2006 Activities

In 2006, the OSI Public Health Program continued building the leadership of NGOs representing the human rights and health needs of socially marginalized groups, and emphasized the active participation of civil society voices in local and global public health policy debates.

Throughout the year, the Public Health Program worked with partners to advocate on key issues often neglected in public health discourse, including reduction of harm (such as HIV infection) associated with drug use; access to antiretroviral treatment for drug users; health services for sex workers; equal access to health care for the Roma, palliative care for the sick and dying, and increased attention to TB and HIV co-infection. These efforts have been aided by the program’s recently established Law and Health Initiative, which supports the development and use of legal advocacy tools to advance the health and human rights of marginalized groups.

The following briefs describe some of the program’s activities and achievements in 2006.

International Harm Reduction Development Program (IHRD)

IHRD Expands HIV Treatment Options for People Who Use Drugs

IHRD released a report, Delivering HIV/AIDS Care and Treatment for People Who Use Drugs: Lessons from Research and Practice, in time for the 2006 International AIDS Conference in Toronto. IHRD publications and advocacy helped create protocols for including drug users in HIV treatment, new models of care in Russia and Ukraine, and global awareness of the problem.

Lithuania Adopts Effective Harm Reduction Guidelines

IHRD partners and grantees advised the Lithuanian Ministry of Health on its new harm reduction guidelines, which called for confidential or anonymous needle exchanges, safer injection and safer sex education and supplies, counseling, and educational, legal, and medical support for drug users and their families. IHRD advocacy to ensure medical and social support for drug users also included analysis of ways in which drug users in Eastern Europe, Central Asia, and Asia are excluded from HIV treatment.

Ukraine Approves SubstitutionTreatment for Drug Use

The Ukrainian government agreed to the use of buprenorphine and methadone in tablet form as substitutes for heroin and other opiates in treatment programs. Plans call for pilot methadone programs in ten regions of Ukraine, with a total of 3,000 patients receiving methadone by October 2007. Methadone and buprenorphine are proven to reduce illicit drug use and HIV risk, and to support adherence to antiretroviral treatment. Ukraine’s action resulted from the concerted efforts of IHRD, the International Renaissance Foundation, and numerous partners. In addition to advocacy, IHRD funds organizations that use peer counseling, outreach, and social support to increase drug users’ access to care, linking substitution therapy with HIV/AIDS prevention and treatment.

Sexual Health and Rights Project (SHARP)

Courts Rule USAID Antiprostitution Pledge Unconstitutional

Two U.S. district courts ruled that a USAID requirement that public health groups pledge opposition to prostitution violates the constitution’s First Amendment by forcing groups to adopt the government’s view to remain eligible for funds. The decisions, which apply only to named plaintiffs, including OSI affiliate AOSI, could have a broad impact on many other public health organizations. The decisions, however, have been appealed. SHARP campaigned against the pledge by supporting research and communications efforts demonstrating that, in addition to being unconstitutional, the pledge was counterproductive as a public health policy because it alienated sex workers, who play an important role in HIV prevention.

Sex Worker Advocates Organize in Central and Eastern Europe

The Hungarian Civil Liberties Union, with support from OSI, established a first-ever regional network of groups working on sex worker advocacy and policy issues in Central and Eastern Europe and the former Soviet Union. The Sex Workers’ Rights Advocacy Network started with a nucleus of 16 organizations from 15 countries. SHARP funded the presence of sex worker advocates at important forums, such as the XVI International AIDS Conference in Toronto, to ensure that they participated in decisions that affect their lives.

International Palliative Care Initiative

First International Pain Policy Fellows Selected

The International Palliative Care Initiative and the Pain & Policy Studies Group of the University of Wisconsin Comprehensive Cancer Center selected the first class of eight International Pain Policy Fellows from Nigeria, Serbia, Panama, Vietnam, Argentina, Uganda, Colombia, and Sierra Leone. During the two-year program, fellows will be trained and mentored by pain and palliative care experts who will help them develop a project for improving the availability of opioid analgesics for pain management in their respective countries.

