An international public health crisis: can global institutions respond effectively to HIV/AIDS?

The United Nations Millennium Project (2005 UN Millennium Project , 2005 . Combating AIDS in the developing world ( London : Taskforce on HIV/AIDS, Malaria, TB, and Access to Essential Medicines: Working Group on HIV/AIDS, Earthscan ). [Google Scholar]) describes the HIV/AIDS epidemic as a ‘global catastrophe, threatening social and economic stability in the most affected areas, while spreading relentlessly into new regions’. Multilateral institutions under the leadership of the Joint United Nations Program on HIV/AIDS and World Health Organization have been charged with coordinating the worldwide response. Yet with attention and funding diverted between bilateral, regional and multilateral aid providers, and little discernible success in containing the global epidemic to date, it remains an open question whether traditional global institutions are able to effectively combat HIV/AIDS. It is argued that bilateral relationships are still heavily relied upon at present as traditional multilateral arrangements struggle for resources and political attention. The critical questions discussed here are whether global institutions should, can and will respond effectively to the HIV/AIDS crisis. This analysis finds that the most readily organised and deployed global response will likely involve an alliance of public and private agencies that can escape some of the domestic, political and organisational constraints inherent in existing HIV/AIDS funding arrangements. Ultimately, newer hybrid arrangements that have emerged recently, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, may offer a more enduring global regime to control the HIV/AIDS epidemic. The corollary is that UN agencies alone in their traditional form, hampered by multilateral practicalities, will be less effective.     

General Assembly pledges support for war against AIDS

At a special meeting held in October 1987, the World Health Organization called for a concerted, international response to acquired immunodeficiency syndrome (AIDS). Announced was the creation of a WHO Global Commission on AIDS comprised of experts in health, social, economic, legal, ethical, and biomedical fields who will advise WHO officials of developments in various aspects of the disease. Member States were united in terms of the need for open communication and support of WHO efforts to combat AIDS. By December 1987, 129 countries had reported 73,747 AIDS cases to WHO and another 3 million new cases are likely to develop by 1982. The WHO strategy is based on several concepts: 1) even in the absence of a vaccine, AIDS is controllable through widespread education; 2) longterm commitment to eradication is necessary; 3) AIDS prevention and control must be integrated into national health systems; and 4) international cooperation, coordination, and leadership is vital. National AIDS committees have been established in over 100 countries.     

UN transformation in an era of soft balancing

Between 2003 and 2006 UN Secretary General Kofi Annan pursued the most ambitious overhaul of the United Nations since its inception. This transformation effort aimed to make the UN more effective in addressing non‐traditional threats and to persuade the United States to re‐engage with the world body. Launched during a time that was unpropitious for achieving far‐reaching change, the effort nonetheless produced some surprising agreements. Several factors prevented greater achievement: the episodic attention of the Bush administration and the personal agenda of John Bolton, the US permanent representative to the UN; the failure of the UN Secretariat to pursue a capital based strategy that engaged heads of state and foreign ministers; and the decision by many member states that they would rather have an ineffective United Nations than an effective one that furthered the interests of the Bush administration. Whether future efforts to transform collective security will fall victim to the same fate depends in part on the actions and words of a new American president in 2009.     

A Global Journey – Ancel Keys,the FAO,and the Rise of Transnational Heart Disease Epidemiology, 1949–1958

Few people have influenced western eating patterns in the twentieth and early twenty-first centuries as much as physiologist and epidemiologist Ancel Keys (1904–2004). Keys not only developed the K Ration for the United States military, but also advocated for diets that lowered blood cholesterol and famously discovered the health benefits of the Mediterranean diet in the 1950s and 1960s. Keys’ interest in the Mediterranean diet arose from his service on the United Nations (UN) Food and Agriculture Organization (FAO)-World Health Organization (WHO) Joint Expert Committee on Nutrition, which allowed him to explore nutritional status, dietary habits, and regional eating patterns across the globe. This paper examines how Keys’ service as chair of the UN FAO Committee on Caloric Requirements and the UN FAO Expert Committee on Nutrition led him to think globally about the relationship between diet and cardiovascular health, and to launch the first international comparative epidemiological study of diet and heart disease, the Seven Countries Study.     

