Open Society Institute Research Articles

Reforming Serbia’s Local Government Finance System*

Approximately 30 percent of all local government revenues in Serbia come from shared sales taxes. In the immediate future, the Government will have to replace sales taxes with a value added tax in order to meet EU norms. This will require a fundamental overhaul of Serbia’s intergovernmental finance system because unlike sales tax, the VAT cannot be shared on an origin basis. This paper outlines the origins of Serbia’s current intergovernmental finance system, summarizes its strengths and weaknesses, and then, in light of the necessity of change, sketches a set of reform proposals. These include creating a formula-based equalization grant funded by a fixed percentage of national budget revenues; introducing the legal possibility for block grants, categorical grants, and grants for delegated functions to fund the devolution of new responsibilities to local governments and to support specific (investment) programs; and restoring local government control over Serbia’s ad valorem property tax. *This paper could not have been written without the painstaking groundwork laid by Mr. Branisilav Stipanovic, and his endless patience in explaining to me the operation of the Serbian intergovernmental finance system. For this I am sincerely grateful. I would also like to the Local Government and Public Service Initiative of the Open Society Institute for supporting his work, and the PALGO Center for organizing many aspects of this endeavor. Throughout the process, I received critical logistical and analytical support from the members of the Serbian Local Government Reform Project’s Policy Reform Unit, Tatijana Pavlovic-Krizanic, Milica Milosevic, and above all Team Leader, Dusan Vasiljevic. Finally, I would like to thank Mark Birnbaum for his assistance in data analysis and presentation as well as for his invaluable editorial help. Obviously, however, all mistakes are my own.

THE RIGHT TO EDUCATION IN OCCUPIED TERRITORIES: MAKING MORE ROOM FOR HUMAN RIGHTS IN OCCUPATION LAW

This article explores the compatibilities and tensions between the human right to education and occupation law. In 2004, the International Court of Justice (ICJ) issued an advisory opinion stating that Occupying Powers must extend their international human rights treaty obligations to the people in the territories they occupy. This finding reaffirmed what many human rights and occupation law scholars and judicial and quasi-judicial bodies have long claimed. While occupation law and human rights law are largely compatible tensions between the two can arise however. This is not surprising given the basic premises that each body of law is based upon. While occupation law largely works to restrict the occupant from tampering with the laws and institutions of the occupied territory, there are significant portions of human rights law that work hard to press states to amend or change laws and develop infrastructure to accommodate the welfare of their populations. This tension is not merely theoretical. It has been the case since at least World War I that occupants have taken an interest in making changes to the education of youth and educational institutions in the territory they control. Relying primarily on the core obligations of the right to education, this study looks at the extraterritorial and positive human rights obligations that occupants have with regard to the primary education of children inside an occupied territory. It also sets out an approach that helps mediate the areas where the two are less than compatible. The views expressed in this article are those of the author and do not necessarily reflect those of the Open Society Justice Initiative.

The American University in Bulgaria and U.S. Agency for International Development Relationship

Upon recognizing a need for a center of western oriented university education, an initiative committee including representatives from the Republic of Bulgaria, the city of Blagoevgrad, and the University of Maine obtained support from philanthropist George Soros's Open Society Institute and the U.S. Agency for International Development (USAID) to start a university in Bulgaria in 1991. The hallmark of its existence was that its programs would be oriented toward teaching democratic values through the American liberal arts tradition. Instruction would be in English so it could draw on students throughout the region if they were proficient in English. The university has grown from a small enrollment of 208 students to over 700 students in several disciplines in the humanities and social sciences. As the American University in Bulgaria (AUBG) has become a regional institution, the AUBG–USAID relationship has been crucial. Now it is beginning to offer an EMBA program and has developed an excellent reputation through its graduated students.

