South Africa's Transition in a Globalizing World: HIV/AIDS as a Window and a Mirror

South Africa's peaceful transition is evolving during a period in which spectacular twentieth-century achievements have greatly improved life for one-fifth of the world's population. These are being gradually eclipsed, however, by the impact of social and economic forces that relegate four-fifths of the world's population to increasingly insecure, miserable and impoverished lives. South Africa's negotiated revolution, which has allowed it to move from the pariah status of apartheid to that of a fledgling democracy, exemplifies the paradigm shift required for global progress towards a more just and peaceful world. The HIV/AIDS pandemic, a major threat to South Africa, the African continent and many others around the world, is used in this article as a window through which to view the prospects for the long-term social success of South Africa's transition. It is also used as a mirror to reflect the world in which such a disease could emerge and spread pervasively. The explanatory links between exploitative global economic forces and the emergence of threats to lives are considered, in order to illuminate new pathways towards global progress in which respect for human rights will be further consolidated through promotion of solidarity, interdependence and social justice.     

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.     

Averting a global financial crisis: the US,the IMF,and the Mexican debt crisis of 1976

This article explains the politics and diplomacy of the initial use of an International Monetary Fund (IMF) adjustment program as a tactic in a strategy to avert a possible global banking crisis. Scholars typically date the strategy to the Reagan administration's response to the sovereign debt crises in Eastern Europe and Latin America in the early 1980s. This article demonstrates that the approach originated instead during the 1976 Mexican debt crisis – the first potential postwar default by a developing country that threatened international bank failures. Key US and Mexican officials recognized that an IMF program of currency devaluation and austerity would probably fail in its stated objective of reducing Mexico's balance of payments deficit. Nevertheless, US Treasury and Federal Reserve officials, fearing that a Mexican default might lead to bank failures and subsequent global financial crisis, intervened to an unprecedented degree in the negotiations between the IMF and Mexico. The United States offered direct financial support and worked through diplomatic channels to insist that Mexico accept an IMF adjustment program, as a way of bailing out US banks. Mexican president Luis Echeverría's administration consented to IMF adjustment because officials perceived it as the least politically costly option among a range of alternatives.     

The HIV/AIDS pandemic: human rights,societal, and developmental issues

Abstract

This paper quotes examples from the long list of past and contemporary national accords that have linked health to human rights. It describes the dimensions and urgency of the global threat posed by the current HIV/AIDS pandemic and its continuing global acceleration, and suggests that it is failure to address the associated societal, human rights, educational, poverty, and related issues that accounts for the failure to contain it. Stressing the essential nexus between these issues and the pandemic, it is pointed out that they are most pressing in those countries in which the pandemic is spreading most rapidly, that concurrent national or international strategies to deal with them would be essential prerequisites for the success of any HIV/AIDS control programme, and that success will call for wide international collaboration and response. Recent international action on HIV/AIDS is reviewed, including the Geneva (1998) and Durban (2000) meetings of international health planners and drug manufacturers, the Cologne (1999) and Okinawa (2000) meetings of leaders of the G8 countries, and the enactment by President Clinton (2000) of the Global AIDS and Tuberculosis Relief Act. In conclusion it is stated that in spite of the urgency of the need for such international action, there are still roles for special interest community groups and for governmental and non-governmental organisations. And, while it is recognised that educational campaigns by such groups are liable to run up against entrenched taboos or conflicting cultural norms, it is acknowledged that the significant drops in infection rates recently achieved in Senegal and Uganda are evidence that such campaigns, appropriately structured, vigorously administered, and promoting the appropriate societal transformations, can work. Finally, likely roles for youth led, peer directed educational initiatives are recognised.     

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.     

After the Exception: HIV/AIDS Beyond Salvation and Scarcity

Abstract: Access to treatment for HIV/AIDS became a flashpoint for global justice struggles in the late 1990s. An expanding international response, premised to a significant extent on the idea of HIV/AIDS as an exceptional global problem, has since delivered treatment, care and prevention to growing numbers of people. HIV/AIDS exceptionalism, however, has increasingly been questioned, many aspects of the response have been critiqued and donor funding has started to decline. I argue that, having been framed as an exceptional humanitarian emergency, the question of HIV/AIDS as a global problem is increasingly located within a discourse of scarcity. Tracking the growing entanglement of global HIV/AIDS relief with neoliberal governmentality and the emergence of something I term therapeutic neoliberalism, I argue that the shift from a rationality of salvation to one of administration poses new challenges for global health activism. Questioning the discourse of scarcity remains essential to an alternative global health agenda.     

