Showing posts from category HIV/AIDS.
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PRB’s Jay Gribble at Kenya’s National Leaders Conference on Population and Development
›November 29, 2010 // By Wilson Center StaffJay Gribble, vice president of International Programs at the Population Reference Bureau (PRB), recently attended the Kenya National Leaders Conference on Population and Development, November 15-17, at the Kenyatta International Conference Center in Nairobi. During the conference, he produced a series of posts for PRB’s Behind the Numbers on some of his impressions. Gribble focuses on Kenya’s resurgent interest in integrating population issues into the development agenda, the country’s ongoing HIV/AIDS epidemic, and the importance of family planning.
Below are the introductory excerpts from his posts; to read the full posts, please visit Behind the Numbers.
“Anticipating Change in Kenya”
Sitting in the hall where Kenya’s National Leaders Conference will be starting in a few minutes, I can’t help but feel that there is an opportunity to refocus national attention to development…to the goal that I have heard repeatedly of becoming a Middle Income country. And to achieve this goal, they must first recognize that population is an underpinning development issue that cannot be ignored.
In the 1980s and 1990s, Kenya was a leader in reproductive health and maternal health, really setting a pace for the continent. But during the 2000s, Kenya turned its attention to other pressing issues – namely HIV/AIDS – and began to give less attention to population issues. Though HIV continues to be a plague, it is now time to return to the importance of slowing population growth, for until this fundamental issues is addressed, there will be less opportunity for education, jobs, and better health. At the same time, as a predominantly rural country with agriculture representing a major part of the economy, smaller families will be critical to maintaining farms that are large enough to feed families and the country.
Continue on PRB.
“As the Rich Get Richer, the Poor Get Children”
The Kenya National Leaders Conference has begun, representing the first time since 1989 that Kenya’s national population policy has been discussed in a large, open forum. With a new national constitution, Kenya is poised to redress many of the social and economic inequalities that have stood in the way of its development. In fact, the current population policy expires in December, 2010, and one of the purposes of this conference is to gather the input from leaders throughout the country on how a new policy should be framed. I find it impressive that such a large conference is convened to ensure that a new policy reflects the needs of the nation. The conference is also a forum for reaching leaders with important information about the need to address population growth through family planning if Kenya is to achieve its Vision 2030 development plan.
Continue on PRB.
“In Kenya, Prioritizing Population…and Family Planning”
As Kenya’s National Leaders Conference on Population and Development winds down today, it offers leaders an opportunity not only to think and talk about how population growth is an issue that underlies the country’s development, but to act on it too. Whether thinking about business, agriculture, or the environment, it is impossible to be strategic about Kenya’s future without also considering how rapid population growth will affect it.
In talking with Kenyans who grew up in the 1970s and 1980s – back when family planning and population growth were a priority – they remember the messages that were at the tips of people’s tongues – smaller families live better. Before the HIV/AIDS epidemic, family planning and slowing population growth was a priority and a source of national pride because it put Kenya on track for prosperity and development.
Continue on PRB.
Photo Credit: Adapted from “King Kenyatta?” courtesy of flickr user rogiro. -
Nigeria’s Future Clouded by Oil, Climate Change, and Scarcity [Part Two, The Sahel]
›November 19, 2010 // By Schuyler NullIf southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.Nigeria holds nearly a fifth of the entire population of sub-Saharan Africa. By 2050, it’s expected to pass Indonesia, Brazil, and Bangladesh and take its place among the top five most populous countries in the world, according to UN estimates. But a litany of outstanding and new development, security, and environmental issues – both in the long-troubled Niger delta in the south and the newly inflamed north – present a real threat to one West Africa’s most critical countries.
If southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.
Climate, Culture, and Discontent in the North
Last summer, in an offensive that stretched across four northern states, a hardline Islamist group called Boko Haram emerged suddenly to challenge the government, attacking police stations, barracks, and churches in escalating violence that claimed more than 700 lives, according to The Guardian. The government responded with a brutal crackdown, but recent targeted killings and a prison break seem to indicate the group is back.
Perhaps most distressingly, Boko Haram appears to have won some local support. Said one local cloth trader to The New York Times in an interview this October, “It’s the government’s fault. Our representatives and our government, they are not sincere. What one person acquires is enough to care for a massive amount of people.”
