This is a very complex question that I shall try and answer. But I must begin by making the point that I use the term 'Empire' to connote a decentralised network of hegemonic power relations, hence I use it in a philosophical rather than a historical sense.
The question of whether AIDS is a product of Empire or not encompasses many debates surrounding the global pandemic- treatment versus prevetion debate, the access to medicines debate and so on. Under Bush's new AIDS plan, $15 million is going to be given to South Africa to combat AIDS, but much of this is going to be focussed on 'preventive measures' like education initiatives. What this ignores is that the the top epidemiological predictor for HIV infection around the world is not a "risk behavior" but rather a low income level, those most vulnerable to HIV infection will not significantly benefit from a model focused exclusively on education--a model that assumes people in poverty have sufficient agency to control the circumstances of their lives, even in the context of gender inequality or in locations without income opportunities other than trading sex for money.
In interviews, those most vulnerable regularly discuss other concerns about life (access to clean water and food, gaining financial independence, and so forth) that take precedence over preventing HIV transmission 19, 25-30. Yet the "targeted" public health rhetoric ignores these issues and even equates the concerns of the poor with the rhetoric of politicians by labeling both "in denial". As one miner put it: "Every time you go underground you have to wear a lamp on your head. Once you take on that lamp you know that you are wearing death. Where you are going you are not sure whether you will come back to the surface alive or dead. It is only with luck if you come to the surface still alive because everyday somebody gets injured or dies".
The use of the term 'culture' to deny African AIDS victims any solace is again an old argument. It suggest that an 'African' sense of 'masculinity' and the inability to adhere to a proper drugs regime will in fact be more detrimental than the non availability of drugs. What such rhetoric seems to argue is that culture is a fixed unalterable concept viewed from the perspective of the dominant power groups, and the sub culture of those marginalised, one of poverty, inequality and structural violence cannot in reality be tackled. This rhetoric has also been used in recent years by public health workers, who have then left the real fight to the NGOs and the activists. "Culture" is conflated with the structural violence of inequality and lack of access to resources--and when these issues are unaddressed, even the most "culturally-competent" prevention initiatives still focus on merely co-opting local culture to suit the needs of "targeted" interventions. The co-opted "culture" rhetoric re-appears under this framework. U.S. presidential candidate Howard Dean, claiming to be the "Democratic wing of the Democratic party," has argued that antiretrovirals are of humanitarian importance but should not be emphasized because they are not as "culturally appropriate" as prevention initiatives; some prominent African country ministers have made similar claims to rationalize their inaction on the issue. Culture once again becomes ammunition for elites to justify inequality. And culture is simultaneously blamed as reports are produced about the increasing prevalence of drug resistance in the U.S. and Europe. Drug resistant strains of viruses emerge when patients intake medicines irregularly, and while the reports of new resistant strains are all from Northern countries, they have been projected onto the South under the assumption that "if drug resistance emerges here, it'll emerge there," particularly in the "cultures of denial".
Again what much of this rhetoric ignores is that AIDS is a victim of a neo liberal agenda which emphasises the rapid movement of capital to the exclusion of long term investment, thereby destroying rural agricultural communities, through drastic drops in the prices of primary commodities, and forcing people to migrate to urban areas to seek jobs. This has been seen as the chief cause of the rapid spread of HIV in much of Latin America, Southern Africa and South East Asia.
Thabo Mbeki, the current President of South Africa was criticized during the World AIDS conference in Durban, 2000 for suggesting that HIV was not the cause of AIDS. I do not wish to deny that HIV is the biological cause of AIDS but that poverty is also one of the disease's top two risk factors. Hence, the argument is simpler. You need preventive measures to educate people, yes. But, you also need to tackle the bigger issues- poverty, access to facilities, access to medicines (Brazil's scheme is particularly revealing in this context, where the introduction of generic medicines has reduced hospitalizations by over 80%) which are the prime facilitators for the disease spreading. Not doing so, would be missing the wood for the trees. This is in fact precisely what public health workers have been doing for a while, and the pandemic we have before us is there for all to see.
To return to my original proposition, that AIDS is a symptom of Empire building (please look at my access to medicines debate, Pfizer and 'smuggling of fluconazole' nodes for more information on these issues, both of which are directly related to this WU), I would like to point out that this Empire can be resisted by transnational building of links between people in different locales who find themselves in similar situations. The current anti-AIDS efforts bolster and disguise the mechanisms of Empire. AIDS becomes the product of "individual responsibility" and anonymous, disconnected Third World destitution. To expose this rhetoric's basic fallacy will require a serious criticism of public health's behaviouristic leanings, as well as a transformation of the dominant political power imbalances that render HIV a plague of the poor.
To respond to Sekicho however: of course, HIV is the biological cause of AIDS, but there is little doubt that poverty and inequality assist in its spreading. To say that AIDS is caused by ignorance, is then to say by extension that Southern Africans (who are a majority of those with AIDS- of the 42 million who suffer) are ignorant. Numerous studies have shown that most are aware of what causes AIDS but that when e.g. miners in a a Johannesburg mine are in fear of their life in a mine, the recreation offered by companies like Anglo American in the form of sex workers, is hard to resist. When you live in daily fear of your life, its a little hard to be concerned about a disease that could kill you 10 years from now.