Warrior Women,the Holy Spirit and HIV/AIDS in Rural Papua New Guinea

ABSTRACT This article analyses a group of Gogodala Christian women in the Western Province of Papua New Guinea who are referred to as ‘Warrior women’ and who pray, sing and call upon the Holy Spirit to cleanse their own bodies and ‘turn their eyes’, so that they are able to see those who threaten the health and well‐being of the wider community. These women have focused primarily on bringing male practitioners of magic — iwai dala — shadowy and powerful men who operate covertly and away from the gaze of others, out into the open. Whilst this has been happening for many years, the spread of HIV and AIDS into the area, fuelled by what many in the area believe is the rise of unrestrained female and male sexuality and the waning of Christian practice and principles, has meant that those perceived to bring harm to the community through their sexual behaviour have become recent targets for Warrior women. HIV/AIDS, referred to in Gogodala as melesene bininapa gite tila gi — the ‘sickness without medicine’ — is understood as a hidden sickness, one that makes its way through the community without trace until people become visibly ill. Warrior women seek to make both AIDS and those who, through their behaviour, encourage or enable its spread more visible. In the process, however, a small number of them are overcome by the Holy Spirit, so much so that they become daeledaelenapa — mad ‐ their behaviour increasingly characterised by childishness and uncontrolled sexuality.     

EPIDEMICS AND CONTAINMENT: Cuba and the HIV/AIDS epidemic

The Cuban response to a new and little understood disease, HIV/AIDS, was swift. A ban on imported blood was followed by mass testing of HIV antibodies, beginning with Cubans who had travelled abroad. In 1986, a sanatorium – ‘Los Cocos’ – was opened to treat Cuban soldiers who had returned with AIDS from Angola. Soon after, Cubans who had never left the country began testing HIV positive, most of whom were gay and bisexual. ‘Los Cocos’ was neither a hospital nor a prison. The campus was large, and duplex apartments and sports areas were built. The director, Dr Jorge Perez Avila, an infectious disease expert, stepped in as the Dr Fauci of Cuba. His goal was to continue his research on AIDS while simultaneously ensuring that the sanatorium formed a safe refuge for patients while awaiting antivirus medicines. Through his work, Dr Perez managed to transform the sanatorium into a place where sex and sexual differences were accepted, and where a gay community could emerge to produce theatre, arts and sex education for Cuba's public schools. In 1994, the sanatorium became a voluntary institution and many of the patients opted to remain.     

HIV/AIDS and security: fact, fiction and evidence—a report to UNAIDS

The link between HIV/AIDS and 'security' is said by many to be well understood, particularly that between the movement and activities of uniformed services and the epidemic. There are strong opinions widely asserted. But recent research undertaken for UNAIDS by LSEAIDS (which brings together leading social scientists at the LSE to confront the social and economic implications of HIV/AIDS), reveals that this is not at all the case. The evidence base is patchy—strikingly so. It has been over-interpreted and even misinterpreted in the rush to respond to a perceived threat by asserting generalizations that do not stand up. In this article the arguments and some of the evidence are reviewed, as are the forces advocating a precipitate response based on poor evidence. The article describes the principles that should underlie an empirically more robust approach.     

流动人口与HIV／AIDS扩散——以云南省为例

本文以云南省为例探讨了流动人口与HIV／AIDS(艾滋病病毒／艾滋病)扩散的关系。表明流动人口是造成HIV扩散的重要因素,流动人口通过其特性和具体地域因素对HIV扩散起作用。最后提出了相应的对策。     

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.     

The politics of civil society in confronting HIV/AIDS

Civil society organizations have been at the forefront of the response to the HIV/AIDS epidemic. However, the contributions and the models of action they offer have remained marginalized by most governments and international organizations. This article looks at the initiatives of civil society actors. It discusses some of the political reasons and rationale behind the less than enthusiastic support for these initiatives from governments and large aid agencies. Two reasons are suggested: many politicians fear providing support and credibility to civil society organizations that might then build upon their success to question and challenge development failures; and the threat perceived by national and international bureaucrats to their own assumed expertise and solutions to the pandemic. In some cases, civil society organizations have been co-opted to fill gaps that governments themselves can not or will not address. However, even here, governments assume the credit for 'successes' in controlling HIV/AIDS.     

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.     

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.     

Redundancy, Third-Party Government, and Consumer Choice: HIV/AIDS Nonprofit Organizations in New York City

This article addresses two questions: (a)Why were so many new nonprofit organizations in New York City created to “fight AIDS?” and (b) What are some consequences of this phenomenon? Drawing on redundancy theory as a partial explanation, it also considers the role of racial and ethnic politics and the impact of government contracting on the formation and growth of community-based organizations. For clients, the effect has been paradoxical: financial support of a large number of organizations led to a complex and fragmented delivery system offering some clients a range of choices but decreasing access for those less able to navigate a complex system.