The Global Health Workforce Alliance (GHWA) is convening the first ever Global Forum on Human Resources for Health in Kampala, Uganda from March 2-7, 2008.

The GHWA, hosted and administered by the World Health Organization (WHO), has been created to identify and implement solutions to the health workforce crisis. What is this crisis and how does it impact on the AIDS response?

Healthcare systems depend on trained staff

One of the major obstacles identified to scaling up access to HIV prevention, treatment, care and support in a country is a weak national healthcare system.

The question of human resources for health is a critical factor in any effective response to AIDS. A shortage of trained health care workers, particularly in low and middle-income countries, presents a real challenge to the ability of a country to respond to the HIV prevention, treatment and care needs of their populations.

In parts of sub-Saharan Africa shortages are so acute that they limit the potential to scale up programmes aimed at achieving health-related Millennium Goals including the roll-out of treatment for AIDS. - World Health Assembly, 2005

WHO estimates that more than 4 million additional doctors, nurses, midwives, managers and public health workers are urgently needed to avert serious crises in health-care delivery in 57 countries around the world—26 of these in sub-Saharan Africa. WHO estimates that at least 1.3 billion people around the world lack access to even the most basic health care.

Insufficient human resources has been identified as a primary obstacle to the delivery of antiretroviral treatment and other HIV-related services in many countries in Eastern Europe, Africa and Asia. Many healthcare systems have poor availability and quality of pre- and post-test counselling, health education, home care, diagnosis and treatment of opportunistic infections.

Governments pledge to increase capacity

At the 2006 High Level Meeting on AIDS, UN Member States reaffirmed their commitment to fully implement the 2001 Declaration of Commitment on HIV/AIDS and further strengthened international commitment on AIDS by:

“Pledging to increase capacity of human resources for health, and committing additional resources to low- and middle-income countries for the development and implementation of alternative and simplified service delivery models and the expansion of community-level provision of comprehensive AIDS, health and other social services.” However translating government commitment to increasing capacity into more health workers on the ground is a challenge of some complexity.

Balancing macroeconomic stability and staff retention

While AIDS funding has increased in recent years, simply pouring this into the healthcare system of a country to strengthen capacity is not the solution.

Most economists agree that a high rate of growth of a money supply causes a high rate of inflation - a rise in the general level of prices of goods and services in a given economy over a period of time.

Governments believe that fiscal and monetary policies – to keep inflation low - are needed to control and manage their economy to prevent potentially damaging sharp shocks and fluctuation in growth.

Low-income countries with high HIV-prevalence have to juggle the need to invest in their healthcare systems with a responsibility to maintain macroeconomic stability – nationally and regionally.

These economic policies include keeping salaries low and so constrain the hiring of the doctors, nurses, community health-care workers. Low salaries lead to low worker morale and low productivity and make it extremely difficult for some countries to retain their staff.

Open labour markets mean skilled professionals are migrating in record numbers to high-income countries, draining human capacity where it is most needed.

Global Forum on Human Resources for Health

Consensus is growing that this is a global crisis which calls for coordinated action.

The Global Health Workforce Alliance (GHWA) has been established to explore and implement solutions to this health workforce crisis. It is hosted and administered by the World Health Organization (WHO).

As a first step in the process, the GHWA are holding the first Global Forum on Human Resources for Health in Kampala this week. This meeting brings together government leaders, health and development professionals, civil society and academics from around the world who hope to consolidate a global movement on this.

Participants will explore solutions to improving education, training, and health sector management as well as looking at recent trends in migration.

The need to further engage young people in the AIDS response was a key element of discussion at the recent Commonwealth Heads of Governments Meeting (GHOGM), which took place in Kampala, Uganda.

UNAIDS Deputy Executive Director Deborah Landey joined Uganda AIDS Commission Director General Dr David Kihumuro Apuuli and youth representatives Johnah Josiah of Kenya and Mobafa Baker of Trinidad in a plenary session at the meeting, focusing on the health of young people. During her intervention, Ms Landey discussed the importance of engaging young people in the HIV response.

The Commonwealth Heads of Government Meeting is a biennial meeting convening representatives from 53 member states. The commitment to young people played a significant part in this year’s meeting, which was officially opened by the Head of the Commonwealth, Her Majesty Queen Elizabeth II.

