This article was downloaded by: [Universitaetsbibliothek Heidelberg]On: 15 November 2014, At: 14:30Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T3JH, UK

AIDS Care: Psychological andSocio-medical Aspects of AIDS/HIVPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/caic20

HIV-related politics in long-term perspectiveS. R. FRIEDMANPublished online: 27 May 2010.

To cite this article: S. R. FRIEDMAN (1998) HIV-related politics in long-termperspective, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 10:2,93-103, DOI: 10.1080/09540129850124208

To link to this article: http://dx.doi.org/10.1080/09540129850124208

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of allthe information (the “Content”) contained in the publications on ourplatform. However, Taylor & Francis, our agents, and our licensorsmake no representations or warranties whatsoever as to the accuracy,completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views ofthe authors, and are not the views of or endorsed by Taylor & Francis.The accuracy of the Content should not be relied upon and should beindependently verified with primary sources of information. Taylor andFrancis shall not be liable for any losses, actions, claims, proceedings,demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, inrelation to or arising out of the use of the Content.

This article may be used for research, teaching, and private studypurposes. Any substantial or systematic reproduction, redistribution,reselling, loan, sub-licensing, systematic supply, or distribution in any form

to anyone is expressly forbidden. Terms & Conditions of access and use canbe found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

AIDS CARE, VOL. 10, SUPPLEMENT 2, 1998, pp. S93 ± S103

HIV-related politics in long-term perspective

S. R. FRIEDMAN

National Development and Research Institutes, Inc., New York, USA

Abstract Some long-term, large-scale socio-economic changes may affect the politics of HIV and

other emerging viruses such as hepatitis C. It is useful to ask why the potential `peace dividend’ of

the early 1990s failed to provide adequate resources for HIV-related social and medical service

delivery in developed or developing nations. This failure can be understood by looking at long-term

global economic trends and the pressures they put on governments and corporations. They have

produced a period in which fundamental issues of political and economic structure are at stake and,

often, the response is a divide-and-rule politics to promote stability. National politics differ in terms

of the extent to which such a `politics of scapegoating’ is institutionalized and in terms of which groups

are scapegoated. Groups such as drug injectors, gay and bisexual men and sex traders are particularly

likely to be targeted both by the scapegoaters and by HIV. Given this framework, how should public

health professionals and activists engaged in HIV-related issues respond? Under what circumstances

should we orient efforts `upwards’ towards corporate, political or bureaucratic leaders? Under what

circumstances, and how, should we orient towards `popular’ forces? Relatedly, we need to consider an

issue we often ignore: What do we have to offer potential allies? That is, in terms of their goals,

philosophies and needs, why should they ally with us?

Introduction

This paper takes a long-term, large-scale view of some of the factors that may affect the

politics of HIV and of other emerging viruses such as hepatitis C. To do this, it ® rst looks at

the prospects that the potential `peace dividend’ of the early 1990s offered for HIV and for

related issues of social and medical service delivery in the developed and developing

nationsÐ and at the implications of the fact that these prospects came to naught. It then

proposes that the failure to have a peace dividend of this kind can be understood by looking

at long-term global economic trends and the pressures they put on governments and

corporations. In periods of such `crisis’ , fundamental issues of political and economic

structure are at stake, and ruling groups often use divide-and-rule politics to minimize the

probability that they will face the fate of the `Eastern’ regimes in the late 1980s and early

1990s. National politics differ in terms of the extent to which such a politics of scapegoating

is or is not institutionalized; and in terms of the groups which are picked upon as scapegoats.

Given this fram ework, the question then becomes how public health professionals and

activists engaged in HIV-related issues should respond. To what extent, and in what

circumstances, should we orient our efforts `upwards’ towards friendly members of the

Address for correspondence: Samuel R. Friedman, National Development and Research Institutes, Inc., Two World

Trade Centre, 16th Floor, New York, NY 10048, USA. Fax: 1 1 2128454698.

0954-012 1/98/03S093-11 $9.50 Ó Carfax Publishing Ltd

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

S94 S. R . FRIED M AN

leadership of corporate, political, or bureaucratic circles? Under what circumstances, and

how, should we orient towards `popular’ forces?

Relatedly, we need to consider an issue we often ignore, since the importance of HIV

and the goodness of our own motives seem self-evident to us: What do we have to offer

potential allies? That is, in terms of their goals, philosophies and needs, why should they ally

with us?

