Complete Wellness

NEW DELHI, India, Aug 31 2021 (IPS) – With elections right round the corner in Canada, Prime Minister Justin Trudeau recently said that a re-elected Liberal government would spend billions in the coming years to hire family doctors. This says, Justin Trudeau promised that the Liberals would spend $3 billion over four years starting in 2022 to hire 7500 family doctors and nurses as well as tax and student loan incentives for health professionals who set up shop in rural or remote communities and also pledges an extra $6 billion to wrestle with wait lists.

Dr. Shafi Bhuiyan

A 2019 states that there were 91,375 physicians in Canada, representing 241 physicians per 100,000 population. According to the Canadian Medical Association, around five million Canadians don’t have a primary care physician, or family health care team.

Canada’s overburdened healthcare system is yet to tap into its advantage all the untapped talent and skills available to it, as seen during the significant role Internationally Trained Medical Doctors, pandemic, supporting the vaccination clinics, working as contact tracing managers and mental health advisors.

Canada is losing out by not involving and including ITMDs, says Dr. Shafi Bhuiyan, a health professional and Chair of ITMDs Canada Network (iCAN). “Over 4.5 million Canadians are not able to find their family physician, as a result the wait time to see a doctor has been increasing continuously, which is also resulting in social peace and justice disruption.”

Canada currently has ITMDs, and the visa process, Bhuiyan says, has “a very thorough and rigorous screening program by the Canadian CIC, where medical experience plays a key role along with other requirements to enter the country, but once they come to Canada, due to multiple reasons, they lose out on securing a residency position”.

Saida Azam

Saida Azam is one such ITMD who moved to Canada almost three years ago with her husband for better career opportunities. Azam, a medical professional with experience working in India and Oman, says, “I have performed a number of surgeries and deliveries, I worked as a family physician for three years, but right now I am waiting to be able to do that here.

“The knowledge that I have in this field is really good, the only difference in relation to the Canadian context, with medicine, is that when I move from one territory or one country to another, things will be different, from the patients to the region and other such things. That doesn t mean that I have less knowledge or the local doctors here have more. What would help people like me is, if there were a training program in place for Internationally Trained Medical Doctors to integrate us better into the Canadian healthcare system.

“Canada is home now, I wouldn t say I am completely disappointed, but I hope that I will be able to share my expertise and pursue my career, says Azam.

One of the key challenges for ITMDs remains cost associated with licensing examinations, the CaRMS application process is often a barrier for newcomers. According to this , 47 % of foreign-educated health professionals are either unemployed or employed in non-health related positions that require only a high school diploma.

The on-going Pandemic has been a time of crisis all over the world, and with shortage and with the under-utilization of health-care workers in Canada, the country is only creating a strain on its health care system by not including and leveraging on its ITMDs.

The (COVID19) report says, “by encouraging the creation of new jobs in the health sector globally, the report suggested a unique opportunity both to respond to the growing global demand for health workers and to address the projected shortages. During the COVID-19 pandemic, many OECD countries have recognised migrant health workers as key assets and introduced policies to help their arrival and the recognition of their qualifications.”

In 2020, Canada, where annual to around 300,000 new immigrants, announced its , saying it would target the highest level of immigration in its history by welcoming 401,000 immigrants in 2021, 411,000 immigrants in 2022, 421,000 immigrants in 2023.

“The only time Canada welcomed over 400,000 immigrants in a year was in 1913, when it admitted 401,000 newcomers. It has never come close to this figure again,” this .

The International Labour Organization (ILO) says developing countries host more than one-third of international migrants in the world and most immigrants are migrant workers and are employed either formally or more often informally in their countries of destination.

This by the ILO states the importance of immigrants and how “immigration plays a key role in the destination countries development and public policies can play an important role in enhancing its contribution to the development of destination countries. Excluding immigration from development strategies can represent missed opportunities for host countries.”

“The Canadian government is missing out by not including a pool of talent it has to its access, if these hurdles can be removed, and instead replaced by a more simpler and transparent process towards obtaining approved medical licence, it would be a win-win situation for all,” says Bhuiyan.

If Canada is able to overcome these systemic barriers and inequity towards its ITMDs, with a pool of talented immigrants, it has the potential that will not only impact the countries economic prosperity, immigrants alter the country’s income distribution and influence investment priorities and as taxpayers contribute to the public budget and benefit from public services.

Africa can expect new spikes in COVID-19 every six months, a report by the Tony Blair Institute for Global Change. The continent with its low vaccination rates could continue to be vulnerable. Credit: USAID/South Africa

New York, Mar 11 2022 (IPS) – Countries on the African continent have a pattern of a six-month break before a new COVID-19 spike happens, researchers at the Tony Blair Institute for Global Change have said in a newly released report.

Marvin Akuagwuagwu, a data analyst in the Africa COVID-19 Policy unit at the Institute, told IPS that it’s the countries with the lowest vaccination rate that are most at risk.
Related IPS Articles

According to from the African Union CDC, the Central African Republic, South Sudan, and Chad are among the countries with the lowest percentage of the vaccinated population – some as low as less than one percent.

These other countries on the continent can learn from Rwanda’s approach, which Akuagwuagwu said is a success story.

“Rwanda has significantly ramped up its vaccination and testing programmes which has reduced their case numbers and the overall impact of COVID-19,” he said.

“With their vaccination rate at almost 60 percent and a positive case rate of less than 10 percent, Rwanda is a good example for other African countries to emulate, particularly for countries in Sub-Saharan Africa that face similar challenges.”

However, vaccine rollout isn’t an issue of supply but a result of wealthier countries , contributing to a grave vaccine inequity. Africa has received six percent of the world’s vaccines, despite the continent hosting seventeen percent of the world’s population, according to the Brooking’s report.

And this only exacerbates the pattern that Akuagwuagwu and his co-author Adam Bradshaw discovered in their report.

Excerpts from the interview follow.

Inter Press Service (IPS): You mentioned there is a pattern of a new wave hitting Africa roughly every six months. How does this affect the continent of Africa specifically?

Marvin Akuagwuagwu (MA): We identified a trend that about every six months, a Covid-19 wave impacts Africa. This was the case with Beta, Delta, and Omicron.

Omicron was like a flash flood – it did some serious damage but thankfully didn’t lead to mass deaths. However, we may not be so lucky next time – the next variant may be more severe, especially in countries with low levels of protection, such as in Africa.

This means we now have a six-month window of opportunity to vaccinate Africa against Covid-19 before the next variant appears – we need to make progress towards achieving the WHO target of vaccinating 70% of the population. TBI is working with a number of countries across Africa to support their vaccine rollout to help get there.

IPS: Why do you believe lockdowns are being approached more cautiously and are “not always the best course of action”?

