AIDS. Grim news for Asia

While Asia was the last region to be exposed to the global spread of HIV and AIDS, the incidence of HIV infection there is increasing fastest. The Asian Development Bank predicts mortality from AIDS will cause some town and village populations to begin declining by the year 2000. With an estimated 1 million people infected in India, and 400,000 in Thailand, these 2 countries are particularly exposed to the risk of epidemic HIV spread. In 5 years, more people may be affected by AIDS in India than anywhere else in the world. Concern over a growing presence of HIV is also merited for the Philippines, Indonesia, China, and the drug trade's Golden Triangle. The Second International Conference on AIDS in Asia and the Pacific in November 1992 stressed that AIDS no longer affects only homosexual and IV drug using populations. 50% of new infections worldwide in the first half of 1992 were among women, 65% of Thailand's AIDS cases are among heterosexuals, and 3-5% of Thailand's long-haul truck drivers have tested positive for HIV infection. HIV and AIDS robs economies and societies of their best workers. The immediate costs of caring for AIDS patients will pale next to the far greater losses to be realized in private sector economic productivity. Asia's more developed economies will probably be able to survive the epidemic, but small, poor countries like Laos will wilt. Prompt action must be taken to overcome public and religious ignorance and objections to promoting and using condoms throughout the region. For the first time, Beijing has organized an AIDS awareness conference for male homosexuals. Further, Singapore has implemented compulsory testing for lower-income foreign workers. Pakistan has even solicited educational assistance and support from Islamic religious leaders; similar action is being considered in Bangladesh.     

HIV/AIDS and development: failures of vision and imagination

As early as the mid-1990s the US Bureau of the Census was making dire predictions as to the effect of AIDS on life expectancy, infant and child mortality and population size and structure in a number of AIDS affected countries. Despite this it was not until 1997 that the United Nations began to consider HIV/AIDS as a development issue. This article looks at how the international community (still) fails to take HIV/AIDS into account in setting development goals. The article argues that this myopic view means that in 2015, when we assess the development goals, we are certain to have 'failed' in a number of countries and, therefore, that a new realism in target setting is imperative. There is a need to understand better the impact of the disease by taking into account that it is a long-wave event with a complex current and future impact. Sustained equitable development will be essential in dealing with this impact.     

Research on human subjects,exploitation, and global principles of ethics

Abstract

In 1997, 5.8 million people became infected with HIV, 30.6 million people were living with HIV/AIDS, and infection was running at about sixteen thousand new infections a day, of which more than 90% were in low income countries. Against this background the urgency and importance of the fight against HIV/AIDS can scarcely be exaggerated. While a cure for AIDS remains elusive research to discover more effective treatment and possible vaccines is vital. It is at this crucial moment that moral criticism has emerged of some of the most promising research towards treatments and vaccines for HIV/AIDS. This criticism has focused on, and purports to be justified by, the major current international principles and protocols on the ethics of research on human subjects. If this criticism is valid and no better ways of prosecuting successful research on AIDS can be found, the consequences, as the figures above indicate, are truly bleak. This paper will attempt to provide an appropriate framework for assessing the ethics of research on human subjects generally and in doing so will assess the relevance and force of the major ethical criticisms that have been levelled at current research on human subjects in the context of HIV/AIDS therapy and vaccines.     

Let's go for human testing of vaccine,says UNAIDS

This is a report on the first large-scale human testing of an experimental vaccine in the developing world; the trial was authorized by Thailand's Ministry of Health and supported by the UN program on HIV/AIDS (UNAIDS). This is a significant step toward the development of a safe and effective vaccine against HIV. However, the vaccine's potential for protecting people against HIV cannot be fully predicted. These multiple trials need to be conducted in developed and developing countries to test the efficacy against different HIV strains in different populations worldwide. The trial in Thailand will test the AIDSVAX vaccine developed by VaxGen, Inc. of California. AIDSVAX is not the first experimental AIDS vaccine to be tested in humans. Several vaccine candidates have been given to people involved in small clinical trials in the US. AIDSVAX has been found to be safe and to stimulate an immune response. Hence, it is the first vaccine test to proceed to large-scale human testing ("Phase III" or efficacy trials). There have been disagreements among researchers on which vaccine to use, but urgent needs must readily be addressed without compromising ethics and science.     