The vanishing `peace dividend’

Under the pressure of economic and military competition from the developed `West’ , which

aggravated fundamental internal con¯ icts, the former USSR and Eastern Europe imploded in

the late 1980s and early 1990s. This led to a drastic decline in the extent to which they

seemed to pose a military threat to the NATO powers, and also in the extent to which they

would be able to spend resources on military goals. This produced hopes that the approxi-

mately 800 billion US dollars spent on military purposes in 1985 (Kidron & Segal, 1987)

could be drastically reduced. Bluntly put, it could have meant that the USA, W estern

Europe, Australia, Canada and Japan could have turned their wealth, academic talent,

cultural power and amazing capacity to deploy hum an effort away from weaponry and

military concerns and towards human welfare and health.

Even a small portion of $800 billion a year could have led to massive increases in

research on HIV prevention and therapy, and on the provision of prevention supplies such as

condoms, clean syringes and the like to persons at risk throughout the world. It could have

made aspirin (and retroviral therapy) available to poor countries throughout the world (and

to the poor within the developed countries). It could have reduced the economic impoverish-

ment and desperation that lead to so many poor women (and men) engaging in sex trading;

and that lead so many persons to leave home in a desperate search for work, and thus to

engage in high-risk sex in their new environment. It might have reduced the social alienation

that makes drug use appealing to manyÐ and the economic pressures that have driven both

the massive increase in heroin and cocaine production and also the international spread of

drug use and drug injection in recent years.

The peace dividend, in short, could have been used for public health, for the welfare of

the poor and for fostering solidarity among people instead of hate.

None of this happened, in spite of a considerable decline in world military expenditure.

Global military expenditure currently amounts to about $600 billion US dollars a year,

which, after adjustment for changes in the US consumer price index, means that military

expenditures remained at 55% of the 1985 level (much of the decline represents decreases in

military spending in the former USSR) (Kidron & Segal, 1995). Unemployment and related

social and health ills abound. Hatred, often sponsored by political parties, governments and

the mass media, is widespread both within nations and between them . Drug injecting has

been spreading internationally, syringes are not available for drug injectors or hospitals in

many parts of the world and AIDS research has seen no massive increase.

In spite of some successes, such as the stabilization or even decline of HIV seropreva-

lence am ong gay/bisexual men and drug injectors in many cities, and the decline in

prevalence levels among Thai military recruits, HIV continues to spread rapidly in much of

Africa, Asia and Latin America; and the potential for rapid resurgence in the cities of the

developed countries if political or economic bad times arise cannot be ruled out. Therapies

have been developed, but pose extremely complex ethical and political issues around the

development of resistant strains. They are also extremely expensive and this too raises

profound issues ethically and politically.

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

1950Year

Pro

fit r

ate

as a

per

cent

age

of in

vest

ed c

apita

l

0

5

10

1955 1960 1965 1970 1975 1980 1985 1990

15

20

HIV-RELA TED POLITIC S IN LONG-TERM PERSPECTIVE S95

FIG . 1. Pro® t rate, USA. Source: NIPA and Department of Commerce , CITIBASE, as presented in Harman (1993).

The promise of the peace dividend clearly failed to transform the prospects for public

health or for handling the HIV/AIDS epidemic. How can we understand this?

Global economic trends and the pressures they put on governments and corporations

Here, we need to consider economics. Economic concerns pose many of the most basic

problems that governments and corporations face, and the resources they have to solve them.

Thus, economics can both compel action and limit the decisions that can be made. As will

be shown below, the economic system of the worldÐ including both developed and develop-

ing countriesÐ is in a long-term crisis due to: (1) declining pro® t rates and (2) globalization

of production.

Data on pro® t rates are dif® cult to standardize, since data are collected on a national

basis by statistical agencies that use a variety of different techniques and somewhat varying

de® nitions. The following charts of time trend data on pro® t rates as a percentage of invested

capital for the USA and for the European Community show that although pro ® t rates were

relatively high until the late 1960s, they have since declined to levels which make it

problematic whether the value of further productive investment can outweigh the risks of

losing what is invested (Figures 1, and 2).

