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Apr-Jun2004-12(2)
ARTICLE
A political economy
perspective on prevention of HIV infection
Justin
Jagosh
When the human immunodeficiency virus (HIV) was
first discovered over 20 years ago, there began a huge effort to educate people
about the risks associated with HIV infection, and promote abstinence, condoms
and clean needles as ways to curb the growing rate of infection. Despite the
massive effort and expenditure put into prevention of HIV infection, the global
infection rate has increased, not decreased. Researchers and the medical
community have had to take a closer look at the problem to realise that
prevention of HIV infection is more complex than just giving people education
about the disease or providing resources in the form of condoms or clear
needles. Cultural, racial, economic and gender barriers put people at risk for
HIV infection. As such, HIV programmes turned their focus to 'empowering'
dis-advantaged groups (e.g. women, drug users, the destitute poor)-people who
may be taking risks because of oppressive conditions regardless of what they
know about how the virus is transmitted. Empowerment programmes, for example,
have attempted to address issues related to HIV infection by investigating
cultural taboos regarding sex or those related to the standard of living of
marginalised populations. Even with programmes that acknowledge and address the
complex and social nature of HIV transmission, the epidemic continues to rise.
This article explores ideas about the broad social, political and economic
factors that affect HIV prevention and highlights some ideas about alternative
ways to understand the root cause of the spread of HIV infection.
Linking illness with social conditions of
oppression
Education regarding prevention of HIV infection has
developed from what modern medicine has told us about the characteristics of the
virus. Yet there is an important contradiction in modern medicine. Its
underlying philosophies and research are supported by the advancement of
industrial society despite the fact that industrialisation is an exploitative
practice that creates conditions of poverty and marginalisation. It is an
approach that strives to prevent, treat and cure illness without accounting for
the broader social, political and economic forces that create vulnerability to
disease. This was clearly shown by Engels in his study,The Conditions of
the Working Class in England. There existed an exceptionally high incidence
of disease, including typhus and tubercu-losis, in the working class population
of Manchester. Engels uncovered that the poor health of this population was
directly linked to their position in the emerging industrial society. While
medical research attempted to find cures by focusing on the biology of disease,
Engels noted that overcrowding, poor ventilation, stagnant sewers and polluted
water were the root causes of the problem and the real cure was to improve the
standard of living among this population (1). Similarly, in the case of HIV
infection, a medical perspective assumes that the virus is the agent of disease,
lack of hygiene is the basis of the problem and behaviour modification is the
way to reduce the rates of infection. However, addressing the issue at the level
of biology does not challenge the imbalance of power embedded in political and
economic systems that put people at risk in the first place. People who
participate in high-risk activity often do so under adverse conditions. As such,
HIV infection-prevention practitioners need to incorporate a perspective that
broadens the focus from individual risk-taking behaviour to studying the social
forces that put people at risk. This would assume perhaps that while the virus
is the agent of the disease, poverty and exploitation is the basis of the
problem and resistance to this exploitation is the way to reduce infection.
HIV, industrialisation and
development
One approach to understanding the challenges of
prevention is to understand its relationship with the forces of
industrialisation and development. Until the mid 1990s, HIV infection was
treated as a health issue addressed by AIDS organisations and public health
departments at the local, national and international levels. However, by the mid
1990s, concern was raised that AIDS was not being adequately addressed through
health programming and was put on the international development agenda. As such,
the World Health Organization's Global Programme on AIDS was shut down and
replaced by UNAIDS. The logic behind the marriage of AIDS and 'development' was
made clear: because the epidemic is affecting large populations of young
employable men and women in parts of the developing world, the future survival
of nations and their economies are at stake.
It is commonly believed that industrialisation and
development help to stimulate economic growth, create jobs, raise the standard
of living, and improve the quality of life of people living in so-called
'developing' countries. Thus, proponents of development, such as the World Bank,
suggest that economic stimulation is the way to eradicate the HIV epidemic. I
suggest that the opposite is true-that international forces pushing for
development and industrialisation of the non-industrial world have exacerbated
the spread of HIV and promoted the devel-opment of an HIV-prevention industry.
Lurie et al. (2) examined the impact of the International Monetary Fund and
World Bank structural adjustment policy on risk factors for HIV transmission in
developing countries. They found that structural adjustment programmes required
developing countries to reduce government spending on health and social
services, increase personal income tax, devalue currency, provide concessions to
foreign investors and increase the price of goods and services. Following these
shifts they noted declining sustainability of rural subsistence economies as
economic activity shifted to the export sector, increasing levels of poverty and
landlessness, development of a transportation infrastructure to serve export
economies and increasing urbanisation. These factors have contributed to the
disruption of family life as rural dwellers have left rural areas for the city
in search of employment. The risk of contracting HIV infection has increased
substantially along transportation routes and drug trade has emerged in many
urban centres.
