Politics, law and a lack of sperm: single women and fertility treatment in the Swedish health system.

In 2016 Swedish law was amended to allow single women to access fertility treatment with donor sperm. In this paper, based on interviews, document analysis and autoethnographic insights, I examine the implementation of this law using human rights approaches, specifically the availability, accessibility, acceptability, and quality framework (AAAQ Framework). While the law extended the scope of reproductive rights, the health system was unprepared. Five years on, women seek care in the private sector or continue to travel abroad due in large part to waiting times which can be up to four years in some regions. The paper also provides a meeting point between anthropology and policy analysis. The law change provides a pathway for analyzing the Swedish health system and political context, particularly the relationships between the private and public sectors and between different regions, and the balance of responsibility between national and regional levels. While many of the challenges are unique to the Swedish context, they also offer lessons for countries which have or are considering expanding access to fertility treatment for single women and other patient groups, thus demonstrating the importance of ethnographic approaches in health policy analysis.

HIV and access to fertility treatment in the European and Swedish contexts.

Across Europe many people living with HIV face discrimination in accessing fertility treatment. This short communication presents an updated mapping of regulations across Europe, along with a consideration of the Swedish context. Overall, the accessibility and availability of MAR for people living with HIV in Europe is complicated and, in some countries, inconsistent. We encourage sharing best practice from countries with less restricted access. We also call for an end to discrimination based on outdated medical knowledge, and for more clearly defined and readily available guidelines surrounding fertility treatment entitlements for people living with HIV.

Medically assisted reproduction for people living with HIV in Europe: A cross-country exploratory policy comparison.

OBJECTIVE: To explore the availability and accessibility of medically assisted reproduction (MAR) for people living with HIV in Europe, including the feasibility of cross-border care. METHODS: We used a polymorphous engagement approach, primarily based on digital and email-based interviews with representatives of national HIV organizations, clinical researchers (infectious disease and/or infertility specialists), European and national professional societies (fertility and/or infectious disease), national regulatory authorities and individual clinics in 14 countries in the WHO European region. The research design and results were also informed by two surveys and a review of the secondary literature, news articles and clinic websites. RESULTS: Although MAR is possible for people living with HIV in 12 out of the 14 countries mapped, accessing services can be challenging for logistical or financial reasons. People living with HIV also face barriers to MAR independent of their HIV status, such as limitations on single women and same-sex couples accessing services. Cross-border care is available for most patients who are self-financing but is limited for publicly funded patients. CONCLUSIONS: Even when MAR is available to and accessible for people living with HIV, there may still be barriers to treatment. Further research on patient experiences is needed to understand these discrepancies between availability and accessibility on paper and in practice.

Imagining the postantibiotic future: the visual culture of a global health threat.

This article is concerned with the visual culture of global health data using antimicrobial resistance (AMR) as an example. I explore how public health data and knowledge are repackaged into visualisations and presented in four contemporary genres: the animation, the TED Talk, the documentary and the satire programme. I focus on how different actors describe a world in which there are no or few antibiotics that are effective against bacterial infections. I examine the form, content and style of the visual cultural of AMR, examining how these genres tell a story of impending apocalypse while also trying to advert it. This is a form of story-telling based around the if/then structure: we are told that if we do not take certain actions today, then we will face a postantibiotic future with certain, often catastrophic, consequences. Within this if/then structure, there are various aims and objectives: the goal may be preventing further spread of AMR, building awareness or pushing for certain policy or funding decisions. These stories also serve to place or deflect blame, on animals, occupations, patients, industries and others and to highlight risks and consequences. These examples share similarities in the forms of story-telling and narrative, and in the use of specific data sources and other images. By using several Swedish examples, I demonstrate how global data are reinterpreted for a national audience. Overall, I argue that while the convergence of a dominant narrative indicates scientific consensus, this consensus also stifles our collective imagination in finding new solutions to the problem. Finally, I also use the example of AMR to discuss the need for a broader social science and humanities engagement with the visual culture of global health data.

Deviant Swedes in the Global Covid-19 Media Environment.

During the early COVID-19 pandemic, many countries took compulsory measures to combating the virus's spread, while Sweden took a more voluntary approach. This led to polarized reactions in the international media, with some praising it and others proclaiming it disastrous. Using the concept of "moral panic" I examine how actors within the global media environment portrayed Swedes as a deviant population, using persuasive language, exaggeration, and selective reporting, and how an amplification of media attention served to solidify the deviant label. I also argue that Sweden was made deviant partly to justify restrictive measures in other countries.

Misinformation and de-contextualization: international media reporting on Sweden and COVID-19.

In the first month of the 2020 COVID-19 pandemic, Sweden took the same strategy as most other countries, working to "flatten the curve," by slowing transmission so that the healthcare system could cope with the disease. However, unlike most other countries, much of Sweden's implementation focused on voluntary and stepwise action, rather than legislation and compulsory measures, leading to considerable attention in the international media.Six main narratives emerged in the international media reporting on Sweden during the first month of the COVID-19 pandemic: (1) Life is normal in Sweden, (2) Sweden has a herd immunity strategy, (3) Sweden is not following expert advice, (4) Sweden is not following WHO recommendations (5) the Swedish approach is failing and (6) Swedes trust the government. While these narratives are partially grounded in reality, in some media outlets, the language and examples used to frame the story distorted the accuracy of the reporting.This debate examines the ways in which international media both constructs and represents a pandemic, and the implications for how researchers engage with news and social media. Cross-country comparison and the sharing of best practice are reliant on accurate information. The Swedish example underlines the importance of fact checking and source critique and the need for precision when presenting data and statistics. It also highlights limitations of using culture as an explanation for behavior, and the pitfalls of evaluating policy during a pandemic.

Accessibility and availability of assistant reproductive technology for people living with HIV in Europe: a thematic literature review.

As antiretroviral therapies have transformed HIV into a manageable chronic disease, many individuals have or will choose to have children, and the use of assisted reproductive technology can serve as an effective risk-reducing strategy. In this thematic literature review, we examine the state of research on access to and availability of assisted reproductive health technologies for people living with HIV in Europe, with the aim of identifying gaps for further research. We find that the existing literature is focused on serodiscordant couples consisting of an HIV-positive man and an HIV-negative women. This is in part because more treatment options are available for men living with HIV than women, reflecting underlying gender discrimination in treatment. The existing scholarship largely ignores reproductive options for seroconcordant couples or single individuals, or for men and women with underlying infertility. Finally, very little research addresses the question of financial affordability, which is a known barrier to infertility treatment.

Sweden's engagement in global health: a historical review.

BACKGROUND: Sweden is a long-standing and significant contributor to overseas development aid. This commitment to global health and development is part of Sverigebilden, or the view of Sweden in the world that is formally promoted by the Swedish government. Sweden is seen by many in the global health community as leader on human rights and health and has traditionally been one of the most engaged countries in multilateral affairs more broadly. RESULTS: This article places Sweden's engagement in global health within the wider context of domestic changes, as well as transitions within the broader global health landscape in the post-World War Two (WWII)- era. In doing so, it reviews the globalization of health from a Swedish perspective. It also addresses broader questions about what it means for a country to be 'active' or 'engaged' in global health and responds to recent suggestions that Swedish influence in health has waned. The article finds that in Sweden there is wide political consensus that international development and global health engagement are important, and both are part of the maintenance of Sverigebilen. While there is a not one single Swedish approach to global health, there are norms and values that underpin global health engagement such as human rights, solidarity, equity and gender equality. A sustained focus on key issues, such as sexual and reproductive rights and health (SRHR), creates a tradition which feeds back into Sverigebilden. CONCLUSIONS: The Swedish experience demonstrates the linkages between foreign and domestic policies with regard to international health and development, and to the globalization of public health practice and diplomacy. In global health Sverigebilden is tied to credibility. Sweden is able to exercise influence because of a successful welfare model and strong research traditions; conversely, long-standing and new threats to this credibility and to Sverigebilden pose challenges to Sweden's future engagement in global health.

Rituals of global health: Negotiating the World Health Assembly.

The World Health Assembly is the WHO's supreme decision-making body and consists of representatives from the 194 WHO Member States who take formal decisions on the WHO's policies, workplan and budget. The event is also attended by representatives of non-governmental organisations, the private sector, the press and even members of the public. Based on participant observation at six World Health Assemblies, in-depth interviews with 53 delegates to the WHA, and an analysis of WHA Official Records, this article examines the ritualistic aspects of WHA negotiations. We argue that analysing the WHA as a ritual provides an insight into power and legitimacy within global health. Not only are certain understandings of health issues and courses of actions decided by the Assembly, but also the very boundaries of global health community are set. The rules of the ritual place limits on different categories of actors, while both formal and informal rules of behaviour further serve to include or exclude actors from the rituals. Success in negotiation is measured by through the inclusion of certain ideas, norms and values in the wording of resolutions and is achieved through the repetition of language in speeches and by adhering to the rules of behaviour.

Achieving the SDGs through interdisciplinary research in global health.

The Swedish Global Health Research Conference held in Stockholm, 18-19 April 2018, convened researchers from across Sweden's universities to foster collaboration and new research. In response to the theme of the conference, How can Sweden contribute to the Sustainable Development Goals? From research to action, many of the plenary and keynote speakers highlighted the importance of interdisciplinary research and teaching. This commentary draws upon a workshop discussing interdisciplinarity, which took place at the conference. Participants included senior professors, lecturers, students and collaborators from the private sector and civil society and we discussed the conceptual and structural challenges that prevent engagement in interdisciplinary research. Although the workshop focused on the Swedish context, issues will be familiar to researchers working outside of Sweden. The 17 Sustainable Development Goals highlight the grand challenges for global society and are intertwined, with progress in one affecting progress in all others. With this starting point, we argue that interdisciplinary research is the way to achieve them. Accordingly, we need to overcome the conceptual and structural challenges that can hinder it. We therefore argue for a paradigm shift of how we value knowledge. We also call for fundamental changes in external and internal (university-level) funding structures, and for the strengthening of interdisciplinary global health teaching.

Measuring success in global health diplomacy: lessons from marketing food to children in India.

Global health diplomacy (GHD) focuses on international negotiation; principally between nation states, but increasingly non-state actors However, agreements made at the global level have to be enacted at the national, and in some cases the sub-national level. This presents two related problems: (1) how can success be measured in global health diplomacy and (2) at what point should success be evaluated? This commentary highlights these issues through examining the relationship between India and the WHO Set of Recommendations on the Marketing of Food and Non-alcoholic Beverages to Children, endorsed by Resolution WHA63.14 at the 63rd World Health Assembly in 2010.

Measuring success in global health diplomacy: lessons from marketing food to children in India

Global health diplomacy (GHD) focuses on international negotiation; principally between nation states, but increasingly non-state actors However, agreements made at the global level have to be enacted at the national, and in some cases the sub-national level. This presents two related problems: (1) how can success be measured in global health diplomacy and (2) at what point should success be evaluated? This commentary highlights these issues through examining the relationship between India and the WHO Set of Recommendations on the Marketing of Food and Non-alcoholic Beverages to Children, endorsed by Resolution WHA63.14 at the 63rd World Health Assembly in 2010.

Challenges in researching violence affecting health service delivery in complex security environments.

Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research collaboration among aid organizations, researchers and multilateral organizations, such as the WHO, is needed to address these challenges.

An analysis of subject areas and country participation for all health-related projects in the EU's FP5 and FP6 programmes.

BACKGROUND: Previous analyses concerning health components of European Union (EU)-funded research have shown low project participation levels of the 12 newest member states (EU-12). Additionally, there has been a lack of subject-area analysis. In the Health Research for Europe project, we screened all projects of the EU's Framework Programmes for research FP5 and FP6 (1998-2006) to identify health research projects and describe participation by country and subject area. METHODS: FP5 and FP6 project databases were acquired and screened by coders to identify health-related projects, which were then categorized according to the 47 divisions of the EU Health Portal (N = 2728 projects) plus an extra group of 'basic/biotech' projects (N = 1743). Country participation and coordination rates for projects were also analyzed. RESULTS: Approximately 20% of the 26 946 projects (value €29.2bn) were health-related (N = 4756. Value €6.04bn). Within the health categories, the largest expenditures were cancer (11.9%), 'other' (i.e. not mental health or cardiovascular) non-communicable diseases (9.5%) and food safety (9.4%). One hundred thirty-two countries participated in these projects. Of the 27 EU countries (and five partner countries), north-western and Nordic states acquired more projects per capita. The UK led coordination with > 20% of projects. EU-12 countries were generally under-represented for participation and coordination. CONCLUSIONS: Combining our findings with the associated literature, we comment on drivers determining distribution of participation and funds across countries and subject areas. Additionally, we discuss changes needed in the core EU projects database to provide greater transparency, data exploitation and return on investment in health research.