Agendas on HIV/AIDS in 2003

By: Catrine Christiansen, Danish Research Fellow, the Nordic Africa Institute.

Twenty years into the epidemic the world has not been able to slow down the level of transmission, the geographical spread or the death rate of infected persons. In fact the appalling estimations made ten years ago have, except for a few cases, become the picture of today, and figures predict that human suffering from HIV/AIDS is still increasing and may not come to a halt before the children of the next generation are (old enough to be!) grandparents.

Twenty years into the epidemic the social science community has not been able to develop the theoretical or methodological approaches required to embed research on HIV/AIDS related issues into classic or current debates within social science. Hence the present situation is marked by an isolated field within social science providing inadequate understandings and which is unattractive to leading academics. When briefly looking at initiatives taken in 2003, contributions from scientists may in the future part from the epidemiological estimations—the necessary restructuring of research is under way. Based on participation in ‘HIV/AIDS conferences’ during 2003 I will describe some observed progress and associated challenges.

‘Thick’ reconceptualization
Rich ethnographic material and analysis containing the complexities of local interpretations, terminologies and practices related to HIV/AIDS, were pointed out as a central key for improving the social scientific understanding of the pandemic sweeping across the African continent.

The ‘pointers’ were 22 scholars, who in the beginning of 2003 gathered in Dakar, Senegal, with the purpose of discussing the drawbacks and potentials of social scientific research on HIV/AIDS related issues. The agenda was cram-med as this topic is characterised by severe hindrances and, as would be expected, many unexplored options. African scholars within CODESRIA (the Council for the Development of Social Science Research in Africa) organised the conference, drew up the agenda, and as only two out of 22 participants were ‘palefaces’, African scholars also dominated the discussions and conclusions.

Their quest was for reconceptualizing the whole enterprise on ‘AIDS in Africa’, especially the apocalyptic discourse articulated in, amongst others, UNAIDS documents, the culturalist framework explaining the rapid HIV-transmission with traditional patterns of sexual behaviour in African culture, and the methodological frameworks imposed from outside with no attempts to adapt these to the local context.

Being an anthropologist myself their concord about the wonders of ethnographic methodology and analysis was sweet music in my ears. While the gathered scholars did not raise the issue of whether African social scientists can produce these anthropological works, the music also included some discords with today’s reality. Despite the fact that many non-African anthropologists—and other social scientists orientated towards qualitative methods—approve of this quest from their African colleagues, it is questionable whether they will become part of such collective efforts of reconceptualization. This situation challenges the CODESRIA initiative, yet hopefully it adds fuel to, rather than draining it from, their driving force.

Prevention versus treatment
The most significant developments on AIDS-related issues in 2003 were the radical reductions in the prices for antiretrovirals and the heated debates which emerged about allocating resources for prevention or for treatment. Probably every participant in these discussions would prefer not to make such a choice, but as the resources are rather limited for prevention, care, and treatment the new treatment option has divided experts (predominantly European) quite sharply into two camps that are unable to agree on such vital concerns as ethics, impact, compliance and means to avoid producing resistance. This results, among other things, in a lack of policies on antiretrovirals among donor countries. At the same time leading African governments such as South Africa and Uganda have declared that within the near future all infected citizens will have access to the life-prolonging medicine. Certain multinationals working in Africa, such as Heineken breweries, have already implemented ways of providing anti-retroviral medicine and other support to infected employees and their immediate family. For social scientists these developments should be considered a new field of inquiry, an ingredient for more profound changes in the scope and focus of research on HIV/AIDS related issues—and an opportunity for leaving behind the contested focus on individual sexual behaviour and culturalist explanations, and for moving towards questions of modernity, the welfare state, human resources etc.

Youthful Africa
Recent statistics have made social scientists aware of a dreadful concurrence: children and youths make up the majority of the population in most African countries and they also dominate the category of newly infected people. This agreement of demographic and epidemiological trends has been revealed at a time when research about the lives of young people is attracting social scientists working in the South as well as in the North. Putting aside the (often) radical different political, socio-economic, cultural and health conditions of young people living in the South and the North, the almost simultaneous emergence of research fields may well prove of mutual benefit in developing definitions, research topics, approaches and analysis.

In June a new collaboration between CODESRIA, the American based Social Science Research Council and the South African National Research Foundation launched a one year fellowship programme on ‘Youth, HIV/AIDS, and Social Transformation’, which will produce 13 studies across the continent. Thematically the studies cover a range of issues integrating social positions of young people, HIV/AIDS, and broad societal changes.

The Africa Studies Association (ASA) had also selected ‘Youth’ as the overall topic for the annual meeting in 2003. Having participated in a workshop with the above mentioned fellowship programme two weeks before the ASA annual meeting it was distressing to find only a few papers discussing how young Africans are being affected as well as infected by the epidemic. The meeting—with 1,500 participants—also revealed that research on children and youth is fragmented in terms of empirical data, methodologies and theories. The research field is in somewhat of an infant state.

Returning to the initiatives taken in the South and the North these may rapidly develop this field—two central challenges will be to establish firm networks across the equator and to integrate HIV/AIDS related issues within studies about young social actors in Africa.

Beyond Africa
The regional perspective on the epidemic is increasingly moving beyond the scope of Africa and into the heart of Asia and to the former East European countries. How will this shift in, or expansion of, geographical focus influence the social scientific understandings of the epidemic? How will culture, gender, sexuality, religion, economics, and political will be integrated in explanations about the rapid transmission of the virus?

Outside Africa, in particular among donor agencies, loud calls are articulated for knowledge on Best Practices: positive experiences with keeping people ‘negative’ and providing adequately for people infected and affected. These voices certainly reflect needs expressed by organisations working closer with the people in focus, however, their prime aim is to prevent ‘donor fatigue’ and motivate ‘scaling up’. Will such Best Practices also form an integral part of interventions in Asia and Eastern Europe? Racism is given as the central argument why ‘scaling out’ might not include knowledge on African experiences of dealing with HIV/AIDS. Provided that social scientists ‘scale in’ research, in the sense of increasing in-depth empirical studies and dwelling on the reconceptualization of the epidemic in Africa, a collective effort might lead to ‘scaling over’ the many gaps in the agendas described .

Selected topical literature
Becker, C., J-P. Dozon, and C. Obbo (eds), Experiencing and understanding AIDS in Africa/Vivre et penser le sida en Afrique. Dakar/Paris: CODESRIA/ Karthala, 1999.

Boyden, J. and D. Levison, Children as economic and social actors in the development process. Stockholm: Expert Group on Development Issues (EGDI), 2000. Working paper no. 1.

Caldwell, J.C., ‘Rethinking the African AIDS Epidemic’. In Population and Development Review 26 (1), pp. 117–35, 2000.

Heald, S., ‘It’s never as Easy as ABC: Understandings of AIDS in Botswana’. In African Journal of AIDS Research, vol. 1 (1): pp. 1–11, 2002.

Kalipeni, E., S. Craddock, J.R. Oppong and J. Ghosh (eds), HIV and AIDS in Africa. Beyond Epidemology. Oxford: Blackwell, 2004.

Putzel, J., HIV/AIDS and Governance in Uganda and Senegal. Institutionalising an Emergency Response. A report submitted to the Department for International Development, 2003.

Silberschmidt, M. and V. Rasch, ‘Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: vulnerable victims and active social agents.’ In Social Science and Medicine, 52: 1815-26, 2001.

Sisask, A. (ed.), One Step Further—Response to HIV/AIDS. Sida studies no. 7, 2003.