The 15th International AIDS Conference held in Bangkok in July 2004 gathered more than 17,000 delegates, including scientists, health officials, policy makers and activists from different parts of the world. The conference theme was very telling: Access for All - as we are living in a world where only seven per cent of those with HIV needing drugs to stay alive over the next two years are getting them.
Reports presented to the conference by the UN and the ILO confirmed once again the scale of a human catastrophe that shows no sign of diminishing.
Workers are inevitably the focus of the ILO report, HIV/AIDS and Work: Global estimates, Impact and Response 2004, which states that 36.5 million of 38 million persons who are HIV-positive globally "are engaged in some form of productive activity."
The report underlines the susceptibility of transport workers to HIV transmission, which is already well understood by transport trade unions:
"As most transport workers (truck drivers, train and airline crews, and sailors, among others) are away from their homes and families for long periods, they face higher-than-average levels of risk as a result of sexual activity with casual partners. This risk is shared by the communities along highways, or concentrated around some of the principal transport nodes (junctions or ports), and the communities from which they come."
HIV infection: the wide reach of transport
“Even a total of about 100,000 transport workers in (Zimbabwe) may appear small in a total population of working age persons of seven million. Nevertheless, findings from the country assessment confirm that, because of the wide reach of transport operations, the sector generates particular vulnerabilities owing to the prevalence of risky behaviours.
“More than 25 per cent of male air transport workers, for example, reported multiple sexual partners in the preceding year, more than one in 10 of the married workers reported that their most recent sexual partner was not their spouse, and nearly a third reported having a sexually transmitted infection.”
– Extract from ILO Programme on HIV/AIDS and the World of Work presented to 15th Internatinal Conference on AIDS in Bangkok, Thailand, July 2004. |
The ITF and many of its affiliates have recognised this reality and begun to address HIV/AIDS as a workplace issue. Some transport unions have now secured provisions in their collective bargaining agreements governing peer education, prevention, non-discrimination, treatment and medical care. It is essential that unions continue their work in these fields to create awareness among transport workers of the danger of transmission - a danger still barely understood in many parts of the world - and to develop the best possible levels of financial security, treatment and care for transport workers affected by the disease.
It is also essential for them to recognise that HIV/AIDS is not just a natural disaster, but one profoundly affected by the same socio-political forces that influence our campaigning as trade unionists in other areas. We can then begin to link HIV/AIDS issues with our campaigning work for example against the negative affects of liberalisation on working conditions.
UN Secretary-General Kofi Annan has bitterly criticised the inaction of world leaders in tackling the scourge, saying recently: "We hear a lot about weapons of mass destruction. We hear a lot about terrorism, and we are worried about weapons of mass destruction because of their potential to kill thousands of people. Here we have an epidemic that is killing millions. What is the response?"
Token efforts
International institutions and leaders are aware that they have not acted decisively to defeat the pandemic up to now. In December 2003 the WHO launched an initiative to provide anti-AIDS drugs to three million people in poor countries by the end of 2005. However it appears that even this humble target, now dubbed the "3 by 5" initiative will be missed.
Dr Jim Yong Kim, Director of HIV/AIDS at WHO said: "We are moving in the right direction, but too slowly." According to the current rate of progress the target may just be reached around 2009, by which time many millions more people will have become infected and died of HIV/AIDS.
Globally nearly 3 million people died of AIDS and five million became newly infected with HIV in 2003. The epidemic is extremely dynamic and is now taking hold in new areas of the world. Two out of three new infections are in sub-Saharan Africa, but the number of cases in China, India, Indonesia and Russia is rising dramatically.
With little media attention focused on the crisis, populations may be left with the impression that they are witnessing some sort of natural disaster unfolding, as though HIV transmission were a random event. In reality of course, the virus is profoundly influenced by social, economic and political factors, which urgently need to be tackled. As Kofi Annan rightly emphasised on one occasion, "AIDS is far more than a health crisis."
�
The poverty factor
“There is a close, two-way relationship between poverty and HIV/AIDS.…Poverty is one of the factors that create situations that cause people to engage in high-risk behaviour that makes them more vulnerable to HIV. For survival in conditions of extreme poverty, people, especially women and young girls, trade sex, often unprotected under the threat of competition, for food, money, school fees or other essentials for themselves or their families, thus exposing themselves to HIV infections…
“HIV/AIDS also exacerbates poverty. The very limited resources of households are drained as sick wage earners lose their jobs, and household assets are used for medicines and health care for sick family members. Savings and capital, which are so important for recovery and rebuilding, are drawn upon, and available resources are utilized for survival consumption instead of investment.”
