United Nations Secretary General Antonio Guterres addresses the 22nd session of the Permanent Forum on Indigenous Issues at the General Assembly Hall of the United Nations headquarters in New York City on 17 April 17 2023. Credit: Ed Jones/AFP via Getty Images
NEW YORK, Sep 7 2023 (IPS) – This September, world leaders and public policy advocates from around the world will descend on New York for the UN General Assembly. Alongside conversations on peace and security, global development and climate change, progress – or the lack of it – on the Sustainable Development Goals (SDGs) is expected to take centre-stage. A major SDG Summit will be held on 18 and 19 September. The UN hopes that it will serve as a ‘rallying cry to recharge momentum for world leaders to come together to reflect on where we stand and resolve to do more’. But are the world’s leaders in a mood to uphold the UN’s purpose, and can the UN’s leadership rise to the occasion by resolutely addressing destructive behaviours?
Sadly, the world is facing an acute crisis of leadership. In far too many countries authoritarian leaders have seized power through a combination of populist political discourse, outright repression and military coups. Our findings on the CIVICUS Monitor – a participatory research platform that measures civic freedoms in every country – show that 85% of the world’s population live in places where serious attacks on basic fundamental freedoms to organise, speak out and protest are taking place. Respect for these freedoms is essential so that people and civil society organisations can have a say in inclusive decision making.
UN undermined
The UN Charter begins with the words, ‘We the Peoples’ and a resolve to save future generations from the scourge of war. Its ideals, such as respect for human rights and the dignity of every person, are being eroded by powerful states that have introduced slippery concepts such as ‘cultural relativism’ and ‘development with national characteristics’. The consensus to seek solutions to global challenges through the UN appears to be at breaking point. As we speak hostilities are raging in Ukraine, Sudan, the Occupied Palestinian Territories and the Sahel region even as millions of people reel from the negative consequences of protracted conflicts and oppression in Afghanistan, Ethiopia, Myanmar, Syria and Yemen, to name a few.
Article 1 of the UN Charter underscores the UN’s role in harmonising the actions of nations towards the attainment of common ends, including in relation to solving international problems of an economic, social, cultural or humanitarian character, and to promote respect for human rights and fundamental freedoms for all. But in a time of eye-watering inequality within and between countries, big economic decisions affecting people and the planet are not being made collectively at the UN but by the G20 group of the world’s biggest economies, whose leaders are meeting prior to the UN General Assembly to make economic decisions with ramifications for all countries.
Economic and development cooperation policies for a large chunk of the globe are also determined through the Organisation for Economic Cooperation and Development (OECD). Established in 1961, the OECD comprises 38 countries with a stated commitment to democratic values and market-based economics. Civil society has worked hard to get the OECD to take action on issues such as fair taxation, social protection and civic space.
More recently, the BRICS – Brazil, Russia, India, China and South Africa – grouping of countries that together account for 40 per cent of the world’s population and a quarter of the globe’s GDP are seeking to emerge as a counterweight to the OECD. However, concerns remain about the values that bind this alliance. At its recent summit in South Africa six new members were admitted, four of which – Egypt, Iran, Saudi Arabia and the United Arab Emirates – are ruled by totalitarian governments with a history of repressing civil society voices. This comes on top of concerns that China and Russia are driving the BRICS agenda despite credible allegations that their governments have committed crimes against humanity.
The challenge before the UN’s leadership this September is to find ways to bring coherence and harmony to decisions being taken at the G20, OECD, BRICS and elsewhere to serve the best interests of excluded people around the globe. A focus on the SDGs by emphasising their universality and indivisibility can provide some hope.
SDGs off-track
The adoption of the SDGs in 2015 was a groundbreaking moment. The 17 ambitious SDGs and their 169 targets have been called the greatest ever human endeavour to create peaceful, just, equal and sustainable societies. The SDGs include promises to tackle inequality and corruption, promote women’s equality and empowerment, support inclusive and participatory governance, ensure sustainable consumption and production, usher in rule of law and catalyse effective partnerships for development.
But seven years on the SDGs are seriously off-track. The UN Secretary-General’s SDG progress report released this July laments that the promise to ‘leave no one behind’ is in peril. As many as 30 per cent of the targets are reported to have seen no progress or worse to have regressed below their 2015 baseline. The climate crisis, war in Ukraine, a weak global economy and the COVID-19 pandemic are cited as some of the reasons why progress is lacking.
UN Secretary-General Antonio Guterres is pushing for an SDG stimulus plan to scale up financing to the tune of US$500 billion. It remains to be seen how successful this would be given the self-interest being pursued by major powers that have the financial resources to contribute. Moreover, without civic participation and guarantees for enabled civil societies, there is a high probability that SDG stimulus funds could be misused by authoritarian governments to reinforce networks of patronage and to shore up repressive state apparatuses.
Also up for discussion at the UN General Assembly will be plans for a major Summit for the Future in 2024 to deliver the UN Secretary-General’s Our Common Agenda report, released in 2021. This proposes among other things the appointment of a UN Envoy for Future Generations, an upgrade of key UN institutions, digital cooperation across the board and boosting partnerships to drive access and inclusion at the UN. But with multilateralism stymied by hostility and divisions among big powers on the implementation of internationally agreed norms, achieving progress on this agenda implies a huge responsibility on the UN’s leadership to forge consensus while speaking truth to power and challenging damaging behaviours by states and their leaders.
The UN’s leadership have found its voice on the issue of climate change. Secretary-General Guterres has been remarkably candid about the negative impacts of the fossil fuel industry and its supporters. This July, he warned that ‘The era of global warming has ended; the era of global boiling has arrived’. Similar candour is required to call out the twin plagues of authoritarianism and populism which are causing immense suffering to people around the world while exacerbating conflict, inequality and climate change.
The formation of the UN as the conscience of the world in 1945 was an exercise in optimism and altruism. This September that spirit will be needed more than ever to start creating a better world for all, and to prove the UN’s value.
Mandeep S. Tiwana is chief officer for evidence and engagement + representative to the UN headquarters at CIVICUS, the global civil society alliance.
The Essence of Pan-Africanism: A Historical Perspective and Contemporary Relevance
7 September 2023
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By Divine Mafa | Pan-Africanism is a dynamic ideology rooted in the historical experiences of the African diaspora. It encompasses a broad spectrum of political, social, and cultural movements aimed at uniting people of African descent worldwide. This essay delves into the history of Pan-Africanism, its pivotal figures, and its contemporary significance, with a focus on dispelling misconceptions.
Historical Context:
Pan-Africanism emerged during the late 19th and early 20th centuries, a time when the African continent was enduring colonization and exploitation by European powers. The African diaspora, particularly those residing in the Americas and the Caribbean, were deeply affected by the horrors of slavery. This shared history of oppression and exploitation fostered a sense of unity among people of African descent.
Key Figures in Pan-Africanism:
1. **Marcus Garvey:** Marcus Garvey is often considered one of the early pioneers of Pan-Africanism. He founded the Universal Negro Improvement Association (UNIA) and advocated for the return of Africans to their ancestral homeland. Garvey’s “Back to Africa” movement inspired a generation.
2. **W.E.B. Du Bois:** Du Bois, a prominent African-American scholar and civil rights activist, played a significant role in Pan-Africanism. He organized the Pan-African Congresses in the early 20th century, providing a platform for discussions on African self-determination and the end of colonialism.
3. **Kwame Nkrumah:** Nkrumah, Ghana’s first president, was a fervent Pan-Africanist. He believed that African nations should unite to achieve true independence from colonial powers. His leadership in the decolonization of Africa set a precedent for the continent.
