From its earliest formulation, the international HIV response has attempted to harness human rights as a central element of public health practice. Policy initiatives aimed at eliminating stigma and discrimination of ...From its earliest formulation, the international HIV response has attempted to harness human rights as a central element of public health practice. Policy initiatives aimed at eliminating stigma and discrimination of affected people would enable them to access health and social services, practice safe behaviors and thereby protect public health. However, this response was characterized by tensions between differing perceptions of public health and human rights and, with the advent of effective treatments, between those who regarded behavioral and biomedical interventions as competing, if not mutually exclusive, approaches. A central theme in all of these elements has been control： control of the virus, control of the behaviors of people affected, control of policy and control of rights. HIV infection is both a cause and a consequence of human rights abuses, but for many people these two aspects are compounded into the same lived predicament; a predicament over which many feel they should have control. The test-and-treat debates at the 2010 IAS Conference demonstrated this as presenters and participants openly clashed over proposals to implement what many see as coercive measures in settings where viral transmission and the public health/human rights collaboration might both be regarded as now ＂out of control＂. This paper will explore issues of control in the international HIV response and how authority, in the forms of law and justice, is contested in that response.展开更多
Background There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to ...Background There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem.Main text During the 2nd International Workshop on OAE held on 19-21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy.Conclusions To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden.展开更多
文摘From its earliest formulation, the international HIV response has attempted to harness human rights as a central element of public health practice. Policy initiatives aimed at eliminating stigma and discrimination of affected people would enable them to access health and social services, practice safe behaviors and thereby protect public health. However, this response was characterized by tensions between differing perceptions of public health and human rights and, with the advent of effective treatments, between those who regarded behavioral and biomedical interventions as competing, if not mutually exclusive, approaches. A central theme in all of these elements has been control： control of the virus, control of the behaviors of people affected, control of policy and control of rights. HIV infection is both a cause and a consequence of human rights abuses, but for many people these two aspects are compounded into the same lived predicament; a predicament over which many feel they should have control. The test-and-treat debates at the 2010 IAS Conference demonstrated this as presenters and participants openly clashed over proposals to implement what many see as coercive measures in settings where viral transmission and the public health/human rights collaboration might both be regarded as now ＂out of control＂. This paper will explore issues of control in the international HIV response and how authority, in the forms of law and justice, is contested in that response.
基金Funding for the 2nd International workshop on OAE was provided by the Research Foundation Flanders(FWO),grant number G0A0522N,the University of Antwerp,and the German Center for Infection Research(DZIF)JNSF received funding from the Research Foundation Flanders(FWO),grant number:1296723N+1 种基金M-GB acknowledges funding from the MRC Centre for Global Infectious Disease Analysis(MR/X020258/1),funded by the UK Medical Research Council(MRC)This UK-funded award is carried out in the frame of the Global Health EDCTP3 Joint Undertaking.
文摘Background There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem.Main text During the 2nd International Workshop on OAE held on 19-21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy.Conclusions To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden.
