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In the current issue of , Soha Sobhy and colleagues have compiled the first systematic review and meta-analysis of anaesthesia-related maternal mortality in low-income and middle-income countries. They find that anaesthesia contributes 2·8% of all maternal deaths in these settings. Although this K03861 percentage is small, the overall frequency of anaesthesia-related maternal death is 300-fold higher for neuraxial anaesthesia and 900-fold higher for general anaesthesia than that reported for the USA (1·2 per 1000 women undergoing an obstetric procedure 3·8 per million, and 5·9 per 1000 6·5 per million, respectively). This disparity highlights a significant opportunity for improvement in safe childbirth worldwide, because anaesthesia-related maternal mortality is almost always preventable. Sobhy and colleagues\' study emphasises the relative safety of spinal anaesthesia when compared with general anaesthesia. When all goes well, spinal anaesthesia is the most straightforward anaesthetic technique for caesarean delivery. But occasionally spinal anaesthesia can lead to disaster. The South African National Confidential Enquiry into Maternal Deaths recently reported an increasing proportion of maternal deaths attributed to spinal anaesthesia. Furthermore, case reviewers noted that many general anaesthetic deaths actually occur in women for whom spinal anaesthesia was first attempted.
2016 is set to be a historic year for people living with and affected by HIV and people who use drugs. The UN General Assembly Special Session (UNGASS) on drugs (April 19–21, 2016; New York, NY, USA), provides a rare occasion to review critically the global drug-control system and to advance alternatives that are balanced, evidence-informed, fair, public health-oriented, and rooted in human rights. The UN Secretary-General Ban Ki-moon urged that the Special Session “considers all options”. The UN High-Level Meeting on AIDS (June 8–10, 2016; New York, NY, USA) offers an opportunity to commit to concrete steps to fast-track the response to ending the AIDS epidemic, including progressive approaches to drugs policy. Evidence of disproportionately high rates of HIV among people who inject drugs has been apparent since the beginning of the AIDS epidemic, and evidence of a higher burden of the disease among some people who use drugs by other means (mainly those who smoke stimulants) has become apparent. Individuals who inject drugs are 28 times more likely to acquire HIV than are the general population. Outside sub-Saharan Africa, 30% of new cases of HIV infection are in people who inject drugs, and in some countries, more than 90% of individuals who inject drugs are also living with hepatitis C. Punitive laws, policies, and practices obstruct access to life-saving harm-reduction services—eg, sterile needles and syringes, opioid substitution therapy, voluntary HIV testing, antiretroviral therapy, and naloxone for overdose management and reversal. Legal approaches that criminalise and dehumanise people who use drugs constitute the primary drivers of both the HIV and hepatitis C epidemics amongst this community. Harm reduction works in preventing new HIV infections among people who inject drugs, but it is not routinely accessible; chemsex (the use of psychoactive substances to extend sexual activities) presents continued challenges to harm reduction. In 2016, we call on the international community to join the AIDS and drug-law reform movements to advance a six-point agenda to ensure aligned policy on AIDS, drugs, human rights, public health, and criminal justice ().
Stigma as an important public health concern has been recognised in relation to conditions as diverse as HIV, leprosy, and mental illness. Little attention has been paid to date, however, to the pernicious effects of stigma on the wellbeing and life chances of one heavily stigmatised population: people with intellectual disabilities. Of the 15 billion people globally affected by disability, an estimated 2%, or 300 million, have an intellectual disability. They experience the same disadvantages and inequities as do people with other types of disabilities, but often face the additional disadvantage of having their needs inadequately understood and met, having limited recourse to assert their rights, and being poorly represented, including within the Disability Rights movement. The majority live in low-income and middle-income countries where there is little impetus or resource to assess or diagnose their struggles in meeting the cognitive, social, and economic demands of everyday life. Whether labelled intellectually disabled or not, they are generally among the most marginalised groups within society, experiencing high levels of health, social, and financial inequities.