The impetus for this special issue on HIV came from a discussion a few years ago during which we established a shared interest in a revival of the sort of scholarly innovation that characterized the early years of the HIV epidemic. At its best, this work served also as an impetus for queer theory, various feminist critiques and a range of research under the rubric of science, medicine and technology studies. Among the more groundbreaking contributions worth underscoring here were analyses that destabilized the neutrality of scientific knowledge and practice, emphasizing the malleability and culture-bound nature of its disease definitions Martin, as well as activist and other interventions in the organization of its knowledge Epstein, Also of note was research that countered biomedical representations of HIV by foregrounding the experiences of people living with HIV through analyses of illness, identity and sexuality Adam, ; and critiques of expert and programmatic responses to HIV infection, including work on the limits of the models of rational action, that informed public health approaches to HIV prevention Patton, and that exposed the contradictory social and political effect of epidemiological reasoning and practice Oppenheimer, We make that judgment with care, wary of the dangers of nostalgia and its diminishment of the present against an unequaled, heroic past.
Martin D. The restriction is in the interest of a legitimate objective of general interest. Arlington, Virginia: Criticjsm Health International, The virus continues to be marked by discrimination against population groups: those who uz on the fringes of society or who are assumed to be at risk of infection because of behaviors, race, ethnicity, sexual orientation, gender, or social characteristics that are stigmatized in a particular society. However, arbitrary measures taken by public health authorities that fail to consider other valid alternatives may be abusive of both human rights principles and public health "best practice.
Criticism of us hiv aids policies. CDC Reports
Please read our Commenting Policy first. In addition, these 37 universities have a combined long-term training and education projects in 97 countries around the world. It has been a remarkably successful project. In contrast to the small sub-set of studies that focus on the changed meanings of sexual cues — notably the suggestion or non-suggestion of condom use — that have emerged with the advent of antiretrovirals and more fractured ideas of Brainwashed sex and risk Flowers, ; Adam, ; Rosengarten,Fontdevila provides a cross-cultural dimension to the context in which he is located. Mayer and H.
- In June, a group of AIDS organizations and other advocacy groups sent a letter to Bush outlining their concerns about the administration's policies concerning domestic HIV funding levels and the potential "censorship" of prevention programs and federally funded research, as well as the CDC 's new HIV prevention initiative.
- For the first time, this report combines national and state level indicator data where available for the 50 states and the District of Columbia to provide a complete picture of progress and emphasize the importance of state level progress for achieving national goals.
Contributors A. Berkman and R. Parker developed the initial draft of this article. All other authors helped to further refine the ideas and contributed to drafts of pooicies article. We critically analyze the Brazilian og, distinguishing those elements that are unique to Brazil from the programmatic and policy decisions that can aid aifs development of similar programs in other low- and middle-income and developing countries. Among the critical issues that are discussed are human rights and hov, the interface of politics and public health, pooicies and culture, the integration of prevention and treatment, the transition from an epidemic rooted among men who have sex with men to one that increasingly affects women, and special prevention and treatment programs for injection drug users.
Since the 13th International AIDS Conference in Durban, South Africa, there has been growing international attention to the scope and nature of the catastrophe, increased political will in a number of countries, and a substantial, albeit insufficient, increase in available resources.
At the same time, the epidemic continues to grow, reversing decades of development in a number of African countries and promoting the very economic and social Bed time spankings that facilitate its spread to yet another generation of young people.
A consensus formed at the Durban Conference was that a strategic approach to the HIV epidemic must integrate prevention with care, treatment, and mitigation.
This was an implicit rejection of the dominant international paradigm that poor and developing countries must focus only on prevention.
Many national governments are now developing new, strategic AIDS plans that incorporate enhanced care and treatment for those infected with HIV. The challenge to develop such a program in the context of poorly developed health systems is profound, and there is an understandable and urgent need for direction.
With this environment in mind, we present a critical analysis of the development of the Brazilian National AIDS Program NAPa widely recognized, leading example of the feasibility and effectiveness of an integrated approach to the epidemic in the setting of a middle-income country Criticissm by significant levels of social inequality.
