Category Archives: Capacity building

Uganda to benefit from multi-million dollar campaign

Health minister Dr. Ruhakana Rugunda

By Anne Mugisa and Cathy Mwesigwa in Kuala Lumpur

28 May 2013

Uganda will be the first African country to benefit from a new multi-million dollar global campaign to increase demand for family planning services and information.

The new campaign dubbed, “It takes two” was announced on the first day of the 3rd Women Deliver Global conference on girls’ and women’s rights in Kuala Lumpur, Malaysia.

Over 5000 delegates from international Development Agencies, funding organisations, philanthropists, government representations, NGOs and Media are in Kuala Lumpur to share best practices, identify opportunities and challenges to improving maternal health and universal access to reproductive health and rights.

The campaign, a partnership between the Global Poverty Project and Women Deliver recently launched in the USA and will start in Uganda in a few months. It aims at raising awareness of, increasing demand for and improving access to family planning services and information.

The two organisations will work with other partners in the campaign which aims to motivate young women and men to demand for family planning information and services.

Three out of ten women in Uganda who need to stop or space their next pregnancy are not using any contraception. There are about 700,000 unwanted pregnancies in Uganda every year.

According to Dr. Jotham Musinguzi, Africa Regional Director, Partners in Population and Development, Uganda needs a total of US$20m annually for its contraception needs.

“Currently Uganda is spending about US$10m annually. The presidential pledge made at the London Summit on Family Planning will reduce the shortfall,” he says.

President Yoweri  Museveni  at the 2012 London Summit on Family Planning  pledged to provide an additional  US$5m annually for reproductive health supplies. Museveni’s pledge will be included in the budget starting the next budget.

After Uganda, the campaign will be gradually spread out to other countries which include Kenya, Tanzania, Rwanda, Zambia, Malawi, Mozambique and South Africa among other countries.

“We don’t want governments to forget commitments they made in 2012. We want to remind the people of their government’s commitments,” said Jill Sheffield, the president, Women Deliver.

Globally 222 million poor women lack family planning services. The target is to reduce that number by 120 million by 2020. The annual global budget for contraception stands at US$8.1bn and at the moment only US$2.6bn has been committed.

The campaigners also want to hold the US to contribute US$1bn annually until 2020.

At the same conference, development experts and researchers warned that there is a connection between denial of women’s reproductive health rights and violence, political instability and extremism. The experts quoted several studies which they said pointed out the danger of denied reproductive health rights.

The absence of reproductive health services, they said lead to large pools of unplanned populations that are ill prepared for development and have to fight for the limited resources. They said that girls are often left out of the picture when issues including health are discussed which leads to omission of some of the vital services like reproductive health services that have a serious impact on society.

As a result, the vicious cycle of poverty continues yet it can be broken by the simple interventions like planned spaced families.

According to Dr. Musinguzi, investment in family planning would save countries a lot in costs of direct and indirect consequences. For example, he said, investment of US$1 in family planning would save the country loss of US$4 in dealing with the consequences of lack of the service.

The experts called on governments and societies to deal with harmful practices and beliefs that impede access and provision of family planning services.

“We need to work for changes that end gross injustices that perpetuate inequalities. Investing in girls and women is the smart thing to do. We need to look at the women’s reproductive and sexual health” Lakshmi Puri, deputy executive director of UNWOMEN said.

Speaking at the opening forum, Jeni Klugman, the World Bank Director, Gender and Development, Poverty Reduction and Economic Management observed that gender gaps have narrowed during the last century. More girls are getting into schools and completing primary education, more women are getting into positions of leadership, however challenges still persist which the experts attribute to lack of prioritisation of women’s family planning and other rights.

“Women labour force participation has grown by only 1% in 30 years, earning disparities persist and are hurting women and their families and so does their lack of voice in household matters,” she said.

She noted that poor reproductive health contributes to the challenge which in turn impacts national and global development.

Klugman said that gender equality and reproductive health are linked and that they have a correlation with high maternal and child deaths and affect future generations.

http://www.newvision.co.ug/news/643288-uganda-to-benefit-from-multi-million-dollar-campaign.html

Child sex law ruling expected.

27 May 2013

CAPE TOWN – The Constitutional Court will decide this week whether to uphold a lower court’s finding that provisions in the Sexual Offences Act criminalise many children who have consensual sex.

The applicants in the matter, the Teddy Bear Clinic and Resources Aimed at the Prevention of Child Abuse and Neglect, said on Monday they hoped the court would take all their arguments into account.

“We feel that targeting children and their consensual sexual behaviour in that criminalisation way is the wrong response,” the applicants’ attorney Carina du Toit told reporters.

“The right response is education programmes and for the school, teachers, and parents to deal with it, rather than the criminal justice system.”

The applicants launched a constitutional challenge against some provisions of the act in the High Court in Pretoria in December 2010. The matter was heard on April 23 and 24 last year.

A ruling was made against Justice Minister Jeff Radebe and the National Director of Public Prosecutions on January 15 this year.

High Court Judge Pierre Rabie found the consensual sexual activities mentioned in the act were of a wide range of acts that children engaging in ordinary sexual exploration, such as “French” kissing, would commonly perform.

He held that criminalisation would constitute an unjustified intrusion of control into the private sphere of children’s personal relationships, in a manner that would cause them severe harm.

The act, as it stands, has criminal implications for children between the ages of 12 and 16 who engage in consensual sexual activities.

Any individual who has knowledge of these acts, such as a parent, health worker, or teacher, is required by law to report the children or face prosecution.

The children, if found guilty, would have their names included on the National Sex Offenders Register.

The Women’s Legal Centre (WLC), a friend of the court, said the application was about protecting the rights of children to dignity, privacy and freedom, and access to health services.

WLC attorney Sanja Bornman said on Monday that the provisions had indirect and unforeseen consequences, specifically for girls.

She said some girls of the relevant age could consent to kissing their boyfriend of a similar age, but not to full sexual intercourse.

“In the course of reporting a rape case, the girl essentially has to admit that she is guilty of a section 16 offence and this means that a young girl can go from being a complainant to a perpetrator,” she said.

In these sexual cases consent could very often not be proved because there was only one witness, or there was a lack of evidence, she said.

“This has the implication that fewer girls will want to report these kind of incidents to the police.”

The applicants also believed that fewer children would seek out health services, such as HIV testing, because they feared disclosure of certain sexual circumstances would lead to reprisal.

Du Toit said the State argued it had discretion on whether or not to prosecute children under these acts and would, in most cases, decide not to.

The applicants argued there was no indication as to how this discretion would be exercised and no guidance on what constituted permissible adolescent sexual development.

