As the HIV/AIDS pandemic enters its third decade in Latin America, not all the news is bad. Large public investments in the treatment and prevention of the disease offer some cautious hope that the pandemic can be slowed, contained, and made more bearable for those who suffer its effects. Even more important, as Shawn Smallman suggests herein, “the political victory that Brazil and other developing nations won, by asserting their right to produce generic drugs against HIV,” has improved the life chances of the region’s AIDS patients. This victory, Smallman continues, has led “both developing nations and international grantors [to] now view treatment in poor countries as feasible.”
In Brazil and several other countries, both the public commitment and the political victory can be traced to the militant actions of civic organizations, as well as the region’s democratic openings that made such civic action possible. This activism has taken on powerful opponents. Civil society has had not only to pressure national governments to do the right thing, but also to confront—or pressure regional governments to confront—Washington and a host of powerful pharmaceutical companies that have been loathe to permit the domestic manufacture of a variety of drugs to make free or low-cost treatment available to large segments of the population.
Particularly important in the mobilization of civil society, says Richard Parker, reporting on the movements of Brazil, have been “the deeply rooted ideologies from the tradition of liberation theology in the Brazilian Catholic Church, the sanitary reform movement in public health during the 1980s, and the newly emerging gay and lesbian and feminist movements that had begun to surface in Brazilian society during the late 1970s and early 1980s.” All this has led HIV/AIDS treatment to move beyond the standard medical model to a one based on social solidarity, respect for diversity, guarantees of citizenship, and the recognition of access to health care as a basic human right, all within a context that recognized the debilitating effects of poverty and social vulnerability.
Not only have these movements created domestic solidarity, but as reported by M. Alfredo González, the U.S. HIV/AIDS movements have moved into positions of global solidarity as well. As González notes, the fight for generics—representing a confluence of the HIV/AIDS movement and the global justice movement—was preceded in the United States in the early 1990s by ACT UP Americas, which early on recognized the disparities between North and South in terms of AIDS education, prevention, and care. These stark contrasts, he says, “demanded solidarity.”
With obvious differences, solidarity and acceptance have characterized the Cuban approach, especially since the end of the mandatory quarantine of AIDS patients in 1993. The country has been quite successful in preventing mother-to-child transmission of HIV, especially since the advent of universally accessible antiretroviral therapy (ART) in 2001. Arachu Castro et al. explain that access to ART, which allows many HIV-positive women to give birth to HIV-negative children, has changed the “social course” of the disease in Cuba—especially in terms of the stigma associated with HIV infection, as more and more HIV-positive mothers “contest, through pregnancy, years of disease and rejection.”
Not surprisingly, the news from Colombia is less hopeful. As Teo Ballvé reports, wartime is not conducive to such public policies of prevention and treatment. Not only do armed groups and insecure, displaced populations constitute vulnerable sectors, but guerrillas and paramilitaries alike, reports Ballvé, “often run prostitution rackets in areas under their control, forcing sex workers to have unprotected sex, which garners a higher price, since clients prefer sex without condoms.” What’s more, they “have also discovered that brothels are effective intelligence-gathering sources, often forcing prostitutes to extract bits of information from enemy clients.”
As this Report makes clear, medicine and prevention efforts never occur in a social vacuum, and neither can be separated from the context in which it is practiced. The treatment and prevention of HIV/AIDS is an eminently political process.
