AFRO-NETS> An alternative approach to AIDS

[Claudio Schuftan <aviva@netnam.vn>]

An alternative approach to AIDS
-------------------------------

From: "Alison Katz" <katzalison@hotmail.com>

Here below an article published as 
'AIDS, individual behaviour and the unexplained variation'
African Journal of AIDS Research 2002, 1: 125-142

The abstract is enclosed; the full version can be had directly from 
Alison.

The paper makes the point that individual sexual behaviour cannot 
possibly explain the epidemics. It points to the possible role of 
malnutrition and co-infection through their devastating effect on im-
mune function as root causes of high transmission rates in poor popu-
lations. I have for long despaired over the neoliberal, individualis-
tic possibly racist approach to AIDS which has had virtually no im-
pact on the epidemic. The international health community must ac-
knowledge the failure of the response so far and be prepared to look 
at alternative explanations and approaches.

Many thanks 
Alison Katz
mailto:katzalison@hotmail.com

--
Abstract

 From the start of the AIDS pandemic, individual behaviour has been 
put forward, implicitly or explicitly, as the main explanatory con-
cept for understanding the epidemiology of HIV infection and in par-
ticular for the rapid spread and high prevalence in sub-Saharan Af-
rica. This has had enormous implications for the international re-
sponse to AIDS and has heavily influenced public health policy and 
strategy and the design of prevention and care interventions at na-
tional, community and individual level.

It is argued that individual behaviour alone cannot possibly account 
for the enormous variation in HIV prevalence between population 
groups, countries and regions and that the unexplained remaining 
variation has been neglected by the international AIDS community.

Biological vulnerability to HIV due to seriously deficient immune 
systems has been ignored as a determinant of the high levels of in-
fection in certain populations. This is in sharp contrast to well 
proven public health approaches to other infectious diseases.

In particular, it is argued that poor nutrition and co-infection with 
the myriad of other diseases of poverty including tuberculosis, ma-
laria, leishmaniasis and parasitic infections, have been neglected as 
root causes of susceptibility, infectiousness and high rates of 
transmission of HIV at the level of populations.

Vulnerability in terms of non biological factors such as labour mi-
gration, prostitution, exchange of sex for survival, population move-
ments due to war and violence, has received some attention but the 
solutions proposed to these problems are also inappropriately focused 
on individual behaviour and suffer from the same neglect of economic 
and political root causes.

As the foundation for the international community's response to the 
AIDS pandemic, explanations of HIV/AIDS epidemiology in terms of in-
dividual behaviour are not only grossly inadequate, they are highly 
stigmatizing and may in some cases, be racist. They have diverted at-
tention from poverty and powerlessness as root causes of vulnerabil-
ity to infection and as such they are a waste of scarce resources.

A return to a basic needs approach to all the diseases of poverty is 
nothing more than proven public health wisdom and experience. A sus-
tainable and meaningful response to AIDS is simultaneously a sustain-
able and meaningful response to all the diseases of poverty.

The obstacles to the adoption of this approach are economic and po-
litical and must be confronted at the level of international finan-
cial institutions, the globalization of neoliberal economic systems, 
the growing power imbalances between and within nations and the un-
dermining of democracy and national sovereignty.

An alternative strategy for AIDS and the other diseases of poverty 
would build on macroeconomic reforms for a fair, rational and sus-
tainable international economic order so that democratically elected 
governments may meet their people's basic needs, including health, 
without external interference.

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