On the Socioeconomic Impact of the HIV/AIDS Epidemic

The UN General Assembly Special Session on HIV/AIDS met 25–2 7 June 2001 and adopted a Declaration of Commitment on HIV/AIDS. The Declaration, in 103 paragraphs, sets out a comprehensive response strategy for governments and UN agencies, supports establishment of a global HIV/AIDS and health fund, and calls for an annual progress report to be reviewed by the Assembly. As part of the Special Session, four “round tables” were conducted on substantive topics: prevention and care, human rights, socioeconomic impact, and international funding. Round Table 3, Socioeconomic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS, was led by the United Nations Development Programme. The background document prepared for it is reproduced in full below. It argues that the brunt of the epidemic's impact on human development has been borne by households, communities, and civil society organizations. The emphasis of national and international action has been on prevention and care rather than on counteracting that impact. “Extraordinary efforts” are now required to intensify poverty‐reduction measures, to assist caregivers and orphaned children, to prevent the collapse of public services, and to promote workplace tolerance and flexibility. “While HIV/AIDS must be seen as an emergency of the highest order, steady progress in reducing poverty is still the long‐term and sustainable solution to the health crisis in the developing world. In the long run, prevention and care will only succeed if people and nations can lift themselves out of poverty.” (The Declaration was not much influenced by such arguments. It devotes two paragraphs to socio‐economic impact, both setting diffuse goals: “By 2003, evaluate the economic and social impact of the HIV/AIDS epidemic and develop multisectoral strategies [on poverty alleviation, etc.]” and “By 2003, develop a national legal and policy framework that protects in the workplace the rights and dignity of persons living with and affected by HIV/AIDS.…”) The Millennium Summit referred to in the document was the meeting on the role of the UN in the twenty‐first century held in September 2000 as part of the 55th session of the General Assembly. The Declaration of Commitment on HIV/AIDS and the Round Table 3 document can both be found at http://www.unaids.org/ungass/index.html .     

AIDS and kitchen gardens: insights from a village in Western Kenya

In rural Africa, indigenous farming and natural resource management systems exemplified by kitchen gardens are being reshaped by the HIV/AIDS epidemic and its negative impacts (illness, stigma and mortality, and economic costs) and positive opportunities (organizational responses to the epidemic). Subtle changes in crops and farm techniques can be traced to these diverse influences of HIV+ infection, illness, mortality, widowhood, foster child care, and AIDS support groups, as well as the organizations, ideas, and flow of funding from outside. These findings draw on original field data: a village census, in-depth interviews with gardeners, and group discussions in a village in Bungoma District (in 2005 and 2007). This part of western Kenya is a typical small-farm zone that has faced a moderate HIV/AIDS epidemic since the 1990s, following decades of demographic, environmental, technological, and institutional changes. Implications of this case study for further research on HIV/AIDS and on micro-level population–environment change suggest that households are useful but imperfect analytical units and are best seen as part of complex social networks, shaping connections to markets. These important “mediating institutions” link AIDS as a demographic and economic force with environmental outcomes in cultivated landscapes.     

HIV/AIDS and Urbanization

It is well known that levels of HIV prevalence tend to be appreciably higher inurban areas. This article considers the reasons for this and shows that within world regions that are relatively homogeneous with respect to their experience of HIV/AIDS, variation in the level of urbanization corresponds to about one‐third of variation in estimated HIV prevalence. Furthermore, for populations in the world's worst‐affected area—eastern and southern Africa—there are signs that, partly by differentially raising urban death rates and depressing urban birth rates, HIV/AIDS is slowing the pace of urbanization. Finally, in countries with very high levels of HIV infection and relatively low birth rates, such as in South Africa, the urban sector will soon constitute a “demographic sink”—with death rates exceeding birth rates.     

The United Nations on the Demographic Impact of the AIDS Epidemic

A report prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting “a grim picture with glimmers of hope”—the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135‐page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst‐affected area, sub‐Saharan Africa, is reproduced below. (Figures shown have been renumbered.)     

