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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.

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

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.

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.

This chapter explores the interrelationships between globalization, development, and security. It shows how globalization, as a neoliberal ideology for development promoted by key international financial institutions, deepens inequality between and within nations on a global scale. This exacerbates global insecurity through a growing sense of injustice and grievance that may lead to rebellion and radicalization. The chapter first considers the neoliberalism of globalization before presenting the case for conceptualizing globalization as a neoliberal ideology for development. It then discusses the legacy of structural adjustment programmes and the harmful effects of neoliberal ideology on societies, particularly across the developing world. Finally, it looks at two case studies to illustrate the link between uneven globalization and global insecurity: the Egypt uprising of 2011 and the Greek economic crisis of 2010.

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.

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.

The causes of human insecurity and suffering in the contemporary world are a major concern of this volume. If security is concerned with the achievement of basic human needs (CHS 2003), then HIV/AIDS poses the foremost challenge to the attainment of security in Africa. Though the exact mechanisms through which the epidemic is unfolding are not fully mapped and understood, it has a non-linear impact on state-society relations. As such, it serves to aggravate existing weaknesses by curtailing the range of options open to policymakers for expanding economies and achieving stated development goals sufficient to arrest underdevelopment on the continent. In the most heavily affected countries the ramifications of HIV/AIDS are evident in the deterioration in social welfare indicators, such as life expectancy, literacy and primary school enrolment that had been improving for several decades. HIV/AIDS is reducing the capacity in all social and economic sectors, as a result of the mortality and morbidity of highly skilled and experienced people who cannot be replaced quickly or easily, but only after long periods of training and skill acquisition. General levels of education fall as enrolments decline among children who lose parents as a result of HIV/AIDS. In some hard hit communities, the epidemic is leading to a retreat into subsistence production in agriculture as a result of reductions in the economically active population. In turn, these declines in economic activity are reducing levels of tax revenue, which lowers the capacity of the public sector to undertake its functions at a time of dramatically increased demand for public services in health, education and training. The net effect of the proceeding processes is the systematic erosion of the ability of all affected societies to safeguard the stock and flow of vital human capacity needed to sustain socio-economic development and political stability. The ability of nations, therefore, to improve the well-being of their citizens, build strong and stable societies, and expand opportunities for all is threatened by the HIV/AIDS. The situation is complicated because many high HIV prevalence countries (especially in Africa) were performing poorly before HIV/AIDS gained a foothold. The issue as to how HIV/AIDS affects society and in the process undermines its ability to sustain the vital human capital needed for sustained human development in Africa is the core preoccupation of this chapter. Using a human security framework (16.2), the chapter charts the rise of the HIV epidemic (16.3), explores the impacts of AIDS (16.4) and, based on primary research, postulates the possible ramifications on sustained human development in the years to come (16.4).

1. Introduction Nana K. Poku and David T. Graham 2. Human security in a globalising world Nana K. Poku, Neil Renwick and John Glenn 3. 'Neither Here Nor There?' The implications of global diasporas for (inter)national security Richard Davies 4. Mapping territoriality: The geopolitics of sovereignty, governance and the citizen Peter Marden 5

At present, there exists a multiplicity of institutional arrangements for facilitating cooperation of various types and involving different degrees of intensity at the sector, institutional and project levels. Principal among these are: the Southern African Development Community (SADC), the Southern African Customs Union (SACU) and the Common Market for Eastern and Southern Africa (COMESA). If the vision of a subcontinental community is truly to be achieved, then it is essential to focus our attention on the available options for moving these crucial institutions from their current positions towards less fragmented arrangements for promoting subregional integration. In what follows, this chapter reviews the positions of these historical institutions and speculates on their transformative potentials.