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In this issue
Universal Health Coverage at a Glance
Sexual and Reproductive Health Rights and Wrongs
• Assault on human rights
• Do we care enough about sexual violence?
• HIV/AIDS and human rights: young people in action
Also . . .
 Union news updates
 News from partners and other actors
Workers’ Health Network News™ is a
joint project of the Canadian Labour
Congress (CLC) – International
Trade Union Confederation Africa
(ITUC-Africa) Partnership that
aims to grow and strengthen a
global network of activists.
May 2014  Issue 3
promoting the right to health



May 2014  Issue 3
News Interviews . . .
Kwasi Adu-Amankwah,
General Secretary of
the African Regional
Organisation of the
Trade Union
What have been the most significant national
trade union centre achievements on AIDS since
the adoption of the first HIV/AIDS resolution at
the 17th ICFTU (International Confederation of
Free Trade Union) World Congress in Durban in
April 2000?
The adoption of the World Congress resolution created
an important framework for trade union work on HIV/
AIDS. Launched the previous year, our major project
with the Norwegian Confederation of Trade Unions
(LO Norway) helped us translate the resolution into
concrete action particularly at the workplace level.
We have also worked with the Trades Union Congress,
United Kingdom, (TUC UK), Swedish Confederation
of Professional Employees (TCO-Sweden) and the
Canadian Labour Congress (CLC). Flowing from all this
work, national trade union centres have realized four
main achievements in their respective countries.
First, we prioritized HIV/AIDS in trade union
programmes of work by establishing permanent
desks and dedicated staff, developing training manuals,
including clauses on HIV/AIDS in collective bargaining
agreements, and increasing the number of workplaces
with policies on HIV/AIDS.
Second, we recognized HIV/AIDS as an occupational
health and safety problem when it was still a hotly
debated issue prior to 2000. We conducted joint
activities with employers, incorporated HIV/AIDS in
labour legislation and inspection, and included HIV/
AIDS in the World Health Organization (WHO) list of
occupational illnesses that qualify for compensation.
Third, we raised the profile of labour and the
workplace in national HIV/AIDS strategies
and structures by strengthening the emphasis on
workplace policies, interventions and increasing
the participation of top national leaders in national
campaigns like Voluntary Counselling and Testing
Fourth, we continued to increase awareness among
trade union leaders, members and all workers,
leading to positive behavioural changes such as the
increased use of condoms, increased acceptance of
workers living with HIV/AIDS, increased willingness
to take HIV tests, and the establishment of special
programmes like food and financial assistance for
workers living with AIDS.
How can unions contribute to eliminating the type
of stigma and discrimination that encourages the
passage of the anti-gays laws we now see in a
few African countries?
The recent passage of anti-gay laws in two African
countries raise some serious questions about human
rights and the extent to which the state should intrude
into the private domain and lives of individuals. They
also raise some fundamental issues of norms and
values that different societies may not cherish or
The issue of gay rights appears controversial in many
African countries. The trade union movement is yet to
address itself to gay rights, especially given the more
critical challenges of poverty, unemployment and
social inequality. Also critical to African unions is the
realization of the organizational rights of trade union
existence and operation.
ITUC-Africa hopes to engage affiliates over time
to consider these new pieces of legislation, in the
hope that we can achieve full understanding for the
protection of the rights of all including those with
different sexual orientations.
“I think it is fair to say that we might not have
this problem with anti-gay laws if R200 had
been made part of national laws years ago.”
The interview continues on page 17.

May 2014  Issue 3
Universal Health Coverage at a Glance
Words matter in shaping health policy or steering
resources to meet health-related goals because a lack of
precision can literally mean the difference between life
and death. That is why WHNnews™ is taking a closer
look at the term “Universal Health Coverage” (UHC).
On its face UHC would appear to be a simple concept,
but it is anything but simple. Even as a campaign to
make UHC part of the Sustainable Development Goals
gains momentum, differing perspectives over what UHC
means could remain controversial for the next 15 years,
complicating chances to reach goals shared by UHC
supporters and sceptics alike.
What is UHC?
There are differences of opinion about what UHC
actually means. Authors of a January 2014 article
in The Lancet warn, “such imprecision can lead to
unintended policy consequences.” The article cites one
example where equitable health policies are presumed
to be a natural consequence of UHC policies, even
though there is a wide disparity in the ways these
policies are designed and implemented.
The World Bank and the World Health Organization
(WHO), leading proponents of UHC, use aspirational
terms to describe UHC: “the situation where all people
are able to use the quality health services that they
need (prevention, promotion, treatment, rehabilitation
and palliative care) and do not suffer financial hardship
paying for them.”
The World Bank and the WHO concede that “UHC goals
(reducing the gap between the need for and use of
services, improving quality, and improving financial
protection) orient the broad directions for progress,
but reform in any country begins with its existing
system and context.”
Sceptical health activists—including Amit Sengupta,
Associate Global Coordinator of the People’s Health
Movement—contend that UHC is a vehicle to combine
sustainable financing for health systems with health
systems design. This means promoting the systematic
participation of the private sector in the provision of
health services. They see the substitution of the term
“coverage” for the earlier “care” as symbolic of a move
away from concerns of health systems design toward
Why is the discussion around UHC
WHO Director-General Dr. Margaret Chan regards
“universal health coverage as the single most powerful
concept that public health has to offer. It is inclusive. It
unifies services and delivers them in a comprehensive
and integrated way, based on primary healthcare.”
Terms like “silver bullet” or the “third great transition”
are used to describe a concept that is seen as changing
how services are financed and how systems are
The sceptics concede that in less than a decade, UHC
has come to dominate most international discussions
on healthcare access. They acknowledge that UHC is
now broadly seen as the solution to pressing healthcare
needs in low and middle income countries (LMICs),
making it all the more important to understand what it
actually promises.
How universal is UHC?