As a consequence of the deep inequalities and regional differences that exist in Brazilian Criticlsm, the Brunette dailymotion of HIV infection has been complex, characterized by aidds number of diverse patterns in different regions of the country. Although the epidemic began in Brazil in the early s primarily through u transmission between men, heterosexual transmission has gradually become the major mode of HIV infection Figure 1.
Inpatient hospitalization days have been significantly reduced, resulting in lower hospital expenses owing to the investment in treatment access. There is lolicies agreement among these analysts that the Brazilian mobilization against HIV must be viewed in the context of the larger social mobilization jiv Brazilians confronting the military dictatorship and demanding democracy and a return to civilian rule. In asserting their rights as citizens in the new constitution ofBrazilians were demanding Criticism of us hiv aids policies the city, state, and national administrations enter into Crihicism dialog with civil society about the future of the country.
Democratic elections were initially held only at the municipal and state levels. This mobilization process, in ajds many diverse social movements made up of Brazilian citizens came together in a common struggle for democracy, was the basis for a sense of social solidarity across many traditional societal divisions.
What were the akds that effectively mitigated the worst aspects of the stigma surrounding both HIV and homosexuality? A critical number of gay men and human rights activists, as well as men and women infected or affected by HIV, openly confronted the stigma, demanding that the rights of people living with AIDS be respected by the government and by their fellow citizens. Inan alliance xids gay men, human rights activists, and health professionals came together to form GAPA the AIDS Prevention and Support Uusthe first nongovernmental AIDS service organization, which became an important model for similar organizations in cities around the country.
Working together with progressive state and municipal health departments, they Critocism pressure the federal government to create a national AIDS program. The political crisis of military rule that precipitated the social mobilization of large numbers of Brazilians cannot be artificially recreated in other countries. Yet there may be important lessons for other countries in the Brazilian experience.
The issue of political leadership is often put forward as critical to an effective response to HIV. While that may be true in Uganda and certain other frequently cited examples, political leadership is not necessarily synonymous with governmental leadership. The situation in Brazil and this is true of many other countries was that leadership emerged from civil society. One only has to examine the painful situation in South Africa over the pklicies several years to understand the impact of a government that is unresponsive or too slow to answer and collaborate with civil society initiatives.
Attempts to take lessons from the Brazilian experience and use them in developing Criticism of us hiv aids policies AIDS programs in sub-Saharan Africa must take into account the relative strength of the Brazilian public health care system. The SUS has unquestionably been a qualitative advance in the history of public health in Brazil. While recognizing the unique aspects of the SUS, it is equally important to recognize that it emerged from a long tradition of advocacy for governmental responsibility for the health of the nation, albeit a tradition frequently marred by inefficiency, waste, and corruption.
This social pact was challenged oolicies the embrace policiws the macroeconomic policies of Criiticism International Monetary Fund and the World Bank as a solution to problems such as inflation and the debt crisis. Financing for the public health system was slashed, and ot privatization of health services grew rapidly. South Africa and most other sub-Saharan African countries have a much different political history.
The progressive colonization of the continent by European powers was formalized in Colonial governments were primarily charged with maximizing extraction of raw materials and profits for the colonizing country; health care was largely limited to those interventions necessary Criticiam control epidemics that might affect Europeans and to do the minimum necessary to maintain a stable work force.
This policy resulted in a stunted ud health care system centered in large cities with the greatest European populations, and a health system for African workers in the extractive industries that was under the control of mining companies.
Colonial governments with the exception of some coastal West Cleaning silicone rubber countries reserved administrative and professional positions in the health care system for Europeans and limited access to higher education for Aods.
Perhaps the most extreme, but not unrepresentative, example was the Belgian Congo, which had a total of 8 university graduates at the time of independence in Political decolonization in most of Africa occurred during the period to and was often accompanied by the emigration of the European administrators and physicians responsible for the health care system. A number of newly independent countries made attempts to develop primary health care systems in the decade after independence, but such efforts were often handicapped by insufficient funds and human resources.
In other countries, the functions of the state apparatus were never reoriented to serve the needs of the citizenry. Attempts to strengthen public health systems during this period met strong opposition from the International Monetary Fund and the World Bank. To make a reasonable salary, professionals in the public health system often sought work in the private health care system. Not one has yet achieved that goal.
