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.     

Introduction:25 years of living with HIV/AIDS: challenges and prospects

To mark the 25th anniversary of the discovery of the HIV virus, this special issue brings together a collection of articles from leading scholars engaged in, or concerned with, the challenges posed by the HIV/AIDS epidemic. Collectively, the articles address the power relations driving HIV/AIDS, frustrating the possibility of alleviation, care and recovery and operating to relegate entire regions to a vulnerable and bleak future.     

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.     

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.     

EPIDEMICS AND CONTAINMENT: Cuba and the HIV/AIDS epidemic

The Cuban response to a new and little understood disease, HIV/AIDS, was swift. A ban on imported blood was followed by mass testing of HIV antibodies, beginning with Cubans who had travelled abroad. In 1986, a sanatorium – ‘Los Cocos’ – was opened to treat Cuban soldiers who had returned with AIDS from Angola. Soon after, Cubans who had never left the country began testing HIV positive, most of whom were gay and bisexual. ‘Los Cocos’ was neither a hospital nor a prison. The campus was large, and duplex apartments and sports areas were built. The director, Dr Jorge Perez Avila, an infectious disease expert, stepped in as the Dr Fauci of Cuba. His goal was to continue his research on AIDS while simultaneously ensuring that the sanatorium formed a safe refuge for patients while awaiting antivirus medicines. Through his work, Dr Perez managed to transform the sanatorium into a place where sex and sexual differences were accepted, and where a gay community could emerge to produce theatre, arts and sex education for Cuba's public schools. In 1994, the sanatorium became a voluntary institution and many of the patients opted to remain.     

Securitising HIV/AIDS in the Xinjiang Uyghur Autonomous Region

For the People's Republic of China, the localised HIV/AIDS epidemics in the Xinjiang Uyghur Autonomous Region are emerging as threats to those persons affected by the disease, but also to the stability of Xinjiang. This article examines the HIV/AIDS epidemic in Xinjiang and considers the impacts it may have on human and political security. The authors argue that due to its remote location and the religious, cultural and ethnic diversity of its population, and current political situation, Xinjiang poses difficult obstacles to effective programs in tackling HIV/AIDS, and the pandemic has disproportionately affected the minority nationalities in the region compared to their Han counterparts. If the HIV/AIDS pandemic among minority nationalities in Xinjiang continues to grow, it has the potential to further weaken social cohesion there, as well as Uyghur human security. Therefore, a HIV/AIDS pandemic in Xinjiang could tip the balance in terms of ethnic and regional stability.     

The Response to HIV/AIDS and the Construction of National Legitimacy: Lessons from Uganda

Uganda faces continual challenges as a low‐income nation reliant on international donors and non‐state actors. It was also one of the first countries to face a population‐wide HIV epidemic, a disease that can strain state capacity to its limits. One would expect that such a combination would weaken the governance structures in a developing country; yet, if anything, the Ugandan state has emerged from its HIV crisis with its legitimacy bolstered. This article reviews the Ugandan response to HIV/AIDS, analysing the ways in which the epidemic has provided a new arena for the Ugandan state to engage with international actors.     

Spatial Diffusion of the HIV/AIDS Epidemic: Modeling Implications and Case Study of AIDS Incidence in Ohio

This paper extends a compartmental epidemiological model for HIV transmission and AIDS incidence to include hierarchical and expansion spatial diffusion. An implication of the resultant model is that hierarchical diffusion causes the large infection growth rates of densely populated areas at the top of the central places hierarchy to “chain” down and dominate small local growth rates during the exponential-growth phase of the epidemic. Also, hierarchical diffusion causes a high transient growth rate in the first few years of a local epidemic. The spatial compartmental model fits observed AIDS incidence spatial diffusion patterns in Ohio reasonably well.     

The assassination of Eduardo Mondlane: FRELIMO,Tanzania, and the politics of exile in Dar es Salaam

This article uses the city of Dar es Salaam as an urban lens for understanding the politics of FRELIMO in exile and the assassination of its first president, Eduardo Mondlane, in 1969. By adopting a multiarchival technique, these narratives can be broken down to a micropolitical level, shedding light on the distribution of agency in the confluence of superpower rivalry and decolonisation in the Third World. The splits within the liberation movement can be explained via the intersection of internal disagreements, Cold War dynamics, and relations with the Tanzanian state, within the context of Dar es Salaam’s cosmopolitan public sphere.     

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.     

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.     

Reproduction rates in multiregion modeling systems for HIV / AIDS

The persistence of HIV/AIDS has seen a revival of academic interest in the development of modeling systems to assist understanding the population dynamics of this infection. Moreover, it has become increasingly recognized that a key component of these systems for interpreting disease prevention is their reproduction rate, which provides an indication of whether an epidemic might start in a community described by a particular set of epidemiological characteristics. The properties of these rates have been explored in detail for models of a single risk behavior but not for multiregion formats that allow for the transfer of infection between geographical units. Therefore, in this paper I derive reproduction rates for a multiregion HIV/AIDS model together with their associated critical thresholds that estimate the minimum population of susceptibles necessary for an epidemic to begin. These statistics are interpreted for a simplified global setting representing regional variations in the potential onset of HIV/AIDS. In the discussion I examine the potential applicability of these results to understanding HIV/AIDS prevention.     

The Americans With Disabilities Act and Reasonable Accommodation: The View From Persons With HIV/AIDS

This study examines the application of reasonable accommodation to situations involving employees with the Human Immunodeficiency Virus or Acquired Immunodeficiency Syndrome. Two questions are posed. What types of accommodations are needed? How readily available is the reasonable accommodation component of the Americans With Disabilities Act? These questions are addressed through qualitative analysis. Three lessons are drawn from the findings.     

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.     

Young people,place and devolved politics: perceived scale(s) of political concerns among under 18s living in Wales

Despite clear linkages between conceptualisations and perceptions of politics, society, culture and territorial rescaling, research into young people’s political engagement, participation and representation is underrepresented in the field of social and cultural geography. Here the gap is addressed using perceptions of devolved politics, as a form of territorial rescaling, among young people living in Wales. Specifically, it shows the geographical scales at which young people locate their political concerns and where responsibility for these concerns is perceived to lie, with a focus on the National Assembly for Wales and the Welsh Government. This is a key contribution to our understanding of the role devolution plays in youth political engagement in the light of the following: the relative infancy of the devolved U.K. institutions; their asymmetrical development and increasing divergences; the growing variation in turnout among young people for different types of election and referenda; and the lack of research examining the youth engagement dimension of Welsh devolution as a political, social and cultural process of territorial rescaling in the U.K. The paper concludes with a critique of the notion that devolution poses a ‘politics of hope’ for youth political engagement in Wales, a very different picture to Scotland.     

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.     

Alternative Population Dynamics in Selected HIV/AIDS Modeling Systems: Some Cross-National Comparisons

This paper examines how demographic representations for the different risk populations influence the epidemic outputs of a simple process-based HIV/AIDS model. Alternative demographic specifications are presented in conjunction with transmission rules for both community and regional settings. Then, the existence, or nonexistence, of equilibrium solutions to these various models is determined to evaluate whether the forecast AIDS series will persist indefinitely or eventually terminate. Last, simulations for countries with distinctive birth and death rates are used to summarize the effect of this variation on the timing and size of the epidemic. All the results assume an epidemic that is unaffected by the practice of safer sex.