Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war.

Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now.

“After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. 

The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon,  Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia.

Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. 

“The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report.

Narrow definition of rape

Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women.

The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen

“It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report.

Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction.

“True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report.

Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape .

Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. 

Marital rape not recognised

Justice for rape survivors

Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. 

The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. 

Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions.

In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled.

“International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. 

“Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.”

Harmful traditional beliefs

Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. 

“Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report.

In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. 

This often results in rape survivors being pressurised to agree to this route.

In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. 

“Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes.

Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. 

Inadequate punishment

Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict.

The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. 

In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement.

Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape.

Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan.

In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts.

With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. 

During conflict, reporting cases, collecting evidence and prosecution are often huge challenges.

Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape

With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction.

Urgent reform 

Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report.

It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. 

“Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes.

It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose”

Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid.

Image Credits: CC, Mohamed Zakaria/ UNICEF.

Ambassador John Nkengasong, head of PEPFAR.

As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January.

“The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday.

However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush.

“It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy.

Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. 

PEPFAR achievements 2024
PEPFAR’s achievements by 2024.

Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. 

“We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim.

“PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added.

But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years.

Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030.

HIV money is drying up

HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV.

As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. 

Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing.

UNAIDS deputy director Christine Stegling.

Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict.

“There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands.

“But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.”

But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added.

“AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling.

Shift to domestic financing

Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. 

“So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington.

Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution.

Professor Dean Jamison

Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV.

“Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted.

Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue.

Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on.

“These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted.

With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. 

What lies ahead?

Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments.

Meanwhile, Nkengasong stressed that progress should not be confused with success.

“The progress that we have made is very fragile,” Nkengasong stressed.

PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,.

“Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day.

“We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.”

Image Credits: US State Department.

A policy panel held at the World Vaccine Congress Europe.

From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape.  

Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in  Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress.

Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations.

The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. 

“Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa.

Impact on families

Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. 

According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner.

The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families.

Long-term burden of respiratory illnesses

Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.”

This chronic burden reinforces the necessity of early intervention.

RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems.

The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by  ambulance. 

New tools to prevent RSV 

With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. 

The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. 

“Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar.

Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV.

This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families.

Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP).  “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. 

Challenges in implementing technologies

Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. 

For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers.

Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres.

The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding.

Pivotal moment

The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said.  

Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. 

Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. 

The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health.

This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD.

Susan Hepworth is executive director of the  National Coalition for Infant Health.

Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation

A new report cautions that land degradation, if not reversed in time, could harm generations.

The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday.

Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with  the UN Convention to Combat Desertification (UNCCD).

Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report.

“We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report.

There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024).

Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction.

Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink.

Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns.

“If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD.

Land is under threat from human activities, climate change

The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009.

How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary.

“The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report.

Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact.

Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use.

In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report.

What governments must do

The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement.

Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution.

In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted.

For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies.

Transformative actions can halt land degradation

Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then.

Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues.

Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed.

They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy.

This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis.

Image Credits: Unsplash, UNCCD report.

WHO’s Dr Maria Von Kerkhove warns against drinking raw milk.

“Much stronger surveillance” of deadly H5N1 and other avian influenza strains in both domestic and wild animals is needed both in The United States as well as globally so as to head off pandemic risks from variants that could mutate to infect humans more directly. 

A senior World Health Organization official, Dr Maria Van Kerkkove, issued the appeal at a WHO press briefing on Thursday. She also said that WHO ‘always’ recommends drinking pasteurized, instead of raw, milk – due to the risks of contamination by a number of pathogens, including H5N1 virus.

At the briefing, WHO Director General Dr Tedros Adhanom Ghebreyesus also welcomed  the new cease-fire between Israel and Lebanon.  But he said that much more still needs to be done to end hostilities between Israel and Hamas in Gaza – where 90% of Gaza Palestinians are now facing winter in tents, with risks of respiratory diseases, cold exposure and malnutrition even more acute than last year. See related story:

WHO Welcomes Israel-Lebanon Ceasefire – But Onset of Winter Increasing Desperation in Gaza   

‘Epizotic’ of Avian flu in animals worldwide 

While the number of human infections from H5N1 is “still small, relatively speaking,” it is also growing  “not only in the US, but around the world over the last several years,”  Van Kerkhove told journalists.

But what is really “concerning” she added, is the “massive epizootic of avian influenza, including H5N1, but not just H5N1, in wild birds, in poultry, expanding to other animals, livestock, dairy cattle in the United States, but also land mammals, marine mammals. 