Contemporary Relevance:
In the present day, Pan-Africanism remains highly relevant. While colonialism in Africa has ended, the legacy of exploitation and inequality persists. The movement serves as a reminder that people of African descent, regardless of their geographic location, share a common history and must support one another.
Moreover, Pan-Africanism aligns with the pursuit of democracy and human rights. Contrary to misconceptions, it is not an ideology of hate but one of solidarity and empowerment. People of African descent in the United States, for instance, have made significant strides in politics, education, and culture. The presence of Black Americans in leadership positions demonstrates the progress achieved over time.
Conclusion:
Pan-Africanism is a powerful ideology rooted in the shared history of people of African descent. It has evolved from its historical roots to become a force for unity, empowerment, and the pursuit of justice in today’s world. By dispelling misconceptions and embracing the principles of solidarity, Pan-Africanism can continue to inspire positive change for the benefit of all.
WaMwari Devine Chaminuka Mafa ZEM AFRICA FOUNDING FATHER
The 10 year ZEM plan
**ZEM Unified Plan for One African Union**
**Vision:** To unite the SADC region under a common goal of economic progress, political transformation, and regional cooperation, ultimately contributing to the creation of a more prosperous and united Africa.
**Why It Matters:**
1. **Economic Prosperity:** By uniting the SADC region under the banner of ZEM, we aim to harness the economic potential of Southern Africa. A unified approach can facilitate regional trade, investment, and economic development, leading to increased prosperity for all.
2. **Political Transformation:** ZEM’s commitment to political transformation addresses the challenges of fair and transparent governance. This is crucial to achieving stability and fostering trust among citizens and international partners.
3. **Regional Cooperation:** In an interconnected world, regional cooperation is vital. ZEM’s unified plan promotes cooperation among SADC countries, allowing us to tackle shared challenges such as climate change, security, and healthcare more effectively.
**Phase 1: Formation of ZEM Divisions in SADC Countries**
**Leadership Selection:** ZEM leaders are carefully chosen for their dedication to our vision. They are the driving force behind our mission in each country.
**Formation of ZEM Divisions:** The establishment of ZEM divisions in each SADC country ensures that local issues are addressed while working towards common regional objectives.
**Membership Recruitment:** Our success depends on the commitment of our members. We seek individuals who share our vision for a better Africa.
**Phase 2: Coordination and Collaboration**
**Regular Meetings:** Open channels of communication among ZEM divisions promote collaboration, the exchange of ideas, and strategic alignment.
**Shared Resources:** By pooling resources, we amplify our impact. Knowledge sharing, financial support, and expertise are shared among divisions.
**Joint Initiatives:** Collective efforts can address regional challenges more effectively. ZEM divisions identify common issues and work together to find solutions.
**Phase 3: Advocacy and Political Engagement**
**Policy Development:** ZEM takes a proactive stance on policy development. Our shared regional agenda focuses on economic integration, trade, currency unification, and harmonized policies.
**Advocacy Campaigns:** Through advocacy campaigns, we seek to influence policy decisions within SADC member states. Our goal is to promote policies that align with ZEM’s vision.
**Phase 4: Grassroots Mobilization and Outreach**
**Youth Empowerment:** Engaging the youth ensures that the next generation is invested in Africa’s future. ZEM provides opportunities for leadership and involvement.
**Public Awareness:** Raising public awareness about our mission is crucial. Through extensive awareness campaigns, we aim to garner support and inspire change.
**Phase 5: Engagement with International Partners**
**International Alliances:** ZEM seeks partnerships with organizations, governments, and entities that share our objectives. We are not alone in our pursuit of a better Africa.
**Phase 6: Continuous Monitoring and Adaptation**
**Assessment:** Ongoing assessment helps us measure progress and identify areas for improvement.
**Adaptation:** Flexibility is key. ZEM is prepared to adapt strategies to address changing political, economic, and social dynamics.
**Phase 7: Transition to an African Union**
**SADC Integration:** ZEM’s vision extends beyond the SADC region. We seek to collaborate with other regional movements to promote unity and integration across the African continent.
**Pan-African Vision:** The ultimate goal is a united African Union, achieved through collaboration with like-minded organizations and movements across the continent.
The ZEM Unified Plan for One African Union is not just a blueprint; it’s a testament to our commitment to a brighter future for Africa. By working together, we can overcome the challenges that have hindered our progress and pave the way for a united, prosperous, and sovereign Africa.
Join us in this historic endeavor, and together, we will make a difference for our beloved continent.
Our Planned branches across Africa.
ZIMBABWE ECONOMIC MOVEMENT FOR AFRICA INC.
1. South Africa economic movement 2. Angola economic movement 3. Botswana economic movement 4. Comoros 5. Democratic Republic of the Congo (DRC) economic movement 6. Eswatini economic movement 7. Lesotho economic movement 8. Madagascar economic movement 9. Malawi economic movement 10. Mauritius economic movement 11. Mozambique economic movement 12. Namibia economic movement 13. Seychelles economic movement 14. Tanzania economic movement 15. Zambia economic movement 16. Zimbabwe economic movement
We are open offices in the region.now write the zem plan for one African union. FOUNDER – Wamwari Devine Mwana +19015459000 USA https://chat.whatsapp.com/FNUUsDel2OHGJ2dHpIv5w5
The 10 year ZEM plan
**ZEM Unified Plan for One African Union**
**Vision:** To unite the SADC region under a common goal of economic progress, political transformation, and regional cooperation, ultimately contributing to the creation of a more prosperous and united Africa.
**Why It Matters:**
1. **Economic Prosperity:** By uniting the SADC region under the banner of ZEM, we aim to harness the economic potential of Southern Africa. A unified approach can facilitate regional trade, investment, and economic development, leading to increased prosperity for all.
2. **Political Transformation:** ZEM’s commitment to political transformation addresses the challenges of fair and transparent governance. This is crucial to achieving stability and fostering trust among citizens and international partners.
3. **Regional Cooperation:** In an interconnected world, regional cooperation is vital. ZEM’s unified plan promotes cooperation among SADC countries, allowing us to tackle shared challenges such as climate change, security, and healthcare more effectively.
**Phase 1: Formation of ZEM Divisions in SADC Countries**
**Leadership Selection:** ZEM leaders are carefully chosen for their dedication to our vision. They are the driving force behind our mission in each country.
**Formation of ZEM Divisions:** The establishment of ZEM divisions in each SADC country ensures that local issues are addressed while working towards common regional objectives.
**Membership Recruitment:** Our success depends on the commitment of our members. We seek individuals who share our vision for a better Africa.
**Phase 2: Coordination and Collaboration**
**Regular Meetings:** Open channels of communication among ZEM divisions promote collaboration, the exchange of ideas, and strategic alignment.
**Shared Resources:** By pooling resources, we amplify our impact. Knowledge sharing, financial support, and expertise are shared among divisions.
**Joint Initiatives:** Collective efforts can address regional challenges more effectively. ZEM divisions identify common issues and work together to find solutions.
**Phase 3: Advocacy and Political Engagement**
**Policy Development:** ZEM takes a proactive stance on policy development. Our shared regional agenda focuses on economic integration, trade, currency unification, and harmonized policies.
**Advocacy Campaigns:** Through advocacy campaigns, we seek to influence policy decisions within SADC member states. Our goal is to promote policies that align with ZEM’s vision.
**Phase 4: Grassroots Mobilization and Outreach**
**Youth Empowerment:** Engaging the youth ensures that the next generation is invested in Africa’s future. ZEM provides opportunities for leadership and involvement.
**Public Awareness:** Raising public awareness about our mission is crucial. Through extensive awareness campaigns, we aim to garner support and inspire change.
**Phase 5: Engagement with International Partners**
**International Alliances:** ZEM seeks partnerships with organizations, governments, and entities that share our objectives. We are not alone in our pursuit of a better Africa.