The State also argued that where a child was prosecuted, diversion would frequently occur, rather than conviction and sentencing, which resulted in a criminal record.

Du Toit said diversion still resulted in harmful and traumatic consequences for children because they would have frequent exposure to the criminal justice system through police and courts.

The applicants emphasised the application was not about justifying adult sexual engagement with children, challenging the criminalisation of non-consensual sexual crimes between children, or lowering the age of consent for children.

It was also not about promoting or encouraging sexual activity between adolescents.

The Constitutional Court would announce its decision on whether to confirm the declaration of unconstitutionality on Thursday.

-By Sapa

http://www.enca.com/south-africa/child-sex-law-ruling-expected

Uganda’s Anti-Pornography Bill: “If a Woman Wears a Miniskirt, We Will Arrest Her”

With its vague and broad definition of ‘pornography’, Uganda’s proposed Anti-Pornography Bill could curb a range of individual rights and freedoms.

Within a inch of the law in Kampala: under the Anti-Pornography Bill, "anything above the knee is outlawed", according to Simon Lokodo, Uganda’s Ethics and Integrity Minister. Photograph Gabriel White.

Kampala, Uganda:

Uganda has hit the international headlines once again recently following the re-tabling in parliament of a proposed Anti-Pornography Bill. Just months after MP David Bahati’s Anti-Homosexuality Bill – referred to by many as the ‘Kill the Gays’ Bill – attracted international attention and much condemnation, the Anti-Pornography Bill has now generated another storm of controversy in Uganda and beyond.

If passed, the Anti-Pornography Bill would cover a range of practices and activities, but much of the outrage and debate has come to be centred on one particular issue: the miniskirt.

The Bill laid bare

The Anti-Pornography Bill is purportedly a reaction to an “increase in pornographic materials in the Ugandan mass media and nude dancing in the entertainment world”. Its provisions would aim to “equip the country with a better law to tackle the insidious social problem of pornography”.

What exactly constitutes pornography, however, has long been a point of contention around the world. In a case in the US Supreme Court in 1964 regarding the proposed banning of a film for obscenity, Justice Potter Stewart famously declined to define pornography, instead saying “I know it when I see it”. His remark reflected the subjective and changeable nature of different societies may deem to be pornography. Unlike Stewart, Uganda’s Anti-Pornography Bill does put forward a definition of pornography. But, ironically, this definition does not seem to iron out ambiguities but rather embraces vagueness. Furthermore, the Bill’s understanding of pornography is so broad as to extend it from something seen on our screens to something seen on our streets.

The Bill defines pornography as “Any cultural practice, form of behavior or form of communication…or leisure activity…that depicts a person engaged in explicit sexual activities or conduct…erotic behavior intended to cause sexual excitement or indecent act or behavior intended to corrupt morals”.

This leaves as much unsaid as it says and could restrict a range of practices and activities, including the wearing of certain items of clothing. Indeed, Simon Lokodo, Uganda’s Ethics and Integrity Minister and the main figure behind the Bill, has clarified: “Any attire which exposes intimate parts of the human body, especially areas that are of erotic function, are outlawed. Anything above the knee is outlawed. If a woman wears a miniskirt, we will arrest her.”

If passed, the Bill could also prohibit the broadcasting of ‘risqué’ musical performances by Western singers such as Beyoncé and Madonna, and allow officials to monitor and establish stricter controls on internet usage.

Anyone falling foul of the pornography bill would stand to face a fine of 10 million Ugandan shillings (nearly $4000), up to 10 years in jail, or both.

Hands off our freedoms

The Bill has received support from some sectors of Ugandan society, such as certain religious groups. Pastor Omelem Paul, who leads a church in Kampala, for example, has high hopes the bill will be passed, saying “it is high time sanity is restored”.

However, it has also drawn strong criticism. To begin with, many disagree with the way in which arguments for restricting clothing seem to spread the blame for sexual violence between both perpetrators and their victims. “An onlooker is moved to attack [a woman wearing provocative clothing]”, Lokodo has said, “He is a criminal but he was also provoked and enticed”.

Many Ugandans also fear a turn towards greater patriarchy, saying that the Bill harks back to the time of Idi Amin when control over female bodies was a hallmark of the regime. Furthermore, some claim the government has no place in legislating on personal choices, freedoms and morals.

“Abolishing miniskirts is not an issue to be discussed in parliament”, Alex Makuyi, a youth chairman from eastern Uganda and a student of law at Kampala International University told Think Africa Press. “These are moral issues which need to be discussed in homes and religious places; the minister should preach this in churches. I think the bill should be abolished because it trespasses the freedom of people.”

Skirting around the real issues

While many are debating the details of the Bill and its repercussions, however, there have also been attempts to understand the intentions behind the Bill. And like with the Anti-Homosexuality Bill, some analysts believe there may be political – rather than just social or moral – motives underlying its discussion.

“They are just passing time because I think they lack things to do in that House,” said singer Moses Ssali. “There are things you can’t afford to discuss in a Third World country which still has roads and hospitals to fix, which has teachers to pay and which has MPs’ morals to put right.”

Similarly, Makuyi commented, “In a country that faces humiliating poverty, gross corruptions, poor roads, bad hospitals and a lousy education system, MPs need to find better ways to spend their time instead of discussing how to abolish miniskirts in the country”.

Meanwhile, Namutebi Sarah*, a leader of a group of sex workers in one of the Kampala suburbs whose livelihood could be significantly affected by the Bill, insisted, “The government should find other ways of impacting good morals in people; they should solve the problem of unemployment because some of us are in this business due to a lack of good-earning jobs”.

While the Bill awaits a final ruling in Uganda’s parliament, those opposing the Bill are trying to make their voices heard. Popular bars and clubs in Kampala have been organising parties to preserve the miniskirt, for example, with some holding “Save the mini-skirt” parties in which girls wearing miniskirts get free cocktails. On the Twitter meanwhile, many Ugandans have been tweeting with the hashtag #SaveMiniSkirt.

With ample support on both sides, it may be too early to speak decisively on the fate of the Bill. But what seems clear is that those opposed to the Bill will not take the potential removal of their freedoms without a fight.

*This name has been changed to protect her identity.

22 April 2013

By Nangayi Guyson

http://www.thinkafricapress.com/uganda/ugandas-anti-pornography-bill-if-woman-wears-miniskirt-we-will-arrest-her

Zambia: Stop Prosecuting People for Homosexuality – Drop Charges, Cease Invasive Exams, Protect Rights of Accused.

