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.     

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.     

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 Impact of AIDS on Rural Households in Africa: A Shock Like Any Other?

In areas where HIV prevalence is high, household production can be significantly affected and the integrity of households compromised. Yet policy responses to the impact of HIV/AIDS have been muted in comparison to outcomes of other shocks, such as drought or complex political emergencies. This article looks at the reasons for the apparent under–reaction to AIDS, using data from Zambia, and examines recent calls to mitigate the effects of AIDS at household level. Critical consideration is directed at proposals relating to community safety nets, micro–finance and the mainstreaming of AIDS within larger poverty alleviation programmes. It is argued that effective initiatives must attend to the specific features of AIDS, incorporating both an assault on those inequalities which drive the epidemic and sensitivity to the staging of AIDS both across and within households. A multi–pronged approach is advocated which is addressed not just at mitigation or prevention, but also at emergency relief, rehabilitation and development.     

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 Ryan White Act in Dallas

Virtually every locality affected by the AIDS epidemic has had to confront changes in the demographics of the disease, shifts in federal priorities, and medical advances in AIDS treatment. Creating a consistent federal policy has proven difficult because the epidemic manifests itself differently in virtually every locality it invades. As a result, some local caseloads increasingly are dominated by intravenous drug users and others by gay men. In recognition of this reality, the primary federal program to fund AIDS services relies on local decisionmakers to make allocation decisions for serving the needs of their caseload. Under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, local Health Services Planning Councils were assigned the task of creating an effective continuum of care for persons with HIV I AIDS and were empowered with the task of allocating federal funds to accomplish that objective. In some cases creating and fostering an effective continuum of care proved to be an essentially noncontroversial managerial task, while in other localities political turmoil and rampant self-interest served as barriers to program effectiveness. This article explores the relationship between local political culture and the development of AIDS programs in Dallas County, Texas. Specifically, we compare the provision of AIDS services in Dallas before passage of the Ryan White Act in 1990, how these services were affected by the Ryan White program, and the experiences since the reauthorization of the Ryan White Act in 1996.     

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.     

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.     

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.     

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.     

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.     

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.     

Contextualising the AIDS epidemic in the South Pacific: orthodoxies,estimates and evidence

There is a growing consensus that HIV/AIDS is a ‘time bomb’ ticking in the South Pacific. This may, in fact, be the case. However, there are at least two major problems with this approach. First, analysis of the implications of the epidemic is based on supposedly concrete links between the epidemic and social, economic and political outcomes. Many of these apparent links have not been established (because the data is not available for the South Pacific). As such, much of the method for analysing the ramifications of the epidemic is borrowed from elsewhere, notably Africa, and the strength of these links is beginning to unravel. Second, research on the vectors of the epidemic that informs this consensus is only as good as the data that it relies on. There are major testing and surveillance gaps in the South Pacific that mean projections are often based on patchy and incomplete data. This can dramatically skew priorities. Reflecting on these problems is important because of the clear ramifications they pose for the development of good public policy in, and toward, the South Pacific.     

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.     

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 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.     

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.     

‘Turning Sex into a Game’: Gogodala Men's Response to the AIDS Epidemic and Condom Promotion in Rural Papua New Guinea

ABSTRACT Rugby league is the national sport of Papua New Guinea and the game's huge popularity and international profile has been used in recent condom promotion campaigns in the nation's fight against the HIV/AIDS epidemic. In this paper, I argue that the promotion of condom use through rugby league requires a national campaign strategy that includes understandings of condom use and masculinity at the rural level. I demonstrate this through a study of Gogodala men's understandings of the epidemic and condom use in Western Province. The Gogodala are a Christian‐based society and many blame the national condom promotion strategy for an increase in promiscuity and for ‘turning sex into a game’. Condom availability in this rural area continues to be restricted to a family planning program that promotes Christian values and excludes unmarried men. I explore the male condom dilemma where young men are more concerned with avoiding accusations that their sexual behaviour puts them at risk of contracting HIV despite acknowledging the preventative value of using condoms. In this context young men disassociate themselves from the disease and condom use through a process of calculated risk or risk minimisation.     

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.     

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.