Why is the world failing to combat the AIDS crisis? Why are the industrialised nations decreasing the resources commited to fighting the HIV virus? Professor JONATHAN MANN, director of the International AIDS Centre at Harvard School of Public Health, gave some answers in a recent talk on the Global Effects of AIDS in Sydney, Australia. This is an abridged version.
ANALYSIS Patten - bigoted Tory THIS IS a critical time in the history of our global con. frontation with AIDS. Today. faced with an expanding pandemic, we can see the limits of our current national and global response. The course of this pandemic is not yet being in. fluenced in any substantial manner by our current efforts.
In 1980 approximately 100,000 people were HIV positive; during the 1980s this in. creased 100-fold: today over 15 million people, including over 13 million adults and over one million children are HIV positive.
Of the 13 million adults. nearly nine million are in Africa, over one million in North America and Latin America. from one to two million in Asia and over 500,000 in Europe. Over seven million are men and over five million are women, and the ratio of men to women has boon steadily increasing.
The pandemic remains highly dynamic and volatile.
Projecuons who the future are only estimates. the Global AIDS Policy Coalition projects that nearly 20 million people will be HIV positive by 1995. and that by the year 2000 between 40 million and 110 million adults, in addition to at least 10 million children will be HIV positive Yet analysis of the pandemic alone is not enough - for our individual and collective response is the determining factor in this global epidemic. tween, 1986-90, we witnessed an extraordinary period of global mobilisation.
Yet since 1990, the world has entered a new phase in the confrontation against AIDS: a po. riod in which the response has stalled and is falling dangerously behind the pace of the pandemic. Our analysis has revealed the depth of global inequity in prevention and care.
Or the $15 billion spent on prevention in 1991 only 6 per cent was for the developing America.
Similarly for care: about 90 per cent of the world's spending was for the approximately 25 per cent of the world's people with AIDS in North America and Europe.
There is also a failure of sirategic thinking.
There is a growing preferto tum away from co-ordinated efforts and to work bilaterally with chosen "popular' developing countries. Many successful "pilot projects' have not been amplified and turned into large AIDS will require that we deal with the key underlying pre-existing issues which fuel the spread of HIV. An analysis of AIDS epidemiology and the global response shows that the pandemic flourishes by exploiting societal weaknesses, especially inequality and injustice and its result discrimination.
Discrimination is the central social lesion which underlies AIDS and ill-health worldwide.
Women's status
The role and status of women worldwide is fundamental to HIV prevention. Women canno, say no to unwansco or un* protected sexual intercourse unless they have the economic and social power to say 'no". Therefore reforms of laws govering property distribution and divorce may be much more important than increasing the disiribution of brochures or condoms. This inequality of wower between men and women is relevant as much in Western societies as it is in the developing world.
An analysis of the relationship between gender and AIDS - and a broader look at gender and health - including maternal mortality, sexual violence. sexually tansmitted diseases and failures of family planning - shows clearly that male domicational policy. Bigoted ideas of cosm of vulncrability to ill-health, disability and premature death.
What then is to be done?
We must launch an assault on the basic problems. This means contront the many forms of discrimination - based on gender, race, religion, national origin, sexual preference or social class - which makes societies vulnerable to furikt spread of the pandemic. This is AIDS; it is a strategy for health - community, national and global.
People in all countries are deeply concerned about their health. Yet why is it that health has nor become a central defin. ing principle of local, national and global purpose?
Paradoxically, we health workers have contributed to this problem. We have generally been silent or well behaved. We have accustomed ourselves to playing a secondary, reactive and manx role a communitynational and global life. We have trained ourselves to expect and accept a second-class political attention for health conThe socond class political attention given to health aspiraions is not limited to AIDS. This is not a problem we can simply allow ourselves to blame on others, on the so-called deci sion makers or on politicians. We must now help to give a voice to the basic desires of peopie for octer Hallul It has become clear that to work against AIDS is to become, to some extent, a revoluBecause in order to achieve the soals of our work it will require change in our societies.
Thus, our global AIDS strategy is about more than AIDSit is part of a more fundamental struggle. This is not a modest aspiration - but please, why should we be modest? to challenge the dogma of com-