Global Fund Consultation: Topic 2: Human rights

Addressing human rights in country settings

Guiding Question
What changes can the Global Fund make to its model to address barriers in the delivery of evidence-based services to most at risk and other underserved populations - in a way that protects human rights and prevents violations?

Have your say! click here


Introductory paragraph
The Global Fund has distinguished itself as a multilateral financing mechanism that has made significant contributions to protecting, promoting and fulfilling human rights through scaling up prevention, treatment, care, and support for HIV, tuberculosis and malaria. In this primary role as financing and not implementing programs, the Global Fund has played a vital role both in supporting interventions to overcome stigma, discrimination and other human rights-related barriers to prevention, treatment, care, and support, as well as in using its unique position to promote positive legal and policy change. Particularly in regard to HIV, the Global Fund has stimulated the creation of in-country processes that have opened doors to participation in HIV programming for people living with and vulnerable to HIV, and the inclusion of the voices of people living with and vulnerable to HIV is required to be demonstrated in all HIV funding applications.

However, on the question of human rights, inherent conflicts can arise in the Global Fund's principles when countries fail to implement rights based policies and programs in their approved funding request, or have policies that undermine human rights and dignity of people in need of services.

On the one hand - the Global Fund explicitly supports rights-centered approaches to the three diseases, with a particular focus on significant issues of stigma and prejudice that arises for people living with or affected by HIV in concentrated epidemics. Most at risk populations in this context include: adults and youth who inject drugs and their sexual partners; female, male and transgender sex workers and their sexual partners; and men who have sex with men, transgender people and their sexual partners. Whilst smaller in number, other at-risk groups include women who have sex with women who are abused through corrective rape practices, and youth who engage in transactional sex in high risk HIV settings.

On the other hand, the Global Fund also claims as a central principle that the programs it funds should result from "country-driven" processes. This dilemma was most recently discussed by Michel Kazatchkine, the Executive Director of the Global Fund, in Toronto in June 2010 when he said:

"Admittedly our dual commitment to human rights and to country ownership sometimes poses challenges, particularly when countries fail to implement rights- based policies and programs or have policies that undermine human rights." However, he also added that "one thing is clear: we do not support interventions that are not evidence-based or that infringe human rights."

Across 2011, the Global Fund is writing its new strategy for 2012 – 2016, and is seeking to target strategic interventions that address human rights and access (to prevention, treatment, and care and support) as a more centralized pillar of its work. In addition to the challenges faced by most at risk populations in concentrated HIV epidemics -across the three diseases, there are also persons who are particularly underserved. These are people who have significantly higher levels of risk, mortality and/or morbidity from HIV, tuberculosis or malaria than the rest of the population – but whose access to or uptake of relevant services is significantly lower others. The potential for human rights related barriers to accessing prevention, treatment and care and support services exist in such contexts also.

Partners collaborating with the Global Fund within its whole of partnership model have similarly developed new strategies or action plans that prominently address human rights, such as the UNAIDS "Getting to Zero" Strategy 2011 - 2015, the WHO HIV/AIDS Strategy 2011 - 2015, and Stop TB Partnership's Global Plan to Stop TB: 2011 – 2015. The Global Fund's new strategy is an opportunity to identify the strategic interventions that it will pursue to promote best practice human rights programming, and simultaneously, address human rights barriers and violations in a way that draws on the important work of other specialized agencies and funds.

Additional resource links
UNAIDS 'Getting to Zero' Strategy 2011 - 2015
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/JC2034_UNAIDS_Strategy_en.pdf

WHO Global Health Sector Strategy for HIV 2011 - 2015
http://www.who.int/hiv/aboutdept/strategy_consultation/en/

Stop TB Partnership's Global Plan to Stop TB: 2011 – 2015
http://www.who.int/tb/strategy/en/

How to Have Your Say?
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Join the Global Fund Consultation English eForum
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This initiative is supported by the AIDSPortal, and Citizen News Service on behalf of the Global Fund to Fight AIDS, TB and Malaria. More information about the process online here

148 comments:

  1. Miriam Edwards, Guyana02 May, 2011

    In Guyana the most-at-risk populations (MARPs) is not getting the priority they need to save lives, prevent infections and protect human rights.

    Sex workers, transgender community members, men who have sex with men (MSM) and those living with HIV are facing discrimination. There is no law to protect their human rights. But funding is going to agencies which are working on the medical or clinical aspect of the HIV pandemic.

    More work need to be done with these groups directly. The Global Fund need to look into this if we want to get to Zero New Infection by 2015.

    So in Guyana we are not doing enough for moving forward in rights-based direction with these target group.

    Miriam Edwards, Guyana
    Email: miriam.passion@yahoo.com

    ReplyDelete
  2. Eric Joshua03 May, 2011

    OVC and WOMEN RIGHTS

    Human Right is essential in all our daily dealing with others, we should all try our best in protecting it.

    Below are the steps that Global Fund can adapt in ensuring that the right of the less-privileged is protected:

    1. Orphans and Vulnerable Children (OVC) activities: Global Fund should try to invest in this area so as to promote their activities on Malaria, Tuberculosis and HIV/AIDS. This will go a long way in protecting Human rights

    2. Women Rights: if Global Fund can help the International Women Association, it will also help in their services to the less-privileged ones. We all know that some countries are still found wanting in this aspect and if Global Fund can help in awareness and funding, it will go a long way.

    Eric Joshua, Nigeria
    Email: ericjossy2003@yahoo.com

    ReplyDelete
  3. Dr Rajesh Gopal03 May, 2011

    INCORPORATE HUMAN RIGHTS AT ALL LEVELS BY CAPACITY BUILDING AND UTILIZING STRUCTURED MONITORING MECHANISMS

    The Global Fund to fight AIDS, TB and Malaria (GFATM) must incorporate the human rights perspective at all levels primarily through the capacity building measures and utilize the structured monitoring mechanism (after further strengthening them appropriately) and tools, to protect, promote and safeguard human rights as an integral aspect of the collective vision and the articulated mandate.

    I strongly believe that the GFATM has already been effectively facilitating interventions in an excellent manner evincing its dual commitment to human rights as well as country ownership. Generation and examination of local evidence may be further facilitated to specifically address the structural barriers with provision of mid way correction/modification of the activities being implemented by the partners.

    As a part of the process itself, the implementing partners in the concerned countries get educated to protect, promote and safeguard human rights. The rights-based policies and programs visibly start getting preference to the dubious policies and practices undermining human rights.

    It would, however, be pertinent on the part of all the stakeholders in general and the PR, SR and SSR in particular to strengthen the robust monitoring mechanisms to ensure that none of interventions that are not evidence-based or the ones infringing human rights get included/ supported from the funds made available by the GFATM.

    The GFATM family which obviously includes the implementers and community must ensure the same with full sincerity and commitment in the letter and spirit of the mandate of the GFATM.

    It is our collective commitment and responsibility.

    Dr Rajesh Gopal
    Gujarat State AIDS Control Society (GSACS) and
    Gujarat State Council for Blood Transfusion(GSCBT)
    Gujarat, India
    Email: dr_rajeshg@yahoo.com

    ReplyDelete
  4. Daniel Angelis03 May, 2011

    HUMAN RIGHTS AN ISSUE EVEN IN USA
    EMPLOYERS DISCRIMINATE AGAINST PLHIV
    PLHIV PUSHED INTO POVERTY

    Human Rights continue to be an issue, even here in the United States. While not blatant, large corporations and employers continue to discriminate against people living with HIV because of fear, or in some cases, have openly admitted that 'I think people with HIV are disgusting.'

    This thinking is pervasive across the employment landscape in the United States forcing many HIV and AIDS patients into poverty through no fault of their own, which also presents additional problems in prevention.

    I think adding businesses as a target audience in HIV education on the global and local levels will not only help lift HIV positive people out of poverty which, in tandem, will also help prevent additional HIV and AIDS infections.

    Daniel Angelis
    Email: danangelis@verizon.net

    ReplyDelete
  5. Dr Shanta Ghatak03 May, 2011

    STIGMA

    The myth that there is anything called HUMAN RIGHTS really doesn't surface when you get to see and face the truth at the community level. The perceptions are skewed and the unforeseen barriers that bar people like us from making ourselves heard in order to address the situations which will always exploit gender based inadequacies and surface as stigma?

    It is easy to say and write volumes on mitigation of stigma but when one tries and wants to quantify the rights based approach, it shows a skewing because with a change of leadership the bell shaped curve also swings in different directions. It is with a heavy heart I write this because no amount of reporting formats and training modules and evaluations will be able to organise TB control in the proper spirit. That determination and motivation is lacking - that understanding and compassion is missing, that kindness and helpful nature to respond truthfully and deliver with technical brevity with proper steering for the unfortunate TB community towards their rightful existence, rightful medications and diagnostics is just not there.

    The migrants, the homeless, the laid off and the well heeled, better earning community all have TB in common. But making them all hope for a proper TB care, addressing their needs for a better community support and delivering quality services have never touched their lives except a handful of patients served by some faith based organisations who had to beg for the money from the national programme at times just to keep their organisations afloat.

    There needs to be a strategy in place as to who will be the volunteer to advocate for the rights based approach for the TB community. Only training several people and organisations and reporting that SOMETHING has been done needs more justification in terms of the tax payers' money being spent towards TB control. Some commitment must be enforced for the planned activities, some prefixed soft criteria needs to be in place before selection processes.

    Dr Shanta Ghatak, India
    Email: drshantaghatak@gmail.com

    ReplyDelete
  6. Miriam Edwards03 May, 2011

    FUND PROGRAMMES TO PROTECT HUMAN RIGHTS

    In Guyana the most-at-risk populations (MARPs) is not getting the priority they need to save lives, prevent infections and protect human rights.

    Sex workers, transgender community members, men who have sex with men (MSM) and those living with HIV are facing discrimination. There is no law to protect their human rights. But funding is going to agencies which are working on the medical or clinical aspect of the HIV pandemic.

    More work need to be done with these groups directly. The Global Fund need to look into this if we want to get to Zero New Infection by 2015.

    So in Guyana we are not doing enough for moving forward in rights-based direction with these target group.

    Miriam Edwards, Guyana
    Email: miriam.passion@yahoo.com

    ReplyDelete
  7. Dr Dinesh Kumar03 May, 2011

    TREATMENT WITH DIGNITY

    BENCHMARK OF GLOBAL FUND'S SUCCESS LIES NOT MERELY IN MAKING THE DRUGS AVAILABLE BUT THE CARE, WARMTH AND DIGNITY THESE ARE WRAPPED IN

    'Treatment with dignity' is a key expectation of a patient, irrespective of the financial or social background the person comes from. When this patient is suffering from tuberculosis or AIDS related health problems the issue of 'Treatment with dignity' assumes multiple dimensions. The provision of free or subsidized anti retro-viral or anti-TB drugs is just not enough to meet the expectations of the patient or the family.

    The stigma of being a victim of a deadly disease like TB or AIDS still torments the lives of patients. In the city I live in the government owned TB and Chest diseases hospital dropped the 'TB' component from its name long ago, but still people hesitate to go to 'Chest Diseases Hospital' lest they may also be labelled as TB patients. Patients on anti retro-viral drugs are still very reluctant to show their treatment cards to physicians which depict their HIV status, unsure of the response of the physician.

    The physicians, surgeons, nurses and other health care providers have been very slow to accept their responsibilities towards the persons with AIDS related health problems. The acceptance is is developing but at a snail's pace. Pregnant mothers or those requiring surgical interventions are still running from pillar to post to get treatment.

    Global Funds needs to discuss the issue of 'Treatment with Dignity' at length. In this post I have pointed only towards a couple of aspects. The benchmark of Global Fund's success lies not merely in making the drugs available but the care, warmth and dignity these are wrapped in.

    Dr Dinesh Kumar
    Health and Development Initiative, India
    Email: dr.dineshkumar@gmail.com
    Website: www.healthinitiative.org

    ReplyDelete
  8. Robert Bennoun03 May, 2011

    HUMAN RIGHTS BASED PERFORMANCE

    There's a need to make attention to human rights based performance through emphasizing funding for civil society organizations within Community Systems Strengthening (CSS) and development if practical guidelines for HRBA within CSS including partnership between Government and civil society in service provision and monitoring if service quality.

    Robert Bennoun
    Email: robert.bennoun@gmail.com

    ReplyDelete
  9. Asim Sarode03 May, 2011

    LAWS TO PROTECT HUMAN RIGHTS

    In India most of the people living with HIV are facing discrimination. There is no law to protect their human rights. But funding is going to agencies which are working on the medical or clinical aspect of the HIV pandemic. So in India we are not doing enough for moving forward in rights-based direction.

    Asim Sarode
    Human Rights Activist Lawyer
    Pune, India
    Email: asim.human@gmail.com

    ReplyDelete
  10. Jordan Kaisi03 May, 2011

    HOMOPHOBIA

    Global Fund has not done much, if any (but it should do) in some African countries especially in Zambia (and as was witnessed in the case in Uganda where Mr Kyato, the human rights activist was killed), in addressing the challenges posed and putting in place intervention strategies to address HIV/AIDS and its resultant conditions in homosexuality.

    This is because the community regards homosexuality as immoral, un-Zambian and sin, and rightly so, because Zambia is a Christian nation. As such, to avoid and overcome the challenges of stigma and discrimination that they may face, gays have as well female sexual partners too; you can imagine in this situation how HIV/AIDS and its resultant conditions perpetuated through this channel are being sustained. The fight against HIV/AIDS then, becomes a mammoth mountain to climb and it is like fighting a losing battle.

    Commercial Sex Work (CSW) or sex between the unmarried are as immoral, un-Zambian and sin just like homosexuality. Society has recognised and knows the danger and challenges posed by sex work and other sexual activities between the unmarried as big problems, as such, strategies for interventions have been initiated, but not in the case of homosexuality.

    Whether we like it or not we have homosexuals in Zambia and the question of HIV/AIDS in these groups cannot be ignored if we are to have a meaningful solution to the challenges of HIV/AIDS. Global Fund should therefore, put in place mechanisms of monitoring and ensuring that global fund addresses and is used for prevention, treatment and support and care for all: the infected and affected by HIV/AIDS regardless.

    Recognising that we have the challenges of HIV/AIDS in homosexuals is not the same as approving the behaviour in homosexuality, as Zambia views it. If the flow of the viruses through one channel are left unchecked and continue supplying communities with this deadly disease the fight against the pandemic will never be won. There is a question of human rights as well to be addressed; the right to health for all.

    Jordan Kaisi, Zambia
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  11. Stephen McGill03 May, 2011

    MORE SUPPORT FOR PROGRAMMES AND PROJECTS ON HUMAN RIGHTS

    Support more program and projects that are sustainable and cost effective, support GIPA, support minorities and human rights efforts.

