Securitizing AIDS/HIV – Cutting the Gordian Knot or Opening Pandora’s Box?

March 11, 2009

For centuries humanity has been looking for a source of unity. Ironically, we finally found it – not in the common values but in the common viruses. It is us against them – people versus diseases.

However, one of the most difficult questions still remains: How do we effectively address these diseses? Despite so-far rather altruistic and humanitarian approaches, HIV has been rapidly spreading in large parts of Africa, Asia, Latin America, and Eastern Europe in recent years.

With the establishment of a clear link between the political stability, economic prosperity and health level, the voices for a new, second way have been growing. A way that is at the same time more effective and more dangerous: the international securitization of AIDS/HIV.

This is not just a new term that will be ascribed to the struggle with some of the most infectious diseases. It is a concept that implies a different approach. If one disease is seen as a threat to national security, then more money from the budget will be allocated for its treatment.

International funding will not only be bigger and faster, but also those states that have so far failed to respond to the disease will be pressured to do so by their neighbors.  Furthermore patent binding agreements such as TRIPS, that previously prevented poorer nations from producing their own, cheaper, generic antiretroviral therapies (ARVs), could be neglected under security threatening circumstances.

But those steps are not without complete danger. Securitizing diseases may deprive those that are infected of their civil liberties. It would be no longer a personal problem but also a national one. Thus, privacy would not be an option anymore.

In 2003, the UK Government was even considering the implementation of compulsory HIV screening for immigrants in order to limit the health tourism. In Colombia, the Revolutionary Armed Forces imposed compulsory HIV/AIDS tests in one of the villages under their control and made the people to wear the card with the test result on their lapel.  In both cases, policymakers could argue that they have acted for the common good sacrificing the needs of the minority.

There have to be clearly defined boundaries for such a security concept, because its traditional meaning would imply that the majority and crucial state institutions (such as military) enjoy a higher priority than the individual. A statement that could have horrible consequences.

There are so many questions to be addressed – for example in what conditions HIV/AIDS transmission can be criminalized or should HIV positive people inform their dentists or sexual partners of their status. If the issue is considered “a national threat”, then disclosure can become even obligatory.

All in all, it is hard to give a definite “yes” or “ no” to the question of whether HIV should be seen as a security issue or not, as there are clear benefits but also potential dangers of classifying the disease as such.  We argue that it should be seen as a security issue in addition to being a health-, development-, economic-, social-, political- and gender issue.

And finally, not those who carry the virus, but the virus itself should be seen as the enemy.

by Martin Kessler and Ilina Georgieva

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7 Responses to “Securitizing AIDS/HIV – Cutting the Gordian Knot or Opening Pandora’s Box?”

  1. Michelle Ren Says:

    Indeed the spread of HIV/AIDS has had an impact on civil liberties, as you have pointed out. However, with the alarming level of infection and its equally disturbing implications in the region of sub-Saharan Africa, I strongly believe that the actions of policymakers to prevent such a situation from occurring in their own countries/regions are justified. You mentioned “disclosure can even become obligatory” should the disease be regarded as a national threat. Shouldn’t disclosure be obligatory even when it is not a national threat? Perhaps then it would not be so widespread in certain regions, although this is not the case where there is a correlation between AIDS and conflict (such as in sub-Saharan Africa).

    As for sub-Saharan Africa, with decreasing average life expectancy and the estimation that it could a considerable amount of its population to HIV/AIDS, I doubt that the issue of privacy or disclosure would matter much in a country that is so plagued by the disease. E.g. Botswana and Zimbabwe.

    I rather disagree with the fact that is it difficult to determine whether or not HIV/AIDS should be considered a security threat. After all, the disease takes millions of lives each year, does substantial damage to the work force, and even undermines economic and development growth in certain regions. If one would classify conflicts, genocides or even food shortage as a threat to national security, why not HIV/AIDS? After all, the Freedom from Want concept places emphasis on a securing “opportunities for people to live in…” And that should include an opportunity to live in a secure, endemic free environment.

