Punitive laws, key population size estimates, and Global AIDS Response Progress Reports: an ecological study of 154 countries
نویسندگان
چکیده
INTRODUCTION UN global plans on HIV/AIDS have committed to reducing the number of countries with punitive laws criminalizing key populations. This study explores whether punitive laws are associated with countries' performance on targets set in the global plans. METHODS The study used chi-square tests of independence to explore associations between legal status, key population size estimates, and HIV service coverage for 193 countries from 2007 to 2014. We used data reported by countries on United Nations Global AIDS Progress Report (GARPR) indicators, and legal data from UNAIDS, UNDP, and civil society organizations. Due to lack of sufficiently reliable legal data, only men who have sex with men (MSM) could be studied. The study utilized public data aggregated at the national level. Correspondence with individual experts in a subset of countries stated the purpose of the study, and all responses were anonymized. RESULTS AND DISCUSSION A significantly larger proportion of countries that criminalize same-sex sexual behaviour reported implausibly low size estimates or no size estimates for MSM. This is consistent with findings in qualitative research that MSMs are marginalized and reluctant to be studied in countries where same-sex sexuality is criminalized. Size estimates are often used as the denominators for national HIV service coverage reports. Initially, countries that criminalized same-sex sexuality appeared to have higher HIV testing coverage among MSM than did countries where it is not criminalized. However, investigation of a subset of countries that have reported 90-100% HIV testing coverage among MSM found that most were based on implausibly low or absent size estimates. CONCLUSION Criminalization of same-sex sexuality is associated with implausibly low or absent MSM size estimates. Low size estimates may contribute to official denial of the existence of MSM; to failure to adequately address their needs; and to inflated HIV service coverage reports that paint a false picture of success. To enable and measure progress in the HIV response, UN agencies should lead a collaborative process to systematically, independently and rigorously gather data on laws and their enforcement.
منابع مشابه
Global Problem of Hospital Detention Practices
Although an official definition by the World Health Organization (WHO) or any other authority is currently lacking, hospital detention practices (HDP) can be described as: “refusing release of either living patients after medical discharge is clinically indicated or refusing release of bodies of deceased patients if families are unable to pay their hospital bills.” Reports of HDP are very scarc...
متن کاملKey Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response
Background Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were ...
متن کاملData and Methods for the Production of National Population Estimates: An Overview and Analysis of Available Metadata
Thomas Spoorenberg Translated by: Elham Fathi Statistical Center of Iran Abstract. Official population estimates can be produced using a variety of data sources and methods. These range from the direct extraction of information from continuously updated population registers to procedures for updating the status of a population enumerated previously in a periodic census. Additional sources and ...
متن کاملGlobal Health Diplomacy, National Integration, and Regional Development through the Monitoring and Evaluation of HIV/AIDS Programs in Papua New Guinea, Vanuatu, and Samoa
The South Pacific countries of Vanuatu, Samoa, and Papua New Guinea have ascended rapidly up the development spectrum in recent years, refining an independent and post-colonial economic and political identity that enhances their recognition on the world stage. All three countries have overcome economic, political and public health challenges in order to stake their claim to sovereignty. In this...
متن کاملHIV estimates at second subnational level from national population-based surveys
OBJECTIVES A better understanding of the subnational variations could be paramount to the efficiency and effectiveness of the response to the HIV epidemic. The purpose of this study is to describe the methodology used to produce the first estimates at second subnational level released by UNAIDS. METHODS We selected national population-based surveys with HIV testing and survey clusters geoloca...
متن کامل