    Stephen McGill
    Email: smcgill_sail@yahoo.com

    ReplyDelete
  12. Caleb Orozco04 May, 2011

    PROTECT HUMAN RIGHTS BY ENGAGING MARPs COMMUNITIES
    - SUPPORT SMALL MARP ORGANISATIONS
    - REPRESENTATION OF MARPs ON CCM
    - DEFINE "SUPPORTING HUMAN RIGHTS FOR CBOs"

    The issue of human rights is in the approach of its enforcement and our perception of how investment are made in stigma reduction. The Global Fund funds while important is inaccessible to small NGO's that are led my marginalized populations.

    It is our view as the United Belize Advocacy Movement that there is a bias to the Global Fund being good at supporting large organizations work, but bad at supporting small organizations, especially those led by sex workers, MSM or transgender population.

    This operational environment tend to isolate and erode the ability of MARPS led organization to be able to access resources that it needs that is relevant to the needs of it particular population.

    Furthermore, CCM do not have MSM, Sex Worker representative most time in country. This further aggravates the impact these populations can have in resource allocations, policy and ground level action. What Global Fund can do is the following:

    1) Ensure that Civil society is fully represented on the CCM and that MSM, Sex workers and Others have full participatory representation
    2) Ensure that at least marginalized led organization have funding priority for their activities.
    3) Ensure that rights-enforcement mechanism are present in every proposal submitted that directly impacts MARPS.
    4) Monitor MARPS representations on CCM in a progress Report.
    5) Ensure that marginalize led organizations have access to Justice Services in activities to protect their populations.
    6) Define Global Fund definition of supporting Human Rights action for community-based organizations (CBOs).

    Caleb Orozco
    Executive President, United Belize Advocacy Movement
    Email: unibambusiness@gmail.com

    ReplyDelete
  13. Dr Heitham M Ibrahim04 May, 2011

    LET's UNDERSTAND HUMAN RIGHTS IN COUNTRY'S CONTEXT

    HIV/AIDS is highly linked to socio-cultural factors. More than 95% spread through 'unsafe sex' which in many communities behave as sin or cultural deviance. Stigma is deeply rooted even among healthcare providers. Religious and cultural beliefs about use of condoms are another issue! Being sex worker or homosexual is a tragedy in many communities.

    This context makes working on 'Human Rights' regarding HIV/AIDS is very essential and country specific and culture specific in the same time. Hence supporting multi-sectoral approach programs that involving all stakeholders and actors of each country at early policy making and planning stages is very important.

    The second suggestion is to let these rights to be flexible and follow regulations and cultures available in each country rather than to push for a universal approach to be followed by all countries this will not benefit the programs.

    Also I want to comment on the vertical approach of the HIV program in many countries and its relation to our topic now. However this approach is considered to be successful but stand-alone non-integrated HIV services by itself deepening the stigma among patients and communities.

    Restructuring of our strategies and approaches to support human rights and to be away from stigma is of great value.

    Dr Heitham M Ibrahim
    TB-HIV coordinator, Sudan
    Email: bauga1@hotmail.com

    ReplyDelete
  14. Jitendra Dwivedi04 May, 2011

    TRANSGENDER COMMUNITY

    I will like to raise the issues of transgender community in the consultation on this topic of human rights and HIV, TB and malaria responses.

    The issues are very specific to transgender community so they should be more meaningfully involved at every level so that programmes meet their needs. Protecting human rights is a major challenge. It is not only sexuality related issues but also stigma and discrimination they often face in their day to day lives. It goes beyond getting prevention, treatment, care and support services in a friendly manner - and addressing their human rights' needs in day to day lives will bring in the difference we wish to see in their vulnerabilities to diseases and conditions.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  15. Piyush Kumar Agarwal04 May, 2011

    CHILDREN

    I will like to ask when a child is denied admission in a school because the child is living with HIV, is it not human rights' violation? It is a different component to work with educationists and other stakeholders to address this issue which we do hear even now.

    Global Fund should consider supporting programmes that bring in broader changes in human rights' context in the lives of children living with HIV. Also thanks to the Global Fund, now the antiretroviral (ARV) roll out is much better than a decade back. With children living with HIV moving into adolescence or their youth, it is important to address their other human needs so that their human rights continue to remain protected.

    Piyush Kumar Agarwal, India

    ReplyDelete
  16. Kiran Jaiswar04 May, 2011

    AIDS LAW

    Unless we have a legislation to back our human rights' based approach, the impact will be limited I believe. There is a news today that an appeal has been made to the Indian parliament to take up AIDS Law in this session. I will like to request the Global Fund to fight AIDS, TB and Malaria (GFATM) to take up this issue with Indian parliamentarians and come up with strong AIDS law in India that protect human rights, especially of those most marginalized - most-at-risk-populations (MARPs).

    Kiran Jaiswar, India
    Email: ashashram@yahoo.com

    ReplyDelete
  17. Maisoon Elbukhari04 May, 2011

    TRAINING SERVICE PROVIDERS IN HUMAN RIGHTS AND GENDER-BASED APPROACHES

    Health service should be accessible to all and the targeted interventions do accentuate the prejudice. The underserved and most at risk populations being part of the community will benefit from the available services if the service providers are well trained on the human rights and gender based approaches.

    One of the strategic interventions is to promote improvement in the available services and raise awareness of the rights and responsibilities of users and providers of health services through sensitizing and training the service providers on the human rights principles and how could the human rights framework support the delivery. Other important intervention is measuring adherence of the GF supported interventions to the basic requirements of the right to health.

    Maisoon Elbukhari, UNDP, Sudan
    Email: Maisoon.Bukhari@undp.org

    ReplyDelete
  18. Asim Sarode04 May, 2011

    MORE SUPPORT FOR AIDS LAWS AND HUMAN RIGHTS BASED PROGRAMMES

    The Global Fund shall focus on the Nations in which there is no Law to protect the rights of individuals who are living with HIV.

    But unfortunately no funds are being provided to organizations and groups who are working against the discrimination. The holistic approach towards fighting AIDS is missing in allocating funding support also. Until and unless the GF will not look into the HIV related issues applying human rights perspective it will be hard to give assurance to the affected communities that they will get all security if they come forward for treatment and the human dignity of all such people will be protected.

    Asim Sarode
    Human Rights Lawyer
    Pune, India
    Email: asim.human@gmail.com
    Website: www.sahyogtrust.in

    ReplyDelete
  19. Dr Godfrey Waidubu04 May, 2011

    I tend to agree with Dr Rajesh Gopal and Miriam, Human Rights affects all population (includes vulnerable populations, at risk and really all persons). It would be nice for GF to implement or incorporate into existing programs to tackle the issues of Human Rights issues across the board or only to the targeted GF population groups (less expense).

    Knowledge, Attitude, Practice (KAP) approach on human rights is lacking for all or most population and we could have a win - win situation (possibly) by delivering health services and human rights issues together.

    Dr Godfrey Waidubu, Nauru
    Email: waidubu@gmail.com

    ReplyDelete
  20. Ritesh Arya04 May, 2011

    DIGNITY

    When I was seeking treatment for TB from a government centre, standing in long queues for hours together waiting to get my anti-TB medicines was not a very convenient experience. Also due to lack of awareness, TB continues to be stigmatised. Stigma associated with HIV and TB, even inside healthcare settings, is alarming.

    Our Indian national TB programme (called Revised National TB control Programme - RNTCP) said about 100,000 women are deserted by their husbands due to TB every year in India.

    So let us begin with the goal of ensuring that every TB, HIV and Malaria service delivery centre treats people with dignity, protect their human rights, and ensure they get best service in a humane manner.

    Ritesh Arya, India
    Email: ritesharya45@yahoo.com

    ReplyDelete
  21. Jitendra Dwivedi04 May, 2011

    IMPLEMENT PATIENTS' CHARTER FOR TB CARE

    I will appeal to the Global Fund to fight AIDS, TB and Malaria to fund programmes that roll out the Patients' Charter for TB Care. That is not happening and even our doctors in eastern Uttar Pradesh are not aware of any such Charter - and needless to say that it is not displayed in Hindi or Urdu in our TB clinics and of course TB patients are not aware of this.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  22. Wabwire PF Okmollo05 May, 2011

    HEALTH IS MADE AT HOME AND ONLY REFURBISHED IN/ AT HEALTH FACILITIES

    In view of the 1978 Alma Ata Conference whose concern was health for all by 2000, and with the WHO Definition of Health, Human Rights is for all.

    For Global Fund, all the three stated diseases affect all classes of people especially in Africa. Although some are more at risk hence more affected than others and reason being they are more left out/ marginalised of the activities of promotion of their rights.

    "The best Doctor to ones illness- is the patient / client him/ herself" and also "Health is made at home and only refurbished in/ at health facilities"

    Therefore, Global Fund support towards promotion of Human Right through scaling up of preventive, treatment, care and support for those vulnerable to the three targeted conditions is paramount and need to aim at maintaining the system.

    Global Fund would consider the following approach:-
    a) Consider Health Promotion Activities
    i) Health Education, Social Mobilization, BCC involving the most at RISK population ( the lower Class i.e. Local villagers),
    ii) Advocacy that should involve the very local people.
    iii) Need for Community/ local people favouring policies and legislation
    b) The messages can be delivered well through universal social areas like Churches, Mosques, Schools
    c) Reduce on the workshops of the already proffessionaly trained people and consider community approach, then line up a fresh M&E System

    Wabwire PF Okmollo
    Email: wabwireokmollo@yahoo.com

    ReplyDelete
  23. Miguel dela Rama05 May, 2011

    ALL SERVICES SHOULD BE ACCESSIBLE TO ALL

    Human right -based: A local policy should be passed (in Philippines' context) to ensure that all services a accessible to all sector. And increase public awareness on the existence of services in every localities.

    Miguel dela Rama, Philippines
    Email: mgdelarama@yahoo.com

    ReplyDelete
  24. Akinbo AA Cornerstone05 May, 2011

    One thing is certain. Human Right is not a disease; it's an issue that needs not be overdressed but acted upon. It would be fair to take note of the existence of small groups of like minds and call on certain authority and institutions to address stigma related issues in any country.

    A citizen can relate more in his/ her immediate Community especially with training Community Based Organizations (CBOs) are willing to stand the challenge. While the call may be mild, attention should be paid to like-minds and off-records that have not been considered but regarded.

    The funds we get in Nigeria could have done more.

    Global Funds need to call for a workshop with Focal Groups and encourage documentations of CBOs with LGA Certification and train them for a period of 18 months. Those who survive this training will be able to domesticate action projects.

    Akinbo AA Cornerstone, Nigeria
    Country Director, Help AIDS Orphans
    Emails: akinbo@helpaidsorphans.com, akinboadebunmiadeola@yahoo.com
    Website: www.helpaidsorphans.com

    ReplyDelete
  25. Tariq Manzoor05 May, 2011

    ENGAGE TRANSGENDER IN PROGRAMME DESIGN

    Transgender community members are not well represented at every step of AIDS responses - so the services are at times not friendly and don’t meet specific needs of the community.

    Solution lies with the affected communities. Programmes aimed to serve transgender community should engage them meaningfully so that we not only address human rights but also increase utilization of services.

    Tariq Manzoor, Bangladesh

    ReplyDelete
  26. Ritesh Arya05 May, 2011

    TREATMENT LITERACY IS A HUMAN RIGHT
    MALARIA CONTROL NEEDS BROADER RESPONSES THAN MEDICINES

    Global Fund should consider supporting treatment literacy and health education related to HIV, TB and malaria. When I got TB and malaria at different points in my life, both times doctor had hardly anytime and got irritable if I insisted to know more about my condition, treatment and other related issues. Later I had to find information and educate myself on what's going on with my body.

    Also structural issues - the drain in front of our house has been there since last 25 years I have lived at this place. So mosquitoes will surely come and risk of malaria and other mosquito borne infections continue to threaten us. Malaria control needs broader responses than medicines.

    Ritesh Arya, India
    Email: ritesharya45@yahoo.com

    ReplyDelete
  27. Annah Irungu05 May, 2011

    ADDRESS CONFLICTING POLICIES TO PROTECT HUMAN RIGHTS

    We need to have policies that are a part of Global Fund evidence-based, human rights approach. There's a need to resolve issues with some working policies with recipient countries to be consistent to with global Rights approaches, one instance is in testing for HIV for children which in some countries like Kenya, can only be consented by the parent. If parents are unwilling, it infringes on these children's right to universal access, as a pre-set condition, the countries would be obliged to comply.

    Annah Irungu
    T-plus CBO, Kenya
    Email: tiplus.org@gmail.com

    ReplyDelete
  28. Yudopuspito Trijoko05 May, 2011

    Human Right is about the balance of rights and responsibilities. This is about life in a responsible way.

    It is of high values when someone understand his/her risks in life and doing efforts to limit their impact in his/her life or to their love ones.

    It means that every effort to sustain a beautiful and joyfully life of human and keep it not only to someone or some groups or specific population but for all human being 'humanize people'.

    The spirit to enhance life in which every human have the same rights and the same chances and makes it in harmony.

    Yudopuspito Trijoko, Indonesia
    Email: tyudop@yahoo.com

    ReplyDelete
  29. PaulPonniah05 May, 2011

    STIGMA

    Stigma is in so many forms the stigma of race, religion, region, status, education, colour, economic status, caste, language, disease, marriage, women, family, customs, rural, super cities, political status, geographical separation, and others factors that compound stigma. Will narrate an incident from the Bible about Jesus give graphic solution to this bigotry. If you have Love among yourselves then you are my disciple. Then He say if you give a cup of water to the little one you have done it to me.

    No race, religion economic status or any other dividing force should not be able to separate from the LOVE of humankind.

    PaulPonniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  30. Miriam K05 May, 2011

    PATIENTS' CHARTER FOR TB, MALARIA, HIV CARE

    Although TB Patients' Charter (Patients' Charter for TB Care) exist since over 6 years, and is part of the Global Stop TB Strategy, yet it is not seen in TB clinics. We need similar rights and responsibilities based policies that are well rolled out to healthcare providers and also the affected communities as effectively as we can. That will be a big service to human rights when it comes to TB, malaria and HIV.

    Miriam K, India

    ReplyDelete
  31. In Western countries, when people are diagnosed with HIV, a lot of effort is made to discover how the they were infected. Sometimes sexual partners are identified and traced. If people are diagnosed with HIV and have had no partners, or have had no partners who are HIV positive, further investigation is needed to discover how they were infected. When their only exposure was, for example, a particular health facility or similar, this facility is investigated. In this way, many nosocomial HIV transmissions have been identified and many further transmissions have been averted.

    In non-Western countries, especially in African countries, it is assumed that most HIV transmission is sexual. This means that partners are often not identified and traced, so it is impossible to tell if they are HIV positive or even if they actually transmitted the infection in question. Possible nosocomial transmissions are rarely identified and tend not to be followed up.

    Western health facilities took steps to eliminate nosocomial infection as much as possible and they are now rare. But in non-Western facilities, the costs involved in eliminating such infections have often not been met. Rates of non-sexual HIV transmission could still be high in some areas, but the assumption that transmission is almost always sexual means that the issue is rarely investigated.

