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Vaccine. 2013 Apr 18; 31(Suppl 2):B81-B96.Middle-income countries (MICs) as a group are not only characterized by a wide range of gross national income (GNI) per capita (US $1026 to $12,475), but also by diversity in size, geography, governance, and infrastructure. They include the largest and smallest countries of the world-including 16 landlocked developing countries, 27 small island developing states, and 17 least developed countries-and have a significant diversity in burden of vaccine-preventable diseases. Given the growth in the number of MICs and their considerable domestic income disparities, they are now home to the greatest proportion of the world’s poor, having more inhabitants below the poverty line than low-income countries (LICs). However, they have little or no access to external funding for the implementation of new vaccines, nor are they benefiting from an enabling global environment. The MICs are thus not sustainably introducing new life-saving vaccines at the same rate as donor-funded LICs or wealthier countries. The global community, through World Health Assembly resolutions and the inclusion of MIC issues in several recent studies and important documents-including the Global Vaccine Action Plan (GVAP) for the Decade of Vaccines-has acknowledged the sub-optimal situations in some MICs and is actively seeking to enhance the situation by expanding support to these countries. This report documents some of the activities already going on in a subset of MICs, including strengthening of national regulatory authorities and national immunization technical advisory groups, and development of comprehensive multi-year plans. However, some additional tools developed for LICs could prove useful to MICs and thus should be adapted for use by them. In addition, new approaches need to be developed to support MIC-specific needs. It is clear that no one solution will address the needs of this diverse group. We suggest tailored interventions in the four categories of evidence and capacity-building, policy and advocacy, financing, and procurement and supply chain. For MICs to have comparable rates of introduction as other wealthier countries and to contribute to the global fight against vaccine-preventable diseases, global partners must implement a coordinated and pragmatic intervention strategy in accord with their competitive advantage. This will require political will, joint planning, and additional modest funding.
New York, New York, United Nations, 2008 Jan.  p. (ST/ESA/SER.A/269)The last decades of the twentieth century witnessed a major transformation in world fertility: total fertility fell from an average of 4.5 children per woman in 1970-1975 to 2.6 children per woman in 2000-2005. This change was driven mostly by developing countries whose fertility dropped by nearly half (from 5.4 to 2.9 children per woman) with the decline being less marked among the least developed countries where fertility remains high (their average fertility declined from 6.6 children per woman in 1970-1975 to 5.0 in 2000-2005). This chart presents some of the data available to assess the change in fertility taking place in the countries of the world. For each of the 195 countries or areas with at least 100,000 inhabitants in 2007, it displays available unadjusted data on total fertility, age-specific fertility and the mean age at childbearing for two points in time: the first as close as possible to 1970 and the second as close as possible to 2005. Data on total fertility for the world as a whole, the development groups and major areas are estimates referring to 1970-1975 and 2000-2005 derived from the 2006 Revision of World Population Prospects. The chart thus presents regional estimates of fertility change and part of the basic data underlying those estimates. (excerpt)
Poverty in Focus. 2007 Oct; (12):6-7.Two years ago at Gleneagles, the G8 countries promised to double their aid to Africa. Since then, they have written off a substantial part of the external debt to the largest and oil-richest country, Nigeria. But new aid to the continent has stayed flat. In 2006, while Europe increased its aid, the two largest G8 economies, USA and Japan, reduced theirs. Africa, quite rightly, commands the growing attention of donors. But aid amount targets, both for Africa and globally, are often missed. Does that matter? This article makes four propositions: (i) traditional aid amount targeting is following a false scent in development terms; (ii) supply-driven aid has questionable value; (iii) aid should be more concerned with genuine country-based development goals; and (iv) rich countries should use aid as a means of facilitation, not as patronage. Targeting aid amounts is nothing new. In 1970, the UN set the target of 0.7 per cent of rich countries' Gross National Product (GNP) for Official Development Assistance (ODA). Since then a growing number of donor countries have stated their intention to reach it. The main purpose for setting such targets for aid is to create and sustain a momentum for ODA. While most donors haven't met the target, many have agreed that they should increase assistance to the poor countries. For the politicians of the rich countries and their constituents, therefore, aid volume targeting plays a useful role in reminding governments of their obligations. The two largest donors, however-USA and Japan-are exceptions. (excerpt)
