Africa

Ghana marks 100 years since the return of a monarch exiled in Seychelles during the colonial era.

Ghana marks 100 years since the return of a monarch exiled in Seychelles during the colonial era.

Ghana marks 100 years since the return of a monarch exiled in Seychelles during the colonial era.

Navinchandra Ramgoolam, in power for a fortnight, spoke after meeting British envoy Jonathan Powell.

Seven people remain unaccounted for after a tourist boat sank on Monday after leaving the Egyptian port of Marsa Alam.

Photo courtesy: Shelter Associates

By Baher Kamal
MADRID, Nov 26 2024 (IPS)

In most Western European countries you can purchase –or rent- a 60 square-metres flat that is equipped with two toilets, one for her and one for him. Larger apartments may feature even more.

For those who can afford it, such facilities are taken for granted. Yet, nearly half the global population—over 3.5 billion people—live without access to safely managed sanitation, including 419 million forced to practice open defecation.

The Hidden Reality of Open Defecation

The consequences of open defecation are stark. Human waste contaminates rivers and groundwater—often the primary sources of drinking, cooking, and bathing water in impoverished regions. It pollutes the air and fuels the spread of deadly diseases like cholera and malaria.

For women and adolescent girls, the lack of sanitation also brings added challenges. Without hygienic facilities, they face health risks and societal stigma, particularly during menstruation, with nowhere to manage this basic need in privacy.

 

Global Promises, Limited Progress

Year after year, the world’s largest multilateral system – the United Nations, tries to draw attention to the dangers of the lack of such an essential sanitation service. And so it does once and again on the occasion of the 2024 World Toilet Day.

These dangers are one of the main sources of concern and worry of at latest 30 specialised bodies grouped in the international system.

Such is the case of the World Health Organization (WHO), the UN Children Fund (UNICEF), the UN Women, among many others, let alone the UN-Water which coordinates the United Nations’ work on water and sanitation.

Politicians promised that by 2030, they would achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.

This promise is part of the Sustainable Development Goals (SDGs).

Safely managed sanitation protects groundwater from human waste pollution. Credit: Lova Rabary-Rakontondravony/IPS

Yet another unmet promise

Nevertheless, “the world is alarmingly off-track to deliver sanitation for all by 2030.”

The evidence is sobering:

• Nearly half the world’s population, 3.5 billion people, use sanitation services that leave human waste untreated, jeopardizing human and environmental health.
• Of those, 419 million lack any toilet and practice open defecation.
• An estimated 367 million school-age children attend schools without toilets.
• Only 32% of forcibly displaced people have basic sanitation access.

At the current pace, sanitation for all won’t become a reality until the 22nd century, warns the World Health Organization.

Also this year, the whole UN system recalls that ‘Safe toilets for all by 2030’ is one of the targets of Sustainable Development Goal 6 . However, “the world is seriously off track.”

Indeed, this goal is among the 17 SDGs which were adopted nearly a decade ago by all members of the United Nations.

Also Toilets Are Under Threat

Yes, as armed conflicts, extreme weather events and disasters can destroy, damage or disrupt sanitation services. Here go some of the consequences:

“When toilet systems don’t work – or don’t exist – untreated human waste spreads in the environment, unleashing deadly diseases such as cholera,” warns the United Nations.

– Unsafe water, sanitation and hygiene are responsible for the deaths of around 1,000 children under five every day. (WHO, 2023)

– Children who live in extremely fragile contexts are three times more likely to practise open defecation, four times more likely to lack basic sanitation services and eight times more likely to lack basic drinking water services. (UNICEF, 2024).

Obviously the citizens living in industrialised countries are not to be blamed for having toilets… not at all. Rather, good for them.

But what about the decision-makers?

Ahead of World AIDS Day (1 December), a new report by UNAIDS released its report, 'Take the rights path to end AIDS.' Credit: UN AIDS

By Ed Holt
BRATISLAVA, Nov 26 2024 (IPS)

Gaps in realising human rights could stop AIDS being ended as a public health threat by 2030, UNAIDS has warned in a report to mark World AIDS Day.

In the report, entitled Take the Rights Path, the group says the global HIV response is at an inflection point and that decisions taken now by governments will determine whether the AIDS pandemic is no longer a public health threat by the end of the decade, a commitment in the UN Sustainable Development Goals (SDGs).

It highlights that a litany of widespread rights abuses, including girls being denied education, impunity for gender-based violence, arrests of people for who they are or who they love, and other barriers to accessing HIV services simply because of the community a person is from, are endangering efforts to end the pandemic.

The group has called on world leaders to ensure rights are upheld so that everyone that needs to can reach lifesaving programmes and AIDS can be ended, or risk “a future of needless illness, death, and unending costs.”

“It is entirely possible to end AIDS—the path is clear. Leaders must only choose to follow it,” Winnie Byanyima, UNAIDS Executive Director, told IPS.

HIV/AIDS activists and public health experts have in recent years increasingly pointed to the effects of repression of human rights on efforts to fight HIV/AIDS.

They have highlighted a growing marginalization and stigmatization of key populations, including LGBT+ people, and drug users, in a number of countries, including the introduction of legislation directly discriminating against those communities. Meanwhile, women’s rights continue to be repressed or not fully upheld in many parts of the world.

The UNAIDS report points out that currently, only three countries report no prosecutions over the past 10 years for HIV non-disclosure, exposure, or transmission and have no laws in place criminalizing sex work, same-sex relations, possession of small amounts of drugs, transgender people, or HIV nondisclosure, exposure, or transmission. It also shows that 44 percent of all new HIV infections worldwide are among women and girls.

Activists say it is essential that criminal and other laws that harm people’s rights must be removed, and at the same time laws and policies that uphold the rights of everyone impacted by HIV and AIDS are enacted.