There isn’t and probably will never be a one-size-fits-
all model for UHC. It is almost certain there will be
differences between the health services countries will
provide and the ways they will be paid for. A World
Bank publication notes “…achieving universal health
coverage is a path specific to each country, and no
single system or model exists to achieve it.”
UHC Forward, a strong UHC proponent, echoes the
notion that UHC “can mean different things to different
people.” It defines UHC by emphasizing the financing
dimension as opposed to healthcare. Without including
healthcare in its criteria the UHC Forward website says
“different countries may make different policy choices,
but those that are pursuing UHC consider these three
principles: 1) reduced out-of-pocket spending, 2)
prepayment, and 3) risk pooling.”
May 2014  Issue 3
Where has UHC been adopted as part of a
country’s national health strategy?
A considerable amount of country experience is cited
by both proponents and sceptics.
A 2013 report, Universal Health Coverage: A
Commitment to Close the Gap (WHO, UNICEF and the
Rockefeller Foundation) notes that since the 2010
World Health Report—Health Systems Financing: The
Path to Universal Coverage—more than 70 countries
have approached the WHO for assistance in moving
forward on UHC. A UN Resolution was endorsed by
more than 90 countries in December 2012 to make
UHC a key global health objective. UHC supporters are
tallying successes in early adopters such as Mexico,
Thailand, Chile, Turkey and Brazil, and more recently
countries including Ghana, Cambodia and Rwanda.
The WHO’s website provides reports from nearly 20
In Universal Health Coverage: Beyond rhetoric, an
Occasional Paper for the Municipal Services Project,
Amit Sengupta points out that highly contested data
related to some early health reforms based on universal
insurance in the South (e.g. Chile, Colombia and
Mexico) have nonetheless been used to legitimize the
current UHC agenda.
Sengupta contends that many proponents of UHC are
actually interested in the creation of health markets for
the private sector. He examines Europe’s experiences in
constructing similar models, wherein health becomes
a marketable commodity, and presents the cases of
Brazil, India and Thailand to illustrate how this trend
has gone global, reinforced by the implementation of
new UHC initiatives.
What can be done to improve the quality of
discussion and debate about UHC in the near
Lancet article authors Thomas O’Connell, Kumanan
Rasanathan and Mickey Chopra propose the following:
A genuinely broad-based consensus on a
precise operational framework would make UHC
achievement a more inclusive and country-
led process, rather than simply one swayed by
global pundits. Development of such a framework
would demystify UHC and encourage sensible
measures for tracking and global comparisons,
build on lessons learned during the pursuit of
the Millennium Development Goals (MDGs), and
contribute meaningfully to the post-2015 agenda.
“…We would like to express our concern on the
promotion of Universal Health Coverage with the
shift in terminology from universal healthcare to
universal health coverage, suggesting a reliance
on an insurance-based model, especially with the
involvement of commercial for-profit private sector.
We are concerned that it would perpetuate the
selective primary healthcare approach that
replaced the Alma Ata principles through a
market driven process. We urge member states to
reconsider such an approach, which can lead to
the dismantling of the public health system while
providing increasing space for the commercial for-
profit private sector.
We suggest the return to the concept of universal
healthcare, to be achieved through organized
and accountable systems of high quality public
provision of comprehensive primary healthcare.”
– Medicus Mundi International, 132nd Session of the WHO
Executive Board on Agenda Item 10.3 Universal Health
Coverage, GENEVA, 21–29 January 2013
May 2014  Issue 3
WHO Definition of UHC
The goal of universal health coverage is to ensure that
all people obtain the health services they need without
suffering financial hardship.
Several factors are necessary for a community or
country to achieve universal health coverage:
• A strong, effcient, well-run health system that
meets priority health needs through people-
centred integrated care (including services
for HIV/AIDS, tuberculosis, malaria, non-
communicable diseases, maternal and child
health) by:
– informing and encouraging people to stay
healthy and prevent illness;
– detecting health conditions early;
– having the capacity to treat disease; and
– helping patients with rehabilitation.
• Affordability – a system for fnancing health
services so people do not suffer financial hardship
when using them.
• Access to essential medicines and technologies to
diagnose and treat medical problems.
• A suffcient capacity of well-trained, motivated
health workers to provide the services to meet
patients’ needs based on the best available
World Health Organization
Selected links:
Background document for WHO/World Bank
Ministerial-level Meeting on Universal Health
Coverage, February 2013: Towards Universal Health
Coverage: concepts, lessons and public policy
Ministerial Meeting Outcome statement
WHO web pages on UHC
World Bank web pages on UHC

Liberalization’s Legacy: Cameroon
Closing Clinics
The Cameroon government is now shutting hundreds
of medical facilities that sprung up since it privatized
the health sector two decades ago. The closures affect
more than 524 medical training centres and 600
private clinics operating illegally in this Central African
nation, according to the Inter Press News agency.
“The uncontrolled number of clinics and training
institutions are responsible for the death and
worsening medical conditions of many innocent
Cameroonians,” says Biwole Sida, a Ministry of
Public Health national health inspector, because they
“lack the training, appropriate staff, equipment and
infrastructure to operate either as a medical training
institution or a clinic.”
Bidjogo Atangana, Secretary-General of Cameroon’s
National Medical Council (NMC), says illegal and ill-
equipped clinics exist partly because the government
“liberalized” the sector some two decades ago. “In the
1990s people were authorized to open health clinics as
a Common Initiative Group (CIG),” Atangana said. Today
the NMC wants all medical centres that have been
operating as CIGs to close down and obtain proper
qualifications and medical licences, which many do not
“The sector may lack qualified professionals, but
putting the lives of innocent citizens in the hands of
charlatans will lead to a bigger public health problem.
There are… many Cameroonians with good graduate
diplomas but their services are exported to countries
that pay higher [salaries],” said Etienne Tsou, Health
Sciences Faculty at Cameroon’s Catholic University.
May 2014  Issue 3
Workers’ Health Network™
Facebook Reaches 80,000 People
How did you learn about WHNnews™?