Similarly, although data are not available on pro ® t rates per se, the rate of growth of

capital (a closely related statistic) has been declining in Latin America (see Figure 3). Pro® t

rates are important. They are the basis for new investment. W hen pro ® t rates for a given

corporation decline, this makes it harder for that corporation to compete with other corpora-

tions. Other expenses get squeezed and corporations ® ght for lower labour costs, lower taxes

and deregulation (so they can have more control over what they can do in their efforts to

rebuild their pro ® t rates). In an economy which is based on corporate pro ® tab ility to provide

economic stability, and in which a corporate economy provides jobs for most people and also

provides the basis for tax revenues (if only via providing incomes for employees and

stockholders which then get taxed), declines in overall pro ® tability make the entire system

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

Year

Pro

fit r

ate

as a

per

cent

age

of in

vest

ed c

apita

l

1965

0

± 2

4

6

8

10

2

12

14

1960 19751970 19851980

01973-80

Rat

e of

gro

wth

of c

apita

l

1

2

3

4

5

6

7

1980-89Year

S96 S. R . FRIED M AN

FIG . 2. Return to capital, European Communi ty. Source: Economis t, as presented in Harman (1993).

have less capacity to meet threats and less capacity to expand. In a word, it makes the whole

system `brittle’ .

Globalization is a dif® cult phenomenon to understand. As the work of Immanuel

W allerstein and others has shown (Chase-Dunn, 1989; W allerstein, 1980; Wallerstein,

1974), capitalism has always been an international system in which competition has involved

both individual ® rms and the actions of states. Large corporations have varying degrees of

ability to compel local governments or nations to assist them. The much-vaunted economic

F IG. 3. Annual average percentage grow th rates of gross non-residential capital stock in six Latin American countries. Source:

Hoffman `Capital accumulat ion in Latin America’ .

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

HIV-RELA TED POLITIC S IN LONG-TERM PERSPECTIVE S97

leverage of big capital to win economic concessions (Ross & Trachte, 1990) is balanced by

the need all ® rms have for police and military assistance against the threat of mass strikes, and

for government-assisted provision of such `externalities’ as a trained and healthy labour force,

transportation infrastructure and the like. These issues make it dif ® cult to assess how the

current situation is different from prior periods of declining pro® tability. Nonetheless, it is

clear that international competition now has important global magnitude. In such industries

as the garment trade, computer chip production and even (to a limited degree) automobile

assembly, corporations have created conditions where workers in France, the USA, Singa-

pore, Bangladesh and Mexico compete with each other. Local governments (and even

nations) frequently compete with each other for new investments by major corporationsÐ or

even by `strategic’ minor onesÐ by subsidizing construction costs, cancelling taxes and/or

promising to control labour or environmental restrictions.

The combination of declining pro® t rates, a heightened sense of global competition and

the fact that national and local governments and politics are dominated by parties (whether

conservative, social democratic or semi-fascist) that accept pro® tab ility and investment as

fundamental to economic health and tax revenues leads to certain patterns that are visible

almost everywhere in broad outline. (The speci ® c forms they take, however, vary by the mix

of private and governmental responsibility for different functions, the vagaries of history and

politics, and the course of social struggles.) In any case, we see a widespread pattern of

corporations cutting wages, attacking working conditions and reducing the number of jobs.

Similar pressures lead governments to reduce social bene® ts and even `unproductive’ infra-

structure expenses like schooling and health. As part of this, in many although not all

countries, media and other forces portray government spending and taxes as `waste’ and

budget de® cits as evil (for example, in the requirements for countries to be able to join the

single-currency Europe). This leads to reductions in government programmes for the pro-

vision of health and social welfare; the privatization of social services; and to large-scale

unemployment in many countries.

Along with these economic pressures, there have been changes in the belief systems of

both the powerful and many of the `people’ . These derive, in part, from the changing

functional needs of a system beset by declining pro® tability and its associated emphasis on

competitiveness. That is, if your job or your ® rm’ s, city’ s or country’ s health seems to depend

upon increased competitiveness, then beliefs about what sacri ® ces can be expected (both of

oneself and, especially, of others) will change accordingly. Thus, belief systems have changed

to put new emphases upon ef® ciency and productivity. Limitations on corporations’ right to

make their own decisions (whether for environmental or labour-protecting reasons, or even

to head off the possibility of de¯ ationary `busts’ ) have come under attack. Privatization is

supported under the concepts of free competition models of economic rationality, and under

viewpoints that see corporations as more ef® cient than governments (usually, by taking ideal

perspectives on corporate bureaucracies and parodies of government bureaucracy).