Life and Death Decisions: Psychological and Ethical Considerations in End-of-Life Care

Life and Death Decisions: Psychological and Ethical Considerations in End-of-Life Care

Developing Business Education Infrastructure in Eastern Europe: Albanian Experience

Because of its unique characteristics, Albania is faced with severe challenges. Business education is no exception. The baggage of its tragic past, under a ruthless communist dictatorship, especially the isolation of its people from free thought for almost 50 years, still lingers in people's thinking and behaviors. Generally, the Albanian schools system is well developed and there is a tradition of sound education. However, Albanian institutions of higher education are ill prepared to provide modern business education to the future leaders. The University of Nebraska—Lincoln (UNL), under the leadership of the first author, has helped modernize business education infrastructure in Albania through multiyear funding from the United States Agency for International Development and Soros Foundation. This article reports several important initiatives for business education launched by UNL: (1) the first ever MBA and MPA (Master of Public Administration) programs in Albania at the University of Tirana; (2) training more than 5000 university faculty, entrepreneurs, and government officials; (3) establishment of Business Assistance Centers at four universities; (4) development of Students in Free Enterprise (SIFE) chapters at most universities in Albania; and (5) focused training for faculty research, teaching methods, teaching evaluations, curriculum development, and outreach services.

Collaboration to Unlock Access : Presentations at the LIBER Conference in ST Petersburg

The opportunities provided by open access to journal literature have generated much interest and discussion. LIBER's approach to this important topic at the St Petersburg Conference was through the theme of collaboration. Each group of stakeholders in scholarly communication, from author through to reader, has an interest in open access. If open access is to be achieved it has to be through collaboration between authors, funding agencies, publishers and librarians working together in the best interests of readers of academic literature. The benefits to individuals and to human society to be gained from open access are described in this quotation from the Budapest Open Access Initiative: "An old tradition and a new technology have converged to make possible an unprecedented public good. The old tradition is the willingness of scientists and scholars to publish the fruits of their research in scholarly journals without payment, for the sake of inquiry and knowledge. The new technology is the internet. The public good they make possible is the world-wide electronic distribution of the peer-reviewed journal literature and completely free and unrestricted access to it by all scientists, scholars, teachers, students, and other curious minds. Removing access barriers to this literature will accelerate research, enrich education, share the learning of the rich with the poor and the poor with the rich, make this literature as useful as it can be, and lay the foundation for uniting humanity in a common intellectual conversation and quest for knowledge." Since calling the meeting which developed the Budapest Open Access Initiative, the Open Society Institute has continued to support discussion and action to implement the two strategies leading to open access identified in Budapest, and the open access session at the LIBER Conference was supported by a grant from OSI.

Punishment and Democracy: Disenfranchisement of Nonincarcerated Felons in the United States

As levels of criminal punishment have risen in the United States, more and more citizens have been disenfranchised because of a felony conviction. This paper provides an overview and analysis of the unique practice of felon disenfranchisement in the United States today. We focus in particular on the political impact of disenfranchising large numbers of nonincarcerated felons—those who have served their entire sentences and those living in their home communities while completing a term of probation or parole. Our discussion is organized around three key issues relating to felon disenfranchisement: (1) the historical and legal origins of this practice; (2) its practical political impact on recent elections; and, (3) the racial dynamics that color both the history and contemporary effects of felon disenfranchisement in the United States. We discuss how felon disenfranchisement laws in many states appear to be out of step with both international practices and public opinion in the United States and consider contemporary policy proposals.Jeff Manza is the coauthor, with Clem Brooks, of Social Cleavages and Political Change: Voter Alignments and U.S. Party Coalitions. With Jeff Manza, Christopher Uggen is coauthor of the forthcoming Locked Out: Felon Disenfranchisement and American Democracy. Research was supported by grants from the National Science Foundation (No. 9819015) and from the Individual Project Fellowship Program of the Open Society Institute. The authors are indebted to the editors and anonymous reviewers for thoughtful comments and suggestions and to Angela Behrens and Sara Wakefield for research assistance.

