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Integration of the human rights of women and the gender perspective. Violence against women. Report of the Special Rapporteur on violence against women, its causes and consequences, Ms. Radhika Coomaraswamy, submitted in accordance with Commission on Human Rights resolution 2002/52. Addendum 1: International, regional and national developments in the area of violence against women 1994-2003.
[New York, New York], United Nations, Economic and Social Council, 2003 Feb 27. 435 p. (E/CN.4/2003/75/Add.1)The present report contains a detailed review of international, regional and national developments and best practices for ways and means of combating violence against women over the period 1994-2003. The report is not fully comprehensive, some regions or countries may have been reported on in greater detail than others, reflecting the information that was available to the Special Rapporteur. In order to provide a systematic analysis of global developments, the Special Rapporteur requested information on efforts to eliminate violence against women, its causes and consequences, from Governments, specialized agencies, United Nations organs and bodies, and intergovernmental and non-governmental organizations, including women's organizations, and academics. The Special Rapporteur expresses her gratitude to all who kindly provided information, which contributed significantly in the preparation of her report. (excerpt)
[New York, New York], United Nations, Economic and Social Council, 2003 Jan 6. 24 p. (E/CN.4/2003/75)Since the creation of the mandate on violence against women, its causes and consequences, in 1994 the world has achieved greater awareness and understanding of gender-based violence, and more effective measures are being developed to confront the problem. The international community has made great strides in setting standards and elaborating a legal framework for the promotion and protection of women from violence. While at the normative level the needs of women are generally adequately addressed, the challenge lies in ensuring respect for and effective implementation of existing law and standards. Much more remains to be done to create and sustain an environment where women can truly live free from gender-based violence. The report documents key developments at the international, regional and national levels. The Special Rapporteur welcomes the many efforts at standard-setting and norm creation at the international level and the array of activities and initiatives taken by States aimed at the elimination of violence against women, including the adoption of amendments to relevant laws, and educational, social and other measures, including national information and awareness-raising campaigns. In addition to the existence of laws, mechanisms for enforcing rights and redressing violations are also of crucial importance. Recent developments at the national, regional and international levels, in the prosecution of those responsible for violence against women are very important steps in the fight against impunity, not only because the perpetrators are brought to justice, but also because of the general deterrent effect such developments will hopefully have. (excerpt)
[Geneva, Switzerland], United Nations, Office of the High Commissioner for Human Rights [OHCHR], 2003. 8 p. (E/CN.4/RES/2003/45)Reaffirming that discrimination on the basis of sex is contrary to the Charter of the United Nations, the Universal Declaration of Human Rights, the Convention on the Elimination of All Forms of Discrimination against Women and other international human rights instruments, and that its elimination is an integral part of efforts towards the elimination of violence against women. Reaffirming the Vienna Declaration and Programme of Action adopted in June 1993 by the World Conference on Human Rights (A/CONF.157/23) and the Declaration on the Elimination of Violence against Women adopted by the General Assembly in its resolution 48/104 of 20 December 1993. Recalling all its previous resolutions on the elimination of violence against women, in particular its resolution 1994/45 of 4 March 1994, in which it decided to appoint a special rapporteur on violence against women, its causes and consequences. (excerpt)
Addressing violence against women in HIV testing and counselling. A meeting report, Geneva, 16-18 January 2006.
Geneva, Switzerland, World Health Organization [WHO], 2006.  p.This report summarizes the discussions and final recommendations from the meeting participants. Section 1 reviews the evidence of the association between HIV testing and serostatus disclosure and women's experiences of violence, describes current strategies to expand access to HIV testing and counselling, and discusses the implications of these various strategies for women. Section 2 describes specific programme approaches to address violence through HIV testing and counselling programmes, including strategies to achieve the following: engage male partners in the HIV testing and counselling process through couple counselling; train and build the capacity of HIV counsellors and other appropriate health care providers to recognize and counsel women at potential risk of violence; integrate HIV testing services into other health-related services, such as those provided to women who have experienced sexual assault; create peer support programmes to support women through the HIV testing and counselling process; and integrate HIV testing and counselling programmes within services for women who have experienced intimate partner violence. Finally, section 3 reflects conclusions and identifies specific recommendations made by the meeting participants to address violence against women: as a barrier to women accessing HIV testing and counselling services; in the counselling that is provided to women on how to disclose their HIV status to their sexual partners or other members of their social networks; and in the risk reduction counselling provided to women; as part of the post-test support needs of women. (excerpt)
New York, New York, United Nations, 2006.  p. (ST/ESA/STAT/SER.K/17)The World's Women 2005: Progress in Statistics focuses on the state of statistics for addressing gender concerns. It reviews the current availability of national data and assesses progress in data reporting from 1975 to 2003, based on the information that national statistical authorities report to the international statistical system. The statistics reviewed include those related to population, health, education and work. Also reviewed in the report is the current state of statistics in some of the relatively newer areas, namely violence against women; poverty; power and decision-making; and human rights. The focus on official national statistics, as differentiated from internationally prepared estimates, reveals the extent to which Governments are able to produce statistics to address various gender concerns. By so doing, the report provides Governments with the means to assess progress, identify gaps and design strategies to improve the national collection and dissemination of gender statistics needed for policy formulation and programme planning and evaluation. (excerpt)
Beijing betrayed. Women worldwide report that governments have failed to turn the Platform into Action.
