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.     

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.     

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.     

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.     

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.     

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.     

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.     

South Africa's Transition in a Globalizing World: HIV/AIDS as a Window and a Mirror

South Africa's peaceful transition is evolving during a period in which spectacular twentieth-century achievements have greatly improved life for one-fifth of the world's population. These are being gradually eclipsed, however, by the impact of social and economic forces that relegate four-fifths of the world's population to increasingly insecure, miserable and impoverished lives. South Africa's negotiated revolution, which has allowed it to move from the pariah status of apartheid to that of a fledgling democracy, exemplifies the paradigm shift required for global progress towards a more just and peaceful world. The HIV/AIDS pandemic, a major threat to South Africa, the African continent and many others around the world, is used in this article as a window through which to view the prospects for the long-term social success of South Africa's transition. It is also used as a mirror to reflect the world in which such a disease could emerge and spread pervasively. The explanatory links between exploitative global economic forces and the emergence of threats to lives are considered, in order to illuminate new pathways towards global progress in which respect for human rights will be further consolidated through promotion of solidarity, interdependence and social justice.     

Theorising other, ‘other childhoods’: Issues emerging from work on HIV in urban and rural Zimbabwe

This paper agrees that universal models of childhood must be unpacked in order to reveal the diversity of ‘other childhoods’ in the global south, but argues that local, culturally specific understandings of childhood also need to be theorised and deconstructed. We attempt to do this by exploring experiences that are ‘other’ to ‘other childhoods’ and so examine the ‘un-childlike’ issues of young peoples' sexual health and child household headship in Zimbabwe. We contend that a century of contestation around the social production of identities in and through space has produced local contemporary understandings of childhood that seriously endanger youngsters in an era of HIV/AIDS. We argue both that other dimensions of ‘other childhoods’ must be recognised locally and that local understandings of childhood require greater international recognition if the pandemic is to be tackled. Finally, our exploration of these ‘margins’ of human experience lead us to believe that children must be understood both as competent and independent agents of social change and as vulnerable social becomings in need of protection.     

Localizing HIV/AIDS discourse in a rural Kenyan community

This paper examines the effectiveness of multimodal texts used in HIV/AIDS campaigns in rural western Kenya using multimodal discourse analysis (Kress and Van Leeuwen, 2006; Martin and Rose, 2004). Twenty HIV/AIDS documents (posters, billboards and brochures) are analysed together with interview data (20 unstructured one-on-one interviews and six focus groups) from the target group to explore the effectiveness of the multimodal texts in engaging the target rural audience in meaningful interaction towards behavioural change. It is concluded that in some cases the HIV/AIDS messages are misinterpreted or lost as the multimodal texts used are unfamiliar and contradictory to the everyday life experiences of the rural folk. The paper suggests localization of HIV/AIDS discourse through use of local modes of communication and resources.     

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.     

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,speech and silence in South Africa (Respond to this article at http://www.therai.org.uk/at/debate)

Confessional technologies are frequently deployed to deal with the HIV/AIDS pandemic. In South Africa, these are most eagerly embraced by activists of the urban‐based Treatment Action Campaign, who use speech such as public confession and testimony to overcome pathos. However, fieldwork in the Bushbuckridge area of the South African lowveld shows wide resistance to direct speech about AIDS. In this article I explore reasons for such resistance. In addition to the stigma of labelling and poor treatment options, I argue that villagers feared the innate power of words such as ‘HIV’ and ‘AIDS’ to crystalize sickness, and bring fears of death into consciousness. In conclusion, I suggest that rather than insist upon confession, health providers could use speech and silence as alternative modes of dealing with AIDS.     

Co-evolution of networks and discourses: a case from North Korean defector-activists

This article uses an eclectic approach of network and discourse analyses to examine symbiotic relations between the formation of professional networks and the constitution of normative discourses in international affairs. Based on more than 2000 English and Korean mixed materials about the five most-mentioned North Korean defector-activists in the media in 1998–2015, and assisted by a computer-based content analysis tool, the author demonstrates how each of those five defector-activists has employed their endogenous identities to join the system of international human rights activism and offered legitimate narratives for the campaigns against North Korea, while forming transnational networks in South Korea, the USA and the UK. She argues that individuals’ endogenous identities and agency are critical for shaping normative discourses in international human rights activism against North Korea in the first instance, which then grow exponentially through transnational networks formed by individuals.     

Patents and medicines: the relationship between TRIPS and the human right to health

The question of access to drugs in developing countries is at present largely influenced by the TRIPS Agreement. TRIPS compliance in the field of health requires substantial changes to existing patent laws in some countries. These changes must be analysed in the context of the spread of epidemics like HIV/AIDS and in relation to other international obligations that states have, for instance, with regard to the human right to health.
Intellectual property rights treaties today have significant impacts on the realization of some human rights like the right to health. This article examines the extent to which TRIPS encompasses flexibility for developing countries to be able to foster better access to medicines. It also examines these issues from the point of view of human rights and considers, in particular, the ways in which the relationship between human rights and intellectual property can be improved in international law.     

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 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.     

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.     

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.