|The HIV Epidemic and Sustainable Human Development (UNDP, 1998, 13 p.)|
|B. WHAT IS THE RELATIONSHIP BETWEEN THE HIV EPIDEMIC AND SHD?|
One of the objectives of SHD is to bring about a wider participation of civil society in the processes of decision making. Or, to put it differently, SHD aims to strengthen social capital through activities which build capacity in institutions and through changes in values that support wider participation by all groups in social decision making. Central to achieving this are policies for greater democracy, more open and accountable systems of governance, and increased authority for those who have responsibility for ensuring that human and legal rights are observed by all. Of course the gap between aim and actuality is presently huge, and many countries in the Asia Region are a long way from achieving the ideal in these respects. Indeed there is continuing dispute in some countries as to whether there are natural and intrinsic rights, with some leaders arguing that there is no such thing. Whether or not there is something that can be described as natural rights which are common to all is not central to our present concerns, important though it undoubtedly is to socio-economic progress in the Region.
What is central to our present concerns is whether the HIV epidemic has created conditions which have moved countries closer to the ideals of SHD or the opposite. The evidence here is, however, very mixed. In many countries in the Region the HIV epidemic continues to be seen as a health problem and responsibility resides still with Ministries of Health. It follows that the epidemic has continued in many places to be viewed as part of the normal response to infectious diseases - to be addressed within the traditional framework of laws and regulations, and utilising traditional health approaches. Indeed in many countries the initial response to the epidemic has been often to seek out ways of applying the law as if using the law as a threat was an appropriate response. Central to this approach is a conceptualisation of the epidemic which sees the problem as one of "core groups" who engage in anti-social and reprehensible behaviours. The aim of policy is to identify these "core groups" and to implement policies and programmes that will change their behaviour. Essentially the approach has been, and in many countries continues to be, one which is the opposite of inclusive - it defines a problem and then seeks to impose a solution.
The problem is perceived as being not the virus but people, and the processes followed are in most countries those traditional to public health programmes. Of course this is not true everywhere in the Region, and Australia is a remarkable example of how to develop a new consensus within society of what the problems are, how to build social capital, and how to develop policies and programmes which are genuinely participative and inclusive. Moreover such policy and programme development can, and should, involve those infected and affected by the HIV epidemic. To achieve these desirable objectives - of inclusion and participation - requires the development of an enabling framework of laws which are supportive of an effective response to the epidemic. It means establishing a set of principles of action for programme activities which ensure that these are based on collaborative processes and are not simply implemented and imposed by Government.
Paradoxically the HIV epidemic has the capacity to make the processes which are considered essential to the achievement of SHD more rather than less achievable. For while the initial response to the epidemic in most countries is, and continues to be, one which is inappropriate (to put it mildly) to what is required for an effective response, there has been in time in some countries a realisation that things have to be done differently. In a real sense the epidemic poses problems which cut across class and interest group identity. It threatens social and economic development, and may yet undermine political stability. Thus in an increasing number of countries, and also at a regional level, there now exist NGOs and networks of PLWHA, legal and ethical and human rights networks, and support groups for those affected - admittedly still too few but it is a start. Some Governments have come to a realisation that they have to broaden their response to the epidemic and this has to involve the rest of civil society - along the way understanding that strengthening the capacity of NGOs and CBOs and involving these in policy and programme development is the only way forward. There still remains a big distance to travel, but the road ahead has begun to look much clearer than it was even 5 years ago.
While policy and programme responses in the region have initially represented a retreat from the inclusive principles of SHD, in some countries there is now a gradual realisation that an effective response requires the active participation of civil society. Paradoxically the HIV epidemic has created a need and an opportunity for innovative approaches to governance which make the processes needed for SHD more attainable rather than less so. But there remains a large gap between those countries that have responded effectively through building social capital and those that have yet to do so.