Brian Ackerman's blog

Is Funding Our Only Global Health Priority?

2009-05-08T12:54:15-04:00

Dear Fellow Advocates,

Surely all of us are scouring over the President's budget released this week to answer the questions on all of our minds: did he listen when we spoke? Did he really mean what he said when he committed himself to increased funding for global health and foreign assistance programs-or were those just empty campaign promises? While our current President is a master of words, we recognize that the budget proposal speaks louder than words - it is the blueprint of his true priorities. And we want to know where we stand.

In a briefing to our advocacy community on Tuesday, May 5, and in an official statement from the President, the Obama Administration introduced budget numbers for global health as part of a "six year strategy." Many members and organizations in our community were quick to respond that the proposed $63 billion over six years amounts to a failure on behalf of this administration to both fulfill campaign promises and that millions of lives may be lost as a result. As a global health advocate, I share a deep sense of disappointment that these numbers are not higher. Global health is but a small slice of our governmental spending, yet its impact is proven to be so crucial in the protection of a right to a healthy life for so many people around the world.

Yet a part of this story is untold when just looking at numbers. Even amidst our disappointment with the President's numbers, there was an increase. And we must recognize that while we lead the world in funding and support for global health programs, we lag - to the detriment of those people we are trying to support - in our commitment to sound policy governing that funding.

Well, fellow advocates, there was another, crucial part of the President's statement on global health that somehow was overlooked by some members of our community who could utter nothing but words of contempt for the perceived stinginess of the six-year strategy. President Obama said in a written statement, "We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health."

Wow. Imagine that. An "integrated approach to global health." What does that mean? They're certainly words for which I've advocated. But in practice - what would this look like and why do I think this is much more monumental than some of our colleagues are recognizing?

Well, for so long, global health advocates have worked tirelessly to build up funding streams and programming for specific issue areas, be they family planning, maternal and child morbidity and mortality, HIV and AIDS, tuberculosis, malaria, other neglected tropical diseases, safe water and sanitation, food security, or others. With a limited amount of discretionary funding to appropriate, this has resulted in competition within our community for the same pots of funding and on-the-ground implementation that is manifest in segmented and disjointed health care services - reflective of the manner in which the funds were authorized and appropriated.

Don't get me wrong - U.S. global health programs are some of the best in the world. However, for a young woman in a low or middle income country in need of contraceptive commodities, she must visit the family planning clinic; if she also wants testing for HIV, she must go to another clinic miles away, and in the case she tests positive, she must access food to take her HIV medication at another source miles away from there. For that young woman, the current U.S. global health portfolio is simply not realistic. The lack of coordination does a disservice to both the people our global health programs try to serve and the ultimate public health and development results we seek to achieve.

A Stanford University Medical School study recently found that the President's Emergency Plan for AIDS Relief had reduced the death toll from HIV and AIDS by 10 percent. Ten percent. That's a million lives. We were able to do that even though our clinics are miles apart and funding for one illness or condition cannot go to the other, etc., etc. And I understand that funding is what made that happen - money flowed and supported the rapid scale up of interventions that transformed HIV from a death sentence to a disease that when treated effectively can be managed indefinitely. All this in very low resource settings where many public health experts said it could not be done.

I write this open letter to our community to ask us to take a step back amidst the budget analysis to imagine what we could do if those clinics were better coordinated and those services were better integrated. Imagine how many illnesses and conditions would be averted, how much more effective treatment would be, how many more lives would be saved-and most importantly - how much more empowered all the people accessing health care would be.

The same Stanford study referenced above also found that PEPFAR "has had no appreciable effect on prevalence of the disease in those nations." No appreciable effect on prevalence. If we do not integrate our global health programs, especially reproductive health (including comprehensive sex education, family planning, maternal health, among other emphases) with HIV, a disease that is primarily transmitted through unprotected sexual intercourse, will any amount of funding ever be enough? I don't think so. And even if we were to fund treatment for every person living with HIV throughout the world, where are our priorities as a country if we are not equally as committed to empowering those persons to prevent the transmission in the first place?

President Obama's global health strategy, while it may not deliver on the numbers, indicates that the administration is ready to do the difficult task of adjusting and reconfiguring the way we do global health work. Moreover, Secretary Clinton's recent testimony to the House Committee on Foreign Affairs unapologetically declared this administration's support for healthcare and foreign aid investments that focus on the empowerment of individuals to make choices about their reproductive health despite the widespread politicization of those interventions. The Obama Administration is by no means perfect, and a "strategy" is nothing without implementation. But this is undeniably a step in the right direction.

