HIV/AIDS: An Emergency that Demands an Integrated Analysis

Dr. Arturo Quizhpe P., Coordinador MSPL

From the beginning of the AIDS pandemic, the primary concept for understanding the epidemiology of HIV infection, and particularly for explaining its rapid dissemination and high prevalence rates, has been individual behavior, whether implicitly or explicitly stated.

This idea has had enormous implications for the international response to AIDS and has profoundly influenced national public health policies, program designs, and strategies for prevention and intervention at national, community and individual levels.
However, individual conduct and behavior alone has not been able to explain the enormous variation in HIV prevalence among populations, regions and countries. These differences have remained unexplained and, unfortunately, unexamined by international organizations, as well as academics.
Biological vulnerability and susceptibility
Biological vulnerability to HIV associated with severe immune system deficiency has been ignored as a determinant of high levels of infection in certain populations.
The coexistence of HIV infection with malnutrition and other diseases of poverty, including tuberculosis, malaria, leishmaniasis, and parasitic infections, has been omitted as a basic cause of susceptibility, infectivity and high rates of transmissibility at the population level.
The social vulnerability of the victims of globalization, labor migration, prostitution, dislocation provoked by war, military occupation and violence has received some attention; however, the proposed solutions to these problems have been inappropriate and oriented toward individual conduct, ignoring their political and economic roots.
The explanation for the epidemiology of HIV/AIDS as a consequence of individual conduct is not only inadequate, it is also highly stigmatizing and in some cases racist. This one-sided focus has turned attention away from poverty and powerlessness as the fundamental causes of vulnerability to infection.
Why is there no change in strategy?
Obstacles toward adopting an integrated strategy are economic and political and have a close relation to neoliberal globalization, the increasing unequal power within and among nations, and the assault on human dignity and national sovereignty.
An alternative strategy for AIDS and other diseases of poverty must be based on macroeconomic reforms that are just, rational and sustainable, in which governments respond to the fundamental needs of their people, including health, without outside interference.
Strategy should be based on a pyramid of interventions and actions. Economic reforms should constitute the base, the foundation upon which the other actions can rise. These include primary health care, food security, and the state's responsibility to guarantee the fulfillment of basic needs, which constitutes the second level of the pyramid. Community mobilization will breathe life into a solid national social security system. Finally, actions oriented toward changing individual behaviors constitute the peak of the pyramid, where they will take root and blossom as human rights flower in the fertile terrain of social and economic justice.
(unofficial translation: Todd Jailer, PHM-USA)

Dr. Arturo Quizhpe P., Coordinador MSPL
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