    People have a right to know how they were infected, they have a right to be protected against such infection and non-sexual transmission needs to be investigated fully, in order that it might be eradicated in non-Western countries. At present, they are denied these rights because of an assumption about sexual transmission which is not supported by evidence. If this doesn't change, transmission rates are unlikely to reduce much and stigma will continue to be as high as it is now.

    Regards
    Simon Collery

    ReplyDelete
  32. Rajesh K06 May, 2011

    FEMALE INJECTING DRUG USERS (IDUs) AND/OR FEMALE PARTNERS OF MALE IDUs

    The Global Fund to fight AIDS, TB and Malaria (GFATM) should consider increasing support for harm reduction services for male and female injecting drug users (IDUs) and female partners of male IDUs along with working with the government of countries where conflicting policies exist.

    In many countries drug is criminalised and there is a clear need to protect public health policies from such demonising laws because it is neither in interest of social justice nor public health.

    Harmonising policies on harm reduction and de-criminalising drug use is high priority in communities where injecting drug use has been proven to be a driver of HIV epidemic.

    Rajesh K, India

    ReplyDelete
  33. Shobha Shukla06 May, 2011

    HOMOPHOBIA

    The Global Fund to fight AIDS, TB and Malaria (GFATM) must consider working with the governments of countries where homophobia prevails and laws criminalise same-sex behaviour. Even in countries like ours where the Delhi High Court came up with a progressive judgement decriminalising same sex behaviour to ensure every citizen enjoys a life of dignity and equality, there is still a long way to go to ensure a safe environment free of any homophobia in the society or even within the healthcare settings.

    With International Day Against Homophobia, two weeks ahead of us, let us appeal to the Global Fund to invest more to sensitize people at all levels for supportive environment that can eventually increase programme impact.

    Shobha Shukla, India
    Email: shobha1shukla@yahoo.co.in

    ReplyDelete
  34. Anand Pathak06 May, 2011

    NO DRUG STOCK OUTS

    I will like to bring the issue of drug stock outs to the fore. Government needs to ensure uninterrupted drug supply more so when we are faced with rising drug resistance. This is also about the human rights of people who are on treatment and deal with drug resistance for no fault of theirs.

    Anand Pathak, India
    Email: contactanandlko@gmail.com

    ReplyDelete
  35. Rahul Dwivedi06 May, 2011

    TRANSPORT OR HOME BASED CARE - WHAT WORKS IS BEST!

    The issue of transport had come earlier too in the discussion on lives saved. It is clearly an issue of human rights particularly in places where clinics are either in difficult to reach areas from people on treatment or there are other factors which make it difficult for affected communities to access existing services. Why government is not considering Home-Based Care (HBC) that has shown to work so well in African nations in Asian nations too? Few examples of HBC are not enough and communities need to be trusted more that they are competent to be equal partners in the fight against these epidemics. Either transport should be provided or through programmes like HBCs should ensure that those who need to be on treatment are cared for with dignity.

    Rahul Dwivedi, India
    Email: tambakoo.kills@gmail.com

    ReplyDelete
  36. Amungwa Athanasius Nche06 May, 2011

    I believe that human rights is a cross cutting issue in GFATM programmes and activities and if we want to improve programme performance the obstacles it is imperative to give human rights a change or a good place.

    I would like to suggest that there are five types of obstacles that could limit the implementation of GFATM activities to achieve expected outcomes a reality unless human rights is addresses as a cross cutting issue during the implementation. These could be:

    - Client factors which could be psychological (depression, stigma, substance or alcohol abuse), socioeconomic (cost of transportation, food insecurity and lower literacy), demographics (younger age, gender) and clinical (prior and current medication) or co-morbidities which may complicate client-provider interactions.

    - system factors which may include access (distance, long waiting periods, cost of co-payment or out of pocket payments), environment, provider relationships and support services.

    - Community factors such as lack of knowledge and awareness and stigma.

    - Medication factors in case of ART which may include pill burden, dose frequency, dietary restrictions and side effects.

    It is clear that GFATM money would take off the burden of disease from the poor but this would be most effective if their universal, individual and patient/client rights are fully respected and to do this a lot of capacity building in this direction is necessary for all stakeholders.

    If the GFTAM can successfully fight stigma so that people living with HIV can speak openly about their situations and stories and thus doing all to pull along others just entering into the continuum, then the battle would have been greatly won.

    There must be a strong focus on tackling personal stigma (SELF STIGMA) because if this is done successfully, stigma coming from others could easily be cushioned off. I know this is going to be difficult but it could be the neglected corner stone could firmly prop up the foundation for the fight against AIDS.

    Amungwa Athanasius Nche, Cameroon
    Email: athanestherhaw@gmail.com

    ReplyDelete
  37. Jitendra Dwivedi06 May, 2011

    PREVENTION AND TREATMENT FOR CO-MORBIDITIES

    I will like to commend the Global Fund to fight AIDS, TB and Malaria (GFATM) for saving millions of lives through its programmes and also for putting so many on the antiretroviral therapy (ART). However with the blessed situation where people living with HIV (PLHIV) are alive and healthy, there are other conditions they are dealing with due to a range of factors.

    Studies have shown that benefits of early start of ART are profound on the quality of life. However in most clinics PLHIV show up quite late with CD4 count well below 100. They deal with lot of complications like renal (kidney) related problems, cardiovascular problems, cancers, to name a few. Many non-communicable diseases (NCDs) are becoming common which includes diabetes too.

    Studies show that diabetes is a risk factor for tuberculosis (TB) and we all know that PLHIV are more at risk of TB. TB is the biggest killer of PLHIV. Smoking or tobacco use increases the risk of TB and diabetes both manifold.

    Is it not a human rights issue where health literacy is so low and PLHIV are not even aware of the risk factors that scale up their risk to diabetes, TB, and other conditions like NCDs?

    Health literacy is central to health responses be it for malaria, TB or HIV. It is a human rights issue and will maximise programme outcomes in terms of quality of life and well being, if the Global Fund considers supporting comprehensive healthcare programmes for PLHIV and other affected communities.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  38. WHAT ABOUT LAWS THAT CRIMINALISE IDU?
    LEGAL REFORMS

    What about the laws that criminalise injecting drug use (IDU) and people who use drugs? We need supportive policies - in line with evidence-based public health and social justice. Global Fund should consider such legal reforms.

    Sandeep, Nepal
    Email: sandeep.napm@yahoo.com

    ReplyDelete
  39. Andrew Hunter06 May, 2011

    What the Global Fund should do less of.....

    GFATM funds are being used in numerous countries in Asia (and probably other regions as well) for programmes that violate basic human rights and accepted universal ethical standards in health care.

    The funding of compulsory detention centres for drug users and sex workers is one example.

    The other things we see over and over in sex work programming is compulsory or highly coercive testing- for STIs and HIV.

    Compulsory testing of sex works is not only driven by government policies which ignore human rights- but is also being driven by GF indicators which give programmes ridiculous targets of the number of sex workers (or MSM or IDUs) who must be tested in order to meet M and E targets.

    This not only violates the rights of sex workers and others, but in many cases it wastes huge amounts of money doing repeat tests for people who really don't need testing.

    These results are then not kept confidential- they are, in many cases, shared with sex business owners and needlessly shared among staff of implementing organisations.

    In many cases sex workers were better off before the Global Fund came in and scaled up the abuses of their rights and gave governments and NGOs money to further control their lives.

    Andrew Hunter
    Asia PAcific Network of Sex Workers (APNSW), Thailand
    Website: sexwork.asia
    Email: apnswbkk@gmail.com

    ReplyDelete
  40. Rahul Dwivedi06 May, 2011

    SEX WORK AND HUMAN RIGHTS

    Why are sex workers at local level not represented as equal partners in programmes addressing them? In different states of India, dignified representation and participation of sex workers from local areas is far from satisfactory - and this does has a human rights implication. Unless we genuinely want to change human rights of sex workers, and protect public health and promote social justice, we will never maximise programme outcome.

    Rahul Dwivedi, India
    Email: contactrahullko@gmail.com

    ReplyDelete
  41. Wabwire PF Okmollo07 May, 2011

    Alma-Ata Conference of 1978 stated the element of Living and Working Conditions as some of the important determinants of good health. The Ottawa Charter - 1986 states that health promotion is a PROCESS of enabling people to increase control over and to improve their Health.

    The political and legal organisation of the policy-making process has been noted as major determinant in the Health of any community where HIV/ TB and Malaria occur.

    This then calls for the Global Fund through this Policy and Legal organs not to only address the immediate factors but also the underlying and particularly the fundamental causes of social level of related health issues such as poor housing and working conditions and also increase the inter-sectoral involvement so as to allow free and easy message delivery to different levels of people.

    Health Promotion activities about HIV/ TB and malaria prevention and management should be put at the forefront.

    Policy makers should consider sitting together with especially the church/ mosque leaders so as to agree on the method of passing the messages concerning HIV/ TB and malaria during their religious/ Islamic congregation.

    Wabwire PF Okmollo, Uganda
    Email: wabwireokmollo@yahoo.com

    ReplyDelete
  42. Lalji K Verma07 May, 2011

    HUMAN RIGHTS FOR SEX WORK and IDU

    Apart from legislative aspects, Global Fund could also work towards removing or mitigating adverse laws towards sex workers where those soliciting sex are viewed as criminals, and those taking advantage are not under any such law.

    Secondly IDU should not be viewed as criminals but offered 'safe haven' and clean syringes in exchange of used ones; and of course effective counselling.

    Lalji K Verma
    Email: vermalk@bol.net.in

    ReplyDelete
  43. Dr Asomba Tobias07 May, 2011

    My appreciation to all the stake holders regarding their effort
    in fighting tuberculosis, malaria and AIDS.

    It will be a contributing factor if a fair logistics system is put place within nations hoping to attain successful achievements. And the stakeholders especially those working at the community level should be ready to serve their community without ostracism.

    Dr Asomba Tobias, Cameroon
    Email: asombacohecf@yahoo.com

    ReplyDelete
  44. Nadeem Ahmad07 May, 2011

    DIGNITY

    Although legal reforms are underway on homosexuality, still life with dignity is an ongoing challenge. Also stigma within healthcare settings exists - some healthcare settings treat us with dignity but not all. We are also human beings and need general healthcare services as well, not just HIV or TB prevention, treatment and care services. So Global Fund should support programmes that aim to grant us a life of dignity - that will surely increase programme impact in a profound manner.

    Nadeem Ahmad, India
    (submitted on web)

    ReplyDelete
  45. Jordan Kaisi07 May, 2011

    When we talk of human right for women and children but we leave out men, impliedly to many, it means men are the perpetuators and violators of these human rights. Although of course, there are violations committed between women themselves and between woman and child; but unfortunately, no mention is made of how much man suffers in the hands of and is mistreated by woman. As such, we have interventions to rescue woman and child from the jaws of man, such as: women empowerment and others, but no interventions to safe guards man from woman; because it is assumed and have been taken for granted that man is safe in the hands of a woman.

    When we talk of gender issues in Zambia, to many, it is misconstrued to mean in favour of a woman and not man; although in workshops and other forums it means a balanced situation. That is just theory of course, but in practice it is something else. There are even sayings like, “if you empower a woman you empower the nation”, and,”behind every successful man there is a woman.” Meaning empowering man the opposite is true and that behind every successful woman there is a failure man. Why all these good saying in favour of woman but not man? We have women clubs in Zambia that are being funded by the government and other donors. Clubs for men alone do not qualify for funding. In this case, we hear terms of gender issues; yet, there is no 30% men involvement in women clubs and other organizations. The Zambian first lady has been all over the country funding these women groups in the spirit of up-lifting their standard of living, “empowering the nation.”

    That is a very wrong strategy and we will never be there. We will never achieve what we want to achieve; that is basic human rights for all. Woman depends on man and man depends on woman. No one can exist on his/her own without the other; no one (man or woman) is an island. Man has now become a willing creature going down slowly but surely. I have seen so many broken marriages because wife who was just as vulnerable has husband is now well off compared to her husband because of women empowerment programs. Where woman now becomes the head of the house instead of man, misbehaving by coming home any time she feels like and doing all sorts of rubbish things and when man complains, he meets a shocking rude answers, like: “It is me who feeds you after all”, or, “are you man enough to depend on a woman?” And so forth.

    They have been programs in the past that were thought best if targeted women alone like antenatal. In African set up, even with modern health facilities, antenatal was for women only; man was excluded, that was and to some extent still is the trend now. Man was not involved during the process of antenatal and he is not, up to this day, allowed in maternity ward when his wife is in labour. Yet, this program is well suited for Prevention of Mother to Child Transmission (PMTCT). Now that PMTCT has some challenges due to lack of partner HIV status notification and disclosure to spouse, man is blamed for it. We now have programs to do with “Male Involvement” because it has been realized as being a very big gap in the intervention strategy in PMTCT to exclude man. The one billion dollar question is: Why was man not involved right from the beginning? The same goes with women empowerment now. It will back fire, to me it stinks.

    The Global Fund should instead come up, of course, not only with programs that will bring our women folks at the same level with men without pushing man under a woman but also, programs that will simultaneously address the challenges of both male and female. When we talk of empowerment, it should not be for women alone but family empowerment. If we have women clubs, let also men clubs be recognized and allowed for empowerments just like women clubs. Men too have issues as well that are peculiar to them and them alone.

    Jordan Kaisi, Zambia
    TALC Copperbelt
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  46. Jordan Kaisi07 May, 2011

    There was a case where a physically built and strong woman battered her husband in a dispute, and when she was reported to the Victim Support Unity (VSU), the man was laughed at by those who were supposed to help him; that how can a man be battered by a woman? Man in this case becomes vulnerable with no forum to address his challenges. Most of the ills committed by woman find an accusing finger pointing at man (because of his vulnerability) just to console woman and find something against man. We got talking one day about how awful it was in an incident that happened in Kitwe, Chisokone market here in Zambia early this year when a passing taxi with a woman in it threw a newly born male child who was wrapped in clothes and placed in a basket on a rubbish dumping place. I was surprised when some women and some men alike pushed the blame on a man for the women’s behavour; that, it was likely that woman did what she did because, probably, man had refused to take responsibility for the pregnancy, and so on her delivery; a woman got rid of the child. My view is different: “it takes two to tangle.” So, intervention strategies should target both, male and female.

    Jordan Kaisi, Zambia
    TALC Copperbelt
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  47. Dr Muherman Harun07 May, 2011

    HUMAN DIGNITY IS THE MAIN FUNDAMENTAL IN HUMAN RIGHTS

    Thank you very much indeed, Ritesh Arya from India, for emphasizing Dignity in our endeavour to treat TB patients. Because Human Dignity is the main fundamental in Human Rights. Human Dignity comes first, before Human Rights.

    It is not enough to uphold human rights, or in this matter, to promote patients' rights to have the best diagnostic services, to get the best of anti-TB drugs available, or to assist/ observe patient's commitment to take the full course of TB treatment.