Geneva, Switzerland, WHO, 2006. 15 p. (WHO/HIV/2006.05)In August 2006, the World Health Organization (WHO) launched a coordinated global effort to address a major and often overlooked barrier to preventing and treating HIV: the severe shortage of health workers, particularly in low- and middle-income countries. Called 'Treat, Train, Retain' (TTR), the plan is an important component of WHO's overall efforts to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. It is also part of WHO's effort to promote universal access to HIV/AIDS services. TTR will strengthen and expand the health workforce by addressing both the causes and the effects of HIV and AIDS for health workers (Box). Meeting this global commitment will depend on strong and effective health-care systems that are capable of delivering services on a scale much larger than today's. (excerpt)
Lancet. 2007 Jul 28; 370(9584):297-298.Several affluent countries have announced donations totalling US$1.5 billion to buy new vaccines that will help eradicate pneumococcal diseases in the world's poorest children. Donations from the UK, Italy, Canada, Russia, and Norway launch what many hope will be a new era to ease the burdens of disease and foster economic growth. Yet only a quarter of the money will be spent on covering the costs of vaccines-three-quarters will go towards extra profits for vaccines that are already profitable. The Advanced Market Commitment (AMC), to which the G8 leaders and the Bill & Melinda Gates Foundation have committed, is the difficulty. An AMC is a heavily promoted but untried idea for inducing major drug companies to invest in research to discover vaccines for neglected diseases by promising to match the revenues that companies earn from developing a product for affluent markets. By committing to buy a large volume of vaccine at a high price, an AMC creates a whole market in one stroke. However, no moneyis spent until a good product is fully developed. (excerpt)
Lancet Infectious Diseases. 2007 Jul; 7(7):439.The 2007 Group of Eight (G8) summit, which took place in Heiligendamm, Germany, on June 6-8, has been described by John Kirton (G8 Research Group, University of Toronto, Canada) as an "emerging centre of democratic global governance". Like many self-appointed elites, the G8 is an idiosyncratic club. The eight started as six in 1975 with a meeting in Rambouillet, France, of the heads of government of France, West Germany, Italy, Japan, the UK, and the USA-the most economically powerful democratic nations. This annual forum for discussion of matters of mutual interest was joined by Canada in 1976, by the European Union in 1977, and by Russia in 1997. Although the G8 nations account for nearly two-thirds of world economic output, the Russian economy is not among the world's top eight, whereas China with the fourth largest economy remains outside the G8 club. (excerpt)
Bulletin of the World Health Organization. 2007 Mar; 85(3):192-199.International health policy-makers now have a variety of institutional instruments with which to pursue their global and national health goals. These instruments range from the established formal multilateral organizations of the United Nations to the newer restricted-membership institutions of the Group of Eight (G8). To decide where best to deploy scarce resources, we must systematically examine the G8's contributions to global health governance. This assessment explores the contributions made by multilateral institutions such as the World Health Organization, and whether Member States comply with their commitments. We assessed whether G8 health governance assists its member governments in managing domestic politics and policy, in defining dominant normative directions, in developing and complying with collective commitments and in developing new G8-centred institutions. We found that the G8's performance improved substantially during the past decade. The G8 Member States function equally well, and each is able to combat diseases. Compliance varied among G8 Member States with respect to their health commitments, and there is scope for improvement. G8 leaders should better define their health commitments and set a one-year deadline for their delivery. In addition, Member States must seek WHO's support and set up an institution for G8 health ministers. (author's)
Matrix of major donor government structures and mechanisms for financing the HIV / AIDS response in low and middle income countries.
