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.     

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.     

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.     

PATHS IN TRANSNATIONAL TIME-SPACE: REPRESENTING MOBILITY BIOGRAPHIES OF YOUNG SWEDES

This article sets out to capture and describe individual transnational mobility from a long‐term, biographical perspective. The purpose is to discuss the use of a time‐geographical form of notation to represent people's transnational mobility as paths in time and space, and to demonstrate how such representations can contribute to explaining some of the dynamics of longdistance mobility. An advantage of using time‐space paths is that several aspects of an individual's travel biography can be represented in a single image: intensity and extensity are immediately evident, and the temporal and spatial relationships between the various mobility actions are made visible. Using data describing all transnational trips taken during childhood and adolescence by sixty‐two Swedish youth with different backgrounds, three aspects of how trajectories develop over time are discussed in more detail. The first concerns overall change in travel pattern with time. A dominant pattern of increase in travel with increasing age is observed, indicating the importance of further investigating how travel behaviour is related to experience and life‐course transitions. Second, sequential relationships between migration and temporary mobility are examined. In spite of the relatively small number of respondents, a wide range of such relationships are disclosed in the material. Third, regularity and repetition in long‐distance travel patterns is discussed as an increasingly important aspect of contemporary transnational mobility. Among these young people, highly regular travel is often motivated by enduring long‐distance social relationships, but is also generated by leisure or holiday travel alone.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

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.     

The Response to HIV/AIDS and the Construction of National Legitimacy: Lessons from Uganda

Uganda faces continual challenges as a low‐income nation reliant on international donors and non‐state actors. It was also one of the first countries to face a population‐wide HIV epidemic, a disease that can strain state capacity to its limits. One would expect that such a combination would weaken the governance structures in a developing country; yet, if anything, the Ugandan state has emerged from its HIV crisis with its legitimacy bolstered. This article reviews the Ugandan response to HIV/AIDS, analysing the ways in which the epidemic has provided a new arena for the Ugandan state to engage with international actors.     

Spatial Diffusion of the HIV/AIDS Epidemic: Modeling Implications and Case Study of AIDS Incidence in Ohio

This paper extends a compartmental epidemiological model for HIV transmission and AIDS incidence to include hierarchical and expansion spatial diffusion. An implication of the resultant model is that hierarchical diffusion causes the large infection growth rates of densely populated areas at the top of the central places hierarchy to “chain” down and dominate small local growth rates during the exponential-growth phase of the epidemic. Also, hierarchical diffusion causes a high transient growth rate in the first few years of a local epidemic. The spatial compartmental model fits observed AIDS incidence spatial diffusion patterns in Ohio reasonably well.     

The genocidal virus: Addressing beliefs among students of colour that AIDs is a man‐made disease (Respond to this article at http://www.therai.org.uk/at/debate)

This paper explores beliefs revealed in classroom discussions at a majority black university in the United States that HIV/AIDS is a form of genocide. The perspective of the sociology of knowledge, a critique of the realist interpretation of science, argues that these beliefs are rational given the students' social relationship to the scientific establishment. Paolo Friere's philosophy of popular education and the anthropological method teach us to take these beliefs seriously. The white instructor's own gaps in knowledge counsel humility in teaching about the origins of HIV to students of colour. Finally, the paper describes how the students and the instructor were able to find a common ground in the interpretation of AIDS as a man‐made epidemic.     

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.     

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.     

Of Sodomy and Cannibalism: Dehumanisation,Embodiment and the Rhetorics of Same‐Sex and Cross‐Species Contagion

This article explores ideas of the ‘human’ in discourses surrounding the AIDS epidemic, from the 1980s to the present. It compares two sequential lines of thought: first, the notion of AIDS as the result of ‘unnatural’ gender behaviours and queer sexualities; and second, the notion of AIDS and other zoonotics (cross‐species diseases) as the result of non‐western dietary practices and social mores. In the first case, the early years of the AIDS crisis are traced through the languages of sexual perversity utilised by the popular press and the Christian right. In the second case, the later years of the epidemic are traced, once the ‘roots’ of the virus became tied to Africa, and carriers became bestialised in narratives that located HIV as a consequence of unnatural, or inhuman, interactions with the animal world. The article argues that we have witnessed a paradigm shift in the didactics of the epidemic, from a narrative of sexual impropriety to one that also includes a narrative of dietary impropriety, each of which consistently relies upon a clear dichotomy between the human and the inhuman.     

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.     