    All people, including TB patients, whatever creed, gender or social economic status have Human Dignity, which should be respected regardless of any situation and condition.

    We, health and medical providers, administrators, policy makers should reaffirm our faith in the dignity and worth of the human person and in the equal rights of men and women as is mentioned in the Preambule of the Universal Declaration of Human Rights on 10 December 1948.

    This would imply that protection of Human Dignity should supersede protection of Human Rights. Implementing Human Rights while ignoring Human Dignity may lead to unacceptable inhumane situations.

    If we KNOW HOW to implement Human Rights, can we also SHOW HOW to respect Dignity of those human wrecks caused by TB, HIV/AIDS, leprosy, malaria, malignancy or other cripling disease?

    Dr Muherman Harun, Indonesia
    Email: muhermanharun@gmail.com

    ReplyDelete
  48. Kiran Jaiswar07 May, 2011

    MATERNAL AND CHILD HEALTH AND RIGHTS

    The Global Fund to fight AIDS, TB and Malaria (GFATM) surely needs to be commended to support programmes aimed to provide services for women and children, but that is clearly not enough. We need to do a lot more beyond HIV prevention, treatment and care services and while discussing human rights, wanted to flag maternal and child health as it also needs to be articulated in human rights' online consultation.

    Kiran Jaiswar, India
    (submitted on web)

    ReplyDelete
  49. Rahul Kumar Dwivedi07 May, 2011

    BONE LOSS AND OTHER HEALTHCARE NEEDS AMONG PLHIV

    I will like to share a news: http://www.citizen-news.org/2011/01/bone-loss-in-people-living-with-hiv.html and our own experiences of how people living with HIV (PLHIV) need more than antiretroviral therapy (ART). This is a human rights issue because renal or kidney related issues, cancers, starting ART late, bone loss and other diseases also need to be covered by AIDS programmes for PLHIV as they can threaten to reverse the gains made by ART at times in terms of longevity or quality of life or both!

    Rahul Kumar Dwivedi, India
    Email: contactrahullko@gmail.com

    ReplyDelete
  50. Shobha Shukla07 May, 2011

    STARTING ART OR ANTI-TB TREATMENT SO LATE IS ALSO A HUMAN RIGHTS VIOLATION

    Programmes must reach out to people with HIV or TB or both at the earliest. Recently in Chennai, India, YRGCARE study showed that most patients are reaching out to ART centre with CD4 count below 100. When evidence exists that starting ART early on when CD4 count is much higher has profound health benefits on quality of life and longevity and prevents many life threatening conditions associated with AIDS, why are we not improving our reach out to communities so that we can get to people early on!

    Same goes for TB. The TB programmes say that they aim for 'new case detection' - how are we going to reach out to the currently unreached populations dealing with TB? The answer probably lies in partnering with affected communities with dignity. DIGNITY and as EQUAL PARTNERS are keywords and values to making such programmes work far beyond the level they currently are aiming at.

    Shobha Shukla, India
    Email: shobha1shukla@yahoo.co.in

    ReplyDelete
  51. Jitendra Dwivedi07 May, 2011

    REPRODUCTIVE AND SEXUAL HEALTH RIGHTS FOR YOUNG PEOPLE

    Currently there are hardly any safe services which cater for adolescents and young people on reproductive and sexual health and rights. Global Fund should consider supporting this area,

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  52. Amungwa Athanasius Nche10 May, 2011

    NUTRITION

    In fact I agree with Rahul Kumar Dwivedi that ART can be positively consequential. However I would think that there are many human rights issues in ART. First of all before giving ART we have to let the takers know what they are going into and how they can mitigate some of these consequences. If a client on ART is poor and the nutrition he/she is taking is not enough with the ART who will be answerable to consequences if they develop complications? If the GFATM operators highlight the importance of nutrition and HIV/AIDS and ART whose obligation does it become to ensure that the client also has supportive nutrition or that the client behaves in an ART-supportive manner.

    Is it even worth it to give ART to a poor person who cannot afford a balance diet knowing that poor eating habits may affect ART or cause the client some harm. In other words can harm arise from ART and if so what can HIV/AIDS activists do or what can ART implementors do?

    Yes ART can prevent some problems in PLWHA but can it also happen that it can cause problems? If it can cause problems then is this not a human rights issue worth some serious consideration?

    Amungwa Athanasius Nche, Cameroon
    Health and Development Certified Training Professional
    Email: athanestherhaw@gmail.com

    ReplyDelete
  53. Joy Ganguly10 May, 2011

    The key issues for GFATM to focus on:

    - To strengthen country ownership in proposal development, implementation and lapses;
    - More proactive approaches to grant-making to maximize the impact;
    - Primary focus on strategic approach to strengthen M&E systems;
    - More focus on quality assurance mechanisms and long-term capacity building;
    - Improve certainty of funding to reinforce country planning processes;
    - Differentiated approaches to grant management;
    - To improve communications for better mutual understanding of roles and responsibilities.
    - Apart from that the entire performance-based funding system should be reviewed to streamline it and ensure its integrity. It is an urgent need to clearly articulated roles and responsibilities that are going beyond the MoU model, under the partnership framework and it should focus on key factors limiting scale-up and be implemented through partnership arrangement in order to strengthen the present health system.

    The most important part is to emphasize quality management approaches to build capacity for grant supervision and it is important to strengthen the civil societies role on CCMs. It should also emphasize on the need to increase resources for the provision of Technical Assistance.

    Adding to this, a better focus on cost-effective strategies is needed keeping country ownership as a key standard. There is also a need for improvement in aligning and harmonizing GFATM processes and to strengthen the linkages between programme areas.

    Joy Ganguly
    Consultant/Technical Specialist - Harm Reduction
    New Delhi, India
    Email: gangulyliani@gmail.com

    ReplyDelete
  54. Simon Collery10 May, 2011

    PEOPLE HAVE A RIGHT TO KNOW HOW THEY WERE INFECTED
    HOSPITAL ACQUIRED INFECTIONS
    RIGHT TO BE PROTECTED AGAINST SUCH INFECTIONS

    In Western countries, when people are diagnosed with HIV, a lot of effort is made to discover how they were infected. Sometimes sexual partners are identified and traced. If people are diagnosed with HIV and have had no partners, or have had no partners who are HIV positive, further investigation is needed to discover how they were infected. When their only exposure was, for example, a particular health facility or similar, this facility is investigated. In this way, many nosocomial HIV transmissions have been identified and many further transmissions have been averted [Nosocomial infections are infections that are a result of treatment in a hospital or a healthcare service unit].

    In non-Western countries, especially in African countries, it is assumed that most HIV transmission is sexual. This means that partners are often not identified and traced, so it is impossible to tell if they are HIV positive or even if they actually transmitted the infection in question. Possible nosocomial transmissions are rarely identified and tend not to be followed up.

    Western health facilities took steps to eliminate nosocomial infection as much as possible and they are now rare. But in non-Western facilities, the costs involved in eliminating such infections have often not been met. Rates of non-sexual HIV transmission could still be high in some areas, but the assumption that transmission is almost always sexual means that the issue is rarely investigated.

    People have a RIGHT TO KNOW HOW THEY WERE INFECTED, they have a RIGHT TO BE PROTECTED against such infection and non-sexual transmission needs to be investigated fully, in order that it might be eradicated in non-Western countries. At present, they are denied these rights because of an assumption about sexual transmission which is not supported by evidence. If this doesn't change, transmission rates are unlikely to reduce much and stigma will continue to be as high as it is now.

    Simon Collery
    (posted on web)

    ReplyDelete
  55. Dr K Suresh10 May, 2011

    - STIGMA, DISCRIMINATION AND OTHER HUMAN RIGHTS-RELATED BARRIERS TO PREVENTION, TREATMENT, CARE, AND SUPPORT
    - LEGAL AND POLICY CHANGE

    At the outset I wish to bring up the issue of barriers in the delivery of evidence-based services to most at risk and other underserved populations - in a way that protects human rights and prevents violations is with in the priorities of the Global Fund. An average readers will find the word HIV/AIDS, TB and Malaria and making the services for these conditions in the ration of 100:10:1 in all documents, despite knowing the fact that the diseases' toll is not in that ratio?

    First change I propose be made in Global fund Thrust among the three conditions being addressed. Global Fund has to play a vital role both in supporting interventions to overcome stigma, discrimination and other human rights-related barriers to prevention, treatment, care, and support, as well as in using its unique position to promote positive legal and policy change for all three conditions based on country specific situation and priorities for these 3 diseases. Otherwise GF loosed the moral right to advocate equity and right based approach.

    The key strategies and what changes may be considered are discussed in the following paragraphs.

    MALARIA:
    1. Pursue high-quality anti-malaria treatment and quality enhancement : The GF should ensure that most recent and successful combination of drugs are mandated to be used in malaria management in all the projects supported especailly in High endemic areas and outbreaks.

    2. Address the needs of poor and vulnerable populations: The project support should provide for free treatments with area specific (drug sensitivity - wise) combination of drugs to the vulnerable and poor population, This should include insecticide impregnated mosquito nets supply according to sleeping habits of the family number (ie. based on groups of inhabitants sharing the bed) free of cost.

    3. Contribute to health system strengthening based on primary health care: In practical terms this means the GF should discourage short term contractual staffing for enhanced activities. Instead it should support a regular long term HR solutions for implementation, monitoring with clear result based management principles.

    4. Engage all care providers: GF need to ensure Involvement of Large health facilities and Private set ups in Malaria management.One sees lot of variations in malaria management and leading to drug resistance. The irrigation projects need to include anti-malaria activities for approval with appropriate funding. Urba malaria is taking larger toll as the Civic bodies (Corporations, municipalities) are neither equipped nor provide enough funding

    5. Enable and promote research: It is surprising that research in this intervention is the least developed and least attended to compared to newer diseases like HIV/AIDS. Fundamental reserach on drug /insecticide resistance, human Beauvoir for self/family actions for preventing oneself from mosquito bites etc are key areas of research the GF should actively invest and guide.

    to be continue...

    Dr K Suresh
    Public (Child) Health Consultant
    Email: ksuresh@airtelmail.in

    ReplyDelete
  56. Dr K Suresh10 May, 2011

    TUBERCULOSIS:
    1. Pursue high-quality DOTS expansion and enhancement: The developing countries need to hasten the speed with which this is being pursued for an early control

    2. Address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations: The understanding and management of these 2 phenomenon is of recent origin and needs lot of efforts to address the local situation and take up effective implementation on large scale.

    3. Contribute to health system strengthening based on primary health care: The RNTCP (revised national TB control program) has actually reversed the approach. In the context of improving quality of lab services, the program has restricted the diagnostic and treatment facilities in select PHC. The Microscopic enters which were there in all PHC have now been rationalized. My field observations indicate that his is retrograde step.Remote rural people find it difficult to travel and seek care from the microscopic centers if there is a PHC without the same facility (microscopic center))closer to their community. GF should also discourage short term contractual staffing for enhanced ( monitoring, lab quality etc) activities. Instead it should support a regular long term HR solutions for implementation, monitoring with clear result based management principles.

    4. Engage all care providers: Though there is a provision for PPP, there is still a bit gap. The GF should encourage involvement of private practitioners on a large scale.

    5. Empower people with TB, and communities through partnership: Community system strengthening is key in long term diseases like TB. Most of the projects do make a passing reference with no specific funding of activities for the same. GF should encourage country/state specific issues and strategies for strengthening the community systems with provision of appropriate funds.

    6. Enable and promote research: Fundamental research on drug resistance, human Beauvoir for self/family actions for preventing oneself from infected persons in the family/neighborhood etc are key areas of research the GF should actively invest and guide.

    HIV/AIDS:

    1. Countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half: The punitive laws if any need be taken up upfront with the countries by GF. More important is inactivity / delay in implementing the provisions available under law.The project proposal should be cleared only if there are definite activities / actions contemplated.

    2.HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions; More that residence this practice in public places like schools, offices, industries need attention and proactive oversight and suitable actions.

    3. HIV-specific needs of women and girls are addressed in at least half of all national HIV responses: The challenge in the developing countries to address this issue is of service providers of the same sex.The GF should get commitment from the countries/states for the same particularly in socio-culturally restricted societies.

    4. zero tolerance for gender-based violence. An ideal and excellent statement of Intention !! GF need to articulate this better to facilitate countries in translating into actions.

    Dr K Suresh
    Public (Child) Health Consultant
    Email: ksuresh@airtelmail.in

    ReplyDelete
  57. Prakash Gupta10 May, 2011

    NUTRITION

    I see patients on strong medications for antiretroviral therapy (ART) or anti-TB medicines who have hardly anything to eat. Not surprisingly they feel the brunt of drug toxicity and deal with other conditions like nausea all the time. Just a biscuit and a cup of tea is not breakfast and we need to complement treatment programmes with nutrition for good programme outcomes.

    Prakash Gupta, India
    (on the web)

    ReplyDelete
  58. Alberto Colorado10 May, 2011

    CREATE A POLICY OF ACCOUNTABILITY ON IMPLEMENTING THE PATIENTS' CHARTER FOR TB CARE

    For tuberculosis (TB): The Global Fund needs to create a policy of accountability on the implementation of the Patients' Charter for TB Care: The Charter outlines the Rights and Responsibilities of persons affected by TB.

    Right now, for application purposes, the GF promotes the Charter but is left to the CCM and Principal Recipient the implementation. At present time, I do not know how many countries receiving funds from the GF are really supporting and honouring the Patients' Charter?

    Alberto Colorado, Mexico
    Patient Advocate/ International Public Health Consultant
    Email: actbistas@yahoo.com

    ReplyDelete
  59. Pastor Phainos Muhindi10 May, 2011

    SOCIAL SECURITY FOR WIDOWS AND ORPHANS

    First, however, need to reflect on the norms and values we hold in relation to those in our communities who are in a weak and vulnerable situation especially widows and orphans. Global Fund have made effort to protect the weak against those who wish to exploit and abuse them. Some of us, however ,have turned a blind eye to situations where the weak in our community have been exploited and abuse.

    We might, for example, have refused to became involved when relatives or other people have taken away the land and property of widows and orphans. We might have been involved in depriving widows and orphans of their land and property.

    Pastor Phainos Muhindi
    Eldoret,Kenya.
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  60. Mohammed Kibirige10 May, 2011

    COMMUNITY ENGAGEMENT

    Affected communities should be more, and genuinely, involved at a strategic level to address human rights. Planning, Education, Training, Service development, Monitoring and evaluation based on specific targets for all and accountability using the same formula. There is a lot that can be achieved with equal partnership with affected communities in proper planning and understanding of the specific goals.