Menlo Park, California, Henry J. Kaiser Family Foundation, .  p.Donor governments provide multiple types of financial and other assistance to address HIV/AIDS in low and middle income countries, including grants, loans, concessional loans, commodities, and technical assistance. In addition, international assistance is provided through both bilateral and multilateral channels, and some mix of the two, reflecting donor decisions, capabilities, and preferences. Donor funding strategies and mechanisms also differ across several other dimensions, including funding cycles, regional focus, types of aid recipient, and period over which funding is committed and disbursed. Understanding such differences across donors is important for gaining a fuller picture of the international response to the epidemic. (excerpt)
Female Migrants: Bridging the Gaps throughout the Life Cycle. Selected papers of the UNFPA-IOM Expert Group Meeting, New York, 2-3 May 2006.
New York, New York, United Nations Population Fund [UNFPA], 2006. 136 p.Women make up nearly half of all migrants, an estimated 95 million of 191 million people living outside their countries of origin in 2005. Having said this, after many years of observing migration and collecting data there is remarkably little reliable information about women as migrants. This anomaly underlines their continuing invisibility to policymakers and development planners. The High-Level Dialogue on International Migration and Development by the General Assembly on 14-15 September 2006 offers the best opportunity in a generation to address the rights, needs, capabilities and contribution of women migrants. Equal numbers do not confer equality of treatment. Women have fewer opportunities than men for legal migration; many women become irregular migrants with concomitant lack of support and exposure to risk. Whether they migrate legally or not, alone or as members of a family unit, women are more vulnerable than men to violence and exploitation. Their needs for health care, including reproductive health care, and other services are less likely to be met. They have more limited opportunities than men for social integration and political participation. Migration can be beneficial, both for women and for the countries which send and receive them. Women migrants make a significant economic contribution through their labour, both to their countries of destination and, through remittances, to their countries of origin. In societies where women's power to move autonomously is limited, the act of migration is in itself empowering. It stimulates change in women migrants themselves, and in the societies which send and receive them. In the process women's migration can become a force for removing existing gender imbalances and inequities, and for changing underlying conditions so that new imbalances and inequities do not arise. Women's voluntary migration is a powerful force for positive change in countries both of origin and of destination. (excerpt)
Bulletin of the World Health Organization. 2006 Dec; 84(12):992-999.In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development. Responsiveness, a mother's/caregiver's prompt, contingent and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child, from better cognitive and psychosocial development to protection from disease and mortality. We examined two facets of responsive parenting -- its role in child health and development and the effectiveness of interventions to enhance it -- by conducting a systematic review of literature from both developed and developing countries. Our results revealed that interventions are effective in enhancing maternal responsiveness, resulting in better child health and development, especially for the neediest populations. Since these interventions were feasible even in poor settings, they have great potential in helping us achieve the Millennium Development Goals. We suggest that responsiveness interventions be integrated into child survival strategies. (author's)
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. II. Factors associated with the length of amenorrhea.
Fertility and Sterility. 1998 Sep; 70(3):461-471.The objective was to determine the relation between infant feeding practices (and other factors) and the duration of postpartum amenorrhea, and to establish whether there are real differences in the duration of postpartum amenorrhea for similar breast-feeding practices in different populations. Design: Prospective, nonexperimental, longitudinal follow-up study. Setting: Five developing and two developed countries. Patient(s): Four thousand one hundred eighteen breast-feeding mothers and their infants. Breast-feeding women collected ongoing information about infant feeding and family planning practices, plus the return of menses. Fortnightly follow-up occurred in the women's homes. A multivariate analysis explored the association between the risk of menses return and 16 infant feeding variables and 11 other characteristics. Ten factors (in addition to center effects) were significantly related to the duration of amenorrhea. Seven of these were infant feeding characteristics and the remaining three were high parity, low body mass index, and a higher frequency of infant illness. The breast-feeding stimulus is strongly linked to the duration of postpartum amenorrhea. Cross-cultural effects also are extremely important and may have caused the variations in feeding, the variation in amenorrhea, or both. (author's)
