Sunday, November 27, 2005

Rethinking AIDS, rethinking our cities

Once again, December approaches, and once more, “World Aids Day” arrives: the world’s attention is temporarily riveted to a health crisis.

But why should the “remembrance” of AIDS be consigned to one specific day? Isn’t AIDS a daily reality for millions? Are we going to turn our engagement with HIV-AIDS and related issues into a once-a-year event during which we wear red ribbons, attend a rally, visit a gallery, sign a visitors’ book, and then take a deep breath and move on to a new chapter in our lives?

Will December the 2nd be a new day with a new cause and with different concerns completely disconnected from those of the 1st of the month?

It’s highly likely that for several people the answer to these questions will be “Yes”. After all, it is typical in this day and age for us to devote our full attention to a given issue for a short period of time before fatigue sets in and we lose all zeal for the cause. The question is, “Why do we behave this way”? The answer is probably that we don’t know what else to do.

Any problem is our problem only for as long as it touches us, and then, if it has no direct bearing on our daily lives, we leave it behind. Interestingly enough, though, the very problems that we refuse to “own” are the same ones that claim us and pull us down years later. The fact staring us in the face is that all our problems are interconnected. While several in the “developed” world might think of HIV-AIDS as a problem limited to the “undeveloped” world, it is unrealistic to do so.

HIV-AIDS has had a huge impact on every aspect of human life. On a personal level, millions have lost their parents, siblings and friends: families and communities have been broken apart or even annihilated. Do we have any idea what impact child-led households are going to have on our societies? Not really, but this is a reality that is facing several regions. National economies are already facing the challenges associated with shrinking workforces. The lack of access to formal education is becoming an even more pressing problem and religious groups are facing existential crises. Malnutrition, which was already a major problem, is only going to become more acute. The future impact on the global economy is looming. Keep in mind that this is only a minuscule part of the picture. For each issue or problem mentioned, there are thousands more that go unnoticed or unarticulated.

The trauma that is HIV-AIDS first came to our attention in the early 1980s and yet, more than 20 years later, we still don’t know what to do. It is still a highly stigmatized condition, and we still insist on condemning the subject to whispered conversations. Why are we unable to talk frankly and openly about it even today? Is it because we think of it as a sexually transmitted disease, or is it because it is so often fatal? Is it because we think that it is a disease that only strikes individuals of a certain race or of a certain sexual orientation? Is it because we view it as a punishment from God? And why don’t we talk about AIDS when we talk about urban planning, “development,” urbanization, finance, governance, safety and security? Several barriers remain to be crossed, but few want to be the first to attempt the crossing.

AIDS is very much tied up with the events and conditions of the 20th century. For this reason, perhaps, it is still a murky subject about which people say much without actually reaching any conclusions. Everything about AIDS is still being contested on some arena or another. A cursory glance at the literature on the subject reveals that not everyone is in agreement about the origins of the disease, about what methods should be used to limit its spread and about its epidemiology.

One of the myths concerning AIDS is that it is associated with a specific race. However, its impact has already been felt on more than two continents. The fact of the matter is that AIDS is very much associated with poverty and with the trauma of colonization and rapid urbanization. The 19th, 20th and now 21st centuries have seen revolutions in several aspects of human society. All these transformations, associated with “development,” have caused such disturbances in social relations, in sexuality, in family structures, and in nutrition that it is not surprising that HIV-AIDS has taken on epidemic proportions in specific regions of the world.

HIV-AIDS is certainly not solely an urban disease. However, its spread cannot be separated from the mushrooming of urban centers, and the growth of the transportation systems linking them.

Case in point: the lorry drivers who plied the road networks linking the coastal towns of Eastern and Southern Africa to the landlocked nations in the heart of the continent were among the first sizeable known group of victims in the region. And in Southern Africa, where thousands upon thousands leave their rural homes, often crossing national borders to seek employment in mines, husbands and wives are separated for years at a time. Not surprisingly, patterns of sexual behavior are affected; both men and women seek extra-marital sexual partners. Driven by a need to feed and clothe their families, several move to and from urban centers, carrying the infection with them.

To further complicate the picture, health facilities are not widely accessible and available in urban and rural areas. Medical treatment is beyond economic and physical reach. As a result, the management of opportunistic infections associated with HIV-AIDS is a nightmare.

How does one begin to address these complications within the rubric of a discussion on urban sustainability? Frankly speaking, I have no idea. The city in Kenya, India or anywhere else in the world for that matter, is a behemoth that one can hardly begin to describe. It is almost impossible for a single individual to know every part of a city intimately or to be familiar with the lifestyles of all its residents. When planners sit down to construct a city or to modify it, the concerns of the lower income groups are often not factored in. Cities in colonized territories were often segregated, with careful planning dedicated to the colonizers’ quarters and “modern” facilities incorporated within these privileged sections, while less attention was paid to “natives' ” quarters.

Several independent nations inherited such cities. Rapid population growth and increased migration complicated already uneven situations. Next to the more prosperous, well-planned neighborhoods, shanty-towns grew larger and larger. Increasingly drastic economic disparities have compounded the situation even more. Thus, while in some cities, urban planners are able to talk about expanding transportation systems, or creating more environmentally-friendly means, in other cities, the discussion cannot be as straightforward.

In Nairobi, for instance, tens of thousands (this figure is likely an underestimation) walk across the city for two or more hours everyday to get to their places of work. About half of Nairobi’s population is estimated to live in slums with inadequate sanitary facilities and medical facilities, few schools and high insecurity. Projects to upgrade these slums have been discussed, and some are underway. I am not qualified to comment on the progress of these projects, but cannot help feeling that it will take a long time before their effectiveness is felt. Keeping this in mind, if one considers the effect of a disease such as AIDS on the national community then it becomes clear that the obstacles that lie ahead are even larger than what has been visualized.

There’s no room here to go into the impact that global slavery, imperialism, genocide, wars and the plunder of our environment have had on the development of our nations and cities. However, I want to emphasize the importance of keeping these factors in mind when we talk about development and urban planning. Our slums and cities have histories which are tied up with the factors that led to development and spread of diseases such as HIV-AIDS.

We need to examine the direct and indirect connections between impoverishment, our political set-ups, environmental degradation and disease. We have to examine the connections between the policies of global monetary bodies and the conditions of recipient nations or between the break-down of our ecological systems and the breakdown of our social systems and of our immune systems. Otherwise we will continue to propose solutions that only address one thread in a constantly evolving and growing tapestry.


First published in TakingITGlobal's Panorama Zine on 27th November, 2005.