ELIAMEP's Forum on New Security Issues (FONSI): ‘Shared interests & values between Southeastern Europe & the transatlantic community’

Click to increase image sizeClick to decrease image size Notes Organized by the Hellenic Foundation for European and Foreign Policy (ELIAMEP) in cooperation with the Center for Liberal Strategies, Sofia; with the support of the German Marshall Fund of the United States and the Open Society Foundation, Sofia.

Policing Post-Communist Societies: Police-Public Violence, Democratic Policing, and Human Rights (review)

Eastern European countries have been involved in a complex transition towards more democratic forms of government. Since the demise of communism, the building up of an independent judiciary and a general reorientation of the police role within society have been key-issues On the basis of three country studies in Russia, Lithuania and Mongolia, this book analyses the present state of policing in a variety of post-communist societies in terms of police-public violence, democratic policing, the rule of law and human rights. It is also complemented by recent comparable and previously unpublished police data for Romania, Bulgaria and Poland. Those studies have been carried out amongst the rank-and-file of the uniform branch in Lithuania and Russia which were commissioned by the Soros Open Society Foundation. They were specifically concerning views and experiences concerning police-public violence and current policing problems in general. A third study was carried in Mongolia amongst criminal investigators, and sought to explore (violent) investigative practices. This book seeks to combine a thorough theoretical analysis with unique empirical data. It analyses the different problems of transition of post-communist societies towards more democratic forms of government with unique data from both outside and inside the police.

Does Opiophobia Exist Among Pain Specialists?

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsArthur G. LipmanCherokee Layson-Wolf, PharmD, is Assistant Professor at the University of Maryland School of Pharmacy. At the time that this review was conducted, she was a Community Care Pharmacy Practice Resident at Virginia Commonwealth University.Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.Jonathan R. Gavrin, MD, is the Internet editor for the Journal. He is Associate Professor of Anesthesiology and Adjunct Associate Professor of Medicine at the University of Washington School of Medicine; Associate Member, Fred Hutchinson Cancer Research Center; and Associate Director for Clinical Anesthesia Services, Harborview Medical Center.Philip J. Wiffen, is the Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service Executive, a member of the Oxford Regional Pain Relief Unit and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.Howard A. Heit, practices pain medicine and addiction medicine in Fairfax, Virginia, and is Assistant Clinical Professor of Medicine at Georgetown University, Washington, DC. Dr. Heit was a member of the Liaison Committee on Pain and Addiction.Perry G. Fine, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.Last Acts is a Robert Wood Johnson Foundation funded campaign to improve end-of-life care by a coalition of professional and consumer organizations. This coalition works to improve palliative care, focused on managing pain and making life better for individuals and families facing death. Last Acts envisions a world in which dying people and their loved ones receive excellent care and are honored and supported by their community.S. R. Ghooi, MBBS, is a Medical Consultant in New Delhi.Gustavo G. De Simone is Medical Oncologist (with Diploma in Palliative Medicine) and Pallium Latinoamérica Association Medical Director and Chief, Section on Palliative Care, Hospital Bonorino Udaondo, Bonpland 2287 (1425) Ciudad de Buenos Aires, Argentina ( pallium@elsitio.net.The Reverend John S. Lunn, RN, MDiv, is Palliative Care and Hospice Consultant, Global Ministries for the Disciples of Christ and United Church of Christ, and former President, Board of Directors, Kauai Hospice, Hawaii.Jan Stjernswärd, MD, PhD, FRCP (Edin), is Former Chief, Cancer and Palliative Care, World Health Organization, Geneva, Switzerland, and International Director of the Oxford University International Centre for Palliative Care and World Health Organization Collaborating Centre for Palliative Care, Churchill Hospital, Oxford, UK. He also serves on the Steering Committee of the Diana Palliative Care Initiative, Diana Princess of Wales Memorial Fund in the UK, as a Consultant to the Open Society Institute in New York, and continues to serve as a World Health Organization advisor.Barbara L. Kass-Bartelmes, MPH, CHES, and Ronda Hughes, PhD, wrote this report for the Agency for Health Care Research and Quality (AHRQ) of the U.S. Public Health Service.

