Download The Heller School for Social Policy and Management Brandeis

The Heller School for Social Policy and Management
Brandeis University
HS304F – Spring 2017 Module I
Sexual and Reproductive Health and Development
Room X
Tuesdays,
6pm-8:50pm
Sean Cahill, Ph.D.
Email: [email protected]
Office Hours: By appointment
Sexual and Reproductive Health and Development
This course will focus on sexual and reproductive health, especially as it affects women
and girls, and especially in the Global South. We will link access to high quality sexual
and reproductive health for women and heterosexual couples to HIV prevention and
care and the rights of lesbian, gay, bisexual and transgender (LGBT) people.
While we have made significant strides in HIV prevention and care since the launch of
PEPFAR in 2003, more than 2 million individuals are newly infected with HIV each year,
including 45,000 in the U.S. Thirty-five million are living with HIV, most in sub-Saharan
Africa. Women and girls comprise three-fifths of those living with HIV in Africa, and
women’s and girls’ inequality is a key structural driver of vulnerability to HIV infection.
Significant disparities play out in HIV incidence and treatment in the U.S. and globally.
Black American women and men, gay and bisexual men, and transgender women are
disproportionately burdened in the U.S. While in sub-Saharan Africa HIV is a
generalized epidemic, it is also connected to gender-based violence and oppression.
Recent epidemiological research indicates that concentrated epidemics exist in most
countries among men who have sex with men (MSM) and transgender women. Sex
workers and injection drug users are also priority populations for prevention and
treatment. Gender inequality, racism, poverty, and the oppression of LGBT people are
structural drivers of HIV vulnerability. In recent years global policy and funding agencies
have acknowledged these structural drivers and promoted policy change as a key to
reducing HIV vulnerability for women, girls, MSM, and transgender women. In the
Global South, HIV prevention funding has helped support the development of LGBT
community infrastructure.
We will examine the status of LGBT people around the world, with a particular focus on
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sub-Saharan Africa, the former Soviet bloc, and mostly Arab and Muslim countries. We
will review successful strategies for promoting an end to violence and discrimination
against LGBT people across the globe, and for promoting greater attention and
protections in global bodies such as the UN. We will review lessons from the
international experience in responding to the epidemicEmerging biobehavioral
approaches, including pre-exposure prophylaxis and microbicides, will also be
examined, as well as emerging challenges such as the aging of people living with HIV
into older adulthood, the needs of long-term survivors, incarceration, and integration of
HIV prevention and care into broader health systems.
We will also examine facilitators and barriers to young people, especially young women,
accessing sexual health education, sexual health care, and reproductive health care,
with a focus on the Global South. The widespread lack of access to safe abortion will be
examined, as well as causes of and solutions to this public health challenge. This
course is geared towards students with limited experience in sexual and reproductive
health, HIV/AIDS and LGBT equality as public policy issues. Economic perspectives, a
social impact perspective, and a rights perspective on sexual health will be examined.
Recent political developments in the U.S. will have significant implications for abortion
rights, LGBT rights, and sexual health policy, both domestic and global. We will
examine these implications as well.
Core Competencies: This course teaches concepts and skills which have been
identified as core competencies for degrees in sustainable international development
and health, as follows:
The HIV/AIDS epidemic is one of the greatest public health and development
challenges affecting both economically advanced as well as low-income countries. Its
impact has been most devastating in the Global South and with most at-risk populations
such as gay and bisexual men and sex workers throughout the world. Since the
emergence of the epidemic in the mid-1980s the world has gained rich experience in
prevention, treatment, care and support. The response to the epidemic as a serious
social, cultural, economic and political challenge has been varied within nations, as well
as across continents and regions. Even though there have been welcome advances,
including an overall decline in new infections worldwide, HIV remains one of the key
challenges to health and wellbeing of communities around the world, particularly in
socially and economically vulnerable and disadvantaged communities.
