Thelot Fils-Lien Ely
Centre d'enseignement et de recherche en action humanitaire (CERAH), Institut de hautes études internationales et du développement (IHEID), Université de Genève 24, rue du Général-Dufour CH-1211 Genève 4, Suisse.
Sante. 2009 Jul-Sep;19(3):121-32. doi: 10.1684/san.2009.0170.
Since their adoption in 2000 by the United Nations, the Millennium Development Goals set for 2015 appear to have become a part of the policy agenda of all of the member states. Three of these eight objectives deal with health issues. "Combat HIV/AIDS, malaria and other diseases": this is the formulation of the sixth MDG. Observing that in many countries strongly affected by poverty and inequalities, the epidemic continues to spread, without really reversing at all, and that access to antiretrovirals is possible for only a small proportion of the patient who need them, we consider the problems of global governance in the field of health. Our intention is to explain that the failure to deal with the HIV/AIDS epidemic may constitute an obstacle to the achievement of the MDGs by 2015. Proposing a comprehensive sociology of HIV/AIDS, this article pays special attention to the dimension of the meaning of the disease, simultaneously as a policy issue, a social construction, and an object of study in the social sciences. Looking at the two countries most affected by the epidemic in Africa and in the Caribbean, we examine the different aspects that have determined the failure of governance and the effects of this failure on the populations concerned. The excessive conflictuality in South Africa and the biopolitics of "let them die" and the fragmentation of the networks involved in the combat in Haiti are considered to have contributed to a crisis in the epidemic's governance. In both cases, the consequences have been expressed by a reduced life expectancy, insufficient access to antiretroviral drugs, reinforcement of the socioeconomic inequalities of health, the production of new pockets of poverty, more fragile household and national economies, an increase in maternal and child mortality ... The failure of the governance of the HIV/AIDS epidemic in countries such as Haiti and South Africa appears to foretell the impossibility of achieving the MDGs by 2015.
自2000年被联合国采纳以来，设定到2015年实现的千年发展目标似乎已成为所有成员国政策议程的一部分。这八项目标中的三项涉及卫生问题。“防治艾滋病毒/艾滋病、疟疾和其他疾病”：这是千年发展目标6的表述。鉴于在许多深受贫困和不平等影响的国家，疫情仍在持续蔓延，根本没有真正得到扭转，而且只有一小部分有需要的患者能够获得抗逆转录病毒药物，我们思考了卫生领域的全球治理问题。我们旨在说明，未能应对艾滋病毒/艾滋病疫情可能会成为到2015年实现千年发展目标的障碍。本文提出一种全面的艾滋病毒/艾滋病社会学，特别关注该疾病意义的维度，它同时是一个政策问题、一种社会建构以及社会科学的一个研究对象。通过审视非洲和加勒比地区受疫情影响最严重的两个国家，我们考察了导致治理失败的不同方面以及这种失败对相关人群的影响。南非过度的冲突性、海地“任其死亡”的生命政治以及参与防治工作的网络的碎片化，都被认为导致了疫情治理的危机。在这两个案例中，后果都表现为预期寿命缩短、抗逆转录病毒药物获取不足、卫生领域社会经济不平等加剧、新贫困群体产生、家庭和国家经济更加脆弱、孕产妇和儿童死亡率上升……海地和南非等国在艾滋病毒/艾滋病疫情治理上的失败似乎预示着到2015年实现千年发展目标是不可能的。