    Mohammed Kibirige
    Email: Mskibirige@btinternet.com

    ReplyDelete
  61. Amungwa Athanasius Nche10 May, 2011

    DIGNITY

    I fully agree with Dr Muherman Harun about the centrality of dignity in Human Rights and how this principle ought to be respected by all stakeholders in all programmes where human beings are either beneficiaries or stakeholders. The human mind is the most sensitive 'thermometer' in the behaviour continuum, either someone changes towards the expected good or away from it and the catalyst responsible for this sliding change movement from good to bad or even remaining neutral would stem from how operators respect the dignity principle.

    If this is the case, the GFATM should be very sure that in its systems approach the respect for human dignity as a prerequisite for service provision should equally be the fulcrum around which all interpersonal relationship whether for professional and non professional encounters should spin.

    I would imagine that if human rights is regarded as an important cross-cutting issue, a lot of capacity building, supervision and backstopping should be the backbone of human resource and performance management.

    Amungwa Athanasius Nche, Cameroon
    Health and Development Certified Training Professional
    Email: athanestherhaw@gmail.com

    ReplyDelete
  62. Gunjan Singh10 May, 2011

    NUTRITION

    I will like to request the Global Fund to ensure that people like me who are blessed to get treatment should also be counselled on nutritional needs - I figured it out much later on my own initiative. Many fellow people who were in the same clinic were not that fortunate to have access to good nutrition - it is so key to treatment success rate.

    Gunjan Singh, India
    (on the web)

    ReplyDelete
  63. Saaeda Diep10 May, 2011

    WOMEN RIGHTS

    Unless the gender-based inequalities and structural changes in communities from patriarchal to a more human setup happens, women will continue to be the last to access services. In TB programmes, women often come late but studies show that they are more complaint to treatment than men. Partnering with groups that are addressing women rights' issues will give more value for every dollar spent and increase take up of services among women. Engaging women from communities at every step will be crucial.

    Saaeda Diep, Pakistan
    (on the web)

    ReplyDelete
  64. Nazir Bakht10 May, 2011

    CURRENT SERVICE COVERAGE IS VERY LOW FOR MSM

    Current service coverage is very low for men who have sex with men (MSM) and this situation needs to change. It is a human rights issue because after so many years, we still are dealing with abysmally low service coverage. Solution might lie in engaging MSM community people more.

    Nazir Bakht, Pakistan
    (on the web)

    ReplyDelete
  65. Dr Shrestha10 May, 2011

    STIGMA WITHIN HEALTHCARE SETTINGS

    Making healthcare service facilities stigma-free and more friendly should be a priority for the Global Fund. Outside of AIDS clinics or related services (TB clinics etc), stigma is high within healthcare settings for general healthcare services. People with HIV, TB or malaria are human beings too and they have general healthcare needs too. Stigma impedes access to existing services -so please address that.

    Dr Shrestha, Nepal
    (on the web)

    ReplyDelete
  66. Dr R Sethi10 May, 2011

    DOCTORS HAVE HUMAN RIGHTS TOO

    With hardly any universal precaution measures available in public hospitals, I will like to request the Global Fund to please address this issue and ensure regular supply of quality standard universal precaution measures in public sector hospitals. I had to buy my own supply in India for a number of years

    Dr R Sethi, Singapore
    (on the web)

    ReplyDelete
  67. Mohammed Asif10 May, 2011

    REPRODUCTIVE HEALTH SERVICES FOR FEMALE IDUs

    It is a human rights issue to provide reproductive health services for female injecting drug users (IDUs) - the stigma in general healthcare services is alarmingly high - and a friendly, safe and supportive healthcare service facility for female IDU is a rare find.

    Mohammed Asif, Bangladesh
    (on the web)

    ReplyDelete
  68. Michèle Lafay10 May, 2011

    TRAINING HEALTHCARE WORKERS
    COLLABORATIVE PROGRAMMES ON MALARIA AND TB

    I have been working many years with a tribal population in the Philippines where they are plagued both by Malaria and more recently by Tuberculosis; they are scattered, living by small group, and the health personal belong to other ethnic groups.

    I would like to make these 2 suggestions to the Global Fund :
    1) group together the health care for the 2 diseases
    2) train and promote health workers belonging to the same ethnic group, even in a short course with a limited but useful task.

    Michèle Lafay, Philippines
    Email: mlafay55@hotmail.fr

    ReplyDelete
  69. Wabwire PF Okmollo10 May, 2011

    RAISING AWARENESS ABOUT RIGHTS

    We should realize our social responsibility. I agree with some of my friends like Amungwa of Cameroon, Joyce of India but deviate a little from Simon Collery. Health is every one's right and a responsibility too.

    The only best way to promote peoples' Rights is to make them know what their RIGHTS are. The Global Fund should support health promotion activities, to help the communities learn about their rights in relation to HIV/ TB and malaria.

    Wabwire PF Okmollo, Uganda
    Email: wabwireokmollo@yahoo.com

    ReplyDelete
  70. Florencia FarEDas Franzosi10 May, 2011

    I would to introduce myself before the Forum. My name is Florencia FarEDas Franzosi and I belong to ISO at ICW Global. On behalf of the network, I would like to share these thoughts about Human Rights.

    In many countries, the stigma and discrimination suffered by women, young women, girls and adolescents living with HIV/AIDS have consequences of big scope from the loss of job position and properties, lack of access to food and/ or education, the abandon of family or friends, violence against her life or in danger. All these conditions, related to different areas of the human nature, should be taken into consideration in the programs. So, that they comply with the real needs of its population. Thus, to ensure universal
    access to prevention it is essential that an approach from the perspective of human rights and gender into these programs to ensure effective and fully the rights of women, youth and adolescents living with HIV/AIDS.

    Florencia FarEDas Franzosi
    ISO
    ICW Global
    Email: info@icwglobal.org

    ReplyDelete
  71. Fred Mwansa10 May, 2011

    Human rights is the fundamental issue, otherwise human being without it, life would have been useless and human being would have been abused by people who have power in everything.

    Human life have been safeguarded and protected which is very cardinal and important. Even though other people do not understand this because of poverty and other barriers, like information sharing and poor communication. I would also to see monies going into translation of information in our local languages, so that people can easily understand.

    Fred Mwansa
    Email: fredmwansa@yahoo.ca

    ReplyDelete
  72. Paul Ponniah10 May, 2011

    Human Rights are more in Book form, then it reaches the head. It stops there. I wish it continues to go down to the HEART, THE SEAT OF EMOTIONS, the art of Rights will be Human.

    Human Rights are not whips to chastise but the golden rods to correct in consideration of being Humans and not animals.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  73. Daniel Wolfe10 May, 2011

    Comments from colleagues in Thailand and Nepal moved me to write in too. I agree with all those who note the central and crosscutting place of human rights programming for most at risk populations or vulnerable groups or key affected populations or whatever you want to call them. No health services can work if people are afraid that using them will expose them to police violence, arrest, harassment, discrimination, or cruel, inhuman or degrading treatment.

    Unfortunately, these bad things are not the product of people's imagination, and occur regularly--including at or around services funded by the Fund.

    While my program works mostly to support the health of people who use drugs in Eastern Europe and Asia, there are some common themes and particular areas where the Fund can and should do more to protect against abuses and ensure its money isn't going, directly or indirectly, to support them. I won't go on and on, but it's worth naming a few.

    to be continue...

    Daniel Wolfe
    Email: dwolfe@sorosny.org

    ReplyDelete
  74. Daniel Wolfe10 May, 2011

    1) CRIMINALIZED POPULATIONS: If you are talking about people who use drugs, or sex workers, or MSM, or migrants in places where moving to another city without permission makes you an illegal resident, you must address the need for protections from rights violations from law enforcement. Look at the "shame parades" police subjected sex workers to in China (at the same time as the Fund was supporting outreach to this population), the reports of police rape and abuse of MSM in Uzbekistan (at the same time that the Fund was supporting outreach to this population), or the harassment of patients and providers of methadone in Ukraine, including demanding their HIV test results at clinics and then revealing these to neighbours (at the same time as the Fund was supporting methadone programs there) and you get the idea.

    Countries do not provide, and often do not have, a human rights protection plan for criminalized groups they propose to work with, but they should and the Fund should ask them for one. This could include an analysis of how much money is going to services like legal aid, and clear plans on how the country will respond when the police round up sex workers and forcibly test them for HIV or announce quotas for drug users to be sent to labor centers and do wholesale urine testing of people they find outside a needle exchange.

    2) PEOPLE in STATE CUSTODY. Whether you are talking about prisoners, people in pre-trial detention, or people in drug or sex work "rehabilitation" centers (which in some countries getting Global Fund money are really slave labour camps where people are put for years, made to work without pay in the service of private companies, and never see a judge or lawyer), those in the custody of the state are particularly vulnerable. A lot of Global Fund grants involve work with these populations. Very few discuss human rights protections for them.

    Drug detention centers are a particularly good example, both because there are hundreds of thousands of people in them in countries receiving Global Fund monies, and because the Fund actually has engaged the issue, with Executive Director Michel Kazatchkine saying that the Fund will review proposals and ensure, through work with countries, that money is going only to critical HIV prevention and treatment services and not to infrastructure or to "capacity building" of staff who are really jailers by another name. This is a great step, and recognizes - rightly - that places that beat you if you "pretend to be sick," force you to work, take away your food or torture you if you don't make your labour quota or talk back to the "teachers" are not places you want to strengthen. But there are other places where the Fund hasn't made a similar statement, and where the same kinds of things happen.

    What about sex worker detention centers, also operating in countries where the Fund funds?

    to be continue...

    Daniel Wolfe
    Email: dwolfe@sorosny.org

    ReplyDelete
  75. Daniel Wolfe10 May, 2011

    3) People in countries where NGOs and free flow of information are severely restricted, and where patterns of rights abuses (not just related to health) are routine. The Global Fund has used an "additional safeguards" approach to examine funding in places such as Myanmar, where it decided at one point to stop making grants because Fund representatives couldn't have free access to sites to determine what was really happening with their money. Given that the Fund regards genuine civil society participation on the CCM and in program delivery as essential, in countries where there are reports of wholesale closure of NGOS, use of foreign aid to shore up supporters of the government and weaken those who are critics, arrests or beatings or imprisonment for years of AIDS workers, etc., there should be a plan for the Fund to make sure that it's not harming and giving legitimacy to practices or governments that are frankly abusive. China, Zimbabwe, Myanmar, and North Korea, all countries that have received Global Fund support, come to mind. Uzbekistan sentenced an AIDS worker giving out information (reported, though incorrectly, to be produced with Global Fund support-it was really USAID) to seven years in prison. They then got another Global Fund grant.

    There are ways to include, as part of HIV services, measures that increase human rights protections. UNAIDS has identified a number of them-access to legal aid and justice, know your rights campaigns, police and judges training, etc. Some Global Fund applications contain these, but the Fund's reviewers and the officers in Geneva managing country portfolios don't usually analyze how much money is being spent on them. Many times, the human rights protections that are in the proposal in the beginning are cut out by the time countries are asked to make "efficiency gains" and reduce their budgets. The result is what we see in too many places-disproportionately low access to HIV prevention and treatment from the people who need them most. Does the Technical Review Panel really look for legal aid provision when they go over proposals? Do they ask if countries are spending any money to keep people out of the institutions-prisons and police lockups and detention centers - where ARV treatment is interrupted, where high risk behavior continues, and where needles and condoms are almost never available?

    We and the Fund should be clear that when it comes to HIV prevention and treatment for many people in many countries, human rights protections for many people-especially a lot of the people getting HIV-- are as crucial as a condom, a clean needle, or combination therapy. Vague promises of antistigma campaigns are no substitute for solid programming to keep people from being hurt, degraded, and detained or imprisoned without cause or recourse.

    Daniel Wolfe
    Email: dwolfe@sorosny.org

    ReplyDelete
  76. Jitendra Dwivedi10 May, 2011

    SEX WORK

    Supporting legal reforms are required to ensure that sex workers and service providers (at times they can be the same people in community-driven interventions) are safe, supported and are able to do the public health and social justice work optimally.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  77. Amir Siddiqui10 May, 2011

    CORRECT DIAGNOSIS IS A RIGHT

    Diagnosing TB is a challenge at times but doctors should not 'guess' TB and put people on anti-TB treatment without confirmed diagnosis.

    Amir Siddiqui, Dubai
    (on the web)

    ReplyDelete
  78. Shailendra Malhotra10 May, 2011

    NO DRUG STOCK OUTS

    Maintaining uninterrupted supply of medicines (standard and quality assured medicines) is so central to good programme outcome. Why cannot government ensure uninterrupted drug supply without exception?

    Shailendra Malhotra, India
    (on the web)

    ReplyDelete
  79. V Shankhdhar10 May, 2011

    UNIVERSAL PRECAUTIONS

    Please Global Fund ensure regular universal access precautions in healthcare settings and protect healthcare providers. In public sector hospitals, how far is it justified that healthcare providers have to get their own supplies?

    V Shankhdhar, India
    (on the web)

    ReplyDelete
  80. Kusum Verma10 May, 2011

    DIGNITY

    Not only health services for HIV TB and malaria need to be delivered to people with dignity but in general the situation in public sector hospitals is very serious in terms of the way people are treated! That is why those who can afford try to go to private sector hospitals. Ensuring dignity in service provision is important Global Fund.

    Kusum Verma, India
    (on the web)

    ReplyDelete
  81. Pastor Phainos Muhindi11 May, 2011

    We need to confront our own values and ask ourselves: what would our Lord Jesus Christ expect from us in this situation?

    This Chapter is aimed at helping us to:
    * Identify the major challenges related to HIV/AIDS, which weak in vulnerable people in our community are facing.
    * Define the roles which churches or organizations can and should play in protecting the weak in relation to the AIDS epidemic.
    * Take practical action to protect and support people especially widows and orphans who are in danger of, for example, losing their property or suffering abuse because of their vulnerability which is heightened by the AIDS epidemic.

    Pastor Phainos Muhindi
    Eldoret, Kenya
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  82. Lauren Alexanderson11 May, 2011

    Orphans and other vulnerable children (OVC) are susceptible to abuse, exploitation, violence, and neglect and often do not have access to support systems designed to assist in these instances. To protect OVC from abuse, exploitation, violence, and neglect, the Legal Units Program is helping local social and justice service providers apply UNICEF's Protective Environment Framework to their programs.

    For a case study on this subject: http://j.mp/lZYVgC

    Lauren Alexanderson, USA
    Web Content Editor
    John Snow, Inc.
    AIDSTAR-One
    Email: lauren_alexanderson@jsi.com
    Websites: http://www.jsi.com , http://aidstar-one.com

    ReplyDelete
  83. Hari Singh11 May, 2011

    My name is Hari Singh PLHIV from last 17yrs and taking 2nd line ART treatment from last 17 yrs and working in field of HIV/AIDS last 8yrs as National AIDS Activist and Resource person.

    I agree with Gunjan Singh's comments from India about nutrition because ART treatment & OI's medicines prolong our lives. A healthy food-nutrition with Art of living, Medication with Meditation and self-assessment about our daily bad or good habits matter in Happy Healthy life.