New York, New York, Women's Environment and Development Organization [WEDO], 2005. 207 p.Beijing Betrayed is the fifth global monitoring report published by the Women's Environment and Development Organization (WEDO) assessing governments' progress in implementing the commitments they made to the world's women at the United Nations Fourth World Conference on Women in Beijing, 1995. Beijing Betrayed brings together the diverse voices of women in some 150 countries in subregions across Africa, Asia and the Pacific, Europe and North America, Latin America and the Caribbean and West Asia to influence the United Nations 10 Year Review of the Beijing Declaration and Platform for Action. This report presents women's realities - their concerns, experiences, perspectives and analyses - in the implementation process and contrasts sharply with the more formal and often abstract reports governments have presented. The reports presented here are a testimony to women as agents of change and give us cause for celebration. They show that women advocates everywhere have stepped up their activities since Beijing using the Platform for Action and other key global policy instruments to push governments into taking action. In every region of the world, women have taken the lead in crafting legislation and conducting public awareness activities to promote women's human rights, peace, and sustainable development. (excerpt)
[WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 15 p. (Actualitati in planificarea familiala No. 1)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
Journal of International Women's Studies. 2007 Nov; 9(1):212-233.This essay analyzes the contributions of three Young Women's Christian Association leaders who chaired the nongovernmental organization forum planning committees during the UN Decade for Women (1975-1985). It assesses the effectiveness of their leadership and addresses questions of distribution and uses of power within women's international NGOs and in relationship to the global feminist community. (author's)
Forced Migration Review. 2007 Dec; (29):42-44.The international community has been mandated to mainstream gender into humanitarian response ever since the landmark Beijing conference in 1995. The current humanitarian reform process provides unique opportunities to accelerate this integration. Taking gender issues into consideration in planning and implementing emergency responses is not only a question of protecting the human rights of the persons affected. It is also a means to make emergency aid more effective. It is thus natural that ensuring gender-sensitive responses should be at the heart of humanitarian reform. Gender has been identified as a crosscutting issue to be mainstreamed into the Cluster Approach. The IASC Task Force on Gender and Humanitarian Assistance has been transformed into an IASC Sub-Working Group (as of December 2006), expanding its mandate to become more operational. (excerpt)
Development and Change. 2007 Sep; 38(5):843-864.This article examines the initial response by national and international agencies to gender issues during the aftermath of the Maldives tsunami, arguing that it was, in general, inadequate. Some agencies took a gender blind approach, ignoring different impacts on men and women, as well as the effects of complex gender relations on relief and recovery efforts. Other agencies paid greater attention to gender relations in their response but tended to focus exclusively on the universal category of the 'vulnerable woman' requiring special assistance, whilst at the same time ignoring men's vulnerabilities. This article argues that such language entrenched women as victims, excluding them from leadership and decision-making roles and as such served to reinforce and re-inscribe women's trauma. It is suggested that it is partly because of the nature of international bureaucracies and the fact that this disaster drew foreign 'experts' from around the world that the response neglected or over-simplified gender issues. (author's)
Archives of Gynecology and Obstetrics. 2007 Dec; 276(6):583-589.The objective was to evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 plus or minus 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL. (author's)
Low sensitivity of total lymphocyte count as a surrogate marker to identify antepartum and postpartum Indian women who require antiretroviral therapy.
