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

南部非洲国家占全球艾滋病毒感染的50%以上，该地区14个国家中有9个国家的成人艾滋病毒感染率超过10%。虽然艾滋病毒治疗的进步使人们保持健康并阻止感染，但每年有200万人感染，3800万人感染艾滋病毒，超过2000万人无法获得抗逆转录病毒治疗（ART）（UNAIDS 2016）。追踪捐助国政府资助解决低收入和中等收入国家艾滋病毒流行问题的最新数据的研究显示，捐助国资助从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年）估计，到2030年，应对这一流行病的资源需要从2015年的190亿美元增加到2020年的262亿美元，以实现全球可持续发展目标。津巴布韦的局势是严峻的。超过75%的人口处于贫困状态，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年至2010年，津巴布韦因艾滋病毒/艾滋病而过早死亡的总寿命损失增加了150%以上，但国内用于艾滋病毒的资金仍然微不足道（IHME 2014）。捐助国政府是津巴布韦和其他低收入国家最大的抗逆转录病毒疗法捐助国，其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毒感染者都难以获得抗逆转录病毒治疗，最贫穷的人，性少数群体，女性性工作者，囚犯，妇女和儿童都有困难（Machingura 2016）。除非在获得抗逆转录病毒治疗方面的不平等得到解决，否则这些弱势社会群体将继续成为被遗弃者中日益边缘化的群体。这种不平等将破坏消除艾滋病和减贫的进展，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，并使各国远离积极参与国际进程。在我的博士研究的基础上，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，媒体和政策受众以我的博士研究成果为起点，进一步讨论不让任何人掉队。具体而言，这项工作将与卫生部、国家艾滋病委员会和津巴布韦的UZ、UKZN-南非、南部非洲发展共同体-博茨瓦纳、ECSA-HC坦桑尼亚和从事艾滋病毒感染者工作的民间社会合作。它还将涉及曼彻斯特大学和全球智库。这个国际网络将协助利用和建立影响机会，使政治和政策重新关注艾滋病毒的允许死亡。其次，这项工作旨在通过社区一级的数据跟踪，将艾滋病毒感染者的边缘化群体的优先事项数字化和加权，从而确定他们的优先事项。这些将通过福利加权经济技术与大数据联系起来，并转化为社区艾滋病毒结果衡量标准（CHOM），以加强对最脆弱人群重要的事情以及最脆弱人群如何吸收数据可以改善患者选择的了解。这一方法意义重大，尤其是当数据跟踪是获得免费医疗保健的条件，也是在需求最大的社区一级解决不平等问题的途径时。这项工作的方法独特，将高质量的研究与沟通工作、高级别的政治和学术网络、战略召集和政策咨询、传播和公众参与相结合，探讨如何应对可允许的死亡和“不让一个人掉队”。“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，并在实施可持续发展目标和跟踪边缘化社会群体的进展方面表现出相关性。这项工作旨在将最贫困人口的生活置于中心，并展示如何将他们的观点和价值观更好地纳入政策制定中。

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.