**Phase 6: Continuous Monitoring and Adaptation**
**Assessment:** Ongoing assessment helps us measure progress and identify areas for improvement.
**Adaptation:** Flexibility is key. ZEM is prepared to adapt strategies to address changing political, economic, and social dynamics.
**Phase 7: Transition to an African Union**
**SADC Integration:** ZEM’s vision extends beyond the SADC region. We seek to collaborate with other regional movements to promote unity and integration across the African continent.
**Pan-African Vision:** The ultimate goal is a united African Union, achieved through collaboration with like-minded organizations and movements across the continent.
The ZEM Unified Plan for One African Union is not just a blueprint; it’s a testament to our commitment to a brighter future for Africa. By working together, we can overcome the challenges that have hindered our progress and pave the way for a united, prosperous, and sovereign Africa.
Join us in this historic endeavor, and together, we will make a difference for our beloved continent.
Our Planned branches across Africa.
ZIMBABWE ECONOMIC MOVEMENT FOR AFRICA INC.
1. South Africa economic movement 2. Angola economic movement 3. Botswana economic movement 4. Comoros 5. Democratic Republic of the Congo (DRC) economic movement 6. Eswatini economic movement 7. Lesotho economic movement 8. Madagascar economic movement 9. Malawi economic movement 10. Mauritius economic movement 11. Mozambique economic movement 12. Namibia economic movement 13. Seychelles economic movement 14. Tanzania economic movement 15. Zambia economic movement 16. Zimbabwe economic movement
We are open offices in the region.now write the zem plan for one African union. FOUNDER – Wamwari Devine Mwana +19015459000 USA https://chat.whatsapp.com/FNUUsDel2OHGJ2dHpIv5w5
The global prevalence of human immunodeficiency virus (HIV) infection continues to place a significant burden on healthcare systems, especially in sub-Saharan Africa (SSA), with South Africa remaining the epicentre. In addition, the impact of the COVID-19 pandemic has seen an increase in annual HIV infections in many countries and a decline in targets for prevention and treatment.1 The introduction of antiretroviral therapy (ART) has resulted in a significant decline in the morbidity and mortality of people with HIV (PWH). With this increased life span, PWH are at risk of developing non-communicable chronic diseases, similar to those of the general population. The collision of the three pandemics, DM, HIV and kidney failure (KF) has significantly impacted on morbidity and mortality, as well as treatment costs. In areas where HIV infection is most prevalent, there is also restricted access to kidney replacement therapy (KRT). Therefore, this review seeks to address the epidemiology and pathophysiology of the interaction between HIV infection and DM and the impact that these diseases have on chronic kidney disease (CKD) progression. It also aims to discuss the implications for management, which stems from the growing burden of all three diseases.
Global Burden of Diabetes
Type 2 DM (T2DM) is one of the fastest growing global health emergencies of the 21st century. According to the International DM Federation (IDF), the global prevalence of DM in adults aged 20–79 was 10.5% in 2021, with an estimated 537 million adults living with DM. This is projected to increase to 783 million by 2045.2 Over the next 10–20 years the greatest increase in prevalence is expected to occur in Africa and, already, 80% of people with DM (PWD) are living in low- and middle-income countries (LMICs). DM is considered a leading cause of disability adjusted life years (DALYs), together with DM-related deaths estimated at 6.7 million worldwide in 2021. In LMICs, most of these deaths occur in people <60 years of age. The direct costs of managing DM are prohibitive for many economies. The global health expenditure due to DM has grown from USD 232 billion in 2007 to USD 966 billion in 2021 for adults aged 20–79 years.2 In many countries in Africa, especially South Africa, the financial burden of managing the morbidity from DM falls on a healthcare system already struggling with the burden of infectious diseases such as HIV and tuberculosis. A cost of illness study in the public sector in South Africa in 2018 showed the annual direct costs due to T2DM to be ZAR 2.7 billion if diagnosed and ZAR 21.8 billion if undiagnosed with an estimated increase in annual total costs to ZAR 35.1 billion by 2030.3 A major challenge in Africa is that over 1 in 2 (54%) PWD are undiagnosed on the continent.4 In addition, those who are diagnosed often do not receive adequate care due to poor access to healthcare services, lack of resources, and low awareness levels.
Global Burden of CKD
CKD contributes significantly to the annual global mortality. This is particularly concerning, given the lack of access to KRT in many LMICs.5 In 2017, there was an estimated 843.6 million people reported to have CKD worldwide.6 Between 1990 and 2017, CKD caused an increase in mortality of 41.5% globally, resulting in it becoming the 12th leading cause of death globally.7 A systematic review and meta-analysis (including 100 studies) revealed the global prevalence of CKD stages 1–5 to be 13.4% and 10.6% for CKD stages 3–5.8 In 2017, there were 35.8 million DALYs attributed to CKD, with almost 33% due to diabetic kidney disease (DKD). The CKD burden predominates in the three lowest quintiles of socio-demographic indices. Given their level of development, the burden of CKD was much higher than expected in Oceania, SSA, and Latin America.7 More effective and targeted preventative interventions to reduce the CKD burden particularly addressing risk factors including DM, are urgently needed.
Impact of DM on CKD
The global prevalence of T2DM is increasing due to the rapidly increased prevalence of obesity, metabolic syndrome, and westernization of lifestyle. DKD is a microvascular complication of both type 1 DM (T1DM) and T2DM. Approximately 40% of people with T2DM will develop DKD which is associated with a high mortality.9 Although CKD may be the most recognizable consequence of DKD, most patients actually die from cardiovascular diseases and infections before needing KRT.10 Early detection and adequate treatment of DM can slow DKD progression; however, it still accounts for approximately 50% of cases of KF in the developed world. There are limited epidemiological data on CKD in PWD living in low and middle-income countries (LMICs). A systematic review on studies from Africa showed the prevalence of CKD in people with T1DM and T2DM varied from 11% to 83.7%.11 Incident event rates were 34.7%, 94.9%, and 18.4% for KF at 5 years, proteinuria at 10 years and for mortality from nephropathy at 20 years of follow-up, respectively. These figures suggest a greater incidence of DKD in Africa. Common determinants of DKD were duration of DM, blood pressure (BP), increasing age, obesity and glucose control.11
Impact of HIV Infection on CKD
HIV was first deemed an epidemic in the 1980s and remains an important contributor to the burden of disease, particularly in Africa. In 2020, there were 37.7 million PWH globally with 1.5 million new cases during that year. East Africa and SSA had the highest disease burden.1 PWH have an increased risk of developing both acute kidney injury (AKI) and CKD.12 ART has significantly altered the spectrum of kidney disease seen in this population.13–15 There has been a steady decline in HIV-associated nephropathy (HIVAN) since the introduction of ART, without which there is a rapid decline to KF requiring KRT.16 A systematic review and meta-analysis showed the prevalence of CKD in PWH to be 6.4% globally but SSA had the highest prevalence at 7.9%.17
Impact of Both HIV Infection and DM on CKD
With the improved access to ART and increased life expectancy, PWH are now contributing to the global prevalence of noncommunicable diseases (NCDs), including DM. In a systematic review and meta-analysis by Ekrikpo et al, sociodemographic and clinical factors such as gender, age, co-infections with hepatitis B and hepatitis C did not significantly affect the CKD estimates. However, CKD prevalence was significantly increased with comorbid hypertension (MDRD: 20.7% [95% CI 14.3–27.8%] vs not hypertensive 5.4% [95% confidence interval (CI) 3.4–7.9%]; p < 0.001) and DM (MDRD: 19.4% [95% CI 13.5–26.0%] vs non-DM 8.4% [95% CI 5.5–11.8%]; p < 0.001).17 In addition, the combination of HIV and DM led to an increased risk of progression compared to either alone.18 In South Africa, the HIV Directorate and HIV Clinician’s Society have made concerted efforts to upskill clinicians at primary level care to better manage NCDs within HIV clinics. Primary care guidelines have been developed to assist with this process coupled with a HIV/TB hotline to allow real-time conversations to assist with care. These initiatives could be adopted for other high burden regions on the continent.