Journal of Acquired Immune Deficiency Syndromes. 2007 Nov; 46(3):338-342.Some studies support the use of total lymphocyte count (TLC) as a surrogate marker for CD4 cell count to guide antiretroviral therapy (ART) initiation. However, most of these studies have focused on nonpregnant adults. In light of expanding ART access through prevention of mother-to-child transmission (PMTCT)-plus programs in resource-limited settings, we assessed the sensitivity, specificity, and positive predictive value (PPV) of TLC for predicting low CD4 counts in antepartum and postpartum women in Pune, India. CD4, TLC, and hemoglobin were measured at third trimester, delivery, and 6, 9, and 12 months postpartum (PP) in a cohort of 779 HIV-infected women. Optimal TLC cutoff for predicting CD4 < 200 cells/mm3 was determined via logistic regression where sensitivity, specificity, PPV, and an area under the receiver operating characteristic (ROC) curve were calculated. Among the 779 women enrolled, 16% had WHO clinical stage 2 or higher and 7.9% had CD4 < 200 cells/mm3. Using 2689 TLC-CD4 pairs,the sensitivity, specificity, and PPV of TLC < 1200 cells/mm3 for predicting CD4 < 200 cells/mm3 was 59%, 94%, and 47%, respectively. The sensitivity of TLC < 1200 cells/mm3 cutoff ranged between 57% and 62% for time points evaluated. Addition of hemoglobin < 12 g/dL or < 11 g/dL increased the sensitivity of TLC to 74% to 92% for predicting CD4 < 200 cells/mm3 but decreased the specificity to 33% to 69% compared to TLC alone. A combination of TLC, hemoglobin, and WHO clinical staging had the highest sensitivity but lowest specificity compared to other possible combinations or use of TLC alone. The sensitivity and specificity of TLC < 1200 cells/mm3 to predict a CD4 < 350 cells/mm3 was 31% and 99%, respectively. Our data suggest that antepartum and PP women with TLC < 1200 cells/mm3 are likely to have CD4 < 200 cells/mm3. However, the sensitivity of this TLC cutoff was low. Between 45% and 64% of antepartum and PP women requiring initiation of ART may not be identified by using TLC alone as a surrogate markerfor CD4 < 200 cells/mm3. The WHO-recommended TLC cutoff of < 1200 cells/mm3 is not optimal for identifying antepartum and PP Indian women who require ART. (author's)
Is gender justice a priority for the UN and what more is needed for a coordinated institutional approach?
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 7 p.The challenge for us in the United Nations system is how to work with our international and local partners to undertake national reconstruction using a human rights based approach, to enable a transition to rule of rights, not a continuation of rule of abuse. We must develop a common approach to ensure that war-torn societies are rebuilt in such a way that nondiscrimination, and a total respect for rights, particularly those of girls and women, can be used to develop constitutions, legal frameworks, justice and security systems underpinned by the primacy of equal enjoyment of rights. UNICEF is currently covering a range of activities from the overall umbrella of child protection, including issues of child soldiers and DDR, mine action, juvenile justice, and international accountability for crimes against children to broader humanitarian survival issues such as health, nutrition and education. With its rights-based approach to policy development and programme implementation, UNICEF is strategicallyplaced to uphold the pre-eminence of the rights of women and girls and to work with partners to address gender justice issues at field level. (excerpt)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 8 p.For 25 years war raged in Afghanistan, destroying both the institutional fiber of the country and its justice system. Even in the period before the wars, the justice system had only managed to impose itself sporadically. Disputes that arose had to be resolved, for the most part, through informal religious or tribal systems. However acceptable some of the main laws may have been technically, they were offset by various factors: the poor training of judges, lawyers and other legal workers; decaying infrastructures; and ignorance of the law and basic rights by common citizens and even the judges themselves. The prison system had suffered even greater damages. Its infrastructure and organization were in ruins. Today enormous efforts have been mobilized to build a fair and functioning system that is respectful of human rights and international standards. It will take years for the Afghan government and people to do the job-with the help of the international community. (excerpt)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 5 p.Why Women and Peace? The theme imposed itself. The last year of the 20th century represented an invitation and challenge to recapitulate and remember as well as to compare scores and balance sheets of the turbulent epoch we were leaving behind. No doubt, the 20th century was the century of wars. As never before in human history civilians paid the highest price of conflicts and conflagrations. In the two world wars and innumerable local wars, interventions, internal ethnic clashes, revolutions and coups, more than 100 million people were killed - the vast majority of them being civilians. Sometimes they were directly targeted; at other times they were "collateral damage" - to use an ugly euphemism coined by NATO during its 1999 intervention against Yugoslavia. From Hiroshima and Nagasaki to Vietnam to Pol Pot's Cambodia to Iran-Iraq to Afghanistan to Liberia to Sierra Leone to Rwanda to Burundi to Colombia to Iraq again... it is the civilians who suffered the most and among them, women and childrenas the most vulnerable ones. (excerpt)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 4 p.Unfortunately, this is extremely well documented in countries in conflict. Many of the reports submitted to the Security Council include mention of the use of rape as a weapon of war. Recently, a report of the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC) on