“And over the last couple of years, this expansion of H5N1 of avian influenza is putting more people at risk,” she added.  

So far, there have been about 55 human infections reported in 2024, she said, 52 in the United States. All but two of others had “known exposure” to infected animals. And there are extensive investigations that are underway looking at the pathway of exposures in the different cases, to see how people were in fact infected, she added. 

“But what we really need globally, in the US and abroad, is much stronger surveillance in animals, in wild birds, in poultry, in animals that are known to be susceptible to infection, which includes swine, which include dairy cattle to better understand the circulation in these animals, ,” stressed Van Kerkhove. And, she added, “we need much stronger efforts in terms of reducing the risk of infection between animals to new species and to humans.”

The US Department of Agriculture has confirmed cases of infected cattle in some 505 dairy herds in 15 US states since the outbreak was first reported in March, as well as in 50 commercial poultry flocks, according to the latest government data.

H5N1 outbreaks in cattle since beginning of outbreak in March 2024.

More protection of people occupationally exposed also needed

Van Kerkhove also called for more protection of people most at risk – those working with, or handling animals, “making sure that they have the right personal protective equipment, that it’s worn appropriately and properly when they are handling infected animals or even suspected infected animals. 

“We need to make sure that they have testing, that they have access to care, so that we can mitigate any potential spread. We have not seen evidence of human to human infection, but again, for each of these human detected cases, we want to see a very thorough investigation taking place, including further testing of context.

Finally, she added that WHO recommends that the public always drink pasteurized milk rather than raw milk products “for a number of different health benefits…. This is just as important for H5N1 as it is for other pathogens, other bacteria.”

WHO appeals risk a chilly reception from the new US administration 

Robert Kennedy Junior’s photo on X. The nominee for US Secretary of Health and Human Services advocates raw milk consumption and has promised to shift attention from infectious to chronic disases.

The recommendations for stepped-up surveillance of H5N1 in animals and people, as well as  avoidance of raw milk consumption, are likely to meet with a chilly reception in the new US administration of President-elect Donald Trump, who will be inaugurated on 20 January 2024.  

Although US dairy cattle are currently at the epicenter of an outbreak of H5N1 surveillance of both human and animal cases has so far been based largely on voluntary testing and reporting. 

And Robert F Kennedy Jr, Trump’s nominee for the head of the US Department of Health and Human Services (HHS), has long been a proponent of expanding raw milk consumption, and he wants to put a bigger focus on the US epidemic of non-communicable diseases, as compared to infectious disease risks.  

At the same time, concerns over raw milk contamination are rising after some state and county health officials, notably in California, recently began testing bulk milk supplies – finding traces of avian flu in one lot just last week, produced by Raw Farm LLC of Fresno. The company voluntarily recalled the lot.  

A lot of raw milk, was voluntarily recalled by a California manufacturer after Fresno County authorities reportedly found traces of H5N1 virus during bulk testing.

The enhanced testing followed an announcement by the US Department of Agriculture, 30 October, that it would support more bulk milk sampling as well as enhanced testing of dairy cattle herds’ milk samples for H5N1 nationally, in collaboration with veterinarian groups.  

But it remains unclear if Trump’s new DOA nominee, Brooke Rollins, a conservative lawyer and Trump loyalist who grew up on a Texas cattle farm, would continue to expand or restrict such surveillance.  

Meanwhile, Trump’s nominee for the head of the US Food and Drug Administration, Johns Hopkins Professor Martin Makary, is a more conventional pick. But his track record during the COVID-19 pandemic, when he argued against lockdowns, masking, questioned the benefits of vaccine boosters, and incorrectly predicted in February 2021 that “COVID-19  will be mostly gone by April” due to acquired herd immunity, bodes ill for closer tracking of H1N1 infections, or future pandemic preparedness measures. 

Image Credits: Raw_farm_USA, US Department of Agriculture.

Most families in Gaza facing winter cold and rain in tents.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus welcomed the new ceasefire deal between Israel and Lebanon, which took effect Wednesday, but he noted that health needs in Gaza remain huge and “will only increase” with the onset of winter cold and rains.  

While there is an opportunity now to rebuild southern Lebanon’s shattered health infrastructure, the plight of Gazans is only getting worse, he said: 

“A year ago, almost all those displaced by the conflict were sheltered in public buildings or by family members. Now, 90% are living in tents,” Tedros observed, referring to the massive military destruction of schools and other public spaces that has since occurred over the course of the war. 