New England Journal of Medicine. 2006 Jun 8; 354(23):2414-2417.On June 5, 1981, when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia in young homosexual men in Los Angeles, few suspected it heralded a pandemic of AIDS. In 1983, a retrovirus (later named the human immunodeficiency virus, or HIV) was isolated from a patient with AIDS. In the 25 years since the first report, more than 65 million persons have been infected with HIV, and more than 25 million have died of AIDS. Worldwide, more than 40 percent of new infections among adults are in young people 15 to 24 years of age. Ninety-five percent of these infections and deaths have occurred in developing countries. Sub-Saharan Africa is home to almost 64 percent of the estimated 38.6 million persons living with HIV infection. In this region, women represent 60 percent of those infected and 77 percent of newly infected persons 15 to 24 years of age. AIDS is now the leading cause of premature death among people 15 to 59 years of age. In the hardest-hit countries, the foundations of society, governance, and national security are eroding, stretching safety nets to the breaking point, with social and economic repercussions that will span generations. (excerpt)
Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Bulletin of the World Health Organization. 1955; 22:63-83.This paper presents the results of the tuberculin-testing of over 3,600 patients in tuberculosis hospitals and of nearly 34,000 schoolchildren in widely separated areas where arrangements could be made for specially trained personnel to work uniform materials and techniques. Both patients and children were tested with an intradermal dose of 5 TU, and the children were retested with 100 TU if the reactions were less than 5 mm. The results confirm those of earlier papers, that at least two different kinds of naturally acquired tuberculin sensitivity are found in many human populations: a high-grade sensitivity, designated as specific for virulent tuberculous infection, and a low-grade kind designated as non-specific, or not specific for tuberculous infection. Specific sensitivity is the kind found in tuberculous patients and in some schoolchildren everywhere. It follows a remarkably uniform pattern wherever it is found, apparently varying only in prevalence, not in degree, from place to place. In contrast, non- specific sensitivity varies both in prevalence and in degree. It ranges from nearly universal prevalence in some localities to almost complete absence in others, from a low degree to a relatively high degree approaching that of specific sensitivity. Non-specific sensitivity is not correlated with specific sensitivity and may have different causes in different places. (excerpt)
World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women.
American Journal of Obstetrics and Gynecology. 2006 Mar; 194(3):639-649.The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Randomized placebo-controlled, double-blinded trial in nulliparous normotensive women from populations with dietary calcium !600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) throughout pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates. The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow-up losses (calcium, 3.4%; placebo, 3.7%). Calcium supplementation was associated with a non-statistically significant small reduction in preeclampsia (4.1% vs 4.5%) that was evident by 35 weeks of gestation (1.2% vs 2.8%; P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48-0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61-0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66-0.89; life-table analysis, log rank test; P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70-0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were %20 years of age (risk ratio, 0.82; 95% CI, 0.67-1.01; risk ratio, 0.64; 95% CI, 0.42-0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56-0.88) in the calcium group. A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes. (author's)
UN Chronicle. 1993 Mar; 30(1): p..The growing economic divide between North and South may well be reflected in the upcoming World Conference on Human Rights, as many developing and industrialized countries define their human rights concerns in sharply different terms. One basic difference over how much emphasis to place on the "right to development" may set the tone for a pointed debate at the Vienna conference. Many developing countries contend that political and civil rights cannot be separated from or be given priority over economic, social and cultural rights. Increasingly, they have asserted that development is an essential human right and objected to what many see as the industrial countries' narrow view of human rights as solely involving political and civil liberties. Indeed, in their view, economic development and an adequate living standard are preconditions of expanded political and civil rights. Further, the "collective rights" of people, some argue, may take precedence over certain rights of individuals. (excerpt)
