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"HIV/AIDS is the fastest growing threat to development today
and a potential risk for national and regional security – as recognized by the United
Nations Security Council in January 2000. What sets the disease apart from other epidemics
is the speed of its spread and the extent of its devastation."1
The incidence of AIDS along with the HIV virus that causes AIDS are a relatively recent
phenomenon. Yet the pandemic that has resulted by the spread of HIV/AIDS has had tremendous
consequences. In the past two decades since AIDS and the HIV virus that causes it
have been identified, about 65 million people have contracted the disease and approximately
25 million have died.2 Trying to address the spread
and consequences of the disease, the United Nations General Assembly Special Session
on HIV/AIDS that was held June 25-27, 2001 ended with a goal to reduce by half the
number of HIV-infected people by the year 2015. In trying to meet that challenge,
the Declaration of Commitment adopted at the UN meeting promised to take into account
"the diverse situations and circumstances in different regions and in different
parts of the world..."3 But it is also clear
that because of their own perceptions the different delegations to that session (i.e.,
the United States, Western Europe, Islamic countries, Africa, the Vatican, NGOs representing
women’s groups, AIDS activists, etc.), each had different views on what causes the
spread of HIV and AIDS as well as how to deal with the pandemic. Although representatives
could all agree that both prevention and treatment are needed, there was little agreement
on how this was to be done.
In the time since the Special Session was held, it can be estimated that more than
6 million people have been infected, with the number of people infected and dying
from the disease likely to increase. And little progress has been made about ways
to address the pandemic, which shows no signs of abating.
AIDS and the HIV virus started to take on epidemic proportions in the 1970's. The
United Nations estimates that there are about 18,000 new infections each day and more
than 5.8 million each year.4 And recent statistics
indicate that there have been some significant changes to the patterns seen earlier.
For example, currently the United Nations estimates that of the 38.6 million adults
worldwide who have HIV, 19.2 million, or about half, are women. This is due especially
to a growth in the number of HIV cases among women in Sub-Saharan Africa, North Africa
and the Middle East, and also the Caribbean as a result of the spread of the disease
among heterosexual sex partners. In another change in pattern, in the "developed"
world a growing proportion of HIV cases are found among both male and female heterosexuals,
a marked departure from what was seen ten years ago where the largest incidence of
the disease was found in gay men. This change in transmission pattern has been noted
especially in Europe and among those who have visited Europe and engaged in risky
sexual practices while they were there.5
The spread of HIV/AIDS is not only a health crisis of immense proportions but it has
other major policy implications as well. The disease is virtually decimating parts
of Africa, causing a humanitarian disaster. Not only does AIDS account for 20 percent
of all deaths in the region, but the debilitating effects of the disease mean that
agricultural workers cannot produce food, adults and children are less able to farm,
and women and children are being drafted to care for sick relatives, all of which
reduce time and energy that can be devoted to raising food in a region that is already
suffering from famine. Further, as the WHO notes, dealing with the rising health care
costs and care for those who have the disease are overwhelming the resources of entire
communities and also keeping children from school, thereby further undermining economic
capabilities.6
The change in transmission patterns and spread of the disease will have important
economic as well as military implications in other parts of the world as well. If
the latest trends continue, Eurasia will be the next major region to be impacted by
the disease, specifically the countries of China, India and Russia all of which have
seen an increase in HIV/AIDS cases; an estimated 7 million people in this region were
HIV carriers in 2001.7 The impact of the disease
in this region has the potential to alter significantly the economic potential and
contributions of each of the three major countries involved and, with that, the military
and political balance of power in the region as well. Hence, the impact of this pandemic
has implications that are potentially significant for international political and
economic relations.
Because of its long incubation period, one of the most devastating impacts of the
disease is its ability to spread. In fact, one of the consequences of a globalized
world, in which people can move relatively freely across borders, has been the ease
with which the disease can – and has – spread. Its effects have been especially devastating
on the developing countries, especially in Africa and parts of Asia. While the international
system recognizes the devastation caused by this disease, and despite ongoing international
conferences to address the issue, there has not been any single global policy arrived
at to address the situation.
The 1998 12th World AIDS Conference, held in Geneva,
Switzerland, had bleak news regarding the spread of the disease that foreshadowed
what was to lie ahead. The overall theme of that meeting was "bridging the gap"
between what is available to HIV-infected patients in the developed and developing
world. The Executive Director of the UN AIDS program noted that the virus is causing
a runaway epidemic in parts of the world. All participants to the conference agreed
that there needed to be more of an effort made to educate and to introduce preventive
programs that would bring down the incidence of the disease. But at a time when borders
can be crossed easily, unless countries can work together and an international policy
formulated, the disease will continue to spread quickly. And there were few specific
recommendations coming out of this conference as to how to address this issue. Hence,
the 12th World AIDS Conference ended on a decidedly
somber note. And, as the 2001 United Nations General Assembly Special Session on HIV/AIDS
illustrates, little has been done since the 1998 conference to address the challenges
posed by the spread of the disease.