Alongside this, and paralleling the emphases on self-sacri ® ce and ef® ciency, there are

new religious and secular forms of Puritanism. In the USA, these include fundamentalist

Christianity, Orthodox Judaism and the Black Muslims. Elsewhere they take different forms

but have similar content: an emphasis on `traditional’ morality and proper behaviour as

required of all persons, and also usually on `individual responsibility’ for one’ s economic fate.

As they use it, `individual responsibility’ is a complex concept which means that individuals

or fam ilies without suf® cient land or other resources to produce goods or services to sell are

required to ® nd employment from a ® rm (or government agency). Those who are unable to

do so are seen as dependents upon the charity of the religious `believers’ (with state safety

nets heavily stigmatizing, often requiring labour under very poor conditions, or non-existent).

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

S98 S. R . FRIED M AN

Table 1. Partial listing of mass strikes 1994± 1997

1994 1996 1997

Spain South Africa Greece

Indonesia Brazil Haiti

Nigeria Argentina Belgium

Paraguay Italy Ecuador

Greece Columbia

1995 Ontario, Canada Ontario, Canada

Panama Venezuela

SpainBolivia

KoreaBrazil

Brazil-Argentina-UruguayFrance

Ontario, Canada

Source: Moody (1997).

Overall, then, the effects of these conditions are that the lives of millions of people are

disrupted; community services like ® re® ghting, schools and health care decay; hopes are

disappointed; and community and class solidarity become harder to sustain.

The powerful, whether corporate or governmental, should not be viewed as lacking in

problems under these circumstances. Pro® ts are down, competition is up, government

budgets become major areas for elite contention. Perhaps most important, they face a serious

medium-term threat of rebellion or revolution by those harmed or threatened by cutbacks.

This is perhaps most clearly illustrated by the rebellions that brought down the USSR and

the governments of Eastern Europe. In addition, there have been many mass strikes in recent

years. A partial list is provided in Table 1.

Divide-and-rule politics

Thus, fundamental issues of power and of social structure are potentially at stake in the

politics of periods such as this. Governments and corporate elites have often used `divide-

and-rule’ politics as a way to meet their problems during such periods. This involves

`scapegoating’ as a way to divide and distract potential opposition. Such scapegoating

sometimes is as conspiratorial as it soundsÐ that is, as the conscious strategy of persons

whose rule is threatened. Examples include the famous quotation by Henry Frick, a leading

US industrialist of the late 1800s, to the effect that capital could hire one half of the working

class to keep the other half down. More recently, the writings of Kevin Phillips, an important

political advisor to Republican Party of® cials in the USA, have advocated using `social issues’

to prevent the emergence of serious threats to current patterns of economic and political

power (Phillips, 1969). On other occasions, however, scapegoating is less conspiratorial and

arises from the shared beliefs of elites and of some of the less powerful sections of the

population that particular groups of people are inferior, undeserving and (crucially) vulner-

able, and thus can be targeted to bear extra burdens during economic hard times.

Regardless of whether it arises from conspiracy at the top or out of deep-seated beliefs,

scapegoating involves blaming the `weak’ for the ills of the system, appealing to the

frustrations that the systemic crisis creates in the lives of the middle class and the working

class but directing the ensuing discontent (and/or desperation) at the scapegoats. People are

more willing to listen to scapegoating when their lives are hard.

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

HIV-RELA TED POLITIC S IN LONG-TERM PERSPECTIVE S99

International variation

There is considerable international variation in the extent to which scapegoating is

`normal’ in different countries. In som e countries, it has a long history. Some of the

most egregious examples involve some of the most powerful countriesÐ such as Germany’ s

mass murder of Jews, gays and other scapegoated groups during the Holocaust, or the

deeply institutionalized racial divide-and-rule politics of the USA. (In the USA, there were

over 100 lynchings of African-Americans a year in the period of class con¯ ict during

the 1890s; and the post-® rst World War period of class con¯ ict was also a period

of widespread white riots in which African-Americans were beaten and killed). India also

has a long history of `communal’ scapegoating. This is most clearly indicated by violence

directed towards Muslims. In addition, Tamil refugees from Sri Lanka have recently

faced problems as immigrants. They have high rates of drug use and of HIV and sexually-

transm itted diseases. The police and law enforcement authorities have targeted them for

special attention.