MA: Lockdowns are effective, but they are not always the best course of action to tackle Covid-19 due to their negative economic and social impacts.

As the virus evolves and we learn more, countries in Africa are gradually moving away from blanket lockdowns. We now have a range of tools in the toolbox to tackle Covid-19 and lockdown is only one of many options.

When the pandemic first started, no one had ever been exposed to Covid-19 – now billions of people have been infected or vaccinated, so it’s a different ballgame, and we need to adapt with it.

IPS: With the six-month window between variants, are there spill-over effects? (For example, even though Omicron wasn’t as bad as Delta, were any Delta effects that spilled over to the phase where Omicron was present)?

MA: The low testing and vaccination in Africa during the Delta wave spilled over to the Omicron wave. African countries have just started ramping up their vaccination and testing programmes, which were significantly lower in the Delta wave.

Without a continued acceleration of vaccination programmes, Africa will remain behind other regions in vaccination rates. International actors, donors, and partners should listen and respond to African countries to adequately support their vaccination and community engagement programmes and enhance their data management systems and associated human resources required.

IPS: How does the current financial inflation affect the measures you’ve proposed?

MA: The current financial inflation impacts the measures we have proposed as they require adequate funding. However, strong political will and community engagement are catalysts to enhancing these measures and curbing health and social inequalities caused by the pandemic.

IPS: One of the recommendations suggests: “increase testing and genomic sequencing to reduce transmission.” How many countries have the economic capacity and manpower to ensure this? How realistic is this goal?

MA: We understand that this is a significant challenge for low- and middle-income countries, but the alternative is far worse – serious illness, lockdowns, and deaths which also affect the economy and society at large.

It goes back to global cooperation – the Tony Blair Institute for Global Change is working in Africa to build long-term resilience in data, vaccine, and testing infrastructure and provide greater institutional strength to withstand future Covid-19 waves. We support governments to build their capacity and deliver for their populations.

We are calling for global leadership to develop a global pandemic plan to support the Global South to vaccinate their populations and increase testing.

IPS UN Bureau Report

The 24th International AIDS Conference is taking place in Montreal, July 29 to August 2.

A man is tested for HIV at a health centre in Odienné, Côte d’Ivoire. Credit: UNICEF/Frank Dejongh

MONTREAL, Aug 2 2022 (IPS) – This week, the global HIV response community is to address the crisis of stalling progress that is putting .

Delegates here are clear on two things: first, the world is not on track to end AIDS, second, the world can still get on track and end AIDS as a public health crisis by 2030, but only if leaders are bold. This includes removing laws which are perpetuating the pandemic.

Punitive and criminalizing approaches to law have been catastrophic for the AIDS response. They need urgently to be repealed.

When people are targeted by punitive laws, they fear the government, and many hide from it. And this lack of trust spills quickly over into responding to a pandemic: a government that proposes to lock a person up one day is unlikely to be trusted when it sends them to an HIV test the next. When people fear public shaming, many try not to be seen. Too often, this means people miss out on HIV prevention, treatment, and care.

The evidence is clear: punitive laws that push people into the shadows are continuing to drive HIV.

In countries that criminalize consensual same-sex sexual activity, the evidence is clear that the risk of acquiring HIV is higher, access to HIV testing is lower and populations remain hidden, underground.

We know that men who have sex with men living in countries where they are not criminalized are half as likely to be living with HIV compared to countries where they are criminalized, and eight times less likely to be living with HIV compared to countries with extreme forms of criminalization.

Gay men and other men who have sex with men are three times more likely to know their HIV status if they live in a country that does not criminalize same-sex sexual behaviour. Population size estimates for gay men and other men who have sex with men are also more likely to be implausibly low where such criminal laws exist.

So too, laws which criminalize gender identity, HIV status, drug use, and sex work, discourage and obstruct people from accessing vital health services: the costs of these laws remaining on statute books would include millions of lives lost and the perpetuation of the AIDS pandemic.

The laws described above that criminalize same-sex sexual conduct have also been utilized to target trans people in many countries, alongside laws prohibiting cross-dressing or “impersonating the opposite sex” as well as petty offence laws.

The use of these criminal laws perpetuates transphobia, discrimination, hate crimes, police abuse, torture, ill-treatment and family and community violence. It obstructs trans people from access to HIV prevention, treatment and care.

In 36% of countries with available data, more than 10% of transgender people reported avoiding healthcare in the last 12 months due to stigma and discrimination. Studies show that transgender people who have experienced stigma in health care settings are three times more likely to avoid health care than transgender people who have not experienced stigma.

Criminalization of HIV non-disclosure, exposure or transmission undermines effective HIV prevention, treatment, care and support because fear of prosecution discourages people from seeking testing and treatment, and deters people living with HIV – and those most at risk of HIV infection – from talking openly to their medical providers, disclosing their HIV status or accessing available treatment services.

Criminalization of drug possession for personal use propels new HIV cases. The presence of criminal laws and associated enforcement has been associated with higher rates of needle sharing, increased HIV risk behaviours, reduced access to HIV services and increased prevalence of HIV.

Where sex work is criminalized, HIV rates are seven times higher than in countries where it is partially legalized. In jurisdictions with enabling legal environments, prevalence of HIV among sex workers is similar to the rest of the population, indicating it is not involvement in sex work that creates HIV risk, but the lack of an environment that enables sex workers to protect their health and wellbeing.

Criminal laws prevent sex workers from being able to screen clients, negotiate condom use, or access the protection of law enforcement if they are in danger of, or experience, physical and sexual violence. Fear of stigma or arrest can also prevent sex workers from being able to access HIV services on an equal basis with others.

Studies have long shown that decriminalization of sex work could avert between 33-46% of new HIV infections among sex workers and their partners.

The criminal law is one of the harshest tools that governments wield, and one of the most blunt. Punitive approaches are harm where help is needed. They ferment stigma, fear and hatred and are perpetuating a health disaster.

We have powerful reasons to hope, however, that with a strong push, punitive approaches to HIV can end.

We have the high-level political declaration agreed last year at the United Nations General Assembly High-Level Meeting on AIDS. One of the critical commitments that countries made was to reform laws that create barriers to accessing HIV services or increase stigma and discrimination, in order to end AIDS as a public health threat by 2030.

We have support available on how to most effectively reform laws so they support rather than undermine the HIV response. The Global Partnership for Action to Eliminate all forms of HIV Related Stigma and Discrimination, is bringing together governments, civil society and the United Nations, to exchange learning on what works.

One key lesson is that for law reform to have maximum success, changes should be shaped by the communities most affected, from the start through to implementation.