Pathophysiology of DKD
The combination of hyperglycaemia, haemodynamic changes and ischaemia results in the activation of the renin-angiotensin-aldosterone system (RAAS), oxidative stress and ultimately fibrosis.19 The hallmark structural abnormalities include mesangial expansion, fewer podocytes, progressive thickening of the glomerular basement membrane and development of Kimmelstiel-Wilson nodules.20
Incipient DKD results from afferent arteriolar vasodilatation and an increase in efferent arteriolar resistance, thereby raising intra-glomerular pressure resulting in hyper-filtration.21 Angiotensin II, endothelin-1 and urotensin II cause vasoconstriction of the efferent arterioles, resulting in the production and release of pro-inflammatory and pro-fibrotic mediators. These haemodynamic alterations are important for the development of glomerulosclerosis and proteinuria.22
In view of the high-filtered glucose load, both sodium chloride and glucose are reabsorbed in the proximal tubules, through up-regulation of the sodium glucose co-transporter 2 (SGLT2). As a result, there is decreased delivery of sodium to the macula densa, dilating the afferent arterioles. There is simultaneous vasoconstriction of the efferent arteriole, due to activation of RAAS and down-stream activation of angiotensin II, giving rise to glomerular hypertension.23
Both hyperglycaemia and hyperinsulinaemia are central to the development of endothelial dysfunction with a direct relationship between the extent of hyperglycaemia and tissue damage.24 A complex interplay between endothelial dysfunction, protein kinase C and the polyol pathway results in increased reactive oxygen species, stimulation of advanced glycation end products, pro-inflammatory cytokines and chemokines leading to an inflammatory cascade. This culminates in vasoconstriction and kidney ischaemia, oxidative stress, podocyte injury and apoptosis, and ultimately fibrosis.25–29
Activation of the RAAS is responsible for the progression of DKD. Angiotensin II and transforming growth factor β1 are intimately involved in kidney fibrosis and tubular dysfunction.30 Damage to the basement membrane in the glomerular wall of the kidney leads to abnormal excretion of albumin and it is also responsible for the deposition of extracellular matrix proteins, particularly type IV collagen.31
The Association Between HIV Infection and the Development of DM
Data showing a direct link between HIV infection and the development of DM are conflicting and dependent on the population studied.32,33 However, a systematic review and meta-analysis assessing the incidence and prevalence of T2DM with HIV infection in Africa showed no association between the prevalence of T2DM and HIV infection or ART.34 PWH are now living longer and are at risk of developing the metabolic sequelae associated with a westernised lifestyle and aging, similar to those without HIV infection. Since 2016, the World Health Organisation (WHO) have recommended the initiation of ART at diagnosis; therefore, it is now difficult to dissect the contribution of HIV infection itself to the development of DM in PWH. Since the prevalence of DM is increasing globally in all populations, it is likely that traditional risk factors such as high carbohydrate intake, obesity, aging and sedentary lifestyle will contribute more to the risk of developing DM than HIV infection itself.
The Association Between ART and the Development of DM
Glucose dysregulation is a well-documented consequence of the treatment of HIV infection when using the initial types of ART, with a number of cross-sectional studies of variable size documenting a high prevalence of insulin resistance, impaired glucose tolerance (IGT) and overt DM amongst patients receiving these types of ART.35–38 Although protease inhibitors (PIs) have often been the main culprits, there is evidence also implicating the use of nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs).33,38 The Multicenter Aids Cohort Study reported a 4 times greater incidence of DM in men with HIV on ART than that of men without HIV.39 However, a recent meta-analysis of 9 studies (n = 13,742 PWH) failed to show an association between PIs and the development of DM but did show an association with the development of the metabolic syndrome [(RR: 2.11; 95% CI 1.28–3.48; p-value 0.003)].40 The mechanisms of glucose dysregulation caused by the initial types of ART have been well studied in vitro. PIs, as a class, have been shown to selectively inhibit the transport function of Glut4, a major glucose transport molecule.41 Both PIs and NRTIs increase pro-inflammatory cytokines such as TNF-α, IL-1β and IL-6 from adipocytes, thereby causing insulin resistance.42,43 In addition, there is some evidence that stavudine decreases adiponectin, a peptide hormone secreted by adipocytes which correlates directly with insulin sensitivity.44
Contemporary ART is considered to be more “metabolically friendly” than the initial types of ART. The integrase strand transfer inhibitors (INSTIs), the first-choice ART recommended by the WHO, have been associated with weight gain.45 In the ADVANCE Study, Venter et al showed a significant increase in weight over 48 weeks in men and women using a dolutegravir (DTG)-based regimen when compared to those using a standard non-DTG-based regimen.46 Meta-analyses and systematic reviews have not shown an increased risk of developing DM when using an INSTI, despite the weight gain associated with their use. In a meta-analysis and systematic review by Kajogoo et al, that included 10 studies (n = 62,400 participants), participants on INSTI-based regimens were shown to have a similar incidence of DM to those on other ART regimens.47 In fact, Mulindwa et al showed in their meta-analysis of 13 pooled studies (n = 72,404) that there was a lower risk of incident DM with exposure to an INSTI than to any other ART (RR 0.80, 95% CI 0.67 to 0.96, I2 = 29%).48 However, they also showed that there was an increased risk of DM in PWH of African origin (RR 2.99, 95% CI 2.53 to 3.54, I2 = 0%).
HIV and the Presentation of DKD
In two early kidney biopsy series from adults with HIV in the United States (US), the prevalence of DM was found to be 5.4% and 6.7%, respectively. These two series were small, with 152 biopsies (1995–2004) in the one study and 89 biopsies (1995–2001) in the other.49,50 A more recent biopsy series (n = 437) from the US (2010–2018), noted that comorbidities of NCDs were more common. In this cohort, 57% had hypertension,31% had DM, obesity was observed in 11%, and cardiovascular disease in 9%.15
However, in contrast, a review of two large recent kidney biopsy cohorts of PWH from South Africa reported that neither had an increase in DM. Diana et al evaluated 690 biopsies (from 1989 to 2014) and found no change in the proportion of patients diagnosed with DKD (p = 0.810) or hypertensive nephropathy (p = 0.33), pre and post ART.13 Similar findings were observed by Wearne et al where no change in the proportion of those with DM was seen pre and post ART roll-out in 671 patients undergoing a kidney biopsy.14 In contrast to the studies from the USA, the two large studies from South Africa showed the prevalence of DM to range between 3.6% and 4%, and the trend did not change between 2005 and 2020. However, the cohorts from the two countries are different in that the South African studies included patients with more advanced disease with associated co-morbidities, such as tuberculosis, and who were ART-naïve or not adherent to treatment.13,14
When compared to other ethnicities, African-Americans have been shown to have a higher rate of KF. African-Americans have around a 3-fold increased incidence of treated KF compared to Caucasians.51 Part of this increased risk is at least in part due to the inheritance of an apolipoprotein L1 (APOL1) gene variant. The protein apolipoprotein L1, encoded by this gene, has a historical role in conferring innate immunity against most strains of Trypanosoma brucei.52 Initially identified in individuals of African descent, two gain-of-function (APOL1) variants, G1 or G2 have been found to have a high prevalence particularly in West Africa.52,53 These coding variants have since spread widely throughout the African diaspora, with frequencies of 21% for G1 and 13% for G2 observed among African Americans.54
APOL1 risk variants have been associated with an increased risk and accelerated progression of focal segmental glomerulosclerosis (FSGS), HIVAN and hypertensive nephrosclerosis (OR 7.3).55,56 There have also been studies suggesting a role in progression of DKD.57
Both DM and APOL1-associated kidney diseases are common entities, as such, they are likely to occur synchronously. In addition, obesity, commonly associated with DM, on its own, can cause glomerular damage resulting in proteinuria and reduction in GFR. In Black individuals with DM who have no other complications and a marginally elevated HbA1c, kidney dysfunction should not be assumed to be due to DKD. In this setting, APOL1 genotyping may help the decision-making in whether a biopsy is required in selected individuals.58
The data on the mechanisms of the progression of CKD in people with HIV and DM are sparse, however, a study by Osafo et al did show that kidney damage is accelerated when there is co-existing hypertension, HIV, genetic predisposition, and DM.59 This is demonstrated by the earlier onset of KF in African populations compared to those in developed countries (40–45 years versus 63 years).59Figure 1 shows the HIV-related and traditional risk factors influencing the development and progression of CKD in PWH.12 Examples of risk factors increasing CKD progression include: co-infection with hepatitis B and C (2–3 fold increase) and episodes of AKI (3.8–20-fold increase).12 Similarities and differences of clinical presentation and investigations of CKD in HIV and DKD are demonstrated in Table 1 and 2, respectively.10,12,16,60–62 Patients with combined HIV and DM should have more frequent screening and follow-up, and more intensive management of existing CKD and its risk factors.