– United Nations Conference on Trade and Development (UNCTAD), The Least Developed Countries Report 2004, pp. 39-40).
|
Neo-liberal policies and global health
The connection between the AIDS epidemic and the extreme poverty of many of the most severely infected nations is very clear. Countries like Zambia and Malawi for example; who have HIV prevalence rates approaching 30 per cent of the population, spend much more money in debt repayments to foreign creditors than on essential health services.
In the face of these harsh realities, desperation has mixed with free market dogma to create a cynical momentum for making money at any cost. A report by the UN's World Health Organisation, Changing History, documents how the thinking of influential economists has changed. The report refers to an approach which has not only proved economically ineffective, but is devoid of morality or humanitarian concern:
"Studies previously misinterpreted the effects of epidemics as being similar to those caused by one-off shocks, such as natural disasters or international economic downturns, which many economies can absorb and which are beyond the control of planners. Predictions have also frequently reflected assumptions that the worst-hit countries in Africa had an excess of labour, and suggested that a contraction in workforce numbers might lead to more efficient use of land and capital.
"The belief was that GDP per capita would actually increase if a fall in GDP were lower than the fall in population. Similarly, it had been thought that the destruction of the labour force and hence the reduction in labour supply caused by HIV/AIDS could result in an increase in the productivity of each remaining worker because each would have more land and capital with which to work. The result of these misinterpretations and assumptions was a widespread failure nationally and internationally to revise economic policies to take account of HIV/AIDS."
(World Health Organization, The World Health Report 2004, Changing History, p. 10)
The consequences of inaction
The world has the means to avert HIV/AIDS, yet we are allowing it to progress largely unabated. According to the WHO: "It has been estimated that almost two thirds of the new infections projected to occur during the period 2002-2010 can be prevented if the coverage of existing HIV prevention strategies is substantially increased." (WHO, Changing History, p.11).
Since combination antiretroviral therapies were developed in 1996, more than 20 million people in the developing world have died of AIDS, when in fact it was possible to keep most of these people alive.
"Structural adjustment" programs imposed by the International Monetary Fund and the World Bank create many disasters for poor countries with trillions of dollars in debt. In many of these countries debt payments take a larger slice of the budget than public health and education. Reductions in spending for education and health care have been leaving people ignorant of basic health issues and unable to receive treatment for basic diseases. These diseases also increase people's susceptibility to HIV infection.
Growing social inequality is aggravating the susceptibility and vulnerability of the labour force to HIV/AIDS. There are some important statistical studies, which reveal this relationship. Higher rates of nutritional deficiency and unequal distribution of income have a positive correlation with high rates of HIV transmission (see box on page 22, "The poverty factor").
The challenge for trade unionism
The global union federations, including the ITF have declared a commitment to making the fight against AIDS a priority. But the trade union movement should not only focus its efforts on information, prevention, rights campaigns and putting protective clauses in collective agreements - critically important though these aspects of the battle may be.
Unions should also build a global struggle against HIV/AIDS, which combines this struggle with the struggle against neo-liberal policies and the negative effects of globalisation on workers. The trade union movement cannot deal with HIV/AIDS successfully in isolation from neo-liberalism and globalisation itself. This challenge must be taken up by the ITF and its affiliates too.
The case of Thailand illustrates how socio-economic and health issues may be inextricable. Here HIV infections began to soar in the early 1990s but they were dramatically reduced within a decade after non-governmental organisations forced the governments to act to bring about behaviour change. Unfortunately there are fears of an HIV resurgence following recent cutbacks in government funding due to the pressures of the IMF and the World Bank. The UNAIDS report 2004 states that "progress is lagging" in Thailand and the success story is a very fragile one.
Thai workers are conducting an ongoing campaign against government plans to privatise a number of highly profitable state enterprises, including ports, airports, public transport, electricity, water and power generation. For months, Thai trade unions including ITF affiliates have been protesting against these measures. Massive protests and demonstrations have been staged, which forced the government to temporarily halt the privatisation process. Thai workers successfully connected their campaign against privatisation with other demands including a higher minimum wage, more health and child care centres, protection for the right to organise and the protection of migrant labour.
It is easy to see the strong links between these trade union struggles, the struggle against HIV/AIDS and cuts to social programs, deregulation, privatisation and the liberalisation of labour markets. The more unions bring the bigger picture into their campaigning work on HIV/AIDS, the more powerful our campaigns will be.
Kemal Ulker is HIV/AIDS campaign coordinator in the ITF Education Department.