We are seeing that law reform is not only possible, it is happening across all continents. In recent years sparked, by court judgements and law reform efforts, punitive laws are continuing to disappear.

Last year the Bhutanese Parliament passed a reform which ended the criminalization of same sex relationships, Botswana s Court of Appeal upheld a ruling that decriminalized same-sex relationships, and Angola began implementing their new criminal code which no longer criminalizes same-sex relationships.

This year already both Belgium and Victoria, Australia have removed laws criminalizing sex work, and Zimbabwe has decriminalized HIV exposure, non-disclosure and transmission.

We have the evidence of what works. It is no coincidence that the government of New South Wales, Australia, a jurisdiction that does not criminalize sexual orientation, gender identity, HIV status, or sex work, recently announced it is on track to eliminate new HIV infections by 2025.

Decriminalization is happening, but it is too slow. In 2022, of the countries reporting to UNAIDS: 14% criminalize gender expression, 36% criminalize consensual same-sex sexual relations, 62% criminalize HIV exposure, non-disclosure and transmission, 90% criminalize possession of drugs for personal use and all reporting countries criminalize some aspect of sex work.

In 2021, 70% of new HIV infections were among groups who are affected by these laws. Eastern Europe and central Asia, Middle East and North Africa and Latin America have all seen increases in annual HIV infections over several years.

In Asia and the Pacific UNAIDS data now shows new HIV infections are rising where they had been falling. Without movement on societal enablers, and on criminal laws in particular, we will struggle to reverse this trend, let alone end AIDS as a public health threat by 2030.

We can end AIDS, but to do so we must end the punitive laws perpetuating the pandemic. Now.

Suki Beavers is UNAIDS Director of the Equality and Rights for All Global Practice.

IPS UN Bureau

ROME, Jun 1 2022 (IPS) – Developing countries – in Africa, in Asia, in Latin America and in the Middle East are facing a combination of crises that are unprecedented in recent times. Over the last three years they have had to face the COVID-19 crisis, the food crisis, the energy crisis, the climate change crisis, the debt crisis and, on top of all this, a global recession. The crises have overlapped, and each has added to the problems created by the previous ones.

Daud Khan

First among the crises relates to food – the most basic of human needs. Even before the events in Ukraine there were shortages and uncertainties. International food prices rose by 40% over their level of 2020 – with increases of almost 90% in the price of vegetable oil pushing up domestic food prices in both importing and exporting countries, and driving millions towards food insecurity. And then came the Ukraine crisis; and price of cereals and cooking oils spiked yet again up 20% for cereal and 30% for vegetable oils.

And it is not just an issue of prices. Supplies are hard to come by. In April 2022 Ukraine exported only 1 million tons of grain as opposed to a normal export volume of 5 million tons and Indonesia banned exports of palm oil. On top of this came climate change. Low rainfall and drought-like conditions have also affected production in several major wheat exporting countries such as France and the USA. Scorching temperatures across northern India and Pakistan have reduced wheat output by 20% and in response, India has now banned exports of wheat.

The second crisis relates to the price of energy. Energy prices before the Ukraine crisis has risen 75% in twelve months and another 25% since then. This has raised costs of transport, manufacturing and services. Prices of natural gas, which drives the prices of urea fertilizer, rose by over 140% and this will impact plantings, yields and output of food crops in coming years. The prices of phosphate fertilizers have also risen by over 200% the last year with about a third of the increase coming since January 2022, mainly as a result of disruption of supplies.

The next punch in the belly for developing countries came from interest rates increases. Developing country debt has boomed in over the past decades years, fueled by the easy availability of savings and real interest rates of virtually zero. With rising inflation, the US Federal Reserve Board has hiked up interest rates. This has not only increased interest payments but also the value of the US$ in which much developing country debt is denominated. This is making debt servicing vastly more expensive and balance of payments problems are looming large for many countries. Higher debt servicing is also putting pressure on Government budgets and is resulting in large cuts in development and social spending.

And we are not finished yet. Global GDP and trade are slowing down. This reflects the recessionary cocktail of high energy prices, supply bottlenecks, rising interest rates and political uncertainties around the globe, as well as COVID-related lockdowns in China.

This perfect storm is mostly the result of the policies of the big economies the ongoing US/Russia/China rivalry; rapid globalization followed by the strict COVID-related lockdowns; and easy monetary policies which first pumped in huge sums of money into the economies and are now raising interest rates to rein in inflation. Climate change has much to do with large and continued emission of GHGs, the bulk of which comes from the big economies, including China. And now, speculative capital, mostly originating in the developed world, is further aggravating the situation in food, fuel and other commodity markets.

But the interlinked nature of the globalized world implies that in relative terms the financial and human burden of these actions falls heaviest on developing countries. After all it is one thing for food and energy prices to rise, or for GDP growth to slow in rich countries such as the USA, Europe and Australia, or even in China. In these countries living standards are high, infrastructure and services are well developed, and often well designed social safety nets are in place. It is quite different in developing countries, where large numbers continue to live with poverty and hunger; where basic services such as education, health and clean drinking water are scarce; and those facing old age, illness or loss of earnings can only rely on the goodwill of friends or family.

There is, quite rightly, much concern about the situation. Several high level meetings have been convened, including by the UN, and there are strong calls for increased aid flows and debt relief, as well as for the creation of special funds for the countries most affected by high prices, debt burdens or climate change. These actions are needed and necessary to avoid widespread suffering, political turbulence and increased migratory flows. And the developed countries will likely bear most of the financial burden of these measures.

But many of the measures, even if implemented, are short term palliatives and will not solve underlying problems. Moreover, developing countries cannot continue to rely indefinitely on goodwill and charity. The risk of doing this became very clear during the COVID crisis where little of the vaccines available and none of the vaccine production technology were shared.

However, times of crisis also create opportunities. There is a need for new thinking and for paradigm shifts in developing countries but also for Governments to undertake reforms that they have been postponing for years, if not decades, due to fears that such reforms would hurt vested interests and national elites. It is now time to act bravely.

Part two of this article will discuss some of the concrete measure that developing countries could take to address the various crises.

Daud Khan works as consultant and advisor for various Governments and international agencies. He has degrees in Economics from the LSE and Oxford – where he was a Rhodes Scholar; and a degree in Environmental Management from the Imperial College of Science and Technology. He lives partly in Italy and partly in Pakistan.

IPS UN Bureau

A medical officer preparing to give a COVID-19 vaccine in Somalia in May 2021. Credit: Mokhtar Mohamed/AMISOM

UNITED NATIONS, Sep 8 2022 (IPS) – With the outbreak of Monkeypox in non-endemic countries leading to a scramble for vaccines, global health advocates are again calling for equity to be prioritized in the international response.