the situation of human rights in Ituri provided information on this problem which is as specific as it is frightening. But, paradoxically, in countries which are not in conflict, the issue of violence against women is often neglected, where it is not concealed. But the private sphere cannot be an area where rights do not apply. (excerpt)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 5 p.When wars occur, women are usually the most abused, aggrieved and powerless. In the vast majority of countries, women play no significant role in the decision-making process of whether war is warranted or lawful. When hostilities break out, women are exposed not only to the forms of violence and devastation that accompany any war but also to forms of violence directed specifically at women on account of their gender. The use of sexual violence and sexual slavery as tactics and weapons of war remains at a high level in spite of tremendous strides made by the global community over the past decade. It is imperative to acknowledge the immeasurable injury to body, mind and spirit that is inflicted by these acts. The overall deterioration in the conditions of women in armed conflict situations is due not only to the collapse of social restraints and the general mayhem that armed conflict causes, but also to a strategic decision on the part of combatants to intimidate and destroy the enemy as a whole byraping and enslaving women who are identified as members of the other warring party. (excerpt)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 5 p.In 1999, I stood among a sea of 20,000 desperate people on a dirt airfield outside Skopje, Macedonia, listening to one harrowing story after another. I had come to the Stenkovec refugee camp to record those stories and to help set up a system for documenting atrocities in Kosovo. The refugees with whom I spoke described being robbed, beaten, herded together and forced to flee their villages with nothing but the clothes they were wearing. Yet, what I remember most vividly are the lost expressions on the faces of the young women and girls in the camp. At first, they did not speak a word. Their silence acted as a veil, concealing crimes that they could not emotionally recollect. However, slowly, through time and comfort in speaking to female counsellors, their stories emerged. The brutality and systematic consistency of the sexual violence perpetrated on these women were mind-numbing. The widespread practice of rape against Muslim women was more than a consequence of war, it was an instrument of war with the intent of destroying the cultural fabric of a targeted group. This experience brought home to me a truism in international and national conflict: women suffer disproportionately to the atrocities committed against civilians. (excerpt)
International Journal of Gynecology and Obstetrics. 2007 Nov; 99(2):157-161.National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states' explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors' scrutiny. (author's)
New York, New York, United Nations Population Fund [UNFPA], 2007.  p.The influence behind faith-based organizations is not difficult to discern. In many developing countries, FBOs not only provide spiritual guidance to their followers; they are often the primary providers for a variety of local health and social services. Situated within communities and building on relationships of trust, these organizations have the ability to influence the attitudes and behaviours of their fellow community members. Moreover, they are in close and regular contact with all age groups in society and their word is respected. In fact, in some traditional communities, religious leaders are often more influential than local government officials or secular community leaders. Many of the case studies researched for the UNFPA publication Culture Matters showed that the involvement of faith-based organizations in UNFPA-supported projects enhanced negotiations with governments and civil society on culturally sensitive issues. Gradually, these experiences are being shared across countries andacross regions, which has facilitated interfaith dialogue on the most effective approaches to prevent the spread of HIV. Such dialogue has also helped convince various faith-based organizations that joining together as a united front is the most effective way to fight the spread of HIV and lessen the impact of AIDS. This manual is a capacity-building tool to help policy makers and programmers identify, design and follow up on HIV prevention programmes undertaken by FBOs. The manual can also be used by development practitioners partnering with FBOs to increase their understanding of the role of FBOs in HIV prevention, and to design plans for partnering with FBOs to halt the spread of the virus. (excerpt)
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
Washington, D.C., World Bank, Gender and Development Group, 2004 Nov.  p.This Operational Guide provides specific guidance to national HIV/AIDS program management teams, public-sector ministries, private sector entities, and non-governmental and community-based organizations (NGOs/CBOs) implementing World Bank-financed HIV/AIDS programs and projects, as well as the World Bank's operational staff who design these programs and projects. It provides concrete examples of the integration of gender concerns into all stages of project preparation, implementation, monitoring and evaluation (M&E). The immediate objective is to provide the tools needed to identify and analyze gender-specific issues and concerns in HIV/AIDS programs and make appropriate provisions in HIV/AIDS operations to address these concerns. The ultimate goal of this Operational Guide is to enhance the effectiveness of HIV/AIDS interventions by ensuring that the gender inequalities that underlie the epidemic are addressed. (excerpt)
The gender dimensions of HIV / AIDS: challenges for South Africa. Extracts from a regional scan and South Asian Regional Consultation.