As in the south, mismanagement of natural resources has also played a role in creating a dangerous atmosphere of distrust in the government. After gold was discovered this spring in northwestern Nigeria, many under- and unemployed flocked to the region to try their luck, but they also unwittingly contaminated local water with high levels of lead. Although the state health officials say they have now identified more than 180 villages thought to be affected, the epidemic was only discovered after a French NGO stumbled upon it while testing for meningitis in June. More than 400 infant deaths have been connected to the mining, according to Reuters.
Contributing to natural resource-related misery in the north are climatic changes. Declining rainfall in the West African Sahel over the last century has pushed rain belts successively south, driving pastoralists into areas often already occupied. According to Anthony Nyong’s work, presented in ECSP Report 12, these changes have elevated competition over natural resources to the single most common cause of conflict in northern Nigeria in recent years.In addition to the long-term trend of declining rainfall, an acute drought in 2009 and another this year in neighboring Niger and Chad have created the worst food security crisis in 30 years. The droughts have also driven a great deal of cross-border migration into Nigeria, which itself saw lower than usual rainfall in the north, especially the northeast, around the ever-disappearing Lake Chad (see map above for resulting migration patterns).
What rain did fall in the border areas fell suddenly and torrentially, causing rampant flooding that affected two million people. The floods not only caused physical damage but also came just before harvest season, destroying many crops and further reducing food security. Made more vulnerable by the number of displaced people and flooding, the area was then hit with its worst cholera outbreak in years, which has killed 1,500 people so far and spread south.
Cholera is not the only preventable disease to flourish in northern Nigeria in recent years. In 2003, cleric-driven fear of a U.S. plot to reduce fertility in Muslim women caused the widespread boycott of a UN-led polio vaccination drive. The fast-spreading disease then emerged in six of Nigeria’s neighbors where the disease had previously been eradicated. The northern states today remain the only consistently polio-endemic area in Africa, according to the Global Polio Eradication Initiative.
“A Stable Nigeria Is a Stable Africa”
Nigeria’s size and its wealth of natural resources make it a strategically important country for the future of the region. “A stable Nigeria is a stable Africa,” said Wilson Center scholar and former NEITI officer Uche Igwe in an interview. “Nigeria is 150 million people and the minute Nigeria becomes unstable, the West Africa sub-region will be engulfed.”
While there have been some strides in recent years in reducing corruption and addressing infrastructure needs (for example, NEITI’s work to promote revenue transparency), the development, health, environmental security, and human security situations remain dire in many parts of the country. With one of the fastest growing populations in the world and severe environmental problems in both the north and the south, scarcity will almost certainly be a challenge that Nigeria will have to face in the coming years. How the government responds to these challenges moving forward is therefore critical.
In 2008, in response to high oil prices, British Prime Minister Gordon Brown announced his intentions to send military aid to help combat Niger Delta militants. The statement was met with dismay from humanitarian organizations and caused the collapse of a ceasefire (which was then resumed for a time and now seems to be falling apart again). Brown was forced to backtrack into simply offering training support to Nigerian security forces.
In terms of U.S. assistance, USAID requested $560 million for Nigeria in FY 2010 – 75 percent of which is allocated towards HIV/AIDS – and the U.S. military has engaged in joint exercises with Nigerian forces. But so far, little has been done to integrate U.S. aid in a cohesive manner. Given the breadth of these issues, such integration is crucial.
“We need partners, like the United States and Europe, who have a stake in stability – in Nigeria, the Niger Delta, the Gulf of Guinea, and the world,” Igwe said. It remains to be seen what the Nigerian reaction would be to an offer of aid from the West that addresses not only the country’s security issues but also its myriad other problems, in a substantial and integrated fashion.
Part one on Nigeria’s future – The Delta – addresses oil, insurgency, and the environment in the south.
Sources: AFP, AFRICOM, AP, BBC, Global Polio Eradication Initiative, The Guardian, Independent, The New York Times, ReliefWeb, Reuters, SaharaReporters, USAID.
Photo Credit: “The Ranch,” courtesy of flickr user Gareth-Davies, and “Niger and Nigeria: Food security drives population movement,” courtesy of the U.S. State Department. -
Former Botswana President Champions Health, Governance Issues
›November 16, 2010 // By Wilson Center StaffOriginally featured in the Scholar Spotlight, Centerpoint, November 2010.
His Excellency Festus Mogae, who served as president of Botswana from 1998–2008, recently spent several months at the Wilson Center as a public policy scholar. During his stay, he conducted research, networked with senior policy officials in the U.S. government, the United Nations, and with NGO representatives in Washington and New York, and attended Wilson Center seminars related to health and governance.
