The Global HIV/AIDS Pandemic, Structural Inequalities, and the Politics of International Health

In spite of recent advances in treatment and care available in most developed countries, the HIV/AIDS pandemic continues to spread throughout the developing world. Structural inequalities continue to fuel the epidemic in all societies, and HIV infection has increasingly been concentrated in the poorest, most marginalized sectors of society in all countries. The relationship between HIV/AIDS and social and economic development has therefore become a central point in policy discussions about the most effective responses to the epidemic.

UNAIDS estimates that by the end of 2000 approximately 36.1 million people were infected with HIV globally. Of these, approximately 34.7 million are adults -- 16.4 million are women -- and 1.4 million are children. Since the beginning of the epidemic, 21.8 million people have died -- 17.5 million adults (roughly 9 million women) and 4.3 million children. In 2000 alone, 3 million deaths were attributed to AIDS, and 5.3 million new infections are believed to have occurred -- 2.2 million among women and nearly 570,000 among children.

Beyond the sheer weight of the numbers, what is perhaps most important about the shape of the HIV pandemic is the fact that the global distribution of infection has been anything but equal. It is estimated that approximately 920,000 people have been infected in North America, with 540,000 infections in Western Europe and another 15,000 in Australia and New Zealand. In sub-Saharan Africa, by contrast, it is estimated that as many as 25.3 million people have been infected with HIV. Another 5.8 million have been infected in South and Southeast Asia, and 1.4 million have been infected in Latin America. In short, the vast majority of HIV infections can be found in the poorest regions of the world, in developing countries already facing a wide range of other serious public health problems.

In all societies, regardless of their degree of development or prosperity, the HIV/AIDS epidemic continues to rage -- but it now affects almost exclusively the most marginalized sectors of society. UNAIDS and the World Bank predict that HIV, which was responsible for 8.6 percent of deaths from infectious disease in the developing world in 1990, will be responsible for 37.1 percent of such deaths among adults between the ages of 15 and 59 by 2020. HIV/AIDS continues to stand as one of the most significant global health problems that must be confronted in the new millennium.

One of our greatest challenges is to build an understanding of the broader structural forces that have shaped not only the first epidemics of a truly globalized world, but also its most recent political and ideological challenges. Important progress has been made in recent United Nations initiatives. Maintaining long-term commitment to initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria is especially important in the wake of September 11 and ensuing events, which threaten to redirect necessary resources to seemingly more urgent security concerns.

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