1. HIV and AIDS: The health development challenge of our times; 20 years of falling behind...
MP20 10 year Reunion
Jerker Edstrom
MP 11 ( )
Fellow: HIV/AIDS and Development, IDS (2006-now/08)

2. What went wrong with the “global response”?
Projections of the epidemic and its impact from 1985 and 86 predicted adult HIV prevalence rates today of 15-30% in SSA by 2005, “in the absence of effective prevention”
By and large, this is where we are today…
In other words, the response has largely failed, with a few exceptions (Senegal, Thailand, Cambodia, Uganda?..) and
Development community was hugely complacent

3. Why didn’t the powers that be respond?
Homosexuals.. Heroin addicts.. Hookers.. Haitians… (4 Hs)
Uncomfortable issues raising old taboos or “social evils” around sex, drugs, racism
It raised very difficult questions around the intersections;
fertility/mortality, (life and death) pleasure/pain (sex and disease)
power, inequality, mobility, marginalisation and exclusion,
human sexuality/social regulation of gender
Upper and middle class professionals, international civil servants and intellectuals just didn’t feel at ease here..

4. Early responses - old school Public Health followed by ‘development generalism’
The first responses to HIV/AIDS were mounted by epidemiologists, clinicians and gay men in the North
In the South; targeted ‘risk group interventions’ and parallel generalised awareness campaigns which fell short of behaviour change
The links with community development were becoming recognised in the 90s and UNAIDS was created without real teeth..
Central to the approach was linking HIV to gender, sexuality and other development concerns of communities
But, frameworks and analyses were ‘general’, ‘gender binary’ and broadly stereotyping of ‘vulnerable victims’

5. The Millennium Bug
By the end of the century, the focus was shifting to treatment and - as ARV prices gradually came down - WHO raised the stakes and target to 3Mn on treatment by ‘05 (“3 by 5”)
US declare AIDS a National security threat, UNGASS steps up and all provide massive investments into something that visibly works..
Crucial: treatment is no alternative to prevention, though it opens up the possibility of “positive prevention”
But, there were other challenges looming at Millennium…

6. Challenges
Emergency & security discourse (sort-term action and scale up) complicates a development approach to AIDS
The re-medicalisation of the response under-estimates the real role of community action and over-estimates the likely efficacy of a treatment based response
The resources and political momentum of the response was being hi-jacked by faith-based religious fundamentalist agendas threatening progress in gender and sexual health and fuelling increased stigma, exclusion
Meanwhile, development actors are scrambling for AIDS resources for general unconditional Social Protection

7. Hmm..
Public health
Human rights
/ empowerment
Development
PEPFAR
Evidence based approach

8. Go forth and...
Public health
Faith-based approach
Human rights
/ empowerment
Development
Evidence based approach

9. Public health
Faith-based
Human rights
/ empowerment
Development

10. Opportunities
The reality of treatment (for all it’s difficulties) is opening up new opportunities for re-thinking prevention ‘with care’; find and follow the virus, engage and empower HIV positive people to lead
Despite these best intentions of governments or the development and medical communities, local communities are responding and we can learn...
The main successes of the response to date have been led by sexual minorities and ‘social deviants’ on the margins, whilst the generalised gender and development approach died a death
How should development studies/work change its ways and engage with this?