If you read about this newsletter on its sister Facebook
page, “World Health Network™,” you are part of the
fastest growing trade union-related social media
network on any topic. If not, you need to see what you
are missing.
Pay attention organizers and activists! As this issue
goes to press, more than 80,000 individuals can be
reached through the Facebook page’s 20,000 fans—
making it a platform with huge potential for unions
and their allies to interact and communicate with
each other in order to promote the right to health for
all. For the uninitiated, in Facebook parlance “fan”
means you’ve chosen to “like” the page. When “fans”
post stories, comment, and share the information they
take from “World Health Network™” with their own
networks, they continue to extend the pages “reach”
beyond more than 80,000 people.
Like WHNnews™, “World Health
Network™” is a joint project of
the CLC ITUC Africa Partnership
and is published in both English
and French. Each language
version has attracted more than 10,000 fans and the
numbers continue to grow. Facebook readers come
from virtually every African country, with smaller
proportions from North America, Europe and other
industrialized countries. Many of the current fans from
anglophone Africa are from Libya, Kenya, Nigeria,
Ghana, Tanzania and Uganda. Countries topping the
list on the French page are Egypt, Côte d’Ivoire and
Algeria. World Health Network readers are young, with
ages ranging between 18 and 34.
So whether you are a young person or a veteran
organizer or activist anywhere in the world interested
in making the world a healthier place, hook up with the
World Health Network™ by becoming a “fan,” “posting”
your news, commenting, and inviting your friends.
Search for us on Facebook or use the links below:
Workers’ Health Network™ (En)
Réseau de santé des travilleurs et travailleuses (Fr)
TB Control – On Track
for 2015?
Two years before the MDG
deadline, the WHO’s Global
Tuberculosis Report 2013
assesses progress towards
the 2015 targets and the top
priority actions needed to
achieve and move beyond them.
TB remains a major global health problem, even though
most TB deaths are preventable, the report says. In
2012, an estimated 8.6 million people developed the
disease and 1.3 million people died from it (320,000
of them co-infected with HIV). On the positive side, by
2012 the TB mortality rate had been reduced by 45%
since 1990 and the MDG target to reduce deaths by
50% by 2015 is within reach. However, reaching the
target of a 50% reduction in TB prevalence by 2015
isn’t expected. Neither the African nor the European
region are on track to achieve the mortality or the
prevalence targets.
Key factors include missed cases and treatment
coverage gaps, including for multi and extensively
drug-resistant TB (MDR-TB and XDR-TB). The report
estimates that there were about 2.9 million missed
cases in 2012 people who were either not diagnosed or
diagnosed but not reported to the national treatment
programme. Most of the missed cases (75%) were
concentrated in twelve countries, a third of them in
India. MDR-TB is most often found in Eastern Europe
and central Asia.
The WHO identified the top three priority actions to
accelerate progress towards the 2015 targets: 1) reach
the missed TB cases, 2) address MDR-TB as a public
health crisis, and 3) accelerate the response to TB/
HIV by (i) increasing coverage of antiretroviral therapy
(ART) for HIV-positive TB patients and (ii) increasing
coverage of TB preventive treatment among people
living with HIV/AIDS.
Giorgia Sulis and Alberto Matteelli of the University of
Brescia, Italy, argue in research published in December
2013 that “the importance of poor-quality drugs cannot
be underestimated, as they may disrupt all major...
interventions to ensure treatment efficacy. Not only
treatment failure may ensue, but, more importantly,
rapid emergence of acquired drug resistances can also
be favoured.”
May 2014  Issue 3
A quality-assured drug supply is vital to global disease
control strategies, with counterfeits and sub-standards
on the rise. Counterfeit drugs are deliberately and
fraudulently mislabelled medicines, with altered
ingredients and/or fake packaging. Substandard
medicines are those which have not been subject to
quality control requirements.
Hunger in a World of Plenty: One in Eight
Go Hungry
The heads of UN’s Food and Agricultural Organization
(FAO), the International Fund for Agricultural
Development (IFAD) and the World Food Programme
(WFP) comment in Resurgence (2013) on the latest
report jointly produced by their agencies on the State
of Food Insecurity in the World (2011-2013). Although
they estimate that the numbers of people suffering
from chronic hunger have fallen (to 842 million from
868 million) about one person in eight still goes hungry.
Just 62 countries have achieved the MDG 1 target to
halve the proportion of undernourished people.
There are persistent inequalities across regions, with
Sub-Saharan Africa having the highest prevalence of
undernourished (almost 25%). Most progress has been
in East and Southeast Asia and Latin America.
The agency heads point out that food security doesn’t
only depend on food availability but equitable
economic growth and access to jobs. They note that
agricultural development is five times more effective in
reducing poverty than growth in any other sector. Also
crucial are safe water, sanitation, healthcare, transport,
and good feeding practices.
They conclude: “We urge governments, organizations
and community leaders... to make economic growth
more inclusive through policies that target family
farmers and foster rural employment; strengthen social
protection:... improve dietary diversity and the health
of the environment, especially for women and youth;
and promote the sustainable management of natural
resources and food systems.”
Free Trade Protections for Tobacco
As public health campaigns and increased regulation
of the sale of tobacco succeed in reducing numbers
of smokers in industrialized nations, the tobacco
industry has turned to less-developed nations to find
new markets, according to the International New York
Times (December 2013). Tobacco companies target
countries where government restrictions and education
on the dangers of tobacco are more limited.
There is a profound clash of interests between the aims
and provisions of the WHO’s Framework Convention
on Tobacco Control (FCTC) and the efforts of tobacco
companies to undermine the rights of countries to
protect the health of their citizens. The South-East
Asia Tobacco Control Alliance (Seatca) is calling on all
countries involved in the negotiations of the Trans-
Pacific Partnership (TPP) agreement to fully support
Malaysia’s proposal to totally exclude tobacco from the
trade pact. One proposal under discussion would allow
companies to take legal action against other countries
that “violate” the TPP by imposing tobacco control
measures. The United States is the only country among
the twelve negotiating the TPP which hasn’t ratified
the FCTC, so it is to be hoped that the others support
Malaysia and take a similar stand.