The association between maternal employment and child survival in India, 1998–99 and 2005–06

While many studies contend that a mother's economic activity may generate positive outcomes for both mother and children, empirical results from less developed countries actually indicate higher mortality rates among children of working mothers. This article examines the association between maternal employment and child survival using India's National Family Health Survey. Using propensity score matching, the study compares working with matched nonworking mothers in child's risk of death. To address the heterogeneous nature of working mothers, the employment-survival relationship is analysed across various occupational categories. A supplementary analysis examines gaps between children of working and nonworking mothers in nutritional status and low birth weight (LBW). Our results show that high risk of mortality and low nutritional status are more pronounced among children of mothers working in low-status occupations. The results indicate insignificant differences in LBW, a finding that favours the explanation that the mortality disadvantage of children of working mothers emerges primarily after birth most likely because of inadequate childcare. The article discusses these findings in relation to various potential mechanisms mediating the negative association between maternal employment and child survival.     

Wealth alone does not buy health: Political capacity,democracy, and the spread of AIDS

Although there have been have numerous studies on AIDS documenting its mortality, its epidemiological features, and its relationship to poverty and development, few studies have systematically analyzed how political factors and policies may help curtail the spread of AIDS. In this paper I consider how a variety of domestic factors influence HIV infection rates across countries. I argue that states with higher state capacity are better able to reduce the spread of the HIV/AIDS epidemic. Moreover, I argue that while strong autocracies can implement efficient policies with fewer constraints, democracies tend to be more responsive to the needs of the population and can be more efficient in curtailing the spread of HIV/AIDS. I empirically evaluate the hypotheses using a cross-sectional time-series sample of 117 countries. The empirical results indicate that greater state capacity indeed appears to help curtail HIV/AIDS infection rates.     

Parental Grief and Mourning in the Ancient Andes

Parental grief is an intense emotion shaped and mediated by cultural attitudes toward death, the strength of parent-child attachment, the age of the deceased child, and the role of children in society. Despite some assertions that high infant mortality or economic hardship may lessen parental grief, cross-cultural studies show that child death often causes emotional distress to parents, in particular mothers. Funerary treatments of children, especially infants, are often simplified, contradicting more immediate and immaterial expressions of parental grief that cannot be studied archaeologically. In this study, I examine the funerary treatment of children in ancient Andean Tiwanaku society (A.D. 500–1100). I assess the use of ritual practices and objects associated with children’s burials as indicative of children’s social identities and parental mourning. The nature of grave assemblages in regard to different ages of the children suggests that parental attitudes toward their children changed over the course of childhood. The choice of offerings seems to reflect parental attachment to and recognition of the child’s life. Modifications of ceramic vessels point to the intimate mourning gestures of grieving mothers who sought to provide their deceased children with the necessary offerings to assume their place among the community of venerated ancestors. This study draws on ethnographic, psychological, and ethnohistoric sources of parent-child bonds in the Andes and beyond to investigate children’s burials not merely as reflective of childhood and children’s role in society but as the material record of parental attachment and emotion in the past.     

Women endangered,says world population report

This report highlights key points from the UN Population Fund's "State of World Population 1997," which focused on women's right to choose in matters relating to reproductive health. The report documents global progress toward achieving reproductive rights for women and recommends more funding for reproductive health care and family planning and increased efforts to promote gender equality and individual rights. International agreements protect: the right to reproductive and sexual health throughout the life cycle; voluntary choice in marriage and childbearing and the means to determine when to have children; equality and equity in all spheres for men and women; and freedom from sexual violence and coercion. When these rights are denied, the result is maternal mortality (a death every minute). There is a lack of access to contraceptive services that affect 350 million women. Unsafe abortions are performed on 20 million women, of whom 70,000 die. There is a lack of access to sex education and services for teenagers that results in HIV infections and sexually transmitted diseases (STDs). 1.5 million die from HIV/AIDS related causes, and another 1 million die from reproductive tract infections and STDs. Teenagers represent about 50% of the 333 million new cases of HIV and STDs that occur each year. Female genital mutilation is performed on 120 million girls and women, and 2 million are at risk each year. 2 million girls aged 5-15 years enter the commercial sex trade each year. The report documents the suffering from anemia and malnutrition and complications from pregnancy.     

