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Multilateral, regional, and national determinants of policy adoption: the case of HIV/AIDS legislative action.
International Journal of Public Health. 2013 Apr; 58(2):285-93.OBJECTIVES: This article examines the global legislative response to the HIV/AIDS epidemic with a particular focus on how policies were diffused internationally or regionally, or facilitated internally. METHODS: This article uses event history analysis combined with multinomial logit regression to model the legislative response of 133 countries. RESULTS: First, the results demonstrate that the WHO positively influenced the likelihood of a legislative response. Second, the article demonstrates that development bank aid helped to spur earlier legislative action. Third, the results demonstrate that developed countries acted earlier than developing countries. And finally, the onset and severity of the HIV/AIDS epidemic was a significant influence on the legislative response. CONCLUSION: Multilateral organizations have a positive influence in global policy diffusion through informational advocacy, technical assistance, and financial aid. It is also clear that internal stressors play key roles in legislative action seen clearly through earlier action being taken in countries where the shock of the onset of HIV/AIDS occurred earlier and earlier responses taken where the epidemic was more severe.
Washington, D.C., Futures Group, Health Policy Initiative, 2010 Sep.  p. (USAID Contract No. GPO-I-01-05-00040-00)The Global Fund to Fight AIDS, Tuberculosis and Malaria is a major funder of HIV programs worldwide, including programs that support orphans and vulnerable children (OVC). Following on a desk review of OVC-related content in Global Fund HIV / AIDS grants, this study in Kenya sought to explore the country-level processes and issues that affect inclusion of OVC goals and strategies in Global Fund country proposals and grants. The study involved interviews with 23 OVC stakeholders, including representatives of government ministries, international agencies, the country coordinating mechanism, principal and sub-recipients, NGOs, faith-based organizations, and OVC network members.
Getting in line: Coordinating responses for children affected by HIV and AIDS in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2010 Jun; 5(Suppl 1):92-100.Only one in every eight households containing orphans and vulnerable children (OVC) in African countries received any support from an external source (UNICEF, 2008). This is a reflection of how governments, both rich and poor, have ignored obligations ratified in conventions to ensure the social protection of vulnerable children (United Nations, 1989). Consequently, a disproportionate proportion of the financial burden of care of vulnerable children is borne by affected families and communities. It is deplorable that vulnerable children are forced to rely on the charity of income poor relatives and community members (Wilkinson-Maposa et al., 2005; Foster, 2005b). This situation is likely to continue until governments adequately assume their responsibilities. In countries such as Botswana, governments have responded to the crisis of children and AIDS and consequently most households containing vulnerable children now receive external support (UNAIDS et al., 2006). The movement to establish national social protection schemes for vulnerable households is gaining momentum. If cash transfers become established nationally, they may alleviate suffering on a wide scale (JLICA, 2009). In that case, community groups and non-governmental organizations (NGOs) that are currently responsible for implementing responses to support children affected by HIV and AIDS will still be needed to administer psychosocial and other services that are complementary to those provided by these schemes. It is vital that governments develop a central role in coordinating civil society responses and ensure that resources for vulnerable children are used more effectively. But most African governments have limited capacity to coordinate responses and have only recently engaged in this area that involves a few well-resourced international organisations, many local NGOs and innumerable community initiatives. This article reviews the responses of different sectors responding to the impacts of HIV/AIDS on children, and discusses how these may be better funded, coordinated and monitored, utilizing the findings from a study of civil society OVC initiatives and evolving national responses.
