Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

Reproduction rates in multiregion modeling systems for HIV / AIDS

The persistence of HIV/AIDS has seen a revival of academic interest in the development of modeling systems to assist understanding the population dynamics of this infection. Moreover, it has become increasingly recognized that a key component of these systems for interpreting disease prevention is their reproduction rate, which provides an indication of whether an epidemic might start in a community described by a particular set of epidemiological characteristics. The properties of these rates have been explored in detail for models of a single risk behavior but not for multiregion formats that allow for the transfer of infection between geographical units. Therefore, in this paper I derive reproduction rates for a multiregion HIV/AIDS model together with their associated critical thresholds that estimate the minimum population of susceptibles necessary for an epidemic to begin. These statistics are interpreted for a simplified global setting representing regional variations in the potential onset of HIV/AIDS. In the discussion I examine the potential applicability of these results to understanding HIV/AIDS prevention.     

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.     

Population geography and HIV/AIDS: The challenge of a ‘wholly exceptional disease’

This paper justifies and elaborates Huw Jones’ identification of HIV/AIDS as a ‘wholly exceptional disease’. It identifies the global pattern of the disease and how geographers have dealt with it, and considers its exceptional character in respect of its medical, demographic and behavioural dimensions. Implications of these dimensions are integrated into discussions of geographers’ use of two major conceptualisations in population analysis: the demographic transition model and disease diffusion models. It is argued that HIV/AIDS is wholly exceptional in that its essentially behavioural character — both in terms of spread and control — must strengthen the case for more explicit behavioural perspectives in population geography.     

China's Response to Pandemics: From Inaction to Overreaction

Two U.S. specialists (on the governance and foreign policy aspects of China's public health issues as well as its human and medical geography) examine how two different sets of policies implemented by the government of China have affected both the geography and political ecology of pandemic disease outbreaks (HIV/AIDS, SARS, and H1N1) over the past two decades. More specifically, they argue that: (1) broad development and reform policies largely responsible for China's rapid modernization/urbanization and increasingly successful perfomance in the global economic arena have generated unexpected side-effects in terms of the location, incidence, and spread of pandemics as well as the state's capacity to mount an adequate health care response; and (2) politically motivated public health policies implemented in response to the spread of specific pandemics in China have had unanticipated impacts on the progression of disease outbreaks and their outcomes. Journal of Economic Literature, Classification Numbers: H510, H750, I180. 3 figures, 2 tables, 76 references.     

Counselling Citizens and Producing Patronage: AIDS Treatment in South African and Ugandan Clinics

Global health interventions to provide antiretroviral (ARV) drug treatment for people living with HIV/AIDS in developing countries have linked global and local actors in unprecedented ways. These uneven relationships have been described as creating new forms of citizenship that challenge the liberal understanding of rights and responsibilities bestowed by the state. A comparative case study based on fieldwork from South Africa and Uganda suggests different theoretical understandings of the link between technologies of AIDS treatment and relationships of belonging. Yet, ethnographic data from local clinics in both countries point to similarities that exist across AIDS interventions, and to the importance of counsellors in negotiating the rules of ARVs. Neither patients living with HIV nor the local providers of their AIDS treatment are ‘bare life’ subjects to be acted upon by a global development intervention. As ARV technologies are increasingly prescribed in developing country clinics, diverse social relationships are taught and negotiated as part of the pedagogy of biopolitics. The following discussion demonstrates how local counsellors and clients negotiate the rules of AIDS treatment together for mutual benefit. The article concludes that AIDS treatment creates relationships of therapeutic citizenship and clientship in ways that constrain the possibilities of citizenship and development.     

AIDS,speech and silence in South Africa (Respond to this article at http://www.therai.org.uk/at/debate)

Confessional technologies are frequently deployed to deal with the HIV/AIDS pandemic. In South Africa, these are most eagerly embraced by activists of the urban‐based Treatment Action Campaign, who use speech such as public confession and testimony to overcome pathos. However, fieldwork in the Bushbuckridge area of the South African lowveld shows wide resistance to direct speech about AIDS. In this article I explore reasons for such resistance. In addition to the stigma of labelling and poor treatment options, I argue that villagers feared the innate power of words such as ‘HIV’ and ‘AIDS’ to crystalize sickness, and bring fears of death into consciousness. In conclusion, I suggest that rather than insist upon confession, health providers could use speech and silence as alternative modes of dealing with AIDS.     

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.     

An international public health crisis: can global institutions respond effectively to HIV/AIDS?