Deborah Landey took part in the meeting as part of a country visit to Uganda where she also met with various leaders in Uganda’s AIDS response from government and civil society.

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Links:

Read UNAIDS Deputy Executive Director's speech
View photo gallery of UNAIDS Deputy Executive Director's visit
Visit the CHOGM 2007 Uganda Web site

HIV strategies work best when there is a clear understanding of the relationship between AIDS, poverty and human development. In an article published in leading scientific magazine PLoS, UNAIDS examines this relationship and the often called ‘vicious circle’ within which the impacts of AIDS increase poverty and social deprivation, while socio-economic inequalities increase vulnerability to HIV infection.

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Links:

Read article - Squaring the Circle: AIDS, Poverty, and Human Development
Read presentation - HIV and development challenges for Africa

AIDS and human rights are inextricably linked as demonstrated by Beatrice Were, a leading advocate for the rights of people living with HIV in Uganda who recently received the Human Rights Watch Defender Award in recognition of her work.

Mrs. Were is the co-founder of the National Community of Women Living with AIDS (NACWOLA), a grassroots organization that provides services to more than 40,000 women in 20 districts of Uganda. She has served as Executive Coordinator of the International Community of Women Living with HIV/AIDS, Uganda, has worked with UNAIDS over the years and was formerly a member of the UNAIDS Reference Group on HIV and Human Rights. Beatrice Were is currently working as the National HIV/AIDS coordinator for ActionAID International and has collaborated with different organizations to re-address the HIV prevention policies towards a more evidence and rights based response to AIDS in Uganda.

Beatrice Were talks to UNAIDS about the implications of the award on her work and on the rights of people living with HIV.

What does this award mean to you?

Basically this award means that my work is being recognised but also, in a much broader sense, it means that there is recognition of HIV as a Human Rights issue and more specifically there is recognition of the rights of women living with HIV. This award has also challenged me to do more to sustain the visibility of the rights of the people living with HIV as part of the Human Rights.

Is this award going to have any repercussions on your work?

As an HIV positive activist, my work towards the promotion of Human Rights and specially those of women living with HIV has been regarded by governments or scientists as emotional or unscientific. The award gives me the opportunity to show that contributions from activists like me and contributions from women living with HIV are essential to an effective response to AIDS and specifically in protecting the rights of people living with HIV.

Please, tell us about your professional trajectory.

I started from the grassroots level by working with home-based-care programmes for people living with HIV. Soon after, I decided to start an organization to support women living with HIV, addressing issues of property rights, doing advocacy, awareness raising and fighting stigma and discrimination. Today I focus my work on policy issues, accountability and critical engagement with government, donors and stakeholders to ensure that HIV is treated as a Human Rights issue. I’m also working to address gender inequality and access to treatment and prevention as well as dealing with issues of government corruption on abuse of funds committed to AIDS programmes.

What inspires your work?

After my husband’s death, I also tested HIV positive. My in-laws wanted to grab my property, take my children and marry me to my brother in law. Although I was still a young woman then I struggled, I fought back for my rights and I started speaking out. My inspiration today comes from the fact that what I started as a personal struggle when my own rights were abused has helped and improved the live of thousands of women. I am encouraged because I have seen that the power that lies within me has changed things and I believe that any woman once they are informed and supported can also make that change happen.

What do you think the role of the community is in promoting human rights in relation to HIV?

First of all communities need to be conscious that human rights are not a favour from government, that they own those rights and that they have the power to demand governments, NGOs and civil society to respect and fulfil those rights. Communities can do a lot by mobilising themselves and use the power of numbers to speak loud to address human rights and HIV, issues of property rights of women, gender violence or marital rape. The other thing that communities can do is protect the rights of people affected by HIV by respecting them and reducing stigma. The engagement of community leaders is particularly important to lead this process.

What has changed in the last ten years in Uganda?