    Hari Singh, India
    Ex-National GIPA Coordinator(INP+)
    Executive Board Member Asha Kiran(CBO)
    Executive Board Member Dnp+
    Website: www.inpplus.net/dnpplus.net
    Email: hari_singhdnpplus@yahoo.co.in

    ReplyDelete
  84. Dr Lalji Verma11 May, 2011

    I am in total agreement with Dr Sethi that Human Rights for doctors also needs to be highlighted. It is in this context that precautionary measures and proper waste management are important to be adopted and ensured in any healthcare setting.

    Dr Lalji Verma, India
    Email: vermalk@bol.net.in

    ReplyDelete
  85. Rajesh Khanal11 May, 2011

    More focus is needed in taking care of the children born HIV positive. These children are the most innocent and worst hit by the epidemic. More effort is needed in increasing the access to prevention of mother to child transmission and providing care and support services in remote areas with higher HIV infection. Children are mainly from the poor families and do not even have access to treatment, care and support facilities in their own communities.

    Ensuring their right to treatment, care and support along with education is vital at this moment.

    Rajesh Khanal
    Email: khanal.com@gmail.com

    ReplyDelete
  86. Dr Girish Panth11 May, 2011

    Access to healthcare and human rights are the fundamental necessities for human beings around the globe. Human rights violations are rampant in certain sections of our society and they especially impact women, children and minority groups allied to a variety of castes, religions and people with a different sexual orientation. The violations happen with or without the support of the governing and legislative authorities. The right to health is an all-encompassing right. Optimum delivery of services is possible only with help of the government and the law enforcing agencies.The need to create an open and supportive environment for those infected with HIV/TB is a very important human rights issue. Women and children are a very important demographic of the world population. There are issues of issues of child abuse, prostitution, trafficking which can impact the effectiveness of healthcare delivery.

    Discrimination against, and harassment of those with a sexual orientation different from the heterosexual is being more openly addressed in the past ten years than it was earlier. However, a lot needs to be still achieved for the programs of the Global fund to become effective and sustainable in the long run.

    Dr Girish Panth, India
    Email: drgirishpanth@gmail.com

    ReplyDelete
  87. Omidiji Bolanle11 May, 2011

    Global Fund should not stop funding those human rights programmes in countries that penalise populations but they should partner directly with organizations that are working on human right and gender.

    Omidiji Bolanle
    Email: omidijiocb@yahoo.com

    ReplyDelete
  88. Paul Ponniah11 May, 2011

    The following may be practised in relation with GF;

    1. prime Education of human rights on prevention, treatment awareness, diet, nutrients needed, and contact with human right activists.

    2. Human Rights cannot be availed or used by individuals except by team: TOGETHER EACH ACHIEVES MORE.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  89. Soe Thant Aung11 May, 2011

    There are many evidences of TB in low income levels at urban cities. Not many are properly diagnosed and treated due to marginal income and also for afraid of isolation from the societies to get contaminated.

    Poorer citizens are forced to use crowded public bus and private commuters.

    TB is worsen the affect of AIDs and Malaria victims who need to
    uses of medicines for diferring treatments.

    TB is easily contracted (compared to AIDS and Malaria) one to another even to the doctor and patients.

    It is important to look on the right of citizens access to affordable public transport to control TB with public education.

    Education awareness with the commitment of government should be demanded as precondition well before the Global Fund assistance is provided.

    Soe Thant Aung, Myanmar
    Email: soethant@yahoo.com

    ReplyDelete
  90. Pastor Phainos Muhindi11 May, 2011

    As global fund worked hard to address the various impact of hum;an right on peoples life. The oppressions could the way in which our families or clan treat widows and orphans e.g in relation to property right or sexual exploitation. However, this could also be government policies which fail to meet the needs of HIV positive people, widows and orphans or the way could come from a person within our own community who we would not suspect of carrying out sexual abuse or exploitation.

    Pastor Phainos Muhindi
    Eldoret, Kenya
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  91. Jitendra Dwivedi11 May, 2011

    Why cannot HIV TB and Malaria programmes join hands with nutritional programmes of the government to improve programme performance and also quality of life particularly of people from MARP communities?

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  92. Kiran Jaiswar11 May, 2011

    Women are often delay going to seek healthcare services - this needs to change and human rights of women to health, to life and to equity must be protected. Global Fund should consider supporting initiatives that aim to change such patriarchal social constructs

    Kiran Jaiswar, India
    (on the web)

    ReplyDelete
  93. Ritesh Arya11 May, 2011

    Shortage of healthcare workers is causing long queues, disrespectful and undignified experiences for service seekers in health facility, and that is a barrier in itself which prevent people from seeking existing services. Global Fund should help retain and increase healthcare workforce or consider measures like task shifting

    Ritesh Arya, India
    (on the web)

    ReplyDelete
  94. Nadeem Ahmad11 May, 2011

    Unless cleanliness, hygiene and conditions in which people live are not changed, diseases like malaria and others that affect poor communities more will continue to challenge us. Global Fund should consider supporting or joining hands with other agencies that are working to address issues related to broader areas of development, health and poverty alleviation,

    Nadeem Ahmad, Saudi Arabia
    (on the web)

    ReplyDelete
  95. Dr Rakesh Kapoor11 May, 2011

    I agree with comments to support provision of supplies for universal precautions in public sector hospitals - especially those in smaller towns and cities.

    Dr Rakesh Kapoor, India
    (on the web)

    ReplyDelete
  96. Dr GK Singh11 May, 2011

    Global Fund should visit smaller periphery hospitals and see the plight of universal precautions! Protect healthcare workers first - that is so crucial to improve services,

    Dr GK Singh, India
    (on the web)

    ReplyDelete
  97. Anand Pathak11 May, 2011

    Nutrition should not be ignored. The drugs are so strong and particularly for poor people it is all the more difficult to deal with this treatment with no or poor nutrition.

    Anand Pathak, India
    (on the web)

    ReplyDelete
  98. Rahul Kumar11 May, 2011

    Protecting people living with HIV or those having TB from other co-morbidities is also critical - like renal or kidney related diseases, cancers, diabetes, CVD etc

    Rahul Kumar, India
    Email: contactrahullko@gmail.com

    ReplyDelete
  99. Suneel Qamra16 May, 2011

    Misuse and misappropriate handling of the fund should be strictly checked. Like duplicate receipt or without the purchase of an item the bills are enclosed, this can occur at various level which reduced not only the outcome but big faulty findings based on earlier studies etc.

    Secondly awakening of community is utmost desirable to keep people equipped with rights may it be disease or otherwise, hence community involvement based studies are desired to prevent three diseases by shouldering responsibility at community/people not only on lab/clinical trial based etc

    What happens all the big funders declined to community based intervention studies saying that such researchable topics are not in the purview of our funds

    Suneel Qamra
    Email: suneelqamra@rediffmail.com

    ReplyDelete
  100. Isaac Kireti16 May, 2011

    Its true prevention is better , small Ngo took the initiative , but its good if Global Fund supervise the grants itself rather than sub-tendering CCM.

    Isaac Kireti, Tanzania
    Email: kili-heritage@email.com

    ReplyDelete
  101. Ana del Carmen Rojas16 May, 2011

    [Mods note: Originally this comment came in Spanish so below is the English translation. Original Spanish text is given below, Thanks]

    [ENGLISH]
    Nicaragua, which is located in Central America has addressed the crosscutting theme of Human Rights in its strategies for prevention, treatment, care and support for people living with HIV.

    From my experience in the execution of these Projects it will be important to consider developing new activities aimed at strengthening the legal framework of human rights from the perspective of equity but also considering the need to update concepts related to the population MARPs as subjects with equal rights, and making visible the rights of drug users.

    The scenario is positive as it has been strengthened institutionally from the Procurator for the Defence of Human Rights (PDDH) we have a Special Prosecutor for Sexual Diversity.

    [SPANISH]
    Nicaragua, pas que est ubicado en Amrica Central aborda como un eje transversal el tema de Los Derechos Humanos en la plicacin de las estrategias de promocin, prevencin y atencin de las personas con VIH.

    Desde mi experiencia en la ejecucin del Proyecto sera importante considerar desarrollar nuevas actividades dirigidas a fortalecer el marco legal de los Derechos Humanos desde la perspectiva de equidad pero tambin considerando la necesidad de actualizar conceptos relacionados con la poblacin MARS como sujetos con iguales derechos, y visibilizando los derechos de las personas usuarias de drogas.

    El escenario es positivo ya que institucionalmente se ha fortalecido pues desde la Procuradura para la Defensa de los Derechos Humanos (PDDH) tenemos un Procurador Especial para la Diversidad Sexual.

    Ana del Carmen Rojas
    Masaya, Nicaragua
    Email: anitamasaya1007@yahoo.com

    ReplyDelete
  102. Paul Ponniah16 May, 2011

    EXPLOITED SHOULD FIND THE RIGHT TO SURVIVAL AND SUSTENANCE

    There are always two schools of thought TO DO OR NOT TO DO. those who have do not need help, those who don't have need the funding for the said purpose.

    In every society this is the challenges to let the suffering increase then they will profit by the exploited. The exploited should find the right to survival and sustenance.

    I personally appreciate the work done by Global Funding is impartial and poor oriented. It be continued for common good of the needy.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  103. Martha Tholanah16 May, 2011

    NEED FOR TOOLS TO MEASURE THE HUMAN RIGHTS COMPONENT WITHIN THE PROGRAMMES

    The rights of health consumers continue to be blatantly violated in health care systems, even within programmes heavily supported by Global Fund. There seems to be more of an emphasis on numbers - number of people on ARVs, number of people tested and counselled, number of condoms distributed, number of microscopists trained, number of primary care counsellors trained, etc - but no equal emphasis on quality.

    The fact that one of the objectives of the Global Fund (on HIV and AIDS for example) is to reduce incidence, reduce morbidity and mortality, and yet no one has ever been able to give an answer on how this is measured means people's rights are violated.

    People living with HIV need to be considered (within the health care system) as human beings beyond their levels of CD4 and viral loads. The numbers captured in the data monitoring, and pitched as success stories of programmes do not always necessarily translate into quality lives saved. Many times the violation of human rights occurs because health care workers are frustrated by the conditions their employers make them work under. We always say poor working conditions are no excuse for health care workers to trample on the rights of patients, but we also know as long as the issues are not adequately dealt with, the violations will continue. Addressing the rights of health care consumers cannot be complete without addressing the human rights of the health
    care workers in their workplace.

    There is need for tools to measure the human rights component within the programmes.

    Martha Tholanah, Zimbabwe
    Email: m_tholanah@yahoo.com

    ReplyDelete
  104. Pastor Phainos Muhindi16 May, 2011

    The AIDS epidemic has left many families and individuals in a very weak and vulnerable situation. The economic and social effect of the epidemic include loss of land and property, early marriages, child labour, sexual exploitation and many others abuses of peoples human rights .These problems may have existed in our communities before the emergence of HIV/AIDS. There is no doubt ,however, that the high death toll of the epidemics has greatly magnified their impact on our communities.

    Pastor Phainos Muhindi
    Eldoret, Kenya
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  105. Dr Adel Aljasari16 May, 2011

    I think the CCM can play a major role to address this issue. e.g. the CCM should issue an annual report to address all barriers in the delivery of services to the most and other underserved population. The GF Secretariat can develop a list of the main barriers known to be available in the countries to be investigated and addressed. The report should be signed by the CCM and the representatives of people living with the three diseases and should mentions steps and actions taken by the CCM and the PR to deal with these barriers.

    The GF can consider the issue of this report a prerequisite document when countries submit their new proposals to the GF. The GF can develop also a scoring system to classify the countries according to the barriers available or the malpractice in each country. What are the indicators of the scoring system I think it can be developed by the professional experts?.

    The most important issue is when we can collect the information and address the barriers based on accurate information not just only few cases not represented the situation in the country. The information can be collected through quick surveys or interviews with the patients and people who seeking the health services delivered by the PR or SRs either the curative or preventive services.

    The issue of the report will not prevents the violations and convince the service providers who deliver the services to the people to change their negative behavior, but it will enable the CCM to monitor the situation and carry out more efforts to address the barriers in the delivery of evidence-based services to most at risk and other underserved populations and will contribute to protect human rights and prevent violations.

    Dr Adel Aljasari
    Malaria Control Program Director, Yemen
    Email: aljasari@hotmail.com

    ReplyDelete
  106. Beatrice Minja16 May, 2011

    Human rights based approaches to development are key in directing the available resources to the targeted groups in service delivery. However most countries lack the appropriate policies to guide the integrated program developments and implementation towards achieving the desired results that are expected at the grassroots or household levels.

    Since the households and the community expected results are not attained the sustainability and ownership of the interventions may not happen.

    The following recommendation may help the transformation process to the desired end.

    1) Call for Community based programs/projects in addressing health issues and especially Malaria. By involving the community, demands for quality services and individual responsibilities may be realised.

    2) All strategies in addressing the malaria problem should be given equal opportunities in scaling up achievements. To date too much efforts have been given to human treatment and minimum strategies for dealing with the vector have been adopted.

    3) Consider Information, Education and communication (IEC) focus on behaviour development from childhood in addressing key health issues rather than the current trend on behaviour change Communication which is focusing adults. The younger generation constitutes about 50% of the population in developing countries therefore more investments in school curriculum development for transforming health knowledge/ education may lead to more informed population for sustainable developments.

    Beatrice Minja, Tanzania
    Coordinator, Tanzania NGOs Alliance Against Malaria (TANAM)
    Email: beatriceminja@yahoo.co.uk

    ReplyDelete
  107. Maria Phelan16 May, 2011

    'Know your epidemic, Know your Response'

    Currently the Global Fund specifies that bids should be led nationally, although the value in this is clear and should continue it should be of the utmost importance that funding proposals should reflect the epidemic within the country. "know your epidemic, know your response" framework should guide all funding proposals. Currently, particularly in HIV/AIDS funding harm reduction interventions are ignored by governments when it is clear that there are rising rates of HIV infection in communities of people who use drugs.

    Communities affected by HIV should be included in CCMs, especially those from most at risk communities such as people who use drugs. A report by the HIV/AIDS Alliance implied a direct correlation between participation in CCMs and resource allocation to respective population groups. The data also suggests that key populations organisations are more likely to receive funds as sub-recipients on grants which have a civil society principle recipient.