“This leaves them vulnerable to respiratory and other diseases, cold weather, rain and flooding are expected to exacerbate food insecurity and malnutrition,” Tedros said. 

Northern Gaza ‘blockade’ still limiting access to aid – Tedros

WHO Director General Dr Tedros Adhanom Ghebreyesus.

A continuing Israeli blockade of northern Gaza is limiting the entry of essential resources, “including blankets, fuel and food, all of which are already in short supply,” Tedros added.   

Israel has denied that it is limiting aid deliveries to the area, but it admits that aid distribution is a growing challenge due to the hijacking of deliveries by criminal gangs. Some 101 Israeli and foreign hostages also remain in Hamas captivity in Gaza, for the 14th month, with dwindling prospects for their survival as time goes on. 

Over the past month, Israel leveled thousands of homes and ordered the relocation of tens of thousands of Palestinians away from the sprawling Jabaliya refugee camp and other northernmost Gazan communities in the course of fierce battles with still-active Hamas forces in the area. 

The displacement has occured amidst growing signs that Israel’s hard right leadership bloc and its settler supporters are planning to reoccupy depopulated areas of northern Gaza, contrary to international law – and despite the denials of Prime Minister Benjamin Netanyahu and other top military and foreign ministry officials. 

Critical shortages of medicine and fuel  

Al Shifa hospital 23 November: WHO describes critical shortages of medicines and fuel following recent visit to northern Gaza hospitals.

Most immediately, however,  severe shortages of fuel and medicines, as well as food, in the besieged area pose continued challenges even to the limited functionality of the area’s hospitals, said WHO officials.  

“This week, WHO and our partners conducted a three day visit to the north of Gaza,” Tedros said. “The team visited 17 health facilities, including five hospitals. They saw a high number of trauma patients and increasing numbers of patients with chronic disease needing treatment. 

“There are critical shortages of essential medicines,” he asserted adding, “WHO and our partners are doing everything we can, everything Israel allows us to do, to deliver health services and supplies.”  

Tens of thousands of Palestinians who were displaced from Jabaliya and areas along the border with Israel have now moved south to Gaza City, added said Rick Peeperkorn, head of WHO’s Office in the Occupied Palestinian Territory (OPT). 

“There’s between 100 to 150,000 people from the north who are now actually camping in Gaza City,” he said. 

Huge increase in insecurity, crime and looting

Dr Rick Peeperkorn, head of WHO’s Office for the Occupied Palestinian Territory (OPT)

“There’s a huge need for mental health, psychosocial support, especially also for the health workers,” Peeperkorn said. “And of course, the shortages in supplies, staffing, but also the high influx of trauma patients. And the shortages remain in the key area, energy, as well as antibiotics, surgical supplies, oxygen, IV fluids, etc.” 

In the wake of the progressive destruction of Hamas,  “we have seen a huge increase in insecurity, crime and looting,” Peeperkorn admitted, compounding the problems with delivery of aid.  

On a faintly positive note, WHO this week facilitated the medical evacuation of some 70 patients to Jordan and elsewhere abroad for medical treatment – one of the largest groups to be moved out of the conflict zone since the  Rafah crossing closed, Peeperkorn noted. 

But he called for the re-establishment of more “consistent” medical corridors abroad, noting that with 12,000 chronically ill or injured people waiting to be referred out of Gaza  “if we continue at this pace, we’ll be busy for the next 10 years.” 

Added Tedros, “Once again, the ultimate solution to the suffering is not aid but peace. As we always say, the best medicine is peace.”

Image Credits: @WHO.

Burundi health officials conduct medical consultations and awareness sessions about sexual and reproductive health and mpox with displaced people in camps in Mubimbi and Rumonge.

Despite having the second biggest mpox outbreak in Africa, Burundi has no immediate plans to vaccinate those at risk.

Donated vaccine doses are available to Burundi for free but “vaccine hesitancy” might be playing a part in the government’s reluctance to vaccinate people, according to Dr Ngashi Ngongo, mpox lead for the Africa Centres for Disease Control and Prevention.

Over the past week, Burundi has registered 273 new mpox cases – an 13.8% increase over the previous week – and its first death. Overall, it has over 2,000 cases.

“The problem is not really the availability of vaccines. The problem is more on the country’s side,” Ngongo told an Africa CDC briefing on Thursday.