The course examines the essential elements of a successful policy response that could
effectively control the epidemic and promote sexual health, gender equality, and an end
to anti-LGBT stigma, violence and oppression. It will also look at the key developmental
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determinants affecting policy and successful programming at national and community
levels. The lessons learned from early policy interventions from a developing country
perspective will be followed up with a closer examination of evolution of the global
thinking and practice. The sessions will include discussions on gender, human rights,
security and humanitarian concerns, and drug policies. The course will also deliberate
on multi-sectoral approaches, public-private partnerships, and global institutions such
the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) aimed at
steering the international response towards HIV/AIDS prevention, control and care.
Sustainable Development: This course relates to sustainable development as follows:
HIV/AIDS, gender equality, LGBT equality, and sexual/reproductive health are among
the key challenges affecting development. They also have the potential to reverse the
hard won socio-economic achievements in many countries. The course reviews the
underlying determinants and factors that promote the spread of HIV/AIDS and other
STIs and those which are directly related to sustainable development. It reviews the
development impact as well as successful policy interventions which form an integral
part of a broader framework of sustainable development practice.
Gender and Human Rights Perspective: Gender is a key factor related to HIV/AIDS
and sexual health, cutting across almost all aspects related to prevention, control, care
and support. Other issues related to human rights are also relevant, including sexual
orientation, gender identity, sex work, incarceration, migration, and drug use. In much
of the Global South gay rights groups have been funded indirectly through HIV
prevention work with gay and bisexual men and transgender women. While HIV can be
used to stoke anti-gay prejudice, many gay men in Africa believe that HIV is a
heterosexual issue, and they are not at risk. These issues will serve as cross cutting
themes and therefore animate the course. In addition, some readings and classes will
specifically focus on these issues.
This course starts on January 17th, 2017 from 6pm-8:50pm in Classroom G053.
This syllabus is subject to change. When in doubt about it, please ask me.
Course Requirements
Attendance at all sessions; prompt arrival
Preparation of all readings and exercises
Active participation in class discussions and any group work
Timely submission/presentation of written and oral assignments
Preparation and presentation of class assignments
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Basis of Course Grade:
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Careful, critical reading of all required course assignments as evidenced by
participation in class discussions. (20%)
Oral, in-class presentations on assignments. (20%)
Mid-module assignment: Brief paper (3 pages double spaced) on a topic to be
assigned. Due February 7 (20%)
Final assignment: Individual reflection paper (5-7 pages double spaced). Topic
to be agreed with instructor by February 14; to be printed and submitted to the
instructor in class on Tuesday March 7). (40%)
Performance Feedback: By mid-way into the module (February 14), I will provide
feedback to students on their performance and discuss any issues they would like to
raise. If any student has concerns on the lectures, discussions or reading material, he
or she can individually contact me and discuss by prior appointment.
University Notices:
If you are a student with a documented disability record at Brandeis
University and wish to have a reasonable accommodation made for you in this
class, please advise me immediately. You are expected to be honest in all of
your academic work. The University policy on academic honesty is
distributed annually as section 5 of the Rights and Responsibilities handbook.
Instances of alleged dishonesty are subject to possible judicial action.
Potential sanctions include failure in the course and suspension from the
University. If you have any questions about my expectations, please ask.
Academic integrity is central to the mission of educational excellence at
Brandeis University. Each student is expected to turn in work completed
independently, except when assignments specifically authorize collaborative
effort. It is not acceptable to use the words or ideas of another person—be it
a world-class philosopher or your roommate— without proper
acknowledgement of that source. This means that you must use footnotes
and quotation marks to indicate the source of any phrases, sentences,
paragraphs or ideas found in published volumes, on the internet, or created
by another student. If you are in doubt about the instructions for any
assignment in this course, you must ask for clarification.
