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.     

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.     

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.     

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.     

Ryan White CARE Act Title I Funding Priorities and Unmet Service Needs in Baltimore, Maryland

The analysis presented in this paper explores the similarities and differences between the services selected as priorities for funding by the Baltimore Ryan White CARE Act Title I Planning Council during the first 2 years of the program in this metropolitan area, and services perceived by HIV/AIDS service providers and people living with HIV/AIDS to be unmet needs. The data used for these analyses were collected as part of a study to assess the implementation and impact of the CARE Act legislation in the Baltimore eligible metropolitan area( EMS ). This project includes three interrelated components: (a) a case study of the legislatively mandated Planning Council, (b) a survey of providers representing HIV/AIDS service organizations, and (c) a qualitative field study of the perceptions of people living with HIV/AIDS about the service delivery system. Taken together, the data from these three sources describe the similarities and differences among these three groups involved in HIV/AIDS care in Baltimore, in terms of their perceptions of services needed by people living with HIV / AIDS. The conclusions drawn from this study can be used to strengthen needs assessments in Title I-EMAs throughout the United States.     

Disease, Social Identity, and Risk: Rethinking the Geography of AIDS

The emergence of new diseases and the re-emergence of 'old' diseases necessitates a relook at what shapes vulnerability to ill health. A framework is proposed that combines a realist approach to mapping vulnerability with feminist and post-structural approaches that focus more attention upon the role of social identities and cultural framings of disease. Too often investigations of disease focus either upon structural determinants of risk such as political policy and the economy, or on discursive definitions of disease that impact its experience. A combination of these approaches would result in a more effective framework for evaluating vulnerability, and subsequently for generating effective disease prevention strategies. The social, economic, political, and cultural context of HIV/AIDS in Malawi is given as an illustration of this framework.     

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.     

Feminizing risk at a distance: critical observations on the constitution of a preventive technology for HIV/AIDS

Distance is a key idea in contemporary literatures on geography and the government of risk, and it is central to the work presented in this paper, which focuses on Western media representations of an innovative ‘first-generation’ non-contraceptive microbicide, Carraguard. A preventive technology that has been developed under the auspices of the US Population Council and the Bill and Melinda Gates Foundation, Carraguard is represented in the media in ways that produce certain noteworthy cultural geographies of HIV/AIDS. Via an analysis of a selection of such media representations of Carraguard, and focusing on sexual citizenship, political subjectivity and three socio-spatial orderings of risk (displacement, replacement and reorientation), we posit that Carraguard has effected a feminization of the government of risk at a distance. Specifically, we contend that HIV/AIDS has been displaced from the marginalized spaces of metropolitan centres of the West and replaced at the world's under-developed margins, being reoriented from dangerousness/deviance and the masculine to risk and the feminine in that process. In this work, we have taken up Dean's (1999) call to use an analytics of government to highlight the effects of certain ways of thinking and acting, and have also sought to respond to observations by Craddock (2000) that the silences in geography about HIV/AIDS and the regional coordinates of risk and vulnerability need to be addressed. In the final analysis, it appears that media representations of Carraguard reproduce and intensify much older geopolitical and socio-spatial orderings and relations of power that give effect to conceptions and practices of political obligation and sexual citizenship.     

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.     

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.     

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.     

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.     

Knowledge,Morality and ‘Kastom’: SikAIDS among Young Yupno People,Finisterre Range,Papua New Guinea

ABSTRACT This paper investigates the extent of knowledge about HIV/AIDS among young Yupno women and men. Local understanding of sikAIDS is shaped by cultural, moral and religious concepts and processes that are based on social values and practices. Difficulties these young people face in accessing information about HIV/AIDS and using it to implement preventative measures — for example by obtaining condoms — have to be seen in the framework of ‘kastom’ and a moral discourse coined and influenced by the Lutheran Church. As the research shows, there is an urgent need for a broad and contextually sensitive approach to sexual health, including information about conception, family planning methods, and sexually transmitted diseases when planning awareness campaigns for teenagers in rural regions.     

Navigating the AIDS industry: being poor and positive in Tanzania

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care — essential to the survival of many — are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.     

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.     

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.     

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.     

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.     

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.