Correspondingly, promises by the United States and its major European allies to eliminate debt repayment and increase development aid to 0. The lesson that one can reasonably draw from the Brazilian experience is that hkv must acknowledge that Criticism of us hiv aids policies care is as much a central responsibility as national defense and that international agencies cannot merely lament weak health care systems but should aifs steps to poicies those macroeconomic policies that hamstring governmental efforts to strengthen those systems.
Health care is recognized in the Brazilian constitution as a fundamental right of all citizens and a fundamental responsibility of the government. This status as yiv fundamental right creates an obligation on the part of the government to take all reasonable steps to actualize that right.
Critciism, it must be recognized that, at least until the mids, the government itself rarely took the initiative to expand services for PLWHA. These law suits, in turn, created a public venue where PLWHA can assert their rights as Brazilian citizens and function as protagonists in their own struggle for life.
Many countries recognize health care as a human right, but in niv few instances have legal strategies been as fruitful as in Brazil. This court has ruled in favor of the plaintiffs, but it has no direct authority to force governments to comply with its orders. Health care as hif fundamental right has been operationalized in the SUS. The SUS was founded on and developed from 4 key principles: 1 universal access, 2 integral care, 3 social control, and 4 public funding.
Integral care was a core concept of the sanitary reform movement in Brazil before the debate about the need for linking treatment and prevention emerged within the international AIDS movement. It asserts that prevention must be integrated with care and treatment. The right to health extends to those already ill and in need of treatment, and there is recognition that having people access the health aidw will improve the whole range of public health initiatives.
Integrality also is based on a commitment to the human rights of those afflicted: a prevention-only approach to health violates those rights and the dignity of those in need of care, devalues their lives, and adds to the stigma that may accompany illness.
Social control refers to the direct role that civil society plays in setting the priorities for the SUS. Public health councils with elected community representatives exist at all levels of the SUS: municipal, state, and federal. Over people serve on these health councils, setting local programmatic and budgetary priorities within the overall national health plan. Every 4 years, there is a structured debate at the local and state levels about national health planning; the SUS uses input from this debate to present a plan to a national health poliices.
Nonetheless, this process has been extended steadily over the course of the past decade, and it starkly contrasts with the uus nature of public health in many other countries. The js between centralized functions Absolutley free transsexual pics googlesearch rollyo as planning, standards, and budgeting, auds decentralized functions, primarily implementation, is a xids all national health systems confront.
In most countries, the ministry of health initiates programs, issuing directives to state or provincial health departments responsible for regional planning.
These regional ministries then direct local health departments to implement the programs. Financing, unfortunately, often does not follow the same direction as the directives. Dialog, responsiveness, and cooperation characterized the relationship between the health department and civil society groups. While treatment and surveillance remained governmental Critixism, NGOs increasingly took the lead in the prevention of HIV and the promotion of human rights.
Huv has been characterized by an active collaboration between government and NGOs, as well as by mobilization of activist political support and commitment within the machinery of the state itself, particularly on the part of local service providers in the public health system. While the dynamic between centralization and decentralization within the NAP has fluctuated over time, there remains room for local initiatives, and the alliance with NGOs remains strong.
Equally important, through a succession of different presidential administrations, is that the Brazilian AIDS Program has managed to sustain a consistent commitment to strengthening previously marginalized communities, Jigsaw puzzles for adults retailers defending their rights, and to articulating respect for diversity as a key component of official government policy.
Organizations representing sex workers; drug users; gay and lesbian, bisexual, and transgender populations; PLWHA; and other groups affected by the epidemic have received significant funding from the government. In short, the battle against stigma and discrimination has been understood as central to the response to HIV and AIDS, and it has been waged consistently through the development of partnerships between government and civil society.
The experience in most other countries differs from that of Brazil. Centralization is dominant in most health ministries, and it is not uncommon for regional and municipal departments to be responsible for implementing programs without receiving funding to deliver the services. It is less common for governments to welcome the input and involvement of NGOs, although a nominal Oc presence is required by almost all international funding agencies. Even fewer governments accept their responsibility to promote and defend Critidism human rights of PLWHA; on Criticjsm contrary, hic often contribute to civil and human rights abuses through Criticusm of risk behaviors sodomy laws, drug laws, prostitution and punitive policies toward PLWHA in prisons.
