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Progress is hampered by continuing gaps in detection and treatment. * With evidence that TB programs are hampered by the legal environment, we analyze the degree to which law reform is needed to align with promises at the United National High Level Meeting on Tuberculosis to promote human rights and dignity in the TB response. * Exploring the laws at key points of vulnerability to TB in 20 high TB-burden countries (HBCs) shows that internationally recognized rights related to medical isolation, privacy, home inspection, and medical examination are insufficiently protected in the laws of most of these countries. * Exploration of the legal environment for migration shows that restrictions or bans on travel and immigration for those with TB is the norm, along with limitations on access to medical care, in contravention of international standards. * Fundamental human rights, expected in other areas of public life, are often missing for people with TB. [...]TB stands in stark contrast to HIV/AIDS, for which the international community has moved far more decisively to recognize and protect key rights, even as more progress is needed [8,9]. Shown in Table 1, indicator 1 codes whether a country’s law describes when and how health agencies can compel isolation. Since there is not a particular consensus agreement on exactly when isolation is necessary with regards to TB, we code simply whether laws indicate some criteria or mirror the language around “necessary,” which might be interpreted through local law. South Africa offers a rare illustration of laws that do meet international standards, clearly spelling out in its recently revised regulations that public health officials must consider “the need, nature and extent of the intervention, based on the nature of the public health threat and the particular circumstances of the individual” as well as the likelihood of transmission [22].

The Global Fund to Fight AIDS, Tuberculosis and Malaria has proven highly effective at fighting the world's major killers. Strong governance and robust development institutions are necessary, however, for improving health long-term. While some suggest that international aid can strengthen institutions, others worry that aid funding will undermine governance, creating long-term harm. The Global Fund is a unique aid institution with mechanisms designed to improve transparency and accountability, but the effectiveness of this architecture is not clear. This study seeks evidence on the effects of Fund financing over the past 15 years on national governance and development. A unique dataset from 112 low- and middle-income countries was constructed with data from 2003 to 2017 on Global Fund financing and multiple measures of health, development, and governance. Building a set of regression models, we estimate the relationship between Fund financing and key indicators of good governance and development, controlling for multiple factors, including the effects of other aid programs and tests for reverse causality. We find that Global Fund support is associated with improved control of corruption, government accountability, political freedoms, regulatory quality, and rule of law, though association with effective policy implementation is less clear. We also find associated benefit for overall adult mortality and human development. Our data are not consistent with recent claims that aid undermines governance. Instead our findings support the proposition that the Global Fund architecture is making it possible to address the continuing crises of AIDS, tuberculosis, and malaria in ways that improve institutions, fight corruption, and support development. Amidst the complex political economy that produces good governance at a national level, our finding of a beneficial effect of health aid suggests important lessons for aid in other settings.

How do choices in criminal law and rights protections affect disease-fighting efforts? This long-standing question facing governments around the world is acute in the context of pandemics like HIV and COVID-19. The Global AIDS Strategy of the last 5 years sought to prevent mortality and HIV transmission in part through ensuring people living with HIV (PLHIV) knew their HIV status and could suppress the HIV virus through antiretroviral treatment. This article presents a cross-national ecological analysis of the relative success of national AIDS responses under this strategy, where laws were characterised by more or less criminalisation and with varying rights protections. In countries where same-sex sexual acts were criminalised, the portion of PLHIV who knew their HIV status was 11% lower and viral suppression levels 8% lower. Sex work criminalisation was associated with 10% lower knowledge of status and 6% lower viral suppression. Drug use criminalisation was associated with 14% lower levels of both. Criminalising all three of these areas was associated with approximately 18%–24% worse outcomes. Meanwhile, national laws on non-discrimination, independent human rights institutions and gender-based violence were associated with significantly higher knowledge of HIV status and higher viral suppression among PLHIV. Since most countries did not achieve 2020 HIV goals, this ecological evidence suggests that law reform may be an important tool in speeding momentum to halt the pandemic.

Introduction Despite international commitment to achieving the end of HIV as a public health threat, progress is off‐track and existing gaps have been exacerbated by COVID‐19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community‐led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence‐based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services. Discussion Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community‐led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community‐led advocacy, with the aim of increasing duty‐bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long‐term approach to building meaningful engagement in systems‐wide improvements rather than discrete interventions. Conclusions The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.

Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance—building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate substantial variation in the content of law and policies between countries, regions and policy areas. Given progress in basic and implementation science, it would be tempting to believe most countries have adopted policies aligned with global norms, with a few outliers. Data show this is not the case. Globally, alignment is higher on clinical and treatment policies than on prevention, testing and structural policies. Policy-makers, researchers, civil society, finance agencies and others can use these data to better understand the policy environment within and across countries and support reform. Longitudinal analysis enables evaluation of the impact of laws and policies on HIV outcomes and research about the political drivers of policy choice.

After Covid-19, the global health community must address major gaps in global preparedness, critical capacities needed for a safer and fairer world, and international instruments required for realizing them.

A new era of long-acting antiretrovirals for HIV treatment and prevention demands a nonlinear approach to global access with faster sharing of technology, decentralized production, and products that meet needs in the Global South.

The African Centers for Disease Control and Prevention (CDC) has announced a plan for 1 million tests and a promising partnership aiming to produce 10 million tests, but this will not solve the immediate need.6 National contexts and responses are diverse—which will continue in the short term and longer term. In Veneto, Italy, home-based care was combined with widespread testing and early diagnosis, resulting in a mortality rate four-times lower than that reported in Lombardy.10 Such home-based care could be a model for African contexts, building on community-level response experiences from the west African Ebola outbreak.11 Africa competes for testing kits and a future vaccine Rolling out testing, tracing, and care across Africa will not be easy. On vaccines and therapies, the current situation of inequitable access will repeat without action, as leaders highlighted at the launch of a new international effort to accelerate COVID-19 tools.20 Rich countries monopolising vaccine markets would mirror past actions.21 Meanwhile, demand for masks, gloves, and other personal protective equipment face similar dynamics. Binding human rights treaties are not specific on distributing scarce goods in health emergencies.23 World Trade Organization rules require free flow of medical goods in the market, with little provision for crises when markets inequitably distribute goods in ways that undermine public health.

Industry must not be allowed to block sharing of knowledge for medicines and vaccines