May 2014  Issue 3
See too reports by the Southeast Asia Tobacco Control
Alliance and Common Dreams.
Looking Ahead: The G20 Summit
If anyone harboured hopes the 2014 G8 would provide
a break from a run of disappointing G8 summits,
they are probably going to be disappointed again.
The prospects for any significant development-
related outcomes were doubtful even before the
allies summarily downsized the G8 to the G7 as a
consequence of Russia’s invasion and seizure of the
Crimea. Russian Foreign Minister Sergey Lavrov’s
contention “no one can expel members from the G8” to
the contrary, current plans call for the G-7 to go forward
with a meeting in Brussels, Belgium, presumably on
June 4-5.
Australia’s G20 2014 Agenda
Australia’s G20 Presidency will focus on the key themes
• Promoting stronger economic growth and
employment outcomes
• Making the global economy more resilient to deal
with future shocks
The G20 2014 agenda is structured to address the
growth challenge articulated in the St Petersburg
G20 Leaders Declaration through the key themes of
stimulating growth and building global economic
resilience. More information on Australia’s approach
to hosting the G20 is available in the Overview of
Australia’s Presidency.
The Labour 20 – L20 represents workers at the
G20 and is composed of trade unions from G20
countries and Global Unions. The L20 is led by the
ITUC and Trade Union Advisory Committee (TUAC)
to the Organization for Economic Co-operation and
Development (OECD) to convey key messages of the
global labour movement to Employment Task Force
and Sherpa meetings, Labour and Finance Ministers
meetings and G20 Summits which are an integral part
of the G20 process.
The Civil Society 20—C20 is a platform for dialogue
between the political leaders of G20 countries and
representatives of civil society organizations. Through
the C20, civil society can have a say in the discussions
shaping our global economy.
• Inclusive Growth and Employment
• Infrastructure
• Climate and Sustainability
• Governance
Summit Time Lines
ITUC L20 timeline
May 2014  Issue 3
Peter Piot: 10 Myths Towards a
Collective State of Denial
Peter Piot, ex-UNAIDS director and
now head of the London School of
Hygiene and Tropical Medicine,
made the keynote speech at the 20th
anniversary convention of the
International HIV/AIDS Alliance.
Click this link to read the Alliance
story about his remarks.
1. The end is in sight, with a variation that AIDS is
2. All we need is better coverage of ART, which will
wipe out the epidemic.
3. Behavioural interventions don’t work; we can only
rely on biomedical prevention.
4. There is no longer a need for distinct HIV
programmes, integration is the answer!
5. The epidemic is on a downward trajectory – let’s
continue doing what we are doing and it will wipe
out HIV.
6. Stigma and discrimination has disappeared now
we have ART, and the promotion of human rights
as part of the AIDS response is an unnecessary
luxury which can be handled by others.
7. There is no longer a need for civil society;
physicians will fix this for you.
8. Domestic funding will now cover all necessary
costs of the response.
9. We cannot do better with current funding, and
managerial and programmatic efficiency are
unnecessary business concepts.
10. There is no need to continue investing in a
Sexual and Reproductive Health Rights
and Wrongs
Sexual and reproductive health covers some of the
key stages in life. It promotes the health of mothers as
they carry and deliver a new child as well as the health
of the babies themselves. It also takes into account
the reproductive process, which is basically a sexual
one. There are many concerns here, from the age of
sexual debut to the availability of contraceptives and
appropriate information.
Sexual and reproductive health rights (SRHR) are
the rights of all people to make decisions regarding
their own sexuality, without infringing upon the
rights of others. This includes the right to decide if,
when, and how many children to have; the right to the
information, means, and services available to ensure
the best possible sexual and reproductive health;
and the right to be free from coercion, stigma, and
Workers, their families and their organizations are
all affected when these rights are limited or denied
because services are unavailable or unaffordable.
Discrimination in its many forms including anti-gay
laws also deny people their sexual and reproductive
health rights, as has been vividly illustrated recently.
Our network stands for the right to health, and
opposes attempts to limit it or make exceptions. Sexual
and reproductive health — although a minefield of
cultural taboos and political manoeuvring — must
be understood as a basic issue of human rights. The
marginal status of women and young people, the
acceptability of domestic violence, and discrimination
on the grounds of sexual orientation are a denial of
rights and undermine the health of the community as a
Trade unions are able to share their considerable
experience in fighting for human rights when others
are intent on taking them away. Trade unionists are
quick to spot the tactic of undermining solidarity
through spreading lies, fueling hatred, and vilifying the
vulnerable. They know that unless the “universal”
in universal human rights means that fundamental
rights apply to everyone, they can be taken away
from anyone.
May 2014  Issue 3
Canadian Unions Call on Government for
Action on Uganda’s Anti-Gay Law
Canadian unions uphold a long tradition of fighting for
human rights in response to the recent signing of anti-
gay legislation in Uganda. The CLC, CUPE (Canadian
Union of Public Employees), UNIFOR and OSSTF
(Ontario Secondary Teachers’ Federation) have called
on the Prime Minister and Foreign Affairs Minister to
send a clear message to Ugandan President Museveni
opposing the law and upholding the rights of the
country’s LGBT citizens.
Canadian unions want the government to underscore
the gravity of its concerns by recalling Canada’s
Consulate Representative from Kampala, which is
considered a serious diplomatic protest.
On 24 February 2014, Uganda’s President signed into
law legislation criminalizing same-sex relations in
Uganda. The law provides for life imprisonment for
same-sex relationships between consenting adults.
Even more ominously, the law also makes it a crime not
to report to authorities people who are gay.