    In order to achieve this the Global Fund should consider:
    - Global fund grants should include capacity building to key population organisations both in delivery of Global Fund projects and in proposal writing
    - Improving access to and understanding of Global Fund related information specially aimed at key populations
    - Spaces should be created where key pops can meet coordinate strategies and actions and share knowledge
    - Training should be provided to ensure key population representatives know how best to strategically operate in spaces such as CCM's
    - With regards to a lack of relevant and up to date epidemiological data: Global Fund grants should be evidence based but in areas where evidence does not exist - for example there is very little robust data on injecting rates across Sub Saharan Africa, however we are aware from grey material and reports from CS that it is on the rise. There is a real need for the Global Fund to commission the gathering of up to date epidemiological data. Without accurate data portraying the reality if the epidemic in each country, it is impossible to develop effective proposals and it is easy to shift the focus of the bid.
    - The Global Fund secretariat should play a stronger role in supporting in-country adherence to their governance guidelines

    For more information the Alliance report is here: http://www.aidsalliance.org/includes/Publication/Report_on_Key_Populations_access_to_resources_ENG.pdf

    Maria Phelan, International Harm Reduction Association (IHRA)
    Email: maria.phelan@ihra.net

    ReplyDelete
  108. Yudopuspito Trijoko16 May, 2011

    We already know about the Global Fund that cover AIDS, TB and malaria, but there is a lot more that needs to be done on supporting TB-HIV programmes and other cross linkages or to address common or shared risk factors for co-morbidities.

    I think that the Global Fund needs to expand its area of work to non-communicable diseases (NCDs) in relation to TB, HIV and malaria.

    World has already learnt more about comprehensive integrated approaches but still needs a clear proportion among those work in that areas.

    Yudopuspito Trijoko, Indonesia
    Email: tyudop@yahoo.com

    ReplyDelete
  109. Anonymous16 May, 2011

    I think more money should reach the people at the grassroots. You find that a lot of the time the money gets stuck somewhere due to bureaucracy. For example I know in a community around Kitwe in Zambia that has been trying to do something for their youth in terms of prevention but have been unable to due to shortage of funds. They have applied for funding/ grants from middle of last year and to date they have not had a response. I think delays like this that contribute to loss of more lives than necessary with regard to HIV/AIDS, TB and malaria. So basically the money is not reaching the people it is intended for in a timely manner!

    Anonymous

    ReplyDelete
  110. Dr Naeem Hassan Saleem16 May, 2011

    Let me extend my profound thanks for providing an opportunity of this global interaction. Undoubtedly, GFATM had been pinnacle of HIV response during the last decade.

    Despite many gains, the effort has not been desultory. Prevention must remain the theme of parent governments due to discounting effects. GFATM can play advisory role in such instances. Cure must be the main thrust as ARV are still far more expensive especially in countries with pharmaceutical monopolies.

    GFATM must deal with corruption, enhance local capacities and avoid fat bureaucracy.

    Dr Naeem Hassan Saleem, Lahore, Pakistan
    Email: nhs_naeem@yahoo.com

    ReplyDelete
  111. Nomsa Mlambo16 May, 2011

    MALARIA IS LARGELY AN INFRASTRUCTURAL DISEASE PROBLEM

    I am looking at the Global Fund to come up with a comprehensive strategy for the broad-based community of South Africa that unless we wage a full scale war to this threesome epidemics of HIV, TB and malaria, we still have not fully addressed ourselves to the issue of the pandemic. Unless all of them are equally de-stigmatised and their solution is solicited in a coordinated manner we are not going to win.

    Sexually transmitted infections (STIs) are still largely perceived in my community as petty female problem, even reduced to common female body reaction? I am touched by a one men effort of Mr Hollogate the explorer in fighting malaria. The question is where are our Government's effort in Africa to match
    the effort of one family one malaria net?

    Malaria is largely an infrastructural disease problem. We need to answer lot of question about our sanitation system, in particular to see why and how our people contract Malaria. In 1983 I contracted one in Zimbabwe, was hospitalised for seven days at Parerinyatwa Hospital in Harare. Ten years later working as a development worker I contracted typhoid in Maputo three days later I became critical and malaria was found in my blood?

    Because of my socio economic status I am here today telling the tale. For millions of our people in the Continent who live below poverty line they succumb and die in front of this disease and mainly these people are children and women.

    Nomsa Mlambo, South Africa
    Email: nomsa.mlambo@executivemail.co.za

    ReplyDelete
  112. Andrew Hunter16 May, 2011

    GFATM funds are being used in numerous countries in Asia (and probably other regions as well) for programmes that violate basic human rights and accepted universal ethical standards in health care.

    The funding of compulsory detention centres for drug users and sex workers is one example.

    The other things we see over and over in sex work programming is compulsory or highly coercive testing- for STIs and HIV.

    Compulsory testing of sex works is not only driven by government policies which ignore human rights- but is also being driven by GF indicators which give programmes ridiculous targets of the number of sex workers (or MSM or IDUs) who must be tested in order to meet M and E targets.

    This not only violates the rights of sex workers and others, but in many cases it wastes huge amounts of money doing repeat tests for people who really don't need testing.

    These results are then not kept confidential- they are, in many cases, shared with sex business owners and needlessly shared among staff of implementing organisations.

    In many cases sex workers were better off before the Global Fund came in and scaled up the abuses of their rights and gave governments and NGOs money to further control their lives.

    Andrew Hunter
    Asia PAcific Network of Sex Workers (APNSW), Thailand
    Website: sexwork.asia
    Email: apnswbkk@gmail.com

    ReplyDelete
  113. Maisoon Elbukhari16 May, 2011

    Health service should be accessible to all and the targeted interventions do accentuate the prejudice. The underserved & most at risk populations being part of the community will benefit from the available services if the service providers are well trained on the human rights and gender based approaches.

    One of the strategic interventions is to promote improvement in the available services and raise awareness of the rights and responsibilities of users and providers of health services through sensitizing and training the service providers on the human rights principles and how could the human rights frame work support the delivery. Other important intervention is measuring adherence of the GF supported interventions to the basic requirements of the right to health.

    Maisoon Elbukhari, Sudan
    Email: Maisoon.Bukhari@undp.org

    ReplyDelete
  114. Dr Prakash KH16 May, 2011

    The Global Fund should prioritise the countries based on the need in terms of the diseases/epidemics situation of the country. It is not just AIDS,TB and Malaria which are killing people across poor countries. Think of other Chronic diseases and special situations which has huge Morbidity/ Mortality
    like filariasis, NCDs, MMR & IMR related to poverty, Malnutrition non availability of quality/emergency care.

    As regard to selection of members for CCM it has been observed that few strong people/NGOs who does lots of lobbying & influence get selected and they unilaterally influence the allocation of GFATM funds to their own NGOs or NGOs they are well connected this results in poor programme output and misappropriation of funds. GFATM should look at other ways of /criteria for selection of CCM members.

    Dr Prakash KH, India
    Director, Medical services
    Karnataka Health promotion Trust
    Email: prakashkh@khpt.org

    ReplyDelete
  115. Mavis Kahwemba16 May, 2011

    I would think recipients of funds should be young children and pregnant women. In putting to the use of these vulnerable groups of society we ensure the existence of future generations. Furthermore patients need to be treated with sensitivity and human dignity so health workers need to be trained in that direction. They also need to have their conditions of services improved to motivate them.

    Mavis Kahwemba, Zimbabwe
    Email: kahwemba@uz-ucsf.co.zw

    ReplyDelete
  116. Kennedy Kassaza16 May, 2011

    In order to deal with the issue of discrimination and stigma, Global Fund should partner with Rights organizations to help in sensitization and advocacy on behalf of the PLHIV and TB. Some countries have already made some good progress in fighting stigma and discrimination, but others are still a long way to go.

    So to ensure that the vulnerable people get the services adequately without being sidelined, global fund can work out a way of involving some of the Rights organizations working with the local communities. In most cases these organizations are on the ground and with a clear working goals and understanding, they can help raise awareness and enhance the success of global fund intervention in the fight against TB, HIV and Malaria.

    Kennedy Kassaza
    MSF-Epicentre Mbarara Research Base,
    Mbarara, Uganda
    Email: kennedy.kass@gmail.com

    ReplyDelete
  117. Mikhail Golichenko16 May, 2011

    1. Criminalization of
    A)drug users (through criminalization of drug use; possession of drugs for personal use; violations of the right to fair trial, including sentencing users as traffickers and planting drugs; no access to free legal advice)
    B) sex work
    C) HIV transmission or exposure

    2. Access to prevention treatment and care programs which are human rights oriented and evidence based (including adequate access to all 9 interventions of the comprehensive package for IDUs)

    3. Discrimination in labour, family, housing, education for people living with or vulnerable to HIV

    4. Freedom of expression, including freedom to receive and impart information on health matters.

    Without this the impact and sustainability of the GF funded projects will remain inadequate to the fast growing AIDS epidemic in the countries of the former USSR.

    Mikhail Golichenko,
    Moscow, Russia

    ReplyDelete
  118. Dr Heitham M.Ibrahim16 May, 2011

    HIV/AIDS is highly linked to socio-cultural factors. More than 95% spread through unsafe sex which in many communities is considered as sin or cultural deviance. Stigma is deeply rooted even among healthcare providers. Religious and cultural believes about use of condoms. Being sex worker or homosexual is a tragedy in many communities.

    This context makes working on 'Human Rights' regarding HIV/AIDS very essential and country specific and culture specific in the same time. Hence supporting multisectoral approach programs that involving all stakeholders and actors of each country at early policy making and planning stages is very important.

    The second suggestion is to let these rights to be flexible and follow regulations and cultures available in each country rather than to push for a universal approach to be followed by all countries2C this will not benefit the programs.

    Also I want to comment on the vertical approach of the HIV program in many country and its relation to our topic now. However this approach is considered to be successful but stand-alone non-integrated HIV services by itself deepening the stigma among patients and communities.

    Restructuring of our strategies and approaches to ease human rights and to be away from stigma is of great value.

    Dr Heitham M.Ibrahim, Sudan
    TBHIV coordinator
    Email: bauga1@hotmail.com

    ReplyDelete
  119. Pastor Phainos Muhindi16 May, 2011

    Human right of property ownership and inheritance can play a significant role in potential breaking the cycle of AIDS and poverty.

    There is growing evidence to suggest that where human right to property are upheld, acting as heads and /or primary caregivers of HIV/AIDS, affected household are better able to mitigate the impact of AIDS on their families and communities and can help to prevent the further spread of HIV/AIDS. Realistic and workable strategies at the grassroots have demonstrated that increasing economic security and empowerment ,increasing their negotiating power in family and is a means to reduce their physical and social vulnerability to HIV/AIDS.

    Pastor Phainos Muhindi, Kenya
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  120. Konjit Kifetew16 May, 2011

    Training service providers in HR and Gender based approaches.

    I do agree with Maisoon on working toward human right based approach to HIV/AIDS and reproductive health (RH). This of course entails knowledge building among the duty bearers and the claim holders in accessing and provision of services. Gender based approach will guide that services are based on equity (to reach the most vulnerable ). One recommendation I have for the GF is to allocate funds for countries to work on awareness, advocacy and knowledge building on human rights and gender. This is very important to have access for all.

    Konjit Kifetew, UNICEF, Ethiopia
    Email: kkefetew@unicef.org

    ReplyDelete
  121. Usman Al-Rashid16 May, 2011

    Protecting the rights of individuals, families and communities is the first step towards combating the epidemics particularly so in developing countries. The inability of institutions to protect the rights of individuals fuel outburst of epidemics whether concentrated or generalized.

    One of the consequences of this is stigma, discrimination and self denial. The outcome of this is that it further fuels the epidemics. Evidences abound of how, non-protection of the rights of infected/affected persons have increased incidences of leprosy, tuberculosis and other neglected tropical diseases.

    This is also happening in HIV at the moment. Sex worker abandoning their localities to new environment for fear of their rights being violated by policemen or law enforcement agencies. The success of reaching more lives at affordable cost can easily be attained if countries provide enabling legislations and policies that protect the rights of people infected or affected by TB and/or HIV. This is the first step towards the provision of comprehensive prevention, treatment, care and support services in HIV and TB. In addition to the enabling legislations and policies adequate attention need to be paid to the following:

    - concerted efforts at improved advocacy, communication and social mobilization activities at community levels.
    - Improved access to and availability of quality integrated services. This is linked to health system strengthening.
    - Trained and re-trained Health Care Worker (HCW) on empathy and good caring skills.
    - Implementation of right-based approaches in activity program design, implementation and monitoring. Very important is mainstreaming right-based issues such as gender, into these programs.
    - Very key to addressing human rights issues in GFTAM, is the inclusion of reproductive health as enshrined in ICPD.
    - Operations research on barriers to increasing access to underserved/hard to reach population could facilitate better understanding of the underlying challenges for better programming.

    Usman Al-Rashid
    Senior Policy Advisor
    USAID-Targeted States High Impact Project (TSHIP)
    Bauchi, Nigeria
    Emails: alrashidusman@yahoo.com, Ual-Rashid@futuresgroup.com, Ualrashid@tshipnigeria.org

    ReplyDelete
  122. Dr Fatai Wole Bello16 May, 2011

    To be crisp about issues concerning Human Rights and diseases, stigmatization in all its ramifications should form the fulcrum. To navigate the challenge, doable Policies supported by political commitment should be the engagement of all stakeholders.

    Dr Fatai Wole Bello
    Executive Secretary, CCM, Nigeria
    Email: fwbello@yahoo.com

    ReplyDelete
  123. Mohammed Saadi Sukkaria16 May, 2011

    I think it is necessary to form a working group which is able to communicate with people living with HIV, especially with sex workers and that this team should have the efficiency of operations in psychological and behavioural counselling.

    This team should have contacts with civil society organizations to integrate these patients properly in the community and secure a new environment.

    As well as to be a database for these patients and the people most at risk and try to make all aid to avoid the risk of the disease and this needs to be cooperation between all segments of society

    It also has to be drawn to the culture of each country in the development of goals for the quest to find the plans and means commensurate with the culture of this country

    Mohammed Saadi Sukkaria, CCM member, Syria
    Email: islamz@gmail.com

    ReplyDelete
  124. Wabwire Paul Francis16 May, 2011

    PROVIDE MOTIVATING, CONDUCIVE AND PROTECTED WORKING CONDITIONS FOR HEALTHCARE PROVIDERS AND SERVICVE SEEKERS

    Human Rights is for all, therefore need to consider health workers as well by providing motivating, conducive and protected working conditions like it would be for those clients with HIV, TB and malaria.

    Therefore during the moment of carrying out Health Promotion activities in the fight against HIV, TB and malaria, health workers should be considered.

    Wabwire Paul Francis, Uganda
    Email: wabwirepaulfrancis@yahoo.com

    ReplyDelete
  125. Yudopuspito Trijoko16 May, 2011

    HUMAN RIGHT VS VOLUNTARY AND CONFIDENTIALITY ISSUES

    In some population, definition of the most at risk is not suitable; it is contra-productive for the human right principles itself like equity and equality because the right is about life and how to get access for better and highest health level. To overcome disparity, GF need to suggest government to build a standardized health services for all.

    In many condition, voluntary was depend on some understanding of self-needs and self-risk perceptions although self-ability to caught the health services; it is means that truly information and education had their impact on individual insight. Whenever we wait for the betterment of those perceptions, maybe it is too late to save lives and it could be dangerous for others health condition, and will affect their productivity to keep life.

