Let's go for human testing of vaccine,says UNAIDS

This is a report on the first large-scale human testing of an experimental vaccine in the developing world; the trial was authorized by Thailand's Ministry of Health and supported by the UN program on HIV/AIDS (UNAIDS). This is a significant step toward the development of a safe and effective vaccine against HIV. However, the vaccine's potential for protecting people against HIV cannot be fully predicted. These multiple trials need to be conducted in developed and developing countries to test the efficacy against different HIV strains in different populations worldwide. The trial in Thailand will test the AIDSVAX vaccine developed by VaxGen, Inc. of California. AIDSVAX is not the first experimental AIDS vaccine to be tested in humans. Several vaccine candidates have been given to people involved in small clinical trials in the US. AIDSVAX has been found to be safe and to stimulate an immune response. Hence, it is the first vaccine test to proceed to large-scale human testing ("Phase III" or efficacy trials). There have been disagreements among researchers on which vaccine to use, but urgent needs must readily be addressed without compromising ethics and science.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

“Dissemination as Intervention”: Building Local HIV Competence through the Report Back of Research Findings to a South African Rural Community

Abstract: What ethical obligations do researchers have to research informants in marginalised communities in serious distress? Our “dissemination as intervention” exercise reported research findings back to a South African rural community—using a dialogical approach which sought to strengthen participants’ confidence and ability to respond more effectively to HIV/AIDS. Nine workshops were conducted with 121 people. Workshops provided opportunities for participants to start developing critical understandings of the possibilities and limitations of their responses to HIV/AIDS, understandings which constitute a necessary (though obviously not sufficient) condition for further action. Workshops alerted participants to the valuable role played by local HIV/AIDS volunteers, facilitating reflection on how local people might better support the volunteers. These discussions served as the impetus for the establishment of a three‐year community‐led intervention to further these goals.     

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.     

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.     

‘Let's talk about sex,baby…’: Conversing with Zimbabwean children about HIV/AIDS1

The lack of HIV/AIDS research with children under 15 in Zimbabwe indicates that most researchers believe children are too young to ‘talk about sex’. However, some are already sexually active, the rest soon will be and children constitute 45% of Zimbabwe's population. This mixed methods study surveyed 118 children and interviewed 36 about their understanding of sex and HIV/AIDS. The study revealed that the children had a range of knowledge levels about HIV/AIDS and sexual issues. It established that children can and want to discuss these sensitive issues, and that their attitudes towards safer sex are often more advanced than those of adults.     

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.     

Women endangered,says world population report

This report highlights key points from the UN Population Fund's "State of World Population 1997," which focused on women's right to choose in matters relating to reproductive health. The report documents global progress toward achieving reproductive rights for women and recommends more funding for reproductive health care and family planning and increased efforts to promote gender equality and individual rights. International agreements protect: the right to reproductive and sexual health throughout the life cycle; voluntary choice in marriage and childbearing and the means to determine when to have children; equality and equity in all spheres for men and women; and freedom from sexual violence and coercion. When these rights are denied, the result is maternal mortality (a death every minute). There is a lack of access to contraceptive services that affect 350 million women. Unsafe abortions are performed on 20 million women, of whom 70,000 die. There is a lack of access to sex education and services for teenagers that results in HIV infections and sexually transmitted diseases (STDs). 1.5 million die from HIV/AIDS related causes, and another 1 million die from reproductive tract infections and STDs. Teenagers represent about 50% of the 333 million new cases of HIV and STDs that occur each year. Female genital mutilation is performed on 120 million girls and women, and 2 million are at risk each year. 2 million girls aged 5-15 years enter the commercial sex trade each year. The report documents the suffering from anemia and malnutrition and complications from pregnancy.     

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.     

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.