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.     

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.     

By the time you read this one million children infected with HIV will be living in the shadows

Every day, 1000 children become infected with HIV. UNAIDS therefore estimates that by the end of 1997, 1 million children under age 15 years will be living with HIV and experiencing the physical and psychological consequences of infection. Since the beginning of the pandemic, more than 2 million HIV-positive children have been born to HIV-positive mothers, and hundreds of thousands of children have acquired HIV from blood transfusions and through sex or drug use. More than 9 million children are estimated to have had a mother who died due to AIDS. Although AIDS is the most recognized disease in the world, insufficient attention has been given to the impact it is having upon children. Unless the spread of HIV is quickly checked, gains achieved in reducing infant and child death rates will be reversed in many countries. An UNAIDS report estimates that by 2010, AIDS may increase infant mortality by as much as 75% and under-5 child mortality by more than 100% in the worst affected countries in the world. It is clear that AIDS will soon be a major cause of death among children. Since about 90% of children under age 15 years acquire HIV from their mothers, either before or during birth or through breast feeding, reducing the vulnerability of infants to HIV infection means enabling women to prevent themselves from contracting HIV and to procure antiviral drugs which can reduce the risk of mother-to-child HIV transmission.     

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.     

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.     

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 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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.