Nairobi — Zambian authorities should dismiss all charges and release two men arrested for engaging in homosexual acts, Human Rights Watch said. The police should immediately cease forensic anal examinations, which are intrusive, invasive and constitute cruel, inhuman, and degrading treatment in violation of international law.

On May 6, 2013, police in the Kapiri Mposhi district in central Zambia arrested James Mwansa and Phillip Mubiana in response to reports from neighbors that the two were engaging in homosexual acts. Both men were subjected to anal examinations without their consent by forensic doctors at the Kapiri Mposhi District Hospital, as part of the police investigation. On May 8, the district magistrate formally charged Mwansa and Mubiana, and denied their request for a postponement even though they had no legal representation.

“It’s bad enough that Zambia wants to prosecute these two men for homosexual acts, but to subject them to invasive examinations is just outrageous,” said Monica Tabengwa, researcher in the Lesbian, Gay, Bisexual, and Transgender (LGBT) Rights Program at Human Rights Watch. “The authorities should immediately drop the charges and free them, and stop bringing such cases.”

The arrest, detention, and prosecution of men suspected of homosexual acts is only one aspect of a looming human rights crisis for LGBT people in Zambia. Since April, politicians, religious, and community leaders have been carrying out vicious campaigns to vilify LGBT people, Human Rights Watch said.

Juliet Mphande, director of Lusaka-based LGBT organization Friends of Rainka, told Human Rights Watch that Mwansa and Mubiana, both 21, were coerced to confess to the allegations and have been deprived of adequate food and water in detention.

This is the second time the men have been arrested on similar charges, Human Rights Watch said. In April,the two men were arrested and detained for a week before being released on bail on a charge of engaging in “carnal knowledge against the order of nature,” as set out in the Zambian Penal Code.

The Zambian government is obligated under international law and its own constitution to respect the private lives and personal liberties of everyone in the country, and to cease prosecuting people for consensual adult sex, Human Rights Watch said.

Forensic anal examinations are used on suspected homosexuals in various countries to prove “habitual” anal penetration, Human Rights Watch said. The tests are intrusive, invasive, and abusive, and they violate the individual’s rights to integrity, dignity, and privacy. They are a cruel, inhuman, and degrading treatment that may amount to torture, violating the African Charter on Human and Peoples’ Rights, the Convention Against Torture, and the International Covenant on Civil and Political Rights, all of which Zambia has ratified.

The examinations have no forensic or evidentiary value for consensual homosexual acts. They are contrary to medical ethics as laid out by the World Medical Association and the United Nations Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment.

Principle 4 of the UN principles states:

It is a contravention of medical ethics for health personnel, particularly physicians… to apply their knowledge and skills in order to assist in the interrogation of prisoners and detainees in a manner that may adversely affect the physical or mental health or condition of such prisoners or detainees and which is not in accordance with the relevant international instruments.

“Medical professionals participate in a miscarriage of justice when they subject people arrested for homosexuality to anal examinations,” Tabengwa said. “These invasive procedures are painful and humiliating and can be a form of torture. They should be banned immediately and evidence obtained should be declared inadmissible.”

The Zambian government should respect its own constitutional provisions guaranteeing non-discrimination and equality before the law by ordering an immediate halt to arrests and prosecutions based on suspicion of homosexual conduct. As part of its obligation to protect and promote human rights for all, the government should also repeal all laws criminalizing consensual sexual sex between adults, including Penal Code sections 155 (“Unnatural Offences”), 156 (“attempt to commit unnatural offences”), and 158(“indecent practices between persons of the same sex”), Human Rights Watch said. These provisions provide maximum penalties from 5 years to life in prison.

The recent efforts in Zambia to vilify LGBT people have publicly portrayed homosexuality as immoral and un-African. The government’s unwillingness to assert constitutional protections and ensure redress for discrimination and abuse of minorities, as well as the arbitrary arrest and prosecution of individuals suspected of homosexual acts, show the vulnerability of the country’s LGBT community.

On April 10, on Radio Phoenix, on a live radio panel discussion among religious leaders led by the former Orthodox Bishop Edward Chomba, another religious leader suggested that the most appropriate way to deal with gay people was death. The minister of youth and sports, Chishimba Kambwili, called in during the program and said defenders of the rights of LGBT people were “agents of the devil.” He also said that the Zambian government will be “introducing stiffer penalties against homosexuality,” instead of repealing the existing laws.

A police spokeswoman, Elizabeth Kanjela, told the media that homosexuality was a serious offense and appealed to the public to report anyone involved to the police. This statement followed a news report involving the attempt of four gay couples to register marriages during the Easter holidays. Same-sex marriage is an offense under Zambian law. The attempt to register same-sex-marriages provoked an outcry from several traditional and religious leaders who wrote a letter to the Daily Mail newspaper calling for “gays to be caged.” The LGBT community has never raised same-sex marriage as a priority in Zambia.

When the human rights defender Paul Kasokomona appeared on Muvi TV on April 6 to discuss LGBT and HIV issues, he was arrested as he left the television station. He was denied bail for five days, then finally released on April 11. He was charged with “soliciting in a public place for immoral purposes” and faces a court appearance on May 22. If convicted, Kasokomona may be imprisoned for one month or fined.

“The Zambian government should take immediate action against government officials who make discriminatory statements against LGBT people, or arrest or detain them,” Tabengwa said. “The attacks on LGBT people need to stop.”

 

20 May 2013

by Human Rights Watch

http://allafrica.com/stories/201305200305.html?viewall=1

 

Male circumcision could save Zimbabwe US$3 billion.

Zimbabwe could save up to US$3 billion in treatment of HIV and Aids and downstream costs if the country can scale up its Voluntary Medical Male Circumcision (VMMC), a health official has said.

Report by Christopher Mahove

Ministry of Health and Child Welfare, HIV and Aids and TB Specialist, Owen Mugurungi, said if the VMMC was to make an impact in the country, there was need for a rapid scaling up of the programme among the 15 to 49 age groups to above the 80% mark, which translated to 1,9 million men.

“If we do that, we will be able to reduce the rate of HIV infection from the current 130 000 new infections to less than 50 000 per year by 2020,” said Mugurungi.

“What it means is we would have also prevented close to 750 000 new HIV infections throughout the country and we would have invested around between US$100-US$120 million, but in terms of treatment and downstream costs, we will probably save US$2,9 billion.

“So you can see from an investment perspective, of saying where should we put our money, this is one of the high return areas in which we should be able to put our money.”

He said at community level, there were also even more benefits for partners of circumcised men and others, as it contributed to more than 75% prevention of HIV and Aids transmission to spouses.