    About confidentiality, mainly depend on health info distribution system. In some condition, there is a need for shared-confidentiality in order to help people. Confidentiality issues should never abandon people to health access.

    There is a case of breaking confidentiality issue of HIV result test in a tribe of remote population. Even though we educate them that this result is confidential, meaning just for the patient and need some chronic medication, they already talked about their test result just over they moved out of the room. They shared their condition, support and help each other. When we asked them why, they said that they always shared every condition like when they sick because of malaria or tb or frambusia they do so, let the healthy keep healthy and helping the sick ones. Unfortunately, a lot of them are positive based on cultural activities.

    It is means to me that human right is how avoid human extinction whatever the causes.

    Yudopuspito Trijoko, Indonesia
    Email: tyudop@yahoo.com

    ReplyDelete
  126. Paul Ponniah16 May, 2011

    Why not kill malaria by killing Mosquito the positive carrier, the problem to control malaria will be easy and disease will be stopped. Unless we address other related-development issues so that effective mosquito control can happen in communities that are at most risk of mosquito borne diseases, just providing treatment is not enough!

    The use of certain chemicals used to kill mosquitoes does not totally kill mosquitos, at times it builds active resistance.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  127. Ainsley Reid16 May, 2011

    STRATEGIC THINKING, INTEGRATED APPROACHES, AND POLITICAL COMMITMENT URGENTLY NEEDED

    Based on what I have seen in the Caribbean - programme cost, sustainability challenges, human resource challenges, capacity challenges, patients' social and economic challenges, I would suggest that both HIV and TB Programmes be integrated (especially knowing the scale of our HIV and TB epidemics) and mainstreamed 'into the broader health agenda....in the broader strategic planning approaches and financial framework aimed at poverty reduction.'

    I think the days are long gone when we think of health in relation to pills, nurses, doctors, and facilities, we must look at how we involvement and empower the citizens and communities through capacity building to play key roles indecision-making that will result in improvement in their quality of life (socially, physically, emotionally/ mentally, environmentally, spiritually, etc) in ways that reduce cost and cut waste.

    In that context we must address stigma and discrimination, gender inequality, social support and protection for the vulnerable and marginalised in the society, committed leaders who will hear and understand the citizenry and respond in sense of urgency. Both TB and HIV should have thought us that is the way to go.

    Ainsley Reid
    GIPA Coordinator
    National HIV/STI Programme (NHP)
    Ministry of Health
    Kingston, Jamaica
    Email: akrinja@yahoo.com

    ReplyDelete
  128. Pastor Phainos Muhindi16 May, 2011

    When people have problems or seems confused, or scared, we likely to have clear simple answers to their sufferings. However, we have seen how our lives are full of uncertainty and that easy solutions are rarely available. Global Fund is now to do an exercise which will help us to think about how we can handle risk in general to human right progress.

    Pastor Phainos Muhindi
    Eldoret, Kenya
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  129. Lydia Lungu16 May, 2011

    To empower commercial sex workers and vulnerable in communities. Funding should also target the organizations that are directly involved with the communities.

    Lydia Lungu, Zambia
    Email: lungulydia41@yahoo.com

    ReplyDelete
  130. Emmanuel Abi Couson16 May, 2011

    What really comes to mind is that in most countries like Nigeria MARPS are mostly culturally tabooed. So it will be very difficult to hide under any human rights to provide services without taking into consideration the Socio-cultural and political differences in each country.

    It therefore means that for example in Nigeria what are the laws in-country that could be relied upon to provide these services? If there is can it be applied throughout the country bearing in mind the different socio-cultural behaviours in different areas in the country. If there is none what strategy can be used to put one in place without resistance from the people?

    Emmanuel Abi Couson
    Media and Communication Officer
    Country Coordinating Mechanism (CCM), Nigeria
    Emails: emmaabi@yahoo.com, emmaabi1964@gmail.com, ecouson@ccmnigeria.org
    Website: www.ccmnigeria.org

    ReplyDelete
  131. Robert Bennoun16 May, 2011

    It would be useful if the GF strengthened attention to human rights in GF proposal, even to the extent of suggesting key indicators for inclusion, participation and access to goods and services for most at risk/ most discriminated against populations.

    There also needs to be more education of key national stakeholders to raise understanding and attention to rights - both through publications and guidelines as well as through CCM advice and country/ regional fora supported by the GF.

    Currently I'm in Bhutan working on the health sector review of the national response to STI/HIV and AIDS, and will then work on redevelopment of the national strategy. Even though the GF is the main continuing external donor for health/HIV in Bhutan, to date my perception is that most affected people
    - people living with HIV, sex workers, drug users, men who have sex with men
    - could have been much more actively involved in the review.

    To me, this limited inclusion threatens the legitimacy and credibility/thoroughness of review and development of national strategies, which form much of the basis for GF proposals.

    Robert Bennoun, Bhutan
    Email: robert.bennoun@gmail.com

    ReplyDelete
  132. Jitendra Dwivedi16 May, 2011

    JUST TB-HIV SERVICES UNDER ONE ROOF IS NOT A HUMAN RIGHT
    CORRECT TB DIAGNOSIS IS A HUMAN RIGHT

    Just providing TB and HIV services under one roof is not enough - because it is so difficult to confirm TB in people living with HIV (PLHIV). Global Fund should support programmes that aim to confirm TB in PLHIV as well. New diagnostic tools for PLHIV is a human right. Sputum microscopy centres are clearly not working enough for PLHIV.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  133. Shobha Shukla16 May, 2011

    IPT OR TB PREVENTIVE THERAPY IS A HUMAN RIGHT

    Why is Isoniazid Preventive therapy (IPT) to protect people from TB, particularly those living with HIV not being rolled out in India? There is so much evidence now in support of IPT. Global Fund must consider

    Shobha Shukla, India
    Email: shobha1shukla@yahoo.co.in

    ReplyDelete
  134. Nguyen Hua16 May, 2011

    RIGHTS OF IDUs

    Human rights of IDUs to health, life, dignity, services without stigma, discrimination must be protected. Health facility should be safe place - have laws to protect public health for IDUs in countries that have laws criminalizing drug use.

    Nguyen Hua, Vietnam
    (on the web)

    ReplyDelete
  135. PROTECT SEX WORKERS

    Laws to protect human rights of sex workers must be in place.

    Supalak, Cambodia
    (on the web)

    ReplyDelete
  136. Chuong Hy16 May, 2011

    WAR ON DRUGS MUST STOP

    Why we have war on drugs by government and health department of government talking about health of IDU? Why this two face? This should change Global Fund

    Chuong Hy, Laos
    (on the web)

    ReplyDelete
  137. Dr Adnan A Khan16 May, 2011

    Please forgive me if this has been said before, I noticed that we have had close to 150 comments so far.

    The GFATM is a sea-change concept that has prioritized funding for these diseases and changed the level of activities in many countries. The large scale of its funds have also advocated for additional funding from country governments who have sometimes sought to follow lead of the GFATM and its partners and fund prevention and treatment of these diseases.

    The GF must be commended for its evolution over time and the lessons that it has incorporated. I remember the discussions about funding prevention, IDU programs and more - all of which have now become relatively common among the GF grants.

    In my opinion, GF grants and their funds are essentially life saving resources that are meant for the disease affectees. As such there is an even more need to ensure that the funds actually reach their intended beneficiaries. All too often we still see much of funds wasted in the "system" due to incompetence, diversion or poor design. This happens with both public and private (including NGOs) sector implementers. To minimize such wastage of these life saving resources may I suggest that

    *During evaluation of grant applications*

    1. Ask for country specific and rationalized costing data
    2. Ask for country specific AND non-government/ UN system (since the UN agencies are obliged to accept government data) data as basis of grant rationale. This is based on data from UN Reference Group on IDU and HIV showing the wide differences among data on coverage and effectiveness between governmental and non-governmental data (IHRA conference 2011)
    3. Find ways to obviate political interference from evaluation process

    *During Implementation Process*

    1. Mandate that CCMs have the capacity to monitor/ evaluate grant activities. Perhaps even better would be to have mechanisms that go beyond GF reporting requirements and look at the benefit of the grant to the country - a sort of effectiveness/ cost effectiveness analysis

    2. In addition to having just a financial audit with a local funding agent (LFA), have an effectiveness audit periodically to see if the grant is actually helping its intended beneficiaries

    3. Develop mechanisms that study GFATM grant effectiveness - ie things like lives saved, cost effectiveness analyses etc.

    Dr Adnan A Khan, Pakistan
    Emails: adnan@khans.org, adnkhan1@gmail.com

    ReplyDelete
  138. Moses Mazyopa16 May, 2011

    The right to life is a human right that needs to be upheld for all citizens, and tribute needs to go to the Global Fund that have made such a difference to communities in Zambia.

    People are accessing HAART because of these initiatives, which governments would not have been able to afford doing in normal circumstances. That is why the current scenario in Zambia, where the Global Fund is withholding the release of Grants to Zambia are a threat on the right to life of people.

    We may still have HIV medications in our clinics, but the support services system has totally collapsed because CBOs, NGOs do not have resources to provide support services to the people taking the medication. The Global Fund needs to look into this.

    We are grateful that the CCM is been reconstituted, and we demand that the PLHIV representative is replaced. We need a representative who is fearless, vibrant and is going to cry foul when things are not going well, providing proper oversight to the disbursement of GF monies.

    But we implore the GF to continue the flow of these funds to our country, as the civil society HIV response is on the verge of collapse.

    Written by a PLHIV in Zambia

    Moses Mazyopa, Zambia
    Email: mosesmazyopa@yahoo.com

    ReplyDelete
  139. Luke Samson16 May, 2011

    On the 12th of May 2011, Civil Society Organizations and all Most at Risk populations (MARPS) met to give feedback to the National AIDS Control Organisation about the non-inclusive process engaged in planning phase 4.

    The impact of stigma and discrimination is faced most severely at the level of MARPS, and donors and Governments need to take cognisance of how much AIDS civil society has contributed to a health and human rights framework.

    It is critical that issues such as political change and donor whim do not change our commitment to Health and Human Rights because it appears govts want to turn the other way if the AIDS fund dries up.

    Our challenge is to ensure a continual commitment to protect this agenda, and to see the critical linkages between infection control and prevention and intervention measures including care and support.

    The real way to clean up our streets is through health and human rights and it is hoped that CCMs can structure service delivery agendas to ensure programs are evaluated bottom up apart from the current top down process.

    Luke Samson, GFATM SR (round 9 for IDUs), India
    Email: horairk@gmail.com

    ReplyDelete
  140. Tabrani Yunis16 May, 2011

    PROVIDES GOOD QUALITY SERVICE FOR THE POORER

    Most people who are suffering from various disease such as malaria, TB, HIV/AIDS and others are waiting for a good quality and cheap treatment. Most of them are not satisfied because of the bad services or treatments. They complain because the cost is getting higher and higher. Ideally, the government should provide the quality and cheap treatment especially for the poor and the poorer. Unfortunately because of the Provider poverty, they do not get good services as the richest. They are often neglected. Health is a basic needs and right. But is always neglected by the government. It means that the human right is also neglected. Therefore it is expected that this condition must be changed to be better Providing good treatment and service are parts of protecting human rights.

    Tabrani Yunis
    Center for Community Development and Education (CCDE)
    Indonesia
    Emails: ccde.aceh@gmail.com, potret.ccde@gmail.com
    Website: www.ccde.or.id

    ReplyDelete
  141. Eric Aborgah16 May, 2011

    The conventional way of managing TB patients sometimes must be combined with innovative approaches. Behavioural and psychological counselling of TB patients is Key. Extreme poverty due to inability to work is a major cause of some frustrations patients go through. I think the enablers package is not adequate enough to meet the transport and dietary needs of patients. Some patients still do not believe that TB is curable indicative of the fact that education and communication need to be scaled up.

    On the whole the enormous task of eliminating TB requires inter-sectoral collaboration. It is not a preserve of Health agencies alone. I believe religious leaders could leverage their skills in sensitisation, counselling and advice since churches are potential hotspots due to the large congregation of people.

    Eric Aborgah, Ghana
    Email: eraborgah@yahoo.com

    ReplyDelete
  142. Wabwire Paul Francis16 May, 2011

    Human Rights is for all, therefore need to consider health workers as well by providing Motivating, Conducive and protected working conditions like it would be for those clients with HIV, TB and Malaria.

    Therefore during the moment of carrying out Health Promotion activities in the fight against HIV, TB and Malaria, health workers should be considered.

    Wabwire Paul Francis, Uganda
    Email: wabwirepaulfrancis@yahoo.com

    ReplyDelete
  143. Paul Rodriques16 May, 2011

    HEALTHCARE WORKERS

    Global Fund must ensure proper universal precaution measures and infection control is in place in healthcare settings to protect healthcare workers, patients and attendants.

    Paul Rodriques, Sri Lanka
    (on the web)

    ReplyDelete
  144. Asif Ali16 May, 2011

    FAITH BASED AND RELIGIOUS LEADERS

    For addressing human rights related to HIV, TB and malaria, please do engage and seek partnership with faith based and religious leaders

    Asif Ali, Afghanistan
    (on the web)

    ReplyDelete
  145. Gunjan Sharma16 May, 2011

    INFECTION CONTROL

    Global Fund should visit healthcare facilities not only in cities but also in peripheries to see the situation of infection control measures. Putting people, patients and other healthcare providers at risk of infections is a violation of human rights.

    Gunjan Sharma, Nepal
    (on the web)

    ReplyDelete
  146. Jitendra Dwivedi16 May, 2011

    UNIVERSAL PRECAUTIONS

    Will like to support Dr Sethi for raising ground reality of government hospitals - where universal precautions are not observed because of lack of facilities, awareness and supplies.

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  147. Rahul Kumar16 May, 2011

    PATIENTS' CHARTER FOR TB CARE

    While Global Fund might expand its work on human rights, let us begin with rolling out patients charter for TB care which already exists since so many years and is part of our global and national strategies.

    Rahul Kumar, India
    Email: contactrahullko@gmail.com

    ReplyDelete
  148. "Human Rights

    The protection of fundamental human rights was a foundation stone in the establishment of the United States over 200 years ago. Since then, a central goal of U.S. foreign policy has been the promotion of respect for human rights, as embodied in the Universal Declaration of Human Rights. The United States understands that the existence of human rights helps secure the peace, deter aggression, promote the rule of law, combat crime and corruption, strengthen democracies, and prevent humanitarian crises.

    Because the promotion of human rights is an important national interest, the United States seeks to:

    * Hold governments accountable to their obligations under universal human rights norms and international human rights instruments;
    * Promote greater respect for human rights, including freedom from torture, freedom of expression, press freedom, women's rights, children's rights, and the protection of minorities;
    * Promote the rule of law, seek accountability, and change cultures of impunity;
    * Assist efforts to reform and strengthen the institutional capacity of the Office of the UN High Commissioner for Human Rights and the UN Commission on Human Rights;"

    ReplyDelete