Is the Democratic Republic of Congo
MP Steve Mbikayi, member of the Democratic Republic
of the Congo’s (DRC) Parti Travailliste Congolais,
is proceeding with plans to introduce a bill to the
Congolese National Assembly explicitly criminalizing
homosexuality. The online magazine, ThinkAfricaPress,
says Mbikayi’s bill contains 37 articles that would
render homosexuality and transgenderism illegal. The
proposed penalty for engaging in a homosexual act is
3 – 5 years in prison and a fine of 1 million Congolese
francs (about $1,000). A transgender person would face
the same fine and a jail sentence of 3 to 12 years.
The allAfrica news service has published Africa: A
Look At Africa’s Anti-Gay Laws, a useful analysis
and overview of the trend to expand and increase
punishments for same-sex acts.
World Medical Association (WMA)
Condemns Portrayal of Homosexuality as
a Disease
The persistent portrayal of homosexuality as a disease
is condemned by the WMA along with attempts to
treat it using so-called “conversion” or “reparative”
At its October 2013 Assembly in Fortaleza, Brazil, the
WMA issued a strong statement condemning all forms
of stigmatization, criminalization and discrimination
of people based on their sexual orientation. It said that
homosexuality is a natural variation within the range of
human sexuality.
WMA President, Dr. Margaret Mungherera, said:
“Homosexuality itself is not a disease. It is the
stigmatization and discrimination experienced by
people with a bisexual or homosexual orientation
which can be harmful to health.”
May 2014  Issue 3
Extracts from R200 on Rights
and Discrimination
General principles, clause 3:
(c) there should be no discrimination against or
stigmatization of workers … on the grounds of
real or perceived HIV status or the fact that they
belong to regions of the world or segments of the
population perceived to be at greater risk of or
more vulnerable to HIV infection; …
National policies and programmes, clause 14:
Measures should be taken in or through the workplace
to reduce the transmission of HIV and alleviate its
impact by:
(a) ensuring respect for human rights and
fundamental freedoms;
(b) ensuring gender equality and the empowerment
of women;
(c) ensuring actions to prevent and prohibit violence
and harassment in the workplace;
(d) promoting the active participation of both women
and men in the response to HIV and AIDS;
(e) promoting the involvement and empowerment
of all workers regardless of their sexual
orientation and whether or not they belong to a
vulnerable group;
(f) promoting the protection of sexual and
reproductive health and sexual and reproductive
rights of women and men; and
(g) ensuring the effective confidentiality of personal
data, including medical data.
“Discrimination” means any distinction, exclusion
or preference which has the effect of nullifying or
impairing equality of opportunity or treatment in
employment or occupation, as referred to in the
Discrimination (Employment and Occupation)
Convention, 1958, and Recommendation, 1958.
Queen Elizabeth II Backs Gay Britain for
the First Time
In a landmark statement, the reigning monarch of
the United Kingdom and the Commonwealth has
announced her support for a gay charity in what is
believed to be her first ever comment about the LGBTI
community. The Queen praised the London Lesbian and
Gay Switchboard on its 40th birthday, and said: “Best
wishes and congratulations to all concerned on this
most special anniversary”. Every year, the Switchboard
answers thousands of calls from people who feel
isolated by their sexuality.
Monitoring and Defending Same-Sex
Human Rights
Human Dignity Trust is a London-based NGO whose
small staff coordinates a global network of lawyers that
challenge laws criminalizing private consensual sexual
activity between adults of the same sex. Its Persecution
Alert documents the latest human rights violations
stemming from same-sex sexual activity. The Trust
cannot give legal advice on individual cases, but when
someone is affected by laws criminalizing same-sex
sexual activity, they pledge to provide assistance or a
referral to an organization or lawyer who can help.
Do we Care Enough about Sexual
Jaspeer Kindra reviews examples of gender-based
violence in IRIN News (13 January 2014) and what
some communities in India and South Africa are doing
to challenge people’s apathy. Apathy paralyzes the will
to action and allows the violence to continue.
People often feel they are less qualified, that others
would be in a better position to help, or that helping
could involve them in time-consuming legal processes.
Members of the police force might be apathetic because
of personal prejudice—usually no different from
society at large—which often blames victims for being
in the “wrong” place at the “wrong” time, and exposing
themselves to risk. If the victim is a baby, the parents
are blamed.
Jaspreet Kindra/IRIN
May 2014  Issue 3
Men can also start changing their attitudes towards women.
Activist Michael Urbina runs a blog with “101 everyday ways for
men to be allies to women”. It offers simple tips: “Be conscious
of where your eyes wander as a woman walks by—change that
behaviour”, and “Remove photos of semi-nude women from your
phone wallpaper.”
More information on other forms of sexual violence:
Issue 271/272 (2013) of Resurgence, the magazine of Third World
Network, was devoted to Violence against women of the South in a
globalised world.
See too the websites of V-Day (14 February), a global movement
to end violence against women and girls, and the White Ribbon Campaign, men working against violence against
women. (Note the White Ribbon Alliance campaigns for safe motherhood.)
Disparities in Sexual and Reproductive Health Persist,
with Grave Consequences for Health and Development
222 million women have an
unmet need for modern

16 million girls and young women
become pregnant between the
ages of 15 and 19.
An estimated 287 000 deaths
occur due to pregnancy-related
complications. The extent of
adverse outcomes for young
people including maternal
mortality is poorly understood.
Complications of unsafe
abortions account for an
estimated 47 000 maternal
An estimated 39 000 child
marriages occur globally every
13.8 million girls have undergone
female genital mutilation in Africa.
One in three women globally
experiences violence, including
intimate partner or sexual
violence by someone other than
a partner, or both.
Each year, 499 million new cases
of sexually transmitted infections
Source: WHO and ICPD beyond 2014
World Health Organization (WHO) and the International Conference on Population Development (ICPD)
Alicia Field
Community members publicly declared their rejection of
female genital mutilation in Kolda, Senegal, November 2013
May 2014  Issue 3
Adolescent Health in Sub-Saharan Africa:
Global Guidelines Versus Local Realities
Nearly half of the world’s population is
under the age of 25, and more than one
in five people are adolescents aged 10
to 19 years. Approximately 85 percent
of them live in developing countries. In
Sub-Saharan Africa about three-quarters
of young people would have had their first
sexual intercourse by age 20.