Equity was a top concern during the initial stages of the COVID-19 pandemic emergency health response. The World Health Organization (WHO) helped spearhead several in an attempt to reduce disparities between nations, notably, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator.
Related IPS Articles

Yet, despite these efforts, from Our World in Data show that only one in seven people are fully vaccinated in low-income countries. In contrast, almost three in four people have been fully vaccinated for a year in high-income countries.

Fatima Hassan, human rights lawyer and founder of South African-based civil society group Health Justice Initiative, sees the current disparity in Monkeypox vaccine access as the latest example of the Global South, and Africa especially, being disadvantaged in the global health space.

We still as Africa don t have any supplies of monkeypox vaccines, even though as a continent, we ve been dealing with this disease for a number of years. So on one level, now that it s become a Global North problem, the vaccines have been found for them, but not for us.

Monkeypox can be combated with smallpox vaccines, which are 85 percent effective against the virus. Since the disease was eradicated in 1980, the WHO has had 31 million doses set aside for a rapid response in case smallpox should re-emerge. The organization is the potency of this stockpile and whether it can be deployed against Monkeypox.

However, these doses have never been distributed in Africa, where Monkeypox has circulated since the. The continent is also facing a much higher death rate. When the WHO declared a global health emergency, the only deaths recorded were from West and Central Africa, where 4.7 percent of people who contracted the disease had died.

In the case of COVID-19, many saw the international rules that allow pharmaceutical companies to protect their intellectual property (IP) as simply reinforcing existing disparities between countries.

Several wealthy countries signed contracts with pharmaceutical companies, helping finance private sector research and development, in exchange for prioritized access to vaccine supply. When companies eventually developed successful vaccines, the technology they used was restricted from being shared with the global community. Nations that lacked both the technology and the resources to purchase on the open market resources had to rely on vaccine donations from rich countries that came several months later.

Over 100 organizations and networks joined a coalition called to call for the suspension of intellectual property rules and mandatory pooling of COVID-19-related data and technologies. Those supporting the alliance s call include the current leaders of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the UN Special Rapporteur on extreme poverty and human rights, and former Secretary-General Ban Ki-Moon.

For Hassan, intellectual property regulations were especially problematic given the participation of Africans in trial phases for Moderna and Pfizer s COVID-19 vaccines.

We did all those trials; we ve contributed to the knowledge generation and to the scientific knowledge that allowed [pharmaceutical companies] to get emergency use authorization. But we were not guaranteed supplies or access or preferential access. So the deeper inequity in this entire setup was also that the Global South was asked to participate in the research and the trials, but there was no regulated way of ensuring […] genuine benefit sharing agreements.

For countries worldwide, the COVID-19 pandemic has highlighted the importance of increased self-sufficiency in coping with global health emergencies.

I think that was the lesson of COVID. For the global South, it was like, oh, okay, we need to actually figure this out by ourselves, Hassan said.

Several initiatives have been created to fulfill this goal, including a new mRNA vaccine technology hub in South Africa.

The hub was launched by the WHO and COVAX in Afrigen, Cape Town, on June 21, 2022. It aims to bolster low and middle-income countries capacity to produce COVID mRNA vaccines by training scientists in developing mRNA vaccines and pooling all knowledge acquired by partners. The site in Afrigen will be run by a consortium that includes Biovac, Afrigen Biologics, and Vaccines, a network of universities, and the Africa Centers for Disease Control and Prevention (CDC).

When the hub launched, South African President Cyril Ramaphosa commended the initiative and its implications for Africa s role globally.

The COVID-19 pandemic has revealed the full extent of the vaccine gap between developed and developing economies and how that gap can severely undermine global health security. This landmark initiative is a major advance in the international effort to build vaccine development and manufacturing capacity that will put Africa on a path to self-determination.

African scientists are heading the technology transfer hub. It has the first batches of an mRNA vaccine with technology that will be transferred to

Reflecting on Africa s response to COVID-19, Public Health Professor Flavia Senkubuge told IPS that she s proud of how well the continent dealt with the caseload, especially as many predicted COVID-19 would literally obliterate the region.

The WHO has Africa as one of the least affected regions of the world throughout the pandemic. The number of total deaths from the continent, 256 555, makes up of the world s total, 6.49 million. In contrast, deaths from the Americas and Europe accounted for 46 and 29 percent, respectively.

Senkubuge told IPS that predictions that Africa would be completely overwhelmed overlooked the expertise Africa has garnered in combating public health crises, notably HIV and AIDS.

If you look at South Africa, for people like me who trained and practiced as physicians during the HIV and AIDS period, we are used to those large numbers of very sick patients. Additionally, in South Africa, you must remember that we are a country that has a quadruple burden of disease, therefore which means we have a high volume of patients coming into our health establishments. We are therefore used to working differently, having an optimum triage system, and working in under-resourced and high-pressure environments.

Being underestimated also extends to the work of African scientists. Both Hassan and Senkubuge told IPS that the work of Africans is often neglected and overlooked in global settings.

Yet, the pandemic has also highlighted their contributions to global health, Senkubuge said. She pointed to South Africa s discovery and swift response to the emergence of the Omicron variant. She believes this has led to a shift in how African scientists are considering their work on the global stage.

As African [scientists], […] I think we have kind of shifted the paradigm to say we are here, we are not going anywhere. We re not going to try and convince anyone regarding the excellence of our work, we ll just do our work, continue to share it with our communities, publish in the top journals and be part of the global discourse on our own terms. You re welcome to retake, amend, recheck, but actually, we stand resolute in our unapologetic knowledge that the work we do here in Africa is excellent and contributes significantly to global health.

IPS UN Bureau Report

Testing new approaches for preventing gender-based violence to galvanize more and new partners and resources. Credit: UN Women

UNITED NATIONS, Nov 30 2022 (IPS) – How are the multiple shocks and crises the world is facing changing how we respond to gender-based violence? Almost three years after the COVID-19 pandemic triggered high levels of violence against women and girls, the recent (SVRI) shed some light on the best ways forward.

Bringing together over 1,000 researchers, practitioners, policymakers and activists in Cancún, Mexico, the forum highlighted new research on what works to stop and address one of the most widespread violations of human rights.

While some participants candidly – and bravely – shared that their initiatives did not have the intended impact, many discussed efforts that transformed lives, in big and small ways.

After 5 days of the forum one thing was clear; a lack of evidence is not what is standing in the way of achieving a better future. It is a lack of opportunities and the will to apply that evidence.

Among the many shared findings, UNDP its own evidence.

Since 2018, the global project on Ending Gender-based Violence and Achieving the Sustainable Development Goals (SDGs), a partnership between UNDP and the Republic of Korea, and in collaboration with United Nations University International Institute for Global Health, has tested new approaches for preventing and addressing gender-based violence, to galvanize more and new partners, resources, and support to move from rhetoric to action.