New York, New York, UNFPA, 2005.  p.Population dynamics and reproductive health are central to development and must be an integral part of development planning and poverty reduction strategies. Promoting the goals of the United Nations Conferences, including those of the International Conference on Population and Development (ICPD), is vital for laying the foundation to reduce poverty in many of the poorest countries. At the ICPD in 1994, the international community agreed that US $17 billion would be needed in 2000 and $18.5 billion in 2005 to finance programmes in the area of population dynamics, reproductive health, including family planning, maternal health and the prevention of sexually transmitted diseases, as well as programmes that address the collection, analysis and dissemination of population data. Two thirds of the required amount would be mobilized by developing countries themselves and one third, $6.1 billion in 2005, was to come from the international community. (excerpt)
New York, New York, UNFPA, 2005.  p.The 1994 Programme of Action of the International Conference on Population and Development (ICPD PoA) recommended a regular review of its implementation. This publication presents the official outcomes of the ICPD at Ten review. The declarations, resolutions, statements and action plans included here are taken from the official meeting reports of the United Nations Regional Commissions and the Commission on Population and Development, held between 2002-2004. Each region undertook a review process most relevant to its situation, so the review outcomes may vary across regions. The Introduction to this volume is comprised of the Opening Statement by Louise Fréchette, Deputy Secretary-General, United Nations at the General Assembly Commemoration of the Tenth Anniversary of the ICPD, held on 14 October 2004. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2005.  p.At the Fourth World Conference on Women (FWCW) in Beijing, China, September 1995, 189 countries adopted the Declaration and Platform for Action, reflecting a new international commitment to the goals of equality, development and peace for all women everywhere. Five years later, in June 2000, Member States reaffirmed their commitments to the twelve critical areas of concern in the Beijing Platform at the Beijing +5 session of the General Assembly at United Nations Headquarters in New York, and considered future actions and initiatives for the year 2000 and beyond. The United Nations Population Fund (UNFPA) is fulfilling the principles and recommendations of Beijing through its ongoing work, mandated by the Programme of Action endorsed by 179 countries at the International Conference on Population and Development (ICPD) in Cairo in 1994. The Cairo agenda represents an international commitment to principles of reproductive health and rights for women and men, gender equality and male responsibility, and to the autonomy and empowerment of women everywhere. (excerpt)
Lewis questions results of G8 Summit; calls for independent, international women's agency; challenges scientists to engage in campaign of advocacy. Statement by Stephen Lewis, UN Envoy on HIV / AIDS in Africa, at the opening of the 3rd International AIDS Society Conference, Rio de Janeiro, Brazil, 24 July 2005.
AIDS Bulletin. 2005 Sep; 14(3):10-13.This is a meeting of scientists and experts in the world of AIDS. I am neither a scientist nor an expert. I'm an observer. I have spent the last four years, traveling through Africa, primarily southern Africa, watching people die. I think I understand, better than most, why your collective scientific and academic work can be said to be the most important ongoing work on the planet. But precisely because the work you do speaks to the rescue of the human condition, you carry an immense public and international authority. I beg you never to underestimate that authority. And I beg you to use it beyond the realms of science. What we desperately need in the response to AIDS today are voices of advocacy: tough, unrelenting, informed. The issues are so intense, the situation is so precarious for millions of people, the virus cuts such a swath of pain and desolation, that your voices, as well as your science, must be summoned and heard. (excerpt)
Lancet. 2005 Jul 16; 366(9481):177.This year people in bars and at football matches were asking about the Group of 8 (G8) nations summit in Gleneagles, Scotland. Such unprecedented popular interest was prompted by Bob Geldof’s Live 8 concerts and the Make Poverty History campaign. These initiatives were organised to raise awareness about African poverty and to pressure politicians into tackling the preventable global burden of disease afflicting billions of people living in low-income settings. When asked if his lobbying had paid off, Geldof said, “A great justice has been done”. He should have said “No”. While the concerts were successful as entertainment and the Make Poverty History campaign certainly raised awareness, they failed as political levers for change. What did the G8 achieve? One objective of the summit was to design policies to help Africa meet the UN Millennium Development Goals (MDGs) by 2015. The first MDG calls for the eradication of extreme poverty and hunger. The G8 achieved almost nothing new here, despite the impressive rhetoric of the final Gleneagles communiqué. The G8 pledged to forgive debt for many of Africa’s poorest countries and to increase total aid to developing nations by US$50 billion by 2010. But that investment is too little too late. (excerpt)
