Allowable deaths, Leave-no-one-behind and the value of human life in Zimbabwe. What actions to accelerate early progress on the implementation of SDGs

南部非洲国家的艾滋病毒感染率占全世界的50%以上，该区域14个国家中有9个国家的成人艾滋病毒感染率超过10%。尽管艾滋病毒治疗的进步使人们保持健康并遏制了感染，但每年仍有200万人感染，3800万艾滋病毒携带者，超过2000万人无法获得抗逆转录病毒治疗(ART)(联合国艾滋病规划署2016年)。追踪低收入和中等收入国家应对艾滋病毒流行的捐助政府资金的最新数据显示，捐助资金从2014年的86亿美元减少到2015年的75亿美元(Kates等人，2016年)。联合国艾滋病规划署(2016)估计，应对疫情的资源需要从2015年的190亿美元增加到2020年的262亿美元，才能在2030年达到全球可持续发展目标。津巴布韦局势严峻。超过75%的人口经历贫困，15%的成年人口感染艾滋病毒(ZimSTAT 2015)，占非洲所有新感染病例的5%。1990至2010年间，由于艾滋病毒/艾滋病，津巴布韦因过早死亡而损失的总寿命增加了150%以上，但国内为艾滋病毒提供的资金仍然微不足道(IHME 2014)。作为津巴布韦和其他低收入国家最大的抗逆转录病毒治疗捐赠者，捐赠政府资金的不确定性加剧了艾滋病毒的挑战。但是，并不是所有的艾滋病人都在努力获得抗逆转录病毒治疗，而是最贫穷的、性少数群体、女性性工作者、囚犯、妇女和儿童艰难地获得了抗逆转录病毒治疗(Machingura 2016)。除非艺术品获取方面的不平等问题得到解决，否则这些弱势社会群体将继续构成越来越多的被边缘化的留守群体。这种不平等将破坏在消除艾滋病和减贫方面取得的进展，造成可能破坏可持续发展目标议程的社会紧张局势和政治动态，并迫使各国远离积极参与国际进程。在我博士研究的基础上，拟议的工作以两种方式面对这些挑战。首先，这项工作旨在让政治、学术、媒体和政策受众进一步对话，以我的博士研究成果为起点，不让任何人掉队。具体而言，这项工作将与卫生部、国家咨询委员会、津巴布韦乌兹兰共和国、南非UKZN、南部非洲发展共同体博茨瓦纳、坦桑尼亚幼儿保育和儿童权利中心以及从事艾滋病毒防治工作的民间社会进行接触。它还将涉及曼彻斯特大学和全球智库。这一国际网络将帮助利用和创造产生影响的机会，重新引起对艾滋病毒允许死亡的政治和政策关注。第二，这项工作旨在通过社区一级的数据追踪数字化和加权他们的优先事项，从而确定艾滋病毒感染的边缘群体的优先事项。这些将通过福祉加权经济技术与大数据联系在一起，并转变为社区艾滋病毒结果衡量标准(CHOM)，以加强对最脆弱者的重要性以及最脆弱者获取的数据如何改善患者选择的低估。这种办法意义重大，特别是在数据追踪是获得免费保健的条件和在最需要的社区一级解决不平等问题的途径的情况下。这项工作在方法上独树一帜，将高质量的研究与沟通工作、高级别的政治和学术网络、战略会议和政策建议、传播和公众参与结合在一起，探讨应对可允许的死亡和不让任何人掉队意味着什么。这项工作将保持继续就艾滋病毒问题进行对话所需的行动势头，并在落实可持续发展目标和跟踪边缘化社会群体的进展方面显示出相关性。这项工作旨在将最贫穷者的生活放在中心位置，并展示如何更好地将他们的观点和价值观纳入政策制定。

countries in Southern Africa account for over 50% of HIV infections worldwide, with 9 of the region's 14 countries registering an adult HIV prevalence rate of over 10%. Although advances in HIV treatment have kept people well and stemmed infections, 2 million get infected yearly, 38 million live with HIV, and over 20 million don't access antiretroviral therapy (ART) (UNAIDS 2016). Research tracking the latest data on donor government funding to address the HIV epidemic in low and middle-income countries shows a decrease in donor funding from US$8.6 billion in 2014 to US$7.5 billion in 2015 (Kates et al 2016). UNAIDS (2016) estimates that resources to address the epidemic need to rise from US$19 billion in 2015 to US$26.2 billion in 2020 to reach global SDG targets by 2030. The Zimbabwean situation is severe. With more than 75% of its population experiencing poverty, 15% of its adult population living with HIV (ZimSTAT 2015), it accounts for 5% of all new infections in Africa. Zimbabwe's total years of life lost due to premature mortality increased by over 150% between 1990 and 2010 because of HIV/AIDS, yet domestic funding for HIV remains insignificant(IHME 2014). The uncertainty of donor government funding, the largest ART contributor in Zimbabwe and other low-income countries, aggravates HIV challenges. But, it is not all PLHIV who struggle to access ART, it is the poorest, sexual minorities, female sex workers, prisoners, women and children who have it the hard way (Machingura 2016). Unless inequality in ART access is tackled, these vulnerable social groups will continue to constitute an ever-growing marginalized group of those left behind. Such inequalities will undermine progress on AIDS eradication and poverty reduction, creating the kind of social tensions and political dynamics that can derail the SDG agenda, and drive countries away from positive engagement in international processes. Building on my doctoral research, the proposed work confronts these challenges in two ways. Firstly, the work sets out to engage political, academic, media and policy audiences to further conversation on leaving no one behind using my doctoral research findings as a starting point. Specifically, the work will engage with the MoH, NAC; and UZ in Zimbabwe; UKZN-South Africa; SADC-Botswana; ECSA-HC Tanzania and civil society working with PLHIV. It will also involve the University of Manchester, and global think tanks. This international network will assist to leverage and build impact opportunities to bring back political and policy attention on HIV allowable deaths.Secondly, the work aims to pin down the priorities of the marginalized groups of PLHIV by digitizing and weighting their priorities through community level data traces. These will be linked with big data through wellbeing weighting economic techniques and transformed into a community HIV outcome measure (CHOM) to strengthen understating on what matters for the most vulnerable and how data uptake by those most vulnerable could improve patient choice. This approach is significant especially when data traces are the condition to access free health care and a pathway to addressing inequality at the community level where the need is greatest. This work, unique in its approach, combines high-quality research with communications work, high-level political and academic networking, strategic convening and policy advice, dissemination and public engagement on what it means to confront allowable deaths and to 'leave-no-one-behind.' This work will maintain the momentum for action needed to continue dialogue on HIV and also demonstrate relevance in the implementation of SDGs and tracking progress for marginalized social groups. The work aims to put the lives of the poorest at the center and to show how their views and values can be better incorporated into policy making.