The Pattern of Response to HIV/AIDS and Climate Change -- A Commentary

Almost three decades into the HIV/AIDS pandemic, there is still widespread stigma, denial and government inaction. There are reports of rising rates of infection in the Western industrialized nations and concerns about the possibility of explosive epidemics in the Asian block; yet sub-Saharan Africa, with less than 15 per cent of the world's population, remains at the epicentre of the epidemic, with over 70 per cent of the infections worldwide.

Given the amount of time and energy devoted to AIDS, it is sobering to ask why this should be the case. Starting with the World Health Organization's Global Programme on AIDS which developed into the Joint United Nations Programme on HIV/AIDS (UNAIDS), there has been, almost since the start of the epidemic, a very high-level, globalized response: biannual international AIDS conferences which attract over 10,000 people; regional AIDS conferences and many related conferences on drug use, sexuality and public health; a UN General Assembly Special Session in 2001; regional government meetings resulting in declarations and statements of intent; a range of donors funding HIV/AIDS-related work around the world; and a seemingly endless range of training manuals for education, prevention, community care and support, gender equity, treatment and care.

High-level meetings are held to ensure that Governments are held accountable and that populations are able to respond effectively. Prominent people are asked to endorse campaigns, be tested for the virus, disclose their status, and lead the fight against HIV/AIDS as well as AIDS-related stigma and discrimination.

And yet, despite all this energy, dedication and commitment, in many parts of the world infection rates are rising, communities are dealing with high numbers of death and suffering, families are affected by the death of young people, and millions of youth face an uncertain future due to the death of their parents, siblings and relatives. The provision of treatments seemed to herald a new era in HIV/AIDS, and drugs have been promoted as the best option for "prevention". Today, as the expected success of voluntary counselling, testing and treatments has not materialized, there is the push for male circumcision and for an end to concurrency in sexual relationships.

HIV/AIDS is one of the most fascinating social issues of our time. It has bred in the existing fault lines of society and exposed new ones. Old tensions in society that have been tolerated or hidden have been exposed. The reality of gender inequality and patriarchy and the abuse and exploitation of young people have been exposed; the lack of food, housing, education, health care and access to medications have been exposed. The pandemic has also starkly highlighted the inequality as well as the hypocrisy of societies and global political relationships.

HIV/AIDS has, in many instances, shown how difficult it is to make democracy and accountability effective, how culture and cultural practices collude with the epidemic and fuel it, and how corruption permeates through all societies, whether rich or poor. The pandemic has opened a new form of neo-colonialism as donors and UN agencies patronize the developing world about bad governance and offer technical support and funding.

UN agencies and many donors are, however, caught in a bind. They want an effective global response, but they also have to recognize that it may fail precisely because a global response oversimplifies the pandemic and the societies that suffer from it. Often, these outside groups define not only the pandemic but also the societies in which they are working. They tend to frame the pandemic in generalized ways, giving money for specific projects that they alone define, evaluate and lead, and which they believe best suit the people living in that society.

These interventions may indeed mitigate the present situation and may also lead to some long-term social and political changes, but they cannot address the root causes of poverty and disease which are deeply ingrained in post-colonial heritage, international political relationships, entrenched global inequality and a failure to respect human rights.
The HIV/AIDS pandemic grows from and contributes to poverty, hunger, exploitation, migration, lack of education and a failure of political will and imagination. In most cases the reaction to the pandemic has been to describe "what is" and to find attempts to manage the existing status quo and protect it from anticipated effects. Rather, our reaction should be to actively seek out "what could be" and find ways to challenge and change the status quo into a future that looks at new social, community and family formations, new ways of understanding sexuality and human rights.

We are seeing exactly the same patterns of response to climate change, which are the consequences of a lack of social and political integrity in the dominant world economic and political order. Just like HIV/AIDS, climate change has attracted many nations and the UN to develop protocols and adopt declarations. People are exhorted to change their behaviour with dire warnings and predictions of calamities.

The spread of HIV/AIDS and the impact of climate change have many things in common. People with the least amount of resources are affected most. There is also a lack of political will and the technical capabilities to contain either calamity. Third, even if people are included in mitigation, decisions will be made for and about them. Communities often cannot act on declarations and protocols because in reality they are unable to carry out the good intentions of the policy makers. Fourth, just as HIV/AIDS exacerbates poverty, gender vulnerability, exploitation of children, and access to health care, so too may climate change heighten social dislocations.

Many people migrating from oppressive regimes and poverty, seeking a better life, may be joined by "climate refugees", and wealthy nations may find ways to deny them entry. Like with HIV/AIDS, people are looking for ways to protect and strengthen the status quo from the impact of climate change, rather than creating a fundamentally changed world, with an intellectual curiosity that will allow us to devise new ways of living.

In large measure, the inability to stem the spread of HIV/AIDS and deal effectively with pressing social and health needs has come about because of a lack of emphasis on good research. Social science research was needed so that we could understand the effects of race, class, culture and gender in societies in which the epidemic was playing itself out. Impetus on social research has been swept aside in the need for quick fix solutions and for Governments to preserve existing political relationships as we know them.

HIV/AIDS and climate change may radically and fundamentally alter the world, and yet we cling to the existing world order, without investing the time and money to foster critical research into the issues that both the epidemic and global warming raise. We seek easy solutions and lock complex issues into neatly packaged sound bites and politically correct clichés. We have not produced critical insights into how diverse societies and power operate, and we have not produced viable and innovative ways in which political systems might change.

Beyond the declarations and the rhetoric, there needs to be good, critical, stimulating research in both fields that will allow societies to imagine a new, challenging and attainable future. Just as we need to think ahead to tackle the fall out from HIV/AIDS, we need to think quicker than climate change.