‘The Constructive Use of Abundance’: the UN World Food Programme and the Evolution of the International Food-Aid System during the Post-War Decades

This article studies the expansion of multilateral economic development aid in the early 1960s by exploring the history of the United Nations (UN) World Food Program. It analyses the pivotal role played by key development economists within the UN Secretariat, such as Hans Singer, alongside US policy-makers in the Kennedy administration in framing and directing the debate on multilateral food aid. It specifically argues that this period marked a shift in how food aid was perceived and utilised by donor and recipient countries - as well as international organisations like the UN and Food and Agriculture Organization (FAO). Ultimately, what began in the 1950s as a bilateral method to feed the hungry through the disposal of surplus agricultural commodities evolved into an international food-aid system by the 1960s centred on the utilisation of surplus agriculture for economic development. This change showcased both the common goals and competing interests of US and UN policy-makers as food aid now joined the wider debate on various doctrines of development.     

River blindness. Protection for 54 cents a year

Infection by onchocerca volvulus, a parasitic worm, causes onchocerciasis (river blindness), a debilitating and often blinding disease endemic to tropical areas of Africa and Central and South America. The adult onchocerca volvulus invades the human host where it lives and reproduces for up to 14 years, creating millions of infant worms which cause itching, loss of skin color, rapid aging, and disfiguring skin disease in the host. Onchocerciasis often causes blindness in the human host by approximately age 35 years, and is the third leading cause of blindness in Africa. Onchocerca volvulus is transmitted among humans through the bite of blackflies which breed in fast-flowing rivers. The Onchocerciasis Control Program (OCP) was formally launched in 1974 by the UN's Food and Agriculture Organization (FAO), the UN Development Program (UNDP), the World Bank, and the World Health Organization (WHO) in Benin, Burkina Faso, Ghana, Cote d'Ivoire, Mali, Niger, and Togo. Vector control is the central strategy of the OCP, consisting of weekly helicopter spraying of larvacide to prevent the blackfly from reproducing and transmitting the disease. In addition, Merck & Co. is providing drug therapy against the infant worms in the human host free of charge to 16 million people in endemic areas. Onchocerciasis has now almost been eradicated in the 7 original target countries. Also through the OCP, by 1996, more than 34 million people were protected against the disease, about 2 million who were seriously infected have fully recovered, and an estimated 600,000 people have been prevented from going blind. 12 million infants born since the launch of the OCP face no risk of contracting the disease, and approximately 25 million hectares of arable fertile riverine land has been opened for resettlement. Labor productivity has also increased.     

International Institutions and Social Learning in the Management of Global Environmental Risks

This article investigates the role played by formal international institutions in the broader process of international efforts to respond to and manage global and transboundary environmental risks. Because few international institutions are designed to deal with the broad nature of environmental risks, it focuses on institutional learning. By analyzing the experiences of the United Nations Environment Program, World Meteorological Organization, and other international institutions involved with global warming, this article identifies institutional properties (or functions) that encourage or inhibit social learning in the management of global environmental risks by international institutions, and that influence the adoption of such lessons by their constituent members.     

小泉政府力促联合国改革的玄机

2005年是联合国改革年,小泉政府籍此推进其联合国改革外交,把删除敌国条款和加入常任理事国作为其主要目标。从国家利益出发,日本提出自己的联合国改革方案:恢复联大生机与活力、改革安理会、改革秘书处、修改敌国条款、重新考虑联合国会费分摊及增加联合国日本工作人员数量等。但由于联合国改革本身的复杂性和小泉政府的强硬外交路线,其联合国改革方案能否实现及落实程度仍未可知。     

Assessing the relationship between physician availability and viral load suppression in British Columbia

