Gender inequality and restrictive gender norms: framing the challenges to health.

Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.

Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon.

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3-6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030.

International health financing and the response to AIDS.

Efforts to finance HIV responses have generated large increases in funding, catalyzed activism and institutional innovation, and brought renewed attention to health issues and systems. The benefits go well beyond HIV programs. The substantial increases in HIV funding are a tiny percentage of overall increases in health financing, with other areas also seeing large absolute increases. Data on health funding suggest an improved "pro-poor" distribution, with Africa benefiting relatively more from increased external flows. A literature review found few evidence-based analyses of the impact of AIDS programs and funding on broader health financing. Conceptual frameworks that would facilitate such analysis are summarized.

Coming to terms with complexity: a call to action for HIV prevention.

A quarter of a century of AIDS responses has created a huge body of knowledge about HIV transmission and how to prevent it, yet every day, around the world, nearly 7000 people become infected with the virus. Although HIV prevention is complex, it ought not to be mystifying. Local and national achievements in curbing the epidemic have been myriad, and have created a body of evidence about what works, but these successful approaches have not yet been fully applied. Essential programmes and services have not had sufficient coverage; they have often lacked the funding to be applied with sufficient quality and intensity. Action and funding have not necessarily been directed to where the epidemic is or to what drives it. Few programmes address vulnerability to HIV and structural determinants of the epidemic. A prevention constituency has not been adequately mobilised to stimulate the demand for HIV prevention. Confident and unified leadership has not emerged to assert what is needed in HIV prevention and how to overcome the political, sociocultural, and logistic barriers in getting there. We discuss the combination of solutions which are needed to intensify HIV prevention, using the existing body of evidence and the lessons from our successes and failures in HIV prevention.

The role of HIV research in building health system capacity in developing countries.

PURPOSE OF REVIEW: There is growing recognition that greater investment in research is needed to expand our knowledge and understanding of how to scale up HIV programmes effectively and equitably in the context of weak health systems. Current debates acknowledge that there remains a gap in evidence on how HIV resources can best be managed to contribute to building health system capacity; how to integrate HIV interventions into primary healthcare systems; and how HIV scale-up is affecting other disease programmes. RECENT FINDINGS: Findings suggest that global health initiatives, including HIV/AIDS programmes, should allocate a set portion of funding for research and knowledge generation in improving health system performance. Forms of HIV research with potential for building health system capacity in developing countries include clinical research, implementation and operations research, quality improvement research, economic evaluation and cost-effectiveness, HIV surveillance and population-based surveys, and monitoring and evaluation. SUMMARY: In this review, we present an overview of the imperative for HIV research in building health system capacity, provide examples of current trends and the forms of research with potential for enhancing health system performance, and highlight priorities for enhancing the role of HIV research in building health system capacity.

What policymakers should know about drug resistance and adherence in the context of scaling-up treatment of HIV infection.

With the imminent massive scale up of antiretroviral therapy in developing countries concerns have been raised regarding the spectre of widespread viral drug resistance. These concerns should not lead to a slowing of the pace at which these life-preserving medications are made available to the millions in need in those countries. With proper HAART regimens and proper adherence, development of drug resistance is not a common event. Increasing simplicity of antiretroviral drug regimens, as well as supportive services, promote adherence and have been shown to lead to extremely high therapeutic success rates in both developed and developing countries. Moreover, the possibility of drug resistance has not discouraged industrialized countries from offering universal access to antiretrovirals. If anything, the situation in developing countries, where few patients have been previously exposed to suboptimal drug regimens and where a public health approach may be taken to the treatment of HIV infection, is in many respects more favourable to the prevention of widespread viral drug resistance than that in the developed world. This conclusion is underscored by available evidence presented in this supplement. Experience in developing countries also suggests that greater treatment access will help alleviate HIV-related stigma and provide major new incentives for individuals to learn their serostatus, thus strengthening prevention efforts.