[Bangkok, Thailand], ITPC, 2007 Dec.  p.In the first section of the report, nine country teams provide first-hand reports on central issues related to AIDS service scale-up in their countries. Each demonstrates that increasing access to AIDS treatment brings not only better life and new hope, but also shines light on challenges and effective approaches to a spectrum of health, poverty, and human rights issues. In part two of this report, 14 national teams review drug access issues, and find that global and national processes for AIDS drug registration are burdened by inefficiencies, duplications, delay, and, in some instances, corruption. In many cases key ARVs, particularly newer and second-line therapies, are not yet registered in high impact countries - an administrative roadblock that puts lifesaving care out of reach for hundreds of thousands of people. The report makes a number of concrete recommendations to the key players who are responsible for making near universal access to AIDS treatment a reality by 2010. (excerpt)
International Affairs. 2006 Mar; 82(2):269-284.This article attempts to lay out a set of broad theoretical questions, illustrated with material from two visits to sub-Saharan Africa, including interviews with government officials and international organization representatives in Botswana and Malawi, about 70 interviews with staff from AIDS NGOs across sub-Saharan Africa, and an initial effort at mapping the universe of organizations responding to Africa's AIDS pandemic. The article focuses on four issues: (1) the nature of the organizations responding to AIDS in Africa; (2) the relation of AIDS governance to existing patterns of African governance, including the possibilities of syncretism and, conversely, a stand-off between the organizational models created by AIDS NGOs and existing patterns of authority and cooperation in African societies; (3) the problems and possibilities of 'cultural match' between existing repertoires of 'collective action schemas' and those proffered by NGOs and international organizations;1 and (4) the slippery matter of the play of power, money and identity in a field of power with very unequal players. (excerpt)
Africa Renewal. 2005 Apr; 19(1): p..When a reporter first met seven-year-old Bongani in a hardscrabble shantytown near Johannesburg in 2003, it was evident the child was dying. He was too weak for school, stunted and racked by diarrhoea. There was little question that he, like his deceased parents, was infected with the human immunodeficiency virus that causes AIDS. It seemed equally certain that he would soon lie in a tiny grave next to theirs -- joining the 370,000 South Africans who died from the disease that year. But when the journalist, Mr. Martin Plaut of the BBC, returned a year later, he found a healthy, laughing Bongani poring over his lesson book. “The transformation,” Mr. Plaut wrote last December, “was remarkable.” That transformation -- and the difference between life and death for Bongani and a growing number of people living with HIV and AIDS in Africa -- has resulted from access to anti-retroviral drugs (ARVs) that attack the virus and can dramatically reduce AIDS deaths. For years high costs severely limited their use in Africa. The Joint UN Programme on HIV/AIDS (UNAIDS) estimated that only about 50,000 of the 4 million Africans in urgent need of the drugs were able to obtain them in 2002. But with prices dropping in the face of demands for treatment access and competition from generic copies of the patented medications, the politics and economics of AIDS treatment have finally begun to shift. (excerpt)
Population 2005. 2004 Sep-Oct; 6(3):5.The Yangtze Declaration, adopted by the International Forum on Population and Development (Wuhan, China, 7-9 September), calls upon governments and international agencies to take all possible steps to fully integrate sexual and reproductive health and the HIV/AIDS program and to accord due importance to the integral relationship between reproductive health and poverty alleviation, in the context of the review of implementation of Millennium Development Goals (MDGs) in 2005. About 400 participants from more than 50 countries met in Wuhan, capital of Central China’s Hubei Province, to mark the 10th anniversary of both the International Conference of Population and Development (ICPD) and the Partners in Population and Development, an intergovernmental alliance of 21 countries dedicated to promotion and strengthening of south-south collaboration in population and development. (excerpt)