Figure 1 HIV-related and traditional risk factors influencing the development and progression of CKD in PWH.
Table 1 Similarities and Differences in the Clinical Presentation of CKD in HIV and DKD
Table 2 Similarities and Differences in the Investigation of CKD in HIV and DKD
In a large cohort of 31,072 veterans with a baseline estimated GFR (eGFR) ≥45mL/min/1.73m2 in HIV-positive and matched HIV-negative individuals, there was a significant and graduated independent association between HIV and DM status and the risk of decline in eGFR. Co-existing HIV and DM had a greater effect on the relative risk of progression of CKD (HR 4.47, 95% CI 3.87–5,17), compared to either disease alone [HIV (2,8, 95% CI 2.50 −3,15) or DM (HR 2.48; 95% CI 2.19–2,80) only].18 Similar results were demonstrated in an earlier study by Choi et al who demonstrated a 4-fold increase in risk of KF in those with DM and a 7-fold increased risk in those with the combination of DM and HIV. However, a limitation of this study is that it only examined differences in ethnicity and did not adjust for other factors known to influence CKD progression.63 A single centre study reviewing PWH (n = 1494), comparing those with DM (n = 156) and those without, demonstrated a more frequent need for antihypertensives and lipid-lowering agents and a higher prevalence of kidney dysfunction (12.4% vs 7.1%, p = 0.030) in those with co-existing DM.64
A retrospective study of 653 PWD found that the majority of PWH on ART failed to achieve target glycaemic control, resulting in a greater incidence of neuropathy and nephropathy (when defined by overt proteinuria). Proteinuria was present in 25.7% of the HIV-positive patients and 15.4% of the HIV-negative patients. Obesity was also a concern; however, it was noted in both HIV negative and positive cohorts.65
Challenges in Calculating eGFR
Using the serum creatinine in the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate the GFR is the most practical and reliable way of determining the prevalence of CKD.66 This equation has recently been updated with the removal of the race- based correction factor for African Americans.67 To note, these equations were developed in the US and have not been validated against measured GFR (mGFR) in other regions. Whether this correction factor is applicable to patients of African descent living in Africa is controversial.
In a recent study by Fabian et al conducted in Uganda, Malawi and South Africa, 3025 subjects underwent determination of mGFR using the slope-intercept method for iohexol plasma clearance and this was compared to eGFR using a variety of creatinine and cystatin C-based equations (with or without the correction factor for African Americans). The principal findings of the study were that creatinine-based equations overestimated kidney function compared with mGFR, which was worsened by use of the inclusion of the race-based correction factor. The greatest bias occurred at low kidney function, such that the proportion with GFR < 60 mL/min/1·73 m² directly measured was more than double that estimated from creatinine. Cystatin C-based equations performed better than all creatinine-based equations. Using a model to impute kidney function based on mGFR, the estimated prevalence of impaired kidney function was more than two-times higher than creatinine-based estimates in populations across six countries in Africa.68 The authors speculate that the poor performance of creatinine-based eGFR equations is more likely due to non-GFR determinants of creatinine rather than ethnicity. These include lower muscle mass due to growth stunting, wasting or inflammation from chronic infection (eg tuberculosis and HIV), lower dietary protein ingestion, and undiagnosed liver disease.68
Over estimation of GFR with the resultant under estimation of CKD has major implications for health planning given the high costs of treating CKD and the high associated morbidity and mortality.
Medical Management of T2DM in PWH
There are only a few observational studies and no RCTs specifically assessing the use of any of the treatment options for managing T2DM in PWH. Han et al conducted a longitudinal cohort study in HIV-positive and HIV-negative veterans who were new users of oral DM medication (mostly metformin, sulphonylureas and thiazolidinediones). They found that the glycaemic response was independent of the initial class of medication and was not influenced by HIV infection.69 Interestingly, in their multivariable model, Black race and Hispanic ethnicity were associated with a poorer response to these DM medications. Since there are no robust data to guide treatment options for T2DM, most guidelines recommend that local guidelines for the pharmacologic management of T2DM are followed for PWH. However, there is an extra caution regarding the use of metformin. Metformin is often a good initial choice for the management of T2DM in PWH as insulin resistance is often one of the dominant pathophysiological mechanisms. No dosage adjustment is required when using metformin with non-nucleoside reverse transcriptase inhibitors, PIs or NRTIs. However, when metformin is used with INSTIs (eg dolutegravir), the area under the curve of metformin is increased, therefore, by consensus, the maximum daily dose of metformin when used with dolutegravir should be limited to 1000 mg daily.70 Sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists have been shown to prevent progression of DKD in HIV-negative people with DM; however, this has not yet been studied in PWH. Tables 3–5 reflect the dose adjustments that are required for DM medications with CKD stage 3–5 and those on KRT.71–75
Table 3 Adjustment of Diabetes Treatment in Chronic Kidney Disease
Table 4 Adjustment of Incretin Treatment in Chronic Kidney Disease
Table 5 Adjustment of Diabetes Treatment for Kidney Failure-Dialysis Requiring
In terms of DKD management, identification of additional risk factors for CKD is essential. In PWH, this includes a suppressed HIV viral load, early identification of hepatitis B and/or C virus coinfection, exclusion of nephrotoxins as well as managing episodes of AKI. All PWH should be on ART, including those with DKD. A baseline eGFR and assessment for microalbuminuria should be performed. However, a change in type of ART is required when the eGFR falls to <50 mL/min/1.73m2. Tenofovir, atazanavir and lopinavir should be avoided in those individuals with established CKD.76 Unfortunately, there are limited data concerning recommendations for the concurrent management of DKD in PWH. However, data from large RCTs in people without HIV-infection have shown the importance of DM and BP control in preventing and decreasing the progression of DKD.77,78 Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have an important role in slowing the GFR decline in DKD with albuminuria.79–81 In addition, ACE inhibitors and ARBs have been shown to prevent the progression of HIVAN.82
Additionally, a multi-faceted approach in the management of DKD in PWH should include intensive lipid management being careful with the concomitant use of simvastatin with PIs due to the increased risk of rhabdomyolysis. Comprehensive lifestyle interventions including a low protein and salt diet, moderate intensity physical activity, cessation of smoking, alcohol reduction and weight management.
