Living with Uncertainty: Acting in the Best Interests of Women

A recent multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. Together with a prior cohort study on African women seeking health services, these data are the strongest yet to appear on the HC-HIV risk. This paper will briefly review the Heffron study strengths and relevant biological and epidemiologic evidence; address the futility of further trials; and propose instead an alternative framework for next steps. The weight of the evidence calls for a discontinuation of progestin-dominant methods. We propose here five types of productive activities: (1) scaling injectable hormones down and out of the contraceptive mix; (2) strengthening and introducing public health strategies with proven potential to reduce HIV spread; (3) providing maximal choice to reduce unplanned pregnancy, starting with quality sexuality education through to safe abortion access; (4) expanding provider training, end-user counseling and access to male and female barriers, with a special renewed focus on female condom; (5) initiating a serious research agenda to determine anti-STI/HIV potential of the contraceptive cervical cap. Trusting women to make informed choices is critical to achieve real progress in dual protection.

The United States and the politics of trade: the banana war with Europe and the Caribbean

This thesis examines the involvement of the United States in the decade-long trade dispute before the World Trade Organization (WTO) over the European Union's preferential banana regime. Washington's justification for bringing this case to the WTO comes from Section 301 of the U.S. trade act, which allows for disputes to be undertaken if U.S. "interests" are violated; however, this is the first case ever undertaken by the United States that does not directly threaten any American banana industry, nor affect any American jobs. Why, then, would the United States involve itself in this European-Caribbean-Latin American dispute? It is the contention of this thesis that the United States thrust itself headlong into this debate for two reasons: domestically, the United States Trade Representative came under pressure, via the White House and Congress, from Chiquita CEO Carl Lindner, who in the past decade donated more than $7.1 million to American politicians to take the case to the WTO. Internationally, the United States used the case as an opportunity to assert its power over Europe, with the Eastern Caribbean islands being caught in the economic crossfire. According to existing literature, in undertaking this case, the United States did as any nation would: it operated within both domestic and international levels, satisfying at each level key interests, with the overall goal of maintaining the nation's best interests.