In dealing with HIV, AIDS and the spread of other sexually transmitted diseases (STDs)
globally, the international community must confront social, cultural, and political
issues that are difficult to change. In India, for example, it has been common for
long-haul truckers to stop and frequent prostitutes in small villages along their
routes, and to engage in unprotected sex. Once infected, they then pass the disease
on to their wives and children. Thailand, which traditionally has had liberal prostitution
laws, has been the destination for businessmen from other Asian countries, especially
Japan. For religious and cultural reasons these men eschew the use of condoms. The
wives of these men, who remain at home, have become part of the growing group of women
infected with the disease which is passed on to them by their spouses. Thus we see
the change in pattern whereby nearly half of the reported cases now are among women.
Cultural taboos in parts of Asia and Africa, the regions that have been hardest hit,
have been such that many of these women are virtually powerless to stop those practices
which endanger their lives and those of their children.
Over the past few years there has been news of new drugs which, when taken in combination,
can inhibit the course of the disease. This treatment, known as triple-drug therapy,
relies on mixing a number of drugs including AZT, which has been proven to delay death
from AIDS, with a newer class of drugs called protease inhibitors, which can actually
block the damaging actions of the HIV virus. While the news of this therapy has been
greeted with relief by many governments and AIDS sufferers alike, it also raises the
moral dilemma of who can pay and how to pay for these treatments. It is estimated
that one year’s course of the triple-drug therapy will cost $10,000 to $12,000. And,
since more than 90 percent of those infected with HIV live in the developing world,
the therapy is virtually out of reach to them.
Further, as word of these drugs spreads, demand for them will increase. Those who
can afford it can travel to the United States or other countries, such as Germany
and Japan, which are marketing and distributing the drugs. Further, even as they travel
to other countries for treatment the risk of transmitting the disease across borders
increases. And many of those infected in Africa and Asia do not have travel as an
option. In Russia, there is $5 million in the AIDS budget for the next four years,
and that money includes the cost for constructing a new hospital. The idea of spending
public health money on AIDS is politically impossible in Russia when there is no money
for basic childhood vaccinations. These issues pertaining to the gap between rich
and poor and the range of treatments now available to each are part of an international
initiative of "bridging the gap," which is the result of fears that the
drugs will only be available to those who can pay.
The international system is facing a number of dilemmas regarding AIDS and the HIV
virus. Given the ease with which people can and do move around, one dilemma facing
the international system is how to control the spread of HIV/AIDS across borders without
impinging upon the rights and freedoms of any individual who wishes to travel. The
international community must confront the often-conflicting dilemma of prevention
versus treatment and how best to achieve each, while simultaneously confronting the
realities of the health gap between rich and poor and taking into account cultural
norms. And there are questions about how many restrictions or policies the international
community can impose without impinging upon the sovereignty of any nation to designate
for itself what it can and should do about the prevention and spread of the disease
within its own borders.
Dr. Peter Piot, the Director of the United Nations AIDS program, noted that success
in fighting HIV, where it has occurred, has been due to prevention programs that "have
fostered a number of behavioral changes: postponing the age of first intercourse;
increasing the use of condoms, having fewer sex partners and fewer encounters with
prostitutes; and improving education and access to HIV tests." But the UN also
estimated that "the minimum spending needed to make prevention programs effective
in low- and middle-income countries....is $10.5 billion between now and 2005."8
While the good news is that prevention efforts are working in some countries, like
Cambodia, where rates appear to be stable or declining, AIDS has exploded in others,
such as Indonesia, which has had relatively low infection rates for many years.
Endnotes:
1 World Health Organization, "WHO and HIV/AIDS,"
http://www.who.int.
2 Nicholas Eberstadt, "The Future of AIDS,"
Foreign Affairs (November/December 2002), 22.
3 Quoted in Karen DeYoung, "Immune to Reality,"
Foreign Policy (September-October 2001), 72.
4 Charles W. Kegley, Jr. and Eugene R. Wittkopf,
World Politics: Trend and Tramsformation, 8th
edition (Belmont, CA: Wadsworth, 2001), 341.
5 Lawrence K. Altman, "Women Catch Up to Men
in Global H.I.V. Cases," New York Times, November 27, 2002, A10.
6 http://www.who.int.
7 Eberstadt, 2002, 22.
8 Altman, 2002, A10. |
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