“The science couldn’t be more clear—criminalization is prolonging the HIV epidemic and erodes the trust in the health system that is necessary not only for an effective HIV response but also for strong pandemic responses more broadly. But these gaps can be overcome—what’s missing is political will,” Asia Russell, Executive Director of campaign group Health GAP, told IPS.

There is concern, though, that against a backdrop of growing authoritarianism and a pushback against rights in many countries, this will be challenging.

“Scapegoating and criminalizing communities is a tool dictators and autocrats are turning to more frequently, driving people away from life-saving health services and making all communities less safe,” said Russell.

Ganna Dovbakh, Executive Director at the Eurasian Harm Reduction Network (EHRA), went even further, suggesting widespread criminalisation meant that achieving the end of AIDS as a public health threat increasingly appeared to be “wishful thinking.”

“It sounds unrealistic. Taking into account anti-gender and anti-human rights movements across the globe, it sounds too ambitious,” she told IPS.

However, while the report raises concerns about how the failure to ensure human rights is impacting efforts to fight HIV/AIDS and the potential for inaction on the matter to halt or even reverse progress in battling the disease, UNAIDS points out that there has been success in countries where people-centred approaches to fighting HIV have been adopted.

“Seven countries in Africa (Botswana, Eswatini, Kenya, Malawi, Rwanda, Zambia, and Zimbabwe) have already reached UNAIDS testing and treatment targets (95-95-95) for the general population.

“This is a testament to global solidarity, African political leadership, and the strong collaboration between governments, communities, civil society, science, and the private sector,” said Byanyima.

“While there are rising threats from anti-LGBTQ fundamentalists in the US, Russia, Uganda, Kenya, Tanzania, and elsewhere, not all countries are blindly embracing criminalization,” said Russell. “Some governments, however, have recently rejected this approach—such as Namibia, pointing to the racist and colonial origin of such laws and their destabilizing effect not on the HIV response but on society as a whole.”

However, the report lays bare the scale of the global challenge to end AIDS by the end of the decade.

In 2023, 9.3 million [7.4 million–10.8 million] people living with HIV were still not receiving antiretroviral therapy, and 1.3 million [1.0 million–1.7 million] people newly acquired HIV. In the regions where numbers of new HIV infections are growing the fastest, only very slow progress is being made in scaling up pre-exposure prophylaxis (PrEP). These regions also lag behind sub-Saharan Africa in progress towards meeting the 95–95–95 HIV testing and treatment targets, according to the report.

It also said that coverage of prevention services among the populations at greatest risk of HIV is very low—typically at less than 50 percent—and that HIV infections are rising in at least 28 countries around the world.

“These countries need to look at their policies and programmes and build a rights-based approach to turn their epidemics around,” said Byanyima.

Despite this, the group remains optimistic that the disease can be ended as a public health threat by the end of the decade—if governments take action now.

“It is still possible, but leaders must act now to dismantle barriers to health. I remain hopeful, but it will only happen if countries with expanding epidemics change course and protect everyone’s rights to protect everyone’s health,” said Byanyima.

Some others agree, but say it is likely governments will need to be pushed into taking the action necessary to end AIDS.

“We have the interventions that can deliver the defeat of the AIDS crisis—if deployed at scale, with the people most in need at the front of the line rather than pushed to the back. What’s missing is equitable access to the advances of science and human rights and the political will,” said Russell.

“The case for closing the HIV funding gap, reversing criminalizing laws, and accelerating deployment of superior prevention technologies could not be stronger. Unfortunately. Many governments are not, on their own, showing the leadership we need… pressure is needed now to compel government action—political will in response to the AIDS crisis rarely happens because of benevolence; it emerges in response to the pressure of accountability from communities,” she added.

Mark Harrington, Executive Director of the Treatment Action Group campaign organisation, said decades of advances in medical science meant “the toolkit we have to prevent and treat HIV, and to ensure that people can live healthy long lives regardless of HIV status, is better than it’s ever been,” but that governments must be pushed to ensure they are “responsive to the health needs of their people to fulfill the promise of all these results of decades of research and activism.”

“Political will has to be continually created and strengthened. As activists, that is our job. Over the past four decades, scientists and activists have made unbelievable progress against a once untreatable disease. We need to keep on reminding policymakers of their duties and communities of their rights to health,” he told IPS.

IPS UN Bureau Report

 

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Excerpt:

Ahead of World Aids Day 2024, UNAIDS released its report 'Take the rights path to end AIDS,' in which it stressed the world could meet the agreed goal of ending AIDS as a public health threat by 2030—but only if leaders protect the human rights of everyone living with and at risk of HIV.

COP 29/CMP 19/CMA 6 closing plenary Credit: Vugar Ibadov/UNFCC

By Joyce Chimbi
NAIROBI & BAKU, Nov 26 2024 (IPS)

The culmination of bitter, difficult, and challenging climate negotiations concluded with an announcement from the COP29 Presidency of Azerbaijan of the “agreement of the Baku Finance Goal—a new commitment to channel USD1.3 trillion of climate finance to the developing world each year by 2035.” This is on top of the USD 300 billion that the developed world is to extend to developing nations annually by 2035.

Developed nations appear perturbed by the outrage from the Global South as the COP29 Presidency big-up what is for all intents and purposes a bad deal for vulnerable nations on the frontlines of climate change. Once an annual inflation rate of 6 percent is factored into the new goal, USD 300 billion is not the tripling of funds that is being made out to be.

The Baku deal indicates that “developed countries will lead a new climate finance goal of at least USD 300 billion per annum by 2035 from all sources, as part of a total quantum of at least USD 1.3 trillion per annum by 2035 from all actors, with a roadmap developed in 2025.”