As advocates, I think we can all agree on one thing: we have a responsibility to our constituents, not our political representatives. Our government leaders are to be held accountable-decried when they make bad decisions and praised when they show bold leadership. In this instance, I must voice my strong disagreement with those who are choosing not to recognize the critical paradigm shift that has been introduced in the administration's strategy: a focus on integration. I will be the first to challenge the administration if I believe it is falling short on following through with this strategy - but at this moment, integration is the bold and transformative change to global health policy on which the lives of millions depend for their health and wellbeing, and on which the future of the U.S. global health portfolio depends for its success. Money is an important part, but not the only part of the equation and we as advocates have a responsibility to our constituents to support this agenda.

Sincerely,

Brian Ackerman

This post first appeared on Amplify.

Ugandan Physician on Global AIDS Prevention: "Reproductive Health Is Not a Dirty Word"

2009-04-02T08:00:00-04:00

On Wednesday, March 18, I attended a presentation entitled "It's not Over: Global AIDS Funding in an Era of Uncertainty," sponsored by Physicians for Human Rights (PHR) and Georgetown University. The speaker, Dr. Peter Mugyenyi, Executive Director of Uganda's Joint Clinical Research Center, pioneered the administration of anti-retroviral (ARV) therapy on the continent of Africa.

During his introduction of Dr. Mugyenyi, former U.S. Global AIDS Coordinator, Ambassador Mark Dybul and current co-Director of the O'Neill Institute for National and Global Health Law at Georgetown University, cited Dr. Mugyenyi's ARV treatment and care delivery strategy as the model for the President's Emergency Plan for AIDS Relief (PEPFAR).

Dr. Mugyenyi expressed gratitude to both Ambassador Dybul and the American people in the opening sections of his speech. He also noted that PEPFAR's immense successes, particularly in terms of treatment access, had made an enormous difference. He stressed that the difference between people accessing life-saving interventions and not, was really a question of political will and not simply one of resource availability.

But it was his statement about prevention that really gave me goosebumps. He called for a redesigned prevention strategy that would address the realities of the epidemic in 2009. Mugyenyi noted that women are at a higher risk of infection, not just for biological reasons, but particularly because of the social and political marginalization that they face caused by a system of gender inequality. "The epidemic has changed," Mugyenyi said. "Many people say that reproductive health is a dirty word. It becomes even dirtier when you call it ‘family planning.' But it is not a dirty word. It is a clean word. And integration of reproductive health services with HIV testing and care services is critical for women's health."

Let's take a moment to reflect! The doctor whose program was the basis for the President's Emergency Plan for AIDS Relief (at least according to former U.S. GAC Dybul), said that "reproductive health is a clean word," and that the "integration of reproductive health services with HIV" programming should be a priority for the future of PEPFAR's implementation.

Feels good, doesn't it? Having spent the last two years fighting for improvements to PEPFAR's prevention policies toward young people and women, Dr. Mugyenyi's statements really made my day. There was just one down side - while Dr. Mugyenyi focused on the specific vulnerabilities of very young children and women to infection, he did not elaborate on the particular needs of adolescents. According to UNAIDS, young people under the age of 25 comprise 45 percent of all new infections. Young people must be at the core of any new strategy. The stigma of sex blocks the information and resources critical to the prevention of transmission among youth. Dr. Mugyenyi's point, that reproductive health care must be integrated with HIV testing and care services, would not only serve women, but also young people. Adequate sexual and reproductive health care resources for young people would serve to help normalize sexual health among adolescents and young adults, thus weakening the power of stigma to fuel new infections transmitted through unprotected sex.

As Dr. Mugyenyi is a pediatrician, I am sure that he is aware of the epidemic among youth. But we must all ensure that the realities of HIV among adolescents are never an afterthought when we discuss prevention strategies. Fifteen years after the International Conference on Population and Development (ICPD) in Cairo, Egypt, where participating country delegations established that young people have the right to medically accurate information and evidence-based care for their sexual and reproductive health, the inclusion of adolescents and young adults in HIV prevention strategies should be a given. Well, here we are fifteen years later and we are still fighting for inclusion.

Let's take full advantage of this political springtime - this new beginning - in the United States by demanding a change in U.S. global AIDS policies. Just as we knew that ARVs saved lives and used our "political will" to make the impossible possible (their delivery in low-resource settings), we can garner that same "political will" to ensure that comprehensive, medically accurate information about the prevention of HIV - especially for young people - also be available.