Great Ancestral Women: Sexuality,Gendered Mobility,and HIV among the Bamu and Gogodala of Papua New Guinea

Faced with a potentially devastating epidemic of HIV/AIDS in Papua New Guinea (PNG), sexuality and mobility have become a focus of national research and prevention programs. In Gogodala and Bamu communities in the Western Province, gendered mobility and sexuality intersect with ancestral narratives that form part of a wider series of Hero Tales found in the southern regions of PNG and Irian Jaya. In this paper we highlight the way these stories detail the travels and activities of female ancestors – known as Sagalu among the Bamui and Sawiya among the Gogodala. We outline the way such ancestral figures are now linked to understandings of contemporary STIs such HIV/AIDS as well as gendered mobility and sexuality more generally. Among the Bamu such links are sometimes directly asserted, with Sagalu represented as the origin if not cause of a uniquely defined variant of HIV/AIDS. Among the Gogodala, however, HIV/AIDS is predominantly understood as something external to the Gogodala and unrelated to ancestors like Sawiya. To explain this difference we note that, historically, Gogodala women have been less mobile and less transactable than their Bamu counterparts who have continued to enact unique understandings of the intersection of heterosexual marriage, gendered mobility, and illness. We argue that the mobility and sexuality of gendered ancestors is salient to understanding these contemporary enactments and their potential implications in light of the HIV epidemic in PNG.     

异托邦：音乐节事活动的空间实践——以迷笛音乐节为例

文章使用异托邦理论为概念框架,以迷笛音乐节为案例,通过参与式观察与深度访谈法,试图揭示音乐节空间实践中构建的另类特征。研究发现,迷笛音乐节所承载的功能逐渐由叛逆的“出口”转变为“好玩”的生活方式;音乐节事空间实践中呈现出多元的功能并置,矛盾与流动的融合;音乐节事空间的文化实践也呈现出日常结构的超越与反抗,以及作为理想的补偿空间。周期性节事时空实践中文化的稳定性则使其成为对称而不可分割的系统性时空。该研究为节事空间提供了新的认知途径,也从节事的角度丰富了异托邦理论的微观案例。     

Spatial-Temporal Spread of the AIDS Epidemic, 1982–1990: A Correlogram Analysis of Four Regions of the United States

We applied correlogram analysis to county-level AIDS data of four regions—the Northeast (Delaware, the District of Columbia, Maryland, New Jersey, New York, and Pennsylvania), California, Florida, and Louisiana—for the period 1982–1990 to characterize the spatial-temporal spread of the AIDS epidemic. Correlograms computed from yearly incidence rates differ substantially among these four regions, revealing regional differences in the spatial patterns and intensity of AIDS spread. A general trend of increasing spread to rural America, however, can still be detected. Contagious spread was predominant in the Northeast throughout the nine-year period, whereas California was dominated by hierarchical spread through time. The spatial-temporal changes of AIDS incidence patterns were most drastic in Florida, where the correlograms show hierarchical spread in the early years and then contagious spread in the later years. As a representative region for most other states in the United States, Louisiana has low spatial autocorrelation and no definite spatial pattern of spread. Grouping data into three-year periods for states with low yearly incidence rates such as Louisiana should help identify the dominant trends for these states. The correlogram results could provide useful insights into the specification of spatial models for AIDS forecasting.     

Scaling health and healthcare: re‐presenting Thailand's HIV/AIDS epidemic with world regional geography students

Authors of world regional geography textbooks have recently become more interested in the broader theoretical changes that have emerged in human geography. Relying on feminist and other critical perspectives, concepts such as space, place and scale are being re‐imagined in this ‘new world regional geography’. This paper intervenes on behalf of a more critical world regional geography by suggesting how world regional geography teachers can educate students about scale as a social construction through the use of empirical data. Relying on fieldwork conducted in Thailand, this paper lays out a lesson on the HIV/AIDS crisis and how different representations of that crisis, from the national to the individual, offer different ‘ways of knowing’ the epidemic. Furthermore, this paper examines how we can push students to consider the ways in which scales of analysis are constructed and constituted through our own geographic practices.     

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.     

Introduction:25 years of living with HIV/AIDS: challenges and prospects

To mark the 25th anniversary of the discovery of the HIV virus, this special issue brings together a collection of articles from leading scholars engaged in, or concerned with, the challenges posed by the HIV/AIDS epidemic. Collectively, the articles address the power relations driving HIV/AIDS, frustrating the possibility of alleviation, care and recovery and operating to relegate entire regions to a vulnerable and bleak future.     

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.