Population 2005. 2004 Sep-Oct; 6(3):6-7.We, the members of an alliance of developing countries, Partners in Population and Development, composed of more than half of the population of the world and a fifth of its land area, and many other developing countries, attended the 2004 International Forum on Population and Development . . . to review the implementation of the Program of Action adopted at the United Nations International Conference on Population and Development (ICPD/PoA) and the Millennium Development Goals (MDGs) in our countries, on the occasion of the 10th Anniversary of both the ICPD and that of Partners in Population and Development (PPD). (excerpt)
The contemporary response of the Brazilian government, the civil society and UNESCO to the HIV / AIDS epidemic. CCO Meeting, New York, New York, October 2003. [Respuesta contemporánea del gobierno brasileño, la sociedad civil y la UNESCO a la epidemia de VIH/SIDA. Reunión del Comité de Organizaciones Copatrocinadoras, Nueva York, Nueva York, octubre de 2003]
Brasilia, Brazil, UNESCO / Brazil, 2004.  p. (BR/2004/PI/H/1)Brazil has handled HIV/AIDS problems with much innovation and effectiveness, thereby creating good practices that other countries can learn from. As a universal organization, with a mandate encompassing the whole world, UNESCO must seek solutions wherever it can. Today, preventive education to fight HIV/AIDS is at the top of its agenda. Hence we must draw lessons from Brazil's experience so that your example can save lives and help development elsewhere: in Latin America, in Asia, in Africa, in Europe. We must learn from Brazil. We must learn fast. And we must apply what we learn quickly and effectively. (excerpt)
New York, New York, UNICEF, Programme Division, HIV / AIDS Unit, 2003 Jun.  p.The devastation brought about by HIV/AIDS is a human rights catastrophe. The epidemic has emerged as the single greatest threat to the fulfillment of the rights of children and women in sub-Saharan Africa and increasingly in most other regions of the world. The disease has already claimed tens of millions of lives and, unless dramatic action is taken, it promises to wipe out millions more. As HIV/AIDS sweeps mercilessly through nations, it disproportionately affects the world’s most vulnerable: women, adolescents and children. Those affected are routinely denied their rights to education, economic opportunity and health care and to protection from exploitation and harm. They are discriminated against and left powerless to resist the dangers they face. Yet every government has a responsibility to create an environment where children’s rights are protected and defended. Almost every country in the world has ratified the Convention on the Rights of the Child (CRC), which recognizes that children have the right to develop to their fullest potential physically, mentally and socially, and to express their opinions freely. These rights should be guaranteed by the State. The cost of HIV/AIDS rises with each minute the epidemic grows. As HIV/AIDS spreads, the cost of tackling the epidemic increases. In affected countries, trends in reducing child mortality and malnutrition and in expanding access to education are being reversed; and the population of orphans and other vulnerable children is exploding. The potential of young people to develop, and to participate in and contribute to society is being threatened as HIV/AIDS kills their mothers and fathers, brothers and sisters, schoolteachers, friends and young people themselves. (excerpt)
Geneva, Switzerland, UNAIDS, .  p.UNAIDS in collaboration with the Office of the High Commissioner for Human Rights (OHCHR) and other partners has developed guidelines advancing human rights in the context of HIV/AIDS. In February 1998, UNAIDS and OHCHR jointly published the International Guidelines on HIV/AIDS and Human Rights. These guidelines set the standards for upholding HIV/AIDS related human rights at the national, regional, and international levels. These Guidelines are a useful resource in the necessary scaling up of the response to HIV/AIDS by all actors concerned - governments and non-governmental organizations, the United Nations system and other international and regional organizations. Through UNAIDS funding and technical support, the International Council of AIDS Service Organizations (ICASO) published the NGO Summary and Advocates Guide as a more user-friendly form of the International Guidelines to enhance the document's accessibility. The NGO Summary and Advocates Guide has been distributed widely at national, regional, and international levels. It has been translated into Spanish and French. In July 2002, the OHCHR and UNAIDS convened a group of experts to update Guideline 6 of the International Guidelines on HIV/AIDS and Human Rights. The Revised Guideline 6: Access to prevention, treatment, care and support provides an up-to-date policy guidance that is based on current scientific progress, international law and best practice at country level. (excerpt)
Sport for development and peace: towards achieving the Millennium Development Goals. Report from the United Nations Inter-Agency Task Force on Sport for Development and Peace.