Three key strategies have emerged.

1. We need to integrate

Gender-based violence (GBV) intersects with all areas of sustainable development. That means that every development initiative provides a chance to address the causes of violence and to transform harmful social norms that not only put women disproportionately at risk for violence, but also limit progress.

Bringing together diverse partners to jointly incorporate efforts to end GBV into “non-GBV” programmes has been central to the Ending GBV and Achieving the SDGs project. Pilots in Indonesia, Peru and the Republic of Moldova integrated a GBV lens into local development planning.

The results were local action plans that focused on needs and solutions identified by the communities themselves, including evidence-based GBV prevention programming such as the , which has been proven to reduce violence along with risk factors such as alcohol abuse. This approach is growing, opening up new and more spaces for this work.

2. We need to elevate

While evidence is crucial to creating change, the work doesn’t stop there. We also need to elevate this evidence to policy makers and to support them in putting the findings into action. In our global project, we went about this in different ways.

In Peru women’s rights advocates and the local government worked together to draft a local action plan to address drivers of violence in the community of Villa El Salvador (VES). By working collaboratively and building trust between key players, the project was able to take a more holistic approach and to create stronger alliances to boost its sustainability and impacts.

In particular, the local action plan was informed by cost analysis research that showed that this approach would pay for itself if it prevented violence for only 0.6 percent of the 80,000-plus women in VES who are at risk for violence every year.

Since the pilot’s launch, more than 15 other local governments have expressed interest in the model, and it has already been replicated in three.

3. We need to finance

of bilateral official development assistance (ODA) and philanthropic funding is given to prevent and address GBV, despite the fact that roughly a third of women have experienced physical or sexual violence.

The , funded by the EU-UN and presented at the SVRI Forum, shows just what can be achieved with a US$500 million investment. The study highlights that Spotlight’s efforts will have prevented 21 million women and girls from experiencing violence by 2025.

The Ending GBV and Achieving the SDGs project also finds positive results when financing local plans. Through pilot initiatives in Peru, Moldova and Indonesia, it was possible to mobilize funds when different municipal governments take ownership of participatory planning processes at an early stage.

The local level is a key, yet an often overlooked, entry point to identifying community needs and, through participatory, multi-sectoral partnerships, to translate them into funded solutions.

In Moldova the regional government of Gagauzia assigned funds to create the region’s first safe space, with the support of the community.

The SVRI Forum was living proof that a better future is possible. It offered profound moments for thoughtful exchange, learning with partners and peers, and deepened our own reflections on the outcomes and next steps for this global project.

As we approach the final countdown to meeting the SDGs, including SDG5.2 on eliminating violence against women and girls, it has never been more urgent to take all this evidence and turn it into action against gender-based violence. Let’s act today.

Jacqui Stevenson is Research Consultant UNU International Institute for Global Health, Jessica Zimerman is Project Specialist, Gender-based Violence, UNDP, and Diego Antoni is Policy Specialist Gender, Governance and Recovery, UNDP.

Source: UNDP

IPS UN Bureau

KUALA LUMPUR, Malaysia, Feb 2 2023 (IPS) – Few policymakers ever claim credit for causing stagnation and recessions. Yet, they do so all the time, justifying their actions by some supposedly higher purpose.

Now, that higher purpose is checking inflation as if it is the worst option for people today. Many supposed economists make up tall tales that inflation causes economic contraction which ordinary mortals do not know or understand.

Jomo Kwame Sundaram

Inflating inflation’s significance
Since early 2022, like many others in the world, Americans have been preoccupied with inflation. But official US data show inflation has been slowing since mid-2022.

Recent trends since mid-2022 are clear. Inflation is no longer accelerating, but slowing. And for most economists, only accelerating inflation gives cause for concern.

Annualized inflation since has only been slightly above the official, but nonetheless arbitrary 2% inflation target of most Western central banks.

At its peak, the brief inflationary surge, in the second quarter of last year, undoubtedly reached the “highest (price) levels since the early 1980s” because of the way it is measured.

After decades of ‘financialization’, the public and politicians unwittingly support moneyed interests who want to minimize inflation to make the most of their financial assets.

War and price
Russia’s aggression against Ukraine began last February, with retaliatory sanctions following suit. Both have disrupted supplies, especially of fuel and food. The inflation spike in the four months after the Russian invasion was mainly due to ‘supply shocks’.

Price increases were triggered by the war and retaliatory sanctions, especially for fuel, food and fertilizer. Although no longer accelerating, prices remain higher than a year before.

To be sure, price pressures had been building up with other supply disruptions. Also, demand has been changing with the new Cold War against China, the Covid-19 pandemic and ‘recovery’, and credit tightening in the last year.

There is little evidence of any more major accelerating factors. There is no ‘wage-price spiral’ as prices have recently been rising more than wages despite government efforts ensuring full employment since the 2008 global financial crisis.

Despite difficulties due to inflation, tens of millions of Americans are better off than before, e.g., with the ten million jobs created in the last two years. Under Biden, wages for poorly paid workers have risen faster than consumer prices.

Higher borrowing costs have also weakened the lot of working people everywhere. Such adverse consequences would be much less likely if the public better understood recent price increases, available policy options and their consequences.

With the notable exception of the Bank of Japan, most other major central banks have been playing ‘catch-up’ with the US Federal Reserve interest rate hikes. To be sure, inflation has already been falling for many reasons, largely unrelated to them.

Making stagnation
But higher borrowing costs have reduced spending, for both consumption and investment. This has hastened economic slowdown worldwide following more than a decade of largely lackluster growth since the 2008 global financial crisis.

Ill-advised earlier policies now limit what governments can do in response. With the Fed sharply raising interest rates over the last year, developing country central banks have been trying, typically in vain, to stem capital outflows to the US and other ‘safe havens’ raising interest rates.

Having opened their capital accounts following foreign advice, developing country central banks always offer higher raise interest rates, hoping more capital will flow in rather than out.

Interestingly, conservative US economists Milton Friedman and Ben Bernanke have shown the Fed has worsened past US downturns by raising interest rates, instead of supporting enterprises in their time of need.

Four decades ago, increased servicing costs triggered government debt crises in Latin America and Africa, condemning them to ‘lost decades’. Policy conditions were then imposed by the International Monetary Fund and World Bank for access to emergency loans.

Globalization double-edged
Economic globalization policies at the turn of the century are being significantly reversed, with devastating consequences for developing countries after they opened their economies to foreign trade and investment.

Encouraging foreign portfolio investment has increasingly been at the expense of ‘greenfield’ foreign direct investment enhancing new economic capacities and capabilities.

