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Background The dependence on the law to direct people’s behaviour is known for its imperfections, yet it has become a mainstream response to social problems in modern day society. It is also the pathway through which internationally-recognised rights obligations, including sexual rights, are anticipated to diffuse across distinctly different societies. We studied the introduction of new legal standards in Mozambique, with an interest in their ability to promote the rights of lesbian, gay, bisexual, transgender, intersex (LGBTI) people and sex workers. Methods Between 2019 and 2020, we conducted sixteen key informant interviews with jurists, policymakers, and civil society advocates at national level and seventy-eight interviews with opinion leaders from local communities in three urban sites situated across Northern, Central, and Southern Mozambique. Results The new legal standards, in which same-sex sexuality and sex work are no longer criminalised, found little resonance with intersecting religious, sexual, gender, and socio-cultural norms. Whilst there was a consensus not to discriminate, sensitisation and rehabilitation of LGBTI people and sex workers were considered imperative. This stance, coupled with a continued presence of ambiguous language in and incongruences between legislative pieces, attenuates the country’s commitment to internationally recognised rights obligations. Conclusions In a context of weak civilian awareness and support, the legal reforms are not likely to make a profound positive impact on the lives of LGBTI people and sex workers. Policy action should extend beyond health and law enforcement institutions and draw in community leaders to mediate the social processes that undercut the universality of rights.

Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors.The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative.From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date.At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history.SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

This chapter proposes that globalization is a neoliberal ideology for development, consolidated and promoted by key international financial institutions (the World Bank and the International Monetary Fund), which deepens inequality between and within nations on a global scale, resulting in increased global insecurity through a growing sense of injustice and grievance that may lead to rebellion and radicalization. It is argued that, ultimately, the globalization ideology for development services the interest of its advocates, the elites of the core capitalist economies that dominate the international financial institutions, at the expense and immiseration of the majority of people in developing economies and the weaker segments of their own societies. The chapter is set out in three stages: first, it presents the case for conceptualizing globalization as a neoliberal ideology for development; second, it provides evidence to demonstrate the harmful effects of the ideology on societies, particularly across the developing world; and third, it explores the connection between uneven globalization and global insecurity through two case studies: the uprising in Egypt in 2011, and the collapse of the Greek economy in 2010.

AIMS: We assessed the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. METHODS AND RESULTS: International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID-19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF-COVICAV). The primary endpoint was in-hospital mortality. Of 1974 patients hospitalized with COVID-19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62-81] years, 58% male), with HF being present in 256 [20%] patients. Overall in-hospital mortality was 25% (n = 323/1282 deaths). In-hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non-HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44-2.59], P

This chapter presents an overview of what is known about the SRHR of young key populations (YKP) in Southern Africa, using specific examples from five countries, namely Angola, Madagascar, Mozambique, Zambia and Zimbabwe, to anchor the discussion. The discussion draws on the social determinants of health framework to structure an analysis of what is known about the determinants and drivers of SRH risk and to highlight the gaps in evidence and understanding of specific vulnerabilities of these groups of youth. Our initial findings point to the importance of understanding the vulnerabilities and risks faced by young people in these key populations in the context of a wider consideration of the social determinants of health of all young people, as well as in the context of the full range of SRH needs and priorities which include but go beyond HIV alone. Moreover, looking more broadly at the economic situation of young people, educational and employment opportunities, health systems, and peer and family networks will give us a more complete picture that will help us to understand how and why certain young people are more at risk for negative SRH outcomes than others. This more comprehensive approach creates the foundations for the development of equally comprehensive and more inclusive policies and programmes to protect and promote the SRHR of all young people in the region in all of their diversity.

In this chapter we will present evidence from a systematic literature review of interventions designed to reduce the risk of HIV for adolescent girls and young women in sub-Saharan Africa. We will highlight interventions that have demonstrated effectiveness in reducing HIV and the structural drivers related to HIV. We will also critique interventions that have not demonstrated effectiveness. Within this context we will discuss both the benefits and challenges of designing and evaluating complex interventions, which are often designed to intervene on ‘upstream’ factors and impact on multiple outcomes. Based on this review, we will highlight gaps in the evidence and describe ongoing trials that are designed to fill some of these gaps. Finally, we make recommendations for policy-makers and implementers about the best ways to intervene to reduce the risk of HIV infection for adolescent girls in sub-Saharan Africa.

