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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.

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.