An article in the Journal of Public Health in Africa 2013,
volume 4:12 looks at the difficulties of many countries
in translating global policy guidelines on adolescents’
sexual reproductive health (ASRH) into national
policies and action.
Complications arise from knowledge gaps and
sometimes a clear conflict of interest between national
laws and global guidelines. The authors point to the
neglect of many vulnerable groups, including HIV-
positive adolescents; pregnant street youth; young sex
workers; orphans; adolescents in conflict areas and
refugees; adolescents and young adults in rural areas
and the informal economy.
“Economic and cultural globalization has a significant
influence on adolescents’ values and lifestyles
worldwide…”, write the authors, from Thamassat
University Faculty of Public Health, Thailand.
“Moreover, poor reproductive health is both a cause
and consequence of poverty. Poverty is associated with
high-risk behaviors, such as coerced sex, rape, and
unsafe sex in exchange for monetary incentives. [They]
put young women at risk of unintended pregnancy, of
HIV and sexually transmitted infections, which in turn
can affect their reproductive health.”
HIV/AIDS and human rights: young people in action
(UNAIDS and UNESCO): A kit of ideas for youth
In Brief
Conflict of Interest? Aidspan CCM Study
A new report identifies threats that can compromise
the process of principal recipient selection or grant
implementation. The report. Conflict of Interest
in Country Coordinating Mechanisms: An Aidspan
Survey, was prepared by the independent organization
Aidspan is an international Kenya-based NGO that
serves as an independent watchdog of the Fund and its
grant implementers. The report surveyed thirty-three
CCM members from seven countries as a baseline for
future research on the extent of conflict of interests
within CCMs.
Where There are Few Unions: Health and
Safety Education for Organizing in Export
The November 2013 research and policy brief of the
UCLA Institute for Research on Labor and Employment
reviews the growth of Export Processing Zones (EPZs)
and introduces a new Guide to Workers’ Health and
Safety (see below). It criticizes voluntary systems
such as Codes of Conduct and Corporate Social
Responsibility programmes, and argues that the best
guarantee of a safe workplace is an educated and
empowered workforce.
May 2014  Issue 3
Guide to Workers’ Health and Safety
As a tool in the struggle for workers’ rights
and occupational health, non-profit publisher
Hesperian is producing a guide to assist workers
and their supporters in organizing safe workplaces
in the garment, shoe, electronics and chemical
industries. It also deals with a range of general
work hazards as well as stress, mental health and
working from home.
MiNDbank: Towards Inclusiveness in
WHO launched this online platform in December
2013 to promote dialogue, good practice and health
reform. It brings together resources on mental health,
substance abuse, disability, general health, human
rights, and development. There is free and easy access
to national and international health and rights policies,
laws, conventions and reports.
MiNDbank is part of WHO’s QualityRights campaign to
end violations against people with mental disabilities.
Disability and Development
The Guardian’s Global Development Professionals
Network is a forum for raising issues and open access
comments. On 7 February Anna Scott put this question:
“Disability entrenches inequality but has been
woefully neglected in development policies. How
can the problems facing disabled people be better
… 80% of people with disabilities across the
world live in developing countries, where they are
three times more likely to be denied healthcare
and nearly twice as likely to be unemployed as
they would be in industrialized countries. In some
communities, where disability is seen as a curse or
form of possession, they also face a deep-rooted
culture of abuse and punishment. It’s surprising,
then, that disability was not included in the
millennium development
goals ….”
The Guardian’s “Live chat” received several hundred
comments on the piece.
International Baby Food Action Network
(IBFAN) Breastfeeding Brief: Infant /
Young Child Feeding and Chemical
All human beings carry a “body burden” of up to 200
industrial chemicals. Babies in the womb, infants and
young children are particularly vulnerable to the effects
of exposure because they are at the most sensitive
stages of development. Breast milk contains protective
agents and helps the child develop a strong immune
system. It can mitigate the effects of chemical exposure
in the womb and after. This holds true even when there
is evidence of the presence of chemical residues in the
mother’s milk because the benefits of breastfeeding far
outweigh any possible harm.
The latest Breastfeeding Brief (No. 55) from the IBFAN
provides comprehensive information, based on peer-
reviewed scientific research, to guide parents, care-
givers, and health professionals.
May 2014  Issue 3
Nigeria’s National Agency for the Control
of AIDS (NACA)/Nigeria Labour Congress
(NLC) Launch HIV/AIDS Testing Drive
NLC President, Comrade Obdulwahed Omar (Middle), being screened for
HIV, during the launch of the NACA and NLC HIV testing drive. (29/8/13).
At right is the NACA Director-General, Professor John Idoko.
United Kingdom Trade Union Congress
(UK TUC) and Transport Workers Mark
World AIDS Day: Focus on Social
Protection, Stigma and Discrimination
On World AIDS Day, the UK’s TUC released a report on
how social protection floors can help deliver the ‘triple
zero option’ of zero deaths from HIV-AIDS, zero new
infections and zero stigma and discrimination, as part
of the post-2015 international development agenda.
Transport Workers
More than 150 affiliates of the International Transport
Workers’ Federation (ITF) took action on World AIDS
Day in over 50 countries. More detail is available in
HIV/AIDS quarterly HIV/AIDS update no. 131 and
here’s a sample from across the world:
In Burundi, transport unions organized special peer
education sessions at border points and transports
hubs, and distributed condoms. The Transport and
Communications Workers’ Trade Unions Industrial
Federation (TCWTUIF) in Ethiopia collaborated
with employers to provide education and training on
overcoming stigma at the workplace. In Ghana, unions
organized rallies and discussion sessions. A consortium
of ITF affiliates in Kenya held activities over a week,
covering all transport sectors and including USAFIRI,
the network of HIV-positive transport workers. There
were peer education sessions, workplace seminars, VCT
camps, rallies, campaigns at border points and story-
telling sessions.