Ethics and palliative care in pediatrics.

Cynda Hylton Rushton is associate professor of nursing at the School of Nursing and on the faculty of the Phoebe R. Berman Bioethics Institute at Johns Hopkins University, as well as program director at Harriet Lane Compassionate Care Program, Baltimore, MD. She is director of the Nursing Leadership Consortium on End-of-Life Care project and the Nursing Leadership Academy on Palliative and End-of-Life Care, both funded by the Open Society Institute through its Project on Death in America. Currently she is chairwoman of Maryland’s Council on Quality Care at the End of Life. Contact author: 525 North Wolfe Street, Box 420, Baltimore, MD 21205; [email protected]. This article is the 12th in a series on palliative nursing that is supported in part by a grant from the Robert Wood Johnson Foundation. Betty R. Ferrell, PhD, RN, FAAN ([email protected]), and Nessa Coyle, PhD, NP, FAAN ([email protected]), are the series editors. The author of this article has no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

Prisoners of the Census: Electoral and Financial Consequences of Counting Prisoners Where They Go, Not Where They Come From

* This research was supported by grants from the Soros Justice Fellowship Program of the Open Society Institute. † Eric Lotke is Director of Research and Policy at the Justice Policy Institute. He performed this research as a Soros Senior Justice Fellow. Previously, he was the Executive Director of the D.C. Prisoners Legal Services Project, a judicial clerk on the Supreme Court of Connecticut, and an adjunct professor at Georgetown and George Washington Law Schools. He is a graduate of Wesleyan University and of the University of Wisconsin. ‡ Peter Wagner, JD, is a Soros Justice Fellow and Assistant Director of the Prison Policy Initiative, a widely-used internet project providing accurate, timely research and policy reports on criminal justice issues. He is the author of Importing Constituents: Prisoners and Political Clout in New York, the first systematic state analysis of the impact of prisoner enumeration policies on legislative redistricting. As part of his Soros Justice Fellowship, he is currently measuring the impact of prisoner enumeration on legislative redistricting in a number of states and publishing the results on the project’s website, PrisonersoftheCensus.org. 1. BUREAU OF JUSTICE STATISTICS, U.S. DEP’T OF JUSTICE, BULL. NO. NCJ 200248, PRISONERS IN 2002 1 (2003), available at http://www.ojp.usdoj.gov/bjs/pub/ pdf/p02.pdf [hereinafter PRISONERS IN 2002]. 2. See BUREAU OF JUSTICE STATISTICS, U.S. DEP’T OF JUSTICE, BULL. NO. NCJ 175688, WOMEN OFFENDERS 8 tbl.18 (1999), available at http://www.ojp.usdoj.gov/ bjs/pub/pdf/wo.pdf; see also BUREAU OF JUSTICE STATISTICS, U.S. DEP’T OF JUSTICE, BULL. NO. NCJ 182335, INCARCERATED PARENTS AND THEIR CHILDREN (2000), available at http://www.ojp.usdoj.gov/bjs/pub/pdf/iptc.pdf. 3. See, e.g., Todd Clear, The Problem with “Addition by Subtraction”, in INVISI-

Progress report on the development of child abuse prevention, identification, and treatment systems in Eastern Europe

