HIV/AIDS and Hope(lessness)

Abstract

Public policy debates, about HIV and prevention policy, have tended to occupy positions at the extremes of the two camps of rational choice, theorists and structuralists. This paper argues that the concept of hope may offer a way through this policy and paradigmatic log-jam. Hope is an individually measurable concept, which serves to link the ecological concept of risk environment with that of individual choice. It may be extended into broader understandings of the social epidemiology of infectious diseases. Use of an operationalised concept of hope also offers a possible way forward for rapid community diagnosis and participation in policy development, because it is immediately and intuitively accessible at three often separated levels: the individual actor, the researcher and those acting in the policy arena.

Keywords:

• HIV/AIDS
• prevention
• rational choice
• structural intervention
• hope

Acknowledgements

My sincere thanks to Dr. William Rau, Ms. Sarah Knights, Ms. Sally Sutton, Ms. Severa von Wentzel, and two unnamed reviewers, for their comments on earlier versions of this paper.

Notes

1. A notable example of a more nuanced approach to ABC, which touches on the substance of this paper, is former US Surgeon General, David Satcher. See: “Former Surgeon General David Satcher Calls for ‘ABC + Hope’ Approach to HIV Prevention in United States”, The Body, 27 May, 2004, available at: http://www.thebody.com/content/policy/art10098.html, accessed 8 June 2007.

2. This is not the place to rehearse these debates, they are summarised in a number of standard text books, including Long (2001) and Giddens (2006).

3. And this part of the argument is further complicated by the recent report of rising rates of HIV incidence; see Schafer et al. (2006).

4. For a survey of the major interventions, see Clarke (2006).

5. A measure of the proportional distribution of income between population fractions, resulting in a scale where, at one extreme, a very small population fraction owns most of the wealth and, at the other, the opposite, and wealth is perfectly equally distributed.

6. See http://www.unaids.org/en/Regions_Countries/Countries/botswana.asp, accessed 22 August 2006.

7. For an entry into this extensive literature, see Harriss (2001) as well as http://www1.worldbank.org/prem/poverty/scapital/whatsc.htm.

8. Explored at great length, from various perspectives, in Bernstein's three volumes: Bernstein [Volumes 1 (1971), 2 (1973) and 3 (1975)].

9. Rhodes et al. (2005).