We all have AIDS: HIV/AIDS is everyone's problem — a global public-health threat of staggering proportions. Wayne Ellwood investigates the social inequalities which nurture the deadly disease - This Month's Theme AIDS/Keynote

New Internationalist, June, 2002 by Wayne Ellwood

Poverty doesn't cause AIDS. But it is the ideal incubator. And gender and poverty are inextricably combined: 70 per cent of the world's poor are women and poor women are most susceptible to HIV. Violence against women and sexual assault are cornerstones of the AIDS epidemic. Says UN special AIDS envoy Stephen Lewis: 'Until there is a much greater degree of gender equality, women will always constitute the greatest number of new infections. You cannot have millions of women effectively sexually subjugated, forced into sex which is risky without condoms, without the capacity to say no, without the right to negotiate sexual relationships.'

Unequal power relations mean poor women can be more easily abused or coerced into dangerous sexual encounters. Researchers from Soul City, a health-education agency in Cape Town, found 'a pervasive sense of male entitlement to sex and the right to discipline disobedient partners'. Said one young girl: 'When a woman refuses to have sex for no reason, then a man is obliged to beat that woman.' (9) Without property or skills, women are forced to sell their bodies to feed themselves and their children - a dismal choice but one which is more lucrative than the alternative. Poverty means sex workers are more concerned with day-to-day survival than the threat of an infection whose deadly consequences lie many years in the future.

Treatment for HIV depends not on medical need but on where you live and how much you can afford to pay. It is unconscionable that millions of AIDS patients across the South suffer and die while drugs which could ease their pain and prolong their lives are denied to them. The death-rate from AIDS in the US dropped by 40 per cent over the last decade as a result of antiretroviral drugs. But the current price for a year of triple combination therapy in the West can be as high as $10,000. Compulsory licensing and the opening of Southern markets to manufacturers of generic drugs could dramatically increase their availability. But even for generics to be affordable in the poorest countries the cost will need to plummet.

There has been a high-profile fight against the giant pharmaceutical companies that control the manufacture of ARVs. Countries like Brazil and India are on the front line of this battle. But the multinationals have mostly held their ground, despite insistent demands from 'treatment action' campaigns in South Africa and elsewhere. The drugs are not a panacea but they do improve quality of life and boost life expectancy. They provide hope in the midst of despair and, critically, offer an incentive to be tested for those who may carry the virus. And visible, effective treatment also helps overcome the social stigma, which is still so pervasive. Treatment benefits communities and individuals, with fewer hospitalizations, fewer deaths, fewer infected infants and fewer orphans. Those treated can support their families and are likely to be less infectious.

UN Secretary-General Kofi Annan has established a global AIDS Fund with an initial target of $10 billion. So far the Fund has garnered about $2.0 billion in pledges. The Bush administration, which came up with $50 billion to fight global terrorism after the 11 September 2001 attack on the US, has committed a mere $200 million. More resources are urgently needed for care and prevention, as well as treatment.