The United Nations Millennium Project (2005 UN Millennium Project , 2005 . Combating AIDS in the developing world ( London : Taskforce on HIV/AIDS, Malaria, TB, and Access to Essential Medicines: Working Group on HIV/AIDS, Earthscan ). [Google Scholar]) describes the HIV/AIDS epidemic as a ‘global catastrophe, threatening social and economic stability in the most affected areas, while spreading relentlessly into new regions’. Multilateral institutions under the leadership of the Joint United Nations Program on HIV/AIDS and World Health Organization have been charged with coordinating the worldwide response. Yet with attention and funding diverted between bilateral, regional and multilateral aid providers, and little discernible success in containing the global epidemic to date, it remains an open question whether traditional global institutions are able to effectively combat HIV/AIDS. It is argued that bilateral relationships are still heavily relied upon at present as traditional multilateral arrangements struggle for resources and political attention. The critical questions discussed here are whether global institutions should, can and will respond effectively to the HIV/AIDS crisis. This analysis finds that the most readily organised and deployed global response will likely involve an alliance of public and private agencies that can escape some of the domestic, political and organisational constraints inherent in existing HIV/AIDS funding arrangements. Ultimately, newer hybrid arrangements that have emerged recently, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, may offer a more enduring global regime to control the HIV/AIDS epidemic. The corollary is that UN agencies alone in their traditional form, hampered by multilateral practicalities, will be less effective.     

The invasion complex: the abject other and spaces of violence

This article examines how the image of the refugee has been defined through the fear of the other, and how the mechanisms of detention have transformed the conditions of belonging. I examine the contemporary geopolitical forces propelling the rise of a new authoritarianism, growing border anxieties and hostility towards refugees, and argue that these emerging shifts provoke an urgent need for a new conceptual framework to understand the dynamics of contemporary global flows and concepts of belonging. I introduce what I call the ‘invasion complex’, a new conceptual hybrid that draws upon elements of psychoanalytic theory and complex systems theory, and Giorgio Agamben's analysis of sovereignty and ‘the camp’, to explain heightened border anxieties and the legitimization of violence towards the Other. I consider the value, applications and limitations of Agamben's analysis, and contend that both the state‐centric moral debate on the refugee crisis, and Agamben's method of privileging political agency in terms of sovereign power, tend to discount the role of complexity. Drawing on the Australian political and public discourse on refugees, and the 2001 Tampa crisis, I argue that the hostile reactions can be traced to a complex interplay between old phobias and new fantasies. I conclude by urging the need to move beyond nation state centric critiques of racism, and propose the development of a new paradigm — a potential politics that recognizes the complex dynamics of global flows, and which opens the way for a discourse of hope based on the rights of the human being, rather than the citizen.     

HIV/AIDS and security

The UN and its associated agencies have been among the most important players in increasing global AIDS awareness. But the intervention of the Security Council has been critical in securitizing HIV/AIDS. Moreover, the claims made by the Security Council have set the agenda for the subsequent debate on HIV/AIDS as a security issue. This article examines these claims—that HIV/AIDS poses a risk to internal stability, national security and peacekeepers, and that conflict is a vector for the spread of the disease. It argues that the evidence is less clear cut, more complex and case sensitive than the original claims suggested. Moreover, the causal links between HIV/AIDS and insecurity appear less robust. It concludes that the case made by the Security Council was somewhat speculative, while the snowballing of subsequent pessimistic thinking led these concerns to a position of orthodoxy that now appears less assured. HIV/AIDS remains a tragedy and a human security issue; whether it is a national security issue is more problematic.     

Securitising HIV/AIDS in the Xinjiang Uyghur Autonomous Region

For the People's Republic of China, the localised HIV/AIDS epidemics in the Xinjiang Uyghur Autonomous Region are emerging as threats to those persons affected by the disease, but also to the stability of Xinjiang. This article examines the HIV/AIDS epidemic in Xinjiang and considers the impacts it may have on human and political security. The authors argue that due to its remote location and the religious, cultural and ethnic diversity of its population, and current political situation, Xinjiang poses difficult obstacles to effective programs in tackling HIV/AIDS, and the pandemic has disproportionately affected the minority nationalities in the region compared to their Han counterparts. If the HIV/AIDS pandemic among minority nationalities in Xinjiang continues to grow, it has the potential to further weaken social cohesion there, as well as Uyghur human security. Therefore, a HIV/AIDS pandemic in Xinjiang could tip the balance in terms of ethnic and regional stability.     