Ambiguous Climate Finance Promises

The promise of a USD 1.3 trillion of climate finance in line with what developing countries wanted rings hollow, for the text does not lay out the road map for how the funds are to be raised, postponing the issue to 2025. Even more concerning, Baku seems to have set things in motion for wealthy nations to distance themselves from their financial responsibility to vulnerable nations in the jaws of a vicious climate crisis.

COP29 text “calls for all actors to work together to enable the scaling up of financing to developing country Parties for climate action from all public and private sources to at least USD1.3 trillion per year by 2035.”

In this, there is a mixture of loans, grants, and private financing. Essentially, the Baku agreement reaffirms that developing nations should be paid to finance their climate actions, but it is vague on who should pay.

Baku to Belém Road Map

For finer details, there is a new road map in place now known as the “Baku to Belém Road Map to 1.3T.” COP29 text indicates that the “Baku to Belém, Brazil’ roadmap is about scaling up climate finance to USD 1.3 trillion before COP30 and that this is to be achieved through financial instruments such as grants, concessional as well as non-debt-creating instruments. In other words, the roadmap is about making everything clear in the coming months.

In climate finance, concessionals are loans. Only that they are a type of financial assistance that offers more favourable terms than the market, such as lower interest rates or grace periods. This is exactly what developing nations are against—being straddled with loans they cannot afford over a crisis they did not cause.

Article 6 of Paris Agreement: Carbon Markets

Beyond climate finance, there are other concerns with the final text. Although it has taken nearly a decade of debate over carbon trading and markets, COP29 Article 6 is complex and could cause more harm than good. On paper, the carbon markets agreements will “help countries deliver their climate plans more quickly and cheaply and make faster progress in halving global emissions this decade, as required by science.”

Although a UN-backed global carbon market with a clear pathway is a good deal, it falls short on the “transparency provision” as the agreement does not address the trust crises compromising current carbon markets. Countries will not be required to release information about their deals before trading and that carbon trading could derail efforts by the industrialized world to reduce emissions as they can continue to pay for polluting, and this will be credited as a “climate action.”

Climate Funds Fall Short

The Loss and Damage Fund seeks to offer financial assistance to countries greatly affected by climate change. There is nonetheless delayed operationalisation and uncertain funding, as COP29 did not define who pays into the fund and who is eligible to claim and draw from the fund.

The Adaptation Fund was set up to help developing countries build resilience and adapt to climate change. Every year, the fund seeks to raise at least USD 300 million but only receives USD 61 million, which is only a small fraction—about one-sixth—of what is required.

Final Text Quiet on Fossil Fuels

The final COP29 text does not mention fossil fuels and makes no reference to the historic COP28 deal to ‘transition away from fossil fuels’. Climate change mitigation means avoiding and reducing emissions of harmful gases into the atmosphere.

Fossil fuels are responsible for the climate crises, but the COP29 text on mitigation is silent on the issue of fossil fuels and does not therefore strengthen the previous COP28 UAE deal. Saudi Arabia was accused of watering down the text by ensuring that “fossil fuels” do not appear in the final agreement. They were successful, as the final text states, “Transitional fuels can play a role in facilitating the energy transition.”

Earlier, while welcoming delegates to COP29, Azerbaijan’s President Ilham Aliyev left no one in doubt about his stand on fossil fuels, saying that oil and gas are a “gift from God,” praising the use of natural resources including oil and gas, and castigating the West for condemning fossil fuels while still buying the country’s oil and gas.

Against this backdrop, COP29 negotiations were never going to be easy, and although the Summit overran by about 30 hours more than expected, it was certainly not the longest COP, and it will certainly not be the most difficult as Baku has successfully entrenched bitter divisions and mistrust between the developed and developing world.

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An AU-backed report says new rules mean the country has made things harder for most African visitors.

Credit: UNDP Suriname

By Michelle Muschett and Flor de Maria Bolaños
NEW YORK, Nov 26 2024 (IPS)

As the world faces escalating challenges, from climate change to biodiversity loss and ecosystem degradation, there is now a rapidly expanding understanding that these crises are deeply interconnected.

This wider recognition of the interconnectedness of these planetary crises is an opportunity to bring interconnected solutions to the foreground and the people who are driving these solutions forward.

Indigenous Peoples and local communities have long adopted integrated solutions that connect climate action, nature conservation, and inclusive economic growth, by amplifying their voices we can accelerate our transition to a sustainable, resilient future.

The United Nations Development Programme (UNDP) is at the forefront of this effort, fostering inclusive governance, building partnerships, and promoting innovative approaches that protect people and the planet.

The urgency of addressing climate change is undeniable, but climate action alone is insufficient. The rapid degradation of ecosystems and loss of biodiversity exacerbate climate impacts, endangering both the environment and people’s well-being.

Forests, wetlands, and other ecosystems are essential in regulating the climate, supporting livelihoods, and ensuring food and water security for billions.

Credit: UNDP Panama

Acknowledging that human and planetary health are inseparable, this year’s 16th Conference of the Parties (COP16) to the Convention on Biological Diversity theme, “Peace with Nature,” emphasized the need for a harmonious relationship with nature. As societies, we are an integral part of the natural world, and only by reversing habitat loss, protecting ecosystems, and creating spaces where biodiversity can thrive can we lay the foundation for a sustainable future.

Nature is embedded in all aspects of life, making it essential for COP16 participants—from governments to Indigenous communities and the private sector—to commit to an inclusive and equitable process in building peace with nature.

The Latin America and Caribbean region, considered a “biodiversity superpower,” holds one of the world’s largest reserves of natural capital, covering 46.5 percent of forested land. This region is home to six of the world’s most megadiverse countries (Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela), including 11 of Earth’s 14 biomes and the Amazon rainforest, the planet’s most biodiverse habitat.

