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Monday, December 24, 2007

HIV/AIDS As a Non – Conventional Threat to Nation States

The African State and the AIDS Crisis

Edited by Amy S. Patterson, Aldershot: Ashgate Publishing Ltd., 2005, pp.240, $ 51.62

Infections and Inequalities: The Modern Plagues

Paul Farmer, London: University of California Press, 2001, pp. 375, $19.95

HIV/AIDS as a Security Threat to India

Happymon Jacob, New Delhi: Manohar Publishers, 2005, pp.97, $5.82

Reviewed By: Javed I. Naqi

“There are men who fight one day and they are good;

Others fight for a year and they are better;

There are men who fight many years and they are very good;

But there are those who fight all their lives:

These are the indispensable one!

Bertold Bretch, in Silvio Rodriquez’s song.

There is a vast literature on the subject of HIV/AIDS and its socio – economic and political implications. These three books under review are continued attempts on the topic by some eminent scholars. As their title indicates, the books share a common overarching theme, but they are complementary to one another in so far as they view the same subject matter through from alternate angles. While the first book throws light on African State HIV/AIDS crisis and States response to the epidemic, the second largely deals with social inequalities associated with infectious diseases and finally the last, examines the security implications of HIV/AIDS on India as a core.
“The African State and the AIDS Crisis” edited by Amy S. Patterson contains a collection of articles from a variety of world regions, which offers a thorough view of the socio – economic and political implications of HIV/AIDS epidemic in context of African States. This volume also examines the role of the African States in addressing the HIV/AIDS crisis. Through the chapters, the book questions how the African state, which is usually seen to be institutionally weak, limited in resources, and lacking in international power, has responded to HIV/AIDS. Though several of the themes are woven throughout the chapters, the book starts at the sub – national level with an examination of the effect of patriarchy, political culture and civil society on State actions to address HIV/AIDS.
Siplon in his individual piece argues that traditional institutions customary laws affects women vulnerability to HIV/AIDS, at the same time cause women to be underrepresented in AIDS policy making. In the subsequent chapter Farlong and Ball demonstrates that inefficiency on the part of civil societies resulted in ineffective AIDS policy making, thus increasing the vulnerability. Eboko in his write up moves beyond a narrow focus on civil society to illustrate how political cultures shape State actions on AIDS. He asserts that political cultures explain the variety of State responses to AIDS as in the cases of Cameroon and South Africa. These chapters set out continental macro causes for the HIV/AIDS epidemic, including, gender inequality, ineffective HIV/AIDS policies, ignorant political cultures and civil war. Next, the book investigates anti AIDS efforts at the national level. It questions the impact of economic and political transitions on the HIV/AIDS epidemic and the ability of states to address AIDS, using the case studies of Ghana, Swaziland, Senegal, Uganda and South Africa. Digging out varied response of African States to HIV/AIDS pandemic, Patterson and her co – authors observe;
“The role of the State in HIV/AIDS has varied dramatically. While the governments of Uganda and Senegal have been proactively engaged in combating the epidemic, other governments such as Ghana and South Africa have been less eager to address the problem. The effectiveness of the State is often limited by domestic considerations. In particular, the tenuous relationship between the government and civil society in many African States such as South Africa has resulted in ineffective responses to HIV/AIDS epidemic. In other areas, such as Ghana and Swaziland this terse relationship has resulted in the State using AIDS funding to garner political favor, further impeding effective HIV/AIDS policy.” (Patterson, 2006)
Further it situates a national level analysis of AIDS policies in Uganda in the larger context of national and international security concerns, particularly in light of the weakness of the African State. In contrast to Happymon’s(2005) approach of how the virus may threaten State security and contribute to State failure, the piece by Robert and Barul investigates an interesting facet that how security threats impact HIV/AIDS. Finally the book turns to the international level, illustrating the role of African states in the development of the Declaration of Commitment on HIV/AIDS and the Global Fund to fight HIV/AIDS, tuberculosis, and malaria. It demonstrates the impact of the TRIPS agreement on the ability of African states to fight AIDS, arguing that the African State has proved fairly impotent in the face on International trade regulations.
Amy S. Patterson in this volume makes use of a broad range of up – to – date literary, scholarly and journalistic, policy and popular sources. The book is of considerable value for its insights into HIV/AIDS pandemic in African States. But some of the concepts outlined in this volume do not always compliment each other. For example, the role of international aid and its effect on the State remain confused. While international aid has undermined the autonomy of the State in decision – making, it has also increased the power of the state versus civil society. Thus creating an overall confusion as to whether the state could be a potential actor for proactive policy making, or whether the State is part of the problem. The conclusion raises questions about the future role of the African States in combating AIDS.