    Michelle Ren

  2. Becky Says:

    Thanks for your post. I think you have mentioned a very interesting point – is there any personal privacy in the international securitization of AIDS/HIV. In global scale, my answer should be “Yes” or “No”, Yes for rich/western countries while No for poor African countries. I think inequality among states is not a new phenomenon. In rich countries, what their government doing to avoid AIDS is to educate their people and AVOID the one with AIDS/HIV from poor countries enter her border (will they do the same to the person who carry AIDS but he is an American?). The rich countries obviously teach their people not to discriminate local AIDS patients, at the same time her government doing something unfair to the immigrants from poor countries for the reason of security. Anyway, poor countries do not have much bargaining power and they resort to the discriminative practice without choice.

    However, I don’t really think privacy is a distinct important issue for AIDS patients as they sometimes even can’t get treatment and an adequate living environment (esp in poor countries). Of course privacy is important, but I think privacy is not the first priority of patients. Further, I think AIDS is not simply “a national threat” but a AIDS free environment would also be the right of individual. While the government is losing police force and agricultural productivity because of AIDS, a family is losing father or mother to take care their children. So is it really simply a national threat?

    Becky

  3. Tse Yuen Ting Veronica Says:

    Dear Martin and Ilina,

    Thank you so much for the post. You two have raised a very interesting issue concerning the continued stigma attached to HIV/AIDS patients and their privacy rights concerning whether or not they should be obliged to disclose their HIV status.

    In my point of view, I would regard the new framework, seeing HIV (or diseases, or public health) as a security issue as enabling the international community to look into the existing problem in greater depth. With the traditional human security paradigm whereby we only focus on state/nation’s interest, less emphasis has been put on the individual themselves. Thus, without the clear analysis of the complicated problem of diseases, actors may not be able to tackle the root of the problem. Instead, money would be put into protecting national sovereignty and even if funds are being invested in anti-HIV/AIDS program, they would only yield short term result. I believe the “securitization of HIV/AIDS” would enable the involved actors to have a more comprehensive picture of the problem, identifying the inter-related relationship between health issues, politics, economic environment and societal factors, hence coming up with more solutions to tackle the fundamentals of the diseases.

    If the paradigm shifts towards a more human-focused one, I believe that it may also enable a more “humane” discussion concerning the issue of stigma attached to HIV/AIDS( whereby long term education and campaigns are needed to uproot the long-existing stigmatization). The problem of whether or not patients should have an obligation to disclose their HIV status or that the state has the authority (like the example in Columbia you raised) to compel people to “wear the card on their lepal showing the test result” would be more people-oriented, with considerations from the national or international point of view, but also the fundamental perspective of the victims themselves.

    Though I believe that different states have already realized the inadequacy of the traditional state-oriented approach in tackling humanitarian issue, it seems that in terms of the practical actions done, there is still a long way for people to realize the human-focused approach in order to bring civil liberties and individual rights into consideration when formulating the solutions and policies.

    Once again, thanks so much for the interesting post.

    Cheers,
    Veronica

  4. Tong Yui Wa Andy Says:

    Thank you very much for sharing your views with us. You have given us interesting and important notions, one of which is privacy. Interest of states does have different bargaining power. As what Marco Antonio Vieria (2007) has mentioned in the article ” The Secruritization of the HIV/AIDS Epidemic As a Norm”, “The securitization of HIV/AIDS Epidemic is an international norm defined and promoted mainly by multilateal bodies, powerful states in the North and transnational HIV/AIDS advocacy networks” Putting HIV/AIDS as an national security issue may result in the powerful states acheiving mainly what they want regardless of the others. It has beeb mentioned by Colin McInnes AND Kelly Lee (2006) that “the interests of the West are prominent on this agenda,
    focusing (largely though not exclusively) on how health risks in the developing world might
    impact upon the West. It is less concerned with the promotion of global public health.”

    In my point of view, AIDS/HIV are undoubtedly a security threat. It is supported by its dehumanizing damages in regions like sub-saharan Africa. However, it should not be nationalized or the humanitarian and global aspect of illness will be disregarded. As what has been mentioned by Junio Valerio Palomba (2008) that “the focus and action of the state actor is likely to be confined to those instances where it touches upon the selfish security interests of the state.” and “the securitizing practices of the WHO tend to put “ the Westerns first” and everybody else behind.” Shall we do nothing when people in the other states are sufffering from HIV/AIDs while we aren’t ? HIV/AIDS should be a issue of human security. A world free of AIDS should be created by us as human kinds on the same Earth. The ones who suffer are human kinds but not the states.