“Requestioning” AIDS: An Ethical Reflection From 1993 to Today

ABSTRACT

This article serves as one of the supplementary pieces of this special issue on “Mapping Queer Bioethics,” in which we take a solipsistic turn to “map” the Journal of Homosexuality itself. Here, the author examines the first feature-length article to address the relationship between HIV status and homosexuality. Lingering on both the temporal gap between the dawn of AIDS in American discourse and its inclusion in this journal, the author asks us to consider (in hindsight) such a delay bearing in mind queer theoretical projects of the present such as gay shame, stigma, and queer biopolitics.     

Why is the History of Heterosexuality Essential? Beliefs About the History of Sexuality and Their Relationship to Sexual Prejudice

Heterosexual people with more positive attitudes to lesbians and gay men generally believe that homosexuality is immutable, is not a discrete social category, and that homosexuality exists in all cultures and time periods. Equivalent beliefs about heterosexuality and beliefs about components of sexuality have been less often researched. 136 people with diverse sexualities described heterosexuality as more universal across history and culture than homosexuality (Study 1). 69 heterosexual-identified participants similarly believed that love, identity, behavior, and desire were more historically invariant aspects of heterosexuality than of homosexuality (Study 2). Less prejudiced participants thought all components of homosexuality—except for identity—were more historically invariant. Teasing apart beliefs about the history of components of heterosexuality and homosexuality suggests that there is no “essential” relationship between sexual prejudice and the tension between essentialist and constructivist views about the history of sexual identity.     

“Not Hiding,Not Shouting,Just Me”: Gay Men Negotiate Their Visual Identities

This study explored how British gay men make sense of their appearance and clothing practices and the pressures and concerns they attend to in discursively negotiating their visual identities. A convenience sample of 20 mostly young, White, and middle-class self-identified gay men responded to a qualitative survey on dress and appearance. The participants clearly understood the rules of compulsory heterosexuality and the risks of looking “too gay.” In the data, there was both a strong resistance to the notion of gay as a “master status” and an orientation to the “coming out” imperative in gay communities. The analysis revealed the overriding importance of discourses of authentic individuality for making sense of visual identity and the reported cultivation of appearance and clothing practices that communicate the message that: “I’m not hiding (too closeted), I’m not shouting (too gay), I’m just me (an authentic individual who just happens to be gay).”     

“The Freak of Nature”: On Erich Fromm’s Vindication of Binomial Sexuality and the Potentials of the “Homosexual Deviation”

As a Freudian revisionist and neo-Marxist, Erich Fromm (1900–1980) lessened the import of sexuality in the individual psyche but stressed the role played by the sex differential in the distribution of power throughout history and in the post-patriarchal form of matriarchy he envisioned. Seeking to reinforce the male/female divide and heteronormativity, Fromm outlined a “New Science of Man” that readily ignored not only the challenges posed to binary sexuality by post-Darwinian critical sexologies, but also the same-sex complexities evinced by key figures of his own cultural pantheon. Regardless of his declared pursuits, however, Fromm at times expressed insights suitable to undermine the cogency of his most cherished sexual convictions. As a tool for uncovering “indubitable commonsensical axioms” as sources of alienation, Fromm’s conception of “idology” challenges his own sanction of sexual binarity and heterosexuality, thus facilitating an understanding of the individual’s sexual difference as a unique modulation of male/female intermediariness.     

Left behind: intergenerational transmission of human capital in the midst of HIV/AIDS

This paper provides evidence on how adverse health conditions affect the transfer of human capital from one generation to the next. We explore the differential exposure to HIV/AIDS epidemic in sub-Saharan Africa as a substantial health shock to both household and community environment. We utilize the recent rounds of the Demographic and Health Surveys for 11 countries in sub-Saharan Africa. First, we find that an additional year of maternal education leads to a 0.37-year increase in children’s years of schooling in the developing economies in sub-Saharan Africa. Second, our results show that mother’s HIV status has substantial detrimental effects on inheritability of human capital. We find that the association between infected mothers’ and their children’s human capital is 30 % less than the general population. Finally, focusing only on noninfected mothers and their children, we show that HIV prevalence in the community also impairs the intergenerational human capital transfers even if mother is HIV negative. The findings of this paper are particularly distressing for these already poor, HIV-torn countries as in the future they will have even lower overall level of human capital due to the epidemic.     