“During the COVID-19 time, it was a similar experience, where there was hesitancy to embrace vaccination. But toward the end of the response, the government of Burundi had accepted for vaccinations to be introduced in Burundi. We are hoping that it will be the same here.”

Ngongo confirmed that “there was really some hesitation” from the government, who wanted more information. 

“That information is being provided in order to get to the point where we can then convince the government of Burundi to move ahead with vaccines,” said Ngongo.

“The vaccines are ready. As soon as they accept, we should be able to deploy them.”

Burundi is one of the poorest countries on earth and two-thirds of the population live below the poverty line, according to the World Bank.

While 44 of the country’s 49 districts have registered mpox cases, the heart of the outbreak is in the economic capital of Bujumbura, where almost 60% of cases are, according to Ngongo.

Children under the age of 15 account for 42.9% of the country’s cases, the highest percentage on the continent. Clade 1B is dominant. 

Former President Pierre Nkurunziza failed to impose public health measures to control COVID-19. But after his death in 2020, his successor, Évariste Ndayishimiye, gave the go-ahead to vaccinations.

Misinformation campaign

However, vaccination campaigns particularly in Francophone Africa have become the target of disinformation campaigns allegedly fueled by Russia, according to The New York Times. 

Pro-Russian social media influencer Egountchi Behanzin has campaigned against malaria vaccines solely because they were developed in Western countries.

More recently, Behanzin – who has a large social media following and posts daily videos – took aim at mpox vaccines and urged Congolese people to reject them.

He claimed Western countries were involved in “health terrorism”.

Steady growth of mpox

In the past week, Africa has recorded 2,680 new cases (492 have been confirmed) and 22 deaths.

Some 84% of cases are located in the Democratic Republic of Congo (DRC), which recorded 2,261 new cases. The country also recorded 21 deaths, representing 95% of the continental total. 

Burundi and Uganda account for most of the remaining cases, while there are smaller outbreaks in Cameroon, Central African Republic and Liberia.

Gabon, Guinea and South Africa have moved from “active” to controlled, with no new cases in the past six weeks.

Meanwhile, the US and Canada have recorded their first mpox cases in people who have traveled to African countries with outbreaks.

Vaccination campaigns

In contrast to Burundi, Rwanda, DRC and Nigeria have started to vaccinate people at risk. Almost 56,000 people have been vaccinated in seven provinces of the DRC.

Rwanda has already reached 44% of its initial target, and is planning a new strategy for the next phase – “cluster vaccination in hot spots”, said Ngongo.

“Given that in some of the areas, the identification of contacts has remained a challenge, I think entire households are also being considered where there’s clear evidence of proximity and increased risk to those around the confirmed case,” said Ngongo.

The Japanese LC16 has now been included in the World Health Organization’s (WHO) emergency use listing for people aged one year and above.

“Now we are just waiting for the confirmation now from the Japanese government when the three million doses going to arrive in the DRC,” Ngongo noted.

Still a public health emergency

The International Health Regulations (IHR) Emergency Committee has resolved that mpox is still an public health emergency of international concern (PHEIC), WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

According to a statement from the emergency committee meeting held last Friday (22 November), the “observed dynamics of transmission” of mpox clade 1b in DRC “are changing over time and are diverse across affected health zones”.

Infections have “shifted from adults, where transmission was first observed and appears to have been sustained by contact within commercial sexual networks, to younger age groups, including children, and sustained by household and likely broader community transmission through close physical contact”, it notes.

“Regardless of the circulating mpox clades, adults of 50 years of age or older are less affected, likely due to the immunity conferred by prior vaccination against smallpox,” it notes.

“As we have said many times, we’re not dealing with one outbreak of one virus, but several simultaneous and overlapping outbreaks of different strains or clades of the virus affecting different groups in different places,” added Tedros.

“We still face many challenges to bring these outbreaks under control. We need stronger political commitment to scale up responses activities. We need fully resourced preparedness and response plans. We need further contributions of medical countermeasures, including diagnostics and vaccines. And we need continued transparency and collaboration between affected countries and partners.”

Ipas CEO Dr Anu Kumar at a meeting in Mozambique.

Dr Anu Kumar, CEO of the global reproductive justice organisation Ipas, outlines the impact of a global clampdown on abortion

“Unsafe abortion remains a leading cause of maternal mortality, and it is entirely preventable,” says Dr Anu Kumar, CEO of Ipas, an international reproductive justice organisation. “So there is something we can do about it. We know what to do and we know how to do it. We just need to do it.”