Problem: After the Soviet Union dissolved in 1989, it became apparent that there was little recognition of the problems of child abuse and neglect, professionally, legally, or societally. There were no effective systems or laws in place to deal with these problems. Method: Beginning in 1995 the Children’s Mental Health Alliance, in conjunction with the Open Society Institute began conducting trainings in Eastern Europe [Journal of the American Academy of Child Adolescent Psychiatry 39 (2000) 660]. Originally 18 countries from the Baltics to the Balkans participated. A program was elaborated which would proceed in several stages: (1) training mental health professionals to deal with child abuse and neglect (CAN); (2) teaching multidisciplinary team work and fostering the development of multidisciplinary NGOs focused on CAN; (3) promoting the self-sufficiency of these NGO’s which would then facilitate social and legal reform and increase public awareness of the problem. Specific methods included multi-national trainings, assignment of mentors to the developing teams who maintained weekly contact with the teams and made yearly site visits to their countries, and overseeing project grants from OSI. Results: NGO’s had been established and registered in 11 countries, many establishing a network of programs within their countries. By 2000, over 3800 mental health professional had been trained, either directly by the program or by the trainees of the program. By the end of 2000, over 17,000 other professionals (lawyers, police, judges, educators, other physicians, etc.) had been trained by the network. Conclusion: While more work needs to be in this region, the teams in 11 countries have made solid starts.

Trauma care and palliative care: time to integrate the two?

The phrase “palliative care in trauma” might seem an oxymoron if we think of the traditional definitions of palliative care and trauma care. Palliative care as defined by the World Health Organization is “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount.” The principles of palliative care encompass excellent communication, pain and symptom management, goals of care, bereavement, and spiritual support, usually for patients who are at the end of life. Conversely, trauma surgery is focused on acute care of the critically injured, where decisions and care are provided to rapidly cure the patient and prolong life, often no matter the cost in suffering and resources. If the patient dies it is often suddenly, in the emergency room or the operating room, leaving little room for the traditional notions of palliative care as we know it. Recent developments in society and medicine have highlighted the importance of end-of-life care and the gap between how we wish to die and how many of us do die. These developments have spread to surgery as well, with increased attention to palliative and end-of-life care in the practice and study of surgery, as demonstrated by the recent publications in this journal and others. But this trend brings with it inherent conflict in values, both for society at large and within medicine. Nowhere is this more apparent than on the trauma service. On one hand, the public increasingly values death with dignity, free of life-prolonging machines, but it also values hightechnology trauma and critical care, with its potential for cure and dramatic life-saving maneuvers. Death from trauma is a tragic event, often afflicting young and previously healthy people. It is rarely peaceful or dignified. This conflict is further played out in the current practice of trauma care. The role of end-of-life care in trauma surgery remains ill defined, and is often something to offer only when all other options have failed. The American College of Surgeons Committee on Trauma Optimal Resource Manual defines an ideal trauma system to “include all the components identified with optimal trauma care, such as prevention, access, acute hospital care, rehabilitation, and research activities.” Palliative or endof-life care has not been considered an essential feature of the trauma system and, if provided, is often relegated to other services or providers, often in the last minutes or hours of the patient’s life when care is deemed futile. Trauma surgeons and other specialists have little expertise and training in the skills of palliative care, such as communication, and pain and symptom management. If all of this is so, then how can palliative care be integrated into trauma care and, more importantly, should it? Several trends in healthcare in general and trauma care in particular suggest that palliative care can and should be integrated into trauma. First, despite all efforts, 10% to 15% of trauma patients who make it to the hospital will die from their injuries. An additional percentage of survivors will be disabled or functionally impaired. Clearly, because end-of-life care is increasingly valued, appropriate management of death must become part of the daily workings of a trauma service. Second, demographics suggest that the population is aging; this is reflected in the demographics of trauma admissions. The elderly are increasingly represented on the trauma service, with the oldest old a fast growing group suffering from injury. Outcomes studies clearly demonstrate increased mortality for the elderly trauma patient, both in the hospital and after discharge, compared with younger adults or age-matched elderly who have not been injured. This group is more likely to have chronic lifethreatening illness, advance directives, and preferences for end-of-life care that may involve limitation of lifesupporting technologies. As the situation of elderly trauma patients becomes more frequent, quality end-oflife care becomes a more important part of trauma care. Finally, the evolution of trauma care itself portends a This article is based on work supported by a Faculty Scholars Grant from the Project on Death in America, Soros Foundation.