The new Cold War has arguably involved more economic weapons, e.g., sanctions, than the earlier one. Trump’s and Japanese ‘reshoring’ and ‘friend-shoring’ discriminate among investors, remaking ‘value’ or ‘supply chains’.

Arguably, establishing the World Trade Organization in 1995 was the high water mark for multilateral trade liberalization, setting a ‘one size fits all’ approach for all, regardless of means. More recently, Biden has continued Trump’s reversal of earlier trade liberalization, even at the regional level.

1995 also saw strengthening intellectual property rights internationally, limiting technology transfers and progress. Recent ‘trade conflicts’ increasingly involve access to high technology, e.g., in the case of Huawei, TSMC and Samsung.

With declining direct tax rates almost worldwide, governments face more budget constraints. The last year has seen these diminished fiscal means massively diverted for military spending and strategic ends, cutting resources for development, sustainability, equity and humanitarian ends.

In this context, the new international antagonisms conspire to make this a ‘perfect storm’ of economic stagnation and regression. Hence, those striving for international peace and cooperation may well be our best hope against the ‘new barbarism’.

IPS UN Bureau

Delegates at the Youth Empowerment: Education, Employment and Sexual and Reproductive Health and Rights forum held in Phnom Penh, Kingdom of Cambodia. Credit: APDA

JOHANNESBURG, Mar 8 2023 (IPS) – With more than 600 million youth aged between 18 and 24 in the Asia and Pacific region, putting their issues front and center is crucial. Speakers at a recent forum, Youth Empowerment: Education, Employment and Sexual and Reproductive Health and Rights, held in Phnom Penh, Kingdom of Cambodia, agreed that policy development and implementation should be youth-centered.

Professor Keizo Takemi, MP (Japan) and Chair of the Asian Forum of Parliamentarians on Population and Development (AFPPD), reminded parliamentarians of the work ahead when he noted in his opening address that while youth were innovative thanks to global digitalization, half are unemployed or underemployed. Therefore parliamentarians have a vital role to play.

The extent of the challenges emerged during the discussions. Raoul Danniel A Manuel, MP Philippines, said teenage pregnancy was higher in rural areas than urban, and there was also an education differential.

The rate is 32 percent among teenagers without education, 14% among teenagers with primary education, and 5% among teenagers with a secondary education, Manuel said, noting that the Philippines was the only country in Southeast Asia where the teenage pregnancy rate is increasing in girls aged 10 to 14.

It is important to raise awareness among young people so that they know how to take care of themselves before they marry. We also need to continue to strengthen services, especially user-friendly services, by focusing on vulnerable groups and young women who do not go to school because this group is at a very high risk of pregnancy, and pregnancy can be risky.

Lisa Chesters, MP (Australia), reminded conference delegates that comprehensive sexual education has a positive impact on young people. It has been credited with delaying sexual debut can reduce unwanted pregnancies and STDs.

Benefits included preventing intimate partner violence, developing healthy relationships, and preventing sexual abuse.

Australia learned after an online petition went viral in 2021 the extent to which students had been subjected to sexual harassment at schools. Following this, ministers for education throughout the country agreed on sexual education at school.

Chesters said it was crucial to include comprehensive, well-planned engagement of young people at the center of any advertising and social media campaigns.

The discussion also centered around employment. Felix Weidenkaff, the Youth Employment Expert for the ILO s regional office for Asia and the Pacific, told the conference that while digitalization was a key strategy to increase youth employment, it wasn t a one-off. Aspects lawmakers should consider would include TVET and skill development (including understanding the needs of those with disability), infrastructure, connectivity, and equipment to create an inclusive system.

Delegates at the Youth Empowerment: Education, Employment and Sexual and Reproductive Health and Rights forum held in Phnom Penh, Kingdom of Cambodia. Credit: APDA

Sophea Khun, Country Program Coordinator of UN Women, said changing gender norms required comprehensive and sustained strategies that engage multiple stakeholders at all levels: households, communities, institutions, and governments.

Girls and young women needed to be given the opportunity for training in STEM (science, technology, and mathematics) to close the digital divide.

In addition, harmful social norms that contribute to controlling women and girls access to communications and technology also need to be tackled, Khun said.

Hun Many, MP (Cambodia) and Chair of the Commission, reiterated in his closing remarks that to create a more elaborate and innovative policy, youth need to be able to be part of the decision-making process and the discussions.

Ahead of the conference, IPS interviewed Cambodian MP Lork Kheng, chair of the commission on public health, social works, vocational training, and women s affairs. Here are excerpts from the interview.

Lork Kheng, Cambodian MP and chair of the commission on public health, social works, vocational training, and women s affairs.

IPS:  A tremendous amount of work is to be done to improve SRHR for all and youth-friendly services. How can young MPs play an enhanced role in developing policy, ensuring services are adequately financed and delivered to the communities where required?

LK: With regards to the role of Parliament, we can oversee the implementation of policies related to education, the provision of safe counseling on sexual and reproductive health, family planning, abortion, HIV/AIDS prevention and care, and local monitoring of child marriages, which are challenges for our Asia-Pacific region. In addition, the National Assembly always provides opportunities for development partners to contribute ideas and proposals for consideration through close cooperation in organizing educational forums and disseminating discussions and exchanges at national and sub-national levels (in their constituencies). We can establish effective monitoring and evaluation mechanisms and coverage of the actual implementation of practitioners and service providers and the effectiveness of policies to ensure that they are providing the anticipated outcomes. Working with think tanks and civil society organizations to conduct research, assessment, and evaluation that informs policymaking and improves service delivery from all stakeholders perspectives.

Another important role is to communicate directly with the people and sub-national authorities in the constituencies where they are based. Young MPs and MPs often use the forum to meet and visit local administrations, etc., to mainstream the information and raise awareness of the importance of youth and family life planning, as well as to share good local and global political experiences and best practices that can be implemented within the existing framework of national and sub-national policies to stakeholders, especially local authorities who work directly with the youth.

In particular, in overseeing the financing, every year, MPs actively participate in the discussion of the draft budget law, in which the whole House closely monitors the progress and changes in the budget allocation according to each program. Furthermore, MPs also provide feedback to the executive branch during the initial consultation phase until the full house passes the draft budget. In this regard, the review of budget allocations for youth health care, such as increased attention to the prevention and control of non-communicable diseases, tobacco control, food safety and diet in general, and sexual issues in particular, has been addressed frequently and has been noted and considered by the relevant ministries as well as the Government.

The Ministry of Posts and Telecommunications has prioritized students who pass the upper secondary national examination with good grades to study digital skills with the support of a student loan that must be repaid when they get a job. This is to strengthen human resources with digital capabilities.

