Neoliberalism and AIDS Crisis in Sub-Saharan Africa: Globalization’s Pandemic
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Other than mother-to-child transmission in utero , and blood transfusions using infected blood, shared needles and sexual contact account for virtually all cases of HIV transmission. In many parts of Asia, the U. In the aftermath of the war in Afghanistan in , there was evidence of increased needle-sharing in Pakistan, a country which still has low rates of reported HIV. Soaring rates of infection in parts of the former USSR are often linked to needle use, especially in prisons and among disaffected and unemployed youth. The vast disruptions to social life in countries that have experienced rapid social, economic and political transition means greater rape, prostitution and transmission of sexually transmitted diseases STDs in environments where social supports and prevention programs are virtually non-existent.
Growing human movement of all sorts, from migrant labor to sex tourism, increases sexual contacts between previously isolated groups. It's not for nothing that the Iron Curtain was once described as the world's largest condom.
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The growth of urbanization and economic development in many parts of the world means the collapse of traditional norms of sexual behavior and increased vulnerability to infection by HIV. And under conditions of social dislocation, poverty and the absence of health services, HIV spreads much faster. Part of the impact of an epidemic linked to social and economic upheavals has been to effectively increase the vulnerability of women, who are less able to protect themselves against infection, even as they enjoy less access to treatments.
Women also carry a greater share of the burden of care for those who are sick.
Oil for health in sub-Saharan Africa: health systems in a 'resource curse' environment
Violence and rape -- usually, but not exclusively, directed at women -- are a major cause of HIV transmission, which increases dramatically in situations of social and political dislocation. The spread of the epidemic has been linked to civil wars and international conflict, above all in sub-Saharan Africa, but also in Cambodia and Haiti. The low prevalence of HIV in Yugoslavia means that the disease was not spread by the widespread rape that accompanied the bloody disintegration of that country. The connection is complex, and seems most evident in post-conflict situations. Equally, refugees and displaced persons face a whole set of conditions that both increase vulnerability to HIV and decrease access to information, prevention and care.
The Global Financial Crisis is reported to have increased HIV transmission in a number of countries, partly due to rising rates of injecting drug use and sex work, as more people struggle to survive. At the same time, already limited resources available for prevention and care were further curtailed, and there were reports in some countries that the equipment to screen donated blood for the virus was no longer available.
Even the United States has seen cutbacks in support for anti-retroviral drugs. Without examining in detail the very complex arguments around increasing access to treatments, the development of expensive and sophisticated anti-retroviral drugs has sharply increased the gap between AIDS in the rich world and the disease in the poor world for ongoing coverage of these issues see ATTN News. Now there are signs that global commitment and funding for treatment, provided for in the Millenium Development Goals, is falling increasingly behind the need, and that global commitments are waning.
It produces a new generation of orphans that increases strains on both communal and state services, which in turn results in more children and teenagers being driven onto the streets, where they are increasingly vulnerable themselves to HIV infection. There is also a psycho-cultural impact: Mass deaths and illness trigger a set of irrational responses involving anger, denial and scapegoating. It is possible that the extraordinary hostility towards homosexuals expressed by the leaders of countries such as Zimbabwe, Uganda and Namibia, is a displacement of the fears and frustrations aroused by HIV, and expresses the particular resentments of leaders of countries whose very survival is imperiled by an epidemic that is spread sexually.
People are made vulnerable to HIV through rapid change and the disintegration of existing social mores and connections, but they are equally vulnerable because of denial and sometimes active persecution justified in the name of culture, religion and tradition. In many countries, there are reports of violence against AIDS outreach workers, who are often seeking to work with people made vulnerable by social change, but who are seen as responsible for declining moral standards.
There have been ongoing reports of harassment, imprisonment and even the killing of people thought to be HIV positive --or those associated with them -- in most parts of the world.
The connection with sex, and the surrounding shame, guilt and silence that have characterized the response to AIDS in most societies sets the disease apart. The vast shifts in everyday life that accompany rapid industrialization, urbanization and civil war inevitably disrupt gender and sexual relations, remake family structures and often force people to adopt sex as a means of survival. Changes in marriage patterns, increasing teenage sex, rising numbers of single parents, and new forms of family structures are occurring across both rich and poor countries as responses to dramatic shifts in the nature of the economy.
Across the world, the impact of neoliberal economics, with its associated growth of increased movement of people and the collapse of traditional family and community ties, means greatly expanded possibilities for sexual contacts outside those prescribed by religion and tradition, with all the accompanying possibilities for the spread of HIV and other STDs. Sex, Money and HIV While it is often said that HIV is "spread through prostitution" -- a formulation that demonizes the sex-worker while ignoring the client -- the vast changes in sexual behaviors and attitudes across much of the world cannot be reduced to simple issues of prostitution and exploitation.
Nevertheless, while it is difficult to assert that globalization has resulted in an increase in prostitution, it has certainly changed the ways in which prostitution is organized and regulated. Fear of HIV infection appears to have played a role in increasing demand for younger -- because presumably uninfected -- prostitutes, often from rural areas. That has sometimes led to increased cross-border trafficking, as in the case of increased demand for young Burmese women in Thailand, Nepali girls in India or Mozambiquean children in South Africa. At the same time, organizations working with sex workers in many countries -- including Brazil, Thailand, India and South Africa -- have had some remarkable successes in both improving conditions and increasing safer practices.