Globalising dynamics have had wide-ranging and pervasive impacts on nearly every form of human relatedness, which now include the bases upon which states calculate and express their political responsibilities. As the ‘reach’ of practical and normative pressures extends and their demands intensify, the compass of state responsibility is becoming a key pressure point for facing the challenges and mediating the tensions of our globalised and still globalising world. This theme is examined from a global health perspective. The general disposition of states toward their acknowledged political responsibilities is unlikely to change, but the combination of legal, normative, political and practical dynamics impinging on them have already begun to register, as both states and the international system adjust to a politics that now have global dimensions.

The Sustainable Development Goals (SDGs) and the Agenda 2063 chart a new development pathway for Africa. ‘Leaving no one behind’, or full social inclusion, is central to this effort. What will this mean for lesbian, gay, bisexual, transgender, or intersex (LGBTI) people in Africa who are among the most socially excluded members of the population? This article explores this through a discussion framed by the concept of social inclusion and the commitments regarding it that appear in the SDGs and the Agenda 2063. Although LGBTI inclusion across Africa is not explicit in either document, there are nevertheless important opportunities for linking continental LGBTI advocacy to the sustainable development enterprise.

The first section opens with an introduction to the fundamental sources of contention around human rights, particularly as they apply to human health. This is followed by an outline of the status of key human rights treaties in the context of sexual and reproductive health in sub-Saharan Africa. A human right to health is then contrasted with citizen entitlements. An integrated conception of sexual and reproductive health is set out in detail, tracing the development of reproductive health from a stand-alone health matter detached from sexual rights to conceptions where the two are viewed as necessarily joined.

In many parts of sub-Saharan Africa, declaratory commitment to sexual and reproductive health rights faces very considerable policy-making conundrums which are reviewed in this chapter. These are most visible in the tensions emerging between the impetus for Universal Health Coverage and the ongoing struggle against HIV and AIDS. The opportunities being developed through African regional bodies are then considered, after which the challenges, progress and prospects for sexual and reproductive health rights in sub-Saharan Africa are reviewed in thematic form.

This chapter concerns the normative dimensions of sexual and reproductive health (SRH) as applied to sub-Saharan contexts and issues. The positive impacts of growing international consensus around SRH are contrasted with both the normative and practical limitations. The conditioning sub-Saharan contexts include demography; gender; HIV and other SRH-related disease burdens; and health systems and health systems funding. The highly diverse normative landscape of sub-Saharan Africa is illustrated by attitudes towards and provision of contraception and abortion.

This chapter begins with a consideration of the strongly relational character of human health by outlining the centrality of gender. The following sub-sections present conceptual understandings of both sexual and reproductive health, followed by definitions of the terms that enjoy a broad consensus. The first section ends with a consideration of sexual and reproductive health as a configuration of closely inter-related issues—including but not limited to HIV and AIDS. The second half of the chapter offers a rationale for the sub-Saharan focus of the study and introduces political, normative and socio-legal perspectives that will inform subsequent chapters.