But Kumar concedes that the election of Donald Trump as United States (US) President has ushered in a “pretty grave and serious moment” for reproductive rights.

Trump draws significant support from vehemently anti-abortion Christian conservatives and is widely expected to entrench more anti-abortion measures when he assumes office in late January, both in the US and globally – and this is likely to impact on millions of women and girls, and organisations like Ipas and its partners.

Ipas focusses solely on expanding access to abortion and contraception services and works in 23  countries, mainly in sub-Saharan Africa, Asia and Latin America, as well in the US.

Last year, the organisation helped over 640,000 people to get abortions and over 1.5 million to get contraceptives.

 

Ipas staff member Adeodatus Shukuru, an internally displaced person and peer educator in the Democratic Republic of Congo, with women who have come for treatment at the Ipas mobile clinic.

US domestic impacts

Abortion access in the US has already been curtailed since the national right to abortion was abolished by the Supreme Court in 2022, thanks to conservative Trump appointees to the court.

Since then, 14 US states including Texas have almost totally banned abortion and four others have severely restricted access. Texas has focused its laws on health professionals who perform abortions, introducing lengthy jail terms for them.

This has instilled fear in health professionals to the detriment of patients. Recently, a Texan woman died in childbirth because doctors were too scared to give her a standard procedure after her miscarriage – presumably in case it was misconstrued as an abortion. 

Porsha Ngumezi bled to death because doctors did not give her get a dilation and curettage (D&C) that would have removed pregnancy tissue from her uterus and stopped her haemorrhaging, reports ProPublica. 

In July, a Texan woman was charged with murder for taking abortion pills to end her pregnancy.

“Right after the election, there was a huge increase in sales of medical abortion pills, which is an indicator in the US that women are expecting there to be a crackdown,” notes Kumar, who is based in North Carolina in the US. 

Restrictions on abortion pill mifeprisone

There are a number of different avenues that the future Trump administration can take to limit domestic access to abortion, through the executive, via administrative powers, Congress and the courts.

“One of the most significant paths will be restrictions on the use of mifepristone, one of two drugs that are that is used to provide medical abortions,” says Kumar, adding that 63% of all US abortions are medication abortions. 

Ipas anticipates that the Trump administration will restrict telehealth abortions, while the  Federal Drug Administration (FDA) may remove or restrict access to mifepristone or rescind the licencing of the drug altogether. 

“We could also see the Justice Department enforcing the Comstock Act that has been on the books since 1873, although it hasn’t been enforced in recent decades,” notes Kumar.

This prohibits the mailing and receiving of “obscene materials”, and abortion-related material, devices and pills could be categorised as obscene. 

“That kind of broad interpretation of the Comstock Act could criminalise people for administering surgical or medication abortion pills. And then, of course, there’s the judiciary, which could rule against access to medical abortion pills.”

Global scenarios

An Ipas-trained Natural Leader conducts a community session on safe abortion services in Achham, Nepal

But the US also exports its anti-abortion agenda, particularly to countries that receive US aid. Fifty one years ago, the US introduced the Helms Amendment, which prohibits the use of US foreign assistance money for abortion. This is adhered to by Republicans and Democrats.

In 1984, Republican President Ronald Reagan introduced what has become known as the Global Gag Rule, preventing NGOs that receive US funding from using their own funds to provide abortions or referrals, or lobby for abortion law reform. Every Republican administration has implemented this since it was introduced, while Democrats have rescinded it.

“The last time the Trump administration was in power, they expanded the Gag Rule to apply to all global health funding, which impacted about $12 billion,” said Kumar. “Now the threat is that it will be expanded even further, and it could impact programmes from HIV to water and sanitation to research.”

It could also be expanded to apply to US-based NGOs and foreign governments. 

“We don’t know if that will be the case, but if we do see such a drastic expansion, it will have a dramatic impact on not only Ipas’s work, but the work of all of our partners in this sector and beyond.”

Antiretrovials or abortion?

For example, in South Africa, abortion is legal and provided in the public health system. But  the country also receives US funding for HIV through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

So would South Africa need to choose between providing abortion or antiretrovirals?

“It’s hard to walk through what that would look like,” says Kumar. “It’s quite complex. Very likely, the announcement will be made about the Gag Rule on Day One of the Trump administration and we’ll see whether they’re expanding it and, if so, by how much.

