It requires people to be active participants in development, demanding services and products that add value to their lives and engaging in behaviors that are conducive to increasing their own welfare. Health prevention is a case in point.
At our HIV Impact Evaluation Workshop in Cape Town, South Africa in 2009, I listened to Nancy Padian, a medical researcher at the Women’s Global Health Imperative, presenting a systematic review of random control trials testing the effectiveness of HIV prevention campaigns.
The study she presented explained how three dozen HIV prevention campaigns had failed to change sexual behavior and reduce HIV incidence.
The presentation gave us pause. The review dismissed the communication campaigns as an ineffective means to change behavior and slow down the HIV epidemic.
A closer look revealed that the campaigns lacked inspiring narratives, and were communicated through outdated and uninteresting outlets such as billboards and leaflets.
The question we asked ourselves was: Can we do this differently?
One woman is victimized by violence every 15 seconds in Brazil, with a total of 23% of all Brazilian women experiencing violence in their lifetime. There are many notable consequences affecting victims of gender-based violence, yet many health consequences of violence have not been widely addressed in Brazil. This leads to the question:
Brazil has 730,000 people living with HIV, the largest number in Latin America and the Caribbean. Brazil is also one of 15 countries that account for 75% of the number of people living with HIV worldwide. Although the HIV epidemic in Brazil is classified as stable at the national level, incidence is increasing in various geographic regions and among sub-groups of women.
Rates of violence against women (VAW) are particularly high in the Southeastern and Southern regions of Brazil. These regions also have the highest HIV prevalence, accounting for 56% and 20% of all the people living with HIV in Brazil, respectively. Violence and HIV in Brazil are clearly linked, with 98% of women living with HIV in Brazil reporting a lifetime history of violence and 79% reporting violence prior to an HIV diagnosis.
Despite these statistics, there is limited research in Brazil examining VAW in relation to HIV. Accordingly, a bi-national collaboration of researchers from the University of California, San Diego, University of Campinas, São Paulo and the University of Rio Grande do Sul, Porto Alegre developed an innovative study to investigate these intersecting epidemics.
The focus of the study is in the regions of Brazil with the highest rates of VAW and highest prevalence of HIV: São Paulo in the Southeastern region and Porto Alegre in the Southern region.
The aims of the research were to describe the contextual factors of violence victimization among women in Brazil and to examine the association with HIV infection.
The study merged two population-based studies with identical sampling methodologies conducted in the São Paulo and Porto Alegre, Brazil. Women ages 18-49 years were sampled from public health centers, including 2,000 women from São Paulo and 1,326 from Porto Alegre. These women were administered surveys that gathered extensive data on violence victimization and social-ecological factors on access to preventative health services.
This week is unique. December 1 was World AIDS Day –a moment to unite with the community touched by HIV and push forward in the fight. December 4 is Ocean Day at COP21 – an opportunity to advance the global ocean and climate agenda toward meaningful impact and action. Two important days with two very different purposes. And yet, each significant in commemorating critical causes that are often just outside the realm of everyday consideration. But it is not only this marginality that links them– and understanding this connection can only strengthen our imperative to act.
Strategies to curb violence against women too often exclude the experiences of lesbian, bisexual, and transgender women. The Human Rights Campaign (HRC) is marking this year’s 16 Days of Activism to End Violence Against Women by highlighting the disproportionate violence and discrimination that many lesbian, bisexual, and transgender women face, and calls on the World Bank to develop policies that consider the unique needs of these women.
The laws are changing but the violence remains
Lesbian, gay, bisexual and transgender (LGBT) people have made great strides in the fight for full equality. As of today, 34 countries permit marriage or civil unions for same-sex couples, and many other countries have passed vital non-discrimination protections. For example, in the United States, the Violence Against Women Reauthorization Act of 2013 expanded non-discrimination protections for LGBT people to prohibit shelters and other domestic violence services from discriminating on the basis of sexual orientation or gender identity.
Sadly, lesbian, bisexual, and transgender women face disproportionate levels of violence at the hands of both strangers and intimate partners. A recent U.N. human rights report noted that LGBT people are at a disturbingly elevated risk of homicidal violence, highlighting the increased risk that lesbian, bisexual, and transgender women face because of gender-based discrimination. Another study by the Human Rights Campaign and the Trans People of Color Coalition estimates that transgender women in the United States face 4.3 times the risk of becoming homicide victims than the general population of women. Factors such as poverty or belonging to a racial minority exacerbated the incidence and rates of violence experienced. Transgender people are also more likely to experience violence from law enforcement, in homeless shelters, and in healthcare settings. The recent Transgender Day of Remembrance served as a stark reminder that transgender people around the world face disproportionate levels of violence: in the United States alone, at least 21 transgender people have been killed in 2015.
