The Heller School for Social Policy and Management
Brandeis University
HS253F – Spring 2016 Module II
HIV/AIDS Policy and Global LGBT Rights
Room G053
Tuesdays, 6pm-8:50pm
Sean Cahill, Ph.D.
Email:
Office Hours: By appointment
HIV/AIDS Policy and Global LGBT Rights
While we have made significant strides in HIV prevention and care since the launch of PEPFAR in 2003, more than 2 million individuals are newly infected each year, including 50,000 in the U.S. Thirty-five million are living with HIV, most in sub-Saharan Africa. Significant disparities play out in HIV incidence and treatment in the U.S. and globally. Black American women and men, gay and bisexual men, and transgender women are disproportionately burdened in the U.S. While in sub-Saharan Africa HIV is a generalized epidemic, it is also connected to gender-based violence and oppression. Recent epidemiological research indicates that concentrated epidemics exist in most countries among men who have sex with men (MSM) and transgender women. Sex workers and injection drug users are also priority populations for prevention and treatment. Gender inequality, racism, poverty, and the oppression of lesbian, gay, bisexual and transgender (LGBT) people are structural drivers of HIV vulnerability. In recent years global policy and funding agencies have acknowledged these structural drivers and promoted policy change as a key to reducing HIV vulnerability for women, girls, MSM, and transgender women. In the Global South, HIV prevention funding has helped support the development of LGBT community infrastructure. We will examine the status of LGBT people around the world, with a particular focus on sub-Saharan Africa, the former Soviet bloc, and Arab and Muslim countries. We will review successful strategies for promoting an end to violence and discrimination against LGBT people across the globe, and for promoting greater attention and protections in global bodies such as the UN. We will review lessons from the international experience in responding to the epidemic. What lessons can be learned from the relative success of Brazil and India? Attention is given to sector-based interventions and necessary coordination between sectors for specific interventions to be effective. Emerging biobehavioral approaches, including pre-exposure prophylaxis and microbicides, will also be examined, as well as emerging challenges such as the aging of people living with HIV into older adulthood, and integration of HIV prevention and care into broader health systems. This course is geared towards students with limited experience in HIV/AIDS and LGBT equality as public policy issues. Economic perspectives, a social impact perspective, and a rights perspective on the HIV epidemic will be examined.
Core Competencies: This course teaches concepts and skills which have been identified as core competencies for degrees in sustainable international development and health, as follows:
The HIV/AIDS epidemic is one of the greatest public health and development challenges affecting both economically advanced as well as low-income countries. Its impact has been most devastating in the Global South and with most at-risk populations such as gay and bisexual men and sex workers throughout the world. Since the emergence of the epidemic in the mid-1980s the world has gained rich experience in prevention, treatment, care and support. The response to the epidemic as a serious social, cultural, economic and political challenge has been varied within nations, as well as across continents and regions. Even though there have been welcome advances, including an overall decline in new infections worldwide, HIV remains one of the key challenges to health and wellbeing of communities around the world, particularly in socially and economically vulnerable and disadvantaged communities.
The course examines the essential elements of a successful policy response that could effectively control the epidemic. It will also look at the key developmental determinants affecting policy and successful programming at national and community levels. The lessons learned from early policy interventions from a developing country perspective will be followed up with a closer examination of evolution of the global thinking and practice. The sessions will include discussions on gender, human rights, security and humanitarian concerns, and drug policies. The course will also deliberate on multi-sectoral approaches, public-private partnerships, and global institutions such the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) aimed at steering the international response towards HIV/AIDS prevention, control and care.
Sustainable Development: This course relates to sustainable development as follows: HIV/AIDS is one of the key challenges affecting development as well as having the potential to reverse the hard won socio-economic achievements in many countries. The course reviews the underlying determinants and factors that promote the spread of HIV/AIDS and those which are directly related to sustainable development. It reviews the development impact as well as successful policy interventions which form an integral part of a broader framework of sustainable development practice.
Gender and Human Rights Perspective: Gender is a key factor related to HIV/AIDS, cutting across almost all aspects related to prevention, control, care and support. Other issues related to human rights are also relevant, including sexual orientation, gender identity, sex work, and drug use. In much of the Global South gay rights groups have been funded indirectly through HIV prevention work with gay and bisexual men and transgender women. While HIV can be used to stoke anti-gay prejudice, many gay men in Africa believe that HIV is a heterosexual issue, and they are not at risk. These issues will serve as cross cutting themes and therefore animate the course. In addition, some readings and classes will specifically focus on these issues.
This course starts on March 15th from 6pm-8:50pm in Classroom G053.