Hidden Child Workers: Young Carers in Zimbabwe

Drawing on an interview‐based case study of young people caring for dependent adult members of their households in Harare, this paper connects the experiences of young carers in Zimbabwe to global forces—namely the HIV/AIDS pandemic and economic liberalisation. It is argued, firstly, that care‐giving by young people is a largely hidden and unappreciated aspect of national economies which is growing as an outcome of conservative macroeconomic policies and the HIV/AIDS explosion. Secondly, that young people have a right to recognition of their work as work. Thirdly, while acknowledging that conceptualising childhood is problematic, there needs to be less emphasis on northern myths of childhood as a time of play and innocence and more attention on defending children's rights to work as well as to be supported in their work under appropriate circumstances. The articulation between global processes and the localised experiences of individual children as providers of care within the home contributes to efforts to re‐introduce social reproduction as an important (but often missing) aspect of debates around globalisation. In addition, this article adds to the growing literature on the geographies of childhood while tackling the imbalance within that literature, whereby working young people and those of the global South are relatively neglected. Suggestions are offered in the conclusions for policy recommendations to recognise and support young carers in Africa, while calling for further research.     

Impact of the Ryan White CARE Act on the Availability of HIV/AIDS Services

This article assesses the extent to which the availability of HIV/AIDS services in the Baltimore and Oakland eligible metropolitan areas (EMAs) increased after receipt of funding under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Survey data on the availability of HIV/AIDS services in each EMA were collected from samples of organizations at two points in time: 1 year before (1991) and 1 year after (1993) the Oakland and Baltimore EMAs received their first installments of CARE Act Title I funds. Cross-sectional and longitudinal analyses of the data were performed to assess changes in the availability of HIV/AIDS services. The results showed that after CARE Act Title I funding became available, the availability of ambulatory medical and social support services in the Baltimore and Oakland EMAs increased. However, the way service availability increased varied significantly, reflecting differing opportunities and constraints present in each community. In Baltimore, the increase in the availability of HIV/AIDS services was due largely to the creation of new organizations that used Title I funds to provide services (system expansion). In Oakland, relatively few new organizations were created, but existing organizations added new HIV/AIDS services (service line expansion). Our data also indicated that in both EMAs the majority of HIV/AIDS organizations receiving Title I funds expanded the capacity of their existing services to meet growing demand.     

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.     

Localizing HIV/AIDS discourse in a rural Kenyan community

This paper examines the effectiveness of multimodal texts used in HIV/AIDS campaigns in rural western Kenya using multimodal discourse analysis (Kress and Van Leeuwen, 2006; Martin and Rose, 2004). Twenty HIV/AIDS documents (posters, billboards and brochures) are analysed together with interview data (20 unstructured one-on-one interviews and six focus groups) from the target group to explore the effectiveness of the multimodal texts in engaging the target rural audience in meaningful interaction towards behavioural change. It is concluded that in some cases the HIV/AIDS messages are misinterpreted or lost as the multimodal texts used are unfamiliar and contradictory to the everyday life experiences of the rural folk. The paper suggests localization of HIV/AIDS discourse through use of local modes of communication and resources.     

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.     

Fat Christians and fit elites: negotiating class and status in Evangelical Christian weight-loss culture

As American culture has become increasingly concerned about fatness, the fat body and weight loss have become salient symbols for other social tensions. This article uses the case of evangelical Christian weight-loss culture to argue that class is one of those tensions. Drawing on ethnographic work in a Christian weight-loss program as well as on recent theories of class, I argue that certain recurring concerns in Christians’ weight-loss discourse, notably concerns about fat Christian leaders and appearing healthy, reflect tensions about class-based aspirations and class-based denigrations evangelicals face in negotiating their position in American society.     

Minding Your Peers and Queers: Female sex workers in the AIDS discourse in Australia and South-east Asia {1}

Sex workers have been incorporated into the Western AIDS discourse initially as a category of 'risk group'. The model of 'peer education' developed successfully by gay men in the West has been used with sex workers in Australia and is being exported to South-east Asia. This paper shows that the role of the 'peer educator' is paradoxical, and embedded in locally specific laws, cultural factors and power relations involving the sex industry. Ignoring the politico-cultural context can mean that peer workers are involved in their own surveillance and in reinforcing the stigma of sex work. The 'Asian prostitute' has been characterised both as an exotic commodity and as the focus of 'AIDS panic'; however, alternative voices express both complexity of the sex industry and more immediate concerns which need to be confronted before HIV/AIDS can be given meaning.