Further, Sekicho doesnt tackle WHY people resort to prostitution. It's a well known fact that in those communities where agriculture has been affected by neo liberal economic policies, leading to migration of menfolk to urban areas, the result is that their women are often left behind to fend for themselves. In these cases, prostitution is a way of keeping the rest of the family alive.
Finally, let's come to the Ugandan example, a favourite of public health workers who refuse to see the real issues behind the virus. Uganda's AIDS initiatives are linked to its 'education model'. Certainly, prevention initiatives in Uganda have reduced HIV prevalence among some populations. But the prevalence rates have increased in some sections of Uganda while decreasing in others; in particular, physicians at the wealthier urban antenatal clinics have observed a decrease in prevalence among their patients, while AIDS prevalence has not been similarly affected in many of the rural and poorer zones where 87% of the population lives. What is often ignored is that even in sectors where prevalence (the number of living people with HIV infection) has reduced, the reduction has not necessarily corresponded to a decline in incidence (new cases) but rather to an increase in deaths, and in those few locales where incidence has decreased it has corresponded most frequently to the effect of changes in social demography rather than to the government's education initiatives.
What is particularly problematic about the Ugandan "model" is that the political advocacy surrounding it makes several wrong assumptions. Given that the top epidemiological predictor for HIV infection around the world is not a "risk behavior" but rather a low income level, those most vulnerable to HIV infection will not significantly benefit from a model focused exclusively on education--a model that assumes people in poverty have sufficient agency to control the circumstances of their lives, even in the context of gender inequality or in locations without income opportunities other than trading sex for money. And dozens of surveys support this fact, confirming that--despite our presumptions--those most at risk for HIV often do know how the virus is transmitted, and even the highest prevalence areas have sex rates lower than in many regions of the U.S. and Japan.
For more information on this please look at www.geocities.com/medicinepolicy. Other than that please check the following references:
1. Barnett, T. and A. Whiteside, AIDS in the Twenty-First Century: Disease and Globalization. 2002, New York: Palgrave Macmillan.
2. Gilbert, L. and L. Walker, Treading the path of least resistance: HIV/AIDS and social inequalities--a South African case study. Social Science and Medicine, 2002. 54: p. 1093-1110.
3. Hunter, M., The Materiality of Everyday Sex: thinking beyond 'prostitution'. African Studies, 2002. 61(1): p. 99-120.
4. Murray, S.O. and K.W. Payne, Medical Policy without Scientific Evidence: The Promiscuity Paradigm and AIDS. California Sociologist, 1988. 11: p. 13-54.
5. Farmer, P., AIDS and Accusation: Haiti and the Geography of Blame. 1992, Berkeley: University of California Press.
6. Farmer, P.E., M. Connors, and J. Simmons, eds. Women, Poverty and AIDS: Sex, Drugs, and Structural Violence. 1996, Common Courage Press: Monroe.
7. Ahlberg, B.M., Is There a Distinct African Sexuality? A Critical Response to Caldwell. African Affairs, 1994. 64(2): p. 220-42.
Again I hate to keep arguing, but the point is that AIDS in the developed world has been largely controlled through the same anti retrovirals that the First World doesn't want to provide to the Third World and which most AIDS patients in the First World have access to. Clearly, when 70% of the 42 million affected belong to a single continent, we have a problem on our hands. Surely this isn't just about finding a vaccine. That's the ultimate solution, but given the urgency of the situation, I find it hard to believe that pharmaceutical companies would sue countries (25% of whose population maybe HIV positive) if they tried to provide their people with medicines. Much of this is to do with politics. After all, medicine access is highly politized, none more so, than in the case of AIDS.
The example of multi resistant TB is a good one. It's only when it hit New York City did finding a cure for it become 'affordable'. Also I've dealt with the cost benefit thing in some detail in the WU. Brazil's example, where they just calculated cost-benefit differently is a good point. And I'm sure you know how much both Brazil and India, which produce generic AIDS medicines, are being targetted by the US and being threatened with 301 status.
I don't think I have denied that prevention is better or worse than treatment. (I'll node the treatment versus prevention dichotomy
separately later. Just that given the nature of the AIDS pandemic, there is an urgent need to address the access to medicines issue. And all the talk of getting hold of a vaccine has actually shunted aside this question of medicine access which is so much more immediate.
Secondly, and more importantly, I use AIDS as an example because of the sheer magnitude of the disease. But there are plenty of other 'developing country' diseases such as TB, malaria and kaala azar that are equally deserving of attention. Again, patients here too suffer from the lack of access to medicines, for pretty much the same reasons as outlined above and in my access to medicines node. So dont restrict this just to AIDS, it's about disease and poverty in the developing world. It's not just about hygiene in the developing world as well, as many health workers would have you believe. You should visit some villages in South Asia and see how well maintained and clean houses there are, despite the grinding poverty within which they live. But when their water systems are polluted from the effluents from big MNCs, and the government couldn't be bothered about treating the water that flows to poor villages, there is little that they can do.