Background For many countries, including Malawi, Tanzania and Zimbabwe, 2017 was a transition year for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria as one funding cycle closed and another would begin in 2018. Since its inception in 2001, the Global Fund has required that countries demonstrate ownership and transparency in the development of their funding requests through specific processes for inclusive, deliberative engagement led by Country Coordinating Mechanisms (CCMs). In reporting results from case study research, the article explores whether, in the context of the three countries, such requirements continue to be fit-for-purpose given difficult choices to be made for financing and sustaining their HIV programmes. Results The findings show how complex, competing priorities for limited resources increasingly strain processes for inclusive deliberation, a core feature of the Global Fund model. Each country has chosen expansion of HIV treatment programmes as its main strategy for epidemic control relying almost exclusively on external funding sources for support. This step has, in effect, pre-committed HIV funding, whether available or not, well into the future. It has also largely pre-empted the results of inclusive dialogue on how to allocate Global Fund resources. As a result, such processes may be entering the realm of ‘political theatre,’ or processes for processes’ sake alone, rather than being important opportunities where critical decisions regarding priorities for national HIV programmes and how they are funded could or should be made. Conclusion To address this, the Global Fund has begun an initiative to shore-up the capabilities of CCMs, with specialised technical and financial support, so that they can both grasp and influence the overall financing and sustainability of HIV programmes, rather than focussing on Global Fund programmes alone. What stronger CCMs could achieve, given the growing HIV-treatment-related commitments in these three countries, remains to be seen. Starting in 2020, the three countries will discover what resources the Global Fund will have for them for the 2021–2023 period. The resource needs for expanding HIV treatment programmes for this period are already foreseeable leaving few if any options for future deliberation should funding from the Global Fund and others not grow at a similar pace. Electronic supplementary material The online version of this article (10.1186/s12992-019-0475-9) contains supplementary material, which is available to authorized users.

Since the start of the HIV epidemic, community responses have been at the forefront of the response. Following the extraordinary expansion of global resources, the funding of community responses rose to reach at least US$690 million per year in the period 2005–2009. Since then, many civil society organisations (CSOs) have reported a drop in funding. Yet, the need for strong community responses is even more urgent, as shown by their role in reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track targets. In the case of antiretroviral treatment, interventions need to be adopted by most people at risk of HIV in order to have a substantial effect on the prevention of HIV at the population level. This paper reviews the published literature on community responses, funding and effectiveness. Additional funding is certainly needed to increase the coverage of community-based interventions (CBIs), but current evidence on their effectiveness is extremely mixed, which does not provide clear guidance to policy makers. This is especially an issue for adolescent girls and young women in Eastern and Southern Africa, who face extremely high infection risk, but the biomedical prevention tools that have been proven effective for the general population still remain pilot projects for this group. Research is especially needed to isolate the factors affecting the likelihood that interventions targeting this group are consistently successful. Such work could be focused on the community organisations that are currently involved in delivering gender-sensitive interventions.Keywords: fast track, health and development agenda, HIV prevention response, costs, community

(2016). Fast-tracking HIV prevention: scientific advances and implementation challenges. African Journal of AIDS Research: Vol. 15, Fast-tracking HIV prevention: scientific advances and implementation challenges, pp. iii-viii.

There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a ‘quick fix’ to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances.

The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of 'the right thing at the wrong time': it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming 'fiscal crunch' makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.

This volume provides a critical and comprehensive assessment of the relationship between gender, inequality and vulnerability to HIV infection and AIDS. It brings together contributions from scholars and practitioners from across the world to explore the relevance of these core concepts to their understanding of the AIDS crisis and the politics of effective response. The chapters in Gender and HIV/AIDS examine current thinking about sexuality, masculinity, gender roles, and culture in relation to HIV/AIDS and global politics of intervention and regulation. In doing so, the volume maps the intellectual and empirical dimensions of a global debate concerning the gendered contours of an epidemic imbedded in the social relations and material realities of societies at large. The normative aspiration of the volume is to stress the enormity and complexity of the relationship between gender inequalities, sexuality and HIV and AIDS, and the impact this has on the lives of affected and infected people, as well as on our work as development practitioners, academics, and activists. We believe that taking gender into account in our response to HIV/AIDS will not only help our understanding of the character and persistence of the epidemic, but has the potential of contributing to both improved policy and to the genuine transformation of gender relations in wider society. The epidemiological statistics show that today women are more vulnerable to HIV than men for a variety of biological and social reasons that will be discussed in this introduction and throughout the book. Policy-makers have recognized this phenomenon as the “feminization of AIDS” (CHGA n.d.; Global Coalition on Women and AIDS 2004; Germain and Kidwell 2005; Piot 2007). This awareness of women’s vulnerability has stepped up prevention work with women, and focused attention on HIV and gender. While this is a necessary development, it is not without controversy. Arguably, the focus on women reinforces patterns of stigma and blame directed at women, portraying them as either vectors or victims of the epidemic (AWID and Kinoti 2008; Busza, this volume). This is partly the result of how “gender” is often addressed in development policy, practice and scholarship, equating gender all too often with women. As a result of the tremendous difficulty of changing entrenched social relationships, policy rarely looks beyond “women’s inclusion,” overlooking the beliefs, norms and values that underpin inequality in