Challenges in KRT with HIV and DM
The KDIGO controversies in HIV state that HIV status should not influence candidacy for KRT. The survival on KRT is similar for those patients on ART with viral suppression compared with HIV-negative patients.12,83,84 However, the survival of people with DM on KRT is significantly worse than those without DM.85–92 The outcome of PWH and DM on KRT is currently unknown.
The choice of dialysis for PWH and KF should be based on patient preference and resources.12,93 Both peritoneal dialysis (PD) and haemodialysis (HD) have disadvantages in the setting of DM. This includes vascular access complications due to accelerated atherosclerotic disease. In addition, the glucose load in PD may accelerate atherosclerosis and worsen DM control. Meta-analyses have demonstrated a superior survival for people with DM on HD compared to PD. This is thought to be due to the increased rate of infection, inadequate dialysis and volume control for patients on PD.94,95 In a cohort of 401 PD patients, followed up for 10 years, DM was shown to be an independent predictor for increased mortality and technique failure, but not for peritonitis-free survival.96
Both DM and HIV, cause marked vascular damage. “Inflamm-aging” describes the increased age-related co-morbidities which occur at a younger age in PWH.97 This accelerated aging may relate to chronic ART usage, immune activation and inflammation.98,99 This is evidenced by a high degree of vascular stiffening and “non-dipping” on ABPM.100 Similarly, endothelial dysfunction and inflammation is also demonstrated in DM.101
Numerous reports have reviewed the adverse effects of HIV and DM on arteriovenous fistula (AVF) creation, but as far as we are aware none have looked at the additive effect. In PWH, AVFs are preferable to dialysis catheters due to the increased risk of infection and stenosis.12,102 On review of 25,711 AVF creations, HIV did not increase the risk of reintervention, occlusion or mortality. In this cohort, 42% had a combination of DM and HIV, however a direct comparison between PWH with or without DM was not performed.103 PD catheter failure rates are similar to HIV negative patients. In addition, PD consumables must be discarded with appropriate infection control measures, as HIV persists in PD fluid.12
The combination of HIV and DM, or each as separate entities, poses an increased risk for cardiovascular disease which is a major cause of death in patients on KRT.104 Once again, there are no recommendations for which modality poses the lowest risk for those with a combination of HIV and DM. However, a meta-analysis and a comparative study comparing PD and HD have shown that PD had a lower incidence of cardiovascular and cerebrovascular events, than HD.105,106
Stock et al first described successful outcomes in HIV-positive transplant recipients from HIV-negative donors.107 Following these results, a crisis for dialysis slots in South Africa prompted clinicians to take a more liberal approach to donor selection. Consequently, a pivotal programme to use kidneys from HIV-positive donors for HIV-positive recipients was initiated in September 2008.108 In the setting of transplantation, HIV-positive recipients have excellent allograft survival at 1 and 3 years. In addition, the safety of transplantation in PWH is well-established.107–109 However, there is still significant bias toward transplantation access for PWH, with longer waiting times for referral, evaluation and waitlisting.110 In contrast, it is well known that DM can adversely affect kidney allograft and patient survival.111 Up to a two-fold higher mortality and graft loss has been described in transplant patients with pre-existing DM and those developing post-transplant DM.112,113
Little is known about the outcomes of PWH and DM post transplantation or the development of new onset DM post transplantation. Of the cohorts described, only Locke et al reported on prevalence of DM in the HIV transplant cohort, with DM being prevalent in 13.3% (57/113) of living and 11.7% (50/426) of deceased donor recipients, respectively. However, no comparison of the combination of HIV and DM was performed.109 There is an increased risk of rejection in PWH.107,108 The higher doses and type of immunosuppression needed to treat this increases the risk of developing DM post-transplant. In a study conducted by Barday et al in HIV-positive transplant recipients, there was an association between increased rate of rejection and use of PIs,12% of the cohort were on PIs at baseline.114 Furthermore, immunosuppression drug-level management is complex in transplanted PWH due to the drug interactions.115
Although the prevalence of KF is increasing worldwide, major global inequalities exist with the largest treatment gaps occurring in LMICs.116,117 Access to lifesaving KRT remains limited or non-existent in many LMICs. It is reported that only 16% of patients requiring KRT on the African continent receive it.116 This means that chronic dialysis and transplantation are either not offered, are unaffordable or rationed resulting in the demise of many patients. The lack of access removes any element of “choice” for KRT (Figure 2). There has been considerable attention drawn to the importance of kidney supportive, conservative and palliative care by the International Society of Nephrology.118 However, in LMICs, there are limited resources to integrate palliative care into all levels of care despite it being demonstrated to be cost-effective.119 The cost of palliative care programs will vary by region and continent depending on access and infrastructure. Therefore, there needs to be greater emphasis on preventative measures to prevent CKD progression as well as improved palliative and conservative management for patients when KRT is limited or not available.120
In a resource-limited setting, when dialysis is rationed, often PWD and PWH who are not virally suppressed, are excluded from KRT programmes.120 The concept of conservative kidney management is directly aligned with the Universal Health Coverage.118 It is crucial that in low resources settings there is early identification and management of kidney disease at all levels of care, this is particularly important in regions where KRT is limited.
Conclusion
Limited data exist on the burden of CKD, in patients with comorbid HIV and DM. Given the growing prevalence of HIV and DM, individually and in combination, this review highlights the need for a call to action to improve care as well as identify areas in which research is required. Future research should focus on the following: a better understanding of the molecular targets and genetic factors (APOL-1) that alter the trajectory of DKD, RCTs to show the efficacy of DM drugs in PWH, a better understanding of the long term metabolic sequelae of the use of INSTIs, especially in Black Africans where there is a possible early signal that they may be at increased risk of developing DM and, lastly, identify the impact of both DM and HIV on KRT. In Africa and other areas with limited access to KRT, strict blood pressure control, good diabetes management, viral suppression with ART and awareness of the multiple drug interactions/toxicity/dosing remain the foundation of therapy to prevent CKD. There is an urgent need to establish or upscale palliative care programs in areas with restricted access to KRT and high burden of disease as these have shown to be cost-effective in the long term.
Disclosure
The authors report no conflicts of interest related to this work.
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Delegates outside the Climate Action Innovation Hub on the frontlines of the Africa Climate Summit. Credit: Aimable Twahirwa
NAIROBI, Sep 6 2023 (IPS) – A group of young African startups made their presence known at the Africa Climate Summit in Nairobi, Kenya, hoping to play a big role in promoting home-grown climate-oriented solutions.
According to Dr Yossi Matias, Vice-President of the Google Research initiative, pushing for innovative solutions and research around climate change remains critical for Africa when considering that the continent continues to feel the impacts of global warming in many ways.
“Most solutions promoted by African startups and innovators are in danger of being ignored because of many factors, but there is a way to overcome these challenges,” Yossi told IPS.
Among the solutions put forward by young innovators at the Climate Action Innovation Hub, which took place on the sidelines of the summit, were clean energy, climate-smart agriculture and sustainable land management, biodiversity conservation, water storage and conservation, waste management, and circular economy.
The innovations can also enhance the key cross-cutting areas needed to amplify climate cooperation and action, including climate advocacy, empowerment, awareness raising, capacity building, and climate literacy.
Other key areas of innovation are green transport and climate-resilient infrastructure, resilient, climate-smart cities, digital transformation, and food security.
The latest estimates by the UN agencies show that changing precipitation patterns, rising temperatures, and more extreme weather contributed to mounting food insecurity, poverty, and displacement in Africa.
