The Current State of AIDS And the Future of Global Security

On the 10th of January 2000, on an unusually warm morning in New York, the United Nations Security Council convened to debate a pertinent security issue described that day by former Nigerian Permanent Representative to the United Nations, Arthur Mbanefo, as on par with the “use of threat or nuclear weaponry”. Since the founding of the Security Council, at the end of the Second World War, issues surrounding violence and armed conflict have dominated the council’s agenda. But with the dawn of a new millennium, emergent forces hitherto relegated to the annals of research in universities and think tanks began to threaten the international order. Especially on the African continent, the global scourge of HIV/AIDS had reached a critical threshold. That day in New York, there was a call to the international community for sweeping action, spearheaded by Ambassador Richard Holbrooke, who famously designated the millennium year as the “Year for Africa”.

An unprecedented situation, the convention in 2000 represented the first time the Security Council would pronounce a health issue a matter of global security. The former Vice-President of the United States and then President of the Security Council, Al Gore, even stated, “No one could doubt that the havoc wreaked and the toll exacted by HIV/AIDS threatened the world’s security.”

In 2006, researchers including Stefano Bertozzi and Nancy S. acknowledged that “Although global commitment to control the HIV/AIDS pandemic has increased significantly in recent years, the virus continues to spread with alarming and increasing speed.” They note further, “By the end of 2005, an estimated 40 million people worldwide were living with HIV infection or disease, a notable rise from the 35 million infected with HIV in 2001. Moreover, “In 2005, close to 5 million new HIV infections and 3 million AIDS deaths occurred, more of both than in any previous year.” And, “Sub-Saharan Africa remains the region most affected by HIV/AIDS”.

For instance, according to the UN, last year, Nigeria had 220 000 new HIV infections and 160 000 AIDS-related deaths. There were 3.2 million people living with HIV in 2016, among which 30 per cent were accessing antiretroviral therapy. Among pregnant women living with HIV, 32 per cent were receiving treatment or prophylaxis to prevent transmission of HIV to their children. That same year, an estimated 37 000 children were newly infected with HIV due to mother-to-child transmission.

In Nigeria, the prevalence of HIV/AIDS cuts across all social strata and is present across a wide-ranging spectrum of the population. In fact, Nigeria currently has the second largest population of people living with HIV anywhere in the world. According to the UNAIDS report on the Global AIDS Epidemic, a key reason for the persistence of HIV/AIDS rests on the liberal disposition towards sex espoused by many sections of society.

The report also argues that the structure of gender relations plays a role. A recent Democratic and Health Survey conducted in Nigeria revealed that “Nearly one-quarter of women aged between 25 and 49 have had sexual intercourse by age 15 and more than half by age 18.” The survey also indicated that between the ages of 25 and 49, the median age at first sexual intercourse is 17.6 years for women and 21.1 years for men. Troubling is that the majority of such incidents are categorized as rape, almost 90 per cent of victims raped during the day are younger than 19.

In addition, transmission of the disease through other avenues than sexual intercourse remains largely misunderstood. For instance, the Democratic and Health Survey also notes that, “While 65% of women and 62% of men know that HIV can be transmitted by breastfeeding, only about half of women and of men know that the risk of MTCT can be reduced by the mother taking special drugs during pregnancy,”—where MTCT refers to mother-to-child transmissions.

Furthermore, the prevalence of HIV/AIDS is worsened by the state of Nigeria’s healthcare system and pharmaceutical industry. Gabriel Olawale and Gloria Orogun, for instance, observe that “Contrary to the recommendations of the World Health Organisation of one doctor to 600 patients, Nigeria currently has a ratio of one doctor to 6,000 patients” (and lifestyle diseases like Diabetes and Hypertension have gradually overtaken infectious diseases in importance). Another crucial factor regarding the prevalence of HIV/AIDS is the high cost of drugs. Though the bulk of medical research and experimentation on HIV/AIDS occurs in Africa, the drugs remain elusive and expensive. According to a 2010 study “the average annual cost of HIV care was $19,912, with most people racking up costs between $11,045 to $22,626 per year”.

