In Acord Newsletter Issue 2: June 2001

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Article 10:

Room for Debate
This is a new page for inAcord readers to express their views and debate current development issues

AIDS Revisted

Reprinted by kind permission from the Inter Pares Bulletin, June 2001. 

Inter Pares is a Canadian Development NGO and an ACORD member.

No health issue has so galvanised the world and public attention, as has the acquired immune deficiency syndrome. At the same time, there is controversy about the nature of AIDS and the best way to respond to it. In approaching this debate, many feel that we have no choice but to rely on dominant medical explanations, and reject alternative explanations posed by other scientists and practitioners. Given the apocalypse that is being predicted in Africa and other parts of the world it is important to scrutinise the lines of the AIDS debate and what we are seeing in the world.

The best starting point for such an examination is the middle ground of common understanding among mainstream and alternative practitioners in the debate. The acquired immune deficiency syndrome is a condition in which a person’s immune system is severely compromised and left vulnerable to a broad range of infections and diseases that debilitate and can lead to death. It is a medical construct that captures many disease phenomena in one basket for purposes of investigation, diagnosis and treatment. Within this complex syndrome there are many factors. No one factor — including the various viruses associated with immunodeficiency — is alone sufficient to bring on the onset of chronic critical immune deficiency. The most determinant predictors of immune suppression and associated disease — in the north and the south — are factors directly related to social and economic status, or to medical treatment itself. Not surprisingly, therefore, the front line in the "fight" against acquired immune deficiency increasingly is in the area of basic health promotion.

Closely read, the in-house literature of the international health institutions and multilateral development agencies explains all of this. Acquired immune deficiency syndrome is multifactoral, and social factors predominate. Yet there has been a tendency to obscure these fundamental understandings for fear of "confusing" people, undermining prevention programs, and eroding political support for program and research funding. It is far easier to mobilise support to fight disease than to fight poverty and injustice. Extensive resources are available for those who develop their programs within the conventional medical framework, and most programs and public education campaigns are built on the "HIV/AIDS" metaphor and image.

Those advocating a more comprehensive and balanced approach in health programming and public education do not insist that poverty is the sole cause of extreme and chronic immune suppression, nor that viruses and microbes can be declared with certainty to have absolutely no role in all cases. Indeed, most resist precisely the notion that what is called acquired immune deficiency syndrome is a single phenomenon or that it has a sole and solitary cause. They do say that the factors and conditions that lead to such immune suppression are dominant among poor populations, that the poor are the most vulnerable, and that it is on poverty and its roots that we should focus.

A virus is a convenient and simple "target" to rationalise medical responses, but it also obscures other factors that would focus responses on long-term, substantive social and economic transformation of the conditions that make people vulnerable to the diseases that take advantage of chronic immune deficiency. The role of "medicine" — that is drugs — in resolving the crisis can only be very limited, and there is profound controversy about the actual effects, negative and positive, of pharmaceutical approaches.

Many have concluded that although prevailing medical theory is not accurate or complete, it is what we have to go with until something better comes along. We can never do away with poverty so we had better make medicine work. Controversy about the nature and cause of acquired immune deficiency syndrome, they believe, undermines the good that medical science and humanitarian aid can accomplish. Scientific issues are matters for scientists to resolve, and not for politicians, or ordinary citizens. Debate only leads to public confusion and "politicisation" of the issues. Controversy needs to be contained, and a consensus created to fight a "war" against the disease.

While perhaps understandable, this approach to knowledge is undemocratic and relies on coercion and propaganda as much as education; it has always failed in the long run, and cannot succeed in this case. To actually overcome acquired immune deficiency syndrome requires that we build a broad public consensus towards a campaign against global poverty itself. It requires a relentless focus on the social and economic conditions that make people vulnerable to the chronic immune deficiency that threatens poor people the world round.

This struggle clearly cannot ignore those presently enduring the deadly effects of immune deficiency. It will, of necessity, involve building the physical and legislative infrastructure to ensure universal access to effective remedies and health treatments. This has to include long-overdue scrutiny and regulation of the research and marketing practices of pharmaceutical companies. But to be truly effective, the emphasis has to be the transformation of the political, social and economic structures that make the lives of the poor a permanent emergency in the first place

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