Summary of Class Schedule
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Session Date
1
January 17
2
January 24
Session Title
The global HIV/AIDS epidemic in 2017
LGBT rights and oppression around the world
3
January 31
Gender equality and oppression, women and girls
4
February 7
5
February 14
6
February 28
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March 7
Sexual health education and access to abortion in the Global
South (mid-module assignment paper due today)
Structural drivers of vulnerability to STIs and human rights
(final paper topic due today)
HIV prevention and treatment; Biobehavioral prevention
(final paper due today)
The U.S. HIV epidemic; key populations and emerging
issues
Session One – Tuesday, January 17, 2017
Topic: The global HIV/AIDS epidemic in 2017
Readings:
Kaiser Family Foundation. The Global HIV/AIDS Epidemic. 2016, November.
http://files.kff.org/attachment/Fact-Sheet-The-Global-HIV-AIDS-Epidemic
UNAIDS. Global AIDS Update 2016.
http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update2016_en.pdf
Kalibala S. The diagonal approach: Programming to combat HIV while
strengthening primary health care systems in Africa. Global HIV/AIDS
politics, policy, and activism: Persistent challenges and emerging
issues, Volume 1: Politics and government (Raymond Smith, editor),
Santa Barbara, CA: Praeger, 2013, 169-196.
Session Two – Tuesday, January 24, 2017
Topic: LGBT rights and oppression around the world
Readings:
Info Graphic World. LGBT rights around the world. 2015.
http://infographicworld.com/lgbt-rights-around-world/
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International Lesbian and Gay Organization. The Lesbian, Gay and Bisexual Map
of World Laws. 2015, May.
http://old.ilga.org/Statehomophobia/ILGA_WorldMap_2015_ENG.pdf
United Nations Office for the High Commissioner for Human Rights.
Discriminatory laws and policies and acts of violence against individuals based
on their sexual orientation and gender identity. Geneva. 2015, May 4.
Semugoma P, Nemande S, and Baral S. The irony of homophobia in Africa. The
Lancet. July 2012, 4-5.
International Gay and Lesbian Human Rights Commission, United and
Strong. Homophobia and transphobia in Caribbean media. A baseline
study from Belize, Grenada, Guyana, Jamaica and Saint Lucia. 2015.
https://www.outrightinternational.org/sites/default/files/BaselineAugust
102015.pdf
OutRight International. Timeline of publicized executions for alleged
sodomy by the Islamic State militias. 2015.
https://www.outrightinternational.org/content/timeline-publicizedexecutions-alleged-sodomy-islamic-state-militias
Session Three – Tuesday, January 31, 2017
Topic: Gender equality and oppression, women and girls
Readings:
UNAIDS. The Gap Report, 2014. Populations: adolescent girls and young
women, 132-145; migrants, 156-169; sex workers, 186-199; children and
pregnant women living with HIV, 228-245.
http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pd
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Jewkes R, Dunkle K, Nduna N, Shai N. Intimate partner violence, relationship
power inequity, and incidence of HIV infection in young women in South Africa: A
cohort study. The Lancet 376, no. 9734 (2010): 41-48. doi: 10.1016/S01406736(10)60548-X.
Mieses A. Gender inequality and corrective rape of women who have sex with
women. Treatment Issues (2009): 1–3. New York: Gay Men’s Health Crisis.
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These everyday humiliations: Violence against lesbians, bisexual women, and
transgender men in Kyrgyzstan. Human Rights Watch, 2008.
http://www.hrw.org/en/reports/2008/10/06/these-everyday-humiliations-0
Arbeit MR, Fisher CB, Macapagal K, Mustanski B (2016). Bisexual invisibility
and the sexual health needs of adolescent girls. LGBT Health. 3(5): 342-349.
Session Four – Tuesday, February 7, 2017
Topic: Sexual health education and access to abortion in
the Global South
Readings:
Sani AS, Abraham C, Denford S, Ball S (2016). School-based sexual health
education interventions to prevent STI/HIV in sub-Saharan Africa: A systematic
review and meta-analysis. BMC Public Health 16:1069.
