The Global Sociology Blog

Looks like she was right (not that I had much doubt about that)… check out this item from the Guardian regarding the relationship between social stigma and HIV prevalence:

"HIV infection rates are rising around the globe because many governments do not want to help high risk groups such as drug users, prostitutes and gay men, the International Red Cross said today.

Discrimination against these groups and the stigma associated with HIV and Aids has led to politicians in many regions, particularly Asia and Latin America, being unwilling to fund programmes to prevent the spread of the disease, the world’s largest humanitarian agency said."

This was reported in the World Disasters Report 2008, published by the International Federation of Red Cross Red Crescent Societies. The report does make a distinction between patterns of infection in Sub-Saharan Africa and other regions. Here is something that should make Elizabeth Pisani happy since it seems to be what she recommends in her book, The Wisdom of Whores: as the report states,

"“We need smart money and not necessarily always more money” asserts Dr Mukesh Kapila, Special Representative of the International Federation, and the co-chair of the Red Cross Red Crescent Global Alliance on HIV. “The rhetoric of good donorship and good partnership must be fully implemented. Tied aid and earmarked aid which is frequently expensive, short term and ill-adapted to local needs must be reduced further. Funding for HIV needs to be evidence-based and results-driven. It must reach those who need it more quickly and more fully. Doing any less will continue to cost lives."

The report recognizes that some programs have been on the wrong targets precisely because there is no political reward to be had in focusing on stigmatized populations such as prostitutes and drug users. It is much more popular to focus on expensive programs for immense populations perceived to be "innocent victims" such as women and children (I am not putting quotation marks because women and children are not innocent but because the very category of "innocent victims" is stigmatizing and analytically, and I would add, epidemiologically nonsensical). As the report states, too much money is spent on the wrong targets, and not enough dealing with what Elizabeth Pisani considers the right targets: sex and drugs.

Furthermore, the report, like its predecessor, focuses on the interaction of stigmatized populations (people living with HIV/AIDS) and disasters, natural or man-made. As the Guardian states,

"It also found that people with HIV were often those hardest hit by natural disasters and war because they were left unable to access medical care.

The situation was worst in southern Africa where at least one in 10 adults are now living with HIV, with some countries predicted to risk becoming subsistence economies within three or four generations.

David Andrews, chairman of the Irish Red Cross, said: "HIV/Aids is the disaster that keeps on killing. Day after day, families are destroyed, economies wiped out and communities crushed as economies disintegrate, parents die and children are born with the disease.

"We must grasp the enormity of a disaster that has already killed 25 million – more than a hundred times the number of people killed by the tsunami, our biggest single natural disaster in living memory."

Again, that is the pattern for Sub-Saharan Africa but not for other regions, especially not for Southeast Asia where the epidemic is not as widespread in the general population. Although some of the solutions mentioned in the report would probably make Elizabeth’s blood boil, for instance:

"“The HIV and AIDS epidemic is a disaster whose scale and extent could have been prevented. Ignorance, stigma, political inaction, indifference and denial all contributed to millions of deaths,” explained Lindsay Knight, editor of the World Disasters Report . “The Report dispels myths about those ‘other’ people who spread HIV – refugees, migrants, people escaping from conflict and poverty. We must all do much more to eradicate stigma. It is also important to recognize that addressing HIV requires a longer-term reaction than the usual response to emergencies but that it also provides an opportunity to build resilience and empower communities, ” she added.

Fighting bureaucracy, simplifying procedures, improving coordination, confronting gender inequalities, and involving local communities including, especially, people living with HIV – are among the solutions offered by the Report, to improve the effectiveness and efficiency of HIV programmes."

Emphasis added. This is the kind of talk that she found annoying because it is not specifically related to fighting and preventing HIV/AIDS. There is no other disease where the affected population is consulted on prevention and treatment programs. This kind of talk waters down HIV/AIDS prevention into wishy-washy development issue. No one denies that development and disease are related but doing so in this fashion again, evacuates the specific focus that should be front and center: sex and drugs. And Pisani has a special chapter in her book regarding the focus on gender inequalities.

At the same time, this report has to be read with its audience (donors) in mind, and here again, focusing too much on prostitutes, their johns and drug users is not very popular. So, common sense considerations are diluted with development talk that makes everybody feel less uncomfortable.