HIV/AIDS and the impact on development

Discuss the extent to which HIV/AIDS has had an impact on development.

The HIV/AIDS pandemic can be pinpointed back to 1981 when the first cases of the disease were reported by the Centre for Disease Control and Prevention (CDC) in Los Angeles, USA (AIDS.gov 2014). As Dossier (1992) explains, a meeting in France in 1987 brought together leaders of development assistance agencies where it was discussed how the disease had the potential to threaten many Third World development achievements. As it can be seen, HIV has been a major factor to consider in the field of development since it was first discovered in the 1980s. Therefore, I will argue how the spread of HIV/AIDS has become one of the greatest challenges to development in developing nations, not only in terms of a “health risk”, but as something which has found it’s in way into every area within the field. It is undeniable that HIV/AIDS has had a very important impact on development. To argue this case, I will directly refer to a study by Maxine Ankrah of Uganda’s Makerere University as quoted by Dossier (1992, p.48), where it is argued 5 areas of need have been created as a result of HIV/AIDS; 1) medical care, 2) basic food and housing plus income or economic assistance, 3) accurate information and health education, 4) HIV testing opportunities for spouses/regular partners, and 5) psychological and social support. It is within these 5 areas that I believe HIV is having the biggest impact on development. As well as this, I will empirically analyse development as a process to suggest how HIV/AIDS provides a different problem for development than other basic human needs, and the role in which women have played in the pandemic.

HIV/AIDS risks the development of healthcare

First of all, the pandemic is essentially a concern for the development of healthcare in developing nations. One of the greatest problems to providing healthcare has been the difficulty in ensuring essential medicines for all, especially on an affordable, sustainable basis (Barton, 2013). According to the World Health Organization (2004) “about one-third of the world’s population still has no regular access to essential medicines”. Although many academics provide much theory and research into why essential medicines has been so difficult to achieve for all, it is not disagreed on that the problem is something which looks achievable. However, much of the discussion into how we can provide medicines for all has now been greatly affected by HIV/AIDS, which now central to the debate, is something of a major obstacle to those working for the development of healthcare. It appears than in order for development to be a success, providing treatment for those with HIV/AIDS is of pivotal importance. Flint and Payne (2013) argue how a HIV free generation is a realistic possibility, but will only be achieved through mounting a serious challenge to the World Trade Organization on intellectual property rights for drugs (patents). As outlined in the TRIPS agreement 1994, “when a pharmaceutical company first markets a drug, it is usually under a patent that allows only the pharmaceutical company that developed the drug to sell it” (News Medical, 2014). This has directly led to inequality amongst HIV victims with only the richest able to afford the best medication to fight the disease. An evident example of this is explained by MSF South Africa (2009), who describe how there are only 2 lines of ARV therapy in the country, whereas victims in the UK have the choice of 24 different lines of therapy. It is apparent that patented drug laws have become extremely problematic across the development of healthcare, however there is vast evidence to support the view that laws restricting the widespread use of the very best HIV medication are the biggest area for obstructing development. The level of impact here is very opaque; HIV/AIDS is threatening the healthcare of nations, because as part of the international protection on pharmaceutical drugs, getting treatment to the most deprived areas has been a great challenge due to the unaffordable and unsustainable costs of the different lines of therapy.

HIV/AIDS – grassroots or top down decision making?

Moving onwards, International Development is seen as a global problem, and in an ever-increasing globalized world, is also seen as something which can be tackled globally. Statements like this appear straightforward and unquestionable, especially with institutions like the UN writing the Millennium Development Goals in order for development to progress with a targets approach (UN, 2014). The impact of HIV/AIDS cannot be denied as anything but a serious, top priority for development, with the central concern of MDG 6 to “combat HIV/AIDS, Malaria, and other diseases”. Nonetheless, speakers at a recent International Development Conference discussed how a community driven approach is much more beneficial for development. Hook and Wynne (2014) comment on how their NGO ‘Temwa’ (a project fighting HIV in Malawi) “don’t incorporate the MDGs in their goals because there is no need, with people in Malawian communities having never heard of them, and cooperative government officials never mentioning them when talking about development”. Their community driven projects are all about listening to the community, involving them at the heart of their projects with the idea of only helping them in areas which they want the help. Other talkers, such as Slujis-Doyle (2014) also promote the theme of community driven approaches, promoting the idea that it is a grassroots approach and not top down decision making which is the most effective form of development in the poorest areas of the world.