Official figures show that food insecurity increases by 5–20 percentage points with each flood or drought in sub-Saharan Africa
While African Governments are committed to supporting climate solution innovation to varying levels and with different approaches to tackle this phenomenon, some experts believe that what is needed is to encourage a growing number of African startups to shift in mindset—by becoming providers of solutions to improving the continental climate change resilience.
“What is needed for these young African innovators is to look for mentors and incubators because, as an entrepreneur, you need to learn how to develop a successful product that brings some short-term and long-term positive benefits to combat climate change in your community,” Yossi said.
Through its Accelerator programs, the Google Research initiative currently seeks to empower startups, developers, and nonprofits, especially in Africa, to better solve the world’s biggest challenges — from economic development, diversity, sustainability, and climate change — relying on its technology.
For example, one of the initiatives presented at the summit seeks to produce plastic waste collected from local communities in the Rwandan capital Kigali where a startup is producing handcrafts from plastic waste collected in the city.
Sonia Umulinga, a young Rwandan female entrepreneur and owner of ‘Plastic Craft’, a company that seeks to tackle the problem of plastic pollution, told IPS that key priority had been given not only to help reduce plastic pollution but also to her new business model in using the collected waste to produce unique products on the markets.
Harsen Nyambe Nyambe, Director, Sustainable Environment and Blue Economy, African Union Commission, told delegates that the current situation where the lack of ownership over innovations, coupled with a whole narrative built around imported solutions, constitutes a major challenge for the continent to combat climate change.
“Africa needs to redefine on how to engage of the issue of climate change, and countries need to work together to find possible innovative solutions to the challenges they are facing,” he said.
While some officials and experts cite innovation as an important driver of growth and the fight against hunger and malnutrition, which continue to affect major parts of the African continent, others believe there is a need for these African startup entrepreneurs to test and refine these ideas for the benefit of their community.
Current efforts for Africa’s transformation emphasize switching agriculture from subsistence to commercial, which means producing a surplus for the markets and making agriculture become a business while relying on home-grown innovative ideas.
“We should not give up because we need these startup home-grown solutions to help small-scale farmers meet their needs,” she told delegates.
However, some small-scale farmers and pastoralists believe that indigenous innovation also constitutes another driver for innovation in African Agricultural systems considering that climate change impacts are stalling progress towards food security on the continent.
Tumal Orto, a livestock breeds farmer from Marsabit County in Northern Kenya, told IPS that weaving indigenous knowledge with scientific research remains critical.
“Small-scale farmers are also innovators in their own ways using local ingenuity in their practices,” he said.
However, most experts at the innovation hub on the sidelines of the Africa Climate Summit (ACS) in Nairobi were unanimous that more productive and resilient solutions to combat climate change in Africa will still require a major shift in the way various resources are managed.
Africa needs approximately USD 579.2 billion in adaptation finance over the period 2020 to 2030, and yet the current adaptation flows are five to 10 times below estimated needs.
This goat died of starvation while surrounded by an inedible invasive plant. Lives hang in the balance as Kenya’s dryland is ravaged by a severe prolonged drought. Credit: Joyce Chimbi/IPS
NAIROBI, Sep 5 2023 (IPS) – As thousands convene in Kenya’s capital, Nairobi, for the Africa Climate Summit, the first time the African Union has summoned its leaders to solely discuss climate change under the theme ‘Driving Green Growth and Climate Finance Solutions for Africa and the World’, the backdrop is a country on the frontlines of a climate crisis.
The severe, sharp effects of climate change are piercing the very heart of an economy propped up by rainfed agriculture and tourism – sectors highly susceptible to climate change. After five consecutive failed rainy seasons, more than 6.4 million people in Kenya, among them 602,000 refugees, need humanitarian assistance – representing a 35 per cent increase from 2022.
It is the highest number of people in need of aid in more than ten years, says Ann Rose Achieng, a Nairobi-based climate activist. She tells IPS that Kenya is hurtling full speed towards a national disaster in food security as “at least 677,900 children and 138,800 pregnant and breastfeeding women in Kenya’s arid and semi-arid regions alone are facing acute malnutrition. Nearly 70 per cent of our wildlife was lost in the last 30 years.”
Despite Kenya contributing less than 0.1 per cent of the global greenhouse gas emissions per year, the country’s pursuit of a low carbon and resilient green development pathway produced a most ambitious Nationally Determined Contribution (NDC) to cut greenhouse gasses by 32 per cent by 2030 in line with the Paris Agreement.
But as is the case across Africa, there are no funds to actualise these lofty ambitions. Africa needs approximately USD 579.2 billion in adaptation finance over the period 2020 to 2030, and yet the current adaptation flows to the continent are five to ten times below estimated needs. Globally, the estimated gap for adaptation in developing countries is expected to rise to USD 340 billion per year by 2030 and up to USD 565 billion by 2050, while the mitigation gap is at USD 850 billion per year by 2030.
After five consecutive failed rainy seasons, food insecurity is expected to escalate as maize crop has failed to flourish due to erratic weather patterns. Credit: Joyce Chimbi/IPS
As dams and rivers dry up, Kenya will continue to be on the frontlines of a climate crisis unless climate change adaptation and mitigation efforts are escalated. Credit: Joyce Chimbi/IPS
Frederick Kwame Kumah, Vice President of Global Leadership African Wildlife Foundation, tells IPS a big part of the problem is Africa’s burgeoning gross public debt which increased from 36 per cent of Gross Domestic Product (GDP) to 71.4 per cent of GDP between 2010 and 2020 – a drag on its development progress and a disincentive for climate finance flows.
“There is a concern that climate finance, if and when provided, will be used to first service Africa’s debt burden. The first step to addressing Africa’s Climate Finance must be action towards debt relief for Africa. Freeing up debt servicing arrangements will release resources for continued development and climate finance purposes,” Kumah explains.
He says there is an urgent need to challenge the existing unfair paradigm for financing by developing countries. It is very expensive for developing countries to borrow for development purposes. Africa must then leverage its natural capital towards seeking innovative financing mechanisms such as green bonds and carbon credits to address its development and climate change challenges.
Nearly half, 23 out of 47 counties in Kenya, are classified as arid and semi-arid. Livelihoods are at risk as pastoralists are unable to cope with drastic weather changes. Credit: Joyce Chimbi/IPS
This waterfall is on the verge of drying up. Kenya’s economy is heavily dependent on tourism and agriculture. The two sectors are highly susceptible to climate change. Credit: Joyce Chimbi/IPS
“Climate finance was, as expected, a key part of COP27. It is a grave concern for Africa that developed countries’ commitment to provide $100 billion annually has yet to be met, even though the need for finance is becoming increasingly obvious. In COP27, we noted that new climate finance pledges were more limited than expected. Countries such as those in Africa are still waiting for previous pledges to be fulfilled,” says Luther Bois Anukur, Regional Director, IUCN (International Union for Conservation of Nature).
Meanwhile, Anukur tells IPS negotiations on important agenda items, most notably the new finance target for 2025, stalled. In COP27, Parties concentrated on procedural issues – deferring important decisions about the amount, timeframe, sources, and accountability mechanisms that may be relevant to a new finance goal in the future. African countries and many other vulnerable countries are in the fight for our lives, and sadly they are losing.
Anukur stresses that Africa’s natural resources are depleted, eroded, and biodiversity lost due to extreme effects of climate change leading to loss of lives and ecosystem services and damage to infrastructure at an alarming rate. Yet climate finance pledges have not materialised. The Africa Climate Summit should be the platform for Africa and developing partners to address existing finance gaps with clear programmatic and project approaches.
Africa must use the Summit to assess and prepare their position for the COP28 in the United Arab Emirates towards strengthening partnerships for the delivery of desired climate finance. Kumah adds that the principle of equal but differentiated responsibilities of nations must be adhered to for climate justice and to enable developing countries, who are least responsible for the effects of climate, to have much-needed resources to cope and adapt to biodiversity loss and climate change.
