Evaluation of a development debate - HIV/AIDS - Dr. Reginald Cline-Cole - CWAS Dec 11th

SRN: 513355 Word Count: 1210

	As the UN states, HIV/AIDS represents "the deadliest epidemic in contemporary human history" (cf. Potter et al: 2003, 208). The scale, nature and effects of the plague force us to re-examine many concepts of development theory and practice; those intervening, or choosing not to intervene need to understand what is really happening, as the consequences of misguided actions could be disastrous. For a practice to be consistently successful, the theory behind it needs to be sound. HIV/AIDS serves as a useful example of how development theory often fails to adequately explain what has the past, present and future of the third world. It also demonstrates various debates, disagreements, inconsistencies and contradictions within the academic discipline of development.
	
	A first step towards understanding should be to recognise that many actors, from nation states (Watts), religious organisations (Bradshaw) to multi-national drugs companies (Boseley) appear to influence the spread of HIV/AIDS, by both creating "conditions that have allowed the disease to spread"(Mathiason) and influencing responses to the pandemic. This has led some to label HIV/AIDS a disease of globalisation. The term 'globalisation' is frequently used in contemporary theoretical debates, yet it is a concept that defies precise definition. It is broadly accepted that, to some degree at least "economic globalisation is...a reality" (Giddens: 2001, 30). This alone asserts globalisation's importance in the analysis on the HIV/AIDS pandemic, as economic factors are widely held to be highly significant determinants of an individual, or society's vulnerability to HIV, and its ability to deal with the consequences of AIDS (Barnett & Whiteside 2002). But Globalisation is not just an economic process; according to Kiely (cf. Potter et al: 2003, 126), "globalisation refers to a world in which societies, cultures [and] politics ... have...come closer together". It seems obvious that culture will affect substantially an individual’s response to and interpretation of HIV, and similarly, at a societal level, political decisions have the potential to drastically alter the effect of HIV/AIDS. A contrast between the openness and honesty of Uganda and China's secretive attitude is illustrative here. Uganda has had considerable success in promoting awareness and "demystify[ing] AIDS", consequently reducing HIV prevalence (Potter et al: 2003, 211). However, HIV is also thought to be a serious health issue in China, yet government responses have been characterised by secrecy and "official corruption" (Hilton). In these two examples, nation states are crucial actors in responding to HIV, yet their actions are also driven by global processes and aspirations; Uganda's desire to embrace Western values, such as free-market economics, and resistance of the Chinese government to democratisation (Hilton).

	To understand what actually leads to someone contracting HIV, it is perhaps best to adopt a narrower focus of analysis. In the third-world, the main method of HIV transmission is heterosexual intercourse (UNAIDS: 2003). The decision to have sex, and the choice over whether or not to do so safely, appears to be primarily a personal one. Even if we acknowledge that certain social and economic variables might affect levels of health education and condom availability, personal choice surely remains a major factor in behaviour. Yet, as Campbell (2003) comments, human sexuality is rarely examined insightfully; 'social cognition' approaches have been used to explain people's sexual behaviour, despite an widespread acknowledgement that "the forces shaping sexual behaviour..are far more complex than individual['s] rational decisions" (p.7). This recognition that external factors shape individual behaviour appears to bring the debate back to an analysis of societal, economic and cultural factors. However, Campbell suggests an intermediate focus, a conceptual framework she labels "community level analysis" (p3). This, she argues, is significant not only because it mediates between apparently flawed macro and micro analysis, but also because it provides an opportunity for individuals to address the issue of HIV/AIDS using concepts of participation and ownership.

	Although by no means universally accepted (Cooke and Kothari: 2001), participation has become an important theme in contemporary development sociology. It is argued that by adopting a 'bottom-up', local orientated approach (Potter et al: 2003, 14), a development intervention is able to give marginalized people a sense of 'ownership'; a idea that their actions have broader consequences for the community in which they live. By linking personal behaviour to something both tangible and valued, i.e. the local community, it is held that people will be more likely to protect themselves. It is this theoretical basis upon which many new development interventions are based, but while initial reports seem encouraging (Dunnet & Taylor: 2003), it is perhaps too early for firm conclusion to be drawn.

	HIV was first diagnosed in 1981, and its prevalence in Africa has been well known for almost as long (Cooper: 2002, 109-111). It has to be asked, therefore, why development interventions have taken so long to mobilise. The nature of HIV is of course critical here; with sex as it primary mode of transmission, it is often an intensely personal matter, one which politicians are often reluctant to address directly. The reasons for this are multiple; as the World Bank (1997) comments, "denial...[a] preference for moralistic responses and pressure to spend on treatment, at the expense of prevention" have all mitigated the effectiveness of politicians in confronting HIV. Similarly, it is vital to note that people do not become HIV+ on an equal basis; intravenous drug users, gay men, sex workers and the poor are disproportionately at risk. The same can be said of women, who are more vulnerable biologically, but also culturally; in the sense that they often lack the societal status or confidence to refuse sex, choose a partner or negotiate condom usage. A common feature of these apparently disparate groups is their lack of a influence in politcal decsion making, and as such their inequality is often deepened by an inability to act positively.
	