Circumcision, Mugurungi said was also crucial in the elimination of the human papiloma virus, which affected the male organ and was the major cause of cervical cancer in women.

“This is because we know that if we circumcise all men, 60% of them are more likely to have reduced risk and if they have reduced risk, they are also less likely to transmit the disease, so that cascades to situations where even at community level, there is higher or better prevention,” he said.

Mugurungi said although the male circumcision programme had started on a slow note in 2009 in terms of uptake, the trend was slowly improving, with high hopes that the country would be able to reach its target.

“….but we are happy that in 2010, we circumcised the whole year, about 15 000, and already this year, 2013, during this previous campaign, which just happened during the holiday, we have circumcised more than 15 000.

“We are happy that we have achieved in less than six weeks what we achieved in 12 months. If that is anything to go by, we are happy to say that at least people are beginning to take it up and we will be able to circumcise more,” Mugurungi noted.

He said there was need for extensive educational campaigns to take the correct message to the people.

There are also other benefits that have for a long time been associated with circumcision, among them the prevention of genital ulcerations and general personal hygiene.

Mugurungi said studies done in South Africa, Kenya and Uganda had shown evidence that HIV infection rate among circumcised males was 60% lower than in those who were not.

Before the introduction of the male circumcision programme only a handful of private health institutions were offering the service and mostly for reasons other than as an HIV intervention measure.

In Africa, the vulnerability of women and girls to HIV remains high, with women constituting 59% of people living with HIV.

19 May 2013

http://www.thestandard.co.zw/2013/05/19/male-circumcision-could-save-zimbabwe-us3-billion/

 

The SA Minister of Health quotes a Lancet article on accountability in health care systems.

Minister says quality of public healthcare must go up, and cost of private healthcare come down, if scheme is to work.

 

Health Budget speech by Dr Aaron Motsoaledi, MP, Minister of Health, National Assembly

 

 

15 May 2013

Honourable Speaker
My colleague the Deputy Minister of Health
MECs for Health present
The Chairperson and members of the Health Portfolio Committee
Honourable Members of Parliament
Invited Guests
Ladies and Gentlemen

Honourable Speaker, it is now well documented and generally understood that South Africa faces a quadruple burden of disease. Many other countries are faced only with a double burden.

These four are:

  1. A very high prevalence of HIV and AIDS which has now entered into a synergistic relationship with TB;
  2. Maternal and Child morbidity and mortality;
  3. Exploding prevalence of non-communicable diseases mostly driven by risk factors related to life-style; and
  4. Violence, injuries and trauma.

These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per year as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels.

We had to respond to these very urgently and very decisively.

In addition to our Ten Point Programme, the Department of Health signed the Negotiated Service Delivery Agreement with the President. We committed to four (4) objectives which we called outputs during this term of government.

These are:

  1. Increasing Life Expectancy;
  2. Reducing maternal and child mortality;
  3. Reducing the burden of disease from HIV and AIDS and TB;
  4. Improving the effectiveness of the health system

After going into a deep analysis of the problems, it became clear that unless we deal decisively with HIV and AIDS and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Hence our plans had to have a very strong element of a desire, commitment and passion as far as HIV/AIDS and TB are concerned.

This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa was largely HIV and AIDS and TB.

Honourable Speaker, we responded comprehensively through well designed plans to deal with HIV and AIDS and TB, and the implementation of these plans was well executed.

Among others Honourable Speaker, we increased the health facilities providing antiretrovirals (ARVs) from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of a doctor were increased from only 250 in February 2010 to 23 000 nurses to date. This programme is called NIMART or Nurse Initiated Management of Antiretroviral Therapy. NIMART made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date – that is actually doubling the number on treatment.

I wish to take this opportunity to thank all the health workers for this sterling performance – especially the nurses without whom this numbers would have been impossible to achieve.

Very recently Honourable Speaker, we have introduced the ground breaking fixed dose combination (FDC) therapy which made it necessary to train 7 000 health workers for smooth implementation.

Another very important windfall from these FDCs is that by February 2010, it used to cost us R313.99 per patient per month to provide ARVs. With the FDCs, it is now costing us only R89,37 per patient per month. We are now able to treat many more people per month with the amount of money that we used to treat one person with in 2009.

The results we achieved from these endeavours are very sweet indeed.

By the end of last year, researchers, local and international started reporting a dramatic increase in life expectancy in our country. They also reported a decline in under five mortality and maternal mortality ratio. Our biggest challenge is the neonatal mortality rate. These researchers include our Medical Research Council’s Rapid Mortality Surveillance Report, the Lancet, and United Nations agencies like the UNAIDS.

All these researchers attributed the decline in mortality and the concomitant increase in life expectancy to our comprehensive response to the HIV epidemic, especially the ARV treatment programme.

The fact that we are testing large numbers of our people and large numbers are on treatment has brought much relief to individuals, families and communities.

As far as TB is concerned Honourable Speaker, we started in earnest on 24 March 2011 to introduce new programmes. We unveiled new strategies to combat TB.

(a) Firstly, we unveiled the GeneXpert technology. Honourable Speaker, the last time in the world that a new technology do diagnose TB was unveiled was more than fifty (50) years ago. The World had then thought we had defeated TB. We now know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation’s Stop TB Partnerships.

Before GeneXpert technology, it used to take us a whole week to diagnose TB. Now it takes us only two (2) hours.

It used to take us three (3) months to conclude that a person has multi-drug resistant TB, now it takes us only two (2) hours to know that.

I am very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 GeneXpert units around the country. This 242 constitute 80% of all facilities we would like to cover. We had spent R117 million shared by the National Department of Health, the Global Fund and the Center for Disease Control in the USA to achieve this 80% coverage. We have conducted 1,3 million tests using this technology since 2011. This constitutes more than 50% of the total tests conducted in the whole world.

In five (5) months’ time, we will achieve 100% coverage of all the district hospitals with the GeneXpert technology. From there we will move to the big community health centers.

The biggest of these machines, that can diagnose forty-eight (48) patients at a time, the others can do only 4 or 16, are called GeneXpert 48. We only have two (2) in the whole country. We have placed one at the Ethekwini Municipality at Prince Mshiyeni Hospital. The second one is in the Cape Metro at Greenpoint National Health Laboratory Service (NHLS) laboratory.

We have done this because both Ethekwini and the Cape Metro are the most very heavily challenged cities as far as TB is concerned.