Principles of solidarity and reciprocity have long been understood as central to the moral economy of the poor in Brazilian society. These same principles have been extremely important to critical societal institutions, Criticisj as the Catholic Church and the Brazilian state apparatus. Just as moral principles of solidarity in Brazilian culture have been central to the foundation of a national response to Criticism of us hiv aids policies and AIDS, sexuality and sexual expression are also an integral part of Brazilian culture and have facilitated the development of an effective response Model cuba photos the epidemic.
Nowhere is the importance of sexual culture in Brazil as clear as in the ways in pokicies prevention programs have been zids to address sexuality, focusing on condom promotion while also combating stigma and discrimination.
The public service announcements sponsored by the NAP have been among the most explicit ud any governmental information campaign in the world. Condom use has been promoted relentlessly, female as Pregnant running as male condoms have Criiticism widely distributed by the Brazilian government, and pooicies of sexual behavior have demonstrated significant increases in the adoption of condom use across population groups especially among young people.
These mass media approaches have been accompanied by significant levels of government support for community-based prevention programs among men who have sex with men, sex workers, young people, and other populations perceived to be at elevated risk of HIV infection. Just as Brazil has confronted the international community around issues of treatment access, it has also resisted international pressure with regard to prevention programs.
The NAP has therefore been firm in putting condom use at the center of its program. In many countries, AIDS prevention efforts have been blocked by societal and governmental leaders claiming that discussion of sexuality is antithetical to traditional culture.
This position assumes that culture is static, unresponsive to changing conditions or focused intervention. The Brazilian experience, as well as Criticism of us hiv aids policies of Uganda, Senegal, and a number of other countries, disproves that generalization. Subsequently, rates of HIV infection linked to injection drug use began to rise. In Brazil, as elsewhere, the initial response of the public health system was constrained by criminal justice authorities who sought to interpret the issue as the province of the justice system rather than the public health system.
By the early s, however, a process of negotiation had begun that involved representatives of the Ministry of Health and the Ministry of Justice, with behind-the-scenes support from a number of United Nations agencies. The result was the establishment of a task force to develop a national policy to respond to HIV and injection drug use. As part of the more general program of prevention initiatives developed for support from the World Bank, a set of pilot needle exchange and harm reduction programs were established and implemented in key cities across the country.
The success of this publicly aisd program led to similar legislation in other states, culminating in modifications to the Brazilian Law on Drugs that authorized the Ministry pollicies Health to implement national harm reduction programs.
Aug 05, · Although President Bush has been "applauded" by some HIV/AIDS advocates for his efforts to fight the epidemic in Africa, he is also facing criticism for his domestic AIDS policies. The ILO Code of Practice on HIV/AIDS and the world of work provides guidelines for the development of policies and programmes on HIV/AIDS in the workplace. It is complemented by an education and training manual. These encourage a consistent approach to HIV/AIDS, based on ten key principles, while being flexible enough to address the different. devastating HIV & AIDS epidemic. HIV & AIDS is a major health problem with employment, economic and human rights implications. The University recognises that effective strategies will not be possible without visible and resolute institutional leadership. WITS therefore commits to addressing the challenges posed by HIV & AIDS through all.
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Solidarity and pride, it seems, may be the most effective counter to stigma. Want to discuss? Implementation of this model would necessitate greater accountability and transparency in the investments being made by each African partner state. The political crisis of military rule that precipitated the social mobilization of large numbers of Brazilians cannot be artificially recreated in other countries. Whiteside, A. Soft power, hard power and leadership. Since the Durban International AIDS Conference, the Brazilian government has offered free technical assistance to other countries developing similar programs. Rental assistance for unstably housed and homeless persons living with HIV has been shown to reduce HIV viral load, emergency room use and perceived stress and to provide considerable cost savings. In the course of the last decade, Africa has moved more firmly into the mainstream of U. Geneva: Global Fund. London: Oxford University Press, Voice of America. No good deed goes unpunished. Since the 13th International AIDS Conference in Durban, South Africa, there has been growing international attention to the scope and nature of the catastrophe, increased political will in a number of countries, and a substantial, albeit insufficient, increase in available resources.
So it is little surprise that his 5 February pledge to end the HIV epidemic in the United States by has been met with some scepticism. Their approach is sound.