Self-care interventions for women's health and well-being.

The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.

Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics.

COVID-19, which killed more than 6 million people, will not be the last pandemic. Vaccines are key to preventing and ending pandemics. Therefore, it is critical to move now, before the next pandemic, towards global vaccine equity with shared goals, intermediate steps and long-term advocacy goals. Scientific integrity, ethical development, transparency, accountability and communication are critical. Countries can draw on lessons learnt from their response to the HIV pandemics, which has been at the vanguard of ensuring equitable access to rights-based services, to create shared goals and engage communities to increase access to and delivery of safe, quality vaccines. Access can be increased by: fostering the spread of mRNA intellectual property (IP) rights, with mRNA vaccine manufacturing on more continents; creating price transparency for vaccines; creating easily understandable, accessible and transparent data on vaccines; creating demand for a new international legal framework that allows IP rights to be waived quickly once a global pandemic is identified; and drawing on scientific expertise from around the world. Delivery can be improved by: creating strong public health systems that can deliver vaccines through the lifespan; creating or strengthening national regulatory agencies and independent national scientific advisory committees for vaccines; disseminating information from reliable, transparent national and subnational surveillance systems; improving global understanding that as more scientific data become available, this may result in changes to public health guidance; prioritising access to vaccines based on scientific criteria during an epidemic; and developing strategies to vaccinate those at highest risk with available vaccines.

Increasing compliance with international pandemic law: international relations and new global health agreements.

Across multiple pandemics, global health governance institutions have struggled to secure the compliance of states with international legal and political commitments, ranging from data sharing to observing WHO guidance to sharing vaccines. In response, governments are negotiating a new pandemic treaty and revising the International Health Regulations. Achieving compliance remains challenging, but international relations and international law research in areas outside of health offers insights. This Health Policy analyses international relations research on the reasons why states comply with international law, even in the absence of sanctions. Drawing on human rights, trade, finance, tobacco, and environmental law, we categorise compliance mechanisms as police patrol, fire alarm, or community organiser models. We show that, to date, current and proposed global health law incorporates only a few of the mechanisms that have shown to be effective in other areas. We offer six specific, politically feasible mechanisms for new international agreements that, together, could create compliance pressures to shift state behaviour.

Digital health and human rights of young adults in Ghana, Kenya and Vietnam: a qualitative participatory action research study.

INTRODUCTION: Digital health offers the potential to strengthen health systems in low- and middle-income countries. However, experts have warned about threats to human rights. METHODS: We used qualitative methods to investigate how young adults in Ghana, Kenya and Vietnam use their mobile phones to access online health information and peer support, and what they see as the effect on their human rights. We applied a transnational participatory action research approach. Global and national networks of people living with HIV, AIDS activists, young adults and human rights lawyers participated in study design, desk review, digital ethnography, focus group discussions, key informant interviews and qualitative analysis. RESULTS: We interviewed 174 young adults ages 18-30 in 24 focus groups in 7 cities in Ghana, Kenya and Vietnam, and held 36 key informant interviews with national and international stakeholders. Young adults reported predominantly using Google, social media and social chat groups for health information. They emphasised reliance on trusted peer networks, and the role of social media health champions. However, gender inequalities, class, education and geography create barriers to online access. Young adults also disclosed harms linked to seeking health information online. Some described anxiety about phone dependence and risk of surveillance. They called for a greater voice in digital governance. CONCLUSION: National health officials should invest in young adults' digital empowerment, and engage them in policy to address benefits and risks of digital health. Governments should cooperate to demand regulation of social media and web platforms to uphold the right to health.

Leveraging the HIV response to strengthen pandemic preparedness.

The COVID-19 pandemic and the expectation of future pandemic threats have generated a global dialogue on strengthening pandemic preparedness and response (PPR). Thus far, this dialogue has largely failed to fully consider the critical role that established, disease-specific programs played in national and regional COVID-19 responses, and the potential for these programs to contribute to stronger pandemic preparedness for the future. The HIV response is an important example of a global health initiative that is already making substantial contributions to PPR. Both the infrastructure and core principles of the HIV response have much to contribute towards pandemic preparedness that is more effective and equitable than seen in the response to COVID-19. This review examines how HIV-related resources and principles can support communities and countries in being better prepared for emerging disease threats, with a specific focus on evidence from the COVID-19 pandemic. Drawing on the current literature, the review explores the clear, multi-faceted intersection between the HIV response and the central elements of pandemic preparedness in areas including surveillance; supply chain; primary care; health care workforce; community engagement; biomedical research; universal access without discrimination; political leadership; governance; and financing. There are many opportunities to be more strategic and purposeful in leveraging HIV programs and approaches for preparedness. Avoiding the longstanding temptation in global health to create new siloes, PPR initiatives, including the new Pandemic Fund at the World Bank, should invest in and build out from existing programs that are already making health systems more inclusive and resilient, including the global response to HIV.

Perspectives on HIV Self-Testing Among Key and Affected Populations in Kenya.

Background: Kenya's Key and Affected Populations (KAP) - men who have sex with men (MSM), female sex workers, people who inject drugs (PWID), and young women aged 18-24 - often experience stigma and discrimination in Kenyan health care settings due to their identity and/or behaviors, which can deter facility-based testing for HIV. Kenya has promoted self-testing as a means to reach these communities. Objectives: To identify KAP perspectives on self-testing and place our findings within Kenya's human rights and legal context. Methods: We conducted 4 focus group discussions (FGD) and 16 in-depth interviews (IDI). One FGD was conducted with each of the following communities: MSM, female sex workers, PWID, and young women aged 18-24. 1-4 IDI were conducted with each KAP community, and 1-3 IDI were conducted with health professionals working on HIV care in each study site. The semi-structured question guideline included one question soliciting opinions on self-testing. Results: KAP support self-testing in concept, however prevailing concerns among participants included access to pre- and post-test counseling services, as well as risk for harms (self-inflicted and otherwise) that might result from a positive result. Conclusion: Kenya should ensure that human rights are promoted and respected through implementing rights-based policies and practices for HIV self-testing, including pre- and post-test counseling.

