HIV Is Not Just a Health Problem

Danielle Toppin

By emphasizing the social dynamics that often contribute to the transmission of HIV, policy planners and practitioners rightly see HIV as a social and development issue, not just as a health issue.

Driving home two days ago, I passed by an alleyway in an economically-deprived area with the words "Use a Condom" sprayed onto a wall. The powerful simplicity of the message made me smile because on some level – however basic – it does signify some shifting of the ways in which people at all levels are beginning to see, think, and speak about sex. For me, it signified some individual's attempt to not only act on a piece of information received, but also to inform others. More importantly, it was a visible example of public education at a rudimentary, though powerful level.

In the global fight to manage and eventually eradicate HIV/AIDS, emphasis has continually been placed on the role of public education in general, and more specifically, on changing sexual and social behaviour that may place individuals at risk for contracting HIV.

By emphasizing the social dynamics that often contribute to the transmission of HIV, policy planners and practitioners are better able to zero in their efforts on issues that may not automatically be seen to be related to HIV. As such, issues such as poverty, gender dynamics (for example, the different understandings of masculinity and femininity), access to education, and community development must be included if we are to create and sustain balanced, effective and sustainable programs and projects. This allows us to broaden our focus on HIV beyond seeing it solely as a health issue, but rather as a social and development issue.

Despite the undeniable need for this broader approach to HIV management, public officials often fail to make the connection between the transmission of HIV and social and cultural behavior.

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In celebration of World Aids Day on December 1, Jamaican Prime Minister Bruce Golding publicly announced that the Global Fund grant – a program which covers the cost of HIV/AIDS programs, including antiretroviral drugs for persons living with the virus – will be sustained over the next five years. The grant, which takes effect in 2008, will provide US$44 million (J$3.1 billion) to carry out HIV prevention, treatment and care programmes.

The Prime Minister also expressed concern about the island's need for an additional US$200 million (J$14.2 billion) to deal with HIV initiatives and programs over the next five years; noting that the government would only be able to provide one-third of that amount. He further stated that despite the importance of the fight against HIV/AIDS, the government must also tend to other national priorities such as crime and education. To this end, the Prime Minister has called on the private sector to step up their role in contributing to HIV causes.

In theory, the Prime Minister is right. With a steadily growing crime rate and particular challenges in the area of education, these are key priorities for national development. However, what is missing from his analysis are the linkages between and amongst these areas. Issues such as education cannot be dealt with in isolation from HIV/AIDS, as over time, the links in these areas will become increasingly apparent. The same can be said for most development issues, yet in public forums, public officials often fail to recognize or underline the interconnectedness between these areas.

Another major oversight made by the Prime Minister is his sole focus on the need for increased private sector involvement, with no specific mention being made of the role of civil society organizations in managing HIV. The empowerment of civil society groups must be a core component of any national policies designed to tackle HIV/AIDS-related issues. Failure to recognise, and beyond that to publicly support the work being done by these organisations leaves many stones unturned. These are the people who are actively working to uncover the linkages between social and cultural development issues and HIV, often with little financial or public support.

A key component of any well thought out policy or program must necessarily be the inclusion of civil society organisations. The focus on public education and meeting the needs of those infected with HIV can take us only so far towards managing it. In order to manage HIV, we must first contextualize it. As necessary as funding and private sector support are, they will only take us so far without the input of key players on the field.

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