On World TB Day, on 24 March this year, you are aware that the Deputy President of the Republic unveiled a GeneXpert technology at Pollsmoor Prison, on behalf of all Correctional Services facilities. This was in response to a Constitutional Court ruling where an inmate took the government to court, and the State was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in correctional service facilities. They too, will be supplied with GeneXpert units to screen all inmates on entry to facilities and also to screen them twice a year once they are inside.

We will also request for the names of those who are found by the GeneXpert to be having TB, from the Minister of Correctional Services in order to send health workers to their families so that the whole family of an inmate can be screened. One person with TB has a potential to infect 15 others in their life time.

Honourable Speaker, the second strategy we have adopted was to establish family teams. On our database, we have 405 000 families in South Africa who have a member diagnosed with TB. The family teams are visiting these families to screen all members within such a family.

About four (4) weeks ago, the Statistician-General went to Thabo Mofutsanyane Region to release StatsSA’s yearly figures on the cause of death. He released the 2010 figures and announced that TB was found to be the number one (1) killer in the country – not surprising given the synergistic relationship between TB and HIV and AIDS as I said earlier.

We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5% but in 2012 it has improved to 75,9%. The target set by the World Health Organisation is 85% cure rate. We are steadily but surely moving in that direction. However Honourable Speaker, I have one very serious request to make. Having turned the corner should not be regarded as a signal for South Africans to be complacent. We still have a very long road to travel with HIV/AIDS and TB.

The National Development Plan has clearly indicated that by 2030, we must have a generation of under twenties (20) being free of HIV and AIDS and we must have a decrease in TB contact indices.

At the recent SANAC Plenary we have decided that the Presidency will we need to re-launch for us the HIV Counselling and Testing (HCT) Campaign in the country. This launch must happen at Gert Sibande District in Mpumalanga. It is now officially declared a district with the highest prevalence rate of HIV in the country.

I have a serious complaint Honourable Speaker, that since the campaign started, there is one extremely powerful place in this country were the HCT campaign was never launched. It is called the Parliament of the Republic of South Africa.

Please Honourable Speaker, may I humbly ask that you choose a date where we will come and publicly launch this campaign here in Parliament with you and the Chairperson of the National Council of Provinces (NCOP) taking the lead, followed by leaders of all political parties in this hallowed chambers. Then the provincial legislatures, District Councils and local councils will follow suite. I will then have the power and courage to ask churches, schools and all other centers of our civil life to choose their own days to do so.

I promise to supply a GeneXpert unit as well as a mobile XR unit for the benefit of Members in this Parliament because you also will need to be screened for TB as well, on top of testing for HIV and AIDS.

Honourable Speaker, let me now deal with the intractable problems that the health care system is faced with. It is output number four, i.e the efficiency and effectiveness of the healthcare system in the country.

You are well aware Honourable Speaker, that our flagship programme to change the efficiency and the effectiveness of the healthcare system in this country is the NHI – the National Health Insurance system.

While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has gone global. The World Health Organisation (WHO), the United Nations (UN), the World Bank, prestigious institutions of high learning such as the Harvard University, have recently entered the fray in support of NHI and in giving well researched guidance to countries on how to get about to implement NHI – not to debate whether it is needed or not. The world has gone far beyond that stage.

Recently the World Bank and Harvard University organised a workshop of all Ministers of Finance to guide them on how their treasuries can support NHI for the benefit of economic growth.

It is of course not called NHI in every country. The World Health Organisation and all the UN agencies are calling the generic term, Universal Health Coverage. We will stick to the term NHI.

The Prestigious British medical journal, the Lancet has launched a series since late last year to allow academics, health activists and researchers to write articles to guide countries about this concept of Universal Health Coverage.

It doesn’t matter what you call it – the concept is the same i.e every citizen has a right to access to good quality, affordable health care, and that the access should not be determined by the socio-economic condition of the individual.

Hence whether you call it NHI as we are doing here in South Africa, or NHS as they do in England, or Seguro Popular as they say in Mexico or Obama Care as the Americans call theirs, the concept is the same.

In the editorial of Vol. 380 of September 8, 2012 of the Lancet it states that “certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressible right. That healthcare should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding”.

The editorial goes further to say: Building on several previous Lancet Series that have examined health systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical political, economic and health arguments in favour of Universal Health Coverage and will be presented in New York on September 26 to coincide with the United Nations General Assembly. The series was facilitated by the Rockefeller Foundation and edited by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation (WHO) Director-General Dr Margaret Chan’s assertion that Universal Health Coverage is the single most powerful concept that public health has to offer”.

Honourable Speaker, the editorial goes on to say and I quote again: “Universal Health Coverage, like any other health system, must be accountable for the quality of its outcome and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for share holders”.

It is very clear Honourable Speaker and Honourable Members that the whole world, and not only our country is gearing to rid itself of archaic healthcare financing systems that cater for the privileged few, and punishes the poor, in favour of healthcare systems that will benefit all – and all citizens of a country.

This assertion, led to another article in the Lancet series I have just mentioned. It argues that Universal Health Coverage is poised to be a third global health transition.

The argument is based on the fact that since humanity came into being, there have been only two great transitions in health on this planet.

The first was the demographic transition that began in the late 18th century and changed the planet in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths greatly.

The second transition was the epidemiological transition that began in the 20th century and eventually reached even the most challenged countries in the 21st century.

Communicable diseases, from smallpox to poliomyelitis were vanquished or controlled on a scale never imagined, opening the way for contemporary action to tackle non-communicable diseases.

Now a third great transition seems to be sweeping the globe, changing how healthcare is financed and how health systems are organised. For a along time, getting healthcare has meant first paying a fee to the provider – a practice that effectively burdens sick and needy people, that has meant choosing between going without needed services or facing financial ruin”.

Honourable Speaker in implementing NHI or Universal Health Coverage countries are clearly going to pay different prices for different durations in time, depending on internal objective factors and dynamics within each country. Hence a country like Qatar, is going to implement NHI starting in July this year and completing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same.

Unlike Qatar, there are two main prices we are going to have to pay for successful implementation of NHI.

The first price is that the quality of services in the public health system has to drastically undergo a metamorphosis – the quality simply has to improve and there is no running away from that.

The second price is that the cost of private healthcare has to drastically reduce. We need to firmly regulate the prices in private healthcare.

Honourable Members, as a Department of Health, we strongly welcome last week’s announcement by the Minister of Economic Development, Honourable Minister Patel, that through the amended Competition Act, the Competition Commission will launch a public market inquiry into the cost of private healthcare. We as a Department are fully behind Minister Patel and the Competition Commission on this one and we are ready to engage and offer all evidence we have at our disposal. We are eagerly waiting for the Commission to call us! For those who don’t understand where this is coming from, I wish to refer you to our National Development Plan, Vision 2030 and I quote:

“A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector”.