A good example of how industrialisation affects the
spread of HIV infection is the World Bank's Chad-Cameroon Oil Pipeline Project.
Beginning in 1998, this 30-year, US$ 3.5 billion project involves developing
oilfields in southern Chad and the construction of a 1,100 km pipeline to port
facilities on the Atlantic coast of Cameroon. During peak construction, the
project will draw over 2,500 construction workers and truckers to areas where
poverty, prostitution and HIV infection are high (3). While the Bank claims that
the project will provide substantial economic benefits to both the countries,
critics are concerned that the migratory labour force will exacerbate the spread
of HIV/AIDS in the project area.
Given the complexity of the HIV epidemic, powerful
institutions that promote industrialisation are taking a more aggressive
approach to solving the problem. For example, the president of the World Bank,
James Wolfsensohn, recently made an historic appearance before the United
Nations Security Council calling for a 'war on AIDS'. He urged the Council to
allocate more money to AIDS efforts because the epidemic is turning back the
clock on development by increasing cross-border conflict, destabilising
economies and undermining large portions of the labour force. Funds taken from
the Council would be used to develop an 'AIDS technology and surveillance
infrastructure.' The World Bank's approach to prevention relies heavily on
technological advance. Yet Clark and Boyles (4) note that World Bank HIV
prevention programmes are failing to curb the high rate of infection in India
and that funds 'are spent on activities like information and communication and
importing expensive blood banking equipment, most of which is lying unused for
lack of basic infrastructure like a steady power supply'. This approach taken to
solve the problem of the epidemic is far from realistic. However, it allows the
technical industries to profit by developing technologies that promise to solve
the problem. Waring (5) points out that the 1989 Exxon Valdez oil spill, in
which 11 million gallons of heavy crude oil spilled in waters near Alaska,
stimulated the economy through the creation of thousands of jobs to clean up the
mess. Similarly, the clean-up of the AIDS crisis will require more jobs and more
loans. If the World Bank is generating income from the interest of HIV
infection-prevention loans, and if profit is being made off technological
advance in the name of HIV prevention, then money is being made off the backs of
those suffering the effects of the epidemic. How can we be assured that global
development efforts in prevention will be effective if HIV is of value in the
global economy?
In examining the medical basis of prevention of HIV
infection as well as the industrial response to the epidemic, it is clear that
the layers of inequity and of inequitable power relations create vulnerability
and that industrialisation impedes real measures to reduce the rates of HIV
transmission. HIV infection-prevention efforts must incorporate an awareness of
the effects of industrialisation and development and must be aligned with
anti-development movements that are restoring dignity, human rights and power to
marginalised people. It is through resistance to globalisation and development
that communities can reduce their vulnerability and develop immunity to disease.
From this perspective, we can begin to understand what is really needed to end
the AIDS epidemic.
References
1. Singer M. The political economy of AIDS. Amityville, NY: Baywood Publishing, 1998.
2. Lurie P, Hintzen P, Lowe R. The impact of International Monetary Fund and World Bank policies on HIV transmission in developing countries. International Conference on AIDS. 1994;10:443.
3. World Bank Report. Confronting AIDS: Public priorities in a global epidemic. New York: Oxford University Press, 1999.
4. Clark C, Boyles S. India: HIV spreads despite World Bank project. Blood Weekly 1999;11-13.
5. Waring M. Who's counting [videorecording]: Marilyn Waring on sex, lies, and global economics. National Film Board of Canada [Studio B], 1995.
1. Singer M. The political economy of AIDS. Amityville, NY: Baywood Publishing, 1998.
2. Lurie P, Hintzen P, Lowe R. The impact of International Monetary Fund and World Bank policies on HIV transmission in developing countries. International Conference on AIDS. 1994;10:443.
3. World Bank Report. Confronting AIDS: Public priorities in a global epidemic. New York: Oxford University Press, 1999.
4. Clark C, Boyles S. India: HIV spreads despite World Bank project. Blood Weekly 1999;11-13.
5. Waring M. Who's counting [videorecording]: Marilyn Waring on sex, lies, and global economics. National Film Board of Canada [Studio B], 1995.
JUSTIN JAGOSH, School Of Communications, Simon Fraser University, 8888
University Drive, Burnaby, British Columbia, Canada V5a 1s6. E-Mail: Jjjagosh@Sfu.Ca