In a closing anecdote, Dr. Mugyenyi noted that, before PEPFAR was a household acronym, he sat in a meeting of public health officials in Uganda. The group collectively stated that anti-retroviral delivery could never take place in Uganda on the same scale and with the same efficacy as it had in the United States. Dr. Mugyenyi said he got up and left the meeting, never to return. He had decided not to waste his time with the naysayers, but to invest in making antiretroviral therapy a reality in his country. Today, Dr. Mugyenyi proudly noted, anti-retroviral delivery and adherence to treatment in Uganda is "just as good" and in some cases "better" than in the United States.

This is a strategy I have not yet employed in my fight to have U.S. global HIV prevention policy reflect the realities of young people's lives, but it sounds like it's a tactic waiting for the moment. Next time policy makers smugly tell me that young people cannot handle comprehensive HIV prevention education, or do not need access to sexual and reproductive health services, I'll be sure not to let the door hit me on the way out.

This post first appeared at Amplify.

World AIDS Day 2031: How We Could Outsmart HIV

2008-11-30T08:00:00-05:00

Imagine: The date is Dec. 1, 2031. HIV/AIDS has ravaged the global population for 50 years. It is World AIDS Day again and I sit down in my futuristic flying chair to draft a blog (an ancient form of personal commentary that only middle-aged people have heard of). The theme of this year's World AIDS Day is "Victory." Here is my blog from the future:

So we made it. 50 years. Millions of lives lost. Millions more chronically ill. But we made it. The world has fought a 50 year battle with AIDS and finally, with infection rates continuing their 22-year-long plummet around the world, nearly universal access to antiretroviral therapy, and a sustainable global healthcare infrastructure that integrates prevention, treatment, and care services, we can claim victory. Many are saying "I can't believe it." But I can. And not only can I believe it, I would find it unacceptable to have it any other way.

At this triumphant juncture in human history I think we must reflect on the path we chose to take together to achieve this feat. While the AIDS epidemic began in 1981, before I was even born, the global response to the disease took a dramatic turn 22 years ago, in 2009. Amidst a crisis in the world economy from which we have only recently completely recovered, and amidst a massive power shift in Washington, D.C., the United States charted a new course in the global response with its five-year, $48 billion initiative to end the pandemic.

The Obama Administration and 111th Congress were charged with calculating the sum of these parts: limited financial resources + an explosive global epidemic + donor fatigue for AIDS-specific funding + the largest generation of young people in human history (3 billion people) accounting for 45 percent of new infections annually + over two decades of data collection and a wealth of evidence-based, best practice models for prevention, treatment, and care.

While many said the sum was in fact, a negative one, the U.S. government decided that the knowledge we had about the AIDS epidemic, about how to prevent it, about how to treat it, and about how to care for those affected by it, was enough to outweigh the challenges of the other parts. And it could do such things because the U.S. government remembered that it was good at defying the odds when it employed science, as was the case with that trip to the moon back in 1969.

So what exactly did the U.S. government do in 2009 that changed the course of human history and led us on a path to victory over HIV/AIDS? The list of specific actions could fill a book, but fundamentally, what is now taught in history books as the eight-year "War on Science," came to an end, and science won! The Office of the Global AIDS Coordinator declared that with regards to prevention, it would fund only comprehensive, medically accurate, and evidence-based programs and emphasized that one of the only ways to outsmart HIV was to not be afraid to address socially complex issues of sexuality and reproductive health in a holistic and healthy manner. Congress amended PEPFAR reauthorizing legislation to eliminate the balanced funding requirement for abstinence and be faithful programs and to fund family planning programs within U.S. global AIDS funding.

The largest generation of young people (half the world's population in 2009) were targeted in these programs and like magic (but better, because it was science), a new generation of sexually educated, informed, and responsible decision-makers came of sexual and reproductive age. Their new world became the one in which we live today, where HIV is no less a reality, but it is a reality that almost everyone on the planet knows how to prevent. Today, using prevention commodities such as male and female condoms during sex is as common as putting on sunscreen before spending a day at the beach or wearing our seatbelts when we fly our futuristic cars (this comparison is particularly apt considering the invention of multicolored seatbelts in 2015 that made them so much more fun to wear!). Even further, young people know how to negotiate safe sex so they are empowered to protect themselves (even if their partner is not as excited about multi-colored commodities).

Thanks to this emphasis on evidence-based prevention programming, we were able to finally catch up with the number of people newly living with HIV and ensure their access to life-extending anti-retroviral therapy and other holistic interventions. The emphasis on quality prevention programming did not detract from treatment access, but in effect, amplified our ability to ensure that a greater percentage of people living with HIV and AIDS could live long, healthy lives.

