Data, priorities and global health


I spent part of January working on my book manuscript, The Uncounted: Politics of Data in Global Health. When I began writing this in 2017, I was just interested in the data paradox: in which criminalized, stigmatized key populations, who lack data to prove they exist, get no funding for programs that save their lives, reinforcing the lack of data. But as I get deeper into the work, I’m noticing the growing dominance of cost-effectiveness language and tools, and how economic values are shaping how we think about priorities in global health finance.

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Sexual violence against migrants

Conflicts around the world are fueling sexual violence against men, women and children. It was an honor to moderate this roundtable at ICRC’s Humanitarium in Geneva on September 10th, with a group of experts who are working in these crises to advocate for, and support the rights of migrants and refugees who experience sexual violence.

Peter Maurer, president of ICRC, gave opening remarks. The panelists included Hillary Margolis (Human Rights Watch), Fouzia Bara (Médécins Sans Frontières), Alexandra MacDowall (UNHCR), and Sophie Sutrich (ICRC). The conversation was enriched by interventions from Karla Avelar and Chris Dolan in the audience, speaking to the challenges faced by male survivors and LGBT survivors in accessing services. Doris Schopper (CERAH) wrapped up the discussion.

A full video of the discussion is online here:

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AIDS 2018: Debates over best use of global funds


(L-R) Chris Beyrer, Michel Kazatchkine, Anka Van Damm at EECA Roundtable. ©Sara L.M. Davis
The last in a series of four articles on AIDS 2018 for Health and Human Rights.


July 26, 2018

Steadily growing rates of HIV infection in Eastern Europe and Central Asia (EECA) are at the heart of a debate roiling health aid at AIDS 2018. While US funding for the global HIV response increased in 2017, that trend is unlikely to continue and most other donors cut back, according to a new report from Kaiser Family Foundation and UNAIDS.

The Global Fund to Fight AIDS, TB and Malaria and PEPFAR argue that given the limited global funding for HIV, they should prioritize investing in Sub-Saharan African countries to reach the largest number of people living with HIV. Middle-income countries are increasingly left to “transition” out of aid and foot their own bill. But critics say EECA governments do not fund services for criminalized populations such as people who use drugs. As a result, 39% of new HIV infections are now occurring amongst people who use drugs in the EECA region, says UNAIDS.

“International aid, and the Global Fund in particular, should not behave like development banks. We should fight AIDS wherever it is, and fund what governments are not willing to fund at the time,” said former Global Fund executive director Michel Kazatchkine. While he congratulated a Russian health official sitting beside him at a roundtable, who asserted that Russia had increased its funding for HIV, Kazatchkine countered, “Funding for prevention in Russia is far from where it should be, and still not at scale.”

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AIDS 2018: New technologies, new data, new risks


Sex workers protest to demand their rights at AIDS 2018

The third in a series of four articles on AIDS 2018 for the Health and Human Rights journal. 


July 24, 2018

Data has been a hot topic throughout the first two days of AIDS 2018—who has it, how to get it, and what kinds of data can speed progress to the end of AIDS. But while new technologies are generating real excitement among donors and researchers, human rights activists are rarely in these discussions, leaving questions of risk and ethics largely in the shadows.

Some new methods that are rapidly on the rise include:

  • Geospatial mapping, which uses individual data to map key population hotspots and patterns of migration
  • Biometrics, the collection of physical markers such as iris scans, fingerprints, or facial scans that can identify individuals, and
  • Phylogenetics, the use of molecular sequencing data, such as DNA, to trace historical relationships among people and chart the transmission of viruses.

These are some examples of data use presented in the first two days: we have heard about the use of biometrics to track sex workers and long distance truckers in African transportation corridors; a Mumbai project that mapped sites around the city of men who have sex with men using Grindr, a gay dating app; use of HIV genotyping and phylogenetics to assess transmission of resistance.

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AIDS 2018: Award to Allan Maleche, a “tireless crusader”


Standing ovation for Allan Maleche, winner of the Elizabeth Taylor Human Rights Award.

The second of a series of four articles for Health and Human Rights on the 2018 International AIDS Conference


July 23, 2018

AIDS 2018 is honoring human rights advocates and acknowledging their work is becoming ever more challenging in many countries. At the opening ceremony, the Elizabeth Taylor award went to Kenyan rights advocate Allan Maleche, executive director of KELIN. He won the award for KELIN’s successful litigation for the rights of people living with HIV and TB in Kenya.

In accepting the award, Maleche said, “There are many days when the challenges we face in Kenya and globally can seem endless. Human rights are never really secure—they must be fought for every day. Even with the advancements in science in the HIV world, the stigma and human rights violations remain the same.”

He said the award would be a huge boost to his organization to continue their work serving affected communities in Kenya.

“The story of HIV is a story of social justice and human rights,” said Quinn Tivey, grandson of Dame Elizabeth Taylor who took up AIDS activism in the 1980s, founding organizations and foundations in outrage over the treatment of her friends and colleagues. International AIDS Society (IAS) president Linda-Gail Bekker called Maleche a “tireless crusader” for the rights of people living with HIV and affected by TB, noting that KELIN had “used the law as a powerful tool.”