Perspectives on HIV self-testing among key and affected populations in Kenya

Background: Kenya's Key and Affected Populations (KAP) ­ men who have sex with men (MSM), female sex workers, peoplewho inject drugs (PWID), and young women aged 18-24 ­ often experience stigma and discrimination in Kenyan health care settings due to their identity and/or behaviors, which can deter facility-based testing for HIV. Kenya has promoted self-testing as a means to reach these communities. Objectives: To identify KAP perspectives on self-testing and place our findings within Kenya's human rights and legal context. Methods: We conducted 4 focus group discussions (FGD) and 16 in-depth interviews (IDI). One FGD was conducted with each of the following communities: MSM, female sex workers, PWID, and young women aged 18-24. 1-4 IDI were conducted with each KAP community, and 1-3 IDI were conducted with health professionals working on HIV care in each study site. The semi-structured question guideline included one question soliciting opinions on self-testing. Results: KAP support self-testing in concept, however prevailing concerns among participants included access to pre- and posttest counseling services, as well as risk for harms (self-inflicted and otherwise) that might result from a positive result. Conclusion: Kenya should ensure that human rights are promoted and respected through implementing rights-based policies and practices for HIV self-testing, including pre- and post-test counseling.

Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund.

We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind.

Assessing a Human Rights-Based Approach to HIV Testing and Partner Notification in Kenya: A Qualitative Study to Examine How Kenya's Policies and Practices Implement a Rights-Based Approach to Health.

Kenya encourages HIV testing and notification services, especially for key and affected populations (KAP), in order to identify persons living with HIV and link them to treatment. Kenya and international supporters of its HIV program have sought to scale up these services through increased capacity and training. However, little is known about how the HIV strategy is implemented and sustained, particularly regarding human rights. Kenya aspires to support human rights in adherence to a human rights-based approach (HRBA) to HIV. This exploratory qualitative study assesses Kenya's progress in implementing an HRBA to HIV. KAP participants conveyed mixed perspectives on their HIV care services, conveying distrust in Kenya's public health care system while also recognizing improvement in some patient-provider interactions. Providers see the need to better engage KAP through community-based organizations and undergo improved, consistent training to sustain practices and policies that promote their rights realization. We believe that our study contributes to both HIV and human rights research by capturing successes and challenges in Kenya's implementation of an HRBA to HIV. These findings should inform future collaboration between Kenyan health authorities and KAP, and shape HIV policies and practices to improve health care utilization and human rights realization.

The missing link in Kenya's universal health coverage experiment: a preventive and promotive approach to SRHR.

This paper explores the universal health coverage (UHC) roll-out process in Kenya through the lens of its potential to progressively realise the constitutional promise of sexual and reproductive health and rights (SRHR) in Kenya. We argue that SRHR requires significant attention to be paid to preventive and promotive approaches to health and that this requires interrogation of barriers around access to information, norms, and legal and policy frameworks. We then unpack the UHC process in Kenya, its genesis, development and eventual roll-out, focusing on the essential benefits package and its components. We argue that a process of democratic priority-setting cognisant of equity, non-discrimination and transparency will better deliver on an essential benefits package for access to SRHR that is legitimate and acceptable. As a result, we submit that Kenya's UHC process fails to take cognisance of the weight placed on sexual and reproductive health in our Constitution and fails to address historical inequities around accessing health services.

UHC2030's Contributions to Global Health Governance that Advance the Right to Health Care: A Preliminary Assessment.

The September 2019 United Nations High Level Meeting on Universal Health Coverage (UHC) aims to mobilize top-level political support for action on UHC to advance the health Sustainable Development Goal (SDG). A driving force behind this meeting is the "UHC Movement," led by UHC2030, which focuses on coordinating and amplifying efforts by WHO, the World Bank, civil society, and the private sector to strengthen health systems and achieve UHC. In line with Horton and Das, this paper contends that while the argument about UHC is won, it is crucially important to focus on "how" UHC will be delivered, and specifically, whether ongoing efforts to advance UHC align with efforts to realize the right to health. This paper offers a preliminary assessment of how UHC2030's contributions to global health governance advance, or not, the right to health care. It builds on a 2014 Go4Health study which identified key normative overlap and gaps in UHC and right to health care principles. Given the importance of civil society participation in advancing health rights, this analysis is complemented by an examination of how UHC2030 might amplify ongoing efforts to advance the right to health care in two UHC2030 partner countries, Kenya and Uganda.

Assessing a Human Rights-Based Approach to HIV in Kenya.

Kenya is actively encouraging HIV testing and notification services in order to identify persons living with HIV and link them to treatment. Recently, Kenya and international supporters of its HIV program have sought to scale up these services through increased capacity and training. However, little is known about how this strategy has been implemented and is being sustained, particularly regarding the human rights of persons living with or at risk for HIV. This exploratory qualitative study seeks perspectives from health providers and populations at risk for HIV, including young women, men who have sex with men, sex workers, and injection drug users. Our primary data collection methods will be focus group discussions and in-depth interviews. We will transcribe and analyze data under a grounded theory approach to compare outputs from populations at risk for HIV with outputs from health providers. We will also apply a rights analysis to the data's codes and themes to assess how effectively Kenya's HIV strategy, policies, and practices adhere to a human rights-based approach. The results will support both rights realization among at-risk populations and the public health objectives for HIV testing and treatment.