9/30 Response to Iliffe and Barnett and Whiteside Readings

In considering the social, economic, political and biological factors that affect the spread of the HIV/AIDS epidemic, I had not ever considered that the timing of the epidemic in various areas of the world could be so influential. Yet, Iliffe makes an interesting point in Chapter 7 when he theorizes that "the fundamental reason why Africa had the worst AIDS epidemic was because it had the first AIDS epidemic" (pg. 58). As Boxes 1.6-1.7 in Barnett and Whiteside's first chapter demonstrate, extensive AIDS epidemics exist outside of sub-saharan Africa as well. However, the concern that an epidemic as dramatic as that seen in sub-saharan Africa may explode in parts of Asia and eastern Europe has proven largely unfounded. Barnett and Whiteside predict in Box 1.2 that "Asia will overtake sub-Saharan Africa in absolute numbers before 2010," (pg. 9), yet thus far, this does not appear to be the case. While timing is obviously not the only factor contributing to the explosiveness of the African AIDS epidemic, I would be interested to further explore the idea that governments elsewhere in the world were better able to prepare for the possibility of a devastating AIDS epidemic, and thus better able to keep the epidemic confined to specific core groups in society.

As Barnett and Whiteside assert on page 15, the world has, until very recently, largely chosen to "deny what is happening and not to recognize the global implications of this epidemic for the welfare and well-being of others." From my own experiences working in HIV clinics in KwaZulu Natal, South Africa, I can attest to the enormous role that denial within a society can play in furthering the spread of HIV/AIDS and contributing to stigmatization of the disease. Government denial plays a particularly destructive role in fighting the spread of HIV/AIDS, which brings me to Iliffe's discussion of the South African epidemic. Illife asserts that "It would be naive to think that even the most vigorous, stable, and popular government could have protected South Africa from a major epidemic" (pg. 43). While he further says that "better political leadership could have reduced the impact of HIV," I believe Iliffe underestimates the role that government denial, particularly on the part of South African president Thabo Mbeki, played in allowing the South African epidemic to continue spreading. A recent Harvard study attributed the death of at least 330,000 South African AIDS victims to the policy of AIDS denialism followed under the Mbeki administration. Mbeki and his Minister of Health extensively delayed the rollout of ARV's and mother to child transmission drugs well past the point at which these drugs were available to South Africa. Furthermore, the psychological effects of AIDS denialism within government leadership are still impacting HIV/AIDS treatment and prevention efforts. Thus, as Barnett and Whiteside discuss as well, I believe government attitudes and policies have a dramatic impact on the spread of the HIV/AIDS epidemic.