“Infection and Inequalities: The Modern Plagues” edited by Paul Farmer deals with Farmer’s medical experience in Haiti to provide a trenchant analysis of the biologic and social realities of chronic infectious diseases. An interesting facet that the work throws is the assertion that the cause of tuberculosis and AIDS, the two epidemics this book addresses, has as much to do with social inequality as they do with microorganisms. Using data mostly from Haiti, in addition to the data from the United States and Peru, Farmer argues that social and economic inequalities have powerfully sculpted not only the distribution of infectious diseases but also the course of health outcomes among the afflicted. The pathogenic agency of inequality is so great, Farmer maintains, that “inequality itself constitutes our modern plague”, a statement he seeks to demonstrate in the balance of the book. In doing so, he repeatedly acknowledges the work of his mentor Arthus Kleinman, economist Amartya Sen, epidemiologist Richard Wilkinson, and others whose work in a variety of disciplines over the past two decades has focused attention on inequality and lack of social cohesion and their adverse effects on हैल्थ.
Farmer argues that anthropological analysis falls short in explaining the causation of disease. He takes aim at anthropologists who explain the failure of tuberculosis – control programme among poor Haitians as the result of either an inadequate understanding of the local culture on the part of the practitioners or the supernatural beliefs of the local, or both. Farmer writes that it is not that cultural analysis is unimportant but rather that it misses the point when it does not place cultural perspectives in a socio – economic context. Farmer also derides the anthropological studies of the 1980’s that explained the emergence of AIDS in Haiti as the consequence of ‘exotic’ indigenous practices. Instead, Farmer argues, these researchers should have emphasized local and regional socio – economic conditions that impeded effective care and promoted dissemination of the HIV. Farmer is right in his illustration that the understanding of local and regional socio – economic conditions and political cultures are more important in order to produce an effective response against an epidemic in addition to the necessary biological causal agents. Looking back, Eboko (Patterson 2005)in his individual piece in the edited book on ‘African State and the AIDS Crisis’ makes the similar argument in context of Uganda where he draws correlation between HIV/AIDS epidemic and political cultures. He sketches the picture of very different official responses in different settings in the following lines;
“Infections and inequalities: in a wealthy country, the specter of biological warfare, for which there is exceedingly slender evidence, triggers a sort of officially blesses paranoia. In a poor country tightly bound to rich one, real infections continue to kill off the poor, and we are told sternly to look harder for cheaper, more “cost - effective” interventions. At best, those of us working in places like Haiti can hope for trickle – down funds if the plagues of poor are classed as “U.S. security interests.” (Farmer, 2001)
Farmer highlights a “critical epistemology” of emerging infectious diseases that explores in detail how poverty and inequality cause infectious diseases to emerge in specific local context. Aiming to explain why infectious diseases such as TB and AIDS targets the poor, he fill his new work with harrowing public health case studies of the pathogenic effects of poverty and other grim social conditions. Farmer provides a well referenced analysis of everything from cell – mediated immunity to health care access issues. The studies outlined show that extreme poverty, filth and malnutrition are associated with infectious disease and what attitudes and behaviors contribute to the lack of understanding about disease. This connection finds amplification in the work of Happymon Jacob on ‘The Dangerous Factors: Poverty, Ignorance and Stigma’ (Jacob 2005), but I return to the specific empirical illustration in greater detail later.
In “HIV/AIDS as a Security Threat to India” Happymon Jacob, addresses India’s HIV/AIDS epidemic and seeks to build up the argument that the epidemic is a security threat to India. The book attempts to bridge the gap that exists between non – traditional security theories and issues. It argues that HIV/AIDS is rapidly becoming a security threat to India as the disease is affecting the traditional, economic, human and societal security of the country. It says that moreover, in India’s case it is necessary to highlight the dangers of HIV/AIDS in the country’s public as well as political leadership imagination as a security issue.
An interesting parallel that may be drawn between Farmer’s work and Happymon’s study is the desire to capture the often neglected aspect of HIV/AIDS pandemic. For instance Farmer’s close examination of poverty and social inequalities and Happymon’s stress on security implications of HIV/AIDS are never studied in greater depth as these authors did, thus raising questions for future research.
