Global AIDS Policy Watch (GAPW) is pleased to announce the publication of the article Moving Beyond Biomedicalization in the HIV Response: Implications for Community Involvement and Community Leadership Among Men Who Have Sex with Men and Transgender People, authored by two members of the GAPW Advisory Council, Professors Peter Aggleton and Richard Parker, published in e-View Ahead of Print format by the American Journal of Public Health and available at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302614
In the article, the authors challenge the ways in which oversimplification and generalization ultimately prevent effective HIV policy and practice, as well as the status quo of current global HIV slogans that predict and cheer for the end of AIDS by 2030, even in the midst of trending resource constraints and the obvious scale-down of funding and program development that is taking place in many countries around the globe.
A key argument that the article makes is that public health practitioners and policymakers have oversimplified complex lived-experiences related to the concepts of ‘MSM’ and ‘community’. Aggleton and Parker argue that in doing so, public health has created a paradox: by abridging complex realities with broad and formulaic prevention and treatment models, researchers, practitioners, and policy-makers have inadvertently shut out the most vulnerable. This abbreviation has impeded the HIV and AIDS response. It is necessary to encourage more comprehensive understandings of the affected communities through their own participation, and to not do so in a way that is convenient for service delivery but rather validates the realities of those who are most in need.
One of the greatest problems with over-optimistic and over-simplified sloganeering is their lack of realism. Aggleton and Parker argue that more realism is needed to develop meaningful strategies because without it, we risk addressing the epidemic in a way that does not reflect the lived experience of the people who are living it. If policymakers continue to promise an “AIDS-free generation,” to predict a world with “zero discrimination,” and to claim that biomedical interventions alone can and will bring the end of AIDS, they deny the actual reality of the epidemic in the real world that we currently live in. This is a reality in which rates of infection among gay and other MSM and transgender people are rising in many contexts, in which hostility and discrimination towards people living with HIV, in addition to sexual and gender minorities, are increasingly being tolerated in various countries, and in which nearly twice as many people who need treatment lack it compared to those who have it.
Aggleton and Parker also point out that efforts towards finding interventions that will work regardless of context ignore the fact that biomedical interventions require individual people to understand them and adhere to them – actions that rely on social practices and behaviors. The authors call for a reassessment of this uncritical push for biomedical interventions, particularly in resource-poor settings. When searching for a one-size-fits-all solution, we cannot forget that successful efforts are successful as a result of the communities and individuals who made them work.
Reference:
Aggleton, P., & Parker, R. (2015). Moving beyond biomedicalization in the HIV response: Implications for community involvement and community leadership among men who have sex with men and transgender people. American Journal of Public Health, e1-e7. Available on-line at: http://ajph.aphapublications.org.ezproxy.cul.columbia.edu/doi/pdf/10.2105/AJPH.2015.302614