IPS: While Asia and the Pacific are home to more than 60% of the world s youth aged between 15 and 24, the COVID-19 pandemic acted to disadvantage youth in poorer and rural communities, especially where schooling was interrupted, and children did not have access to the technologies for remote learning. How can youth MPs ensure that those children (who may even now be young adults) are given the opportunities to complete their education? Secondly, how should policy, infrastructure, and finance be directed at children still disadvantaged by a lack of technology?

LK: We all truly recognize that the COVID-19 pandemic is an extraordinary challenge that has plagued all socio-economic sectors, requiring the Government and authorities to respond with unusual means in these difficult circumstances. In developing countries like Cambodia, when schools were closed to prevent the spread of COVID-19 in its early stages, we did not have the right digital infrastructure for teaching and learning. Students in rural areas and those considered to be disadvantaged groups were the ones who faced barriers to accessing education at that stage. But if we look at the immediate solution of the Head of the Royal Government of Cambodia, we can measure the outcome of solving the challenges with this decision. The Government quickly rolled out vaccinations, especially prioritizing vaccinations for front-line medical workers and educators. That ensured that these two environments gained immunity as soon as possible so that students could return to class quickly with a high sense of security.

IPS: Youth are considered a vital resource for the country s economic development, but they face high unemployment. What are young MPs working on to ensure that youth can get decent jobs and support young entrepreneurs? What are the policy directions needed to foster youth employment?

LK: Specifically in Cambodia, the unemployment rate for youth may be slightly lower than 14 percent. Nevertheless, youth are also facing other major challenges, such as skill mismatches with the job markets and vulnerabilities of international labor migration, which are the major concerns of the Parliament and the Government. As Cambodia is riding high on development in all areas, the labor market has expanded, especially in areas that benefit youth. In response to such demands, the Government has paid close attention to education and vocational training by prioritizing promoting science, technology, engineering, and mathematics (STEM) to encourage young people to acquire high-demand skills.

In this new academic year, the Government has encouraged youth to pursue vocational skills at the primary and secondary levels by giving monthly allowance to approximately 1.5 million students, in addition to their free tuition.

To support the promotion of young entrepreneurship, we have also established a number of mechanisms – both under state supervision and public-private partnerships – that have created entrepreneurship and incubation centers. In particular, during the COVID-19 pandemic, these mechanisms also played an important role in providing much-needed assistance to those businesses through loans and free training to the entrepreneurs so that they could utilize the technology for their businesses against the backdrop of a changing lifestyle in the new normal.

Note: Asian Forum of Parliamentarians on Population and Development (AFPPD), Asian Population and Development Association (APDA), and the Japan Trust Fund supported the hybrid conference.

IPS UN Bureau Report

Nneka Henry is Head of UN Road Safety Fund

An aerial photograph of a busy roundabout in Lusaka Zambia. Credit: UNRSF.

GENEVA, Apr 27 2023 (IPS) – Crises may be a centuries-old phenomenon, but so too is human resilience.

The high number of road deaths and life-changing injuries in the global south is a crisis that affects millions of people every year. In 2018 alone – the year that the UN Road Safety Fund was established – 1.3 million people died on the world’s roads, and another 50 million were injured or disabled.

Recognizing the world’s state of increasing complexities, the Fund has been meeting the global road safety challenge head-on. It has done this through a coordinated and multi-faceted approach that addresses the underlying cause of unsafe roads whilst also addressing interconnections with other global development crises

These numbers are even more sobering against the backdrop of multiple global crises that range from the coronavirus pandemic to the climate emergency, the cost of living crisis to geopolitical conflicts. As daunting as the mounting crises facing the world may be, the millions of lives and livelihoods lost to road crashes has made the Fund as resolute as ever to continue to mobilize and coordinate effective responses to very real road safety needs.

Recognizing the world’s state of increasing complexities, the Fund has been meeting the global road safety challenge head-on. It has done this through a coordinated and multi-faceted approach that addresses the underlying cause of unsafe roads whilst also addressing interconnections with other global development crises.

As the only United Nations body solely dedicated to channelling resources and expertise to tackling the root cause of the crisis, preventing further loss of life is, and will always be, our ultimate goal.

How could it not be – considering that road traffic crashes take the lives of around each day; the equivalent of losing a large cruise ship of passengers at maximum capacity. Through annual Calls for Proposals, the Fund coordinates and finances projects that help ensure road safety is treated as the significant public health issue that it is.

In , our project partner, the UN Economic Commission for Latin America and the Caribbean, worked with the Department of Transport to correct and improve speed control operations including with the use of portable equipment on all of the Pará State highways. The project resulted in a doubling breathalyzer tests to over 78,000 carried out in 2022 and contributed to decreasing the rate of traffic deaths by a third, down from 6.13 per 10,000 vehicles in 2021 to 4.13 in 2022.

Underpinning the Fund’s ability to effectively address the road safety crisis is our comparative advantage of encouraging international collaboration and cooperation through pooled financial resources and technical knowledge. The more financial and technical partners that participate in the Fund the more comprehensive our response has been, spanning road safety-related legislation, enforcement, education, use of technology and implementation of international regulations and standards.

In the case of – led by our project partners the UN Environment Programme and UN Economic Commission for Europe – the Fund collaborated on an initiative with the UN Economic Commission for Africa, FIA, and the International Motor Vehicles Inspection Committee.

This has supported the 15 ECOWAS members states to adopt and roll out a regionally-harmonized vehicle directive and technical inspection system, which sets a common standard to safeguard the safety and environmental-friendliness of used vehicles on West African roads. It is now helping to decrease the number of vehicles involved in fatal crashes due to technical defects by 50%, saving thousands of lives.

Nneka Henry, Head of UN Road Safety Fund

Key to strengthening the Fund’s global outreach and engagement is our commitment to communicate clearly and effectively with the public, stakeholders, and decision-makers to ensure that everyone is up-to-date and engaged in the response efforts.

In addition to project planning which encourage knowledge exchange, and building synergies and complementary financing opportunities before projects are finalized; the Fund also delivers . These include the virtual for project partners to share project results, the , which takes place on the margins of the International Transport Forum Summit, and the for stakeholders to deep dive into projects that the Fund is supporting.

As global citizens we are all facing a crossroads of crises. The Fund s response has been to invest in supporting interconnections with other development priorities as a way to build resilience and preparedness for future crises.

Mindful of economic crises, the Fund s investment in safe transport and road infrastructure is vital. This is what we have been doing in support of the n government – with project partners the International Road Assessment Programme, International Road Federation and the UN Economic Commission for Africa.