This syllabus is subject to change. When in doubt about it, please ask me.
Course Requirements
Attendance at all sessions; prompt arrival
Preparation of all readings and exercises
Active participation in class discussions and any group work
Timely submission/presentation of written and oral assignments
Preparation and presentation of class assignments
Basis of Course Grade:
· Careful, critical reading of all required course assignments as evidenced by participation in class discussions. (20%)
· Oral, in-class presentations on assignments. (20%)
· Mid-module assignment: Brief paper (3 pages double spaced) on a topic to be assigned. Due April 5 (20%)
· Final assignment: Individual reflection paper (5-7 pages double spaced). Topic to be agreed with instructor by April 12; to be submitted by email to the instructor by Tuesday May 3). (40%)
Performance Feedback: By mid-way into the module (April 5), I will provide feedback to students on their performance and discuss any issues they would like to raise. If any student has concerns on the lectures, discussions or reading material, he or she can individually contact me and discuss by prior appointment.
University Notices:
If you are a student with a documented disability record at Brandeis University and wish to have a reasonable accommodation made for you in this class, please advise me immediately. You are expected to be honest in all of your academic work. The University policy on academic honesty is distributed annually as section 5 of the Rights and Responsibilities handbook. Instances of alleged dishonesty are subject to possible judicial action. Potential sanctions include failure in the course and suspension from the University. If you have any questions about my expectations, please ask.
Academic integrity is central to the mission of educational excellence at Brandeis University. Each student is expected to turn in work completed independently, except when assignments specifically authorize collaborative effort. It is not acceptable to use the words or ideas of another person—be it a world-class philosopher or your roommate— without proper acknowledgement of that source. This means that you must use footnotes and quotation marks to indicate the source of any phrases, sentences, paragraphs or ideas found in published volumes, on the internet, or created by another student. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification.
Summary of Class Schedule
Session / Date / Session Title1 / March 15 / The global HIV/AIDS epidemic at 35
2 / March 22 / LGBT rights and oppression around the world
3 / March 29 / Gender equality and oppression, women and girls
4 / April 5 / Policy response: HIV as a security issue; health systems strengthening (first paper due April 5)
5 / April 12 / Policy response: Structural drivers of vulnerability and human rights
6 / April 19 / HIV prevention and treatment; Biobehavioral prevention
7 / May 10 / The U.S. epidemic; key populations and emerging issues (final paper due May 3)
Session One – Tuesday, March 15, 2016
Topic: The HIV/AIDS epidemic at 35
Readings:
Kaiser Family Foundation. The Global HIV/AIDS Epidemic. 2015, November. http://files.kff.org/attachment/fact-sheet-the-global-hivaids-epidemic
UNAIDS. The Gap Report, 2014. Executive summary, 1-22. Regional snapshots: Africa, Caribbean, Asia, former Soviet countries 24-75, 104-116. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
- National HIV/AIDS Policy – Sri Lanka, National STD/AIDS Control Program, Ministry of Health, 2011. http://www.aidscontrol.gov.lk/web/Web%20uploads/Policy%20or%20Law/ National%20HIV-AIDS%20Policy%20Sri%20Lanka%20Book.pdf
Alan Berkman, Jonathan Garcia, Miguel Muñoz-Laboy, Vera Paiva, and Richard Parker, A critical analysis of the Brazilian response to HIV/AIDS: Lessons learned for controlling and mitigating the epidemic in developing countries, Am J Public Health, July 2005;95:7;1162-1172. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449335/pdf/0951162.pdf
Session Two – Tuesday, March 22, 2016
Topic: LGBT rights and oppression around the world
Readings:
Info Graphic World. LGBT rights around the world. 2015. http://infographicworld.com/lgbt-rights-around-world/
International Lesbian and Gay Organization. The Lesbian, Gay and Bisexual Map of World Laws. 2015, May.
http://old.ilga.org/Statehomophobia/ILGA_WorldMap_2015_ENG.pdf
United Nations Office for the High Commissioner for Human Rights. Discriminatory laws and policies and acts of violence against individuals based on their sexual orientation and gender identity. Geneva. 2015, May 4.
Semugoma P, Nemande S, and Baral S. The irony of homophobia in Africa. The Lancet. July 2012, 4-5.