New York, New York, United Nations, 2003. vi, 36 p.This report analyses in detail the potential contribution that sport can make towards achieving the United Nations Millennium Development Goals (MDGs). It provides an overview of the growing role that sports activities are playing in many United Nations programmes and crystallizes the lessons learned. It also includes recommendations aimed at maximizing and mainstreaming the use of sport. (excerpt)
Lancet. 2003 Sep 13; 362(9387):879.In a damning indictment of China’s efforts to control the spread of HIV/AIDS, an international human rights organisation has accused the country’s central and local authorities of a cover-up that fosters discrimination, prevents adequate treatment, and threatens to worsen what is already one of the world’s largest outbreaks of the disease. (excerpt)
Brussels, Belgium, International Crisis Group, 2002. 11 p.This paper reviews the HIV/AIDS crisis in Myanmar. It describes the extent of the crisis in the region, the government's response against it, as well as of the UN agencies, non-governmental organizations, and other sectors.
Washington Post. 2000 Jul 5; A1.This article describes the political infighting, quiet racism, and overall neglect that have impeded the industrialized world’s reaction to the AIDS epidemic. It is noted that less than 20 years after physicians first described its symptoms, HIV has now infected 53 million people and has claimed the lives of 19 million people. In wealthy nations, effective drug therapies against AIDS became available, such as zidovudine in 1987 and then combinations of antiretroviral agents in 1996. But according to AIDS experts, combating the disease requires governments to interpose themselves into controversies of sex, injected drugs, and other taboos. It also requires people in the developed world to make Africa and Africans a priority. Even the WHO has had trouble confronting such realities. In addition, combating AIDS requires costly change in economies and national cultures. In this perspective, the US government, African governments, the World Bank, WHO, and the Joint UN Programme on HIV/AIDS (UNAIDS) are still struggling to agree on, and implement a prevention program in sub-Saharan Africa that would include hundreds of million of dollars in youth- focused education, intensive counseling of sex workers, provision and "social marketing" of condoms and much more aggressive treatment of lesser venereal disease. Some are waiting for a vaccine, but it is noted that it took 183 years between the discovery of a smallpox vaccine and the disease’s eradication.
Death watch, Part 5. An unequal calculus of life and death. As millions perished in pandemic, firms debated access to drugs.
WASHINGTON POST. 2000 Dec 27; A1.In response to the starkness of the global divide between the HIV-positive people and the ones saved from infection, and its growing political repercussions, the pharmaceutical industry and governments have pledged help. Five international agencies (Joint UN Programme on HIV/AIDS, WHO, UN International Children's Emergency Fund, World Bank, and UN Development Program) conducted a meeting with five pharmaceutical companies (Merck, Hoffmann-La Roche, Bristol-Myers Squibb, Glaxo Wellcome, and Boehringer Ingelheim) to negotiate global access to AIDS drugs. Although negotiations began in Geneva in 1991 and lasted for 2 years, both parties have been hesitant to reach a compromise because of one major factor--the price. These companies say they are willing to provide big discounts, yet they required that the concerned government and these international agencies should burden some of the expenses. However, it came out that even these international agencies are reluctant to invest in AIDS drugs saying that it is “cost-ineffective”. The bottomline of the negotiation is that financial resources play an important part when discussing global access to AIDS drugs and until this can be settled, millions of HIV-infected individuals will continue to suffer.
AIDS ANALYSIS AFRICA. 1998 Aug; 8(4):4-6.Each country currently experiencing an AIDS epidemic did not believe that the epidemics would develop, but they did and more than 6 million people have since died. However, if the governments of the approximately 2.3 billion people who live in developing countries where HIV/AIDS has not yet spread to the general population, together with the international community and nongovernmental organizations, act promptly, many lives will be saved. The World Bank publication "Confronting AIDS: Public Priorities in a Global Epidemic" brings, for the first time, an economic perspective to the problem of AIDS. The author considers how developing country governments should respond to the AIDS epidemic when they also face so many other major and pressing problems related to raising more than 1 billion people out of severe poverty. While AIDS is an important problem which must be immediately addressed, using resources to help people with AIDS will come at the expense of other objectives such as sending children to school, providing safe drinking water, and building infrastructure. The serious nature of the HIV/AIDS epidemic and what governments should do are considered.