This has a bigger impact for HIV/AIDS then it appears. Dossier (1992, p.46) explains how the disease is often called the “family disease” in some parts of Africa. HIV is first and foremost a sexually transmitted infection, and thus, the virus predominantly attacks the sexually active. However, because of the long incubation period, young men and women with the disease can have no idea that they are carriers, so can pass it on to their partners and children before they are even aware. Henceforth, HIV can be seen as a “family disease”. The implications of this are apparent in that culturally, there is a strong, negative stigma against people with HIV/AIDS in many parts of Africa. And even if there are family members who are HIV free, the stigma is still attached to the whole family. When someone falls ill of any disease in developing countries, most particularly in rural areas, the burden lies heavily on the extended family for assistance in coping, such as labour, care, food, or even just basic economic support. Because of the longevity in the nature of HIV, the cultural stigma, and the fact that it can easily affect the whole family, it has resulted in coping mechanisms being strained to the point of collapse, especially as the greater number of households affected by the disease in any community increases, the strain on wider social coping systems can become ‘too heavy’. With much development assistance coming from a global level and treated as a global problem, the sheer process and nature of many top institutions like the UN results in a less efficient, limited method of development. As Hook and Wynne, and Slujis-Doyle (2014) explain, unless a community driven approach is taken, which will consider the culture and traditions of each community, combatting a disease as threatening as HIV will always limit the amount of development which can be made. This is not a closed minded opinion, with sufficient evidence available to support the view. Working alongside Purple Field Productions, Temwa released the video “People Like Us” (Purplefieldonline, 2008) to highlight the changing views of HIV in Northern Malawi. Since 2009, Temwa has tested 9,000 people positive for HIV in Northern Malawi (Temwa, 2014) and it is statistics like this which further strengthen how a community based project has successfully been able to work alongside culturally rich deprived areas to try and eradicate the disease from these rural communities. Establishing social solidarity has taken a long time, but it is something achieved quicker than most of Africa, where communities still hold a negative stigma towards HIV sufferers, such as the ignored prevalence by truck drivers and sex workers along the trucking routes in southern Africa (beattheZOG, 2009). Additionally, Dossier (1992, p.49) explains that when more individuals and households within a community are affected by the disease, “discrimination can give way to greater understanding and willingness to give support, with communities functioning more cohesively as death becomes a more ‘commonplace’”. It is evidence like this which suggests that the impact of HIV/AIDS on development has been hugely significant because of the problems it has intensified for development processes in the 21^st century. Due to the sheer nature of the disease, the disease has been treated as a pandemic when being combatted, henceforth globally. Community work has since then gone to show that if the disease is treated as an epidemic, looked at differently from the perspective of each different community or village, success rates in eradicating and supporting people has been higher. And so it can be summarised that HIV/AIDS is creating an even more significant obstruction to development than first appears because the disease limits the capabilities of international institutions to effectively and efficiently fight it.

Women and HIV/AIDS

Gender inequality is a very important issue to institutions across the world, none more so than for developing nations. The inequality in different roles of males and females is still a pressing issue in the wealthy west, yet for those in the developing world, great strides are required to reduce the gap between men and women, with extreme patriarchal societies and communities throughout the developing nations. The role HIV/AIDS has had to play in this disparity has been substantial, with the disease aggravating gender inequality on a global scale, but rather dangerously for poorer, more deprived areas. All over the literature, many commentators discuss how young women are the most at risk of HIV, for example, Grundfest-Schoepf (1993) argues that “more than 90% of women whose major source of subsistence comes from the sale of sex to multiple casual partners are reported to be infected with HIV in several cities in central and east Africa; not surprisingly, young women are at highest risk for AIDS” (pp. 52). She later goes on to mention how discourse about women and AIDS in Africa is amplified by ‘racialist constructions of African sexuality’. The implications of HIV/AIDS and women for development is monumental as it provides yet another barrier for the exclusion of gender based inequalities.

