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The exceptional argument

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In a recent article in the British Medical Journal, Roger England suggests that UNAIDS should be shut down. Over the years, there has been much ink spilled over the issue behind England’s argument. Are HIV and AIDS exceptional? Or instead, is HIV and AIDS something that ought to be addressed in balance with other health issues and within efforts to improve health care overall?

I favour the exceptional argument, largely because I view HIV and AIDS – yes, it is a very real health issue – but on top of as well as intertwined with its biomedical realities, HIV and AIDS is an issue of ideology. About ten years ago an extremely astute and very cool Botswanan woman questioned my interest in HIV/AIDS in Africa, she said: Why do Westerners care so much about HIV/AIDS when Africans have been dying of malaria for much longer? Good point. Why such interest?

It started with Ronald Reagan ignoring the virus because it was (predominately) infecting gay men. Now it’s George W. Bush and PEPFAR’s over-reliance on promoting abstinence. For these persons of power and others, part of the motivation behind interest in HIV/AIDS is to use the virus and the disease as a forum to spread a particular set of beliefs which in turn attempt to dictate a conservative stance on what constitutes appropriate sexual behaviour. It is an interest with shades of both religious fundamentalism and imperialism. But of course, the two have a history of co-mingling, particularly when you consider the convergence of missionaries and colonisers in Africa. For many (myself included), in addition to addressing a health issue, interest in HIV/AIDS in Africa (as exceptional) is to combat the ideology of Reagan, Bush, and anyone else who narrow-mindedly thinks we actually live in (and/or ought to live in) a world that defines mutually consensual sex as occurring only between men and women, in one way/position, and only for the purposes of reproducing.

There are near endless cases where this dilemma ­ exception or folded into something larger ­ comes into play in our thinking. For example: Why the exception of Africa Day? As far as I know, we don’t have days to celebrate the six other continents. HIV and AIDS as an issue of ideology lends insight into the importance of Africa Day. Over the last few years the availability of HIV and AIDS medications on the African continent has increased. But this came only after 2001 when, then director of the US Agency for International Development (UASID), Andrew Natsios was hesitant to implement ARV programmes on the continent. He explained his reason to the Boston Globe and before the US Congress: Africans cannot tell time; thus, not able to adhere to the regimen for taking the medications There was more to Natsios’ hesitancies (i.e., the need to improve health care systems overall), yet his comments revealed all too common views held by some in the United States: Africa as a homogenous continent full of folks who have not kept up with the modern world. Continuing to dismantle such lines of thinking is one of the many reasons there is need to embrace the argument of exception and both critically engage HIV/AIDS in Africa and celebrate Africa Day.

One comment to “The exceptional argument”

  1. Comment by Kubatana.net speaks out from Zimbabwe » Blog Archive » The drugs-only minister:

    [...] I wrote that I believe HIV/AIDS warrants exceptional status largely because of the complex mix of biomedical, economic, judicial, ideological, political, and [...]