By connecting climate, nature, and development across diverse landscapes—from Patagonia and the Caribbean to the Galapagos, Chocó and Magdalena, the Atlantic Forest, the Mesoamerican Biological Corridor, mangroves, reefs, and the Amazon—the region has the potential to lead a global shift from nature-negative to nature-positive and climate-resilient systems.

Biodiversity and ecosystems took center stage in 2024 as the COP16 to the Convention on Biological Diversity convened in Cali, Colombia. Here, nearly 200 countries came together to discuss solutions to halt the rapid destruction of nature.

COP16 was seen as the “first implementation COP,” where governments, Indigenous communities, businesses, financial institutions, and civil society shared progress and strengthened the Global Biodiversity Framework (GBF).

This meeting, alongside Climate COP29 in Azerbaijan and Land Degradation COP16 in Saudi Arabia, underscored the interconnectedness of these crises and marked a pivotal moment in taking bold steps to reduce humanity’s pressure on the planet.

Interconnected crises demand interconnected solutions, and UNDP stands as a connector at the nexus of climate, nature, and development, implementing solutions across 140 countries with a $3.4 billion nature portfolio and a $2.3 billion climate portfolio.

Through the Climate Promise and the Nature Pledge, UNDP supports over 125 countries in enhancing their NDCs and biodiversity action plans (NBSAPs), ensuring that these global commitments result in tangible, on-the-ground progress.

By treating climate, nature, and development as interdependent, we can create solutions that address both environmental and economic goals.

The conviction that climate and nature solutions must be inclusive and equitable is at the core of UNDP’s approach. UNDP brings diverse voices to the environmental agenda, acknowledging the ancestral wisdom of Indigenous Peoples, local communities, women, and youth.

Indigenous Peoples, who have managed biodiversity-rich ecosystems for generations, play a crucial role in protecting the planet’s natural resources. Their culture and profound knowledge—based on centuries of living in harmony with nature—are invaluable for shaping sustainable, resilient solutions.

A successful case of inclusive governance and integrated development is the partnership between UNDP, Ecuador, local communities, and Lavazza. This collaboration focuses on producing deforestation-free coffee, allowing farmers to cultivate coffee while restoring forests and protecting ecosystems, blending environmental protection with inclusive economic growth for local communities.

The “deforestation-free” certification guarantees that coffee production does not contribute to deforestation, preserving biodiversity and boosting Ecuadorian coffee’s global market potential. More than 1,800 families from the Ecuadorian Amazon region have participated, receiving training, infrastructure improvements, and market access. Around 40% of these participants are women, underscoring the project’s commitment to inclusivity and gender equity.

The result is a flourishing coffee sector that supports both environmental sustainability and economic resilience. This partnership provides a blueprint for how businesses can align with environmental goals to drive systemic change, proving that sustainable development not only protects the planet but also generates resilient human development and economic opportunities that directly benefit communities.

Financing is critical to addressing the interconnected crisis of climate change, biodiversity loss, and ecosystem degradation at scale. Financial flows need to triple to meet the targets of the Paris Agreement and the Sustainable Development Goals. UNDP works with countries to access, channel, and deliver finance for nature and climate goals.

This includes large-scale support for countries such as Ecuador, Brazil, and Costa Rica to secure financing for implementing their Reducing Emissions from Deforestation and Forest Degradation (REDD+) strategies. These strategies are critical in reducing deforestation emissions while supporting sustainable livelihoods.

Additionally, UNDP’s Biodiversity Finance Initiative (BIOFIN) supports 130 countries in crafting and implementing national biodiversity finance plans. In Cuba, for example, BIOFIN’s support enabled a policy change that allows landowners to claim payments for carbon emissions offset by forests on their land.

This initiative protects Cuba’s biodiversity while playing a vital role in reducing pollution and mitigating climate change. In Costa Rica, the RAICES Indigenous Tourism Incubator, with BIOFIN’s support, has mobilized over US$1.5 million, benefiting more than 2,000 Indigenous people and establishing 28 tourism projects.

These initiatives help manage nearly 1,900 hectares of forest sustainably. In Colombia, BIOFIN has partnered with FINAGRO, the nation’s largest agricultural development bank, to embed biodiversity protection into its financial tools, advancing Colombia toward achieving its GBF goals.

The enormous challenges of climate change and biodiversity loss present an opportunity to rethink how we develop as a global society. Recognizing the interconnectedness of these issues allows for integrated solutions that unlock new pathways to progress.

As the world approaches crucial tipping points, including the convergence of three major environmental COPs within six weeks, we must embrace solutions that foster nature-positive and climate-resilient economies.

UNDP calls on governments, multilateral institutions, and the private sector to prioritize nature-positive, low-carbon, and regenerative financing, ensuring that ecosystems and communities alike are resilient. The urgency is clear: bold action is needed now, for the benefit of all people and the planet; we need to make peace with nature.

Michelle Muschett is Director, Regional Bureau for Latin America and the Caribbean of the United Nations Development Programme (UNDP); Flor de Maria Bolaños is Country Specialist UNDP for Latin America and the Caribbean.

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Lillian Mworeko of ICWL with UNAIDS Executive Director, Winnie Byanyima, at the launch of the Choice Manifesto. Credit: Wambi Michael/IPS

By Wambi Michael
MBALE, WAKISO, KAMPALA, Uganda, Nov 26 2024 (IPS)

In Uganda, women and girls are more affected by HIV. Out of 1.4 million people living with the disease, 860 000 are women and girls.

According to UNAIDS, every week, 4,000 adolescent girls and young women aged 15–24 years became infected with HIV globally in 2023, with 3,100 of these infections occurring in sub-Saharan Africa.

In 2023, in sub-Saharan Africa, women and girls accounted for 62 percent of all new HIV infections.