Since leaving office, Mogae has advocated for governance reform in Africa, notably presidential term limits, and efforts to mitigate the effects of climate change. Another critical initiative he is pursuing actively is HIV/AIDS prevention across Africa.
Mogae is the founder and chairman of Champions for an HIV-Free Generation, a group that assists current African presidents in dealing with the AIDS pandemic. This year, the delegation visited South Africa, Namibia, Mozambique, and Swaziland and, most recently, Zambia in October. The group seeks policy and attitude changes among the leaders of these nations and also advocates for increased financing for AIDS prevention in their health budgets. “If [these countries] allocate their own resources, the donor agencies will see they are serious about this problem” and match funds, said Mogae.
“We take the view that a more outspoken leadership must come from the continent regarding the AIDS epidemic,” he said. “African leaders must not only care but also be seen by donor countries and agencies as leading from the front on these matters.”
The group includes Mozambique’s Joaquim Chissano, Tanzania’s Benjamin Mkapa, Zambia’s first president Kenneth Kaunda, former Vice President of Uganda Speciosa Wandira, and former Chairperson of Kenya’s National AIDS Control Council, Miriam Were. Also in the coalition are two notables from South Africa, Nobel Laureate Archbishop Desmond Tutu and Constitutional Court judge, Justice Edwin Cameron.
The Champions coordinate with local health representatives based in Africa, from UNAIDS, the World Health Organization, PEPFAR, and the Gates Foundation, which prepare country reports on the status of AIDS. Then, armed with this research, the group meets with African leaders, including the presidents, finance and health ministers, local government and parliamentary officials, private sector, union, and civil society representatives, and church groups to lobby for policy changes.
“We highlight success stories on the continent so others can emulate them,” Mogae said. “We are calling for social behavioral change, but that can only happen if advocated and led by the top religious and traditional leadership.”
One particular challenge has been mother-to-child transmissions. He said in sub-Saharan Africa, in 2000, 40 percent of children born to HIV-positive mothers got infected but by 2008, the figure was down to three percent. The target is zero, he said.
Another major initiative chaired by Mogae is the Coalition for Dialogue on Africa, or, CoDA, a joint venture among the African Development Bank, the African Union Commission, and the UN Economic Commission for Africa. This global effort focuses on education, agriculture and conservation, energy and natural resources, and helping women. CoDA currently is organizing a symposium on women’s empowerment, he said, that will focus on education, and reforming land ownership and marriage laws.
These and other organizations with which he is affiliated aim to help shape policies and set priorities for Africa. He said, “We can’t ask the international community for help unless we first help ourselves.”
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo Credit: AIDS sign in Gaborone, Botswana, courtesy of flickr user cordelia_persen. -
The “Condom King” speaks at TEDxChange on Poverty Reduction and a “9th MDG”
›“We have now found the weapon of mass protection,” said Mechai Viravaidya (a.k.a. the “Condom King”) at the recent TEDxChange event in New York. Viravaidya is the founder and chairman of the Population and Community Development Association and a former senator of Thailand. He spoke about his innovative approaches to addressing Thailand’s once high rates of poverty, child mortality, and HIV through the promotion of family planning and condom use.
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Misguided Projections for Africa’s Fertility
›By assuming that sub-Saharan Africa’s total fertility rate will decrease to 2.5 children per woman by 2050, the most recent population projections issued by the Population Reference Bureau likely continue to underestimate fertility for Africa. Though northern Africa has significantly lowered fertility, sub-Saharan Africa’s TFR is still 5 children per woman. Achieving the levels projected by PRB or the United Nations will largely depend on whether the conditions that led to past fertility declines for other states can be established in sub-Saharan Africa.
Demographers have identified numerous factors associated with fertility decline, including increased education for females, shifting from a rural agricultural economy to an industrial one, and introduction of contraceptive technology. Sub-Saharan Africa is only making slow progress in each of these areas.
Surveying Obstacles to Development
Primary school enrollment is up, but the pace of improvement is declining. Meanwhile, gender gaps persist: Enrollment for boys remains significantly higher than for girls. Girls’ education is associated with lower fertility, partly because education helps women take charge of their fertility and also because education influences employment opportunities. Increased female labor force participation has been shown to increase the cost of having children, and is therefore associated with initial fertility declines.
Disease is one wildcard for Africa that limits the utility of past models of demographic transition in the African context. HIV/AIDS is decimating sub-Saharan Africa’s adult workforce and creating shortages of teachers that will impede future efforts to boost primary school enrollment. According to the United Nations, the number of teachers in sub-Saharan Africa needs to double in the next five years to reach Millennium Development goals.