On the other hand, other countries, such as the Scandinavian countries and

the Netherlands, have recently been much less prone to scapegoating. Although it would

be historically inaccurate to see them as having avoided divide-and-rule politics, their

political and social institutions do seem to be less friendly to these approaches than does

the US culture (in which institutionalized racism and individualism are so dominant that the

response to social problems is to ® nd an individual or group to blame for them).

Scapegoating and HIV `risk groups’

Many of the persons most at risk for HIV in both developed and `developing’ countries are

extremely vulnerable to scapegoating. Gay and bisexual men have been subject to mass

murder (by Nazi Germany), jailings and to widespread beatings and sporadic murders in

many societies. Fundamentalist religions see homosexuality as anathema, and in a serious

socio-economic crisis this might lead to widespread executions. Drug users have similarly

been scapegoated. Harm reductionists visiting China were recently confronted with this when

hundreds of drug users were executed. In Manipur, rebels `kneecap’ drug users and, for

continuing drug use, execute them. In the USA, `drug war’ politics have been a major way

in which anger has been diverted from its policies of bene® ting the corporate rich at the

expense of the poor and of social services; massive numbers of drug users have been

incarcerated in the process (with drug-law violators in prisons increasing from 52,000 in 1980

to 388,000 in 1995Ð in ways that are heavily biased against blacks (Lindesmith Center,

1997)). Furthermore, although the Federal government spends much more than ten billion

dollars a year on drug war expenses, it spends zero dollars a year on syringe exchange

services.

Sex workers and street kids, as well as drug injectors and gay/bisexual men, are at high

HIV risk in many `developing’ countries. Both groups are often targets of scapegoating and

its associated violence, most clearly in the widely publicized murders of Brazilian street kids

in recent years.

Furthermore, there is often a negative interaction between `risk group’ scapegoating and

the scapegoating of other groups of people. In the USA, for exam ple, racial scapegoating and

the scapegoating of drug users have fed into each other. Fundamentalist movements ® nd it

appropriate (and successful) to scapegoat women and `sexual deviance’ Ð by which they mean

sex trading, same-sex sex and multiple partner sexÐ a uni® ed target that makes it easier for

them to gain support.

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

S100 S. R. FRIED M AN

In general, if `bad times’ continueÐ and I see no reason to expect them to disappear in

the near future Ð scapegoating is likely to get worse, not better. This will make it harder to get

support for HIV research, prevention or therapy.

However, there is no reason to take an economic determinist or political deter-

m inist view towards these processes. They can be addressed as problems to be solved

and politically astute action can shape outcomesÐ but the consideration of these

political issues requires a broader conception of politics than is the norm in AIDS-oriented

discussions.

How should public health professionals and activists engaged in HIV-related issues

respond?

To what extent, and in what circumstances, should we orient our efforts `upwards’ towards

friendly members of the leadership of corporate, political or bureaucratic circles? Under what

circumstances, and how, should we orient towards `popular’ forces? The overall implication

of this paper is that we should be coldly realistic about the extent to which political, corporate

and bureaucratic elites will commit resources or take political risks on issues that bene® t `HIV

risk groups’ that can be, or are, scapegoated. Clearly, this line of argument should not be

taken too far: many governments and many corporate leaders have made money available for

HIV research, for treatment and for prevention. During the height of the drug war furor in

the USA during the 1980s, many state and local public health of® cials and some politicians

supported needle exchange in spite of public opposition by Federal political leaders. On the

other hand, this at best leads to a problem (Altman, 1991): balancing the needs of

community constituencies with those of governments and the powerful. At worst, in many

countries, prevention efforts and treatment needs have clearly been subordinated to the

political advantages of divide-and-rule scapegoating. Nonetheless, in any given short-run

(and perhaps medium-term) instance, it may well be reasonable to seek out allies am ong the

powerful.

On the other hand, the analysis of this paper suggests that it would be foolish to rely only

on the powerful. If the economic and political forces discussed above persist, there is every

reason to think that discontent will increase (as frustrations fester over time and as attacks on

living standards and community needs continue). This will make divide-and-rule politics

more attractive to some political and corporate leaders and will make demagogic and/or

fundamentalist scapegoating more feasible as well.