As to how we are going to pay the first price I have mentioned earlier, i.e on the issue of quality in the public health system, we shall outline that in the White Paper that will be released soon. We did indeed take a very long time since the Green Paper was launched. There were lots of inputs and developments that needed our very careful attention and considerations.

We will be ready very soon.

It will be released with a clear plan on how NHI is to be implemented based on the two main prices which I said the country has to pay.

Because these are elaborate plans, it will not be possible at all to outline them here. They will be made available in due course. They will include the whole concept of non-negotiables in healthcare, the delegation of powers to CEOs who are being newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.

But I wish to take this opportunity to emphasize over and over again, that the NHI will be based on a preventative and not a curative healthcare system.

I will then repeat in many more occasions to come that Primary Health Care, meaning prevention of diseases and promotion of health is going to be the heartbeat of NHI in South Africa.

We will drive this healthcare system according to the dictates of the National Planning Commission which clearly states that among the important things to be done, is to reduce the burden of disease, not to allow them to flourish and then try to run helter skelter in trying to cure them, with very limited facilities, both human and financial, which is the hallmark of public health systems on the African continent.

We wish to demonstrate with a few examples on what prevention of diseases and promotion of health can do to a country’s health system.

A report compiled by the Mail & Guardian’s newly established BHEKISISA health reporting center and published on Friday last week demonstrates one of the examples

It shows how four years ago, the Department of Health introduced two very new vaccines, Prevenor, to reduce the risk of children contracting Pneumonia, and Rotarix to prevent incidences of diarrhoea in children. Remember that diarrhoea was killing 25 South African children under the age of five (5) each day.

At the time of the inception of the two vaccines, National Institute of Communicable Diseases, the NICD, was tasked with the work of monitoring and evaluating the impact of these vaccines on hospitalisations in three South African hospitals – in Cape Town, KwaZulu-Natal and Gauteng.

The findings were that at Ngwelezele Hospital in Kwa-Zulu/Natal the under five mortality rate was three times higher than in Soweto. However, the Ngwelezene Hospital ward that deals specifically with diarrhoea i.e the gastrointestinal ward, has recently been closed down as a result of the introduction of this vaccine. Around 2006, this ward used to admit close to 1 000 children annually. It is now closed down – no more need!!

On average, in all these three sites there has been a 70% reduction in admission due to diarrhoeal diseases attributable to Rotavirus.

Seeing the successes that vaccines can bring Honourable Speaker, our next target is cancer of the cervix of the uterus. One of the biggest killers of women.

According to Prof Lynette Deny, and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and Chris Hani Baragwanath Hospital respectively, cervical cancer affect 6 000 South African women annually. 80% of them are African women.

Out of these 6 000 affected, between 3 000 and 3 500 die annually as a result of this cancer.

More than 50% of women affected are between 35 and 55 years of age. Only 20% are older than 65 years of age.

HIV positive women are five times more likely to get it than HIV negative women.

This cancer is caused by another dangerous virus – the human papilloma virus. The good news is that there is now a vaccine against this virus. The very bad news is that it is available in the private sector but the costs are prohibitive between R500 and R750 a dose (3 doses are needed for protection) – even in the private sector the uptake is very slow due to this prohibitive costs.

At the moment Honourable Speaker, to make these vaccines affordable, the Bill and Melinda Gates Foundation established GAVI (Gates Action for Vaccines and Immunisation) to help poor countries.

Unfortunately, South Africa does not qualify for GAVI prices which we are made to understand, are at only $4,00 per dose.

We are also aware that the PAHO (Pan American Health Organisation) has negotiated a price of $13,00 a dose for Latin American countries.

I am extremely happy to announce that in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence to administer the HPV vaccines as part of our School Health Programme as from February next year.

We will enter negotiations in our own right to also be given a fair deal in the interest of the lives of the women of this country.

We are advised by scientists that the vaccine is only fully effective before sexual activity commences.

For this reason, we shall administer it to all 9 year and 10 year old girls in Quintiles 1, 2, 3 and 4 schools.

This will cover 385 000 of the 9 and 10 year olds. We are not unduly discriminating against Quintile 5 schools. Children from poor families who find themselves for one reason or the other in Quintile 5 schools will also be covered.

I am calling for parents of all remaining learners in that category of schools, that since they can afford, for now they must try to acquire the vaccines themselves until we are able to cover all learners in the mentioned age bracket in all the schools. I am calling on all Medical Aid Schemes in the country to pay for these vaccines to help parents in the category of learners who will not be covered when we commence the programme. The benefits far outweigh all the costs. It costs up to R100 000 per patient in the public sector to treat each of the 6 000 cervical cancer patients.

I am scared to quote you the figures for the private sector treatment.

Honourable Speaker, this week, very bad news emerged from our health facilities about an entity called RWOPS – Remunerated Work Outside the Public Service – whereby doctors fully employed by the State conduct their own private work during certain hours. RWOPS is not illegal. It was passed by the Cabinet around 1994.

The only problem is that it is being abused by some unscrupulous individuals.

I must emphasise Honourable Speaker, the overwhelming number of doctors in the public service are very decent law abiding hard working citizens who are deeply committed to their patients.

It is only a few who are tarnishing the name of the profession. I am appealing that the events that unfolded over the media this week must not be misconstrued that most doctors are involved in this practice and start regarding all doctors as some form of criminals. I want to repeat, the majority are very ethical citizens who understand their calling.

The few individuals who are involved, are not only punishing patients, they are also destroying the medical training in the country because they leave medical students to their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.

I have already warned the private sector, who are benefitting from this bad practice, that in the long run, they also will suffer because the country will produce poorly trained doctors.

I have given this matter to the Deans of all our medical schools where this practice seems to be very rife, to discuss the matter and come up with recommendations which will be presented to all stakeholders in health. We will call a press conference to determine the way forward. But we can’t avoid criminal charges to those who have been caught red-handed because we have their names and know their activities.

We will also refer their names to the South African Revenue Service (SARS) to see if they are paying tax in the double income they are getting.

We are also appealing to the private sector who are hell-bent on attracting this public servants with lots and lots of perverse incentives. This is going to destroy everybody in the long run.

I wish to take this opportunity to thank the Deputy Minister, the Director-General and all managers in our Head Offices and facilities. Our health workers still remain our heroes and heroines despite a few who want to tarnish their good names. I wish to thank them for the sterling work performance done under very trying circumstances.

I thank you.

