5 million people are living with HIV in sub-Saharan Africa, with women accounting for 56% []. There has been a 48% decline in new HIV infections among children in the 21 Global Plan priority countries [], but 190,000 African children acquired HIV infection in 2014 [].
The 10th INTEREST Conference heard a call for leadership and activism among HIV investigators and physicians to show global solidarity with PLHIV worldwide and to ensure that resources are used effectively. Sub-Saharan Africa loses over 150 billion USD/year through illicit financial flows [], corruption and money laundering []. This money could replace international donations and fund health care throughout the continent. At the closing ceremony, the Yaoundé Declaration [] (Additional file 1) was read out, calling on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030 [,].
 
Acknowledgments

The authors thank Wendy Smith (Wordsmiths International Ltd, Wells, UK) for providing meeting notes that were used as background materials for writing the manuscript. The INTEREST 2016 organizers acknowledge the support of the Ministry of Public Health, Cameroon; the National Institutes of Health and the Fogarty International Center, USA; the ANRS (France Recherche Nord & Sud Sidahepatites); and the following companies: Gilead Sciences, Janssen Pharmaceuticals, AbbVie, ViiV Healthcare, Roche and Mylan. 

See also

The History of AIDS in Africa

AIDS (tag in our blog)
 
Footnotes

Additional file
Additional file 1: The Yaoundé Declaration can be found at https://www.intmedpress.com/uploads/documents/3939_Hankins_Addfile1.pdf
Disclosure statement
All 12 authors reviewed previous drafts of the manuscript and approve its contents. None of the authors have a conflict of interest, with the exception of CABB of the company Virology Education that provided logistical support for the conference. 
 
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