In 2014, the Joint United Nations Programme on HIV/AIDS set the target of dramatically reducing the burden of HIV through expansion of access to timely HIV treatment. In order to achieve this target, it is necessary to expand access to care along the HIV cascade of care. This study examines the relationship between viral suppression and the availability of physicians providing HIV treatment in British Columbia, Canada. Data from the Drug Treatment Program of the British Columbia Centre for Excellence in HIV/AIDS was analyzed. The floating catchment method was used to assess physician availability and multivariable logistic regression was used to implement a confounder selection technique to independently assess the relationship between physician availability and viral load suppression. Individuals with more than 25 physicians within a one‐hour catchment were more likely to reside in urban areas and almost twice as likely to have a suppressed viral load (adjusted odds ratio: 1.97; 95% CI 1.50 – 2.58). This study highlights the impact of physicians’ availability on viral load levels. Mapping technology was used to identify the locations in which patients were most impacted by the lack of physicians.     

国际移民的最新发展及其特点——兼析国际移民与华侨华人的概念

本文依据联合国、国际移民组织和美国皮尤研究中心发布的数据,分别介绍了国际移民的规模、流向和主要的来源地及目的地,在此基础上对当前国际移民的发展特点作了详细阐述,并对"国际移民"与"华侨华人"概念的区别与联系进行了辨析。认为国际移民与华侨华人的概念既有联系,又有区别。在国际移民的大背景下,国际移民在中国人口中只占很小的比例,中国并非移民输出大国,"中国移民威胁论"等都是没有依据的渲染和猜测。中国重视并积极参与移民领域的国际合作,将与各国及国际组织一起努力,共同促进世界范围内的正常人口流动,实现共同发展与繁荣。     

Innovations in cultural policy and development in Latin America

ABSTRACT

This essay looks at two major tendencies in cultural policy recommendations in Latin America: (1) the economic contribution of arts, heritage and especially the cultural and creative industries; and (2) cultural rights, with a focus on inclusion, access, empowerment, and the integral development/well-being of citizens. The two tendencies, which are part of cultural development policies, are not easily integrated into an all-encompassing policy because they follow different logics and management strategies. Nevertheless, both of these tendencies, which emerged in the heyday of neoliberalism (the 1990s), continue to provide the major justifications for cultural funding, although the current economic crisis has led to budget cuts. After a review of cultural development policies, this essay examines innovative strategies to compensate for scarce funding, including those that seek to bridge both tendencies. The cases examined below correspond to discussions of cultural policies in Latin American forums with hundreds of policy-makers and analysts over the past 20-plus years.

Abbreviations: BBC: British Broadcasting Corporation; CadenAgro: Centro de Apoyo para el Desarrollo de Denominaciones de Origen y Sellos de Calidad de Productos Agroalimentarios; CCI: Cultural and Creative Industries; CEDE: Centro de Estudios de Desarrollo Económico; CMD: Centro de Diseño Metropolitano; CVC: Cultura Viva Comunitaria; ECLAC: Economic Commission for Latin America; ILO: International Labor Organization; IMF: International Monetary Fund; MDG: Millennium Development Goals; MDG-F: Millennium Development Goals Fund; MICA: Mercado de Industrias Creativas de Argentina; MICSUR: Mercado de Industrias Culturales del Sur; MSME: Micro, Small and Medium Enterprises; SEGIB: Secretaría General Iberoamericana; SELA: Latin American Economic System; UCLG: United Cities and Local Governments; UNCTAD: United Nations Conference on Trade and Development; UNDP: United Nations Development Programl; UNESCO: United Nations Educational, Scientific and Cultural Organization; US: United States of America     

HIV/AIDS and development: failures of vision and imagination

As early as the mid-1990s the US Bureau of the Census was making dire predictions as to the effect of AIDS on life expectancy, infant and child mortality and population size and structure in a number of AIDS affected countries. Despite this it was not until 1997 that the United Nations began to consider HIV/AIDS as a development issue. This article looks at how the international community (still) fails to take HIV/AIDS into account in setting development goals. The article argues that this myopic view means that in 2015, when we assess the development goals, we are certain to have 'failed' in a number of countries and, therefore, that a new realism in target setting is imperative. There is a need to understand better the impact of the disease by taking into account that it is a long-wave event with a complex current and future impact. Sustained equitable development will be essential in dealing with this impact.     