Maleche affirmed the cause of 23 women who have written to UNAIDS about sexual harassment, saying, “I believe them and I stand in solidarity with them. We look to the UN to set the standard on human rights and gender equality. We are not there yet.” Maleche also leads the Developing Country NGO Delegation to the Global Fund Board.


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AIDS 2018: Warnings of a resurgent pandemic

IMG_4635I covered the International AIDS Conference in Amsterdam last week for the Harvard University Health and Human Rights journal – here are a few of the blog posts.

July 23, 2018

The International AIDS Conference opens today in Amsterdam, with up to 19,000 scientists, activists, and officials coming together from around the world. The world has come a long way since the last time the meeting took place here, in 1992, with old and new challenges on the horizon.

In 1992, an old world order was giving way: South Africa was dismantling apartheid, Russia was an emerging democracy, and the European Union was newly founded. HIV was a global crisis and fast becoming a leading cause of death, with an estimated 1.5 million cases. Twenty-six years later, although there are an estimated 36.9 million people living with HIV globally, the world has become complacent about the epidemic. That’s in part because of widely available antiretroviral treatment, and global institutions that fund and distribute treatment and prevention in low resource countries.

But delegates and activists gathered here in Amsterdam say a crisis is imminent as a result of donor withdrawal from middle-income countries in Eastern Europe and Central Asia; human rights violations driving transmission among key populations; and cases on the rise among hard-to-reach young people. All this means, according to UNAIDS, that HIV is at risk of becoming a resurgent global pandemic.

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“Everyone Said No”: Key Populations and Biometrics in Kenya


CDC researchers working in Kenya

From the Harvard Health and Human Rights journal:

By Sara L.M. Davis and Allan Maleche


Hands off our fingerprints! That was the message from Kenyan civil society activists who blocked the use of biometric data, such as fingerprints or iris scans, in a government HIV study.

This case study of rights advocacy is the subject of a report, Everyone Said No: Biometrics, HIV and Human Rights, a Kenya Case Study, published by KELIN and the Kenya Key Populations Consortium.“Key populations” in HIV are defined by WHO as sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prison or other closed settings. The case study was written by the authors of this blog and researchers at KELIN and the Key Populations Consortium. It provides an overview of the HIV epidemic and data gaps on key populations in Kenya, an analysis of the legal and human rights issues in use of biometrics in HIV research, and documentation of the advocacy by key populations groups in Kenya. It also makes recommendations to global health donors, Kenyan authorities, and civil society groups who face similar debates in other countries.

The purpose of the government HIV study was to fill critical gaps in data on key populations in Kenya, to enable better targeting of resources. The government research team aimed to use biometric data to manage the risk of double-counting, given that key populations tend to be highly mobile. As soon as Kenyan key population groups learned about the plan to use biometrics, they became vocal in their opposition, citing concerns about criminalization. In Kenya, sex work, drug use, and same-sex sexual behavior are all criminalized. Through persistent advocacy, they successfully blocked any use of biometrics in the study. It will proceed using other methods.

Read the full blog. 

We will launch the report with a Twitter chat at 15:30 CET (16:30 EAT) Thursday 5 July – join the conversation with @KELINKenya.



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Key populations: Lost in the data desert

Along_the_rail_road_-_Iran_-_Shahroud_-_panoramioI’m writing a book on the politics of data for key populations, and it’s led me to think about “data deserts” – areas where no data is produced, so no programs or social services are provided.

It’s a particular problem for key populations (sex workers, men who have sex with men [MSM], people who inject drugs, trans* people and prisoners) in low-income countries. But surprisingly, it’s a problem for countries with higher income too.

Out of the 58 countries that the World Bank classifies as upper-middle income:

  • 17 countries had NO official HIV prevalence data for ANY key population group
  • 8 countries have HIV prevalence data for only ONE key population, but not the others

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A taste of Mexico City

IMG_3402I recently, unexpectedly found myself living in Mexico City for ten spring days. I found it has a hot art scene, independent bilingual bookstores, lovely leafy neighborhoods with old colonial architecture, and world-class food. As soon as you sit down at most restaurants, the chef sends out homemade hot sauces and tortillas. Then you sit back and enjoy the ride. Some of the best meals I scarfed down were at:

Pasillo de Humo– On the second floor of a food hall in colonial Condesa, this modern, airy restaurant specializes in Oaxacan food, including fiery, earthy moles. I went there on my first day, a Monday, and was impressed by the family that had a full mezcal bar wheeled out to their table. At lunch. Continue reading

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Remembering Riyadh

Sky bridge pano, Kingdom Center

Sky Bridge, Kingdom Center in downtown Riyadh © Davis 2018

In February, I gave a talk about the course I teach on sexual violence at the first Riyadh International Humanitarian Forum. I’ve been remembering that trip since learning of the recent arrest of women’s rights activists in Saudi Arabia.


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