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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.

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.

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.

There has been a recent rise in optimism about Africa's prospects: increased economic growth; renewed regional and national political commitments to good governance; and fewer conflicts. Yet, given current trends and with less than eight years until 2015, Africa is likely to fail to meet every single one of the Millennium Development Goals (MDGs). Home to almost one-third of the world's poor, Africa's challenges remain as daunting as ever. Despite highly publicized increased growth in some economies, the combined economies of Africa have, on average, actually shrunk and are far from meeting the required 7 per cent growth needed to tackle extreme poverty. A similar picture emerges from the analysis of Africa's performance on the other MDGs. In a world where security and development are inextricably connected in complex and multifaceted ways, Africans are, as a result, among the most insecure. By reviewing a select number of political, security and socio-economic indicators for the continent, this analysis evaluates the reasons underlying Africa's continuing predicament. It identifies four critical issues: ensuring peace and security; fostering good governance; fighting HIV/ AIDS; and managing the debt crisis. In assessing these developmental security challenges, the article recalls that the MDGs are more than time bound, quantified targets for poverty alleviation–they also represent a commitment by all members of the international community, underwritten by principles of co-responsibility and partnership, to an enlarged notion of development based on the recognition that human development is key to sustaining social and economic progress. In recent years, and often following failures, especially in Africa, to protect civilian populations from the violence and predation of civil wars, a series of high-level commissions and expert groups have conducted strategic reviews of the UN system and its function in global politics. The debate has also developed at the theoretical level involving both a recon-ceptualization of security, from state centred norms to what is referred to as the globalization of security around the human security norm. There has also been a reconceptualization of peacekeeping, where the peacekeeping force has enough robustness to use force not only to protect populations under the emergent responsibility to protect norm, but also enough conflict resolution capacity to facilitate operations across the conflict–development–peacebuilding continuum. This article opens up a discussion of how these ideas might be relevant to security regime building and conflict resolution in African contexts, and suggests how initiatives in Africa might begin to make a contribution to the theory and practice of cosmopolitan peacekeeping.

AIDS-related morbidity and mortality not only affects individuals and their families, but is rapidly undermining African states' capacity to develop. Stemming the impacts of the pandemic has therefore become a major concern. This calls for meeting the needs for care and support of those affected, and increasing the access of persons living with HIV/AIDS to effective treatment. Provision of such complex medication in resource-limited settings is a fairly recent phenomenon. In this context, the article builds on emerging experiences from the field in identifying issues and challenges that need to be addressed in order to facilitate the scaling-up of HIV/AIDS treatment in Africa.

To mark the 25th anniversary of the discovery of the HIV virus, this special issue brings together a collection of articles from leading scholars engaged in, or concerned with, the challenges posed by the HIV/AIDS epidemic. Collectively, the articles address the power relations driving HIV/AIDS, frustrating the possibility of alleviation, care and recovery and operating to relegate entire regions to a vulnerable and bleak future.

There is no doubt that increasing amounts of funding are needed to provide a full package of HIV/AIDS prevention, treatment and mitigation interventions to Africa. However, even the existing funding flows are posing considerable challenges at a national level. In the quest for rapid results, donors have too often chosen to alleviate the lack of local capacity by bringing in foreign technical assistance or building parallel systems for delivering commodities such as drugs that may not be sustainable over the long term once external assistance stops. Even when such interventions may be relevant, they do not address the biggest challenge, namely how to build up the capacity and the systems needed for large-scale implementation of the AIDS response. This article argues that to attain the needed efficacy in HIV/AIDS mitigation programmes, further sustainable increase in external financing is certainly required (particularly for treatment programmes), but even more important is the need to implement them.

although the proximate cause of africa’s aids crisis is hiv, the underlining societal causes are much broader and familiar. across the continent, poverty structures not only the contours of the pandemic but also the outcome once an individual is infected with hiv. thus, until poverty is reduced there will be little progress with either reducing transmission of the virus or creating an enhanced capacity to cope with its socioeconomic consequences. it follows that sustained human development is an essential precondition for any effective response to the pandemic in africa.

As Africa enters its third decade of structural adjustment pressures, the promised advantages of economic restructuring—as hailed by the various lending bodies— have not been forthcoming. The indelible picture emanating from the continent is one of a people relegated to a position of extreme poverty as state managers and the international community either fail to, or seem unable to, pursue policies that will secure the basic needs of its citizens. To compound matters, HIV and AIDS are threatening to erode the continent's already fragile development capacity. Predicated on the continent's limited economic capabilities, this article charts the relationship between poverty, debt relief and the politics of effective response to HIV/AIDS in Africa. The article begins with an assessment of the societal causes and consequences of the epidemic, moving on to contextualize the case for debts cancellation. It concludes by examining the crucial relationship between debt relief and the successful implementation of effective strategies against the pandemic in Africa.

The Global Fund to Fight AIDS offers great promise as an instrument of global action to address the devastating effects of the disease. Yet the enormity of its promise also speaks to the scope of its mission: to facilitate the financing by governments, corporations, philanthropical bodies and individuals of a massive effort to address the epidemic that has to date outpaced previous efforts at effective control. A key challenge is to devise a governance structure that makes effective action likely, satisfies donors, responds efficiently, and produces observable results. By examining recent developments, this paper seeks to outline facets of the governance challenge facing the Global AIDS Fund.

(2002). Global health and the politics of governance: An introduction. Third World Quarterly: Vol. 23, No. 2, pp. 191-195.

The 13th International Conference on AIDS held in Durban, South Africa, highlighted the social catastrophe unfolding on the African continent. The meeting took place in the country with the largest number of people infected by HIV - the virus that causes AIDS - on the continent that is home to 70% of the world's HIV-infected population. The cruel irony of the unfolding human tragedy is that Africa is also the least equipped region in the world to deal with the multiplicity of challenges posed by the HIV virus. Drawn from ongoing research in southern Africa, this article charts the relationship between poverty, HIV prevalence and the politics of global response.