As part of the efforts to prevent new infections and death among the adolescents and women, Uganda adopted oral PrEP in 2017, or pre-exposure prophylaxis. PrEP, or pre-exposure prophylaxis, is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use.

In January 2021, the World Health Organization (WHO) recommended that the dapivirine vaginal ring (DPV-VR) may be offered as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches.

Dr. Daniel Byamukama, the head of HIV prevention at the Uganda Aids Commission, revealed that HIV prevalence remains high among key populations. Credit: Wambi Michael/IPS

Because Uganda largely depends on donor support for HIV/AIDS treatment and prevention, PrEP tools like the dapivirine vaginal ring (DPV-VR) and a twice-yearly injection known as lenacapavira are rolled out in a phased-funded approach, and therefore more women and adolescent girls continue to be infected despite the efficacy of these medications and tools.

A bio-behavioral survey conducted in 12 of Uganda’s regional towns found that 54 percent (over half of the sex workers aged 35-49 years) were living with HIV. The results of the survey released in October indicated that one in three commercial sex workers missed taking their ARVS at least once.

Dr. Geoffrey Musinguzi, the principal investigator, said each female sex worker had had a sexual encounter with at least four men. He suggested HIV pre-exposure prophylaxis (PrEP) could stop the majority of HIV transmissions that still happen in Uganda and most of the sub-Saharan countries.

Lynette Nangoma (not her real name) is one of the lucky female Ugandan women who have had the chance to have access to oral pre-exposure prophylaxis as well as the vaginal dapivirine vaginal ring. She told IPS that there are times when she forgets to take her PrEP pills. Nyangoma usually engages in multiple sexual relationships. ”Thank God I’m still alive and HIV-free. I think those tablets helped a lot. As you may know, this job of ours can be risky,” she narrates.

Dr. Diana Atwine, the Permanent Secretary at Uganda’s Health Ministry, said the dapivirine vaginal ring is only available in seven districts funded by USAID under PEPFAR.

Dr. Daniel Byamukama, the head of HIV prevention at the Uganda Aids Commission, revealed that HIV prevalence remains high among key populations, at 33 percent among sex workers, 15 percent among prisoners, and 17 percent among people who inject and use drugs.

Nangoma told IPS that she has been using the dapivirine vaginal ring for the last four months.

“I feared it at first when a health worker was brought in to teach us about it. It looked too big. But I decided to try it. I can tell that for me, I find very convenient.”

The dapivirine vaginal ring is a female-initiated option to reduce the risk of HIV infection. It must be worn inside the vagina for 28 days, after which it should be replaced by a new ring. The ring works by releasing the antiretroviral drug dapivirine from the ring into the vagina slowly over 28 days.

Nangoma told IPS that some of her colleagues have been hesitant to use it, fearing discomfort.

Dr. Carolyne A. Akello, who has spent over 10 years in HIV/AIDS research with a focus on HIV prevention among women of reproductive age, including adolescent girls and young women, told IPS: “Yes, it looks big, but actually the vagina is a very accommodating organ. The ring is inserted into the vagina, and it is held up by the muscles. The ring was well researched. It is one size fits all. So whether small, big, or short, it fits every woman. It usually goes to the back of the vagina. There is where it sits for all the 28 days.”

“For a woman to use it consistently, we ask her to leave it there even during sex and menstrual periods. And many women, once they fix it, actually say, ‘Wow. The ring seems to have disappeared; I don’t feel it any more.’ And also, many men don’t feel it during sex. Seven out of ten men did not know that their partner was using the ring,” said Akello.

Unlike daily oral PrEP, dapivirine vaginal ring does not rely on remembering to take a pill each day and is also discreet as it stays inside the vagina throughout the month.

HIV/AIDS activist and access to medicine campaigner who leads the International Community of Women Living with HIV in Eastern Africa (ICWEA), Lillian Mworeko, told IPS that one of the advantages of the dapivirine vaginal ring is that it is discreet.

“It gives power to the woman in terms of control. They are able to fix it themselves. They are in charge. You are giving power to the woman to take care of their prevention. We strongly advocate for it,” Mworeko said. “So that women, especially adolescent girls and young women who are not able to negotiate for safer sex, have a tool that is in their control without seeking permission.”

Uganda was among the first countries in sub-Saharan Africa to approve dapivirine ring. Others included Namibia, South Africa, Kenya, Zimbabwe, Zambia, Malawi, Rwanda, Eswatini, Lesotho, and Botswana. The ring was designed for women to use in countries that still carry a high level of stigma around HIV. In 2023, South Africa announced a national rollout of the ring. Eswatini, Zambia, Rwanda, and Kenya have embarked on similar efforts.

Dr. Diana Atwine, the Permanent Secretary at Uganda’s Ministry of Health, said the dapivirine vaginal ring is only available in seven districts funded by USAID under PEPFAR. Less than three hundred women had accessed the vaginal ring through that initiative by the end of August 2024.

While Atwine says lenacapavir will be a game-changer in terms of reducing the burden of daily pills and minimizing stigma and stigmatization, her ministry’s budget cannot afford the high cost of such tools.

As Uganda joins the rest of the world to mark World AIDS Day, Mworeko used the occasion to express her frustration that so many women in Africa cannot access these tools because their governments say they cannot afford them. Gilead Sciences, the company behind lenacapavir, reportedly charges the one-month ring, which currently costs USD 12.8 per month.

“When we talk about life and the lives of people, we need to put it into the context that nothing can compare with a person who is going to live with HIV for the rest of their life. We cannot compare the price of prevention with treating a person for life,” argues Mworeko.

She suggests that other than waiting for donations that delay or never arrive, the leaders of Africa must set part of their national budgets to ensure that women and girls have access to the new prevention tools and methods.

