ICSW

by Caroline Allen & Keith Nurse

“Human security is people-centred. It is concerned with people’s freedom of choice, access and peace”

Since the first case of AIDS was diagnosed in Jamaica in 1982, the number of cases in the Caribbean region has risen consistently every year. By 2000, the annual number of new cases per 100,000 population was three times higher than in North America and six times higher than in Latin America.

It is now estimated that in the Caribbean 2.4% of adults in the age group 15-49 were living with HIV/AIDS (UNAIDS/WHO, 2002). This rate is the highest in the Western hemisphere and second highest in the world after sub-Saharan Africa. It is now the leading cause of death in both male and female 15-49 year olds in the region. More than half a million people in the Caribbean were reported to be living with HIV/AIDS by the end of 2000: 137,000 in member countries of the Caribbean Epidemiology Centre, 112,000 in the Dominican Republic, 250,000 in Haiti and 2,500 in Cuba.

In the Caribbean, HIV is primarily sexually transmitted. Intravenous drug use is rare and accounts for only 1.5% of cases reported since 1982. Almost two-thirds of cases since 1982 were reportedly transmitted heterosexually, while 11% resulted from homo- or bisexual behaviour (While the proportion attributed to male homosexual behaviour is thought to be an underestimate, the predominantly heterosexual character of the epidemic in the Caribbean is also evident from the fact that females have accounted for an increasing proportion of HIV and AIDS cases ever since 1985. This is similar to the pattern in sub-Saharan Africa, and contrasts with the pattern in North American and European countries, where homosexual transmission accounts for the majority of cases among nationals.

AIDS batters women

HIV/AIDS strikes the most economically productive people in society, with the age group 25-45 bearing the greatest burden of illness and death. With female infections rising more rapidly thanmale infections, we should consider this within the context of gender roles in the region. Caribbean women have a large share of economic responsibility for their families, working in the informal and formal economies, often with little or sporadic economic support from men. Infections among young women far outstrip those in young men; in young adulthood, numbers of cases of mother-to-child transmission are likely to be high and surviving children may be left to fend for themselves as women become sick and die. As in Africa, grandparents, and especially grandmothers and other older women, will see their burden of care increase. As middle class women move into a wider range of professions and jobs, HIV/AIDS is likely to erode their gains, as well as diminishing the labour force in occupations which are crucial to development, such as nursing and teaching.

The highest rates of AIDS related illness and death among males are among 35-44 year olds; the disease strikes at the age group most likely to include managers and professionals, whose skills tend to be in short supply given substantial brain drain to North America and Europe. The effect of HIV on poorer and/or smaller countries such as those of the Caribbean is greater because the economy is vulnerable to the loss of even a few skilled people.

The likely disruption to economic activity across sectors would challenge the state’s ability to address its most basic functions in an environment of increased demands on a shrinking productive base. Key among these functions is the area of social policy formulation, which is geared toward fulfilling full employment, reduction of povertyand the maintenance of harmonious relationships among various social groups. This will inevitably affect the provision of key public investments programmes and other related incentives which are a critical stimulus to private investment and social policy formulation geared towards:

increasing the productivity of the poor to better facilitate their integration into the labour force;
promoting the integration of vulnerable groups in the mainstream of the economy; and
the creation of a climate that can promote savings and investment, stimulate efficiency and productivity to achieve sustainable growth.

Increased poverty and marginalisation of social groups will in their turn feed into increased rates of HIV/AIDS. Such a vicious downward spiral is the scenario facing many sub-Saharan countries, whose rates of HIV/AIDS were similar to those in the Caribbean only about ten years ago.

Security for the marginalized

The globally differentiated impact of the HIV/AIDS pandemic (i.e. between high-income and poor regions) and the necessity of long-term, diverse and sustained responses are among the reasons that it is not a popular campaign issue among politicians. Individuals are infected, not states and within states it is usually the most marginalized populations who are the most vulnerable to infection: for example, disadvantaged racial and ethnic minority communities, commercial sex workers, economic migrants and men who have sex with men. This observation is applicable in both developing and developed countries. For example, in the US, the problem of HIV/AIDS is disproportionately distributed among the minority African-American and Hispanic populations as exemplified by the high prevalence among gay and bisexual men of colour and heterosexual women living in poverty in the inner cities.

From this perspective it can be argued that the HIV/AIDS pandemic is not just a cause but also a consequence of global structural inequalities and cultural violence. It is observed that in spite of increased formal public health and education programs and advances in treatment, HIV/AIDS finds fertile grounds in spaces where there are high levels of poverty, racism, gender inequality, and sexual oppression. Addressing HIV/AIDS as a security concern thus means focusing on the interests and concerns of marginalized groups and minorities and attacking the root causes of global and local inequalities and forms of cultural violence.

This requires a fundamental shift in the security perspective away from the traditional realist concern with power politics, national interest, territorial sovereignty and external aggression (e.g. military invasion, terrorism) towards the pursuit of democratic security via sustainable human development). The argument is that the prevailing security approach is based on narrow problem-solving approaches, characterised by short-term action planning and an emphasis on direct forms of violence. Robert Johansen argues that this approach reinforces antidemocratic values and behaviour:

It denies democracy internationally by reinforcing the separation and thereby the irresponsibility of sovereign states to people in neighbouring societies.
It discourages democracy domestically by legitimizing military institutions. These are hierarchical and authoritarian; they thrive on secrecy and encourage an inequitable distribution of a society’s economic and political resources.
It discourages democracy internally, within people’s hearts and minds, by shaping people’s attitudes and moral commitments…to shorten or extinguish the lives of thousands of people in other societies.

The United Nations Development Programme’s (UNDP) shared these concerns in defining human security. In broad terms, human security is “freedom from want as well as freedom from fear.” Human security is about removing or reducing sources of insecurity and vulnerabilities and promoting human participatory development. It is an integrative concept premised on a cosmopolitan and solidarity-based ethos that requires global cooperation for its implementation. This approach to security is articulated in the four essential characteristics of human security defined by the UNDP in 1995:

Human security is a universal concern. It is relevant to people everywhere, in rich nations and poor.
The components of human security are interdependent. There are no longer isolated events that are confined within national borders. Their consequences travel the globe.
Human security is easier to ensure through early prevention than later intervention. It is less costly to meet these threats upstream than downstream.
Human security is people-centred. It is concerned with people’s freedom of choice, access and peace.

The concept of human security has its limits. It is argued that human security can be conflated with human welfare and human development and thus made less urgent. The view is that human security runs the risk of equating “the HIV/AIDS issue with the everyday challenges that governments face.” One analyst also warns, “if all human maladies are a security threat then the potential for complacency or apathy becomes the real threat”. However, this problem is not restricted to the HIV/AIDS pandemic. This is a problem associated with all efforts to widen the security debate, especially where the interest of marginal groups and nations are involved. It can also be argued that human security may be adequate for understanding crises like the HIV/AIDS pandemic but are less adequate in terms of action given the existing configuration of power in the global institutions mandated to effect change. This is because human security calls for structural change in the world-system which hegemonic groups are likely to oppose. Lloyd Pettiford reminds us that “attempts to re-conceptualise security will not be free of political implications”.

Excerpts from “Globalization, HIV/AIDS and Security in the Caribbean”, a paper presented at the ANEC “Globalization and Development Conference”, Havana, Cuba, February, 2003.

Catherine Allen works with the Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, United Kingdom.

Keith Nurse is at the Institute of International Relations, University of the West Indies, St Augustine, Trinidad and Tobago.