HIV This Week

Rethinking the conceptual terrain of AIDS scholarship: lessons from comparing 27 years of AIDS and climate change research.

Chazan M, Brklacich M, Whiteside A. Global Health. 2009;5:12.

While there has recently been significant medical advance in understanding and treating HIV, limitations in understanding the complex social dimensions of HIV epidemics continue to restrict a host of prevention and development efforts from community through to international levels. These gaps are rooted as much in limited conceptual development as they are in a lack of empirical research. In this conceptual article, the authors compare and contrast the evolution of climate change and AIDS research. They demonstrate how scholarship and response in these two seemingly disparate areas share certain important similarities, such as the "globalization" of discourses and associated masking of uneven vulnerabilities, the tendency toward techno-fixes, and the polarization of debates within these fields. They also examine key divergences, noting in particular that climate change research has tended to be more forward-looking and longer-term in focus than AIDS scholarship. Suggesting that AIDS scholars can learn from these key parallels and divergences, the paper offers four directions for advancing AIDS research: focusing more on the differentiation of risk and responsibility within and among AIDS epidemics; taking (back) on board social justice approaches; moving beyond polarized debates; and shifting focus from reactive to forward-looking and proactive approaches.

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Editors’ note: In the lead up to Copenhagen, this article makes for a very stimulating read. You will learn about the similarities and differences between HIV and climate change research but also about how the response to these two threats was conceptualised at different time periods. Both phenomena are complex, unprecedented, and highly dynamic. For both, scholarship has evolved from a physical or life sciences perspective to one that integrates the social sciences. HIV researchers can learn from the forward-looking and longer-term focus of climate change research, along with its well-considered social vulnerability concepts. A strong message emerges: we need to intervene now proactively to identify and address existing context-specific vulnerabilities to HIV infection and AIDS impacts, before HIV epidemics have fully run their course, in order to mitigate future impacts. It means moving away from a crisis footing to a forward-looking proactive stance to understand was is needed now to reduce or prevent future hardships.

Hecht R, Bollinger L, Stover J, McGreevey W, Muhib F, Madavo CE, de Ferranti D. Health Aff (Millwood). 200 ;28:1591-605.

The HIV pandemic will enter its fiftieth year in 2031. Despite much progress, there are thirty-three million infected people worldwide, and 2.3 million adults were newly infected in 2007. Without a change in approach, a major pandemic will still be with us in 2031. Modelling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach $35 billion annually by 2031-three times the current level. Even then, more than a million people will still be newly infected each year. However, wise policy choices focusing on high-impact prevention and efficient treatment could cut costs by half. Investments in new prevention tools and major behaviour-change efforts are needed to spur more rapid advances. Existing donors, middle-income countries with contained epidemics, philanthropists, and innovative financing could help bridge the likely funding gap.

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Editors’ note: Looking at what might be done differently to alter significantly the course of the HIV pandemic in order to achieve by 2031 few new infections, nearly all those in need of treatment receiving it, and children orphaned by AIDS assisted to lead normal lives, this costs and financing group lays out some stark choices. Modelling of four scenarios – rapid scale-up, current trends, hard choices for prevention, and structural change – reveals that at best 1 million new adult infections will occur in 2031. The ‘game-changers’, while waiting for a vaccine or cure, are high reach, effective prevention programmes for people who inject drugs, men who have sex with men, people who sell sexual services, and increasing numbers of discordant couples as the epidemic matures. Anticipating that resource requirements are set to increase rapidly over the next 5 to 8 years, six policy actions are described to expand financing for HIV in low- and middle-income countries. This is a sobering but essential read for us all.