Reconstructing the Space-Time Structure of the HIV/AIDS Epidemic for the Countries of Western Europe

This paper applies a compartmental epidemic modelling system to the estimation of HIV infection transfers between the nations of Western Europe for the period 1973–98. This multiregional model imitates the formation of disease contacts by both local and international travel, where the latter is assumed to have the lower sensitivity to the effects of spatial separation. This system is calibrated in two stages: first, disease parameter sets are found to best fit the timing of recorded AIDS incidence in each nation; and second, these sets are entered into a multiregion setting to identify the travel parameters that support the lags between these series. The outputs include estimates for the first year of HIV incidence in each country and the subsequent pathways of infection transfer that connect these dates. The results indicate the contrasting roles of the southern and northern countries within the continental epidemic and point to national variations in the recent delaying effects on AIDS incidence of drug combination therapies.     

Africa's population and family planning dynamics

The historical and current demography of Africa in this discussion focuses on the context of population policy, contraceptive use, reproductive behavior, polygamy, and economic impacts. Sub-Saharan Africa countries have the highest rate of population growth in the world. 50% are aged under 20 years, and 20% are aged under five years. Urban areas are growing at the fastest rates in the world (5-6% annually). Population density remains low, except for areas where there is high soil fertility. Many African countries recognize the need for population policies. The most important donor to Africa, the World Bank, has pressured African governments to adopt family planning (FP) programs. A major World Bank study has shown that more FP services are desired by African women. Family expenditures for the 1980s for FP were estimated at $100 million annually, of which $53 million was provided by donors. Further expansion in the program is needed. The World Bank targeted contraceptive use at 25% of African married couples. Except for Egypt and North African countries, contraceptive use is around 3-4%. Another perspective on population reduction is to expand programs for child spacing and postnatal nutrition of mothers and infants. There has been a failure to turn health systems around to low-cost preventive health, particularly in rural areas. Infant mortality must be reduced before fertility will decline. Population growth can be slowed by changing the status of African women (high social status and recognition are associated with high fertility), age of marriage, child spacing, agricultural productivity, and nutrition. Demographic data on Africa have only become available during the past 25 years. African demographers are in short supply and require training abroad. Demographic data gaps and reliability problems are offset by the recent availability and quantity of survey data. Historical demography has produced conflicting results. Although some investigators, such as Ester Boserup, argue that population pressure results in agricultural innovations, Africa has yet to experience this phenomena. The youthful composition of the population guarantees continued population momentum. Fertility is enhanced by the cultural emphasis on perpetuating lineage and high fertility. Changes in reproductive behavior will depend on major social changes for women.     

‘Let's talk about sex,baby…’: Conversing with Zimbabwean children about HIV/AIDS1

The lack of HIV/AIDS research with children under 15 in Zimbabwe indicates that most researchers believe children are too young to ‘talk about sex’. However, some are already sexually active, the rest soon will be and children constitute 45% of Zimbabwe's population. This mixed methods study surveyed 118 children and interviewed 36 about their understanding of sex and HIV/AIDS. The study revealed that the children had a range of knowledge levels about HIV/AIDS and sexual issues. It established that children can and want to discuss these sensitive issues, and that their attitudes towards safer sex are often more advanced than those of adults.     

Medical Research Council Programme on AIDS in Uganda – the first 10 years

Abstract

The Medical Research Council (MRC) Programme on AIDS in Uganda is based at the Uganda Virus Research Institute of the Ugandan Ministry of Health in Entebbe on the shores of Lake Victoria. The programme was established following a request in 1988 from the Ugandan Government to the UK Government for assistance with AIDS, which had recently been discovered to be a large and growing health problem in the country. At that time Uganda had the worst published rates of HIV infection in the world. Over the past 10 years, Uganda has to some extent controlled its AIDS problem while other countries have been overtaken by even worse epidemics. From the outset of the epidemic Ugandan political leaders have discussed the dangers that HIV infection presented to the country and looked for support from community and opinion leaders, including religious groups. They have used available human resources in a relevant manner to trigger important social changes. Sex education is becoming integrated into the school curriculum, programmes have been established to improve the treatment of sexually transmitted diseases throughout the country, and the use of condoms has been actively and widely promoted through free distribution and social marketing. In Uganda today, experts estimate that 10–25% of the urban population and 4–10% of the rural population are infected with HIV.     