While the great majority of people who sell sex almost certainly do so without any sense of a shared identity, the growth of sex-worker organizations in both rich and poor countries is a significant step toward breaking down the worst abuses faced by people who live by the sex industry. Such organizations have also been central to HIV-prevention efforts, often with little support from government officials and clients.
Even so, United Nations reports from Bangladesh suggest that the majority of sex workers have not been protected by condoms in at least some of their encounters, hardly surprising in a country where a majority of people are unaware of AIDS. There is a great deal of confusion in the discourses around HIV. Conservatives have seized upon the epidemic as "proof" that anything other than strict rules of exclusive heterosexuality, abstinence and monogamy will promote the epidemic.
Poverty and Development in Africa
Yet the real consequences of these policies -- and the denial of human desires and behaviors that accompanies them -- represent a greater danger for the spread of HIV than does "promiscuous" sexual behavior. As social stability collapses, more young people find themselves living off their wits, and the failure of state services -- due in large part to policies promoted in the name of economic efficiency and rationalism -- further perpetuates this vicious cycle.
The United States has simultaneously exported an ideology of conspicuous consumption and puritanical restrictions on sexuality, as in the ban on any form of birth control advice that might countenance abortion. The de facto result has been to contribute to the spread of HIV, even as other parts of the U. Pressures to control the epidemic have led to a dramatic increase in the knowledge and discussion of sexuality. Measuring changes in behaviors is more difficult, but the evidence suggests that it has taken place, albeit unevenly across the world. The SAPs were replicated across most countries in sub-Saharan Africa over the next decade with grim results.
SAPs exacerbated the crisis of the state in Africa… The limited state capacity at their birth was weakened as the public sector and public bureaucracy became major targets for state budget cuts, often inspired by SAPs. The paradox of SAPs is that, while the state was expected to lead the process of economic reforms, stabilisation and transformation, its capacity was dismembered, and it became unable to pursue the reform measures effectively.
SAPs frequently held back economic growth and social progress, negating the construction of developmental states. Riots brought down the governments in Liberia, Sudan and Zambia and threatened several others. The impact of structural adjustment on the general economy of most African countries was devastating. Deregulation and the opening up of economies to the global market did not result in a significant growth in manufacturing; indeed the result was often deindustrialisation. For example, the textile industry in Nigeria was decimated. The main cause of deindustrialisation in a number of developing countries in the s and s lies in their choice of macroeconomic and financial policies in the aftermath of the debt crises of the early s.
In the context of structural adjustment programmes implemented with the support of the international financial institutions, they undertook financial liberalisation in parallel with trade liberalisation, accompanied by high domestic interest rates to curb high inflation rates or to attract foreign capital. Frequently, this led to currency overvaluation, a loss of competitiveness of domestic producers and a fall in industrial production and fixed investment even when domestic producers tried to respond to the pressure on prices by wage compression or lay-offs.
Eight African countries Chad, Ghana, Liberia, Madagascar, Niger, Uganda, Zaire and Zambia experienced severe drops in real income per capita of more than 20 percent between the early s and late s. Real incomes of almost all households and families declined sharply. Although the details varied from region to region and from country to country, the overall picture was the same.
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Accounts from individual countries may suggest that it was problems with internal policies, the behaviour of their governments and civil servants. But when the timing of the economic reversal is so similar in so many countries, this suggests that the economic problems were mainly due to common external events rather than the particular domestic approach of individual governments.
Capital flight also takes the form of the brain drain. Not only is Africa providing financial capital to develop the rest of the world, but it is also providing it with intellectual capital. It is estimated, for example, that over a quarter of the graduates especially in such fields as engineering, science and medicine have emigrated from West Africa and nearly a fifth from East Africa. In contrast much of the development aid sent to Africa is immediately repatriated to industrial countries via payments to consultants.
The loss of key professionals by emigration from Africa has led to the use of foreign consultants whose daily rate is often equivalent to the monthly salary of local officials. This had a devastating effect on the economy, especially in Southern Africa, with, for example, several countries having more teachers dying each year from the disease than were graduating from teacher training colleges. In some 1. The debt problem continued and its impact on government finances continued to be catastrophic. Limited debt relief was eventually made available to some governments that accepted this further conditionality.
The HIPC initiative has not provided a significant reduction in the debt burden actually suffered by many African countries. Annual debt service relief in for the 20 HIPCs involved was not much more than one 20th of the foreign aid these countries had received in The economies of sub-Saharan Africa finally managed to achieve reasonable economic growth in the early years of the 21st century achieving real per capita growth of over 2.
Over 50 percent of the economic growth of sub-Saharan Africa in the 21st century was due to increased commodity revenue thanks to higher demand especially from emerging economies such as India and China. This is now comparable to the level of exports to the European Union and the United States combined. China is now the largest destination for African exports taking nearly a quarter of the total having increased from only 5 percent in Remittances from Africans working outside Africa exceeded foreign direct investment from and overtook development aid from However, prices for export goods remain volatile and so place future economic growth at a significant risk.
Growth declined after although it was still 3.