Development that would shift the region’s economies from agriculture to industry is also lagging. While several West African countries are seeing some gains, the African continent on the whole faces major structural impediments to development. In The Bottom Billion, Paul Collier points out that many of these countries may have “missed the boat” to attract investment and industry that would pull the region out of poverty, partly because the least developed countries are still not cost-competitive enough when compared with current centers of manufacturing, like China.
Finally, there remains a high unmet need for family planning. One in four women aged 15 to 49 who are married or in union –- and who have expressed an interest in using contraceptives — still do not have access to family planning tools. In general, maternal mortality remains high and adolescents in the poorest households are three times more likely to become pregnant and give birth than those in the richest households, according to the most recent UN Millennium Development Goals report.
Sub-Saharan Africa: Off the Radar?
Sub-Saharan Africa suffers from a lack of attention by the international community and lack of political capacity at home. Many countries in the region are plagued by civil strife and poor governance, and developed countries continue to fall short of development assistance pledges. There is not the same sense of urgency today among developed countries about the global population explosion as there once was. Cold War politics and the environmental and feminist movements motivated much of the study of fertility and funding of population programs during the second half of the 20th century. Attention by governments and NGOs sped the fertility transition among many countries.
Today, the world’s wealthiest countries are not concerned primarily with Africa’s problems, but rather are more concerned with their own population decline and with the national security implications of population trends in areas associated with religious extremism. The recession has further hindered the flow of development funds.
Fertility is the most difficult population component to predict, and demographers must draw on the experiences of other regions to inform assessments of Africa’s population patterns. Demographers seem to be overconfident that Africa’s fertility will follow the pattern of recent declines, particularly in Latin America, which were more rapid than Western Europe’s decline due to the diffusion of technology and knowledge.
Once states begin the demographic transition towards lower fertility and mortality, they have tended to continue, with few exceptions. Therefore, most projections for Africa assume the same linear pattern of decline will hold. Yet, the low priority of Africa’s population issues among the world’s wealthiest states, combined with shortfalls in education, development, and contraception, may mean that the demographic transition in Africa will be slower than predicted.
Projections are useful to give us a picture of what the world could look like if meaningful policy changes are made. In the case of sub-Saharan Africa, prospects for these projections are dim.
Jennifer Dabbs Sciubba is the Mellon Environmental Fellow in the Department of International Studies at Rhodes College in Memphis, Tenn. She is also the author of a forthcoming book, The Future Faces of War: Population and National Security.
Photo Credit: “Waiting,” ECWA Evangel Hospital, Jos, Nigeria, courtesy of flickr user Mike Blyth. -
Boosting the U.S. Role in the Global Health Arena
›A new video from the Commission on Smart Global Health Policy, which was established by the Center for Strategic & International Studies, reviews the commission’s progress towards its goal of encouraging the U.S. government to embrace global health as a pillar of U.S. foreign policy.
The video reviews the recommendations from the commission’s March 2010 report, A Healthier, Safer and More Prosperous World: 1) Maintain robust U.S. support for the fight against HIV/AIDS, malaria, and tuberculosis; 2) Prioritize maternal and child health, especially in sub-Saharan Africa and South Asia; 3) Help other nations improve their capacity to prevent and respond to outbreaks of contagious disease; 4) Expand U.S. capacity to fund future global health initiatives by securing long-term investments for such efforts; and 5) Step up U.S. funding for multilaterals engaged in the global health field, including the World Health Organization, Global Fund, UNICEF, the World Bank, and the GAVI Alliance.
In the months ahead, commission members will be participating in public forums throughout the United States to discuss and promote the recommendations included in the report, before gathering in January to review the Obama administration’s progress on global health as the administration begins its third year. To date, the centerpiece of the administration’s health outreach efforts has been the six-year, $63 billion Global Health Initiative, designed to promote an enhanced U.S. role in addressing public health issues overseas.
The CSIS Global Health Policy Center will also be launching a year-long debate series called “Fault Lines in Global Health,” focusing on controversial topics in the global health field. The series’ kick-off event will center on U.S. AIDS funding, and is scheduled for Friday, August 6, 2010, from 9:30-11:00 a.m. -
Addressing Gender-Based Violence to Curb HIV
›July 28, 2010 // By Marie HokensonAt the recent International AIDS Conference in Vienna, Austria, an astonishing development in the campaign to stem the spread of HIV/AIDS was unveiled—a microbicide with the ability to reduce the risk of transmission of HIV. This welcome development coincides with an intensified focus on women’s health and security needs among donors, especially the United States.