As previously discussed, the disease is first and foremost a sexually transmitted infection, and so the role that sex plays in developing communities is of primary concern. The suggestions made by Grundfest-Schoepf (1993) to do with prostitution in central and east Africa, as well as the earlier mention of sex work along the trucking routes in southern Africa, expose one of the greatest inequalities of gender. Prostitution mostly operates in a way of which women sell themselves to casual partners for immediate cash in order to live. The men are willing to pay and most men will pay more in order to have sexual intercourse with these women without the use of a condom. Naturally, it is too much of a tempting offer for these young women to refuse, as they are doing so in order to live. This sexual manipulation of young women poses an even greater threat to their health, with the risk of catching or transmitting HIV at maximum level. Robin Gorna (beattheZOG, 2009), a senior health and AIDS advisor for international development in southern Africa, explains how it is extremely hard to change pleasurable behaviour, especially when looked at from a western perspective through studies in smoking, eating and drinking. She says how sex is not separate from this, and especially in southern Africa, where it is a cultural, economic norm to have sex with many different casual partners. This is where prostitution differs from that in developed countries, where paid for sex is seen as a commercial interest. But because it is so difficult to change people’s behaviour, particularly pleasurable behaviour, many individuals don’t want to see the negative consequences of unprotected intercourse. With the added dimension of a long incubation period for HIV, the spreading of the disease is still rife throughout developing communities. And therefore, this is putting the greatest risk at the young women selling their bodies in order to feed and clothe themselves and their children. With intensive labour still male dominated throughout developing nations, gender inequality is an issue at the top of the agenda. Because it is such a challenge to change individual’s behaviour, gender inequality is something of even greater importance because of the way in which it is perpetuated by the HIV/AIDS pandemic. Hypothetically arguing is never the greatest way to explain a situation, but it is extremely probable that even if HIV/AIDS didn’t exist, sex work would still be as great a problem, if not greater, for development as a gender based issue. Nevertheless, the fact that HIV/AIDS does exists means that sex work has this added dynamic of being highly secretive. Berer (1993, ‘dedication’) is quoted as saying that:

“women should be treated with respect, integrity, and care, no matter how many partners they have had… whether the experience is positive or negative, women are taught not to reveal it… perhaps if women begin to name experiences openly, they will help each other to find the strength to value themselves and their needs more, and will take more pride in themselves as women”.

What can be taken from this quote is that sex work wherever, but mainly inside developing nations, is threatening the chances of women to ensure gender equality. Women still act as men tell them to, and with something like sex, men are still being able to manipulate women. HIV/AIDS results in further restrictions for women to break out of their situations, especially because if these women do fall victim to the disease, they are limited in their abilities to do much else for help. If they open up about sexual experiences, or tell the men they sleep with they have HIV, then the men do not want to sleep with them. And as has been mentioned, these women do not choose sex labour, they are forced into these roles if they want themselves and their children to survive.

In summary, the exploitation of women in developing nations is a pressing matter. It is something that is being taken seriously by top organizations such as the UN, with MDG 3 being to “promote gender equality and empower women”, but with HIV/AIDS in the mix as well, millennium development goals such as this are difficult to work towards because of the further restrictions and limitations the disease provokes. And so consequently, the extent to which HIV/AIDS is having an impact on development is huge because of the way in which it prevents gender equality.