Of course the United States did not do this alone. It joined a global majority of donor countries and technical institutions that had been saying the same thing for some time. But it seems that the theme of World AIDS Day 2008, "Leadership," must have really been effective. The United States dramatically enhanced its own response to the pandemic in 2009 and led the way for a truly sustainable and effective global response, so much so that I can sit here today and claim victory over HIV along with the rest of the world. Looking back, the moon was pretty cool 80 years ago, but I don't think the world has ever claimed a win as big as this one.

...And we time warp back to the present.

The gross oversimplification of my blog from the future is intended neither to "pit prevention against treatment," nor to place unreasonable pressure on our incoming policy makers. Rather, it outlines a vision of what could be instead of what is, and highlights that we have a choice as a country and as a world, instead of a dilemma. It is no secret that unprotected sex fuels AIDS. Let's choose to utilize our limited resources as best as possible in the coming years, and only fund comprehensive prevention programs to construct a world in which access to HIV prevention information and commodities is universal, so that universal access to treatment can also become a reality.

I expect nothing less from the incoming Administration and, like others, believe it's time.

If you are interested in sharing your thoughts about World AIDS Day, join me for Advocates for Youth's World AIDS Day Bog-a-thon, between December 1-7, 2008 at www.amplifyyourvoice.org/WorldAidsDay

Renewing our Commitment to Comprehensive Sexuality Education

2008-08-12T10:45:17-04:00

In his address during the closing session of the International AIDS Conference 2008, young Mexican gay rights and AIDS activist Rodrigo Olin spoke in Spanish, his native language, so that his fellow people of Mexico would hear and understand his message. During his several minutes on stage, he took the opportunity to challenge the country of Mexico to do better in its fight against HIV and AIDS and all the social inequities that fuel the epidemic.

Rodrigo began his speech by noting that the people of Mexico must hold the government accountable to meeting goals, in particular, universal access to prevention information, treatment, and care. After all, while it has been an incredible accomplishment for the country of Mexico to host the International AIDS Conference, "after the conference ends, almost all of the delegates, organizations, and people from around the world will leave, and Mexicans will remain." Rodrigo emphasized that although the countries of Latin America had come together to sign the agreement to provide comprehensive sexuality education to young people, the test now will be in the effective implementation of this agreement.

"In a country so rich and with so many natural resources," he said, "it is a crime that organizations and individuals that fight homophobia and discrimination do not receive the support from the government that they need." Rodrigo's words particularly resonated with me, as I am both a young gay man and one of those returning home to another country, also rich in wealth and natural resources. In my case, I return to the United States, where I advocate for better policies surrounding HIV and AIDS both within the U.S. and in internationally under my country's global AIDS policy.

Rodrigo's charge to his fellow Mexicans was a charge to all of us sitting in the audience to hold our governments accountable to the promises they make toward achieving better outcomes in the fight against the AIDS pandemic. The disturbing rise in HIV infections in my own country is a theme that was highlighted throughout the International AIDS Conference and a cause for a sense of urgency. Moreover, in the case of the United States which controls the purse strings for many other countries' funding in the fight against global HIV and AIDS, we must also hold our government accountable to the needs of the people whose lives depend on whether or not that funding supports evidence-based programs, best practices, and most importantly, human rights.

Under the Bush Administration, the United States continues to support failed abstinence-until-marriage programs for young people at home and abroad. Numerous reports have documented the limitations of these programs in helping to curb the rate of new infections domestically or globally versus more effective prevention programs for young people that include information about and access to condoms. The expectation that people of my generation have is that educational systems around the world will normalize sexuality and provide young people with the information they need to make healthy and informed decisions about their sexuality. In fact, the end of the HIV/AIDS pandemic may well depend on it.

Youth and Sexuality: It's Not Just a Yes/No Debate

2008-08-07T14:07:07-04:00

"¡Sí se puede, usa el condón! ¡Sí se puede, usa el condón!" (Yes, you can, use a condom!) Members of the Mexico Youth Force and allies of young people fighting for access to comprehensive sexuality education and services rallied outside the Global Village at the International AIDS Conference today. Proudly wearing our pink shirts advocating for Rights, Respect, Responsibility, and Resources to prevent HIV infections among young people and to support young people already infected, we countered the demonstration of another group of young people that was in support of abstinence-only education for youth.

Amidst a conference of rather serious discussions and sessions, this experience was a great expression of youthful debate. It stood out to me because on both ends of the prevention spectrum, young people made their voices heard. As my group waved inflated condoms in the air, the group adorned in lime green shirts spread the message that "zero sleeping around = zero risk." Although at first glance it might seem that this confrontation of demonstrators was based on a visible dichotomy of extremes -- with abstinence (no sex and, so technically, no risk) on one side of the argument for prevention of HIV transmission among young people, versus condoms (sex with a reduced risk of transmission) on the other side. But, as is almost always the case with prevention, the story is much more complex.