The 2030 Agenda for Sustainable Development was adopted by the United Nations general assembly in September 2015. The agenda encompasses internationally agreed development aspirations – the Sustainable Development Goals (SDGs). The health targets of the SDGs are not merely ambitious in themselves; they are configured with a very considerable range of other, hugely expensive global issues: 17 goals and 169 targets covering nearly every important aspect of human well-being, both physical and relational. Within the health sphere, by the end of the SDGs in 2030, the ambition is that the AIDS epidemic and other communicable diseases should have been ended, child and infant mortality should be significantly reduced, and universal health coverage with financial protection should be in place for all. But the Joint United Nations Programme on HIV/AIDS (UNAIDS) 5-year ‘Fast Track’ plan for front-loading resources in order to build on progress against the HIV/AIDS pandemic is already faltering – surely evidence of the squeeze being exerted by the most urgent non-health issues (eg, SDG 13: climate action), together with an unpropitious political climate for Official Development Assistance generally. Whatever political embarrassment it might provoke, we must confront the inescapable conclusion that the SDGs are aspirational rather than a compulsory commitment to a programme: the hard choices will become larger in number and more anguished. …

Donor country initiatives for the prevention and mitigation of HIV/AIDS are not a matter of simple burden sharing. Instead, they have brought in their wake many of the complexities and unforeseen effects that have long been associated with more general overseas development assistance. In the case of funding directed toward HIV/AIDS, these effects are by no means either secondary or easily calculable. It is widely acknowledged that there is no consensus framework on how these impacts may be defined, no framework/toolkit for the evaluation of impacts and no longitudinally significant data that could provide the substance for those evaluations. The subject of this study focuses not on the health outcomes of funding but on how donor-recipient relations could be better deliberated, negotiated and coordinated. We argue that effective leadership and governance of developing country health systems for HIV/AIDS work requires a reconfiguration of how donor-recipient relations are conceived and contracted, and for this purpose, we propose an adaptation of the Organisation for Economic Co-operation and Development Paris Declaration principles of aid effectiveness.

The prospect for the MDGs cannot be reduced to the sum of the eight goals, divorced from international dynamics, the hard interests of states and the global dynamics that impact on both, or from the complexities and intractability of widespread poverty and its consequences. The legacies and controversies of previous international development initiatives also beset perceptions of, and support for, the MDGs. However, the wholly inclusive nature of the goals give them a unique normative standing and momentum; and the quantitative measures of progress ensure that there is more to the goals than lofty ideals. In addition, the thematic linkages between each of the goals is mutually reinforcing. While not discounting either structural difficulties or the lack of adequate progress in some specifics, it is important not to overlook the political consensus, abundant goodwill and normative momentum that have already been generated in the ten years to date. The answer to the question, `How promising is the p...

Five years from the end of the 15-year span of the Millennium Development Goals (MDGs) it is already plain that progress has been patchy and that the larger goals will not be met. The scale and profile of the MDGs will make them subject to eventual success or failure judgments and ‘lessons learned’ analyses, but the evidence of the past decade and current trajectories are sufficient to reveal our conceptual and operational shortcomings and the kinds of reorientation needed to ensure that the last five years of the MDGs will exhibit positive momentum rather than winding-down inertia. Such reorientations would include prioritising actors over systems; disaggregated targets over global benchmarks; qualitative aspects of complex forms of human relatedness over technical ‘solutions’; and the painstaking work of developing country enablement over quick outcome indicators, not least for the purpose of sustainability. Thinking and planning beyond 2015 must be made integral to the last five years of the M...