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New Thinking Required to win the Fight

The pending US legislation to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR) needs to be informed by the fact that increasing targets and money alone will not significantly help in responding to AIDS.

After more that 25 years of a global fight against AIDS with little progress made, it is important to re-define the values and principles that will guide us to achieve the ideal of combating a disease that has brought much suffering to many individuals, families and communities around the world.

In my view, the principle of equity and equality must remain the two key defining elements of local, national and global responses to the AIDS epidemic.First, all human groups, in spite of sexual identity or orientation, must have an un-restricted, user friendly access to appropriate sexual reproductive health services.

Second, public health responses cannot be implemented in isolation from the contextual realities. It is therefore critical to take into account historical, traditional, cultural, and economic factors that have marginalized certain groups in society when putting together policies and finances to guide interventions.

Money tied with restrictions that exclude many groups and limit access to services will only save to extend the lifeline of the epidemic.

In order to make real progress, there has to be a paradigm shift in our perception of sex and sexuality in the context of HIV. Underlying that should be a commitment to principles and ideals of making real progress in the global fight again AIDS.

Global health responses should work to ensure that the weaknesses, needs and concerns that put marginalized groups at risk are reflected in policies and programs.

In that vein, while US’ financial investment on efforts to fight the AIDS epidemic has indeed positively impacted many communities, households and individual in sub-Saharan Africa, much more could be done.

The main problem with the US financial package is that it is not hitched to the ideals that will help individuals, communities and nations to fight the epidemic. Certainly, some progress will be recorded in monitoring and evaluation reports that will end up on cozy shelves but the human damage will be far much more, and difficult to comprehend.

As I see it, the ideological trumping of proven public health strategies that reflects the past and current thinking around PEPFAR is a result of the major challenge which is at the heart of HIV: sex and sexuality.

In order to save lives and truly make an impact, US policy must engage in a process of self-introspection with the aim of removing culture or religious specific notions of sex and sexual engagement.

But honestly, all it takes is to appreciate evidence-based, ground realities, and ensure that they are reflected in public health policies, funding and practices.

Perhaps the major shortfall of US’s “strings-attached” foreign public health assistance to an effective HIV response is that it does not project the holistic approaches required to help affected and infected communities fight the epidemic.

There is nothing inherently wrong with promoting “abstinence-only” earmarks; the problem comes when that is the sole method regarded above all the others. Abstinence only strategies must be part and parcel of other proven initiatives to fight AIDS, such as condom use, and access to services for all groups.

Maintain uncompromising positions on sex and sexuality only means that millions of people will not be reached by services, and intended outcomes of financial investment will remain a pipedream.

It is highly unfortunate that in the design of policies, politicians and government leader fail to listen to ground realities from researchers, implementers and scientists working with affected communities, and instead only cater to the interests of minority constituencies that are far flung from the ground reality.

In that vein, by ignoring evidence-based research, and promoting morality over reason, the US government is wittingly committing genocide against millions of marginalized people, particularly women, girls, youth and children.

The real losers of US straight jacketed overseas public health funding are the weak, voiceless, and highly marginalized groups in already disenfranchised communities.

A more progressive approach must ensure that women have access to medical treatment, including access to drugs that can prevent sexually transmitted infections, condoms, psychosocial and legal support and access to abortion services to terminate forced and unwanted pregnancies.

In communities where PEPFAR is supposed to have an impact, particularly in sub-Saharan Africa, women have a very small voice in deciding sex and sexuality matters. Many are forced to sex work due to lack of economic opportunities.

Denying these women access to services is indeed tantamount to committing genocide, and it’s not due to ignorance but a failure to understand the new thinking required to combat AIDS.

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Monday Morning Coffee

William Safire takes on the etymology of “waterboarding.”

Top Stories

>>Pakistan – Nawaz Sharif, leader of the Pakistan Muslim League-N, agreed on Sunday to join the Pakistan People’s Party — led by Asif Ali Zardari, Benazir Bhutto’s widower — in a governing coalition. They immediately agreed to reinstate judges who Mussaraf dismissed last November. Those judges could rule on petitiions challenging the validity of his last election.

>>Venezuela and Columbia – Leaders from Venezuela and Columbia agreed to a 20-point declaration, which included a commitment by Alvaro Uribe to never again violate the sovereignty of his neighbors, at the Rio Group Summit on Friday, normalizing relations between the two nations only a week after tempers flared due to a Columbian raid on FARC rebels in Ecuadorian territory. Ecuador still needs some time before reconciliation.

>>Spain – Prime Minister Jose Ruiz Rodriguez Zapatero and his Socialist party won a hard-fought election on Sunday, opening the door for the continuation of his liberalization agenda. The Socialist Party claimed five more seats than in 2004 and are just seven seats shy of an absolute majority. The opposition Popular party also carried more seats this time around.