Issued by the Department of Health,

May 15 2013

http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page72308?oid=377010&sn=Marketingweb+detail&pid=90389

Swazi Government and the US-based Futures Group lack accountability in failed circumcision programme?

MBABANE, 16 May 2013 (IRIN)

It was an ambitious plan to circumcise the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world’s highest HIV prevalence. How could it have gone wrong?

“First they told me that circumcision will not really protect me against HIV. Then they tell me that I cannot have sex for some weeks or months after circumcision. I told them ‘fusaki’ [get out]!” Eric Dlamini, a 22-year-old law student, told IRIN.

These views are at the heart of the failure of the Accelerated Saturation Initiative (ASI) to achieve more than a fraction of its targeted goal, the circumcision of 80 percent of Swazi males between ages 15 and 49 within a year.

The programme, a partnership between the Ministry of Health and Social Welfare and the US-based Futures Group, was launched in 2010, and extended to 30 March 2012 when initial efforts showed a failure to achieve targeted results. But only about 20 percent – or 32,000 – of the targeted demographic were circumcised through the programme.

US$15.5 million was spent on the programme, or $484 per circumcised male.

“We do not believe [ASI] was a failure but an additional prevention measure that is contributing to the overall combination efforts to end the HIV/AIDS pandemic in the country,” US Embassy in Swaziland spokesperson Molly Sanchez Crowe told the local press.

Imposed from outside?

Male circumcision has been scientifically proven to reduce a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision in HIV prevention is maintained for several years.

Government health officials, like Minister of Health Benedict Xaba and Khanya Mabuza, the acting director of the National Emergency Council on HIV and AIDS (NERCHA), have noted that ASI taught the country important lessons and left behind several clinics and other health infrastructure.

But a year after the programme ended, Swazi health officials are still trying to figure out what went wrong. Health workers, who spoke to IRIN on the condition of anonymity, pointed out that the programme was hastily implemented. They wondered why the short implementation time was not extended. Ending the programme, they fear, may suggest to international donors that the country is a hopeless cause.

“We have been struggling with HIV for 20 years, and we see programmes come and go. Some are fads… and some are not well thought out. The Swaziland programme came from the outside. The health ministry was willing to go along because there was money there. But it was imposed,” said Thandi Mduli, an HIV testing officer in Manzini.

Officials with health-oriented NGOs admitted to IRIN they are “terrified” of criticizing an initiative funded by the “mighty” US President’s Emergency Plan for AIDS Relief (PEPFAR) and involving the global population control NGO Population Services International (PSI).

The ASI programme was an attempt to duplicate in Swaziland the circumcision successes seen in Kenya and other countries, without apparently doing the pre-campaign ground work. Kenya has carried out an estimated 477,000 circumcisions since its programme started in 2008, according to the government.

In 2011, UNAIDS and PEPFAR launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015.

Reasons for failure

“There were a lot of issues involving male circumcision that were not properly explained to Swazi men, so they rejected it and they talked to their friends, and word of mouth was negative instead of positive. This is the opposite of what a campaign like this needs to work,” said NERCHA’s Mabuza.

Other issues included unfamiliarity of the procedure. “When I heard I would still have to wear a condom, I said, ‘What is the point?’” said Samkelo Mduli, a university student.

A survey commissioned by the Futures Group in 2011 found that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the procedure.

Another reason for the rejection of circumcision was not anticipated by ASI promoters: belief in witchcraft, which is widespread in Swaziland. Criminals are known to seek “strengthening” potions made with human body parts. Killings associated with “ritual murder” routinely correspond with national elections. Victims, usually children or older people, are found with body parts missing. One attack made headlines in the Swazi press recently.

“That’s also what I wanted to know, and they wouldn’t tell me – what happens to my foreskin once it is cut off?” said Mduli.

Health Minister Xaba alluded to this when he told the Times of Swaziland, “Some men feared that the foreskin could end up in wrong hands, being used by some unscrupulous people for their ulterior motives.”

“This is embarrassing and nobody wants to talk about it,” said the programme director of a faith-based HIV/AIDS initiative in Manzini. “The circumcision initiative failed because of this arrogance on the part of its promoters. It would have been easy to be honest and explain to the Swazi men that their foreskins would be incinerated like all surgical refuse. But the promoters said, ‘Oh, no, we can’t talk about witchcraft. What will the donors say?’”

By SAFAIDS

http://safaids.net/content/circumcision-plans-go-awry-swaziland

 

AIDS council adopts National Strategic Plan for HIV, TB

Deputy President Kgalema Motlanthe at a plenary meeting of the South African National Aids Council in Secunda, Mpumalanga. Picture: GCIS

By Samuel Mungadze

A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.

The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.

The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.

Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.

Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.

In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015”, read the statement from the council.

Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.

The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.

Patients living with both HIV and TB, have started being treated on the new therapy.

Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.

This eliminates the need for patients to take three or more pills at various intervals per day.

 

19 April 2013

From the Business Day Live

http://www.bdlive.co.za/national/health/2013/04/19/aids-council-adopts-national-strategic-plan-for-hiv-tb

 

NEW! Fast Facts e-Poster on the Global Fund’s Country Coordinating Mechanisms (CCMs) in Africa

CLICK HERE to download the CCM Fast Facts e-Poster.

The Global Fund to Fight AIDS, Tuberculosis and Malaria has recently published the 2012 CCM Composition data on its website. While AIDS Accountability International commends this transparency, the nature of the large Excel file-format does not make the data accessible or easy to interpret. This is a barrier to accountability. Responding to this need as urgently as possible, AAI has created a CCM Fast Facts e-Poster which highlights some of the more important statistics on CCM composition in Africa:

Q: Did you know that only one country in Africa has sex worker representation? Which one is it?

Q: Which country only has 5% women sitting on its CCM?

Q: Do you know which three African countries have members representing men who have sex with men?

The Global Fund’s Country Coordinating Mechanisms (CCMs) are the in-country boards in charge of deciding what goes into Global Fund proposals, and how the grants are divided up and managed. Who is sitting on these boards? Who is really affecting the Global Fund decision making process?

Statement of Human Rights Defenders on the Need for an Integrated and Comprehensive Approach to the Protection of Human Rights related to sexual orientations and gender identities and expressions at the Human Rights Council.

As many of you know, in June 2011, the Human Rights Council began an important process to strengthen the protection of the human rights of people all over the world on the basis of sexual orientations, gender identities and expressions.

This was the outcome of decades of work by social movements and good strategic leadership by both civil society and many states.

A Resolution was adopted on Human Rights, Sexual Orientation and Gender Identity.

This June marks two years since that Resolution was adopted.