Researchers have argued that by some risk indicators the disease is far more destructive than war to households, overall socio-political and economic stability. According to a United Nations Special Session on HIV/AIDS, “In regions hit by famine, repression or violent conflict, populations are more at risk of HIV infection. Social systems are disrupted, families are separated and communities are displaced. This social dislocation and rampant insecurity creates fertile settings for HIV transmission.”

One could also argue that fragile states are helpless in the face of foreseeable conflict and often lack efficient medical response mechanisms. In the event of a crisis, such states become enabling environments for contracting and spreading diseases, and could foster an epidemic of exceptional magnitude. For instance, the ongoing civil war in Syria has exacerbated the “spread of infectious diseases, particularly poliomyelitis, measles, and cutaneous leishmaniasis, among Syrian civilians, refugees, and citizens of neighboring countries.” Ultimately, the process by which conflict zones become breeding grounds for serious diseases provides a critical link between such societies’ biopolitics and geopolitics. Both “-politics”, or strands of social theory, try to make sense of the political behaviour of agents, states and structures and the conditions under which decision-making occurs.

The concept of biopolitics, according to the French philosopher, Michel Foucault in his Society Must be Defended explores the extents to which the public (and, therefore, states, governments etc.) has power over matters surrounding the bodies of citizens. Geopolitics, however, explores how geographic variables (such as mineral resources, population etc.) influence international political behaviour. A common aim of both concepts is to examine how security is determined, either for the holders of the state apparatus, the individuals, or the state itself.

The notion of security as both a national and international necessity has evolved over time and so has the general understanding of it. In his famous 1952 essay, National Security as an Ambiguous Symbol, Arnold Wolfers argues that the term “security” is an abstraction but defines it concretely as “a rational means toward an accepted end.” But writing in 2004, Roland Paris notes that despite the popularity of “human security” within government and policymaking circles, the concept remains largely bleak and, at best, in “the eye of the beholder.”

Security, however, represents a set of organized actions and processes geared towards the prevention of harm to the greatest number of people. Thus, the securitization of social issues rests on traditional concerns like economic and political instability, and armed conflict. A useful framework then for understanding the securitization of HIV/AIDS is situated within the Copenhagen school of security studies, which proposes that grouping peculiar issues under the umbrella of security is a necessary step government actors take to transform political topics into issues of existential danger, for a greater social benefit.

The impact of HIV/AIDS on the security of households is of striking importance. The cost associated with gaining access to the necessary medication infringes upon potential savings and investment and this keeps the household in a never-ending loop, leading to a strain on available capital. In addition, the disease stifles the development of a skilled labour force as individuals in the prime ages of productivity are most affected. Their demise also increases the burden on the aged population as they are tasked with taking care of orphans and organizing the state of affairs of the household. Jeffrey Sachs in End of Poverty maintains, “millions of households are battling the illness of the head of a household, resulting in an incredible toll in time and expense, to say nothing of the emotional trauma of the family.” This has a crippling effect on society as it propagates issues of domestic abuse, reduces food security amongst children and, therefore, leads to malnutrition in certain instances; it also stimulates a mental environment where crime is not only acceptable, but is allowed to thrive.

Additionally, AIDS puts a heavy strain on budget orchestration and government expenditure. This is because it weakens the expected taxable income and heaps pressures on the financial health of the state as limited generated income, debt cancellations, and aid packages are channelled towards recurrent expenditure. Moreover, the necessary capital expenditure to lay foundations for more equitable income distribution stagnates. Zahid Hussain asserts that “Economic growth and political stability are deeply interconnected” and a nation with an uncertain pace of development fosters discontent in its citizens.

According to Simon Rushton, “It is difficult to think of a body more qualified than the Security Council to make a judgement on whether an issue constitutes a threat to international peace and security” and the establishment of AIDS as a security issue evokes interesting dynamics on an international scale. However, unlike the threats of Ebola and SARS, which have been treated as urgent, AIDS remains described as “a long-wave event”. For instance, Rushton maintains that:

If HIV continues to proliferate in East Asia, as seems likely, the virus will undermine civil society, slow the democratisation process and intensify poverty… [But] what is especially worrying about the AIDS pandemic is that even though Asia has already overtaken Africa as the epicentre of the disease, its full impact will not be felt for perhaps another decade because of HIV’s lengthy incubation period.