Many times the issues for which I advocate as a young sexual health activist are unfortunately simplified to a yea or nay debate on whether young people should be having sex. Visual demonstrations such as today's battle of wits between the "Abstinence Army" and the "Condom Clan" can reinforce this oversimplification, although waving condoms is perhaps a more sexy visual for the media than waving flags that say "comprehensive sexuality education for all." While I shouted vigorously today calling for the accessibility of condoms for young people, that is but one part of my message (and, I believe, the message of many of my peers). We demand recognition of our right to comprehensive sexuality education, to sexual health services and to commodities (of which the male condom is one example). Abstinence, no sex, celibacy, whatever you want to call it, is part and parcel of that package of comprehensive information about sexual health, but it cannot be the only part.

I want to emphasize that the notion of a spectrum of opinions about sexuality and youth has been a common theme of many of the sessions at the conference. This spectrum has included the consideration of sexuality in terms of pleasure, well-being, and health -- not only in terms of a vessel of HIV transmission. Today's friendly battle highlighted this for me. As young people, we are fighting not only for access to information that will save our lives, but also to information that will help us better understand ourselves and explore sexuality safely, as a healthy and natural part of who we are, if that's what we want as individuals.

To those who say that such comprehensive sexuality education cannot be achieved because of social or political resistance, we need not look further than the regional host of the 2008 International AIDS Conference, Latin America, to prove them wrong. Just prior to the start of the global gathering of the AIDS community, the ministers of health and education from countries throughout Latin America and the Caribbean signed an agreement to implement comprehensive sexuality education for young people. In the development of this agreement, two young people, one from Brazil and one from Jamaica, were able to represent our age group, our perspective, and our experiences. It should not come as a surprise to us, then, that the agreement emphasized a comprehensive approach to sexuality education.

If there is anything that over 25 years of HIV and AIDS has taught us, it is that avoiding the source of infections gets us nowhere. In a world with three billion young people under the age of 25, we have the chance as a global community to stop running from sexuality and embrace it as part of the fight against global AIDS, and part of what makes life worth living. Until we accomplish that, let us continue to proudly wave condoms in the air and demand the respect for our rights as sexual beings.

Empowering Our Generation: Mexico City Youth Pre-Conference

2008-08-04T14:16:39-04:00

It is a rare occurrence, for a 21-year-old, to look around at an international conference and realize that it is being entirely run by peers of the same age. More than rare, it is inspiring. The Youth Pre-Conference, organized and implemented by the Mexico Youth Force, is a bilingual (English and Spanish) three-day preparation conference for young attendees of the 2008 International AIDS Society Conference in Mexico City. Our energy, enthusiasm, and passion for both fighting the global HIV/AIDS epidemic and supporting those living with HIV and/or AIDS are nothing short of incredible.

In particular, during my first day, I attended a session on being a strong ally of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Not surprisingly, the room was not filled with heterosexual and cisgender individuals ("cisgender" refers to those who have the same gender as their assigned sex) , but rather, with young people that self-identified as sexual minorities from all around the world. A young LGBTQ activist from Turkmenistan facilitated the discussion.

During the hour and a half allotted for the session, we spent the first 50 minutes simply discussing various terms to explain the expansive array of sexual and gender identities that are different from heterosexual and cisgender. We debated the meanings of transvestite, travesti, transsexual, transgender, bisexual, pansexual, FTM (female-to-male), MTF (male-to-female), homosexual, heterosexual . . . and many others. In that discussion, however chaotic it may have seemed, we collectively recognized the cultural determinants of sexual identity formation and the social construction of marginalization. We noted that in many countries with the worst HIV epidemics, being a sexual minority is not a particularly easy identity to have in society, while in some it is completely criminalized. We connected social marginalization with vulnerability to HIV transmission and explored ways in which we, at our own organizations, could respond to various scenarios involving LGBTQ youth in need of support.

The marginalization of sexual minorities is, to my knowledge, not what most people would consider breaking news. However, I describe this session in detail because it effectively illustrates the significance and meaning of the youth pre-conference overall. While allying with and between different youth communities can be challenging, when young people are given the resources needed to have the opportunity to collaborate with one another in deep discussion and analysis, incredibly substantive conclusions can be drawn and we can educate one another based on our experiences on how to overcome daunting sociopolitical challenges.