Revolution or evolution?

A shift to an open-access model of publishing would clearly benefit science, but who should pay?

The Gordian Knot of Brazilian Foreign Policy: Promoting democracy while respecting sovereignty

President Cardoso has provided decisive impetus for strengthening Brazil's commitment to democracy abroad, both through multilateral diplomacy and foreign policy. However, there exist inherent tensions between the dual principles guiding Brazilian foreign policy, the promotion and protection of democracy abroad and the attachment to national sovereignty and non-interference in internal affairs. This study assesses Brazil's response to threats to democracy during the last decade in 10 case studies. It argues that presidential diplomacy has played a key role in furthering the democratic commitment of Brazilian foreign policy. The author thanks Paulo Roberto de Almeida, Juan Fernando London ˜o, Anja Linder, and Riordan Roett and gratefully acknowledges the support of the Democracy Coalition Project (DCP) of the Open Society Institute (OSI) in Washington DC.

Print in Peril

There is a growing belief among science publishers that the days of the printed scientific journal may be numbered, and that the countdown has begun. Rising print costs, slashed library budgets, and economic uncertainties have reduced income from both institutional and personal subscriptions, and this has encouraged publishers to consider other options, particularly electronic formats. It has also caused them to raise subscription prices, thereby forcing libraries to drop subscriptions to many journals. Over the past few years, a new concept has been spreading through the academic community – the open access movement has added to the mounting pressure on science publishers to let go of traditional publishing models. Briefly, the argument goes like this. The main point of doing research is to disseminate the results as widely as possible, particularly among the scientific community, who will use and build on the information. By assigning copyright to, and publishing in, traditional scientific journals, authors are perpetuating a system whereby publishers act as “toll-keepers”, blocking the dissemination process, since only those who can afford to pay the toll are able to see the information. Publishers are therefore limiting the “impact” of the research. On the other hand, science publishers administer the peer review process, check and edit the manuscripts, convert them to journal page or computer screen, and market the final result. None of this comes cheap. Estimates vary, but it can cost $4000 or more to bring an article onto the printed journal page. Traditionally, this money has come mainly from end-users, in the form of personal and institutional subscriptions and pay-per-view charges. The Budapest Open Access Initiative (BOAI) came out of a meeting organized by the Open Society Institute in December 2001, the purpose of which was “to accelerate progress in the international effort to make research articles in all academic fields freely available on the Internet. The BOAI proposes a system in which all scientific literature is freely available to everyone, online, through a process of self-archiving. Journals will continue to orchestrate the peer review process, thus ensuring that articles meet recognized scientific standards, and will then publish them, either online or in print form, in the (unlikely) event that this is still financially feasible. Authors, however, reserve the right to “self-archive” their own work on aninstitutional or a personal website. A metadata tagging system run by the Open Archives Initiative (www.openarchives.org) will ensure that papers are searchable and retrievable by anyone with a computer. The various BOAI-associated websites (eg www.soros.org/openaccess and www.eprints.org/self.faq), abound with explanations and FAQs. Concerns about search ability, security, and longevity of self-archived material, as well as copyright, licensing, embargoes, legal issues, and much more, are all addressed. What is less well covered is the question of post-acceptance costs. In the free-for-all, post-BOAI world, the onus is now on the author to provide the money, in the form of a flat fee, as in the Public Library of Science model (www.plos.org), or as page charges; presumably they will be able to afford this, thanks to all the money they have saved on personal journal subscriptions. Supporters of BOAI see the future role of journals – online only – as mainly administering the refereeing process, and quote the pre-acceptance cost of a research article as a mere $200–$500. However, this does not take into account the enormous amount of work that must becarried out after acceptance. The manuscript may be scientifically sound, but anyone who has been involved in producing a journal knows that it usually takes a substantial amount of copyediting for clarity and consistency, as well as reference and information checking, before the paper is readable and accurate. When the paper is written by an author whose English is poor, editorial processing increases exponentially. Who will pay for this in the post-BOAI world? The bottom line is that major publishers such as Elsevier and MacMillan have the resources to evolve and survive. Scientific societies, and the publications they produce, which provide income to help support their other activities, may find themselves in serious difficulty if they continue to charge subscription fees in competition with open access publications. The more cynical might say, “Well, turkeys will never vote for Thanksgiving – of course publishers of scientific journals, including the ESA, are going to feel threatened by self-archiving and open access”. In fact, the ESA is ahead of the game in this instance, as its journals all grant authors permission to “post the work in a publicly accessible form on a personal or home institution’s webpages”. Nevertheless, science publishers must make enough money to survive, to play their part in the circulation of scientific knowledge. If too many fail to survive the proposed revolution, access to that knowledge could be severely compromised. Dr Sue Silver, Editor-in-Chief