HIV/AIDS and Cross-National Convergence in Life Expectancy

This article analyzes the effect of HIV/AIDS on the cross-national convergence in life expectancy as well as infant and child survival rates by comparing three scenarios. One is based on historical and future best-guess estimated values given the existence of the epidemic. The second scenario assumes that the effect of the epidemic is much worse than expected. The final scenario is based on hypothetical values derived from estimations where the mortality caused by the epidemic is removed. For life expectancy, convergence becomes stalled in the late 1980s (without weighting by country population size) or 1990s (with weighting). Convergence in infant and child survival rates does not become stalled, but slows down. These results are mainly attributable to the epidemic since all signs of stalled convergence or even divergence disappear in the “No AIDS scenario.” Given the existence of the epidemic, however, the reduced degree of inequality in life expectancy attained by 1985 is only expected to be achieved again by 2015 at the earliest. If the epidemic turns out much worse than expected, divergence could continue to 2050. No divergence is to be expected in infant and child survival rates in any of the scenarios.     

The “Sassy Woman” and the “Performing Man”: Heterosexual casual sex advice and the (re)constitution of gendered subjectivities

Media forums that provide “sex advice” are a rich source of (sexual) information for heterosexual individuals and have been critically examined for the ways in which they construct heterosexuality (and sexual subjectivities). The representations of (heterosexual) casual sex are also prevalent across the mass media. This paper uses a Foucauldian/poststructuralist mode of discourse analysis to explore how casual sex “advice” in three self-help books (two aimed at women, one aimed at men), and online advice articles, constituted casual sex and masculine and feminine heterosexual subjectivities. Four main (profoundly gendered) subject positions were identified in the texts: the “strategic man”; the “performing man”; the “sassy woman”; and the “vulnerable woman.” It is argued that although some alternative ways of constituting heterosexual identities were provided (particularly for women), gender difference was not only implicated in such advice but also, at times, crudely exaggerated. The implications of these representations are discussed in relation to contemporary heterosexualities, heterosexual sexual identities, and heterosexual power relations.     

The Blunt Cutting-Edge: The Construction of Sexuality in the Bengali Feminist Magazine Sananda

This article focuses on the construction of one's relation to pornography in contemporary media by examining agony columns of young adult women's magazines. The analytical approach employed is a “close reading” from the perspective of queer theory, purposing both to “queer” the portrayals of heterosexuality and to critically review representations of non-heterosexuality. The focus is especially on the role of affects and emotions in moving subjects “toward” and “away” from porn and producing conceptions of gender and sexuality. On the one hand, the positive affects of excitement and interest are associated with men in the data corpus, whereas the negative affects of disgust and upset are usually connected to women. On the other hand, affects are absent when discussing queerness. The study thus offers an application of Ahmed's notion of the productive role of emotions both in expanding the idea of productivity from constituting ethnicity to establishing gender and sexuality and also in directing attention to the absence of affects or emotions in constituting norms.     

How to Be a Healthy Homosexual: HIV Health Promotion and the Social Regulation of Gay Men in the United Kingdom

ABSTRACT

Primary Objective: Health promotion has arisen as the main response to the problem of HIV prevention among gay men. Using the linked concepts of governmentality and health promotion as a neoliberal disciplinary technology, this article argues that health promotion in the time of AIDS has contributed to new forms of social regulation and governance for gay men. Methods and Procedures: This article presents an analysis of data from a study of U.K. HIV health promotion for gay men (interviews with health promoters and analyses of health promotion materials). Conclusions: This analysis of health promotion is helpful in describing an emerging form of governance dependent on incentive rather than censure (censure, pathology and “cure” are how we traditionally describe the use of medical knowledge in the regulation of homosexuality).     