International and bilingual, the pre-conference itself is also what some objective observers (and participants) might describe as seemingly chaotic. But judging by the incredible sessions, exchange of ideas, and networking, we are preparing ourselves quite well for participation at one of the largest international conferences in the world. We are sharing with one another our successes and failures in advocating for better policies and for better implementation of policies. We are readying ourselves to fight the battle against HIV and AIDS as our generation matures. Pretty empowering, no? I think so too.

What Does Youth Participation in HIV/AIDS Strategy Mean? Collaboration.

2008-06-24T08:00:00-04:00

Around 32 young people from 20 different countries met in New York on Sunday, June 8, at the Progressive Youth Caucus, gathering to discuss our strategy for advocacy at the 2008 UN High-Level Meeting on HIV and AIDS. One question was on my mind throughout the day's sessions: What does meaningful youth participation mean? And if we can define it, how can we translate it into terms that are useful for policy makers?

During our conversation, Caucus members outlined our concerns with current youth participation in public policy decision making. A quandary arose. How do we lobby for meaningful participation when language has already been written into official documents such as the 2001 Declaration of Commitment on HIV and AIDS and the 2006 Political Declaration? Moreover, language emphasizing the need for meaningful youth participation was included in the 2001 and 2006 Declarations, meaning that our concerns stemmed not so much from poor language but from poor implementation. Some of us could even cite instances from our countries in which young people had been given a "voice" in HIV/AIDS policy making, but a voice that fell on deaf ears.

I noted a theme underlying this conversation for those of us wanting to participate in the political processes that govern our lives: as young people, we seek political space and recognition without becoming token representatives of the three billion members of the world's population that are under the age of 25.

At 21 years old, I am a young person. I am fortunate to be working at an organization that values youth involvement in its decision-making and representation but, three weeks out of college, I feel younger than ever around my more experienced colleagues in the international policy field. This is perhaps one of the greatest challenges youth face. Sometimes the feeling is similar to just arriving in another country -- I may have studied the language, the culture, the people, but until I have experience, it is difficult to communicate and feel comfortable.

During the caucus we resolved to advocate for the following points:

Ensure access to comprehensive sexuality education
Address HIV in the context of other sexual and reproductive health needs
Take positive steps to promote and protect young people's rights
Make health services more accessible to young people
Disaggregate data by age
Invest in youth leadership

These points may not seem strikingly revolutionary or surprising as a contribution from a group of progressive young people and their organizations, but they reflect a commitment from youth to work in partnership with policy makers and governments, to design realistic pathways to achieve the ever-distant universal access targets. The notion of youth-adult partnership in achievement of the universal access targets underpinned many discussions I had with other young attendees at the conference. If we expect our countries to achieve universal access targets by 2010, we expect ourselves and our peers to be active participants in galvanizing social action to successfully realize the targets.

Central to this underlying theme at the progressive youth caucus is the final point in the aforementioned list: "Invest in youth leadership." True youth participation can be facilitated through mentor relationships between experienced leaders in policy and civil society with young people.

The drafting of the Civil Society Declaration, the document which attempted to distill the key messages of member organizations of Civil Society in attendance at the UN meeting, is a good example of experienced members of the policy community reaching out to young people to ensure their inclusion at the highest levels of messaging and decision making.

The organizers of the meeting arranged to write the declaration sent out a broad invitation to youth attendees at the conference to ensure their participation in the messaging discussion. During the meeting, young people were leaders in each of the working groups assigned to draft various pieces of the declaration.

As a result of our inclusion and full participation at that meeting, the official Civil Society Declaration mentioned:

young people as a vulnerable population in need of programs specific to their needs
the unique vulnerability of young women (this was highlighted in a clause noting the feminization of the epidemic)
a re-affirmation of the need for the disaggregation of epidemiological data by age and gender.

I highlight these pieces of language not to harp on "wins" for the youth community but to show that, through meaningful collaboration between adults and young people, substantial results can be achieved in drafting policy and messaging that truly reflects the needs of young people. The Civil Society Declaration and the Declaration of the Progressive Youth Caucus were both delivered to the General Assembly President at the end of the High Level Meeting.

In terms of effecting policy change and urging implementation, the 2008 High Level Meeting on HIV/AIDS was a challenging experience. Many of us in Civil Society were unsure about our role and our capacity to influence the outcomes of the meeting. Fortunately, however, a very forward-thinking concentration of young people and adults in Civil Society were able to collaborate to produce strong and clear messages for our country delegations to take into account.

