Publications

Nearly 20 years after the WHO declaration of TB as a global public health emergency, major progress has been made towards 2015 global targets set within the context of the Millennium Development Goals (MDGs). Two years ahead of the deadline, the Global Tuberculosis Report 2013 and accompanying supplement Countdown to 2015 assess progress towards the 2015 targets and the top priority actions needed to achieve and/or move beyond them. This is the eighteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by 197 countries and territories that account for over 99% of the world’s TB cases.

This report summarises the results of qualitative research that was conducted to better understand reasons for initiating, continuing and ceasing treatment among PLHIV in the Pacific Islands. In total, 49 PLHIV were inter-viewed, including 23 HIV-positive people in Fiji, 11 HIV-positive people in Guam, 2 HIV-positive people in Kiribati, 5 HIV-positive people in Samoa and 8 HIV-positive people in Solomon Islands. A training workshop was held in November 2011 where the team of 10 PLHIV peer researchers, 2 training support facilitators and the team leader worked in collaboration to develop the method for the study. In-depth interviews were selected as the research method to gain a detailed understanding of the participants’ treatment experiences. Research participants were recruited through PLHIV support networks where they exist and through health clinics that provide treatment to PLHIV.

This paper documents the recent developments, opportunities and challenges in intellectual property rights and access to affordable medicines in China. In particular, the paper finds that there have been impressive achievements in the national response to the HIV epidemic in China. Examples include the rapid expansion of government-supported antiretroviral (ARV) schemes and the development of a legal framework on intellectual property to address access to affordable pharmaceutical products in China. Adoption of the National Intellectual Property Strategy by the State Council in June 2008, and the revisions to the Patent Law and the Implementing Regulations with strong focus on public health protection are among the most prominent legal and policy achievements over the recent years, founding an enabling environment for action.

The Treatment 2015 framework leverages existing international and national guidelines to generate new ways of thinking about HIV testing and treatment. Rather than expecting people to adapt themselves to complicated service systems, Treatment 2015 calls for systems to be adapted to the needs and circumstances of the people who use them. Community-led initiatives are vital to expanding and sustaining access to life-saving treatment services. As the evidence base continues to evolve and new challenges and opportunities emerge, new mechanisms for translating evidence into action will be needed. Efforts to scale up treatment will need to respond more swiftly to information on epidemiological trends and service coverage using a data-driven strategic approach that focuses programming on the populations and settings in which HIV is spreading most rapidly and the unmet need for HIV treatment is most acute.

Thailand has committed to the targets of the 2011 High Level Meeting on AIDS and has a prioritized National Strategy which pledges a two-thirds reduction in incidence in sexual transmission, and through injecting drug use, by 2016. Thailand has the potential to be one of the first countries in Asia to ‘End AIDS’ and reach the first milestone on the road to end AIDS by meeting the 2015 HLM targets. The end of AIDS can become a reality if Thailand is able to effectively utilize the preventive effects of antiretroviral treatment. Thailand as has already shown this is possible through the virtual elimination of HIV infections from mother to child.

This Southeast Asia Opium Survey shows that despite eradication efforts, opium poppy cultivation in the region continues to increase. Poppy cultivation in Myanmar rose 13% from the previous year to 57,800 hectares, more than doubling since 2006. In Lao cultivation levelled off but remains a concern. Surveys of farmers in poppy-growing villages, indicate that the money made from poppy cultivation remains an essential part of family income. Villagers threatened with food insecurity and poverty need sustainable alternatives, or they will continue out of desperation to turn to growing this cash crop. In Myanmar and Lao PDR, the use of opium, heroin and synthetic drugs – another growing threat in the region –, remains high. Moreover, the number of registered heroin and synthetic drug users in China has been going up since 2007. This increase in drug production and use represents a clear threat to human security and health. Balanced plans aimed at slowing and stopping production and trafficking, while preventing drug use and providing evidence-based treatment and care for drug-dependent users, in full compliance with human rights standards, must be made a priority by states and international partners.

