Why AIDS?

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We have chosen the pandemic of AIDS as the first topic for discussion in the Politics of Health Knowledge Network for a combination of reasons.

On the negative side:

* HIV-AIDS has rapidly spread to become the world’s fourth most common cause of death.

* The epidemiology of HIV has strong political component. It tends to spread most rapidly in societies with the greatest socioeconomic inequality, and among groups which are the most disadvantaged or powerless.

* The politics of AIDS have largely been overlooked or avoided by politicians and health ministries, mainly for political reasons.

* Systemic efforts to combat AIDS have mostly taken a “blaming the victim” approach. They attempt to correct the behavior of high-risk groups (through education and condoms) with relatively little attempt to correct the underlying inequities of wealth, power, social hierarchy that are at the root of the problem.

* In the poorest countries and most exploited populations (with a few important exceptions) the spread of AIDS continues, with devastating consequences.

* Although special medications have been developed to increase life expectancy with AIDS and to reduce mother-to-fetus transmission, they never reach the vast majority of people with AIDS. To sustain their huge profits, transnational pharmaceutical companies have put extremely high prices on these drugs. Especially for poor people in poor countries, the high cost of drugs – sanctioned through patent laws and WTO rules that favor drug companies – has been a major obstacle in bringing AIDS under control.

* The pandemic of AIDS continues to escalate. After two decades, only two or three of the poorest 100 countries are arguably on track toward achieving the G8 target of a 25% reduction of HIV inflection among youth by 2010.

On the positive side:

* It often takes a major crisis to initiate far-reaching transformation for the common good. In many countries - including India and China - it is beginning to spread alarmingly. AIDS is a wake-up call for the whole of humanity. It is unlikely to be resolved through top-down interventions or technological fixes. Bringing AIDS under control will require confronting, on a global scale, the underlying sociopolitical and economic causes. This will mean questioning the entrenched inequities of the status quo, and perhaps the entire free market system. The benefits of confronting these underlying inequities go far beyond the potential elimination of AIDS.

* While the overall picture today is not encouraging, there have been some significant breakthroughs.

* For example, the middleclass homosexual population in the United States – having a history of fighting tirelessly for their legal rights and social acceptance – has organized to fight the spread of HIV and win institutional support/disability rights for persons with AIDS. As a result, the incidence of AIDS among white middleclass homosexuals has dropped substantially and life expectancy of those who are HIV positive has dramatically increased. (However, among homosexuals belonging to racial minorities in the US, HIV continues to spread drastically. The combination of racial stigma, poverty, and AIDS has so far proved too overwhelming. Among Black and Latino homosexual young men in the US, now almost 1 in 3 is HIV-positive.)

* Act Up activists around the world, spearheaded by organizations of persons with AIDS, have supported the demands of poor countries to produce and purchase generic anti-HIV drugs, challenging the patent laws and trade agreements protecting the interests of transnational drug companies. The US government, World Bank, and World Trade Organization have been forced to bend to these widespread popular demands. This is a huge breakthrough in terms of “people power” to change unjust and unhealthy global policies.

* Many governments, private charities, and international campaigns have pledged sizable amounts of money to fight AIDS. These include the Global Fund to Fight HIV/AIDS, TB and Malaria, and the Massive Effort Campaign, launched in 2001. However the amounts actually donated fall far short of those pledged. And there are questions of mismanagement and misallocation of funds. There is a danger that large amount of money put into selected health campaigns will co-opt and “privatize” the responsibilities of international organizations, like WHO and UNICEF, and once again undermine more comprehensive approaches to improving health.

In sum, AIDS is the symptom of an inequitable and disempowering world order, and its resolution will require far-reaching change. As Kraig Klaudt, leading the Massive Effort Campaign makes clear, “While we have succeeded in securing many pledges from world leaders to take action, we have yet to engage a sufficient number of ‘people on the street’ to become involved in this cause.” There are signs that such engagement of the common people in global health concerns is gathering momentum. More on the Politics of AIDS...