New development goal falls short of protecting those most at risk of HIV

This ISHTAR wellness center in Nairobi works to ensure that gay men have access to non-discriminatory HIV and sexual health services. Credit: Corrie Wingate for the International HIV/AIDS Alliance.

This blog was originally published by The Huffington Post on May 8, 2015.

Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services.  As a result, he is HIV-negative.

Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development goals which expire later this year).

Goal 3 of the SDGs is to “ensure healthy lives and promote well-being for all ages.” Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world — like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).

Global health needs more strange bedfellows, unorthodox partnerships

Puppets walking into the audience at the SwitchPoint conference in Saxapahaw, North Carolina.

The was originally published on the Huffington Post on July 14, 2014.

In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.

The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.

Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.

Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

World Health Assembly has its frustrations, but we have to try

GENEVA, Switzerland — My first World Health Assembly closed yesterday and I am trying to assess what difference it made, how the Global Health Council fits in and whether it is worth our time. I don’t even think I knew what WHA was when I was at PSI. I had heard of it — barely — but had no real idea what it did or why PSI should care.

I have since found out that the WHA is the mechanism through which the World Health Organization (WHO) is governed by its 193 member states, and is the world's highest health policy-setting body. The main tasks of the WHA are to approve the WHO program and budget for the next two years, and to decide major health policy issues.

I came away skeptical of our odds of influencing very much the global health dialogue that takes place in Geneva every may. But I also came away convinced that we — as leaders of civil society on global health issues — have to make every effort on behalf of our members who care about these issues, and very few of whom can come to Geneva themselves. That is one of the many things that they pay us to do when they sign on as members.

And just as I now feel that it is difficult for GHC — or any other member of civil society — to influence the G8 or G20, it is a very appropriate role for us to play as convener and representative of civil society on global health.

I was appalled at how civil society was marginalized (or even ignored) in the larger plenary meetings, where we were confined to an area that was way too small and where we could not hear anything if we did not have headphones, most of which did not work anyway.

But I was delighted that in other “special meetings” and “side events,” we could be sitting next to the health minister of Cambodia or Tanzania, and have just as good a chance of them as being called upon by the moderator to ask a question.

And, in the end, the Global Health Council got three minutes to address all 193 country members of the WHO: http://tinyurl.com/28m5kye. Where else would be get that opportunity?