What do we want to see at the Human Rights Council in taking forward the work on sexuality, gender and genedr identity?

Below, is a Statement that has been shaped by a group of civil society organisations, coalitions and networks from Africa, Latin America and from the Caribbean.

TAKE ACTION!

1. Read the Statement

2. Sign On.

You do this by sending an email to

Mtinkheni Munthali – contact@amsher.net

OR

Eunice Namugwe – eunice@cal.org.za

You can sign on as an individual or as an organisation.

Please state in your email

NAME OF ORGANISATION [in full]

Country/Region

Then insert into SUBJECT LINE the words:

SIGN ON

3. Forward the email to your networks and contacts.

More information will follow in the next days and weeks!

In Solidarity!

The Teams at the Secretariats:

African Men for Sexual Health and Rights

Coalition of African Lesbians

Statement of Human Rights Defenders on the Need for an Integrated and Comprehensive Approach to the Protection of Human Rights related to sexual orientations and gender identities and expressions at the Human Rights Council

-10 May 2013-

We, the undersigned human rights defenders, working to advance societies that affirm peoples’ diversities, choice, human rights and agency throughout the world, hereby state our position on the role of the Human Rights Council following (HRC) the adoption of Resolution 17/19 on Human Rights, Sexual Orientation and Gender Identity by the United Nations HRC and of the Report of the High Commissioner on Human Rights on Discriminatory Laws and Practices and Acts of Violence Against Individuals based on their Sexual Orientation and Gender Identity [A/HRC/19/41].

Progressing from the OHCHR study and Report, as well as the recent Regional Consultations and the Oslo Human Rights Conference, one of the key questions for the international community is ‘what would constitute an effective institutional response from the United Nations HRC to advance the respect, protection and fulfillment of the human rights of people all over the world based on their sexual orientations and gender identities and expressions?’

Our position is that an intersectional approach is required to address violence and violations based on sexual orientations, gender identities and expressions. Such an approach by the HRC will affirm and strengthen existing work for the full integration of the human rights of people based on their sexual orientations, gender identities and expressions into all existing UN mechanisms, agencies and systems. Such integration should be deliberate, systematic, resourced, coordinated and sustained. We believe that this intersectional and integrated approach will ensure respect, protection and fulfillment of the human rights of people from diverse sexual orientations, gender identities and expressions as integral to a comprehensive human rights agenda, and not present as a separate category of rights.

We believe that effective change in the violence and other violations against persons based on their sexual orientations, gender identities and expressions is dependent on an incremental approach. Such an approach will work to build on and sustain the momentum established by Resolution 17/19 and the Report of the OHCHR [A/HRC/19/41] in a context of dialogue and engagement both within regions and across regions and between states and between states and civil society. Such an approach will also ensure that technical assistance is available to enable states to take measures to address the violence and other violations against people on the grounds of their sexual orientations, gender identities and expressions, and enable stronger accountability for implementation.

The mandate of the HRC is not to mirror the prejudice of Member States but to set standards that member States should be held accountable to and be bound by. The international community has witnessed increasing dialogue among States on violence and other violations based on sexual orientation, gender identities and expressions, demonstrating shifts in prejudice and willingness to engage. The HRC must both continue, through ongoing dialogue, to identify and address the intersecting factors of discrimination which make up the root causes of such violations and tobuild on efforts to sustain these shifts.

We are concerned about calls for a special mechanism which would focus solely on sexual orientation and gender identity. We believe that this is a short cut and an apparent quick win to addressing the societal problems that establish and sustain the violence and violation based on sexual orientations and gender identities and expressions.

We believe that the creation of such a mechanism would pose significant risk of contributing to the process of solidify identities even where they do not exist and creating or reinforcing “an other” category.  For some of us the work we do on sexual orientation and gender identity and the way we struggle for recognition of who we are is based on important and sometimes powerful identity categories. Often, these categories are not fixed identities, but standpoints we take in the struggle for dignity, freedom and equality.

As UN special mechanisms are dependent on the cooperation of States either by their own volition or by activation of a treaty obligation, it will be very difficult for a special mechanism on SOGI to function in the absence of an explicit treaty obligation binding States to cooperate with it. Consequently, the UN cannot count on the voluntary cooperation of States with such a mechanism.

We are further concerned that a special mechanism on sexual orientation and gender identity, whether a Special Rapporteur, Independent Expert or Working Group, would for a number of years after its establishment, be immobilized, dismissed or ignored by some states and actively resisted by others. This would have serious consequences for the possibilities of change at a national/country level. It would likely also increase the focus on name, blame and shame processes with the consequences of further polarization within the Council.  We anticipate that the creation of such a special mechanism will, in effect reinforce the opposition to the protection of human rights of people based on their sexual orientations and gender identities and expressions. This could set back gains made since June 2011, as an international tussle ensues within the Council and elsewhere. We believe that such an intervention will for some time to come strengthen the divides amongst states on this issue and will narrow the range of effective measures that some states are willing to take to address the violations; It could reduce the possibilities of and/or delay real change at a local, country/national level where it is most needed. It is unlikely to facilitate or enable the kind of change we need as a community at a local and country level.

In the light of the above positions and concerns, we call on the HRC to adopt a resolution which will:

1.       Request, to give effect to A/HRC/19/41 paragraph 82, the Office of the High Commissioner for Human Rights to convene an expert meeting to prepare Technical Guidance on the application, at a national level, of a human rights-based approach to the implementation of policies and programmes to eliminate discrimination and violence based on gender, gender identity and sexuality with a focus on sexual orientation, gender identities and expressions. This Technical Guidance should be presented to the HRC at a formal plenary session within two years following the resolution and within one year following the report [see 2 below];

2.       Request, in keeping with A/HRC/19/41 paragraph 81, that the OHCHR conduct an in-depth study that demonstrates both the human rights situation in relation to sexual orientation and gender identities and expressions as well as promising and good practices that can serve as a basis for addressing the violence, violation and discrimination facing people all over the world in relation to sexual orientation and gender identities and expressions. The report to make recommendations that can serve as the basis for addressing the implementation/application gap at a country level through the drafting of Technical Guidance

All of this should be located within a process of sustained dialogue at all levels and between states and between states and civil society and supported through properly resourced technical assistance between countries as well as the adequate resourcing of the Office of the High Commissioner on Human Rights.

We further call on the Human Rights Council, subsequent to the adoption of a resolution addressing the above two interventions, to begin a process to encourage existing special mechanisms to identify and make recommendations to address the full range of protection gaps within UN human rights system. These would include but not be limited to protection gaps on the basis of sexual orientation and gender identity.