Shaping The Future

2007-10-22T11:00:00-04:00

My final day at the Women Deliver Global Conference in London could be best characterized as frustratingly inspiring. The gathering of so many passionate world leaders and experts who work in the maternal and reproductive health fields has been an awesome sight, yet simultaneously I end my time in London wondering where we are going from here.

Addressing the Millennium Development Goals is the challenge that we have taken on as a global community. Women Deliver has attempted to be a piece of achieving goal number five, which is related to the reduction of maternal mortality. Hearing vivid stories about the tragedy of unnecessary deaths of women due to pregnancy and childbirth for reasons ranging from the HIV/AIDS epidemic to abuse of human rights has indeed illuminated "MDG 5" for me. Young women my age are dying because of lack of access to basic healthcare.

Thus, I can say that Women Deliver has left me with a visceral drive to reduce maternal mortality. However, at the same time, it has left me with a similar sense of frustration concerning the ability of the international advocacy community-including intergovernmental, non-governmental, and political organizations-to work cohesively to achieve this single end. The many dimensions of maternal mortality necessarily require a multi-faceted response from various sectors of civil society and governments, which I saw represented in the more than 2,000 delegates at the conference. Yet this is the frustrating piece of the puzzle for me: international development itself is a multi-dimensional challenge requiring a multi-faceted response from different levels and sectors of global society. But somehow cohesion in this response seems to remain elusive.

Given the various representatives from important international agencies and organizations and governmental ministries who have walked through the halls of the conference center of the past few days, I personally believe I saw the most potential for action in the youth. I say that not to be cliché, nor to push a "youth agenda," but out of a basic impression. We are working in a global system in which there are developing countries and developed, recipients and donors, those to be helped and those who do the helping.

While I met many young people from "developing" countries, they did not describe a future in which money for AIDS drugs still came from the United States and Europe, or in which maternal mortality continued to be a problem. Why? Because young people of today are part of a new global paradigm that reflects a shift in the world order. Women Deliver showed me more than anything else that if and when maternal mortality is to be reduced substantially at a global level it will be done not through a helper-recipient model, but through a model of collective and equitable support, a new model of global development that is defined most purely by those who know the new world best: its youth.

The Power of Youth at Women Deliver

2007-10-22T09:00:00-04:00

During my second day of the Women Deliver Global Conference in London, I witnessed a stride in the right direction concerning representation and inclusion of the youth voice.

While working at the Youth Commitments Desk, young delegates from Turkey, Paraguay, Ecuador, Uganda, Kenya, China, Panama, Chile, the Congo, Nepal, the Philippines, (the list goes on and on), informed me firsthand about the issues that I advocate for within United States foreign policy. My primary question to them: am I getting it right?

I feel so privileged to have the opportunity to go to university and work in Washington, given the city's immense centralization of global power and influence. I want to make sure I am using my time and energy correctly. While I wish the answer to that question could have been a simple yes or no, the reality was somewhat more complicated.

I heard from a young woman from Uganda that the President's Emergency Plan for AIDS Relief (PEPFAR) programs are saving her family members because of the free provision of antiretroviral therapy. But at the same time, she told me that the prevention messaging ignores the realities of Ugandan social norms regarding monogamy and general sexual practice. I spoke with another young woman from Palestine who told me that while sexual practice is not an open topic in Islamic society, religion and effective reproductive health policies do not have to be at odds with one another. Another young woman from the Philippines told me about the young victims of sexual predation resulting from poverty and lack of education.

Neither of these or my other conversations was particularly shocking to me, nor did I particularly disagree with anyone. Perhaps that is the result of convening a conference of 2,000 like-minded people working for reproductive and maternal health. However, I did learn that something is going right-even though we face seemingly insurmountable challenges to transforming global access to reproductive and maternal health, not all, but many young people the world over are aware that the status quo does not have to be accepted. My work in Washington is but a piece of that global struggle.

Perhaps the best way to conclude the day was seeing Andrew Francis, a member of Advocates for Youth's International Youth Leadership Council on stage as an equal stakeholder with international policy and non-governmental leaders during the afternoon plenary session. Indeed, it was not a resolution to include youth at the stakeholder level, but it was an inspiring step in the right direction.

Youth Panel at Women Deliver Presents

2007-10-19T15:43:17-04:00

Thousands of people from over a hundred countries packed into the general plenary this morning as the Women Deliver Global Conference opened. The main conference objective: empowering women globally. Sometimes the hardest part of a project is identifying the objective, so it seems to me that we, the collection of political, medical, economic, and non-governmental leaders assembled here in London, have made the proper stride in the right direction.

