Global health meetings can be out of reach for attendees from the global south : Goats and Soda Global health meetings are often held in the West — and that's an obstacle for scientists, doctors and advocates from lower resource countries. Which means their voices aren't being heard.

Why visas are a hot topic right now at the International AIDS Conference

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If the pandemic has shown us nothing else, it's that global health matters. And here's a problem for people who try to address many global health issues - when they try to cross borders for international meetings, like an AIDS conference later this month in Montreal, many people from poorer countries cannot get a visa. NPR's Ari Daniel reports.

ARI DANIEL, BYLINE: Tanaka Chirombo is from Malawi, and his life work revolves around HIV. There, he oversees education and anti-stigma projects for young women who are HIV-positive. And when the big AIDS conference takes place in Montreal this month, he wants to be there.

TANAKA CHIROMBO: I would also love to meet stakeholders in Montreal to be able to get funding, to be able to expand our projects in the world and to influence the projects back here at home.

DANIEL: To go to Montreal, Chirombo needs a visa. For someone from a low-income country like Malawi, getting one can be an expensive obstacle course. It ran Chirombo 1,100 bucks. Two weeks after he sent in his visa application, he got his answer from the Canadian government - denied.

CHIROMBO: The main issue was me coming back from Canada. They thought I was going to stay in Canada.

DANIEL: The authorities thought he'd want to stay because of his, quote, "financial status, purpose of visit and current employment situation." None of it made sense to him.

CHIROMBO: I don't think I would ever live abroad because I want to be in my country, to be able to change the landscape in my country, the country I love the most. That's the whole reason I'm doing this sort of work.

DANIEL: The rejection was really hard on him.

CHIROMBO: When I read that letter, I was sad. First thing, I was so sad. Basically, I just slept. It was the easiest way to get over the pain of being rejected.

DANIEL: His experience isn't unique. This problem extends to numerous global health conferences. As for the AIDS conference, organizers are working with the Canadian authorities to clarify what's needed to avoid these kinds of rejections. If attendees can't come in person, they can log in to the proceedings virtually. But Madhukar Pai, an epidemiologist at McGill University, says that's not ideal either.

MADHUKAR PAI: What happens to all of the, you know, side room discussions, the coffee, the chat, you know, at the bar at night - right? - how do you network, make deals, get opportunities - like, all of those intangible benefits of in-person meetings?

DANIEL: And this means, according to Pai, that it's often attendees from higher-income countries who make the decisions that can shape funding and the research landscape.

PAI: People from the global south might be relegated to a secondary status. If we don't do this carefully, we will dramatically worsen the inequities already in global health.

DANIEL: It's a problem that's gone on for years, and that's because high-income countries have had the resources to host these big meetings, so says Adnan Hyder, vice chair of the board of Health Systems Global, a group that promotes health policy.

ADNAN HYDER: Frankly speaking, the decision-making around where to host those meetings was not as sensitive to the concerns that we are talking about today. But I think over the past decade or so, we have a long ways to go, but that has improved. I think the intention always is there for equity.

DANIEL: He cites the symposium that his organization hosts. A few years ago, it was held in Liverpool. But this fall, it'll take place in Bogota, Colombia. When the locations of meetings like these are changed, Dr. Michelle Joseph says that elevates those from the very countries where many global health concerns are most acute. She's in the department of global health and social medicine at the Harvard Medical School.

MICHELLE JOSEPH: Unless you are fully immersed and living and breathing in that country for years, you will not have what lies below, which is so much deeper, more complex. Lived experience takes years, and that's only afforded to those who live and reside and work in that space. And those are the voices that require amplification.

DANIEL: Voices like Tanaka Chirombo, the HIV advocate from Malawi.

CHIROMBO: Why do you even put conferences in such a place where visas are so hard to get?

DANIEL: Since his initial rejection, he submitted a revised visa application. He attached additional bank statements, his return ticket and letters of support.

CHIROMBO: To be able to prove my case, to show my commitment that I'm still going to go back home.

DANIEL: A couple of weeks later, Chirombo got good news. His second visa application was accepted just in time.

Ari Daniel, NPR News.

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