International Gay and Lesbian Human Rights Commission, United and Strong. Homophobia and transphobia in Caribbean media. A baseline study from Belize, Grenada, Guyana, Jamaica and Saint Lucia. 2015.
https://www.outrightinternational.org/sites/default/files/BaselineAugust102015.pdf
OutRight International. Timeline of publicized executions for alleged sodomy by the Islamic State militias. 2015.
https://www.outrightinternational.org/content/timeline-publicized-executions-alleged-sodomy-islamic-state-militias
Session Three – Tuesday, March 29, 2016
Topic: Gender equality and oppression, women and girls
Readings:
UNAIDS. The Gap Report, 2014. Populations: adolescent girls and young women, 132-145; migrants, 156-169; sex workers, 186-199; children and pregnant women living with HIV228-245. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
Jewkes R, Dunkle K, Nduna N, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. The Lancet 376, no. 9734 (2010): 41-48. doi: 10.1016/S0140-6736(10)60548-X.
Mieses A. Gender inequality and corrective rape of women who have sex with women. Treatment Issues (2009): 1–3. New York: Gay Men’s Health Crisis.
These everyday humiliations: Violence against lesbians, bisexual women, and transgender men in Kyrgyzstan. Human Rights Watch, 2008.
http://www.hrw.org/en/reports/2008/10/06/these-everyday-humiliations-0
Session Four – Tuesday, April 5, 2016
Topic: Policy response: HIV as a security issue; health systems strengthening
Readings:
Spiegel P, Bennedsen A, Claass J, et al. Prevalence of HIV infection in conflict affected and displaced people in seven sub-Saharan African countries: A systematic review. The Lancet. 2007;369:2-87-95.
Previous Article|Next Article
McInnes C. HIV, AIDS and conflict in Africa: Why isn’t it (even) worse? Rev Internat Studies. 2011 April. 37(2): 485-509.
President’s Emergency Plan for AIDS Relief. PEPFAR BLUEPRINT: Creating an AIDS-free generation. 2012. Introduction, pp. 1-13. http://www.pepfar.gov/documents/organization/201386.pdf
Grace Chee, Nancy Pielemeier, Ann Lion, Catherine Connor. Why differentiating between health system support and health system strengthening is needed. Int J Health Plann Mgmt (2012) http://onlinelibrary.wiley.com/doi/10.1002/hpm.2122/pdf
Fact Sheet: The Global Fund's approach to health systems strengthening. 2007.
http://www.who.int/healthsystems/GF_strategic_approach_%20HS.pdf
Monitoring and Evaluation of Health Systems Strengthening, An Operational Framework, WHO, Geneva, 2010. http://www.who.int/healthinfo/HSS_MandE_framework_Oct_2010.pdf
Kalibala S. The diagonal approach: Programming to combat HIV while strengthening primary health care systems in Africa. Global HIV/AIDS politics, policy, and activism: Persistent challenges and emerging issues, Volume 1: Politics and government (Raymond Smith, editor), Santa Barbara, CA: Praeger, 2013, 169-196.
- UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. Chapter 10: Strengthen HIV integration. Pages 98-104.
- http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf
Session Five – Tuesday, April 12, 2016
Topic: Policy responses: Structural drivers of vulnerability and human rights
Readings:
Ghanotakis E, Mayhew S, Watts C. Tackling HIV and gender-based violence in South Africa: How has PEPFAR responded and what are the implications for implementing organizations? Health Policy and Planning. 2009;24:357-366.
Ellsberg M, Betron M. Preventing gender-based violence and HIV: Lessons from the field. U.S. Agency for International Development, 2010. http://www.aidstar-one.com/sites/default/files/AIDSTAR-One_Gender_Spolight_Gender-based_violence.pdf
Cowan F, Mtetwa S, Davey C, et al. Engagement with HIV prevention, treatment and care among female sex workers in Zimbabwe: A respondent driven sampling survey. PLoS One. 2013 Oct 15;8(10):e77080. doi: 10.1371/journal.pone.0077080.
Thomas B, Mimiaga M, Mayer K, et al. The influence of stigma on HIV risk behavior among men who have sex with men in Chennai, India. AIDS Care. 2012; 24:11, 1401-1406, DOI: 10.1080/09540121.2012.672717
http://dx.doi.org/10.1080/09540121.2012.672717
Beyrer C, Baral S, van Girensven F, et al. Global epidemiology of HIV infection in men who have sex with men. The Lancet. July 2012, 19-29.
Baral S, Poteat T , Stromdahl S, et al. Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet, March 2013, 214-222.
Ndashe S. Seeking the protection of LGBTI rights at the African Commission on Human and People’s Rights. Feminist Africa. 2011, Issue 15.7-37.
BBC. Uganda fury at David Cameron aid threat over gay rights. October 31, 2011.
http://www.bbc.co.uk/news/world-africa-15524013