The book opens with an overview of India’s HIV/AIDS epidemic. Its history and current status and also takes a brief look at the future of AIDS in India. He argues that there has been a steady increase in the rate of HIV/AIDS infection in India and has now changed its ‘focus groups’ and is increasingly concentrating on the general population and both the rural and the general areas. The author also throws light on the fact that how the disease is a traditional, human, economic and societal security issue. Various levels at which HIV/AIDS acts as a security threat are identified and there is an analysis of its impact on each of these levels. The author finds the future scenario of HIV/AIDS in India highly disturbing because of increased mobility in a highly competitive globalized economy and also the nature of the population that is most vulnerable to this threat. He adds that extensive spread of HIV/AIDS can shaken the pace of economic growth by slowing down the flow of foreign direct investment into India. The author argues that personnel of the armed forces and the state security agencies are highly vulnerable to the risk of contracting HIV/AIDS. Thus the threat of HIV/AIDS is also linked by the author to the traditional military security arena, he records;
India has about 1.3 million military personnel. Since India has a large pool of potential recruits, the disease is unlikely to create a military security problem. However, the lack of recruits is not the only way a nation’s military can be threatened by HIV/AIDS. There are many more ways a country’s military can derail national security which it is supposed to safeguard. As mentioned earlier in a country like India, military personnel who are infected by HIV/AIDS and who would not divulge it due to the fear of losing their job and the social stigma attached to it could jeopardize military prowess and preparedness.” (Happymon, 2005)
Next he analyzes how poverty, ignorance and the social stigma attached to the disease can prove to be accelerators of the epidemic in the country. He writes that ignorance, poverty and social stigma are catalysts in spreading the disease and act as major roadblocks in combating the threat. He argues that wide spread poverty in India, can increase HIV/AIDS through malnutrition, sex for survival and due to the lack of access to health care. Further he makes the point that ignorance and widespread stigma about HIV/AIDS can make it very dangerous as it contributes to the suffering of those infected and their relatives.
Finally the author attempts to briefly describe the HIV/AIDS situation in Africa and compares the experience of African countries in combating the threat of HIV/AIDS to that of India. It highlights the fact that the Indian government must accord HIV/AIDS a special stature of security concern; otherwise India will overtake African States in HIV/AIDS epidemic and India’s situation would be where South Africa is today. He adds up Thai experience in combating the epidemic as a success model which India could emulate in order to reduce the epedimicity of the chronic disease.
The authors endeavor to relate HIV/AIDS epidemic to security threat is praiseworthy. I find Happymon’s study and style of presentation commendable, thus making the text highly accessible even to a general reading public. Several relevant statistics and a treasure of sources have been added. This further enhances the value of the book. However, the book is weak in its analysis and does not address issues that would help us to develop our understanding of the long term solution to this crisis. Nor does it addresses the State and non – state responses to the HIV/AIDS epidemics. More important than minor criticism, this piece represents a stellar contribution in the best tradition of applied social science while providing a bridge heal into the world AIDS pandemic. An interesting and though – provoking book, the piece by Happymon raises questions for further research.
In the final analysis, authors of the three books reviewed herein have tried their best to critically examine and analyze the global HIV/AIDS pandemic. We argue that, in the case of the books reviewed herein, HIV/AIDS pandemic is not only causing a devasting socio – economic and political impact on the nation – states but is also posing a great threat to the security of the nation – states. The books highlight the fact that HIV/AIDS poses new challenges to the existence of humanity. The studies try to show that the epidemic can be catastrophic depending how the states respond. The books therefore, make a valuable contribution to our understanding of the HIV/AIDS crisis and the issues to be addressed. It deals with new initiatives and global priorities and their relevance and implications for developing world in general and India and African states in particular. The winners over the pandemic in today’s world are those who gives top priority to HIV/AIDS crisis as given to other threats like war and terrorism and dealing the situation with well – planned and mass – based programmes, can only reverse the pace and the spread of the disease. That is the illumination brought to fore by these literatures.
Overall the authors of the three books are commended for accomplishing a great task that is to put forth a well argued, well organized and useful contribution on such a sensitive issue.

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