As the rousing applause quieted down following the plenary and the massive conference hall emptied out, a collection of colorful chairs and funky-modern furniture was rolled onto the stage. It was time for the youth panel! Seven inspired, intelligent, empowered, and excited young leaders from around the world walked onto the stage. Sadly, of the thousands who crowded that same room 10 minutes prior, only 20 or so remained scattered around to hear what the world's young people had to say. While I sat, inspired by their words, I was frustrated at a contradiction that manifests itself all too frequently at conferences such as these: although we are aiming to empower women, the assembled global leaders somehow believe that we can achieve this without even lending an ear to an informal discussion among young people.

During the panel discussion, questions from what does "family" mean for today's generation to how do young people impact policy, were considered. Three themes became particularly evident to me while listening to their comments:

Rhetoric has no value if it is not backed with inclusive action.
While it would be nice to put "youth" into a monolithic, cohesive group, with one agenda, such thinking is both ignorant and irresponsible.
Most important: whether or not policy makers and NGO-leaders are listening (they weren't today), young people are redefining social structures and institutions in their own likeness.

If Women Deliver organizers and participants are really going to deliver for women beyond the conference and address the concerns raised in the youth panel, I suggest we put inter-generational collaboration on the list of priorities for governments and civil society. Working together and in true partnership, adults and young people can make a difference so that women and men, both young and older, can truly plan their families and their futures.

A Conversation with Five AIDS Ambassadors

2007-02-01T08:00:00-05:00

Brian Ackerman is an intern at Advocates for Youth and a junior at the George Washington University, majoring in International Affairs.

I always shudder when I hear that young people aged 15-24 account for over 40% of new HIV infections. At 20 years old, I am halfway through college and focused on the youthful experience of "finding myself" and creating my future. I hope HIV never has to factor into my equation, but knowing that it is a daily reality for my peers around the world is an eerie truth. Helping young people protect themselves while still balancing the rest of the costs and needs of the HIV/AIDS epidemic is increasingly difficult.

This was reiterated for me at recent briefing, "A European Perspective on the Future of Global AIDS Programs: A Conversation with Five AIDS Ambassadors," hosted by the Center for Strategic and International Studies (CSIS) and the Center for Global Development. The event began with each ambassador speaking for a few minutes about the commitment their country has made toward fighting global AIDS. Since coming to work as an intern on international issues at Advocates for Youth, I've been exposed to much of the rhetoric about the flow of aid aimed at fighting infectious diseases in the developing world, but the commentary from these ambassadors was both refreshingly honest and difficult to hear.

Sigrun Mogedal, Norway's AIDS Ambassador, left me with goose-bumps as she reminded all of us that beneath everything else, stopping AIDS is about power. The statement was simple, but for me, it was the most articulate explanation of the reality of global AIDS. To successfully turn around the pandemic, governments, institutions, and people must become empowered. Forget the heart-warming speeches about "being the future of the world"; those most affected by AIDS, young people, are not empowered. We exist in an "in-between universe" -- a place where we are still dependent and subject to the decisions of the adults in our lives while, simultaneously, eager to make our own independent decisions.

Paul Bekkers, the Dutch AIDS Ambassador, reminded us of the tragedy of disempowered youth, especially young women. He relayed an all too familiar story about an adolescent girl in sub-Saharan Africa who remained abstinent until her marriage to an older, sexually promiscuous man. She contracted HIV from her husband and subsequently, passed HIV to their child. At the root of this tragedy is the reality of unequal power. While the target population would seem to be young women, Ambassador Bekkers noted, after a discussion on gender, that the focus must also be on educating young men to change the power dynamics of relationships. In the same sense, for young people to be empowered to prevent transmission, adults must recognize the often disempowered nature of being young.

In a breakout discussion on prevention with Lennarth Hjelmaker, Sweden's AIDS Ambassador, the issue of empowerment dominated the conversation. In order to have successful prevention programs, those who have power, at the global, national, and local community levels, must be willing to alter the power relationships to which they are accustomed. No easy task, to say the least. Considering HIV in these terms, it is no surprise that over 40% of all new infections are among young people aged 15-24. Societies around the world are apprehensive about ceding any control to a demographic group defined by its inexperience.

After spending the day with these Ambassadors, it seems to me that the underlying problem is that, while we have taken the first step in identifying the problem fueling HIV/AIDS, we have yet to develop a cohesive plan to effectively resolve it. Yet, I came away from this discussion with a sense of hope, courage, and opportunity. Yes, young people today are faced with the challenge of the AIDS pandemic. But our experience with this disease provides us with the opportunity to develop answers and solutions to the questions that those making the decisions have yet to discover.