December 13, 2006

The Politics of AIDS

            AIDS is now 25 years old. Since the first documented cases in 1981 the disease has turned into a global epidemic, and it is still growing. Here are some statistics from the World Health Organization and the Global Health Institute:

• More than 40 million people are infected with HIV/AIDS, including 18 million women and 3 million under the age of fifteen.
• Over 25 million in Africa alone have HIV/AIDS.
• HIV/AIDS is the fourth leading cause of death in the world, and the leading cause of death in Africa.
• New infections are greater among women than men.
• Drugs to prevent the transmission to newborn children are not available to hundreds of thousands of pregnant women with AIDS.
• Over 95% of people with HIV live in the developing world.
• In some African countries, three quarters of those infected are women.
• Only one in seven Asians and one in ten Africans have access to the medicine they need.
• In six African countries, more than 20% of all pregnant women have HIV.

The origins of this disease in the gay community and among drug addicts greatly slowed our efforts to control AIDS. President Reagan never uttered the word “AIDS.” According to the World Health Organization, stigma and discrimination remain the most difficult obstacles to preventing HIV.

And 25 years later the epidemic has gone way beyond homosexuals and drug addicts. It has reached critical levels in Africa, not only overwhelming health systems but also undermining economic growth and threatening national security institutions.

Disease is one of those security threats that do not recognize borders, race, or sexual orientation. It is not something that goes on “over there” with no possibility of reaching us. Like terrorism, weapons proliferation, or climate change, our own security is dependent on conditions around the world and requires cooperation with other countries to minimize these threats.

AIDS has led to many difficult political issues. What exactly is the role of the government regarding citizens’ health? Is access to health care and medicine a fundamental human right? Are governments obligated to provide treatment, education and condoms to slow this epidemic?

For those with access to treatment and medication, HIV is a manageable chronic disease. For those with access to education and condoms, AIDS is largely preventable. For those without such resources, AIDS is a daily threat.

Over thirty countries have a universal health care system and constitutional language making access to health care a fundamental human right. These protections are now extending to AIDS patients. In a recent case in South Africa, for example, its Supreme Court ruled that the government violated citizens’ rights to access to health care when it failed to provide medicine to pregnant women so that they would not transmit the HIV virus to their newborn children.

Enshrining access to AIDS medicine as a fundamental human right leads to more issues. Can states violate pharmaceutical patents to get medicines to their citizens more cheaply? Does public health override corporate profits?

Brazil, for example, challenged global market rules about intellectual property rights to deal with its AIDS crisis. In 1996 Brazil passed legislation guaranteeing free access to AIDS medicines. It then manufactured those drugs locally through government owned laboratories and handed out the medicine for free. Brazil is one of the few countries that have reduced the number of its AIDS cases. But it did so through public subsidies and denying profits to pharmaceutical companies.

These examples illustrate the tensions between global capitalism and access to health care, between property rights and human rights, and between market-centered and state-centered approaches to public health.

            Epidemics like AIDS force us to choose one of these approaches. That choice hinges on whether we understand that it is in our own interest to help others. The twenty-five year history of AIDS thus far suggests that by the time we realize this it may be too late.