This Project, Assessing the Capacity of National Human Rights Institutions to Address Human Rights in relation to Sexual Orientation, Gender Identity and HIV (NHRI SOGI Project or the Project), forms part of broader regional collaborative efforts to promote an enabling legal environment for the response to HIV. The NHRI SOGI Project aimed to build understanding of the capacity and response of selected Asian National Human Rights Institutions (NHRIs) to the human rights issues faced by people of diverse sexual orientation and gender identity (SOGI). In much of Asia, SOGI-related stigma and discrimination strips people of their rights and excludes them from mainstream health programs, public services, and economic opportunity. Stigma and discrimination also have the effect of increasing the acceptability and incidence of violence perpetrated against men and women of diverse SOGI and transgender people. Under these circumstances people of diverse SOGI face ongoing and dehumanizing harm, humiliation and exclusion. Driven underground, people of diverse SOGI are denied the ability to live productive lives as contributing and engaged members of society. Deep set socio-cultural prejudices are exacerbated by punitive and discriminatory legal frameworks, criminalization of same-sex sexual relations in a number of jurisdictions, and law enforcement practices.

Findings from studies conducted in the United States of America and Europe have shown that transgender people are at a significantly higher risk for HIV and sexually transmitted infections (STIs), as compared to gay and heterosexual men. At the 10th international Congress on AIDS in Asia and the Pacific held in Busan, Republica of Korea, from the 26th to the 30th of August 2011, Republic of Korea, transgender delegates requested the World Health Organization (WHO) to assess the state of transgender health in Asia and the Pacific. The objectives of this assessment report are (1) to examine the current state of evidence on transgender health in Asia and the Pacific, (2) to understand the current needs and concerns of transgender communities in Asia and the Pacific and, informed by objectives 1 and 2, (3) to make technical recommendations to WHO and Member States regarding transgender health.

It is indeed a great achievement that gender equality is a fundamental element of the constitutions of all countries in South Asia, yet women and girls continue to be discriminated against within their homes, in schools, in the work place, in institutional settings, and even by law. More specifically, discrimination is especially strong among women and girls who are affected by HIV. This report looks into existing constitutional provisions, laws, and legal mechanisms in Bangladesh, India, Nepal, and Pakistan, and identifies provisions that provide protection or redress for violations of rights at health care settings. While the report focuses specifically on key HIV-affected women, the legal provisions identified also apply to the general population (including marginalized groups, such as disabled and very poor women) whose rights might be violated in health care settings. The report demonstrates that there are serious gaps in laws to provide protection and redress for violation of rights at health care settings in the four countries under discussion. While the constitutions in all four countries guarantee equality under the law and prohibit discrimination based on sex, there are only a few laws or legal mechanisms that women can use to access justice if these rights have been violated in health care settings.

Transgender people are an integral part of the traditional culture of many countries in Asia and the Pacific and in many places have been accepted into traditional daily life. In September 2012, a regional meeting of transgender advisers and activists adopted a working definition for transgender people in the Asia Pacific context. The adopted definition states that transgender people are: “Persons who identify themselves in a different gender rather than that assigned to them at birth” and may choose to “express their identity differently to that expected of the gender role assigned to them at birth.” Transgender people in the region “often identify themselves in ways that are locally, socially, culturally, religiously, or spiritually defined,” using local terminology and indigenous labels, despite these terms often being derogatory and marginalizing. A report in 2012 documented 50 such different terms for transgender people across 16 countries. However, acceptance and integration of transgender women and, to a lesser-documented extent, transgender men, into the daily fabric of local community life has diminished in recent times. Many assert that this change has been influenced by ‘western’ ideals. Societal acceptance and support of gender identification and varied sexual orientation has been declining, which is resulting in heightened discrimination of transgender people. Cultural and economic influences from the west have brought stigma, prejudice and discrimination towards those in Asia and the Pacific region who are transgender, along with men who have sex with men (MSM) and women who have sex with women.