8 - Responses from Above

Summary

Although it is unlikely that the world's first HIV epidemic in a general heterosexual population could have been prevented from causing terrible suffering, it is also true that the measures taken by national and international authorities during the 1980s and 1990s were generally considered inadequate. Most African governments were slow to grasp the scale of the crisis, because many were weak regimes faced with more immediate problems, the crisis was itself so novel, and they perceived a threat to the national dignity that they had so recently asserted. Consequently, the first epidemic did not produce the first response. When African regimes did eventually react, they found that the Western powers dominating international affairs had already defined strategies designed to tackle their own less threatening epidemics. These strategies, propagated by the World Health Organisation in one of the most striking modern examples of globalisation, proved less effective in Africa. Whether any other strategy could have been more effective, especially in the earlier stages of the epidemic, remains uncertain.

The Western strategy was designed to counter epidemics in stigmatised but articulate minorities of homosexuals and injecting drug users. The crux was to avoid demonising and isolating these minorities, win their voluntary cooperation, persuade them individually to abandon high-risk behaviour, collaborate with them in caring for the infected, and educate the wider public to avoid infection. HIV was not to be treated like the epidemic diseases of the past, which Western societies had not experienced for sixty years, but like the dominant degenerative diseases of the time, such as cancer. This strategy fitted smoothly into the liberal, doctor-dominated health and sexual policies of Britain and France. It worked less smoothly in the United States, where doctors had less control over public policy, the Reagan administration did not conceal its distaste for deviant minorities, and militant homosexual groups defended their interests in the name of human rights. The effect, however, was largely the same: by 1986-7 Western Aids policies were firmly voluntaristic and sensitive to the rights of the individual patient, with a relative unconcern for the protection of the uninfected because infection was concentrated among minorities and easy to avoid.