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GUEST COLUMN |
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Public health as social justice.
Fall in love with it
Susan Hunter |
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| When I was a graduate student back in 1975, I fell in love
with the idea of "public health as social justice."
While I fell in love with many real-time boys as well, none
had the same magical impact as the public health heroes I met
on paper who were making life better for millions of poor around
the world. I had found my mission, and in Uganda as a Rockefeller
Foundation fellow in demography in 1989, I began to live it
out in the world of AIDS. Although AIDS was devastating the
country, all of my department colleagues were still in white
hot pursuit of the prior decade's darling, fertility studies,
so I was "stuck" teaching the graduate course in mortality.
From there began a half-year adventure in orphan counting in
Rakai District, Uganda, then the world's AIDS epicenter. You'll
find the rest of the story of the community groups I worked
with in Black Death: AIDS in Africa. People all over the African
continent are still fighting a devastating epidemic in the same
way--with little but their own two hands. Uganda was the "birthplace"
of AIDS-the country where it hit first and hardest-but it was
also the birthplace of Children on the Brink and the world's
first community-based programs for people living with the disease
and the orphans they left behind. |
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| For the next 12 years, AIDS took me to 17 countries in Africa
on long and short term assignments and to Haiti, too, before
I was invited on a UNICEF "reconnaissance" mission
in South East Asia in 2001. "What," I wondered when
I accepted the assignment, "could I possibly do in a region
of the world where AIDS seemed to be having such little impact?"
Seven countries later, I no longer wonder. Four years later,
I can only scratch my head and wonder how I was so blind. |
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| My latest experience as an "orphan counter" was
in Papua New Guinea. While PNG is a small country of little
more than 5 million people, it has the sad distinction of being
the fourth country in Asia considered by experts to have a generalized
AIDS epidemic. In July 2004, a leading Australian AIDS expert,
Dr. David Cooper from Sydney's St. Vincent's Hospital and a
co-chair of the scientific meetings at the International AIDS
Conference in Bangkok, warned that Papua New Guinea faces the
threat of an AIDS pandemic of Sub-Saharan Africa proportions
unless enormous efforts are taken to stem the virus' spread.
My review of the data and our field research with children and
families more than confirmed this fact. The epidemic has moved
from core groups of infected persons-in PNG's case, poor women
who are forced to turn to sex work in order to survive and feed
their children-to the general population. For now, suffice it
to say that PNG is facing a fast growing epidemic that promises
to have catastrophic effects on the social and economic fabric
of a country already struggling with massive problems of development.
I saw the same thing in India, Laos, Myanmar, Nepal, and to
a lesser extent in the countries that have faced this enormous
public health challenge and appear to have won, at least for
the next little while: Cambodia, Thailand, and Vietnam. |
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| Papuan society has severe human rights problems stemming from
the stress of extreme poverty, prominent among them widespread
and spine tingling levels of violence against women and children.
It has done little to ensure that children go to school, so
many spend their time in much more destructive pursuits, earning
a living or paying their school fees through crime (boys) or
by selling their bodies (girls). If it is to escape the devastation
that is AIDS it must confront these artifacts of well-entrenched
patriarchal dominance with the same vigor Uganda confronted
old and paralyzing ideas about sexuality, gender, and age at
the core of the human rights abuses fueling this epidemic. AIDS
will make that PNG's daunting task of development even more
difficult if not impossible and set a country that had already
acknowledged the impossibility of meeting global goals for children
even further behind on the road to modernity. But PNG will not
be alone for long when the truth about epidemics in other Asian
countries, including the region's largest and most populous,
is known. |
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| As I wrote AIDS in Asia: A Continent in Peril last year, I
had the same chilling and heart rending experience that I had
had in writing Black Death. As I set to the task of knitting
mounds of data about Asian history, society, politics, economics,
and HIV/AIDS together and the lines of the book began to emerge,
I was startled and distressed by what I saw in my work. Not
only is the epidemic huge and growing unrestrained in most Asian
countries, but when the underlying social, political and economic
patterns which fuel its growth are brought together and analyzed,
it is quite clear that there is little standing in the way of
catastrophic impact. Doubt about the severity of the epidemic
in Asia turned to certainty for me. AIDS is huge. AIDS is here.
And AIDS is Asia. It will be here for a long, long time to come,
in epidemic form throughout the 21st century and in endemic
form thereafter. |
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| Public health as social justice. Fall in love with it. It
is an idea made manifest in the relentless spread of HIV/AIDS
across the Asian continent. |
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| (All the views expressed in this column are entirely that
of the author.) |
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