“Then the contract language will come out several months later, and in that contract language, we will actually see how they’re intending on enforcing it.”

But the Gag Rule is also likely to also have a chilling effect on countries that may have been considering liberalising abortion access but decide it’s too high a price to pay given the centrality of the issue for the US, she adds.

Global aid is drying up

There aren’t many countries that can step into the breach left by the US withdrawal of funds for sexual and reproductive health (SRH). The Swedish and the Dutch – historically significant SRH funders, are also under more right-wing governments and are pulling back.

Canada remains supportive, but faces its own election in 2025 and conservatives are strengthening in that country too.

“Potentially other governments could step in, although I have to say I don’t have a long list in mind,” says Kumar.

“The world is in some ways, a much worse place than we were during the first Trump administration. We have at least two active wars going in Ukraine and the Middle East that Europe and the rest of the world are extremely worried about. That is taking not just human lives and resources.”

Alternative to Universal Declaration of Human Rights?

Trump ally Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in front of flags of signatories.

The prospect of the US defunding the UN Population Fund (UNFPA) is “almost a given”, says Kumar.

Its withdrawal from the World Health Organization (WHO) is “pretty likely” because of Republicans’ anger about how the WHO handled the COVID-19 pandemic and the pandemic agreement currently being negotiated.

“But the US withdrawal from these UN technical agencies is really about a broader issue,” says Kumar.

The Trump administration and its conservative allies are proposing the anti-abortion Geneva Consensus Declaration as “an alternative view of the Universal Declaration of Human Rights”, says Kumar. 

“This is a framework that undermines the Universal Declaration of Human Rights and imposes a different worldview, and that is actually what they’re after.”

Glimmers of hope?

“One major area of hope is that the sexual, reproductive health and rights movement has actually been extremely successful over the last 30 years,” says Kumar.

“Sixty countries have liberalised their abortion laws. Only four countries have gone backwards, and the United States is one of them.”

The election of a more liberal government in Poland that is making progress to relax its abortion ban “gave me a fair amount of hope that that the right wing fever may be breaking a little bit”, she added. 

The loss of support of Narendra Modi in the Indian election was also promising, says Kumar, as he has had to “form a coalition government and temper some of his anti-democratic tendencies.” 

Money talks and the US has long used it to force through its ambitions, but Kumar also hopes that countries will “make their values clear and resist some of the the bullying that typically takes place with the US government, especially when it comes to pooled funding mechanisms and working in partnership with the US government”. 

“A withdrawal of of some countries from US partnerships in development systems could send a very strong signal that countries don’t share the same values as the US government does,” she adds.

Image Credits: Ipas, Council on Foreign Relations.

Dr Faustine Ndugulile (centre) flanked by Dr Matshidiso Moeti, current WHO Africa director, and WHO Director General Dr Tedros Adhanom Ghebreyesus after his election in August.

Dr Faustine Ndugulile, the World Health Organization’s (WHO) regional director-elect for Africa, has died while receiving medical treatment in India, Tanzania’s parliament speaker announced on Wednesday.

Ndugulile, aged 55, was due to assume his position as the next leader of WHO Africa in February 

No reasons were given for his death, which has been met with shock and sadness by WHO Director-General Dr Tedros Adhanom Ghebreysus, WHO regions and the Africa CDC.

Ndugulile, a former deputy health minister and ICT minister in his country, has represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

He served as deputy health minister under former President John Magufuli, who denied the existence of COVID-19. However, Ndugulile publicly urged Tanzanians to protect themselves against the disease and this may have cost him his position, according to Tanzanian news outlet The Chanzo Initiative.

Magufuli fired Ndugulile as deputy health minister in May 2020 during the height of COVID-19. Magufuli died in March 2021 aged 61, amid rumours that he had been infected with COVID-19.

Ndugulile was also vice-chair of the global Inter-Parliamentary Union’s advisory group on health. 

Aside from a medical degree, 55-year-old Ndugulile had a Masters degree in public health and a law degree. 

Ndugulile secured 25 of the 46 votes for regional director at the WHO Africa regional conference in the Republic of Congo in August, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

In his CV, Ndugulile lists his notable achievements, including “championing the passage of the Universal Health Insurance Bill in 2023, advocating for the implementation of an integrated and coordinated community health worker program and successfully advocating for the ratification of the African Medicine Agency (AMA) convention”.

