The War on HIV/AIDS

The last edition of Pambazuka News carried an interesting and challenging article (entitled ‘HIV/AIDS in Northern Uganda: A New War’, about efforts to address HIV/AIDS in Uganda in the context of war.

The experience of 'resource-poor' settings in turning around desperation and hopelessness into a prospect of life fulfilled is inspiring indeed. While acknowledging the very serious challenges, these 'rooted' accounts are important to counter the disillusionment and despair generated by images of "Darkness on the Continent" type of claims.

However, in closing the narrative, Odoi Charles of TASO is cited as saying: “We are now going to begin another war: the HIV/AIDS war.” In fact, this provides the title to the article.

So, this got me thinking. War metaphors are very, very common when people talk about addressing the HIV/AIDS epidemic. But do we need a 'war' to address HIV? Is a 'war-like' approach the best way to conceive of responses to HIV? What does a 'war' imply? And, ultimately, do the words used to describe our efforts matter?

If you think about 'war', it is really a signal of the failure of peoples and states to manage conflict. We resort to violence because other options are either not available or are perceived to be ineffective. It is the ultimate expression of power in unequal societies.

And, furthermore, what happens in war is the complete suspension of the rights we consider protected outside of war. The consequences for health and well-being are huge, such that the international community has fashioned humanitarian law to serve as 'rules of war' to protect innocent and vulnerable people. In practice, we know that these rules are abused, misused, ignored, or sometime, simply don't work for certain kinds of conflicts. Only non-derogable human rights are protected from a state of emergency declared during a war but many, many rights are suspended when national security is threatened.

So, should we want a 'war' on HIV/AIDS? And, if we have a 'war' on HIV/AIDS, does the notion of making 'war' constrain or shape our efforts in ways that we may not really want?

Well, let's think about HIV/AIDS as a social dilemma/conflict. Have we exhausted all the 'peaceful' non-warlike methods to address HIV/AIDS? Why are our efforts not effective? In principle, I think it's the lack of political leadership and willingness to tackle serious economic and social injustice that underlies our failures in regard to HIV/AIDS. So, whom should we wage 'war' on? Do we wage war on the political leadership who have not provided the will to do what is needed? I suspect that is not what is being marshalled when activists and governments lay claim to making 'war' on AIDS.

Do we wage war on a virus? Or on the people whose (wanton) behaviour is judged to spread the epidemic? The former is not a form of war that makes any social sense and the latter would be deeply counter to our commitments to human rights and respect for human dignity. So, what does waging 'war' on HIV/AIDS potentially do? It provides us with a sense that there is an enemy and we can join in fighting that (unspecified) enemy, but it doesn't really speak to the underlying power inequalities that drive the HIV/AIDS epidemic. In fact, a government or elite whose policies are fuelling the epidemic can invoke the rhetoric of 'war' to harness a range of social forces to a seemingly benign project (often a national project), when, in fact, the war does not address the real power imbalance that drives the epidemic.

Secondly, in wars, we suspend human rights because of the extreme measures we are forced to take for survival. If we are waging a 'war' on HIV/AIDS, do we suspend rights to privacy, to confidentiality, to freedom from discrimination in the interests of this greater good? The language of 'war' and 'fight' and 'battle' are all about power exercised in ways that are potentially harmful, justified by a utilitarian calculation. But if we want to provide a rights-based approach to HIV, these analogies are all painfully wrong.

I believe that at some level, this preoccupation with the 'war' metaphor is not just about words. It is also about how people unconsciously see the epidemic and what needs to be done. A war is not a space where you guarantee access to health care, or respect for human dignity. It allows unspeakable things to be done to other humans in the name of security and state interests. I think it is part of the cognitive dissonance that political leadership sometimes exercises in viewing themselves as entirely removed from the problem, and placing themselves on the side of the solution, when in fact, they are the problem, or part of it. Having a war on your hands means you need not ask hard questions about your own accountability for human rights.

I would like to see the 'war' metaphor heaved onto a dustbin of global HIV/AIDS discourse. I think it takes us backwards, not forwards. It opens opportunities for bad practice, not good practice. It is not just about words, but about how we view struggles for social justice and human rights.