Dubbink JH, van der Eem L, McIntyre JA, Mbambazela N, Jobson GA, Ouburg
S, Morre SA, Struthers HE, Peters RPH (2016). Sexual behavior of women in
rural South Africa: A descriptive study. BMC Public Health 16:557.
Nawagi F, Mpimbaza A, Mukisa J, Serwadda P, Kyalema S, Kizza D (2016).
Knowledge and practices related to sexually transmitted infections among
women of reproductive age living in Katanga slum, Kampala, Uganda. African
Health Sciences 16(1): 116-122.
Phillips-Howard PA, Nyothach E, ter Kuile FO, Omoto J, et al. (2016).
Menstrual cups and sanitary pads to reduce school attrition, and sexually
transmitted and reproductive tract infections: A cluster randomized controlled
feasibility study in rural Western Kenya. BMJ Open 16;6:e013229.
Lys C, Logie CH, MacNeill N, Loppie C, Dias LV, Masching R, Gesink D.(2016).
Arts-based HIV and STI prevention intervention with Northern and Indigenous
youth in the Northwest Territories: Study protocol for a non-randomised cohort
pilot study. BMC Open 6:e012399.
Cohen S (2012). Access to safe abortion in the developing world: Saving lives
while advancing rights. Guttmacher Policy Review 15(4):1-6.
Cresswell JA, Schroeder R, Dennis M, Owolabi O et al (2016). Women’s
knowledge and attitudes surrounding abortion in Zambia: A cross-sectional
survey across three provinces. BMJ Open 6:e010076.
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Session Five – Tuesday, February 14, 2017
Topic: Policy responses: Structural drivers of vulnerability and human rights
Readings:
Ghanotakis E, Mayhew S, Watts C. Tackling HIV and gender-based violence in
South Africa: How has PEPFAR responded and what are the implications for
implementing organizations? Health Policy and Planning. 2009;24:357-366.
Ellsberg M, Betron M. Preventing gender-based violence and HIV: Lessons from
the field. U.S. Agency for International Development, 2010. http://www.aidstarone.com/sites/default/files/AIDSTAR-One_Gender_Spolight_Genderbased_violence.pdf
Cowan F, Mtetwa S, Davey C, et al. Engagement with HIV prevention, treatment
and care among female sex workers in Zimbabwe: A respondent driven sampling
survey. PLoS One. 2013 Oct 15;8(10):e77080. doi:
10.1371/journal.pone.0077080.
Thomas B, Mimiaga M, Mayer K, et al. The influence of stigma on HIV risk
behavior among men who have sex with men in Chennai, India. AIDS Care.
2012; 24:11, 1401-1406, DOI: 10.1080/09540121.2012.672717
http://dx.doi.org/10.1080/09540121.2012.672717
Beyrer C, Baral S, van Girensven F, et al. Global epidemiology of HIV infection in
men who have sex with men. The Lancet. July 2012, 19-29.
Baral S, Poteat T , Stromdahl S, et al. Worldwide burden of HIV in transgender
women: A systematic review and meta-analysis. The Lancet, March 2013, 214222.
Ndashe S. Seeking the protection of LGBTI rights at the African Commission on
Human and People’s Rights. Feminist Africa. 2011, Issue 15.7-37.