Describing himself as a “technocrat, politician and policy maker”, Ndugulile has promised to “prioritise strengthening of WHO country offices to ensure timely, relevant, optimal and effective support to the member states”.

He was due to succeed Botswana’s Dr. Matshidiso Moeti, who served as WHO Africa director for two terms. 

 

Delegates at ILGA, the international lesbian, gay, bisexual, trans and intersex association, which held its biggest-ever international summit in Cape Town, South Africa, earlier this month.

The global rise of right-wing governments is threatening sexual and reproductive health (SRH) and LGBTQ rights – but human rights defenders and progressive donors are rallying to mitigate this.

US President-elect Donald Trump is expected to reinstate the Global Gag Rule that prohibits foreign NGOs who get US aid from providing or advocating for abortion on Day One of his presidency. His Defense Secretary pick, Pete Hegseth, is predicted to take action against transgender soldiers in the US Army. 

There will also be a substantial reduction in global aid for SRH and LGBTQ communities as Trump will end US support for these issues, both via the US Agency for International Development (USAID) and by reducing funding for UN agencies.

Several European governments that had stepped up during Trump’s previous presidency (2017-2021) to fund SRH and LGBTQ causes are now under right-wing rule and implementing aid cuts of their own. Others are overburdened with aid to Ukraine.

The Dutch government, now governed by a right-wing coalition, aims to cut its overseas development aid (ODA) by almost one-third next year. Grants to Dutch NGOs that dispensed much of the funds will be cut by 70%.

The Netherlands was the second biggest European donor for SRH, but it did not even mention SRH or LGBTQ issues in its mid-November announcement on development budget cuts. Under health priorities, it only mentions HIV and “preventing harmful cultural practices such as female genital mutilation, child marriage and harmful rites of passage to adulthood”.

In 2022, Sweden, under a centre-right coalition, cut its support for SRH by 17%, (168.5 million Euros) and is planning further cuts. However, it has maintained support for LGBTQ rights.

New LGBTQ funding

Days after Trump’s victory, ILGA, the international lesbian, gay, bisexual, trans and intersex association, held its biggest-ever international meeting in Cape Town, South Africa, vowing to act “in global solidarity against the ongoing anti-rights pushback”.

Shortly before the ILGA meeting, the first-ever Global LGBTI Funding Summit secured $100 million in new donor pledges for global LGBTI rights. But only three governments – Denmark, Germany, and Norway – have pledged so far.

“The Global Philanthropy Project (GPP) mobilized this campaign in response to seeing big risks to global LGBTI funding on the horizon,” GPP deputy director Ezra Nepon told Health Policy Watch.

“The US election results confirm and amplify those risks, and the $100 million in pledged new funds for LGBTI communities will be crucial to help resource and defend movements under attack. With the success of reaching our first pledge goal, GPP has extended the campaign to mobilize another $50 million in pledges by June 2025. Now is the time to step forward and commit big new resources for LGBTI movements and communities around the world.”

Germany and Mexico are co-chairs of the Equal Rights Coalition, a 44-country strong alliance of governments and NGOs formed in 2016 to protect the human rights of LGBTI people. Not a single African country belongs to the coalition although South Africa’s Constitution prohibits discrimination based on sexual orientation.

The work of the coalition takes place largely in thematic groups. The Netherlands, with NGO OutRight, heads international diplomacy efforts but its role is in question given its new right-wing government.

Democracy is not a ‘spectator sport’

Dr Alvero Bermejo, Director-General of the International Planned Parenthood Federation (second left), Mpho Tutu-van Furth (right) and others address the ILGA opening plenary.

Addressing the opening of the ILGA conference, Reverend Mpho Tutu-van Furth warned against assuming that the right to equality had been won.

“Complacency is a kind of drugged drowsiness. When we walk around assuming that what has been won will always be ours, we find that those wins are challenged or they’re eroded or they’re ignored,” said Tutu-van Furth, daughter of legendary anti-apartheid leader Archbishop Desmond Tutu.

“In South Africa, we swallowed that sweet syrup of complacency. Justice had won. Justice was done,” said Tutu-van Furth, now a pastor in the Episcopal Church as the Anglican Church withdrew her license to preach after she married a woman.

“We treated democracy as a spectator sport. Our ballot was the ticket to the game. Cast your vote and watch the government of the day do the best for you. But democracy is not a spectator sport, and your ballot is not a ticket to snooze in the stands. Your ballot is a permission slip that allows you to hold your elected representatives to account.”