>>Serbia – The divided government of Serbia collapsed on Saturday due to intractable positions taken by nationalist Prime Minister Vojislav Kostunica and pro-Western President Boris Tadic over the nation’s relationship with the EU in the wake of Kosovo’s unilateral declaration of independence. New elections will be held in May.

>>Israel – Prime Minister Olmert has approved a plan to build 750 new homes in a Jewish settlement in the West Bank, further imperiling peace talks.

Yesterday in UN Dispatch

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UN Plaza: Talking Eritrea

In this installment of Blogging Heads, Matthew Lee and I discuss the collapsing peacekeeping mission in Eritrea

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A New Agenda for Women and Girls: A UN Dispatch Salon


Starting on January 20, 2009, the next President will have a unique opportunity to create a new global agenda for the United States and right the course of America’s foreign policy. Adrienne Germain, President of the International Women’s Health Coalition, believes that such an agenda must include bold plans to improve the health and rights of women and girls around the world. She details her thoughts on what those plans should be in a paper (pdf) commissioned by the Better World Campaign — summarized in the included video.

To foster a discussion on these issues and what might be the most effective agenda for women and girls, UN Dispatch and RH Reality Check are hosting an online salon, in which the following have graciously agreed to participate:

Over the next few days, they will discuss Adrienne’s ideas, as well as their own. We hope you will join this discussion too. For the first time, UN Dispatch will open up posts for comments. You can also subscribe to the salon RSS feed, bookmark the salon archive, or submit your own ideas on Enjoy.

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Talking About Diplomacy Over Breakfast

Yesterday morning, Secretary of Defense Robert Gates met with members of the House Foreign Affairs Committee to discuss the persistent gap — which we’ve decried time and time again — between funding for diplomacy and for the military. Acting Chairman Howard Berman (D-CA) praised Gates’ presence as a potential harbinger of reinvigorated cooperation between these two goals:

“Years ago the U.S. Secretary of Defense came before the Foreign Affairs Committee regularly. Reinstating this custom will help Congress and the Administration work more closely together to restore some balance between what has come to be known as ‘hard power’ and ‘soft power.’ And Mr. Gates’ own statements of late bear that out.”

In the speeches that Representative Berman refers to, Secretary Gates has nodded to the importance of “civilian involvement and expertise” and “non-military instruments of national power.” This is a strong step for a Secretary of Defense to take, and we will need to make sure that next year’s budget builds on this commitment to leveling the vast funding disparity between State — which currently takes up only about 1% of the total budget — and Defense — which eats up over 10 times that.

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War Coming Soon to Eritrea? (UPDATED)


The collapsing peacekeeping mission along the Eritrean/Ethiopian border is obviously not on most people’s radar. But those of us who care about war and peace should be paying attention, because war might be on the horizon.

Facing a fuel shortage engineered by the Eritrean government, the mission was forced to redeploy across the border to Ethiopia, but was prevented from crossing by the Eritrean Defense Force. The mission, which is about 4,000 strong, was then forced to regroup in Eritrean capitol, Asmara. But even getting there proved to be a problem. According to a new report by the Secretary General, Eritrean Defense Forces turned a number of the trucks back–and even stole some of their fuel.

This all portends poorly for other missions around the globe–particularly for the two missions in neighboring Sudan. Governments can take a look at how Eritrea successfully harassed UNMEE out of its mission, and take notes.

More immediately, though, one has to wonder if Eritrea’s decision to obstruct UNMEE means that Asmara is seeking a military solution to its border dispute with Ethiopia. If so, the resumption of war along the border could be devastating. From 1998 to 2000, trench-warfare between Ethiopia and Eritrea claimed 70,000 lives and displaced millions. Without UNMEE watching the border, it will undoubtedly be easier for war to resume. At this point, to avert that outcome, the Security Council has to force Eritrea to let UNMEE fulfill its mandate so a diplomatic — not military — solution can take hold.

UPDATE: Reader MY writes in: [Your post] neglects to mention the fact that a UN-backed final and binding verdict in regards to the border between the 2 countries was announced back in 2002. The peacekeeping mission was located entirely in Eritrean territory and its mandate expired in conjunction with demarcation. The reason it was not implemented on the ground was due to Ethiopian obstruction. Because of this obstruction, the demarcation body known as the EEBC was forced to demarcate based on coordinates, and thus deemed their work complete. So the question is, will the United Nations Security Council put sufficient pressure on Ethiopia to withdraw from sovereign Eritrean territory?

A very fair point. In previous posts I’ve made clear that Eritrean actions stem in large part from frustration over Ethiopia’s unilateral decision to simply ignore binding arbitration that gave certain disputed territories to Eritrea. Both sides are not without reproach. This helps explain–but does not excuse–Eritrea’s actions.

(Photo from Wikipedia)

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