This initiative has been helping to reduce traffic crashes that place a heavy additional economic burden on families, governments and employers – spanning medical expenses, lost income, and reduced productivity – all of which costs the global economy US$ 1.85 trillion each year.

Low- and middle-income countries devote considerable public personnel and other resources to the treatment and rehabilitation of people injured in road crashes. There is, therefore, a compelling need to reduce the road crash burden on national healthcare systems freeing up critical resources to address other pressing health issues.

Considering ongoing health crises, the Fund is investing in effective post-crash responses – a focus area for the 2023 Call for Proposals and an issue we address in countries like and , which suffer high rates of road casualties.

Mitigating the effects of climate change, the Fund also invests in cleaner ways of moving safely, including through the project across Africa to prioritize safe walking and cycling lanes for pedestrians and cyclists who also happen to be our most vulnerable road users.

During these years of polycrises, the Fund has relied on the global solutions approach to rise to the global road safety challenge. And, this month, as the Fund celebrates five years, I challenge more nations, companies and individuals to invest in the only global response comprehensively addressing the root causes of poor national road safety systems across the world. Join us in our sustained effort and rise to meet the serious and interconnected challenges that is the global road safety crisis today.

Thembeni Mkingofa, a woman living with HIV, visits the PMTCT section of the Makhume District Hospital, Zimbabwe. She has three children – 14, 10 and 2 who are all HIV negative. This is her fourth pregnancy. Her husband is also on HIV treatment. Here she is pictured with her two-year-old daughter, Hilda Chakiryizira. 5 November 2019. Credit: UNAIDS/C. Matonhodze

BRASILIA, Brazil, Jun 5 2023 (IPS) – The COVID-19 crisis has shone a light on the danger of pandemics; social crises have shone a light on the danger of inequalities. And the reality is that outbreaks become the pandemics they do because of inequality. The good news is that both can be overcome – if they are confronted as one.

Scientific and medical breakthroughs in the treatment and prevention of HIV should have brought us to the point of ending AIDS. Tragically, however, although the number of new HIV infections is falling fast in many countries, it is still rising in dozens of countries and the goal of ending AIDS by 2030 is in danger.

The reason: economic and social inequalities within countries and between them increase people’s risk of acquiring disease and block access to life-saving services.

Letting inequality grow is driving pandemics and prolonging emergencies that drain economies and health systems. This makes all of us vulnerable to the next pandemic, while placing entire countries and communities of people in harm’s way.

In too much of the world we see policy approaches which leave inequalities to widen, and even, in some cases, deliberately exacerbate inequalities.

On a global level when wealthy countries quickly invest billions in their own medical and social response, while leaving other countries so burdened by debt they have no fiscal space to do so, that undermines the world’s capacity to fight AIDS and pandemics.

During COVID-19 while wealthy countries poured in billions to protect their economies, reduce economic and social hardship and fight the pandemic, almost half of all developing countries cut health spending and about 70% cut spending on education.

Shanenire Ndiweni, has a consultation to receive pre-exposure prophylaxis at the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe) clinic, Mutare, Zimbabwe, 6 November 2019. Credit: UNAIDS/C. Matonhodze

Viruses do not respect borders, so when the vaccines, drugs, and tests intended to stop those viruses go to powerful countries in excess, while other countries have little or nothing and are held back from producing medicines themselves, that perpetuates pandemics everywhere.

Similarly, social and economic conditions that perpetuate pandemics in low- and middle-income countries present a global threat. Much as with COVID-19 the same has happened with the MPox virus.

In recent years twice as many people have died of MPox in the Democratic Republic of Congo as the entire rest of the world combined but, as of today, zero vaccines for MPox had been delivered to the DRC.

Social and legal determinants that make people vulnerable to pandemics must be tackled. Globally almost 5,000 young women and girls become infected with HIV every week. Dismantling barriers to sexual and reproductive health and rights services, investing in girls’ education, and combating gender-based violence to remove gender inequity is key to ending the AIDS pandemic and protecting women’s health.

Laws that criminalize and marginalize LGBT communities, sex workers and people who use drugs weaken public health approaches and prolong pandemics such as HIV. In sub-Saharan African countries where same sex relations are criminalized, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalized.

Even within countries that are making substantial progress against HIV, advances may not be shared equally. Here in Brazil for example, HIV infections are falling dramatically among the white population as access to treatment is widened and new prevention tools such as PrEP are rolled out.

That shows what can be achieved; but HIV infections among the black population in Brazil are still on the rise. A similar story runs in the United States where gay white people are more likely to have access to good health care than gay black people.

We emphasize that it is not only access to health care that perpetuates these inequalities, but the social determinants that increase the risk of infection.

To overcome inequalities in accessing essential services, communities must be empowered to demand their rights. The AIDS movement is one of the best examples of how groups of people experiencing intersecting inequalities can unite to overcome them, leading to millions of lives being saved.

Successive Commissions on Social Determinants of Health have brought together evidence on how the conditions in which people are born, grow, live, work and age are powerful influences on health equity.

To bring together these two strands of knowledge over the coming months we will be convening global experts from academia, government, civil society, international development and the creative arts to build a Global Council to advance evidence-based solutions to the inequalities which drive AIDS and other pandemics.

The council will unite experts from disparate fields of economics, epidemiology, law, and politics and will include ministers, mayors, and former heads of state, researchers and clinicians, health security experts, community leaders and human rights activists.

The work of the Global Council will harness essential evidence for policymakers. It will elevate political attention to the need for action. Most crucially, it will help equip the advocacy of the frontline communities fighting for their lives, with what they need to shift policies and power.

Appropriately, the Global Council is launching in Brazil. Whilst Brazil has exemplified the challenges of intersecting inequalities, Brazil’s social movements have been pioneers in confronting them, and Brazil’s new government under President Lula has committed to tackle inequalities in Brazil and worldwide.

To fight tomorrow’s pandemics, we need inequality-busting approaches to today’s pandemics. The world’s leaders now face a clear choice: stand by whilst the dangers mount or come together to tackle inequalities for a world that is not only fairer, but safer too.

Winnie Byanyima is the Executive Director of UNAIDS and an Under-Secretary-General of the United Nations. Before joining UNAIDS, she served as Executive Director of Oxfam International, a confederation of 20 civil society organizations working in more than 90 countries worldwide, empowering people to create a future that is secure, just and free from poverty.

Sir Michael Marmot is Professor of Epidemiology at University College London (UCL), Director of the UCL Institute of Health Equity, and Past President of the World Medical Association.

They will launch the Global Council on Inequalities, HIV and pandemics in Brazil on June 5. The authors are founder members of the Global Council on Inequality, AIDS and Pandemics and are in Brazil for its announcement.

IPS UN Bureau