Troby
PREVENTION
THE POLITICAL PERSPECTIVE
Starting from the 1st of September 2010, I will give a brief description of the different perspectives that is connected to AIDS in a country, when AIDS has affected a number of people. I will publish All the 13 Perspectives of AIDS - one by one.
The political perspective is unfortunately the one clearest related to denial. Lack of policy initiatives, or completely contradictory priorities have edged the first 30 years of AIDS’s history. Such as the denial of an AIDS problem in China, the blood scandal in Romania and the former South African president Mbeki’s tireless opposition to see the link between HIV and AIDS so that a wide range of work could be done in order to stop the spread of HIV to the 75 percent of the population not yet infected. In the very beginning, when HIV and AIDS were first discovered in 1980 and the following years, the Republican Party representative, Mr Ronald Reagan was president of the United States of America. It took him seven(!) years before he talked about the problems his country started to face. Neither the following presidents, George Bush, Bill Clinton nor George W Bush managed to take on the responsibility of dealing with AIDS in a satisfactory way. This is probably one factor of why the increase in HIV prevalence rates in the US is getting close to 1 percent; despite some positive actions the Obama administration has managed to take.
In the political perspective I also include the nature of the sexual politics, which some organisations – particularly organisations for gays and lesbians in Europe and North America have been engaged in. In some cases, you can reflect on whether it was more important to work for gay rights, the right to marry, the right to be tried as parents/adoption, the right to have sauna clubs and so on, than to take a more reflective approach on behaviour change in HIV prevention activities? HIV prevention funds paid for this work, which ought to have had funds anyway. I would in no way detract from the significance of working for all people’s equal rights and freedom from oppression of any kind. The gay organisations and many prominent figures have meant a tremendous amount for these rights and they have contributed to the increased availability of information about the disease, again risking the illness-stamp. It is after all too many of us who recognise the reasoning in application processes for funds: "If we add some HIV to the project, we could also secure money for...".
In the political perspective I also include the nature of the sexual politics, which some organisations – particularly organisations for gays and lesbians in Europe and North America have been engaged in. In some cases, you can reflect on whether it was more important to work for gay rights, the right to marry, the right to be tried as parents/adoption, the right to have sauna clubs and so on, than to take a more reflective approach on behaviour change in HIV prevention activities? HIV prevention funds paid for this work, which ought to have had funds anyway. I would in no way detract from the significance of working for all people’s equal rights and freedom from oppression of any kind. The gay organisations and many prominent figures have meant a tremendous amount for these rights and they have contributed to the increased availability of information about the disease, again risking the illness-stamp. It is after all too many of us who recognise the reasoning in application processes for funds: "If we add some HIV to the project, we could also secure money for...".
In Sweden in the late 1980’s and early 90’s, there were a lot of money allocated by the politicians for HIV prevention efforts and the city of Gothenburg’s youth clinics were run, in principle, on HIV funds. During one of Gothenburg City’s HIV management group meetings, I wanted to
raise a discussion on how the allocation of resources was done, and how this could be better connected to evidence based and good practice prevention. The head of the infections diseases hospital (Östra Sjukhuset) was expressing his innovative eager. He said, "We must let all flowers bloom". It was not so many in the management group who wanted to listen to science and the best practices which could be expected to have an impact on the disease control. Nor did they listen when my dear friend and colleague, Mrs Margareta Ackerhans tried to point out the need for evaluation of the projects so generously scattered around them. Even if political interference was missing in the group, it was not straightforward when the political will seemed to be to release control of actions, responsibilities and priorities.
The political perspective also includes the need for legitimacy of the organisations and activities carried out by thousands of people round the globe. If there is no top political recognition to the issue, to the global AIDS problem, it is like saying to all these people: “You do not really have to bother that that much.”
In Russia, the top political leader, Vladimir Putin, signed a bill in 2013 punishing people for homosexual "propaganda" of the kind United Kingdom introduced in 1988 an (non-effective) attempt to battle AIDS. Similar legislation as the Russian can be found in, for example Nigeria and Uganda. The UK changed this law in 2003 since it was a violation on Human Rights and an obstacle for HIV prevention work.
I have seen tendencies in many countries that when the politicians stop talking about HIV or AIDS, the funding decreases, and after a while the prevalence rates goes up. I do not claim that the increase in the prevalence rates is all due to the silence from the top political representatives, but I claim that they are all a part of it. And this includes the initiatives taken by politicians on how to control or fund research about the medical treatments and human social behaviour for the sake of prevention. Between 1996 and 2006, when Sweden had the Social Democratic Prime Minister, Mr Göran Persson, he never expressed the words HIV or AIDS in public, which in one sense puts him in the same boat as Ronald Reagan. During a visit in 2005 by PM Göran Persson at the Museum of World Culture (where I worked with the AIDS exhibition “No Name Fever – AIDS in the Age of Globalization”) I asked his secretary why he never spoke of AIDS. The reply I got was: “he has never been asked to participate in anything connected to that”. I believe that top leaders should be leaders, not followers.
For many countries the political perspective on AIDS includes decision-making on how to spend funds on Antiretroviral medicines, health care initiatives, legislation about protecting the community from further suffering, and what the prevention strategies should look like, just to mention a few heavy issues. When it comes to HIV prevention, there are guidelines produced and recommended ways of dealing with strategic framework, the Three Ones etc. In most documents the use of the word “Coordination” can be found, and the documents often highlight the importance the necessity of coordination for a good outcome of the actions taken. It is described as a process, not as a structure or an action plan, which I rather would like to suggest it to be. I have for many years tried to get an answer to what HIV/AIDS Coordination actually is and how UNAIDS and WHO would like to describe it, especially since it is used in many of their documents. I have on several occasions written to the two organisations, and so far I have not received any reply on the topic. Therefore, I have been doing a lot of thinking myself, and I will soon present a suggestion to the definition and content of what HIV Coordination is, in order to contribute to clarification for countries, authorities and organisations involved in the fight against the HIV world pandemic.
HIV Coordination is something that also needs to be legitimised by the top political rulers, and the politicians need to understand the complexity of AIDS, both in their own country as well as how it is connected to the rest of the world. My experience is that people I have worked with or in other situations come in contact with, and to whom I presented All the 13 Perspectives of AIDS, have expressed a much higher understanding of the complexity of AIDS, and they all wanted to participate in making a change. Politicians are human beings, and we must all find ways to encourage and spread awareness of the importance of keeping AIDS on the political agenda.