W e should avoid being blinded by our belief in the goodness of our cause and even by

our belief in the goodness of other people. The `self-evident logic’ that AIDS prevention

should get of® cial support because it saves lives and money is a human logic. It ignores how

the sickness and death of people with AIDS, or at least a politics of blame organized around

this, can som etimes be useful to the powerful. Thus, we need to consider what social forces

exist with whom we can ally in defense of public health and in defense of the socio-be-

havioural groupings who are both at high risk for HIV/AIDS and at high risk of being

scapegoated.

It is very important to realize that the very attacks on people’ s economic fortunes, hopes

and access to social and medical services that make some more open to the ideas of

scapegoaters also `fan the ¯ ames of discontent’ in a more positive way. These same troubles

make many people more open to collective action to confront the sources of their problems

and more open to new ideas about the sources of the problems and ways to act to remove

them. Thus, the same forces that strengthen scapegoating also can help to create social movements

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

H IV-RELATED POLITIC S IN LONG-TERM PERSPECTIVE S101

that may be open to working with those of us who deal with HIV/AIDS-related issues and the persons

who are most likely to be or become infected.

Here, recent events in Ontario, Canada, offer a case in point. Attacks on living standards

and on a wide variety of community services have led to widespread anger and organizing.

Ontario residents have organized a number of mass actions in which workers, unions and

community activists have mobilized against these attacks. As an example, during the Fall,

1996 Days of Action in Toronto, many groups worked together and held gigantic demonstra-

tions and widespread work stoppages in protest against government policies. These actions

mobilized teachers, other school workers, parents, health care workers and community

groups concerned about attacks on health services and a wide range of unions.

W hat do we have to offer potential allies?

Relatedly, we need to consider an issue we often ignore, since the importance of HIV and the

goodness of our own motives seem self-evident to us: What do we have to offer potential

allies? That is, in terms of their goals, philosophies and needs, why should they ally with us?

The fact that persons or groups involved with HIV/AIDS issues want to work with other

groups does not guarantee that they will want to work with us. We have had experience with

this phenomenon in AIDS-related work. Examples include dif® culties in co-operation be-

tween gay/lesbian groups and drug users’ groups, and between biomedical researchers and

activists. To the extent that a given group is being scapegoated by political or corporate elites,

furthermore, it might be expected that organizations representing other constituencies and/or

concerns might be reluctant (or unable) to ally with them.

Also, in forming alliances, it is necessary to understand that other groups and move-

ments have their own concerns, dynamics and philosophies of freedom and solidarity. We

need to remember that they may have reasons not to co-operate. This is particularly true for

powerful groupsÐ why should they want to work with a small group like those involved in

HIV/AIDS issues? Thus, to an extent, we will sometimes have to work within parameters set

by the concerns of others.

Of course, it is also true that if groups at high risk for HIV are being scapegoated, then

issues about them already threaten the unity of other groups’ or movements’ constituencies.

In some circumstances, we can help such communities and workers to work together for

social and economic change rather than remain divided and weakened by divide-and-rule

issues. One small-scale exam ple which is nevertheless international in scope is the `movement

for the reduction of drug-related harm’ . Prior to its formation in 1989, drug policy reformers,

drug treatment providers, HIV front-line workers (outreach workers, needle exchange staff)

and drug users were in many countries mutually suspicious or hostile to each otherÐ with the

high degree of scapegoating of drug users being one important reason for this lack of unity.

The harm reduction movement has drawn ideas and practices from all of these groups, and

has created an alliance with many persons and/or groups engaged in drug reform, drug

treatment provision, HIV prevention and drug users’ unions. The harm reduction movement

is active on all inhabited continents and has attained a degree of in¯ uence in drug/health

policy circles in many countries.

The harm reduction movement, of course, is small-scale, and has built a (limited) degree

of unity among groups who were at least all working in the same general area of `drugs’ . It

is quite another thing to bring together neighbourhood groups, labour unions and groups

involved with HIV/AIDS; and still harder to work in contexts of armed struggle. Yet clearly

it would be useful if we could ® nd ways for HIV/AIDS prevention workers and caregivers to

work effectively in situations of civil war (such as in Zaire in 1997) or long-running

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

S102 S. R. FRIED M AN

insurgency (such as Manipur). It would be illusionary to think that we now know enough to

put forward a recipe for how to proceed. On the other hand, the collective experience of

HIV/AIDS prevention and caregivers is very rich. It includes HIV prevention workers in

Manipur who have found ways to work with drug injectors in areas where insurgent groups

have been shooting selected drug users. It includes gay labour union members in some US

unions who have been able to get their local unions active around HIV/AIDS issues. W hat

is needed is to ® nd ways to learn what has been done, to study what has happened as a result

and to develop theoretical understandings that can guide activity and that can also be

discussed and debated in our meetings.