“What is the cost of preventing a young girl from getting HIV, and they are going to live the rest of their life free of HIV? They are going to deliver babies free of HIV, and they are going to contribute to the economy of their country. Compared to not acting now in the name of the cost, we are going to have this young person infected with HIV, and we must treat them,” Mworeko asked.

When asked about the facts that Uganda and other countries in Africa lacked money to make their own purchases of the prevention measures, Mworeko said, “What are our priorities? Who prioritizes what? We must prioritize where our hearts are. We cannot continue talking about new HIV infections when tools are here.”

Part of Mworeko’s frustration was partly directed towards researchers and the manufacturers of these medicines and preventive measures.

“I think the most disturbing situation is that most of the research is done here in our country. We are slow at rolling them out. Yet other countries pick up and fund these interventions. So we contribute to research, but we don’t benefit as a country. Because there is no one who would want to see their children infected with HIV,” says Mworeko, one of the activists behind the HIV Prevention Choice Manifesto for Women and Girls in Africa.

Uganda was among the countries where clinical trials for Gilead’s PURPOSE 1 were conducted. The results showed the high prevention effectiveness of the six-monthly long-acting injectable drug lenacapavir for cisgender adolescent girls and women, cisgender men, and transgender women.

The Global HIV Prevention Coalition (GPC), UNAIDS, and other partners called on Gilead Sciences to accelerate their efforts in ensuring that it is made available, accessible, and cost-effective, especially to low- and middle-income countries. It said the company’s approach must reflect the urgency of their needs.

“We urge Gilead to act swiftly in ensuring equitable, sustainable, broad access, particularly in markets with the highest need,” said GPC.

Gilead promised in early October that it will prioritize providing lenacapavir to Rwanda, South Africa, Tanzania, Thailand, Uganda, Vietnam, Zambia, and Zimbabwe until generic versions are available.

Dr. Flavia Matovu Kiweewa, one of the researchers on Gilead Sciences’ PURPOSE program in trials in Uganda, said: “I know Gilead Sciences has committed to providing licenses to generic manufacturers to make this product. But countries need to advocate so that we can be the first beneficiaries of lencapvir because we have significantly contributed to the study. But not only that, we are seeing lots of infections in young women.”

Dr. Herbert Kadama, the PrEP coordinator at the Ministry of Health, said Uganda plans to adopt lenacapvir and dapivirine vaginal ring are part of the efforts to address the challenges women also face with HIV/AIDS. He noted that 63 percent of new infections in Uganda, like the rest of Africa, are in women and girls.

According to Dr. Flavia Matovu Kiweewa, lencapvir prevents HIV acquisition by HIV-negative women by 100% compared to other preventive measures, but it is not a vaccine.

”We are glad that for the first time ever in history, we have an intervention that can give 100% protection against acquiring HIV. For us who have been in the PrEP field for quite some time, we faced lots of disappointments, especially for women trials. Because women are not able to adhere to daily interventions and they are influenced by their partners and friends,” said Matovu Kiweewa.

“Lenacapvir is going to be a game changer in the HIV prevention landscape. We are very excited that if we can access lanacapvir in Uganda and other high-burden settings in Africa, we will reduce the incidence of HIV significantly,” she added.

IPS UN Bureau Report

 

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Excerpt:

Ahead of World Aids Day 2024, with the theme Take the Rights Path: My Health, My Right!, IPS looks at options for prevention for women and girls in Uganda and sub-Saharan Africa.

Orlando Pride forward Barbra Banda is voted BBC Women's Footballer of the Year.

Orlando Pride forward Barbra Banda is voted BBC Women's Footballer of the Year.

Netumbo Nandi-Ndaitwah is the candidate for the dominant Swapo party but its popularity has waned.

Netumbo Nandi-Ndaitwah is the candidate for the dominant Swapo party but its popularity has waned.

Netumbo Nandi-Ndaitwah is the candidate for the dominant Swapo party but its popularity has waned.

Maya farmer Leonardo Puc shows an achiote seedling, whose seeds give colour and flavour to a variety of Mexican food recipes, in a cornfield in the municipality of Tadhziú, in the southeastern state of Yucatán. Image: Emilio Godoy / IPS

By Emilio Godoy
CHACSINKIN, Mexico, Nov 25 2024 (IPS)

María Bacab, a Native Maya, considers herself the “guardian of seeds” as she cares for the milpa – an ancestral Mesoamerican polyculture that mixes maize, beans, squash and other vegetables – and promotes its practice and use in Mexico.

“I worked with my parents since I was a little girl, I learned with them. The milpa is a benefit, because we don’t buy corn. I like it, because we’ve been doing it since we were children,” she told IPS in the community of X’box (the black one, in the Mayan language), in Chansinkin, a municipality in the state of Yucatán, southeastern Mexico.

The peasant farmer combines family care work with agriculture. After cooking breakfast and taking her children to school, Bacab, 41, who is divorced and has seven children, works on her one-hectare plot of land, returns at 11 a.m. to care for her children who go to secondary school, and then goes back to planting.

Each year, she grows 750 kilograms of grain for her own use, raises a pig, a native species of this Mexican region, and weaves hammocks to supplement her income. Her three eldest children help on the plantation.

Bacab is the only woman in a group of 11 milpa producers in X’box who store and exchange seeds. They select the best and save them for a year, which prepares them for shortages or losses due to flooding or droughts. The municipality has at least two seed banks .

Each farmer in the group plants different varieties, so that multiple maize options persist, including several drought-resistant ones, and some have hives for sale and self-consumption. They have adopted seeds from the southern state of Chiapas, and theirs have reached neighbouring Campeche, with which they share the Yucatan peninsula.

The peninsula is home to the majority of the Maya population, one of Mexico’s 71 indigenous groups and one of the most culturally and historically representative.

