HIV,AIDS and security: where are we now?

HIV/AIDS is one of the greatest single causes of death and suffering on the planet. Over the last decade the societal impact of HIV/AIDS has been widely discussed in terms of national and international security. This article assesses the securitizing move and suggests that HIV/AIDS was only partially securitized at best and both the political consensus and strength of evidence were overestimated. It argues for greater nuance in our understanding of the link between HIV/AIDS and security, and the effects of its securitization, suggesting that neither is straightforward, and both are subject to case sensitivities.     

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.     

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.     

Taboos and denial in government responses

The most striking fact about HIV/AIDS is that it continues to spread even when the means of prevention are well known and do not demand costly technology to implement. This article argues that the fundamental barriers to effective prevention are social and cultural, and that many authorities place more emphasis on preserving traditional norms and social arrangements than on saving lives. The case is argued with particular reference to the impact of globalization on sexual behaviours, and the attempts by conservatives to deny existing behaviours and vulnerabilities. Current debates around abstinence, homosexuality and harm minimization are discussed to demonstrate the deeply political nature of HIV prevention.     

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.     

Patterns of Vulnerability to AIDS Impacts in Zambian Households

Using household data from Northern Zambia, this article looks at HIV/AIDS impacts on different aspects of people's access to food. The findings draw particular attention to the variances in vulnerability among households burdened by illness and orphans that are headed by men, women and the elderly. It is argued that vulnerability levels to HIV/AIDS impact differ substantially among households and implicitly expose the underlying causal conditions that enable or disable people in their responsiveness. Households affected by HIV/AIDS cannot be treated as a homogeneous group and understanding the differences in vulnerability can play an important policy role in designing targeted support.     

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.     

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.     

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.     

HIV/AIDS financing: a case for improving the quality and quantity of aid

There is no doubt that increasing amounts of funding are needed to provide a full package of HIV/AIDS prevention, treatment and mitigation interventions to Africa. However, even the existing funding flows are posing considerable challenges at a national level. In the quest for rapid results, donors have too often chosen to alleviate the lack of local capacity by bringing in foreign technical assistance or building parallel systems for delivering commodities such as drugs that may not be sustainable over the long term once external assistance stops. Even when such interventions may be relevant, they do not address the biggest challenge, namely how to build up the capacity and the systems needed for large-scale implementation of the AIDS response. This article argues that to attain the needed efficacy in HIV/AIDS mitigation programmes, further sustainable increase in external financing is certainly required (particularly for treatment programmes), but even more important is the need to implement them.     

Impact of the Ryan White CARE Act on the Availability of HIV/AIDS Services

This article assesses the extent to which the availability of HIV/AIDS services in the Baltimore and Oakland eligible metropolitan areas (EMAs) increased after receipt of funding under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Survey data on the availability of HIV/AIDS services in each EMA were collected from samples of organizations at two points in time: 1 year before (1991) and 1 year after (1993) the Oakland and Baltimore EMAs received their first installments of CARE Act Title I funds. Cross-sectional and longitudinal analyses of the data were performed to assess changes in the availability of HIV/AIDS services. The results showed that after CARE Act Title I funding became available, the availability of ambulatory medical and social support services in the Baltimore and Oakland EMAs increased. However, the way service availability increased varied significantly, reflecting differing opportunities and constraints present in each community. In Baltimore, the increase in the availability of HIV/AIDS services was due largely to the creation of new organizations that used Title I funds to provide services (system expansion). In Oakland, relatively few new organizations were created, but existing organizations added new HIV/AIDS services (service line expansion). Our data also indicated that in both EMAs the majority of HIV/AIDS organizations receiving Title I funds expanded the capacity of their existing services to meet growing demand.     

‘Facing it Together’: Early Caregiving Responses to Vancouver's HIV/AIDS Epidemic

This article utilises oral history interviews with long-term survivors and caregivers in Vancouver, British Columbia to foreground the importance of gay men's early HIV/AIDS caregiving work. Caregiving was essential to the health and resilience of Vancouver's gay community and served as a political response to homophobic discourses that demonised gay men and devalued the lives of people living with HIV/AIDS. This analysis of the practical and political significance of HIV/AIDS caregiving demonstrates that historians must find better ways to recover the often-untold histories of men's caregiving and domesticity and appreciate their significance to the success of social movements.     

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.     

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.     

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.     

Hidden Child Workers: Young Carers in Zimbabwe

Drawing on an interview‐based case study of young people caring for dependent adult members of their households in Harare, this paper connects the experiences of young carers in Zimbabwe to global forces—namely the HIV/AIDS pandemic and economic liberalisation. It is argued, firstly, that care‐giving by young people is a largely hidden and unappreciated aspect of national economies which is growing as an outcome of conservative macroeconomic policies and the HIV/AIDS explosion. Secondly, that young people have a right to recognition of their work as work. Thirdly, while acknowledging that conceptualising childhood is problematic, there needs to be less emphasis on northern myths of childhood as a time of play and innocence and more attention on defending children's rights to work as well as to be supported in their work under appropriate circumstances. The articulation between global processes and the localised experiences of individual children as providers of care within the home contributes to efforts to re‐introduce social reproduction as an important (but often missing) aspect of debates around globalisation. In addition, this article adds to the growing literature on the geographies of childhood while tackling the imbalance within that literature, whereby working young people and those of the global South are relatively neglected. Suggestions are offered in the conclusions for policy recommendations to recognise and support young carers in Africa, while calling for further research.     

Endangered Youth? Youth,gender and sexualities in urban Botswana

Age is now recognised as a significant social cleavage in research on youth in the South. Using participatory urban appraisal methodologies, this article explores constructions of sexualities among urban youth in Botswana, a country that is currently experiencing an HIV/AIDS epidemic and high levels of teenage pregnancy. We argue that not only are young people sophisticated sexual beings, but that there is a need to adopt more holistic approaches to examining sexualities among them so as to appreciate that constructions of sexualities are multi‐faceted, highly diverse and heavily gendered. This appreciation must then be integrated into a multi‐sectoral policy approach that moves beyond information provision towards one that addresses changes in gender, cultural and sexual identities.     

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.