In Malawi affiliates organized street theatre, rallies and
condom distribution while the Maritime Transport &
Ports Employees Union (MTPEU) in Mauritius held a
week-long VCT session for seafarers and dockers. The
Namibian Transport Union and Federation arranged
discussion sessions at workplaces. The Air Transport
Staff Association in Nigeria organized education
sessions and condom distribution at airports and
workplaces, and a workshop on HIV/AIDS stigma and
discrimination at work. The long-distance drivers’
union of Rwanda joined forces with the drivers’
spouses association to put on activities for drivers and
their families; in Senegal, too, families were included in
VCT and education sessions.
The Sierra Leone Seamen’s Union organized a
symposium in collaboration with the National AIDS
Secretariat, and South African Transport and Allied
Workers’ Union(SATAWU) in South Africa held
activities at workplaces and wellness centres. The focus
in Tanzania was on VCT camps and education sessions
along the major transport corridors and in Togo,
on workplace information sessions on stigma. The
Amalgamated Transport and General Workers Union
(ATGWU) in Uganda held education sessions and VCT
camps at workplaces. Air transport workers in Zambia
helped run an information market at the airport and
candle light service. The Zimbabwe airway workers
organized rallies at airport across the country.
BREL, Bangladesh, organized a rally for railway
workers and held a meeting with the railway’s Chief
Medical Officer and district Medical Officers. ITF
affiliates in India from road, rail, and ports collaborated
to hold education sessions for workers and family
members, put on street theatre, visit ships to distribute
information and condoms, hold rallies at work places,
and meet with management to develop HIV/AIDS
policies. In addition to ship visiting and education
sessions, the seafarers’ union in Indonesia ran talk
May 2014  Issue 3
shows and AIDS awareness activities, and organized a
“family walk.”
The maritime trade unions in Myanmar organized an
education programme for members and distributed
condoms. In Nepal the ITF affiliates organized
campaign activities and discussions at border points
with India. The seafarers’ centre in Siracha, Thailand,
in collaboration with local organizations ran a range of
events for seafarers and fishermen.
BTB-Belgium discussed HIV needs and responses
at its executive committee meeting and distributed
information materials at workplaces, as did the FNST-
CGT in France. The Norwegian Seafarers’ Union visited
ships and distributed ITF’s campaign materials and
condoms. In the UK, the youth wing of the RMT ran
information campaigns at workplaces. The Marine
Transport Workers’ Trade Union of Ukraine conducted
campaigns for their members all over the country,
while the cadets at the Odessa National Maritime
Academy and Technical College attended a special
Latin America and the Caribbean
The Sindicato Nacional de Trabajadores del
Transporte (SNTT) in Colombia organized activities
across the provinces which ranged from workplace
rallies to condom distribution, as well as meeting
with management to discuss workplace policy. The
affiliates in the Dominican Republic and Guyana
held workshops and rallies. In Guatemala, the
transport unions started World AIDS Day activities
on 25 November to mark the International Day for
the Elimination of Violence against Women. The port
workers in Honduras organized exhibitions, training,
and a rally through the main streets of the port where
they distributed leaflets and condoms. Rallies in
Mexico targeted the main bus and tram depots and
were supported by the distribution of condoms and
information materials. The port workers organized
discussion sessions and ship visiting to distribute
condoms. VCT camps and workshops were at transport
workplaces in Peru, while the Panama canal workers’
union provided information for workers on ships
transiting the Panama Canal and carried out training
for members and maritime cadets. The affiliate in
Venezuela arranged activities at ports and along major
road transport corridors.
See too the ITF’s World AIDS Day campaign pages.
May 2014  Issue 3
The Impact of Employment on HIV
Treatment Adherence
How does having a job affect adherence to HIV
treatment? A team of independent researchers helped
the ILO gather and assess evidence for a 2013 report
in November 2013. The review found that respondents
who were employed were 39 per cent more likely
to have achieved optimal adherence than those
unemployed. Twenty-three studies involving 6,674
people living with HIV were included.
The study also interviewed key informants who
were selected to collect data on the knowledge,
perception, and attitudes from carefully selected
stakeholders. Overwhelmingly, key informants reported
that employment is likely to positively impact ART
adherence by providing food security and money to
attend clinic visits, collect pharmacy refills, and cover
out-of-pocket costs of other health services.
The report’s recommendations were addressed to
governments, health and development organizations,
employers, and other workplace actors. They stressed
the need to promote relevant livelihood interventions,
economic and nutritional incentives, the modification
of working arrangements and clinic opening times,
more HIV-sensitive social protection schemes, and
national and workplace efforts to reduce the stigma
and discrimination. Stigma and discrimination are
persisting barriers to treatment uptake and
Swedish Workplace HIV/AIDS Programme
SWHAP’s well-established programme now supports
over 200 workplace programmes on HIV and wellness
in ten countries in Sub-Saharan Africa. It was started
in 2004 by the Industrial Metal Workers’ Union of
Sweden (IF Metal) and the International Council of
Swedish Industry (NIR). SWHAP presently operates in
Botswana, the Democratic Republic of Congo, Kenya,
Namibia, Rwanda, South Africa, Tanzania, Uganda,
Zambia and Zimbabwe.
SWHAP workplaces are actively involved in the ILO’s
“Getting to Zero at Work” and “VCT @ Work” campaigns
promoting access to testing, counselling and treatment
for workers and their families.
Diabetes and Other Conditions
A broader vision of wellness is now integrated in the
information and screening for diabetes offered during
HIV awareness sessions and Workplace Wellness Days
in SWHAP supported workplaces in sub-Saharan Africa.