Child loss and maternal wages in China

Using data from a random sample of the 2005 National Population Survey of China, we investigate the association between child death and maternal hourly wages. Approximately 1.6 per cent of the population has experienced at least one child death. Such bereaved mothers’ hourly wages are 53 per cent lower than those of non-bereaved mothers. We find that child death carries a significant wage penalty. Son death has a larger impact than daughter death and its effect decreases as the number of children in the household increases. Our decomposition results show that number of children, maternal education and regional characteristics are the three most important contributors to the wage gap, yet unexplained differences remain large, especially at the lower end of the wage distribution.     

Navigating the AIDS industry: being poor and positive in Tanzania

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care — essential to the survival of many — are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.     

Poverty,School and Work: Children during the Economic Crisis in Indonesia

The problem of child labour in Indonesia, although generally less prevalent than in other developing countries at a similar stage of development, is significant. As in other countries, this study finds a strong link between the child labour phenomenon and poverty, with the profile of child labour largely mirroring the profile of poverty. Furthermore, poverty is found to be an important determinant of whether children work. However, working does not always completely eliminate a child's opportunity to obtain formal education: children from poor households can still go to school by undertaking part‐time work to pay for their education, implying that banning these children from working may force them to drop out of school instead. Since the phenomenon of child labour is strongly associated with and determined by poverty, the most effective policy for eliminating child labour is through poverty alleviation. Other policies that can foster the rate of reduction in child labour are those which make it easier for children from poor families to access education and increase the opportunity cost of working by improving the quality of education. Such policies will increase the rate of return to education.     

Towards a jus in bello of Guerrilla Warfare

Abstract

Pentecostalism is the fastest growing form of Christianity in developing countries. Paralleling Pentecostalism's growth has been the HIV/AIDS pandemic. This paper examines how post-apartheid South Africans are responding to the conflicts born of the HIV/AIDS crisis. Fieldwork conducted in 2005 shows that Pentecostals who were not involved in efforts to address HIV/AIDS saw the church's mission as almost exclusively spiritual in nature. Pentecostals who were engaged in HIV/AIDS-related work were more likely to have an integrated worldview and to see the church's mission as relevant to the physical world. Beliefs about removing racism from the church and sin as structural as well as individual were also associated with this integrated worldview. These insights lay the foundation for constructing a Pentecostal social ethic for addressing HIV/AIDS.     

Alternative Population Dynamics in Selected HIV/AIDS Modeling Systems: Some Cross-National Comparisons

This paper examines how demographic representations for the different risk populations influence the epidemic outputs of a simple process-based HIV/AIDS model. Alternative demographic specifications are presented in conjunction with transmission rules for both community and regional settings. Then, the existence, or nonexistence, of equilibrium solutions to these various models is determined to evaluate whether the forecast AIDS series will persist indefinitely or eventually terminate. Last, simulations for countries with distinctive birth and death rates are used to summarize the effect of this variation on the timing and size of the epidemic. All the results assume an epidemic that is unaffected by the practice of safer sex.     

The Process of Famine: Causes and Consequences in Sudan

In the Sudan, where 200,000 children can die from diseases like diarrhoea and measles in a ‘normal’ year, the toll jumped to somewhere between 350,000 and 700,000 [in 1984]; in the next twelve months one million more could die — out of a total child population of only 6 million. UNICEF estimates that over six million sub-Saharan infants and children are endangered by famine.     

HOW MUCH CHILD SUPPORT CAN ABSENT FATHERS PAY?

A variety of empirical studies show that custodial mothers and children are worse off after separation and divorce than absent fathers. Many of these mothers and children live in poverty and many more are above the poverty line but below median family income. Since 1974 the U.S. has had a federal-state program of Child Support Enforcement, but absent fathers still have a poor record of paying child support. To estimate how much money absent fathers could be expected to pay in child support, we used income data from the Panel Study of Income Dynamics, Census Bureau data on the number of custodial mothers and children with living absent fathers, and two systems for determining how much money absent fathers should pay in child support. Using these sources, we estimate that absent fathers could pay $26.6 billion in child support–about 3.6 times as much as they actually paid in 1984. Most of this child support money would come from upper-income families. We conclude that absent fathers could substantially augment the financial security of custodial mothers and their children, and that the U.S. should therefore pursue a vigorous program of Child Support Enforcement.