|AIDS in the Context of Development (UNAIDS - UNRISD, 2000, 77 p.)|
Since the beginning of the pandemic, over 50 million people have become infected with human immunodeficiency virus (HIV); about 34 million are living and over 18 million have died from acquired immunodeficiency syndrome (AIDS). HIV infects an average of 15,000 persons a day, about 10 every minute. Almost 95 per cent live in developing countries. The proportion of women getting infected is becoming more and more significant - with 55 per cent of the infections in sub-Saharan Africa in 1999 occurring among women.1
1 Data from UNAIDS.
Every year the disease takes new directions. South Africa now has the fastest growing epidemic. The number of HIV-infected people is rapidly increasing in Asia - India alone has over 4 million people living with HIV/AIDS, the largest number in any single country. In Eastern and Central Europe the epidemic is concentrated in risk groups, such as intravenous drug users, with subsequently alarming HIV rates.
From the late 1980s onward, infant mortality has seen an unprecedented increase in some countries through transmission from mother to child. The consequence of increased deaths of young people in some countries of Africa has been to decrease life expectancy at birth by 15 to 20 years in southern Africa, and 5 to 10 years in other parts of sub-Saharan Africa,2 effectively wiping out decades of effort toward development in these countries. Infection rates are particularly high among young adults - who constitute the bulk of the workforce and of the current generation of parents.
2 Healthy Life Expectancy, WHO, 2 June 2000.
Against this reality of a rapidly spreading epidemic in many countries, some two decades of prevention interventions have met with limited success. Whatever successes there might be are not to be lightly dismissed. The reasons for the successes, however, are not well understood and thus not readily applicable elsewhere. To date, most prevention efforts have focused on increasing individual awareness about risks of transmission and promoting individual risk reduction through a variety of means. Far less attention has been given to either understanding or designing prevention programmes in light of the social and economic context in which individuals live. It is commonplace for HIV/AIDS programme managers to acknowledge poverty as a causative factor, but to then say that poverty is beyond the scope of their programmes. Analyses hardly exist of the causes and manifestations of impoverishment as factors contributing to HIV/AIDS transmission. Thus, there is little conceptual or programmatic guidance for moving beyond the simple acknowledgment of poverty as a contributing factor in HIV/AIDS risk.
This paper discusses HIV/AIDS not as an isolated disease event, controllable through individual actions. Rather, it looks at HIV/AIDS in a socioeconomic, historical and political context. We argue that economic and social changes over the past three decades, in particular, have created an enabling environment that places tens of millions of people at risk of HIV infection and makes effective governmental and non-governmental responses more difficult.
At the same time, there is substantial analysis from development studies on which to draw in designing socially relevant HIV/AIDS prevention and care programmes. Also, numerous local initiatives provide substantive learning models for blending HIV/AIDS into a wider developmental context that can sustain an enabling environment for improvements in social welfare, including reducing the risks and impacts of HIV/AIDS.
Despite the relatively lengthy bibliography in this paper, the reality is that very few researchers have focused on the socioeconomic dimensions of HIV/AIDS. In order to encourage more such research, we have suggested a number of topics for further study and discussion.