At the conference, the “Gender Programming and Practices: Practical Approaches with HIV and AIDS” session took an integrated approach, examining the links between gender-based violence and HIV/AIDS infection. Women are more vulnerable to gender-based violence and HIV infection than men, particularly in parts of sub-Saharan Africa where “girls and women aged 15 to 19 are three times more likely” to become infected with HIV than men in the same age group, according to the World Bank.
Michelle Moloney-Kitts, with the Office of the U.S. Global AIDS Coordinator, said that gender-based violence “affects not only public health, but [also] the ability of women and girls to contribute to developing their countries.” Since women play integral roles in supporting their families and communities in developing nations, their absence or weakened capacity due to HIV infection, injuries, or unwanted pregnancy can have larger repercussions for economic development and community health.
Deep Roots: Changing Minds About Gender-Based Violence
Elizabeth Mataka, the UN Secretary-General’s special envoy for AIDS in Africa, described the obstacles facing female victims of gender-based violence as “deep-rooted social, economic, legal, and cultural affairs” in their communities. Mataka asserted that “communities must be engaged” through a “change in mindset” in order to allow these women to “claim their basic human rights.” Scrutinizing the paucity of women’s organizations, she cited a “serious shortage of women’s leadership at the grassroots level” as a problem that must be overcome to empower and protect women.
Pamela Barnes, a co-leader of the Partnership to End Sexual Violence Against Girls, highlighted the extent of this “deep-rooted societal issue.” She pointed out that a 2007 Swaziland study found the most “common venue for sexual violence was…within the homes of the victims.”
Rui Bastos, representing Mozambique’s Ministry of Health, added that there is a pressing need to “change relationships between men and women,” and called for a shift in the current relationship dynamic to “give power to the women.” Noting the low number of men receiving HIV treatment, he called on men to “increase demand in treatment” in order to stem the spread of the disease.
Silent Voices: Talking About Sexual Violence Against Minors
Since the Swaziland survey found that “30 percent of the respondents indicated that they had experienced some form of sexual violence prior to the age of 15,” Barnes said greater efforts must be made to educate children about how to protect themselves from sexual violence. She added that efforts to protect children should also address other “risk factors for abuse [which] include lack of education, exposure to emotional abuse, and witnessing sexual assault.”
At a recent Wilson Center event on sexual violence against minors, Jama Gulaid of UNICEF Swaziland said that while talking about sexuality is not easy, “when you bring in violence it is even more difficult.” For that reason, Gulaid said, “you have to do two things—you have to share information and you have to present it in certain ways.” He explained that Swaziland was addressing the issue by relying on school-based interventions, which include trained community-child protection groups, toll-free telephone lines, case investigation services, and personal counseling.
Prevention First: Scaling Up to Stop Rape
While the new microbicide might help female victims of sexual violence avoid HIV infection, it will not stop the problem of gender-based violence. That is why Moloney-Kitts called on donors and NGOs to “scale up gender-based violence programs,” but in a way that goes beyond simply improving “post-rape care” and instead places greater emphasis on prevention efforts.
Not only would better rape prevention help reduce HIV and STD infection rates, but it would also help women avoid psychological damage and unwanted pregnancies—and, as Moloney-Kitts pointed out, improve economic development and enhance public health at the same time.
For more on gender-based violence, see these Wilson Center events:- Gender-Based Violence in Sub-Saharan Africa: A Review of Demographic and Health Survey Findings and Their Use in National Planning
- From Relief to Development: Gender-Based Violence Interventions in Conflict and Post-Conflict Contexts
- Dynamics Of Sexual Violence In The Eastern Democratic Republic Of Congo: Perpetrators, Community Response, and Policy Implications
Photo Credit: “Congo Kivu Violences Panzi,” used courtesy of flickr user andré thiel. -
Watch: Harriet Birungi: Challenges Facing HIV-Positive Adolescents in Kenya
›“Services are not necessarily very adolescent-friendly, so when you get children who are HIV-positive they are likely to face discrimination,” says Harriet Birungi, an associate in the Reproductive Health Program with the Population Council in Kenya, in this interview with ECSP’s Gib Clarke following the Global Health Initiative’s Integrating HIV/AIDS and Maternal Health Services panel.
According to Birungi, medical service censoring and targeted exclusion from schools are among the top challenges facing Kenyan adolescents living with HIV/AIDS. She hopes better support systems and intervention strategies, especially for pregnant individuals, will help medical personnel more quickly identify HIV-positive young adults needing critical medical services.