Let there be light … and bread: the United Nations,the developing world,and atomic energy’s Green Revolution

Although President Eisenhower’s 1953 ‘Atoms for Peace’ speech typically is associated with the promotion of nuclear power, it also recommended other peaceful uses of the atom, including applications in agriculture. ‘Developing’ countries in particular took a keen interest in food preservation, grain disinfestation, fertilizer studies, insect control, and mutation breeding, all using irradiation. A conflict of philosophies emerged at the United Nations between the Food and Agriculture Organization (FAO) and the International Atomic Energy Agency (IAEA). The IAEA stood accused of promoting a narrow range of technological solutions, ignoring more sensible but less sensational techniques, and tempting the poorest countries of the world to achieve ‘modernization’ with unproven technologies. The present essay outlines the origins of FAO/IAEA conflict and collaboration in the 1960s, and explores the failed effort of plant geneticist Ronald Silow to stop what he saw as the IAEA’s hijacking of agriculture at the UN.     

Ghana,India, and the Transnational Dynamics of the Congo Crisis at the United Nations, 1960–1

This article examines the role of Ghana and India at the United Nations during the Congo crisis from July 1960 to February 1961. The role of non-aligned countries both in the UN peacekeeping force, Opération des Nations Unies au Congo (ONUC), and in the negotiation of Congo policy was fundamental to the evolution of events. The article shows how Jawaharlal Nehru of India and Kwame Nkrumah of Ghana used the Non-Aligned Movement (NAM) and the Afro-Asian bloc to alter UN Congo policy. In leveraging their influence with in the General Assembly, the NAM was able to sustain the UN effort in the Congo and preserve the prestige of the organisation. In the process, NAM members realised the benefits and the limitations of non-aligned politics in the context of a violent, anti-colonial war. The crisis had the effect of rupturing the status quo at the UN and in the eight months under study here, it is argued that the actions of the NAM within the UN helped to activate the agency of the organisation in pursuit of neutralist principles. The Congo crisis served as the turning point in the decolonisation drama and NAM's influence over UN Congo policy represented a dynamic form of anti-colonial internationalism.     

Parliament and the Press: Forging the United Nations in Wartime Britain, 1939–45

During the Second World War, not only the United States but also Great Britain played a leading role in planning and establishing the United Nations (UN) as a new international organisation to replace the League of Nations. While scholarship on post-war planning is extensive, relatively little exists on how the planning process was discussed and depicted publicly in Britain. The purpose of this article is to fill such lacunae by examining the two most important domains for public discussion at the time, the press and parliament. It will argue, first, that the League of Nations’ experience – its inability to use collective force and its optimistically democratic structure – overwhelmingly shaped public discourse in reference to the UN. By referring to the past, the press and politicians alike in Britain were content to relinquish interwar ideas such as equal rights and equal representation for all nations. Second, apart from the lessons of history, the less democratic structure of the new world organisation was justified from the perspective of great power politics. The desire to make the grand alliance between Britain, the United States of America, and the USSR functional despite all mutual suspicions, directed the view of the UN, and typically overrode all other concerns relating to post-war planning. Finally, throughout the wartime planning of the UN, public opinion, in so far as press and parliament were concerned, held fast to the idea that the British empire was not to be touched by the UN. In public, the establishment of the UN was hardly considered as a starting point for decolonisation. Instead, the UN was designed to become the post-war embodiment of the grand alliance, a vehicle through which the victory over the Axis powers would be managed at the global level: such management did not envision the need to let empire go. Viewed this way, it also becomes clear that nationalism and internationalism were not mutually exclusive or binary visions, but coexisted and shifted in importance throughout the period examined.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