Taking liberties: four decades in the struggle for rights

A penetrating memoir on forty years of fighting for civil liberties, human rights, and justice by the former executive director of the ACLU and Human Rights Watch and the current President of the Open Society Institute. . Since joining the staff of the American Civil Liberties Union in 1963 and becoming its youngest executive director, Aryeh Neier has been at the forefront of efforts to fight for civil liberties, human rights, and social justice. Whether he was confronting police abuse, defending draft opponents or defending free speech, as he did at the ACLU; out-maneuvering the Reagan administration over military abuses in El Salvador, promoting accountability for political crimes in Argentina and Chile or supporting dissidents in the former Soviet Union and Eastern Europe, as he did at Human Rights Watch; or trying to eradicate landmines, promote stability in the Balkans or establish an International Criminal Court, as he has at the Open Society Institute; Aryeh Neier has been methodical, relentless, and unusually successful. In this look back at an amazing career, Neier both reflects on the unintended consequences of some of his victories and why, if he had anticipated them, he might have done things differently; and reveals that some of the various movements of which he was a part had their greatest triumphs under the most adverse circumstances.

Infectious disease in Haiti. HIV/AIDS, tuberculosis and social inequalities.

More than 50 years after the introduction of chemotherapy for the treatment of tuberculosis (TB), the disease is far from being under control. Among curable infectious diseases, TB remains the number‐one killer—each year, 2 million people still die of the disease and 8.4 million more fall ill (World Health Organization (WHO), 2002a). And future projections are grim. Fewer than half of all TB cases are diagnosed, and of those that are, fewer than 30% have access to the care recommended by the WHO (WHO, 2002a). The increase in TB worldwide is due, in part, to the expansion of the HIV/AIDS pandemic (WHO, 2001): at least one‐third of people with HIV die of TB (WHO, 2002a). HIV/AIDS now causes more than 3 million deaths per year (UNAIDS, 2002). More than 90% of HIV/AIDS deaths and new infections occur in poor countries where less than 5% of those who need antiretroviral treatment have access to these therapies (WHO, 2002b). If we consider that, on average, 10% of people with HIV need antiretroviral treatment, the 5% figure comes down to less than 1% in sub‐Saharan Africa, the region most affected by the pandemic. > The social contexts in which our patients became infected are an integral part of their stories Large‐scale social forces, such as racism, sexism, political violence, poverty and other social inequalities, are rooted in historical and economic processes and sculpt the distribution and outcome of HIV/AIDS and TB. We refer to these social forces as ‘structural violence’ (Castro & Farmer, 2002, 2003a,b; Farmer, 2003), which predisposes the human body to pathogenic vulnerability by shaping the risk of infection and subsequent disease reactivation. After infection, structural violence also determines who has access to diagnostics and effective therapy. Drugs that could stop or slow down these epidemics, such as …

HIV and tuberculosis in the former Soviet Union

HIV and tuberculosis in the former Soviet Union