Invitation to a Dialogue Recasting the Discourse on AIDS WSF- 2004

[Guest guest]

Invitation to a Dialogue Recasting the Discourse on AIDS Lessons for Public

Health from Africa, Brazil & India at the WORLD SOCIAL FORUM - 2004

16th-21st January, Mumbai, Date: 17th Jan. 2004

Time: 1.00pm-4.00pm Venue: NESCO Grounds, Goregaon

This is a continuation of the series of workshops organised as part of the

'Dialogues on AIDS Control Strategies for India/ South Asia'. This one is

being organised by Swasthya Panchayat-Lokayan, ActionAid-India, Apne Aap

Women Worldwide & Coalition for Environment & Development.

The concept note for the workshop has been appended as attachment.

We invite any comments / suggestions / background material on the theme and

concept note before the workshop which will facilitate the dialogue.

Concept Note

There is ferment in health service systems across the world. Challenges of high

costs on one hand, and health sector reforms with declining public expenditures

and health systems' capacity are reopening old and new paths for health services

development. At the same time, the negative impact of economic policy changes

on health status has generated a growing recognition of the need for effective

health systems. Several innovations and 'models' have been generated for health

services development over the 1990s out of the needs of people on one hand and

by the demand generating 'health industry' and its financial interests on the

other. The challenge is to evolve and strengthen pro-people approaches in

policies relevant to the present context and to build pressure to ensure their

implementation.

AIDS is one public health crisis affecting almost the whole world, but with

greatly varying degrees of severity. The efforts to control it have probably

been the fastest and strongest public health response in recent years.

Therefore it is bound to influence the public health discourse and future health

services development. The force of the HIV epidemic in Africa has thrown up

lessons for public health policy analysis, which would be invaluable for other

countries, not yet fully caught in the economic globalisation trap. The

epidemic has followed a different course in different societies in diverse

contexts and evoked diverse responses. The diversity provides lessons that need

to be shared.

The international official discourse has drawn and propagated lessons from

experiences of African countries such as Uganda, South Africa, and Thailand. It

seems important to us that the experiences be examined from within the

perspective of these countries and lessons drawn from this analysis be shared

across the countries of the south directly rather than mediated by analysis by

the north. Some issues have brought this need to the fore, eg. the

international discourse creates an image placing the 'blame' of high HIV

prevalence in Sub-Saharan African countries only on its internal social dynamics

and an inability of these countries to handle the problem due to lack of

political will and the lack of capability of their poor and illiterate people to

change 'risky behaviours' or to 'adhere' to anti-retroviral treatment. However

what the HIV epidemic in these countries also provides is lessons on how such

conditions have come about, including their exploitation by the neo-colonial

processes, adoption of the north-led models of development, and the impact of

globalisation. How have these affected women's lives and gender relationships in

various segments of the population? Is the break down of public health systems

over the 1980s that had been built up by the 1970s in many of the African

countries one of the significant factors in limiting the capacity of the system

to respond to the epidemic? Answers to such questions can provide lessons for

many Asian countries still at the threshold of completely globalising their

economies and of experiencing the AIDS epidemic. At the same time Africa offers

positive examples of community level action borne out of the crisis. Of course,

it needs to be remembered that, since the African experience is

epidemiologically so distinct from other parts of the world, the lessons have to

be specifically contextualised and can only provide ideas to be explored for

other situations.

Brazil provides a different set of lessons as it is a large country which

remains at an intermediate level of epidemic (like much of Asia). It has been a

forerunner in providing universal access to anti-retroviral therapy through a

public programme. How it has been done, the strengthens and limitations of the

programme, the pre-requisites for its successful implementation and the impact

of such a programme on the public health system as a whole, are all issues worth

exploring and learning from.

India, socio-economically closer to the African countries rather than Brazil

(which has about three times the per capita GDP of India), is still a low to

intermediate level country in terms of the AIDS epidemic. The diversity within

the country and various experiments at providing treatment, care and support to

HIV + persons could give different insights in a comparative international

frame.

Examining all these from a people-centred and 'societal' perspective rather than

merely a disease-control and 'programmatic' one, could recast the discourse and

help re-examine what has become 'accepted wisdom' on AIDS. It may bring us to

re-examine the homilies and 'best practices' being offered by the international

AIDS establishment. The prevailing notion of 'well being' itself may need to be

re-examined in the light of the consequences of the contemporary development

approach.

The World Social Forum provides a good opportunity to share experiences and

interact with people engaging with these issues in diverse contexts. Continuing

the series of dialogues on AIDS control strategies, we propose to organize a

workshop at the WSF where we bring together people working on HIV and health

with a critical analysis of the 'globalising agendas' and their international

financial interests but without denying the seriousness of the problem or the

need for responding to it through people-centred public health. The discussion

would focus on:-

1.Capacities of health systems, including the impact of changing policy

perspectives historically.

2.Community level action in responding to health crises and chronic disease care

needs.

3.'Normalizing' HIV and AIDS.

4.Causes of prevailing prevalence levels of HIV.

______________________________________

Swasthya Panchayat-Lokayan, 1312, Poorvanchal, Jawaharlal Nehru University, New

Delhi-110067

ActionAid India, C-88, South Extension Part II, New Delhi-110049 <

nidhi@...>

Apne Aap Women Worldwide, Identity, Himadri Building, 22, Ballygunge Park Road,

Kolkata - 700 019, <tinku@...>

Coalition for Environment and Development, Finland. ced@...

Contact Person

Ritu Priya

Associate Professor

Centre of Social Medicine & Community Health

Jawaharlal Nehru University

New Delhi-110067

Phone: +91-11-26102752, 26102638

Email: ritupriya@...

----------------------------

Yours in Global Concern

A.SANKAR

Executive Director

EMPOWER, 107 J/133 E,puram

Tuticorin-628 008

INDIA

EMPOWER is a non-profit, non-political, voluntary and Professional Civil

Society Organisation and registered in the year 1991and engaged in developmental

work for the past 13 years in Southern Tamil Nadu, INDIA