Epilogue: Homegrown in PNG — Rural Responses to HIV and AIDS

ABSTRACT A three‐years‐long, multi‐sited, multi‐method study conducted throughout Papua New Guinea by the Institute of Medical Research revealed a staggering prevalence of sexually transmitted disease (STD) that threatens an already fragile political‐economy and health services delivery system. Logistics, methodological complexities, and political and especially religious sensitivities hampered conduct of such research. Extremely little HIV social research has been allowed to inform interventions or serosurveillance protocols. Well‐ intended but ill‐conceived international initiatives have promoted a normative AIDS paradigm that misconstrues HIV transmission risk, incites greater fear, increases stigma, and promotes anti‐condom rhetoric. This collection ‘HIV/AIDS in Rural Papua New Guinea’ presents a sustained series of ethnographically based accounts of rural responses. In this epilogue I situate the importance of those responses in a discussion of the great divide between the lived realities of HIV infection and AIDS related suffering on the one hand, and the discursive practices and policies of media, public health, international donors and NGOs on the other.     

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.     

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.     

Rape on the Railway: Women,Safety, and Moral Panic in Victorian Newspapers

In the Victorian press, the railway carriage was painted as a site of particular danger for women travelling alone. As a hybrid public and private space, the carriage placed strangers together in an intimate, quasi-domestic setting for which there were few established norms of behaviour. When male and female solo travellers found themselves confined together, it set the scene both for sexual assault and for false charges of assault, which the newspapers played upon; solo female travellers were depicted as either potential victims or potential Potiphar's wives. These representations were prominent in two moral panics that attempted to regulate women's movement. In this article, I examine accounts of sexual assault from the Lancet, The Times, the English Leader, and the People's Advocate from the 1860s and 1870s and consider newspaper reports as a source of erotic stimulation in a late-century pornographic novel, Raped on the Railway. I argue that the newspapers' fascination with sexual violence on trains, while connected to the weakened division between public and private spaces and an association of railway engines with virility, was primarily a response to fears about women's increasing freedom.     

Poverty, debt and Africa's HIV/AIDS crisis

As Africa enters its third decade of structural adjustment pressures, the promised advantages of economic restructuring—as hailed by the various lending bodies— have not been forthcoming. The indelible picture emanating from the continent is one of a people relegated to a position of extreme poverty as state managers and the international community either fail to, or seem unable to, pursue policies that will secure the basic needs of its citizens. To compound matters, HIV and AIDS are threatening to erode the continent's already fragile development capacity. Predicated on the continent's limited economic capabilities, this article charts the relationship between poverty, debt relief and the politics of effective response to HIV/AIDS in Africa. The article begins with an assessment of the societal causes and consequences of the epidemic, moving on to contextualize the case for debts cancellation. It concludes by examining the crucial relationship between debt relief and the successful implementation of effective strategies against the pandemic in Africa.     

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.     

Time‐Dependent Functions for Avoidance Behaviors Made in Response to the Circulation of HIV and AIDS

Interventions aimed at preventing HIV transmission include avoidance behaviors like condom use and reduced partner acquisition. In turn., engagement in such activities might also entail changed patterns of travel to evade contact with infected individuals. One method of estimating the effects of these actions on the observed distribution of HIV/AIDS involves the specification of space‐time models that imitate the epidemic process. This paper presents an application of this procedure where prevention is construed as a continuous population response to the evolving distribution of HIV and AIDS. This task entails the construction of models with time‐dependent parameters adapted to predicted prevalence or incidence measures to represent the effects of specific avoidance behaviors. In this respect, a multiregion model is described that serves as a baseline for analyzing the impact of preventative actions on the HIV/AIDS epidemic in Western Europe. A series of adaptation functions are derived within this system for imitating both changed rates of partner acquisition and altered travel behaviors. The results elicit modifications to the behavior of the baseline epidemic that are generated by each of these functions. Then, the conditions supporting space‐time variations in rates of survival between core countries (relatively low) and those in the periphery (relatively high) are investigated. The discussion considers the implications of these results for health policies that promote avoidance behaviors.     

