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Is this a “bold” plan?

Adrienne Germain’s “New Agenda for Women” is a solid and fairly comprehensive plan for a US administration committed to partnering with governments north and south that are already on board and working to achieving many of these goals. As the discussion progresses, I am sure we can all tweak these objectives and indeed add to them.

But is it a “bold” plan? Only in the sense that the US is so far behind the curve on modern thought about gender, sexuality and reproduction that getting there with our current mindset is unthinkable. In this sense, it is a good plan for the 20th century, but I say let’s be really bold and move to the 21st.

A few thoughts:

  1. On the “first day,” a symbolic moment for sure, of course all prior presidential initiatives that hurt women can and should be shifted. The Global Gag Rules as related to both family planning and HIV and AIDS can be lifted and funding for UNFPA can be restored. I would like to see another first day action. The administration should take a page from the bold book of Dennis Kucinich who said he would create a Department of Peace. We must have a new cabinet level department on women, appropriately funded and with a broad portfolio for women domestically and internationally on the full range of economic, social and political issues that affect women. Let’s get some of that money that is in the State department, US AID and HHS, Labor and Education into the hands of people whose only job is to ensure that women’s rights and well being are addressed. No waffling, no inter agency council, a real cabinet level department.
  2. Let’s expect the administration to usher in 21st Century thinking about values. Adolescent sexuality is not just “going to happen”; it has its place in adolescent life. Birth control and sex education for adolescents should not just be there as an antidote to the disease of adolescent sexuality but as an aid to healthy and responsible adolescent sexual expression. Ditto on abortion. I note the word appears once in Germain’s agenda while we all know anti-abortion moralizing is one of the key problems in including abortion services and information in sexual and reproductive health programs. The policies of the US government on abortion, both at home and abroad have been a disgrace from Eisenhower forward and include both Democratic and Republican administrations. Every effort must be made to restore public funding for abortions for low-income women in the US and to allow reproductive health and maternal mortality reduction funds to be used to fund abortions overseas.
  3. As a first “post,” let me close with a thought on the role of US non-governmental organizations. We must learn from the mistakes we made during the Clinton administration. We were so glad to have ended the Reagan Bush years that we became apologists for, rather than advocates before, the administration. We were not bold; we asked for very little and that is what we got. On day 1 of the new administration, whether they are friendlier or not to our agenda; we must press for everything we should get and for everything women deserve. Let us not be deterred by administration claims that we must go slowly. Of course we shall be mature and strategic but from day 1 forward we will not be deterred from our goals.

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Climate-Health Nexus

Cross posted at On Day One

Over the weekend, Matt Yglesias and Brad Plumer posited that an auctioned carbon cap and trade system would yield significant benefits to public health. Among other things, “increases in CO2 can worsen the adverse respiratory effects of ozone and other air pollutants” and people would be incentivized to drive less, and walk more, and thus live healthier and longer. (This latter point has been researched by the New America Foundation’s Phillip Longman.)

One Health-Climate nexus less relevant here in the United States but of critical importance in much of the developing world is that warming temperatures have resulted in the appearance of disease vectors where they were previously absent. Mosquitos carrying Malaria and Dengue fever are suddenly showing up in places where the risk of these diseases used to not be so acute. Check out the World Health Organization’s climate change page, for a rather exhaustive explication of the links between human health and climate change in the developing world.

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Letting their voices be heard

I’d like to reiterate that making sure the women and girls of the world are empowered and that their voices are heard is one of the most important things the new administration needs to make a priority. We need to ensure that within our initiatives to assist various nations, we’re working with and funding local women’s organizations, talking to women and girls on the ground, and allowing them to maintain agency so that they’re not just being helped, but being heard. In her report (pdf), Germain writes:

“By emphasizing a bottom-up, locally informed approach for in-country program planning that includes consultation with women leaders and organizations and with demonstrated success in work with women, PEPFAR can be made vastly more effective. Programmers can determine the mix of prevention that best addresses local realities, rather than following what has often been irrelevant or inappropriate guidance from Washington.” (Emphasis mine)

I can’t support this enough. I think many efforts in the past haven’t worked because of our failure to really understand the realities of the cultures and lives that exist in other countries; this is our opportunity to remedy that.

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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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