Lancet. 2005 Jul 2; 366(9479):1.Last week, WHO distributed to all European ministries of health one of the most important documents on prison health ever published. The report, Status Paper on Prisons, Drugs and Harm Reduction, brings together the wealth of evidence that shows that infectious disease transmission in prisons can be prevented and even reversed by simple, safe, and cheap harm-reduction strategies. Perhaps most importantly, the paper affirms WHO’s commitment to harm reduction, despite opposition from many governments who view such approaches as a tacit endorsement of illegal behaviour. The public-health case for action is strong, but political commitment to this method of combating health problems in prisons remains elusive. Indeed, health problems in prisons are numerous. Prisoners are often from the poorest sectors of society and consequently already suffer from health inequalities. Being in prison commonly exacerbates existing health problems—incarcerating anyone, especially vulnerable groups such as drug users and those with mental illness, has serious health and social consequences. (excerpt)
Lancet. 2005 Aug 13; 366(9485):603-605.In September, 2005, a summit of world leaders in New York, USA, will review progress towards the Millennium Development Goals. Three of the eight goals are explicitly health-related: to reduce child mortality by two-thirds between 1990 and 2015, to reduce maternal mortality by three-quarters, and to control HIV, tuberculosis, and malaria. A lack of progress by April, 2001, led Kofi Annan, the United Nations Secretary General, to establish a Global Fund to increase health investment, especially in Africa and Asia. The fund’s focus was control of HIV, tuberculosis, and malaria, which are diseases that kill more than 6 million people every year. To date, the Global Fund for AIDS, tuberculosis, and malaria has committed US$3 billion in 128 countries to support aggressive interventions against the three diseases. Nearly 11 million children and more than 0.5 million mothers die every year, yet progress towards mortality reduction targets has been poor despite the availability of cost-effective and scalable interventions. Investment in maternal and child health programmes has lagged far behind those for AIDS, tuberculosis, and malaria. The investment gap between what is needed and what is spent is large. Mothers and children, not for the first time, have lost out. Here, we put the case for a new Global Fund to reduce maternal, neonatal, and child mortality. (excerpt)
Lancet. 2005 Aug 13; 366:522.The Global Fund to fight AIDS, Tuberculosis and Malaria is in the middle of a public relations offensive. Since June this year, the Fund has been championing a campaign of public awareness to help build confidence in its activities by showing people around the world that “their country’s aid money saves lives”. It already seems to be working. Last week, the UK Department for International Development announced that it was doubling its yearly contribution to the Fund to £100 million for 2005 and 2006. And several donor governments, including the UK, answered the Fund’s plea to hastily fulfill all 2005 commitments by the end of July this year to trigger a full payment of US$435 million from the USA, which, by law, cannot pledge more than 33% of the total held in the Fund’s trustee account on July 31 each year. Despite the recent financial boost, the Fund is still anticipating a funding shortfall of US$700 million. Why is the Fund struggling to gain the credibility that will ensure financial security? (excerpt)
Canadian HIV / AIDS Policy and Law Review. 2002 Dec; 7(2-3):80-84.Health is a fundamental right, not a commodity to be sold at a profit, argues Irene Fernandez in the second Jonathan Mann Memorial Lecture delivered on 8 July 2002 to the XIV International AIDS Conference in Barcelona. Ms Fernandez had to obtain a special permit from the Malaysian government to attend the Conference because she is on trial for having publicly released information about abuse, torture, illness, corruption, and death in Malaysian detention camps for migrants. This article, based on Ms Fernandez presentation, describes how the policies of the rich world have failed the poor world. According to Ms Fernandez, the policies of globalization and privatization of health care have hindered the ability of developing countries to respond to the HIV/AIDS epidemic-The article decries the hypocrisy of the industrialized nations in increasing subsidies to farmers while demanding that the developing world open its doors to Western goods. It points out that the rich nations have failed to live up their foreign aid commitments. The article concludes that these commitments - and the other promises made in the last few years, such as those in the United Nations' Declaration of Commitment on HIV/AIDS - can only become a reality if they are translated into action. (author's)