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.     

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.     

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.     

Scholarly Authority and Lay Mobilization: Yusuf al‐Qaradawi's vision of da‘wa, 1976‐1984

The late 1970s and early 1980s were a propitious yet challenging time for the Muslim Brotherhood in Egypt, as its elites sought to define the movement's priorities in the face of new opportunities to spread their call (da‘wa). The debate over preaching, while one of strategic assessment, also involved a negotiation of intellectual hierarchy: Should laymen lead Egypt's oldest Islamist organization, or should scholars? In contrast to previous studies that focus on how laymen led the Brotherhood's return to grassroots preaching, this article reintegrates scholars into the story of da‘wa by focusing on the organization's most prominent ‘ālim, Shaykh Yusuf al‐Qaradawi, and his vision of institution‐based preacher education and extra‐institutional activism. Drawing on three books written by Qaradawi on this topic between the mid‐1970s and early 1980s, this article casts lights not only on this Islamist scholar's claim to religious authority as he sought to mold the Brotherhood, but also on the ways in which projects of mass mobilization – whether grassroots preaching or the reform of state‐sponsored educational curricula – have transformed scholarly claims to authority more broadly.     

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.     

Hope Movements: Naming Mobilization in a Post‐development World

Social mobilizations that are devoted to contesting development and creating alternative economic arrangements conducive to the pursuit of a dignified life have recently sprung up. Not only do they criticize the current state of affairs but they actively seek and experience new ways of living, inspired by what Bloch calls the anticipatory consciousness of the ‘not‐yet‐become’, that is, another reality not yet materialized but which can be already experienced. This article argues that these mobilizations are not adequately captured by the term ‘social movements’. The uniqueness of these mobilizations requires a conceptual and epistemological turn that is able to accommodate the post‐development critique of development as well as their emancipatory dimension. We propose to name them ‘hope movements’ to account for the collective action directed to anticipate, imperfectly, alternative realities that arise from the openness of the present one. We conclude by discussing the political relevance of hope movements for the pursuit of the good life as an alternative to development.     

Catholic Responses to Evolution, 1859–2009: Local Influences and Mid‐Scale Patterns

This article discusses Catholic responses to evolution between 1859, the year of publication of Charles Darwin's On the Origin of Species, and 2009, the year in which the scientific world celebrated its 150th anniversary. Firstly, I will discuss how the Vatican initially responded to evolution in the period between 1859 and 1907, the year in which Pope Pius X issued the encyclical Pascendi dominici gregis. Secondly, I will explore the responses of Catholic authorities and intellectuals and identify the local factors that influenced their responses. Also, I will demonstrate that, gradually, Catholics have shifted towards a more lenient position concerning evolution. Thirdly, I will demonstrate that, in the end, the Vatican has complied with this pattern. In general, this article shows that not only Protestants, but Catholics too have struggled to come to terms with evolution and evolutionary theory and that local factors had an impact on these negotiations.     

Transition from Shell to Skeleton in Ancient Mediterranean Ship‐Construction: analysis,problems, and future research

During the 1st millennium AD ship‐construction changed. Previously, ships were built ‘shell‐first’—strakes were installed before frames, giving the hull its shape and integrity. About the mid‐1st millennium AD the concept and construction of hulls changed to being shaped by transverse frames fixed to the keel, reinforced by longitudinal members. During the transition varying combinations of the two technologies were used. It has been widely accepted that the transition was completed by the beginning of the 2nd millennium. Recent discoveries, mainly in Dor/Tantura lagoon and lately in Yenikap?, analyses of other hulls, and reassessment of evidence, indicate an earlier completion of the transition. Since this process was the result of many factors, including economic and social, and occurred in different areas of the Mediterranean at different times, no simple linear development is suggested, but a more complex process, which raises questions for future research. © 2012 The Authors