BBC. Uganda fury at David Cameron aid threat over gay rights. October 31,
2011.
http://www.bbc.co.uk/news/world-africa-15524013
amfAR (American Foundation for AIDS Research) (2012). Achieving an AIDSfree generation for gay men and other MSM: Financing and implementation of
HIV programs targeting MSM. Washington, DC. Pp. 4-51, 57-65. Analysis of
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extent to which UNGASS Indicators, Global Fund, PEPFAR address MSM and
HIV. Case studies of China and Guyana.
http://www.amfar.org/uploadedFiles/_amfar.org/In_The_Community/Publications/
MSM-GlobalRept2012.pdf
Kaoma, Rev. K. How anti-gay Christians evangelize hate abroad. Los Angeles
Times. March 23, 2014.
http://www.latimes.com/opinion/op-ed/la-oe-kaoma-uganda-gays-americanministers-20140323-story.html
U.S. State Department fact sheet. Advancing the human rights of lesbian, gay,
bisexual and transgender persons worldwide: A State Department priority. 2013
http://www.state.gov/documents/organization/211690.pdf
Onishi N. U.S. support of gay rights in Africa may have done more harm than
good. New York Times. December 21, 2015.
http://www.nytimes.com/2015/12/21/world/africa/us-support-of-gay-rights-inafrica-may-have-done-more-harm-than-good.html?mwrsm=Email&_r=0
Session Six – Tuesday, February 28, 2017
Topic: HIV prevention and treatment; biobehavioral prevention
Readings:
Dolan K, Wirtz AL, Moazen B, Ndeffo-mbah M, et al (2016). Global burden of
HIV, viral hepatitis, and tuberculosis in prisoners and detainees. The Lancet. 720.
Pickels M, Boily M-C, Vickerman P. et al. Assessment of the population-level
effectiveness of the Avahan HIV-prevention programme in South India: a
preplanned, causal-pathway-based modelling analysis. The Lancet Global
Health, Volume 1, Issue 5, Pages e289 - e299, November 2013.
doi:10.1016/S2214-109X(13)70083-4
Mkandawire P, Luginaah I, Bezner-Kerr R. Deadly divide: Malawi’s policy
debate on HIV/AIDS and condoms. Policy Sci. 2011;44:81-102. DOI
10.1007/s11077-101-9111-5.
Larson E, O’Bra H, Brown J, et al. Supporting the massive scale-up of
antiretroviral therapy: The evolution of PEPFAR-supported treatment facilities in
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South Africa, 2005-2009. BMC Public Health. 2012.
Strathdee S, Hallett T, Bobrova N, et al. HIV and risk environment for injecting
drug users: The past, present, and future. The Lancet. 2010, July 24. 376: 268284.
Grant R, Lama J, Anderson P. et al. Preexposure chemoprophylaxis for HIV
prevention in men who have sex with men. New England Journal of Medicine.
2010: 363:27; 2587-2599.
Cohen M, Chen Y, McCauley M, et al. Prevention of HIV-1 infection with early
antiretroviral therapy. New England Journal of Medicine. 2011; 365(6): 493-505.
Abdool Karim Q, Abdool Karim SS, Frohlich J et al. Effectiveness and safety of
tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in
women. Science. 2010; 329: 1168-1174.
Update from the February 2016 Conference on Retroviruses and Opportunistic
Infections, Boston.
Session Seven – Tuesday, March 7, 2017
Topic: The U.S. epidemic; key populations and emerging issues
Readings:
Cahill S, Mayer K, & Boswell S. The Ryan White HIV/AIDS Program in the age of
health care reform. American Journal of Public Health. 105(6): 1078-1085. June
2015.
White House Office of National AIDS Policy. National HIV/AIDS Strategy for the
United States: Updated to 2020. July 2015.
https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhasupdate.pdf
Millett G, Peterson J, Flores S, et al. Comparisons of disparities and risks of HIV
infection in black and other men who have sex with men in Canada, UK, and
USA: A meta-analysis. The Lancet, July 2012. 11-18.
Brewer R., Magnus M., Kuo I., et al. Exploring the relationship between
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incarceration and HIV among Black men who have sex with men in the U.S.
JAIDS. October 2013.
Cahill S, and Valadez R. Growing older with HIV/AIDS: New public health
challenges. Am J Public Health. 2013 Mar;103(3):e7-e15. doi:
10.2105/AJPH.2012.301161. Epub 2013 Jan 17.
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