Climate change and AIDS: A joint working paper

carol — Thu, 03 Sep 2009 23:40:05 -0600

AIDS and climate change (CC) are two of the most important "long wave" global issues of the recent past, the present and the future. They share similarities, interactions, and present possibilities for a more united response. Yet these links have received little analysis. This paper seeks to address that gap. It first focuses on scientific issues, identifying major, minor, and speculative pathways by which AIDS and CC are likely to interact. These interactions are, here, called the HIV and Climate Change Complex (HACC).

The maximum impact of CC is in the future, likely to occur decades after the peak incidence of HIV. The severity of the HACC will largely be determined by the temporal overlap of these ranges. The HACC will also have an uneven spatial distribution, modified by the regional impact of CC and the regional epidemiology of AIDS, each of which varies by physical and social elements. Populations with currently high rates of HIV are the most vulnerable to a worsening or prolongation of the epidemic due to CC.

This places the people of SSA at the greatest risk of the HACC, though outside Africa populations in north east India and New Guinea may also be significantly impacted.

There is agreement that the most important pathway in the HACC will be further deterioration of regional and global food security. At the individual level, nutrition is vital for good immune function, to reduce the risk of acquiring HIV if viral exposure does occur, and to slow the progression of HIV to AIDS and of AIDS to death. At larger scales, population nutrition is important for good governance, by helping to nurture and stimulate the "effective" demand populations need to reduce corruption and to more evenly distribute available resources. Any substantial decline in the availability and intake of calories or micronutrients brought about by CC is likely to increase poverty, impair learning and expand the number of migrants. The current decline in global food security, partly attributable to CC, is already causing disproportionate nutritional harm to migrants and otherwise impoverished populations, some of whom experience AIDS.

There is agreement that the second major pathway of the HACC is the CC-related alteration in the distribution of infectious diseases, which interact with AIDS. Of these, malaria is the most important, due to its high burden of disease (BOD). CC is projected to reduce malaria transmission in some regions, which experience a comparatively low rate of HIV, both now and in the future. This will reduce the beneficial impact to the BOD of AIDS for these populations. On the other hand, a large population with a high rate of HIV lives on the plateaus of sub-Saharan Africa (SSA), an area as yet little affected by malaria. If the climatic, eco-systemic and other factors for malaria transmission alter sufficiently in these plateau cities then the HIV burden of this population is likely to be substantially higher, and will also be worsened by increased poverty and greater food insecurity.

There are several other plausible biological pathways in the HACC. Of these, the relationship between CC, air pollution and immunity, and CC, heat stress and immunity are likely to be the most important. More speculative is the possibility that that CC will harm infrastructure and governance on a scale sufficient to aggravate and prolong the BOD of AIDS. Again, the population of SSA is judged to be at the highest risk. This mechanism is plausible by interlinked pathways including more extreme weather events and "natural" disasters, increased mobility and additional migrants and refugees. These factors are also likely to aggravate gender inequalities, increasing the frequency of transactional and coercive sex - pathways likely to increase the BOD of AIDS among women and girls, via increased viral transmission and reduced access to treatment and prevention. At the global level, CC may exert an immense opportunity cost, diverting resources of the international community away from public health, including from HIV, poverty alleviation, and the other Millennium Development Goals (MDGs).

Suggestions for a future research agenda include the more accurate assessment of the pathways within the HACC, and an improved conceptual understanding of the linkages between conflict, behaviour, governance and values, environmental factors including climate, and food production, and between each of these macro-elements and sea level rise. This would be best done by an interdisciplinary working group.

Another research gap is the effect of CC on human behaviour, including behavior related directly to HIV risk. From science, the paper moves to strategies and policies. The struggle to address AIDS and CC has generated two vigorous global social movements, with, as yet, little formal interaction or collaboration. We suggest this gap is a microcosm of a separation between two even larger communities - those concerned with the environment and those concerned with social justice. Of course, this is a simplification, but on the whole our perception is that the environmental movement is insufficiently aware of poverty, while the social justice movement is still poorly informed about the environment. The work, advocacy and activism of the leaders and actors within each community who do recognise these linkages will be strengthened by this report.

AIDS has already killed tens of millions of people, while CC may dwarf this number. Those concerned to reduce CC can apply many lessons learned by the AIDS community. These include the need to challenge conventions and to seek benefit for the poorest and most marginalised - and to widen the CC movement's emerging engagement with entrepreneurs, philanthropists and prominent personalities: tools instrumental in the growth of support for those with HIV. The AIDS constituency can benefit from the experience of humanitarian programmes, some of which already see AIDS and CC as cross-cutting issues.

Several actions to reduce the impact of CC on AIDS are proposed. These include the integration of HIV prevention and management into disaster management plans, particularly for populations in SSA, some of whom have already experienced extreme weather events. Means to enhance global and regional food security, especially in SSA, are vital, and much more can be done. A quarter of the world's population is over-nourished, and a more equitable distribution of global food production will go far to defusing any future food crisis, and is likely to improve health for both over and under-fed people. Malaria treatment and prevention in SSA can also be improved. The CC community might also consider strengthening the UNFCCC including with formal links with agriculture, health and security.

Finally, a risk is perceived whereby a relatively privileged stratum of people and interests argue that issues of global health and global social justice must be put aside in the effort to pursue partial CC adaptation. This approach is highly dangerous for global health and global social cohesion. It would also likely generate profound longer-term risks for currently privileged populations pursuing this strategy. A stronger alliance between the AIDS and CC communities will help thwart the emergence of such a policy. A focus on the interconnections between CC, food security, AIDS, health in general and the links between these and the MDGs is key to breaking out of this "either or" myopia."

Information Provided by Carol Lombard, Department of Social Development Population Website

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