Conclusion

In conclusion, the main points of discussion have been healthcare, development processes, and gender inequality. What they have all contributed to is the argument that HIV/AIDS has had a significant impact on development. The health risks associated with HIV/AIDS mean that the healthcare of AIDS sufferers poses an even greater challenge to the development of healthcare systems across developing nations, as well as the fact that patented drug laws have restricted the abilities of developing nations to cope with each and every HIV epidemic. Moving on, the processes through which development has been a factor have also had repercussions for development itself. HIV/AIDS has been treated in an ineffective manner, so it has further restricted institutions like the UN in their abilities at developing the most deprived. And finally, gender inequality has proved to be a stumbling block for development because of the way in which sex and HIV are culturally problematic for developing many regions. Nevertheless, it still seems apparent that despite all of these negativities associated with HIV, there is the rather controversial opinion of some that actually HIV has provided a scope for which development has been able to spread further rather than limit it. This opinion sits on the basis that because the disease is a pandemic and can affect anyone regardless of age, gender, ethnicity, race, sexuality, class, culture and so forth, those with the social and economic means in the developed world have been more willing to help those with the disease in the developing world because it is something which anyone and everyone can relate to. Yet in argument against this, I would say that malnutrition, dehydration and such are just as pressing matters for development, but in fact, everyone can relate to that. A HIV free world would not reduce the social and economic support for development. In fact, because of the points mentioned associated with health, communities, and gender inequality, a HIV free world would actually make development a lot easier. And so, I thereby conclude that HIV/AIDS has had a massive, negative impact on development to an extent far greater than anyone could have predicted upon its discovery in 1981.

References

AIDS.gov (2014) A Timeline of AIDS. Available at: http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ (Accessed: 1^st March 2014)

Barton, C (2014) ‘What is meant by ‘Medicines For All’ and how important is it?’ SPOL20055: Health Policy in a Global Context. University of Bristol. Unpublished essay.

BeattheZOG (2009) African Prostitutes Work Knowing They Have AIDS. Available at: https://www.youtube.com/watch?v=nejZuRbR-os&feature=related (Accessed: 20^th February 2014) (Upload Date 1^st Aug 2009).

Berer, M. (1993) Women and HIV/AIDS: An International Resource Book. London: Pandora Press

Flint A and Payne J. (2013) ‘Intellectual Property Rights and the Potential for Universal Access to Treatment: TRIPS, ACTA and HIV/AIDS medicine’. Third World Quarterly. 34 pp. 500-515.

Grundfest-Schoepf, B. (1993) ‘The Social Epidemiology of Women and AIDS in Africa.’ In: Berer, M. Women and HIV/AIDS: An International Resource Book (eds). London: Pandora Press (pp. 51-53).

Hook, J., Wynne, S. (2014) Bristol International Development Conference: Fighting HIV and AIDS – A Community Driven Approach.  University of Bristol, Bristol, 8^th March 2014.

MSF South Africa (2009) Access to essential medicines – World AIDS Day. Available at: http://www.youtube.com/watch?v=IntAjNVRjhQ (Accessed: 27 November 2013)

News Medical (2014) “Drug Patents and Generics” Available at: http://www.news-medical.net/health/Drug-Patents-and-Generics.aspx (Accessed: 23^rd November 2013)

Purplefieldonline (2008) People Like Us – TRAILER. Available at: https://www.youtube.com/watch?feature=player_embedded&v=kVKv4SUL0iA (Accessed: 9^th March 2014)

Slujis-Doyle, J. (2014) Bristol International Development Conference: Community Empowerment to Promote Gender Equality. University of Bristol, Bristol, 8^th March 2014.

Temwa (2014) How To Help Us. Available at: http://www.temwa.org/page/how-to-help-us (Accessed: 9^th March 2014)

UN (2014) We Can End Poverty: Millennium Development Goals and Beyond 2015. Available at: http://www.un.org/millenniumgoals/ (Accessed: 10^th March 2014)

World Health Organization (2004) “The World Medicines Situation” Available at: “http://apps.who.int/medicinedocs/en/d/Js6160e/9.html” (Accessed: 8^th Jan 2014)