On the positive side, what has changed is the recognition, even up to the UN level, that people living with HIV are critical partners in the response to the epidemic. There is also consciousness and high level of awareness of women’s rights and to some extent acknowledgement of those rights has been important. However, on the negative side, what is changing in Uganda is that we are seeing a new wave of stigma through a moralisation of the disease by new and radical evangelical groups. The influence of US policy on Uganda’s prevention strategy is undermining the efforts that Uganda has made in the last 25 years. There is also corruption in Uganda, embezzlement of the Global Fund money, reduced political will by government over HIV prevention and care programmes, and when a lot of money is coming into the country to strengthen the health system, we are seeing ARVs expiring and an incompetent health system unable to deliver antiretroviral therapy to the 130.000 Ugandans who need it consistently. So it is quite disappointing that Uganda which has been a success story in its response to AIDS is now undermining human rights not respecting the right to health or the right to information by only promoting abstinence-until-marriage prevention programmes.

How do you see the future in terms of Human Rights and HIV?

Personally I see a lot of opportunities in the near future because now there is recognition by international human rights groups like Human Rights Watch or UNAIDS through its Gender and Human Rights department. I see the opportunity of using these spaces to really amplify the issues of HIV and human rights. I also see opportunities for the activism of people living with HIV (PLHIV) and the networks of PLHIV who are at grassroots level. However, it is critical for those networks to be supported so they can grow strong. I also see opportunities in the other human rights groups who are now beginning to work closely with AIDS activists. Finally, there are many treaties on HIV and Human Rights that we need now to start using as guidelines more than ever instead of having those documents lie on the shelves.

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Related Links:

Human Rights Watch news

It is with profound sadness that UNAIDS mourns the death of staff member Mr Sam Were who recently passed away in Kampala, Uganda. Sam lived openly with HIV and served as a role model by declaring his HIV-positive status at a time when few people living with HIV were willing to disclose.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) expresses deep concern over the safety of three individuals who were arrested at the HIV/AIDS Implementers Meeting held in Kampala, Uganda, 3-8 June 2008, and who are currently involved in ongoing court proceedings on charges of trespass.

HIV/AIDS implementers from around the world will gather in Kampala, Uganda from June 3-7 for the 2008 HIV/AIDS Implementers’ Meeting. Recognizing the rapid expansion of HIV/AIDS programs worldwide, the focus of this year’s meeting is building the capacity of local prevention, treatment, and care programs; enhancing quality; and promoting coordination among partners.

The U.S. President’s Emergency Plan for AIDS Relief, along with the Government of Uganda; the Global Fund to Fight AIDS, Tuberculosis and Malaria; UNAIDS; UNICEF; the World Bank; the World Health Organization; and the Global Network of People Living with HIV/AIDS, is pleased to announce a call for abstracts for the 2008 HIV Implementers’ Meeting.

The UN system in Uganda supports the Uganda government policy on prevention of HIV/AIDS including the use of the triple strategy of Abstinence; Faithfulness; and correct and consistent Condom usage (the so-called ABC strategy). The UN system position is that condoms are one of the effective prevention tools in reducing HIV infection rates in Uganda. The UN Theme Group on HIV/AIDS in Uganda has worked closely with other development partners in the last few months to ensure that Uganda’s long standing policy of condom promotion is supported.

Geneva, 10 May 2011—UNAIDS is concerned over the renewed consideration by the Ugandan Parliament of an ‘Anti-Homosexuality Bill.’ UNAIDS considers the criminalization of people based on their sexual orientation a denial of human rights and a threat to public health in the context of the HIV response.

“Uganda’s early leadership in the HIV response under President Museveni helped reverse the rising tide of the epidemic across the country,” said UNAIDS Executive Director Michel Sidibé. “Respect for the rights of all people, including those most vulnerable to HIV, led to the effective roll-out of HIV prevention, treatment, care and support services. The Anti-Homosexuality Bill risks undermining this progress and robs affected Ugandan citizens of their dignity and human rights,” he added.

Under the proposed law, anyone convicted of a homosexual act would face life imprisonment; accused individuals who are HIV-positive would be subject to the death penalty; and all citizens would be required to report any ‘homosexual activity’ to the police. Sex between men is already illegal under Uganda’s existing laws and punishable by imprisonment for up to 14 years.

As the world prepares for the 2011 UN General Assembly High Level Meeting on AIDS in June to commemorate 30 years of the HIV epidemic and commit to the vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths, UNAIDS calls on governments to ensure that their laws uphold non-discrimination for all people affected by HIV.

Seventy-nine countries and territories around the world continue to criminalize same-sex behaviour. UNAIDS urges these countries and territories to review and repeal laws that discriminate against sexual minorities.