The global spread of AIDS and HIV.

Author:O'Hara, Phillip Anthony
Position:Report
 
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Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) emerged on the global scene in the early 1980s, and since then has become one of the critical factors affecting human well-being. Globally it kills over 3 million people annually. It is especially prevalent in Sub-Saharan Africa (SSA), where it kills 2.4 million people per year, and its incidence is expanding dangerously in parts of Asia and Eastern Europe (UNAIDS/WHO 2005). The question raised in this paper is: what does heterodox political economy have to say about AIDS-HIV? A scholarly field of inquiry can reasonably be assessed according to how well it scrutinizes the world's major problems. This paper assesses political economy on this basis.

Political economy posits a number of principles and theoretical concepts for guiding research in the social sciences. These principles do differ somewhat depending on the school and trend in question, but more recently, scholars have been writing on the convergence trends among and between at least some of the schools of political economy (especially along institutional-evolutionary lines). The current paper attempts to synthesize and apply some of these principles and concepts to the AIDS and HIV problem that has befallen the world over the past two-to-three decades (O'Hara 2007). It is believed that these principles are mostly grounded in empirical reality, and are likely to be of assistance in understanding the AIDS-HIV problem. This, indeed, is the principal hypothesis of this paper.

Historical Specificity

The principle of historical specificity says that political economy should center on historical processes set in real time. History is an important part of its edifice. Concepts should be imbedded in real changes in the political economy, and theorizing must have a core element of historical relevance and empirical evidence. Political economy "laws" and "trends" are historical tendencies and stylized facts that center on the workings of institutions and relationships. Without this historical specificity, political economy would be nothing more than an abstract science working around principles that have a universal target, or otherwise an ad hoc series of propositions that lack applicability through long historical time.

This is especially relevant to the study of AIDS and HIV because the natural history of the virus, and the virus within individuals, reveals some quite remarkable facts pertinent to rectifying the condition. Historical analysis reveals, for instance, that there are four main stages in the natural history of the virus: (1) the transfer of virus from monkeys to humans; (2) a period of rapid social change; (3) a period of epidemic and/or pandemic; and (4) a period of declining incidence of the condition. HIV emanates from the early 1900s in sub-Saharan Africa. During Stage One, a retrovirus of the common Chimp, Pan Troglodyte, called SI[V.sub.cpz(P.t.t.)], gradually became transmitted to humans where it mutated forming HIV-1. (A less virulent strain, HIV-2, emanated from Sooty Mangabeys, SI[V.sub.SM], about the same time.) From the 1920s-30s to the 1950s, this transfer to humans developed in very small pockets of west and west-central Africa where it posed few problems and did not escalate in magnitude (Hillis 2000; Gao et al. 1999).

Historical circumstances changed all this, since the struggles and wars of independence against European colonialism (especially Portugal, France, Belgium and Britain), post-colonial instability, as well as urbanization, from the 1950s to the 1970s, led to Stage Two: rapid social change and the assimilation of HIV throughout the population in much of sub-Saharan Africa. By the 1960s and 1970s, variants of HIV came to the West under the impact of imperial pursuits, the greater mobility of the population, and the social-sexual revolution. HIV requires major social disruption for it to start to impact the general population.

Later this led to Stage Three of its natural history, the period of heightened incidence--epidemic and pandemic: in SSA, 1983 to the present (especially in South Africa, Nigeria, Zimbabwe, Zambia, Tanzania, Kenya, Namibia, and the Democratic Republic of the Congo); in the West, 1983-1993; globally, 1983 to the present--when the number of new HIV cases, those living with HIV, and AIDS deaths all increased.

Sub-Saharan Africa and the world have yet to undergo Stage Four of its natural history, when new AIDS cases and deaths start to decline. Such a "declining trajectory" phase started in the United States and Europe in the mid-1990s. An analysis of the historical evolution of AIDS-HIV is critical to comprehending the potential for the declining incidence curve to become evident.

Contradiction

The principle of contradiction states that the major dynamics of evolutionary processes are propelled by internal tensions and conflicts, which variously manifest themselves as limits or enablers, depending on the nature of the processes. (1) A study of the dominant conflicts should enable one to understand the core processes at work.

Contradictions are especially relevant to the AIDS-HIV problem. One such contradiction stands above all others. There is a contradictory limit to the human immune system associated with the tensions and conflicts between humans and microorganisms. To understand this limit one must recognize the existence of three main phases in the natural history of HIV-AIDS in individuals: (1) HIV infection (acute phase usually lasting several months) when minor symptoms occur; (2) a latency (chronic) phase usually lasting between 3-15 years, when low-medium scale opportunistic infections emerge; and (3) the onset of AIDS diseases and possibly death, usually lasting 1-3 years. The lag between the start of phase one and the end of phase three is usually 4-18 years.

Throughout all phases, the HIV viruses have been exploiting one major limit to the proper functioning of the immune system. This limit is associated with CD4 and CD8 white blood cells. CD4 T-cells mostly take the form of "helper cells" in that they...

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