Maize is not only a native and predominant crop in Mexico, but a staple product in the diet of its 129 million inhabitants that transcends the culinary to become part of the country’s cultural roots, linked to the native peoples.

At harvest time, generally from January to March, the furrows of the cornfield are bright with green canes, from which the ears of corn hang waiting for the harvesting hand. From their rows will come the grains that end up in dough, tortillas (flat breads made from nixtamalised grain), atoles (thick drinks) and various other dishes.

Mexico’s three million corn farmers plant around eight million hectares, of which two million are for family use, in a country that has 64 varieties of the grain, 59 of which are native.

Mexico is the world’s seventh largest producer of maize, the world’s most widely grown cereal, and its second largest importer. It harvests some 27 million tonnes annually, but still has to import another 20 million tonnes to meet its domestic consumption.

As in the rest of the country, the milpa is key to the diet in the municipality of Chansinkin. Inhabited by 3,255 people, nine out of 10 were poor and one third were extremely poor in 2023.

Mayan farmer Ricardo Piña grows 14 varieties of maize, and stores the seeds for future planting and exchange, in the community of X’box, municipality of Chacsinkin, in the state of Yucatán, southeastern Mexico. Image: Emilio Godoy / IPS

Seeding the future

The Milpa para la Vida project, implemented by the US non-governmental organisation Heifer International since 2021, with funding from the US-based John Deere Foundation, promotes the improvement of milpa collectives such as the one in X’box.

The initiative is one of several in Yucatán that seeks to defend the territory and offer economic options in rural areas.

It aims to increase incomes by at least 19%, milpa productivity by at least 41%, and the amount of land under sustainable management by 540 hectares among participating farmers in 10 communities from Yucatán and two others in Campeche.

Since 2021, the project has benefited 10,800 people and the goal is to reach 40,000 by 2027.

Demonstration plots have achieved a production of 1.3 tonnes of maize per hectare, through agroecological practices such as the use of native seeds and biofertilisers, compared to the 630 kilograms harvested in 2021 with conventional practices.

But constraints remain, such as the application of pesticides and fertilisers donated by the Ministry of Agriculture.

Mayan farmers check a milpa, an ancient system of polyculture of maize, beans, squash and other vegetables that has spread from Mexico throughout Mesoamerica, in the municipality of Tadhziú, Yucatán state, in southeastern Mexico. Image: Emilio Godoy / IPS

In the neighbouring municipality of Tahdziú (place of the zui bird, in Mayan), 65-year-old Maya farmer Leonardo Puc treasures his seeds as his most precious commodity.

Although there was enough rain this year after an intense drought in 2023, “we face many difficulties, a lot of budworm (which eats the maize plant). We need maize to feed ourselves, producing it is what we do. We can’t just sit back and do nothing,” the farmer told IPS.

“That’s why nature teaches us,” said the married father with six children and coordinator of the 28-member Flor de Tajonal group, named after an emblematic local flower.

There are five seed banks in the Tahdziú area. In a hut with a high roof of huano, a local palm tree, and walls of wooden beams, transparent plastic jars with white lids line a shelf. They hold a key part of peasant life: seeds of yellow and white maize, squash and black beans.

Tahdziú also lives amidst deprivation, as its 5,502 inhabitants are practically all poor, and half of them live in extreme poverty.

Flora Chan inspects a hen in the pen at her home in the municipality of Maní, in the southeastern Mexican state of Yucatán. Image: Emilio Godoy / IPS

Chickens that change lives

Flora Chan’s mother used to buy and raise chickens, so she was no stranger to the cage-free poultry egg farmer programme she joined in 2020 to improve her family’s economy.

“When we started, it was hard because people didn’t know about our eggs. Now they buy every day,” she told IPS in the courtyard of her home in the municipality of Maní (where it all happened, in Mayan), near Chacsinkin.

Chan, who is single and childless, has 39 hens and wants more. Every day she collects between 40 and 50 eggs. She cleans the henhouse early, checks the water and feed and rate of production. She also weaves textiles and oversees 100 hives of stingless melipona bees, a species endemic to the region and with highly prized honey.

A group of 217 women farmers, 19 in Maní, formed the Kikiba Collective (something very good, in Mayan) and whose seal, a hen, goes on each unit.

The breeders belong to the Mujeres Emprendedoras initiative, which began in 2020 in 93 communities from 30 municipalities in Campeche, Quintana Roo and Yucatán, with the help of the organisation Heifer.

A group of 19 women egg farmers make up the Colectivo Kikiba in the municipality of Maní, in the state of Yucatán, in southeastern Mexico. Image: Emilio Godoy / IPS

The programme aims to strengthen local livelihoods in order to alleviate hunger, poor nutrition due to lack of animal protein and low incomes due to lack of market access.

In Mani, three quarters of the 6,129 inhabitants suffer from poverty and one fifth from extreme poverty.

Each participant receives training in the installation of backyard chicken coops, animal care and business management. Each year they replace the batch of 50 birds they receive and pass theirs on to a new member, until the birds stop laying and the women then use them at home or sell them at local markets.

The programme has covered 796 women farmers, with the goal of reaching 1,000 by 2026. The Kikiba Collective delivers 4,300 free-range eggs each week to two restaurants of a well-known Mexican restaurant chain in Merida, the capital of Yucatan. In addition, it sells retail and allocates 30% for family consumption.

At first, Chan’s neighbour Nancy Interiano was not interested in the project, but her friend convinced her to check it out. Today, the 43-year-old businesswoman, who is married with three children, has 60 laying hens.

“Seeing the results, other women are interested in joining and those who are already involved want to increase their poultry houses. With our knowledge and experience, we advise the new ones,” she told IPS.

In Mexico, 14.7 million women live in rural areas, representing almost 23% of all women and 12% of Mexico’s total population.