It is often said that we live in a new data age. Institutions such as the Bank, UN agencies, NASA, ESA, universities and others have deluged us with an overwhelming amount of new data obtained painstakingly from countries and surveys or observed by the increasing number of eyes in the sky. We have modern tools such as mobile phones that are more powerful than old mainframes I used to use in my university days. You can be in rural Malawi and still have access to decent 3G data networks.
I’m a big believer in setting highly ambitious targets in order to galvanize communities and countries to take action on serious issues. When I was at the World Health Organization in 2003, we set a target called “3 x 5” – committing to treat 3 million people with HIV/AIDS in the developing world by 2005.
At the time, just a few hundred thousand people in the developing world had access to the life-saving treatment. When we announced the target, the global health community was still arguing about whether HIV treatment in poor countries was possible. Some called it an impossible dream that would give people false hope.
I responded that no one ever said treating 3 million people would be easy. But we needed a measurable and time-limited target to change fundamentally the way we thought about the challenges of HIV in developing countries. The target helped change the way we worked – we had fewer arguments about if we should do it, and focused on how to get it done.
Jim Yong Kim knows something about prejudice. When he was growing up Asian American in Iowa, kids would make “kung fu” gestures and hurl racial slurs at him. In an op-ed published in the Washington Post, the World Bank Group president writes that his experiences are “trifling indignities” compared to what gay and lesbian citizens of Uganda and Nigeria are now experiencing, in the wake of new laws making homosexuality a crime punishable by up to life in prison.
Institutionalized discrimination goes far beyond those countries, he notes; 81 other countries also criminalize homosexuality. It also goes beyond sexual orientation to encompass laws that discriminate against women and members of minority groups. And aside from being wrong, Kim writes, “Widespread discrimination is also bad for economies. There is clear evidence that when societies enact laws that prevent productive people from fully participating in the workforce, economies suffer.”
He points out the irony that AIDS activists, many of them gay, fought to ensure access to life-saving drugs for people with AIDS, most of them African. Kim concludes, “Eliminating discrimination is not only the right thing to do; it’s also critical to ensure that we have sustained, balanced, and inclusive economic growth in all societies.”
Read the full op-ed here.
Building social movements. I often hear about the need to create social movements to tackle a number of entrenched global challenges such as ending extreme poverty, promoting greater income equality, and combatting climate change.
History is full of social movements that have succeeded and failed. The lessons from one ongoing movement that I know well – the fight against AIDS – should be examined closely by those looking to build movements today.
Lesson No. 1 from the AIDS movement is to believe only in the possibility -- not the inevitability -- of success. Opponents will fight and appear immovable. As those of us who lived through the early days of the AIDS fight, it was always far from certain that we would reach our goals.
Although I have committed much of my career to the global fight against HIV and AIDS, this year's World AIDS Day is a special one for me in two ways. First, there's the remarkable news from UNAIDS that more than 8 million people globally are now on treatment, and 25 countries have achieved more than a 50 percent decline in HIV prevalence. With this progress, I am more optimistic than ever about our ability to end AIDS.
As the US government’s new blueprint for an AIDS-free generation demonstrates, today we have the science, the knowledge, the experience, and the tools to fight the epidemic. I was particularly happy to see that the blueprint included multi-year, sustainability strategies and that it stressed the need to support country leadership. With that leadership, and with a long-term plan owned by countries, these efforts can succeed.
The Bank said today it is mobilizing over $7 billion for health and education to help poor countries battle threats to their social services during the crisis. The new health and education numbers follow an announcement earlier this week that its investments in social protection programs, including social safety nets, are expected to rise dramatically for 2009-2010 to $12 billion.
As part of this announcement, the Bank released a report titled, Averting a Human Crisis During the Global Downturn, which examines how previous financial downturns affected countries’ social protection programs.
Crisis Can Affect Social Services Programs
Evidence from previous crises in Argentina, Indonesia, Thailand, and Russia shows that governments were forced to cut health services as a result of shrinking budgets and that returning health spending to pre-crisis levels took up to 10-15 years to achieve, according to the report.
"We cannot afford a 'lost' generation of people as a result of this crisis," said Joy Phumaphi, the World Bank's Vice President for Human Development and former Health Minister for Botswana. "It is essential that developing countries and aid donors act now to protect and expand their spending on health, education and other basic social services and target these efforts to make sure they reach the poorest and most vulnerable groups."
AIDS Treatment Programs in Jeopardy
The report also warns that according to preliminary findings from 69 countries, which offer treatment to 3.4 million people on antiretroviral treatment (ART), suggests that 8 countries now face shortages of antiretroviral drugs or other disruptions to AIDS treatment. Twenty-two countries, home to more than 60 percent of people worldwide on AIDS treatment , expect to face disruptions over the course of the year.
"We cannot afford a 'lost' generation of people as a result of this crisis," Phumaphi said. "It is essential that developing countries and aid donors act now to protect and expand their spending on health, education and other basic social services and target these efforts to make sure they reach the poorest and most vulnerable groups."