The Caribbean, HIV/AIDS and Security

• Author: Caroline Allen, Roger McLean, and Keith Nurse
• Pages: 219-251

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The Caribbean, HIV/Aids and Security

The Caribbean, HIV/AIDS

and Security

Caroline Allen, Roger McLean, and Keith Nurse

Introduction

As a global pandemic, HIV/AIDS is forecast to claim more lives than

any other outbreak of disease in human history. However, the impact is not

uniform across the globe. HIV/AIDS has already wreaked havoc on the social,

economic and political fabric of sub-Saharan Africa, which is the most affected

region. In North America and Western Europe, the relative affordability of

anti-retroviral treatment has reduced HIV/AIDS-related mortality, while there

has been a steady increase in the number of people living with the virus.

Prevalence is on the rise in regions such as Southeast Asia, the countries of

the former Soviet Union, and South and Central America. In the Caribbean,

adult prevalence of the virus is second only to that of sub-Saharan Africa (see

Table 9.1 below).

With its impact on life expectancies and wider socio-economic and political

consequences, HIV/AIDS has begun to reverse the developmental gains for

many of the world’s most vulnerable groups, nations and regions as well as

create an additional source of instability, including military conflict.

Recognition of the grave threat that AIDS poses has only recently gained

prominence in global policy debates. At the closing session of the International

AIDS Conference in Durban, South Africa in 2000, Nelson Mandela declared

that ‘a tragedy of unprecedented proportions is unfolding in Africa. AIDS

today in Africa is claiming more lives than the sum total of all wars, famines

and floods…’ Mandela’s words highlight the gravity of the HIV epidemic in

Africa by comparing its impact with that of war, a traditional security concern,

and natural or man-made disasters.

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Caribbean Security in the Age of Terror

The HIV/AIDS pandemic has moved from being defined purely as a

health issue to be seen as a development as well as a security threat. In

addition, the AIDS pandemic has emerged as a security concern for both

high and low prevalence countries and regions. The problem of AIDS is

increasingly viewed as a part of the ‘global commons’ and not just as a

problem that can be easily contained within the boundaries of affected nation-

states. The adequacy of the traditional state-centric, militaristic approach to

security has been thrown into question with the recognition of biological

threats, emanating from diseases carried across borders by travellers as the

pace of globalisation quickens.

Table 9.1

Regional HIV/AI DS Statistics and Features, end of 2002

Source: UNAIDS/WHO, AIDS Epidemic Update, 2002.

Outline

The chapter firstly analyses the emerging security discourse and

international relations practice and looks specifically at the development of

US policy towards HIV in developing countries. Attention is given to the

threats to state governance and connections are made with issues such as

travel and tourism, migration, the drug trade and military operations. The

second section presents data on the epidemiological profile and health impact

Region Epidemic started

Adults and

children living

with HIV/AIDS

Adults and

children newly

infected with

HIV

% Adult

prevalence

rate (*)

% HIV-

positive

adults who

are women

Main mode(s) of

transmission (#)

for adults living

with HIV/AIDS

Sub-Saharan Africa Late 70s early 80s 29.4 million 3.5 million 8.8 58 Hetero

North Africa

& Middle East Late 80s 550,000 83,000 0.3 55 Hetero, IDU

South

& South-East Asia Late 80s 6.0 million 700,000 0.6 36 Hetero, IDU

East Asia

& Pacific Late 80s 1.2 million 270,000 0.1 24 IDU, hetero, MSM

Latin America Late 70s early 80s 1.5 million 150,000 0.6 30 MSM, IDU, hetero

Caribbean Late 70s early 80s 440,000 60,000 2.4 50 Hetero, MSM

Eastern Europe

& Central Asia Early 90s 1.2 million 250,000 0.6 27 IDU

Western Europe Late 70s early 80s 570,000 30,000 0.3 25 MSM, IDU

North America Late 70s early 80s 980,000 45,000 0.6 20 MSM, IDU, hetero

Australia

& New Zealand Late 70s early 80s 15,000 500 0.1 7 MSM

TOTAL 42 million 5 million 1.2 50

* The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2002, using 2002 population numbers.

# Hetero (heterosexual transmission), IDU (transmission through injecting drug use), MSM (sexual transmission among men who have sex with

men).

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The Caribbean, HIV/Aids and Security

of HIV/AIDS in the Caribbean. The major characteristics of the Caribbean

epidemic are presented along with factors associated with vulnerability in

the region. The third section evaluates the current and prospective security

risks for the Caribbean. The focus is largely on the mobility of populations

and the possible socio-economic and political implications of the disease.

The fourth section examines the international and regional response to the

epidemic. Particular attention is given to the Caribbean response from a

security perspective. The concluding section provides a critical perspective

on the security concept and its applicability to the Caribbean HIV/AIDS

epidemic. Traditional concepts of security concerned with the territorial

integrity of nation-states are considered, along with notions of human security

that extend the focus from the state to the safety and welfare of other collective

groupings and to individuals.

HIV/AI DS and Security

In 2000, President Clinton declared HIV a security threat to the United

States. Since then, James Wolfensohn, head of the World Bank, speaking at

the UN Security Council on the issue of AIDS argued, ‘we face a major

development crisis, and more than that, a security crisis’. In the US, the State

Department and the CIA are on record as stating that the AIDS crisis is a

threat to national security. The statement by the US under-secretary of state,

Paul Dobriansky, that ‘HIV/AIDS is a threat to security and global stability,

plain and simple’, exemplifies this Singer 2003).

In July 2000, the United Nations Security Council under Resolution 1308

delineated the dangers that HIV/AIDS poses to worldwide stability and

particularly to the role of international peace-keeping personnel. Resolution

1308 requests the secretary-general:

To take further steps towards the provision of training for peacekeeping

personnel on issues related to preventing the spread of HIV/AIDS and to

continue the further development of pre-deployment orientation and on-

going training for all peacekeeping personnel on these issues. (UN Security

Council 2000, 2).

Numerous international agencies and policy makers are now linking the

issues of HIV and security, asserting that the epidemic poses a threat to

international stability. Generally, the security concept remains focussed on

military considerations and the state in this discourse. UNAIDS has recently

launched an initiative on HIV and security, with three main components: