Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak.

BACKGROUND: Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic. METHODS AND FINDINGS: We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), respectively. Chemoprophylaxis beginning 1 wk before departure confers a 91% (78%, 96%) reduction independently, and up to a 98% reduction (94%, 99%) if coupled with vaccination. These results are not sensitive to assumptions about the background cholera incidence rate in the endemic troop-sending country. Further research is needed to (1) validate the sensitivity and specificity of rapid test approaches for detecting asymptomatic carriage, (2) compare prophylactic efficacy across antimicrobial regimens, and (3) quantify the impact of oral cholera vaccine on transmission from asymptomatic carriers. CONCLUSIONS: Screening, chemoprophylaxis, and vaccination are all effective strategies to prevent cholera introduction during large-scale personnel deployments such as that precipitating the 2010 Haiti outbreak. Antimicrobial chemoprophylaxis was estimated to provide the greatest protection at the lowest cost among the approaches recently evaluated by the UN.

Sound and Fury--engaging with the politics and the law of sexual rights.

Although past resistance to sexual rights in global debates has often been grounded in claims to culture, nation and religion, opposition voices are now using, rather than rejecting, the frame of international human rights. This Commentary argues that, despite opponents' attempts to defeat sexual rights with other rights claims, a careful understanding of the principles of international human rights and its legal development exposes how the use of rights to oppose sexual rights should, and will ultimately, fail. The Commentary briefly takes up three kinds of "rights" claims made by opponents of sexual rights: limiting rights to protect rights, textual basis, and universality, and explores the rationales and impact of their application to countering sexual rights. Because sexuality and reproduction intersect as well as diverge in the opposition they face, this struggle matters intensely and plays out across advocacy, programmatic and policy worlds. Underpinning this Commentary is the understanding that opposition to sexual and reproductive health rights uses common arguments about rights principles that must be understood in order to be countered.

Sexual rights as human rights: a guide to authoritative sources and principles for applying human rights to sexuality and sexual health.

This Guide seeks to provide insight and resources to actors interested in the development of rights claims around sexuality and sexual health. After engaging with the vexed question of the scope of sexual rights, it explores the rules and principles governing the way in which human rights claims are developed and applied to sexuality and sexual health, and how that development is linked to law and made a matter of state obligation. This understanding is critical to policy and programming in sexual health and rights, as it supports calling on the relevant range of human rights, such as privacy, non-discrimination, health or other universally accepted human rights, as well as demanding the action of states under their international and national law obligations to support sexual health.

When principles and pedagogy clash: Moving beyond the limits of scholarly practices in an academic-community partnership with sex worker activists.

While U.S. public health education increasingly promotes community-based participatory research (CBPR) as a mode of socially-responsive research, today's intertwined health and social injustice crises demand honest reckoning with the limitations of CBPR as a framework for change. We are a team of students, fellows, and faculty reflecting on the complexities encountered over three years of collaborative work with street-based sex worker activists, in a city characterised by stark wealth disparities reinforced by policies of the university within which we operate. We centre a peer-based needs assessment survey and report on barriers to resources and services for sex workers to highlight hard choices and often unacknowledged challenges to academic partnerships. Our process intends to unsettle the too-sanguine narratives of CBPR, draw from insights arising in the discipline of law, and illuminate practices needed to honour commitments, translate knowledge to power-shifting action, and constructively engage with those most affected in determining the policies that structure their lives.We ask: Can our privileged position within the academy be usefully analysed, confronted, instrumentalised, and even subverted as we shape new practices and interventions in the name of health justice? How might we imagine principles and practices towards a movement public health?

Sexual and reproductive rights at the United Nations: frustration or fulfilment?

Over the past 20 years, advocates have gained formal recognition for some rights in sexuality and reproduction and established the application of human rights standards to sexual and reproductive health issues more generally. However, careful reflection on the state of norm development across sexuality and reproduction as a field reveals fractures and stagnation in the development of standards, and a lack of synergy among advocates and between frameworks for similar rights. This paper seeks to stimulate a more careful accounting for these realities. It examines the formal processes and rules guiding standard-setting, in light of the different intellectual and ideological genealogies of sexual and reproductive rights. We use (homo)sexual orientation and abortion as case studies of current high-profile human rights standard-setting, with specific attention to the contemporary state of human rights law-making in the United Nations today. By placing these two issues in conjunction, we seek to make visible relationships between the vicious political debates in the UN on abortion and sexual orientation, and the multiple and sometimes divergent statements of independent experts and expert bodies in the UN human rights system on these and other sexual and reproductive rights issues. We offer no answers but seek to highlight the need for more investigation and self-reflection by advocates and scholars on how these forces operate and how to work with them.

Health Justice for LGBT Youths: Combining Public Health and Human Rights.

As a socially marginalized group, LGBT youths experience elevated rates of physical and mental health problems that are leading causes of mortality due to a variety of factors. Minority stress theory links exposure to stigma with health outcome disparities. Structural stigma including biased laws, policies, and societal norms predicts approximately 20% of elevated suicidality among LGBT youths. Comprehensive public health efforts to reduce mental health disparities among LGBT youths need to address structural stigma. An interdisciplinary Health Justice approach is described, in which public health evidence is integrated with human rights principles in keeping with the bioethical Justice Imperative. In this approach, epidemiological research is used to inform public health efforts to address health disparities in LGBT youths due to structural stigma in a way that is (1) empirical; (2) aimed at basic goals of reducing morbidity and mortality; (3) applicable to diverse cultural contexts; (4) capable of amending stigma-related power and associated health inequities; and (5) guided by human rights principles. By applying human rights principles to public health needs, this approach will help to achieve health equity for LGBT youths.

Advancing sexual health through human rights: the role of the law.

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.