    Thank you again for sharing your view of us. It has really raised a good discussion topic.

    Cheers,
    Andy

    Reference:
    Marco Antonio Vieria. (2007) “The Secruritization of the HIV/AIDS Epidemic As a Norm”. Retrieved on 12th March, 2009 at http://www.bpsr.org.br/english/arquivos/BPSR_v1_n2_feb2008_05.pdf

    Junio Valerio Palomba.(2008). “What are the risks of securitizing infectious disease pandemics such as HIV-AIDS and SARS?” Retrieved on 12th March, 2009 at http://www.e-ir.info/?p=523

    Kelly Lee and Colin McInnes, “Health Security and Foreign Policy” Review of International Studies 32(1): 5-23, 2006

  5. miuyim Says:

    Dear Martin and Ilina,

    Thank you for raising the interesting issue on possible privacy intrusion while securitizing HIV/AIDS.

    From my point of view, the case in Columbia you mentioned is an extreme when privacy of civilian is not respected with human rights violated to certain extent. How far privacy is intruded does not depend on whether HIV/AIDS is being securitized. It relates to how individual governments view the matter and what relevant policies are implemented. Maclean (2008) has highlighted that health, together with other security concerns, should be viewed from a human-centric approach, rather than a power-centric one. Humans should be placed on the level of primary security referent. If governments have these in mind, mandatory testing would not be a necessary; even when some governments employ this, follow-up measures would certainly be implemented to help integrate the patients into communities without being stigmatized.

    When an issue becomes a global threat that affects the humankinds massively, there is certainly a need to consider securitizing the issue to promote cooperation and dialogue among governments, intergovernmental organizations and NGOs in top agendas, so as to urge governments to take sufficient measures to tackle the issue and maximization the protection to the population.

    Once again thanks for bringing up the possible drawbacks of health securitization.

    Miu

    Reference
    Maclean, S.J. (2008). “Microbes, Mad Cows and Militaries: Exploring the Links Between Health and Security”. Security Dialogue 39(5), 475-494.

  6. ilinageorgieva Says:

    Dear all,

    Thank you a lot for the interesting comments.

    We understand that this is a complex issue and one-sided answer is impossible.

    First, let’s make a clear distinction between “security issue” and “security threat”.

    HIV/AIDS definitely is a security issue since it has the potential of destabilizing national economies and political systems. Thus, it needs to be addressed accordingly but not at the expense of civil liberties of those that are affected.

    AIDS is an international problem and needs to be handled as such. Transforming it solely into a national threat, the policy that will follow will be “Every country for itself”. And this is the worst we can attempt to do. Borders may be closed for people, trade and even war but they cannot be closed for viruses. Viruses will always find a way. Unfortunately it takes us too much time to realize it. Public attitude to AIDS passed through so many stages – first it was seen as an African problem, then as “gay disease” and a virus that affected mainly drug addicts. Now, 28 years later, we know that AIDS kills indiscriminately .Will we need another 28 years to understand that we cannot fight with it individually?

    Probably the destruction caused by AIDS is comparable only to the one that Black Death caused 7 centuries ago. We can adopt the same approach -avoidance and waiting. But the same approach will lead to the same result – devastation, mass death and crashed economy.

    Concerning the privacy issue, it is really a complex topic. But we think that patients have the right to keep the information of their disease confidential. Apart from everything else, it is a disease that is a personal tragedy and the decision whether one will disclose it or not also ought to be personal.

    What will be the use if others know someone is HIV-positive? The practical result is predictable – avoidance and stigma. Would it help to prevent the disease from spreading? Probably. But will it be a long term solution? Definitely not.
    Instead, higher spending that would result from securitization should be used to provide better access to medicine (also by overcoming the TRIPS agreement), better public awareness and potentially further research to fight the disease. Especially western countries have been not eager enough to find a cure, because only few are affected in the western hemisphere, and profits in the 3rd world would look rather meager. Precisely that is why we need to make the virus a security issue.

    Martin and Ilina


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