This is important in a region where the WHO estimate
that the diabetes population will double over the next
May 2014  Issue 3
25 years and more than 80% of people do not know
they have the disease. Addressing the risk factors of
diabetes is also of benefit to workers affected by other
communicable and non-communicable diseases—
including HIV—as changes in nutrition and lifestyle
help keep the immune system healthy.
In South Africa, SWHAP supported a road safety and
wellness campaign over Christmas 2013, offering
wellness checks for truck drivers as well as their
vehicles. Over 500 drivers had glucose, blood pressure
and cholesterol tests at selected truck stops and most
also participated in voluntary HIV counseling and
testing on well-established trucking routes.
More information can be found on the organization’s
website and in its December 2013 newsletter.
News Interviews . . .
Kwasi Adu-Amankwah,
General Secretary of
the African Regional
Organisation of the
Trade Union
Can you identify the main barriers to higher levels
of trade union participation in national HIV/AIDS
strategies? How can national centres work more
actively with sectoral unions for a strengthened,
unified labour response?
The main barriers in terms of participation in national
HIV/AIDS strategies are financial limitations, political
will, over-reliance on the private sector, and failure to
integrate the International Labour Organization’s (ILO)
HIV and AIDS Recommendation, 2010, No. 200 (R200)
in the national policy and legal framework.
Financial limitations: Our participation requires
reliable and adequate amounts of funds. Trade
unions have many responsibilities but often limited
resources. Limited finances have definitely affected our
ability to participate as effectively as we could be in
implementing national strategies.
Political will: In many countries other HIV/
AIDS stakeholders—including governments, non-
governmental organizations (NGOs), and the private
sector—do not regard trade unions as important
partners. Workplace interventions are often carried
out by these partners without making any attempts
to effectively involve trade unions. In the majority of
countries, national union centres are not members of
the national AIDS council or the Country Coordinating
Mechanism (CCM) of the Global Fund.
Over-reliance on the private sector: Many countries
in Africa have adopted the concept of Public-Private
Partnerships (PPP) and regard it as the solution to all
problems. Though the private sector is a key partner,
over-reliance on one partner at the expense of other
partners is counterproductive. HIV/AIDS is not only
a financial and economic health problem, but also a
human and labour rights, ethical, cultural, spiritual
and social health problem. It is a combination of these
factors that will provide the best solution. We need all
actors representing all these areas to work together on
HIV/AIDS. The private sector alone cannot solve such a
complex health problem.
Failure to integrate R200 in national policy and
legal frameworks: R200 can provide much-needed
support in addressing HIV/AIDS in the world of work
and beyond. It is also a very useful tool for trade unions
to participate effectively in implementing national
strategies. The absence of a global instrument like
R200 was a serious omission; it weakened the fight
against HIV/AIDS in the world of work. However, since
its adoption very few countries in the region have
domesticated it, thus prolonging the inability of unions
to engage effectively in national responses.
We can increase cooperation between national
centres and sectoral unions by first, establishing
a regional coordinating structure between ITUC-
Africa and the regional representatives of Global
Union Federations; second, setting up joint steering
committees at the national level for national centres
and sectoral unions; and third, strengthening the
campaign for domestication of R200 and compliance
with the Abuja Declaration on Health.
May 2014  Issue 3
What can be done to increase the engagement
of workplaces—public and private—in HIV/
AIDS action and to boost collaboration between
employers and trade unions?

Collaboration between trade unions and employers
will be improved when: CCMs allocate seats to
national centres as well as employer and private
sector representatives; all-inclusive and transparent
national coordinating institutions are established or
strengthened; R200 is integrated in national policy and
legal frameworks; and employers and unions jointly
develop a model national Capacity Building Assistance
(CBA) and workplace policy.
In November 2012, the ITUC-Africa, the LO-TCO
(Sweden) and the Confederation of Ethiopian
Trade Unions (CETU) held a regional workshop
to strengthen young people’s involvement in
national AIDS councils and national coordination
mechanisms. How would you assess progress to
date? What more can unions do to increase youth
involvement and participation in national HIV/
AIDS bodies?
The ITUC-Africa and LO-TCO initiative with
Confederation of Ethiopian Trade Unions (CETU)
aimed at raising awareness on the importance of
youth involvement in the fight against HIV/AIDS. In
this regard, we have seen increased interest by young
members in awareness-raising and voluntary testing
at the regional level. Resources have not allowed us to
facilitate similar activities at the national level and this
is where efforts should be directed.
Do you believe that trade unions are committed
for as long as it takes to end AIDS?
The war against the HIV pandemic can never be
won without targeting the workplace and without
involvement of those who spend most of their time in
the workplace. As social institutions, trade unions have
suffered most through loss of membership, increased
cost in defence of workers’ rights and difficulties in
negotiating for better working conditions and social
protection. Therefore, trade union commitment is not
only necessary but essential if they are to survive as
viable institutions.
What do you see as the next phase of African
trade union action to build on what has been
achieved? How do you see these next steps
contributing to the long-term HIV/AIDS response?
What advice do you have on the integration of
HIV/AIDS in the broader health and rights issues
that affect workers?
The fight against HIV/AIDS is entering a critical period
due to dwindling financial resources, donor fatigue,
the misconception that HIV/AIDS is under control,
rising rates of unemployment and increasing incidence
of social instability and insecurity in the region. In
addition, the number of HIV/AIDS orphans is high and
the challenge of ensuring their care will haunt Africa
even beyond the discovery of a cure for HIV.
Therefore, it is imperative that the next steps include
the following actions:
• We must keep reminding policy-makers and
decision-takers that the war is not yet over.
Resources are needed now more than ever to
prevent us from sliding back to the 1990s situation.
Unions must engage in promoting peace and
security and address the plight of workers and
others who are affected by the epidemic.
• We must ensure that HIV/AIDS issues are
adequately addressed in the post-2015
development agenda. This also means addressing
health and human rights in a broader and more
integrated manner.
We must put pressure on all countries that are member
states of the Africa Union to domesticate R200 and
comply with the 2001 Abuja Declaration on Health.
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