Developmentalities and Calculative Practices: The Millennium Development Goals

Abstract: This paper focuses on wide‐ranging governmental discourses that enable new ways of shaping social and economic affairs in the field of development. Directing particular attention to the Millennium Development Goals, we refer to these discourses as developmentalities. As a form of governmentality produced through these Goals, developmentalities draw on the turn of the century to recast certain development problems and offer reformulated solutions to these problems. We argue that they rely on three forms of neoliberal rationalities of government—information profiling, responsibilization, and knowledge networks, and their calculative practices, to shape global spaces and new capacities for individuals and social groups. Our analysis is based on extensive policy documents, reports, and development initiatives affiliated with the United Nations and other organizations, as well as insights derived from in‐depth interviews and conversations with United Nations policy and research personnel from the Food and Agricultural Organization (FAO) and the United Nations Educational, Scientific, and Cultural Organization (UNESCO).     

Women endangered,says world population report

This report highlights key points from the UN Population Fund's "State of World Population 1997," which focused on women's right to choose in matters relating to reproductive health. The report documents global progress toward achieving reproductive rights for women and recommends more funding for reproductive health care and family planning and increased efforts to promote gender equality and individual rights. International agreements protect: the right to reproductive and sexual health throughout the life cycle; voluntary choice in marriage and childbearing and the means to determine when to have children; equality and equity in all spheres for men and women; and freedom from sexual violence and coercion. When these rights are denied, the result is maternal mortality (a death every minute). There is a lack of access to contraceptive services that affect 350 million women. Unsafe abortions are performed on 20 million women, of whom 70,000 die. There is a lack of access to sex education and services for teenagers that results in HIV infections and sexually transmitted diseases (STDs). 1.5 million die from HIV/AIDS related causes, and another 1 million die from reproductive tract infections and STDs. Teenagers represent about 50% of the 333 million new cases of HIV and STDs that occur each year. Female genital mutilation is performed on 120 million girls and women, and 2 million are at risk each year. 2 million girls aged 5-15 years enter the commercial sex trade each year. The report documents the suffering from anemia and malnutrition and complications from pregnancy.     

Supporting women's empowerment in Djibouti

This article reports on the work carried out by the UN Population Fund (UNFPA) in the small island of Djibouti, Africa. The republic's population has been plagued with problems of high levels of unemployment, poverty, malnutrition, an almost non-existent family reproductive health care service, 100% prevalence rate of female genital mutilation and low literacy rate, especially for women. In addition, refugees from Ethiopia and Eritrea have settled in the country increasing the risks of sexually transmitted diseases (STDs), HIV/AIDS, prostitution, and other social ills. In 1983, UNFPA started funding family planning and later reproductive health projects aimed at assuring access to services for a majority of Djiboutan women. The first country population program of assistance was started in 1992. This would help the government with health care for its population and to conduct a population census. In addition, the Fund has paid for training of doctors, midwives, and traditional birth assistants in the country and for rehabilitating maternity clinics and information centers. Moreover, it has supported agencies concerned with educating people on STDs, HIV/AIDS, safe motherhood and reproductive health for men and women, and other important issues.     

HIV/AIDS and security

The UN and its associated agencies have been among the most important players in increasing global AIDS awareness. But the intervention of the Security Council has been critical in securitizing HIV/AIDS. Moreover, the claims made by the Security Council have set the agenda for the subsequent debate on HIV/AIDS as a security issue. This article examines these claims—that HIV/AIDS poses a risk to internal stability, national security and peacekeepers, and that conflict is a vector for the spread of the disease. It argues that the evidence is less clear cut, more complex and case sensitive than the original claims suggested. Moreover, the causal links between HIV/AIDS and insecurity appear less robust. It concludes that the case made by the Security Council was somewhat speculative, while the snowballing of subsequent pessimistic thinking led these concerns to a position of orthodoxy that now appears less assured. HIV/AIDS remains a tragedy and a human security issue; whether it is a national security issue is more problematic.