Also addressing the ILGA Summit, Dr Alvero Bermejo, Director-General of the International Planned Parenthood Federation (IPPF), appealed for alliances to secure human rights.

“During the HIV crisis, there were strategic partnerships with very different partners,” Bermejo noted. “The space has shrunk. People are quick to call each other out on social media. But we need to re-create the space to make alliances.”

Rights are good for health

Depriving people of rights has negative consequences for health, particularly in the spread of sexually transmitted infections.

“Studies have consistently found that HIV policies grounded in human rights achieve superior results over those that are not rights-based,” UNAIDS notes in its annual World AIDS report released on Tuesday.

HIV prevalence is five times higher among men who have sex with men (MSM) in countries that criminalize same-sex sexual acts, according to UNAIDS, which has made “Take the rights path to end AIDS” its theme for International AIDS Day on 1 December.

“The human rights environment is deteriorating in many countries, and the commitment to multilateral efforts to address global challenges is often fraying,” the UNAIDS report notes.

“These trends are interconnected and threaten to undermine access to HIV prevention and treatment. Contexts that are experiencing democratic retrenchment are frequently those that are increasingly hostile to gender equality and the human rights of people from key populations.”

“Key populations” refers to those most vulnerable to HIV: sex workers, men who have sex with men, transgender people, prisoners and people who inject drugs.

Andriy Klepikov,  executive director of the Alliance for Public Health, one of the largest HIV and TB NGOs in Ukraine, describes the stalemate over human rights as “a war between ideology, prejudice and stereotypes on the one side and evidence-based science on the other side.”

“Countries like Russia are neglecting all the evidence [which shows] that the HIV epidemic is going up as a result of punitive law and repressive policies,” he told a World Health Summit event last year. 

Writing in the UNAIDS report, Elton John notes: “Shockingly, 44% of all new HIV infections worldwide are among women and girls. The risk of acquiring HIV is 23 times higher for gay men and other men who have sex with men than for people in the general population.”

Mpox vaccinations hindered

Mpox can also be sexually transmitted and “most of the cases that were reported in the multi-country outbreak in 2022/2023 were identified among gay, bisexual and other men who have sex with men,” according to the World Health Organization (WHO).

However, in the large mpox outbreak currently affecting Central Africa, only the Democratic Republic of Congo (DRC) is targeting MSM in its vaccination drive – and it can do so as it doesn’t outlaw same-sex relationships.

The DRC’s neighbours – Burundi and Uganda – are facing significant mpox outbreaks yet they are unable to reach this key group because they have outlawed all LGBTQ activities.

Likewise, banning abortion has never stopped women and girls from ending unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Unsafe abortions are a “significant and preventable cause of maternal mortality”, Dr Anu Kumar, CEO of Ipas, told Health Policy Watch.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

Polarised world

“In such polarised and contentious times, it has been heartening to witness so many people coming together, strengthening bonds to resist the anti-rights wave, and keep advancing the human rights of LGBTI peoples,” Julia Ehrt, ILGA World’s executive director, said after the conference.

“This conference has been a testament to the resilience, courage, and determination of our global movement. In Cape Town, we witnessed the strength of our unity, and we are inspired to continue working toward a world where everyone is free to live authentically and without fear.”

UNAIDS also notes that, “although the declining space for civil society in many parts of the world is alarming, there are places where space for civil society is expanding.

“In 2023, civic space opened up in more than 30 countries, including through judicial decisions, the release or acquittal of human rights defenders, or civil society policy victories,” it adds.

“We can elevate the human rights of all people living with or affected by HIV and end AIDS as a public health threat—or we can scapegoat, ostracize and punish the most marginalized people and watch the long-term human and financial costs of responding to HIV increase ever further,” UNAIDS concludes, calling on governments to fulfill their commitments to ending HIV.

However, the path ahead is rocky. Conservatives across the religious spectrum have formed strong alliances with right-wing politicians to ban abortion and promote the “natural family”, which is male-headed, heterosexual and has no space for LGBTQ people.

This alliance has deep pockets and is intent on rolling back a range of sexual and reproductive rights already won in international agreements, replacing them with documents such as the anti-abortion Geneva Consensus Declaration crafted during Trump’s presidency.

Trump’s US will become a poweful addition to the pushback against abortion and LGBTQ rights – currently led by at UN forums by Russia, Iran, Syria, Egypt and Nigeria.