Experts Develop Essential Drug List for Palliative Care

At the request of the World Health Organization Cancer Control Program, the International Palliative Care Initiative and the International Association for Hospice and Palliative Care cosponsored a meeting in Salzburg, Austria, to develop a list of essential medicines for palliative care. The list of essential medicines selected by 31 representatives from 26 global, regional, and professional organizations has already been published in several medical journals and is available as a model for countries developing their own list of medications for palliative care.

Law and Health Initiative

Lawyers and Palliative Care Providers Plan Integrated Legal Services

South African lawyers and palliative care providers met to discuss collaborations on issues such as protecting property rights for the dying, planning guardianship for children orphaned by AIDS and cancer, and taking legal action to secure funeral benefits. The meeting, organized by the Public Health Program and the Open Society Foundation for South Africa, developed plans for integrating legal and paralegal services into a network of OSI-funded hospices throughout South Africa, home to the world’s worst HIV epidemic.

OSI Grants Support HIV/AIDS and Human Rights Work

The Public Health Program Law and Health Initiative and the Open Society Initiative for Southern Africa invited applications from 12 NGOs for multiyear institutional grants to work at the intersection of HIV/AIDS and human rights in Southern Africa. They also placed law associates at several HIV/AIDS organizations in the region. In Southern Africa, well-financed treatment and prevention programs are hindered by chronic human rights violations against populations most at risk.

Public Health Watch

Brazilian Researcher Raises Awareness of TB Policy

Ezio T. Santos, who is HIV positive and has twice suffered from TB, made significant strides in raising awareness of TB policy in Brazil through the publication of a report for OSI’s Public Health Watch. Santos, interviewed by major media outlets, has also made numerous presentations to policymakers and the medical community, including a keynote address at Brazil’s national conference on tuberculosis. He calls for increased social mobilization to ensure the success of TB control efforts. Working with local researchers, Public Health Watch has also published reports focusing on civil society perspectives on TB policy in Bangladesh, Nigeria, Tanzania, and Thailand.

Lack of a National Plan to Fight AIDS Hurts African Americans

Public Health Watch’s report on HIV/AIDS policy in the United States emphasized the lack of attention to the epidemic’s disproportionate impact on African Americans. The findings attracted extensive media coverage and positive reviews from key decision makers. OSI chairman George Soros discussed the report on Black Entertainment Television. The congressional black caucus heard a presentation on the findings. The Black AIDS Institute began plans to mobilize the African American community to fight HIV/AIDS, and a congressional hearing was proposed on the need for a comprehensive national plan to fight AIDS.

Soros Calls for Social Mobilization to Defeat Escalating TB Epidemic

George Soros, speaking at the World Conference on Lung Health in Paris, and OSI’s Public Health Watch called for massive social mobilization to defeat the deadly resurgence of tuberculosis. OSI reports on TB policy in five countries highlighted how TB, HIV/AIDS, and poverty combine to cause almost two million preventable deaths each year. “The emergence of extensively drug-resistant TB,” Soros said, “sounds the alarm that the world is facing an urgent health crisis.”

Health Media

Thembi’s Diary

To combat the stigma and discrimination faced by people living with HIV/AIDS in South Africa, OSI supported Thembi Ngubaneto in producing an audio diary of her struggle to live with AIDS in South Africa. Thembi, now 20, spent one year with a tape recorder to produce the AIDS Diary Project. After a five-city tour in the United States, Thembi returned to her home country and engaged in a speaking tour to increase public awareness about AIDS. The diary aired on National Public Radio’s All Things Considered.

Reporters Expose Discriminationin Roma Access to Health Care

Despite expenditures of nearly 730,000 euros, an investigative piece concluded the Roma in Braila county, Romania, had no more access to health care or better living conditions than three years ago. On one project, backed-up sewage flooded rehabilitated one-room apartments and a health clinic, now abandoned. The contractor complained that the money went down the drain because the city didn’t maintain the sanitation system. The article exposing the problems and two others resulted from a successful pilot project funded by the Public Health Program. OSI awarded similar grants to media centers in Bulgaria, Macedonia, Romania, and Serbia to increase public understanding of the complex health issues faced by Roma communities.