	There is a third area of HIV analysis that requires consideration: the consequences of HIV/AIDS. A death from AIDS is a personal tragedy, but the effects are not soley private. The death, or prolonged illness, of a family member will place a considerable burden on his kin, as well as colleagues in the workplace. On a larger scale, it is worth pointing out who HIV infects, as it is not the elderly, infants or weak, as is the case with other diseases, but primarily young adults(Barnett and Whiteside: 2000); typically the most economically productive members of a developing society. If a large number of a community’s young, previously healthy members are dead or dying, this might prevent hinder intensive agricultural practices, leading to food shortages. Lastly, HIV prevalence might weaken a society to the extent where it is unable to sustain efforts to provide health and educational services, creating what the African Development Bank calls "a spiral of multiple and mutually reinforcing effects" (1998). Considering this, the truism ‘There are only two kinds of people in Africa — those infected with HIV, and those affected by HIV’ appears depressingly accurate, but it is important to remember the damaging effects of the HIV/AIDS pandemic do not affect everyone in a developing society equally, instead they cripple those already living with high levels deprivation most of all. 

	As I have discussed, many of the issues connected with the spread of HIV are closely linked to our understandings of development theory. In some ways, HIV has been demonstrated the truth behind various development theories; in Marxist analysis of drug companies explotative behavious (Klein)  for example. Yet at the same time, HIV has exposed many weaknesses and limitations within the field of development. To draw from the ideas of Kuhn, perhaps the present era is one which one of a 'paradigm crisis', which is, as Blomström and Hettne (1984, 8) explain, "characterised by a frantic search for a new paradigm". Perhaps seemingly radical ideas such as Campbell's will prove to be useful tools in overcome the problem of HIV, and consequently assert themselves as dominant features of development's theoretical landscape. Perhaps adequate responses will not be so easy to find, and good-intentioned interventions will continue to flounder, lacking a coherent basis. For now, we must accept that it is too early to judge the eventual outcome of this on-going disaster, one that, terrifyingly, might be only in its infancy. 

Bibliography

African Development Bank 2003 African Development Report 1998 [http://web.worldbank.org/ WBSITE/EXTERNAL/EXTABOUTUS/0,,contentMDK:20040614~menuPK:41699~pagePK:43912~piPK:44037~theSitePK:29708,00.html] Multilateral Development Banks

Barnett T & Whiteside A 2000 Guidelines for Studies of the Social and Economic Impact of HIV/AIDS [http://www.unaids.org/html/pub/Publications/IRC-pub01/JC326- Guidelines_eng_pdf.htm] UNAIDS

Barnett T & Whiteside A 2002 AIDS in the Twenty-first Century - Disease and Globalisation. London: Palgrave Macmillian.

Blomström M & Hettne B 1984 Development Theory in Transition. Zed Books: London.

Campbell C 2003 'Letting them die' - Why HIV/Prevention programmes fail. Oxford; Bloomington & Indianapolis; Cape Town: James Currey; Indiana University Press; Double Story.

Cooper, F 2002 Africa since 1940: the past of the present. Cambridge:Cambridge University Press.

Cooke B & Kothari U 2001 Participation: The New Tyranny. Zed Books: London

Dunnet C and Taylor B 2003 Key CRP Outputs 2003.  [http://www.spwtz.org/cprprogrogimpact.htm] Students Partnership Worldwide: Iringa

Giddens A 2001 The Third Way - The renewal of social democracy. Cambridge: Polity

Potter RB, Binns T, Elliot J, Smith D 2003 Geographies of development – Second Edition. Harlow :Prentice Hall.

UNAIDS 2003 Expert Group Stresses That Unsafe Sex Is Primary Mode Of HIV Transmission In Africa. [http://www.uniaids.org/html/pb/Media/Press-Statements01/HIV_Injections140303_en_doc.htm]

World Bank 1997 Confronting AIDS: Public Priorities in a Global Epidemic. University Press: Oxford
Guardian Articles
Bradshaw S 2003 Vatican: condoms don't stop AIDS [http://www.guardian.co.uk /international/story/0,3604,1058966,00.html]

Boseley S 2003 Show them the money [http://www.guardian.co.uk/analysis/story/0,3604,.html]

Hilton I 2003 Killed by Corruption [http://www.guardian.co.uk/aids/story/0,7369,1076544,00.html]

Klein N 2003 Bush's Aids 'gift' has been seized by industry giants [http://www.guardian.co.uk /comment/story/0,3604,1061634,00.html]

Mathaison N 2003 Companies 'undermining global fight against HIV' [http://www.guardian.co.uk/ aids/story/0,7369,1085979,00.html]

Watts J 2003 Hidden from the world, a village dies of AIDS while China refuses to face a growing crisis [http://www.guardian.co.uk/aids/story/0,7369,1070799,00.html]