“In that respect, the creation of a dedicated funding mechanism to address loss and damage and another for adaptation and mitigation to redress historical and continued inequities in contributions towards biodiversity loss and climate change. We must rethink how private investments can be reshaped and harnessed for the benefit of biodiversity and climate action,” Kumah expounds.
“Private investments can be scaled through green bonds, carbon markets, sustainable agricultural, forestry and other productive sector supply chains. Transformative financing architecture is necessary at the domestic and international levels to bring the private and public sectors together to secure the critical backbone of Africa’s natural infrastructure.”
Climate finance gap. Graphic: Joyce Chimbi & Cecilia Russell
While developing countries submitted revised and ambitious National Adaptation Plans and NDCs as requested, Anukur says complicated processes to access financing for their climate actions persist. Stressing the need for reforming the international financial architecture, starting with multilateral development banks.
“The 2023 Summit for New Global Financing Pact held in Paris committed to a coalition of 16 philanthropic organizations to mobilize investment and support UN’s SDG priorities by unlocking new investment for climate action in low- and middle-income countries while reducing poverty and inequality,” Anukur observes.
Civil society organizations and activists such as Achieng have expressed concerns that such announcements are insufficient considering the scale of the challenges facing planet Earth. The Summit will have failed if the global financial architecture is not overhauled in line with the needs of the African continent, she says.
Anukur says the Summit must therefore propel Africa to new heights of climate financing to help reduce Africa’s vulnerability to climate change and increase its resilience and adaptive capacity in line with the Global Goal on Adaptation. Ultimately expressing optimism that the opportunity to unlock the potential of climate financing – breaking the shackles of debt and building a climate-resilient and prosperous Africa is, at last, in sight.
Asian Parliamentarians believe it’s important to prioritise spending on ageing and youth populations. Credit: APDA
NEW DELHI, Sep 5 2023 (IPS) – Legislators from around the world, this week, officially submitted to the Sherpa of the G20 meeting set for September in New Delhi a declaration calling on governments to prioritise spending on ageing, youth, gender, human security, and other burning population issues.
The submission to the G20 Sherpa follows a workshop held on August 22 in New Delhi to discuss the Declaration first presented at the G7 Hiroshima summit in April by the Global Conference of Parliamentarians on Population and Development (GCPPD) under the UNFPA.
“We have now submitted the Declaration to Amitabh Kant, Sherpa to the G-20 so that it can be taken up,” Manmohan Sharma, Executive Secretary of the Indian Association of Parliamentarians on Population and Development (IAPPD), told IPS.
Lawmakers met in New Delhi to discuss the prioritisation of resources to prepare a declaration to the G20. Credit: APDA
Keizo Takemi, member of the House of Councillors, Japan, and Chair of the AFPPD, observed that India faced many challenges that are hard to overcome, and these included the large size of its population, limited school attendance, and a high rate of unemployment. “Prioritisation of population issues is the most important,” he emphasised.
Hooda, a leader of the opposition Congress party from the state of Haryana, said he was concerned at the dwindling budgetary outlay in social sectors like health and education over the last few years in India. “Currently, for some reason, inclusive growth in education and health has fallen,” he told delegates.
A presentation to the workshop by Suneeta Mukherjee indicated that India is among the top five nations leading the ‘out-of-school’ category, with 1.4 million children in the 6-11-years-old age category not attending school. Also, out of every 100 students, 29 per cent drop out of school before completing elementary education.
Mukherjee, an Indian career bureaucrat who has served at the UNFPA, said the situation appeared to be worsening at the upper primary level given that the dropout rate at the upper primary level had gone up to 3 per cent in 2021-2022 while it was only 1.9 per cent in 2020-2021. The annual dropout rate of secondary school students was 14.6 in 2020-2021.
Citing recent studies in her presentation, Mukherjee said 36 per cent of Indians between the ages of 15 and 34 believe that unemployment is the biggest problem facing the country. She said one survey showed 40 per cent of graduates identified unemployment as their most pressing concern.
Said P.J. Kurien, chairperson of IAPPD: “It is important that all MPs take up population-related issues. They need to ask what percentage of the budget is devoted to education and health and ensure that every child goes to school with special attention given to girls.”
Echoing Kurien, Sharma said it was up to members of parliament to ensure that no child is left out in his or her constituency. “The solution is in your hands, but the prioritisation is missing.”
Delegates outlined at the workshop legislative steps taken by Parliamentarians in their countries in implementing the International Conference on Population Development’s Programme of Action and 2030 Agenda.
Josephine Veronique Lacson-Noel, Member, House of Representatives of the Philippines, said over the last two decades, her country had enacted such legislations as the Magna Carta of Women, Reproductive Health Law, 105-Day Expanded Maternity Leave, Act Prohibiting Child Marriage, Universal Health Care Act, Youth Council Reform and Empowerment Act, and an Act to enable conditional cash transfers.
On the anvil, she said, is the Adolescent Pregnancy Prevention Bill, a law to recognise, evaluate and redistribute unpaid care and domestic work done by women, and another to accord social protection for older persons and the promotion of active aging.
For 2023, the budget allocation for reproductive health was $14.9 million dollars, and that for training teachers to implement comprehensive sexuality education was $13.8 million, Lacson-Noel said.
Andrea W. Wojnar, UNFPA India representative and country director for Bhutan, said with the right expertise and skills, India’s 1.4 billion people could be turned into 1.4 billion opportunities.
Wojnar said India, with its large youth cohort — its 254 million youth in the 15-24 age bracket — can be a source of innovation and solutions, especially if girls and women are provided educational opportunities and skills to access new technologies and are empowered to fully exercise their reproductive rights and choices.
With close to 50 per cent of its population below the age of 25, India has a time-bound opportunity to benefit from the demographic dividend, according to Wojnar.
“Women and girls should be at the centre of sexual and reproductive policies and programmes. When rights, choices, and equal value of all people are truly respected and held, only then can we unlock a future of infinite possibilities,” Wojnar said in a statement.
“As the national fertility rate falls below 2.1 (the replacement level), India is at a unique historical opportunity, witnessing a great demographic transition as a youthful nation,” Wojnar said, adding that India also has the largest number of outmigrants and is affected by ageing, urbanisation and issues around sustainable development.
Wojnar warned that, overall, the Asia Pacific region was six times more likely to be affected by disaster events than other regions and is highly susceptible to changing weather patterns, calling for special attention by governments.
The Declaration presented to the Sherpa of the G-20 called on governments, among other things, to implement comprehensive legislation and policies that address all forms of gender-based violence and eradicate harmful practices such as child marriage, early and forced.
It also called for investment in sexual and reproductive health and rights, as well as comprehensive sexuality education toward making future societies economically dynamic and for building peaceful, inclusive, and sustainable societies. Support for political and economic participation by women and girls could ensure the development of societies that guarantee liberty and individual choice for women and girls, it said.
Governments were asked to promote and assure equitable access to health innovation, finance, technology, and medicines in the global community which can support human security, leaving no one behind.
Acknowledgement of the grave impacts of environment/climate change and global warming was important, as also the need to promote policies that address the needs of geographically vulnerable countries, which is a threat to health and human security, the Declaration said.
Investing in young people by providing decent work opportunities and enabling them to become a driving force for sustainable development was important as also addressing active and healthy ageing to enhance people’s overall quality of life by improving areas such as health and long-term care through resilient universal health coverage, physical security, and income stability.
Governments were also asked to enact national legislation and policies and ensure political will through allocation, oversight, and monitoring of budgetary resources to build universal health coverage, which is vital to enhance the global health framework.
