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In recent years the framings of global health security have shifted while the structures governing global health have largely remained the same. One feature of the emerging re-ordering is the unresolved allocation of accountability between state and non-state actors. This brings to critical challenges to global health security to the fore. The first is that the consensus on the seeming shift from state to human security framing with regard to the global human right to health (security) risks losing its salience. Second, this conceptual challenge is mirrored on the operational level: if states and non-state actors do not assume responsibility for health security, who or what can guarantee health security? In order to address global health security against the backdrop of these twenty-first Century challenges, this article proceeds in three parts. First, it analyses the shortcomings of the current state-based World Health Organization (WHO) definition of health security. Second, taking into account the rising pressures posed to global health security and the inadequacy both of state-based and of ad hoc non-state responses, it proposes a new framing. Third, the article offers initial insights into the operational application of beyond state responses to (health) security challenges.
Protecting the vulnerable
(2021)
Contemporary pressures of climate change and migration are abetting the spread of (re)emerging infectious diseases (EIDs), including HIV, Ebola and tuberculosis (TB). While the fact remains that any person can become infected, those most affected are vulnerable populations. In Eastern and Southern Africa (ESA) these include marginalized groups such as people who sell sex, LGBTI and MSM, but more widely also adolescents. Adolescents and young adults represent a particularly vulnerable group, caught as they are on the cusp between child protections and adult citizenship claims, including to health and educational provisions and protections. Without, or with incomplete claims, members of marginalized and vulnerable communities are excluded from access to provisions and protections of health as part of human security, whether out of apathy, fear or jurisdiction or through (deliberate) neglect.
The chapter proceeds through the framework of human security, which puts the security of individuals at the centre of its analysis. This stands in contrast to the 1990s securitization argument which framed HIV as a threat to state security. This chapter analyzes unique challenges of vulnerable adolescent populations as these relate to HIV prevention and treatment access. In doing so, it pays special heed to the “double vulnerability” of non-citizenship and compromised citizenship among this cohort. By invoking the human security paradigm, this chapter explores HIV interventions as they pertain to and aim to protect vulnerable populations beyond borders.