AIDS ILLUSTRATED. 1996 Oct; 2(1):9.War and AIDS-related mortality in Uganda have created an estimated 1.2 million orphans in the country. Child welfare advocates and nongovernmental organizations (NGOs) have therefore been working together for the past 4 years under an umbrella organization to coordinate efforts for vulnerable children. The Uganda Community-Based Association for Child Welfare (UCOBAC), links people and organizations involved in child advocacy, facilitates relations between the government and NGOs, and helps to strengthen the capacity of NGOs to identify and implement projects. UCOBAC emphasizes community-based initiatives which allow children to remain in their own communities instead of being institutionalized. One example of such an approach is a vocational skills training program in Rakai district established to help young orphans trying to make it on their own. More than 300 youths had benefitted from the program as of December 1994 and plans are underway to expand the program to 10 more districts. UCOBAC is also training communities and NGOs to identify and implement viable projects, and helps child welfare organizations by serving as a network for sharing information. UCOBAC came into existence in October 1990 with 93 members, including 57 local NGOs, 17 international NGOs, and 19 individual members. The organization has since established local offices in 35 of Uganda's 39 districts. UNICEF has thus far provided about US$130,000 for UCOBAC activities and will continue to fund local NGO initiatives through UCOBAC. UCOBAC, however, is giving priority to becoming financially independent of UNICEF within a couple of years. Future projects include an inventory of NGO child welfare projects, a child welfare resource library, and networking workshops with NGOs and government policymakers.
Harare, Zimbabwe, UNICEF-Harare, 1994 Jun. v, 113 p.This volume provides a situation analysis of social, economic, structural, and political conditions in Zimbabwe. 14 chapters cover a wide range of topics, including history, geography, demography, government and administration, food security and nutrition, information networks, women's status, laws and statutes, health, AIDS' impact on women and children, education, water and environmental sanitation, orphans, refugees, and the handicapped. The overview describes the situation of children in Zimbabwe as dependent on class and race, gender and place of birth, education and job opportunities, marital prospects, and access to land and resources. Zimbabwe is viewed as a young country, which has experienced independence for only 14 years. In 1990, immunization covered 85% of all children. Infant and child mortality declined. Life expectancy increased. Primary school enrollment rose to 2.1 million. Over the past 14 years the government has expanded social services and enacted legislation for improving the status of women. Recently social indicators have declined. The reasons are multiple and complex. Some of the reasons are identified as the 1991-92 drought, the global recession, structural adjustment programs, declines in real per capita spending on social programs, the HIV epidemic and associated epidemics of tuberculosis and sexually transmitted diseases, and decreased investment in infrastructure.
New York, New York, Oxford University Press, 1993. xii, 329 p.The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
PEOPLE. 1992; 19(1):32-4.The IPPF President asks his fellow Africans to look inward to find sources and solutions to the continent's problems. They can no longer blame colonialism and the international community for its problems, but should realize the governments of African countries which had little regard for their own people have misused government resources and not invested in people. Further the 1 party state is no longer effective at solving Africa's problems and people in many countries are beginning to prefer a multiparty democracy. In addition, 11% of the world's population inhabit Africa but Africa takes part in only 2% of the international trade. Africa's population growth rate is >3%/year and in 1992 it had almost 500 million people, yet the gross national product of the continent equals that of Belgium, a country of 10 million people. Development will need to come from Africans so governments must 1st develop its human resources base such as implementing policies that releases the entrepreneurial spirit, providing universal education, and training high levels professionals including planners, engineers, and entrepreneurs. In fact, military expenditures should be curtailed to make room for the much need development efforts. Further African governments must give priority to developing effective population and family planning programs. African population and family planning experts should convince government officials of the need to appropriate funds to these programs. Governments must also confront the problem of AIDS, but not at the expense of investment and general health programs. The 1990s are the last opportunity for Africa to mobilize its people, especially women and children, to pull itself out of poverty and despair.