Such arguments are self-evident but there are still arguments against the categorization of AIDS as an issue of security. In this, a key concern is the issue of sovereignty. Many nations and certain scholars view treating AIDS as a security issue will lead to violations of international sovereignty, the likes of which occurred with the post-9/11 elevation of terrorism. Instead, they propose keeping AIDS within the realm of international development or human rights and confining the issue of AIDS-related security to, at most, discourse on peacekeeping operations. However, it is precisely because of awareness created by the categorization of AIDS as a security issue that impressive progress has been made in tackling the disease in the last couple of years.

For instance, as a result of the surge in AIDS awareness at the turn of the millennium, the Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002. As at 2015, the Fund had raised a total of USD 17.2 billion from governments and other charities (how these funds were disbursed, however, is another issue. According to Matthew Syed in Black Box Thinking, one of the ironies of charitable giving is that “donors prioritise an overhead ratio measure; which is the amount of money spent on administration compared with the front line. Most donors are keen for charities to keep this ratio low: they want money to go to those who really need it rather than office staff.” Yet, without the presence of adequate pecuniary rewards, the charities cannot attract the best talent and it creates a motive for some involved to mismanage funds.

Nations have also made significant contributions towards promoting AIDS awareness, and have made considerable achievements. Social media, as well as other the modern media outlets, have enabled governments to better combat the stigmatisation people with HIV/AIDS, through education and challenging long-held beliefs by members of society. For instance a New York Times article stressed how Uganda in the early period of the noughties witnessed remarkable success in battling HIV/AIDS by incorporating “grass-roots behavioural change campaigns of aimed at reducing the number of sexual partners.” The Ugandan state championed the use of condoms, and promoted abstinence and monogamous relationships despite stiff opposition from certain religious circles.

Furthermore, in 2015, research pioneered by Cuba eliminated the transmission of HIV from mother to child, a feat lauded by WHO Director-General, Dr. Margaret Chan. She stated: “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation”.

The role of the UN in spurring awareness and research as a result of the adoption of Resolution 1308, the formation of UNAIDS, and the proclamation of the sixth Millennium Development Goal (which is dedicated solely to combatting HIV/AIDS) cannot be overemphasized. Moreover, the international focus in the eradication of HIV/AIDS has fostered great strides in drugs aimed at prevention. For instance, the development of effective Pre-exposure and Post-exposure Prophylaxis drugs has provided a window for exposed individuals to prevent contracting the disease. The U.S. Department of Health & Human Services in partnership with the Secretary’s Minority AIDS Initiative Fund (SMAIF) stresses that PEP should be used cautiously and “only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. It is not a substitute for regular use of other proven HIV prevention methods, such as pre-exposure prophylaxis (PrEP) which means taking HIV medicines daily to lower your chance of getting infected (mostly used by married couples); using condoms the right way every time you have sex; and using only your own new, sterile needles and works every time you inject.”

Despite the welcome changes in global attitudes towards HIV/AIDs, there is still much to be done, particularly within Nigeria. The efforts of the National Agency for the Control of Aids (NACA) in providing “free medical outreaches in many states” has resulted in a “remarkable decrease of HIV cases in Nigeria” but issues of funding and retention of staff remain of primary concern. The bulk of the agency’s funding comes from foreign donors and there is debate on the inclusion of HIV/AIDS in the National Health Insurance Scheme. Perhaps most critical of all the issues is the lack of coordination between private and public healthcare institutions. Absent such coordination, the exchange of resources, ideas and talent between private and public institutions, and the creation of effective planning strategies and synergies to tackle health issues remain largely untapped opportunities.

The securitization of AIDS has provided a lever for understanding and confronting the disease across the globe. And though it is important to conceptualize and segment issues for ease of policymaking and implementation, it is crucial to realize that at the heart of what is often termed “the AIDS epidemic” are human beings who must, together, strive for sustained action