Due to a lack of suppliers of laying hens, breeders are limited in their ability to meet growing demand.

While solving this is out of their hands, Chan and Interiano enjoy every day watching their hens scratching the ground, climbing on wooden beams or settling into nests to lay the eggs that have changed their lives.

Will this free cesarean section policy truly deliver for them? Only time will tell, but much more needs to be done to make it work for all women in Nigeria. Credit: Shutterstock

By Ifeanyi Nsofor and Thelma C. Thomas-Abeku
WASHINGTON DC, Nov 25 2024 (IPS)

In Nigeria, over 80,000 women die each year from pregnancy and childbirth complications. Recently, Nigeria’s coordinating minister of health and social welfare, Muhammad Pate, announced the Maternal Mortality Reduction Initiative. It aims to provide free cesarean section (CS) and essential maternal care to poor women nationwide, ensuring safer childbirth and improved maternal health outcomes. Free CS is a life-saving solution. But while the idea is great, let’s take a closer look to unpack how it can really help Nigerian women.

To access the free CS, pregnant women must be enrolled in the country’s National Health Insurance Scheme, which covers pregnancy-related emergencies. Social welfare units in public hospitals will check if women qualify and can’t afford the procedure. But is this enough?

For a policy like this to work, it must be well-planned, involve many stakeholders, and take into account the rising cost of living, widespread poverty, and the large number of women in informal jobs who are not routinely covered by health insurance

The survival of women at childbirth hinges on availability of expertise to provide cesarean section when needed. A study found a national cesarean section prevalence of 17.6%, with a significantly higher prevalence in facilities in the south (25.5%) compared to the north (10.6%). The authors also identified higher prevalence of emergency cesarean section (75.9%) compared to elective CS (24.3%).

 

The Reality of Maternal Deaths in Nigeria

An unacceptable number of women in Nigeria die before, during, and after childbirth. Those 80,000 annual deaths are equivalent to 80% of the population of Seychelles.

This reaffirms Nigeria as a large country with an estimated population of more than 200 million; covering 36 states, the federal capital territory, and 774 local government areas.

For a policy like this to work, it must be well-planned, involve many stakeholders, and take into account the rising cost of living, widespread poverty, and the large number of women in informal jobs who are not routinely covered by health insurance.

Poverty is a big issue. Many women cannot afford hospital births and instead deliver in places like faith homes (run by churches) or with traditional birth attendants. If this policy is to work, women’s preference for health facility-based deliveries must improve significantly.

These are five ways to make the free CS policy truly equitable.

 

Does Nigeria Have Enough Obstetricians?

A CS is a life-saving surgery for high-risk pregnancies, like those with large babies, breech positions, or obstructed labor. But Nigeria faces a shortage of healthcare workers. Many doctors are leaving the country for better opportunities abroad.

As of 2021, Nigeria had only 84,277 doctors—about 3.95 per 10,000 people, far below the global recommendation. Who will perform these surgeries if our skilled workers are gone? The government needs to retain healthcare workers by offering better pay, housing, and improved working conditions. Training and career development programs are also crucial to ensure enough professionals are available for this initiative.

 

Bridging the Health Insurance Gap

Healthcare costs continue to hinder timely access to essential services, especially for marginalized and low-income populations, including women. To improve women’s health outcomes and realize the right to health, it’s imperative to address these inequities in healthcare delivery.

One effective strategy is to adopt the Health Equity Funds (HEF) model, a proven approach used in various countries. HEFs are third-party mechanisms that cover user fees at public health facilities for eligible low-income individuals.

By establishing and operationalizing a functional equity account, governments can facilitate the enrollment of more women from the informal sector into health insurance schemes, enhancing access and inclusivity.

 

Fighting Stigma and Myths About Cesarean Sections

Another challenge is the negative perception of CS. In some instances, women who undergo CS are stigmatized and labeled as ‘’weak’’. A study reveals that factors such as fear, lack of spousal consent, and poor education contribute to its underutilization.

Addressing these gaps requires intensified public education campaigns to inform women and dispel myths about CS, leveraging platforms like radio, TV, and social media to reach a wider audience. Additionally, integrating accurate information about CS as a normal and safe form of childbirth into school health education curricula is essential for long-term impact.

 

Federal, State, and Local Governments Cooperation

Healthcare in Nigeria is on the concurrent list, which means that federal, state and local councils have core responsibilities for healthcare delivery. How is this policy going to work within states and local government areas? Who is going to cover the costs for women in these sub-national areas?

For this policy to work, all three levels must collaborate. It is not enough for the federal government to announce the policy. State and local governments must also step up to implement it properly. The Federal Ministry of Health and Social Welfare through the National Health Insurance Scheme must collaborate with states through existing State Health insurance Schemes.

 

Will This Policy Truly Save Lives?

Women enrolled in the National Health Insurance Scheme might benefit immediately, but the majority—those poor, uninsured, and vulnerable—are left out. These are the women who need this policy the most. To deliver real change, the government must address these gaps.

 

Conclusion

In the end, every pregnant woman in Nigeria wants the same thing: to deliver safely and not die at childbirth. Will this free cesarean section policy truly deliver for them? Only time will tell, but much more needs to be done to make it work for all women in Nigeria.

 

About the Authors

Dr. Ifeanyi M. Nsofor, a public-health physician, global health equity advocate and behavioral-science researcher, serves on the Global Fellows Advisory Board at the Atlantic Institute, Oxford, United Kingdom. You can follow him @Ifeanyi Nsofor, MD on LinkedIn.

Thelma Chioma Thomas-Abeku is a seasoned communications specialist with a decade-long experience in public health advocacy and communications. She is a graduate of Liverpool John Moores University and University of Abuja. You can follow her @Thelma Thomas-Abeku on LinkedIn.

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