New Delhi, India, Joint United Nations Programme on HIV / AIDS [UNAIDS], South Asia Inter-Country Team, 2004 Aug. 39 p. (UNAIDS/04.47E)The regional consultation brought together key Government representatives from seven countries of the region, across the HIV/AIDS sector, women's machinery, representative of the South Asian Association for Regional Cooperation (SAARC) Secretariat, and UN agencies working at regional levels, bilateral agencies and UNIFEM's partner organizations working on a range of development issues - such as mental health, violence against women, anti-trafficking, home-based work and economic rights, gender and sexuality, media advocacy - and networks of women living with HIV/AIDS. It provided a platform for learning and cross-regional sharing and identification of gaps and opportunities, and enabled the development of a regional strategy to work cohesively towards tackling the gender dimensions of HIV/AIDS. The consultation also provided strategic direction for UNIFEM to advance its work in the region. (excerpt)
Facing the future together: Report of the Secretary General's Task Force on Women, Girls and HIV / AIDS in Southern Africa. Advocacy version.
Johannesburg, South Africa, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2004 Jul. 26 p. (UNAIDS/04.33E)Southern Africa is the epicenter of the global HIV/AIDS pandemic. After growing steadily for two decades, the prevalence rates appear at last to have stabilised - but at shockingly high levels of prevalence. By 2002, more than 20 percent of pregnant women tested were HIV-positive, with several countries in the sub-region reporting a rate of infection in antenatal care clinics of more than 25 percent. Sub-Saharan Africa is also the only region in the world in which HIV infection rates are higher among women than men. For every ten men with the HIV virus, thirteen women are infected. The impact on young women and girls aged 15-24 - those who have only recently become sexually active - is even more dramatic. They are two and a half times more likely to be infected than males in the same age group. The gap is larger still in Southern Africa, where in Zambia and Zimbabwe girls and young women make up close to a staggering eighty percent of all young people aged 15-24 who are living with HIV/AIDS. What are the reasons for this enormous disparity? Why are women and young girls bearing the brunt of the pandemic in Southern Africa? The answers lie in poverty, violence and gender inequality. (excerpt)
Lancet. 2007 Sep 22; 370(9592):1032-1033.Cost-effectiveness analysis, as referenced by Davide Mauri and Nikolaos Polyzos, constitutes one of several sources of information considered by policymakers in developing and developed worlds in making decisions about the optimum efficient use of health-care resources. The WHO Commission on Macroeconomics and Health has suggested that interventions costing less than three times a country's per capita gross domestic product per disability-adjusted life year gained can be regarded as good value, and analysts have equivalently applied this threshold to analyses that use quality-adjusted life years (QALYs). Preliminary results from a cost-effectiveness analysis of vaccination with quadrivalent HPV 6/11/16/18 vaccine in Mexico suggest a cost/QALY ratio well below this threshold in that country. Previous analyses in developed world settings have consistently shown that vaccination of girls and young women has a cost-effectiveness ratio within the range typically regarded as cost-effective. In countrieswith the fewest resources, direct assistance and public-private partnerships can help deliver needed medicines to the population at or below development costs-eg, the ivermectin donation for river blindness. Marc Arbyn states that if the cases of vaccine-type-related disease are subtracted from disease due to all types, there are a larger number of cases in women who received vaccine than in those who received placebo. This subtraction assumes that the subset of disease cases due to vaccine HPV types and the subset of cases due to non-vaccine HPV types are mutually exclusive, which is not the case. Coinfections with vaccine and non-vaccine types are common. In the presence of coinfection, the effect of such a subtraction is to ignore the presence of non-vaccine HPV types in disease where a vaccine-type HPV has also been detected. The effect of the subtraction is to preferentially attribute co-infected disease cases only to the vaccine HPV types. Individuals in the placebo group are more likely to have their non-vaccine type-related disease discounted in this way. Owing to the high efficacy of the vaccine, individuals in the vaccine group have less vaccine-type-related disease, and so those in the vaccine group have fewer such coinfection cases. To illustrate this point, an analysis of the numbers of individuals with disease due to vaccine and non-vaccine HPV types in the intention-to-treat population of protocols 013 and 015 is presented in the figure. The parts shaded blue would be the result of subtraction, similar to Arbyn's subtraction. However, the total numbers of cases of disease related to non-vaccine HPV types are 226+56=282 cases in the vaccine group and 193+106=299 cases in the placebo group. There is not an excess of cases caused by non-vaccine HPV types in the vaccine group. (full text)