“Some University Lecturers Wear Gay Pride T-shirts. Get Over It!”: Denials of Homophobia and the Reproduction of Heteronormativity in Responses to a Gay-Themed T-shirt

ABSTRACT

This article explores an incident involving a gay pride T-shirt, printed with the slogan “Some people are gay. Get over it!,” that I wore during a university lecture, and students’ predominantly negative responses to it. I use the lens of modern prejudice research, particularly discursive psychological approaches to modern prejudice, to interpret the students’ responses to a qualitative survey about their views on the T-shirt. They related strong feelings of upset and anger, particularly because I had—in their view—implicitly accused them of being homophobic. They passionately refused this supposed accusation on the grounds that “everything’s equal now” and “gay people are no different from us.” I argue that the ideological themes of cultural heterosexism and compulsory heterosexuality provide a productive framework for making sense of the students’ responses, as they sanction a rational neoliberal subject who is both non-homophobic and inculcated into heteronormativity.     

Defying,producing, and overlooking stereotypes? The complexities of mobilizing “grandmotherhood” as political strategy

ABSTRACT

This article explores the Canadian Grandmothers to Grandmothers Campaign, a mobilization of older women responding to the effects of HIV/AIDS in sub-Saharan Africa. Based on interviews, participant observation, and archival work, this article looks at how and to what effect “grandmotherhood,” as discourse, was mobilized and deployed, in fluid and fractured ways, in order to increase members’ credibility as global social justice actors and build their solidarity with African women. These mobilizations functioned to uphold essentialist notions of what being a grandmother means, while also challenging stereotypes of older women as frail and disengaged.     

Social networks, perceptions of risk, and changing attitudes towards HIV/AIDS: new evidence from a longitudinal study using fixed-effects analysis

The study presented here is an investigation of the importance of social interactions to perceptions of the risk of AIDS, and explores spousal communication about the AIDS epidemic in rural Malawi. A fixed-effects analysis based on longitudinal data collected in 1998 and 2001 shows that social interactions on the subject of HIV/AIDS have significant and substantial effects on respondents' perceptions of the risk of HIV/AIDS, even after controlling for unobserved factors that affect the selection of social networks. These effects are more complex than previously thought. The dominant mechanisms--social learning and social influence--are found to vary by sex and by region, because of regional variations in the marriage pattern and the resulting implications for the formation of local social networks. The conclusion of the study is that rather than fostering denial and inaction, social interactions are an important vector of change in the face of the HIV/AIDS epidemic.     

HIV and fertility in Africa: first evidence from population-based surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. We utilize recent rounds of the demographic and health surveys that link an individual woman’s fertility outcomes to her HIV status based on testing. The data allow us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that although HIV-infected women have significantly lower fertility, local community HIV prevalence has no significant effect on noninfected women’s fertility.     

The HIV/AIDS Epidemic at the End of 1999

The status of the global HIV/AIDS epidemic is summarized in a report entitled AIDS Epidemic Update: December 1999, issued by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization. The generally bleak but regionally diverse picture is conveyed in the series of bulleted statements at the beginning of the report and in two summary tables, reproduced below. The rest of the report discusses the regional situations in more detail. An earlier UNAIDS and WHO surveillance report (June 1998) was excerpted in the Documents section of PDR 24 (3).     

“The String of This One Story”: Erotica,HIV, and the Construction of Safe Sex in Gay Male Popular Memory

Recalibrating the critical consideration of popular memory, this essay rehabilitates the erotic narrative as an object of critical study and as a political practice via an examination of John Preston's (1985b) print collection, Hot Living: Erotic Stories About Safer Sex. It considers this collection as a use of the erotic genre to produce a popular memory within its reading community to support safer sex practices in the “Age of AIDS.” It examines this collection as a communitarian project that articulates a new erotic rhetoric in response to HIV and considers its individual epistemological and epidemiological implications.     

艾滋病人口扩散的空间差异机制及其对策研究——以云南为例

通过分析1990到2004年云南省艾滋病地域空间的分布特点．得出云南省艾滋病流行扩散的空间差异机制。在此基础上指出需根据艾滋病流行状况的空间差异,在对艾滋病采取系统防治的基础上,对不同等级区域采取差异化的预防控制对策,提高艾滋病防治的针对性。