There is one general suggestion that I would offer based on my studies of social

movements in a variety of ® elds (Friedman, 1969; 1973; 1980; 1982; 1985; 1986; 1996;

Friedman et al., 1991; 1993; Quimby & Friedman 1989): it has generally been the case that

movements that do things `for’ other people have far less insight and success than movements

where the oppressed organize and are a key part of the process. This has been found true for

workers, for racial/ethnic minorities, for conquered nations, for women, for gays and lesbians

and for drug users. W here `risk groups’ are being scapegoated, it will be important to support

them in speaking for themselves and in their strugglesÐ and to bring as many allies to this

effort as possible.

Final thoughts

The issues discussed in this paper may be unfamiliar to many readers. They deal with matters

that seem, initially, to be far from the daily concerns of front-line HIV/AIDS staff or

researchers. On the other hand, if these analyses are correct, they are crucial for the future

of the HIV epidemic and those at highest risk from it.

Thus, we need to discuss the analysis presented here. Even more, we need to ® nd ways

to share with each other experiences in forming alliances with other groups. Little of this

experience, however, has appeared in the literature. For the long run, we need to know a lot

more about what has worked and what has not, and to develop a theoretical understanding

of these issues. Thus, discussion and research on such alliances needs to become an

important part of international meetings and of journals concerned with HIV/AIDS.

References

ALTMAN, D. (1992). The primacy of politics: organizing around AIDS. AIDS, 5 (Suppl.), S231± S238.

CHASE-DUNN, C. (1989). Global formation: structures of the world economy . New York: Blackwell.

FRIEDMAN, S.R. (1969). How is racism maintained? et al., 2, 18± 21.

FRIEDMAN, S.R. (1973). Perspectives on the American student movement. Social Problems , 20, 283± 299.

FRIEDMAN, S.R. (1980). The petty bourgeoisie, social unrest, and the working class: an analysis of class disappearance

and its effects on social unrest and the community. Humanity and Society , 5, 32± 47.

FRIEDMAN, S.R. (1985). Worker opposition movements. Research in Social Movement, Con¯ icts, and Change , 8,

133± 170.

FRIEDMAN, S.R. (1982). Teamster rank and ® le. New York: Columbia University Press.

FRIEDMAN, S.R. (1986). Labor aristocracy theories and workers politics, Humanity and Society , 10, 121± 145.

FRIEDMAN, S.R. (1996). Theoretical bases for understanding drug users’ organizations. International Journal of Drug

Policy , 7 212± 219.

FRIEDMAN, S.R., DE JONG , W. & WODAK, A. (1993) Community development as a response to HIV among drug

injectors. AIDS, 7 (Suppl. 1), S263± S269.

FRIEDMAN, S.R., SUFIAN, M., CURTIS, R., NEAIGUS, A. & DES JARLAIS, D.C. (1991) AIDS-related organizing of

intravenous drug users from the outside. In: E. SCHNEIDER & J. HUBER (Eds), Culture and social relations in the AIDS

crisis pp. 115± 130. Newbury Park, CA: Sage.

HARMAN, C. (1993). Where is capitalism going? International Socialism , 58 , 3 ± 57.

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014

H IV-RELATED POLITIC S IN LONG-TERM PERSPECTIVE S103

K IDRON , M. & SEGAL, R. (1987) The new state of the world atlas . New York: Simon & Schuster.

K IDRON , M. & SEGAL, R. (1995). The new state of the world atlas . New York: Penguin.

LINDESM ITH CENTER (1997). Drug prohibition and the US prison system. New York: The Lindesmith Center.

M OODY, K. (1997). Austerity fuels mass strikes around the world. Labor Notes , 217, 1.

PHILLIPS, K. (1969). The emerging Republican majority . New Rochelle, NY: Arlington House.

QUIMBY, E. & FRIEDM AN, S.R. (1989). Dynamics of black mobilization against AIDS in New York City. Social

Problems , 36(4), 403± 415.

ROSS, R.J.S. & TRACHTE, K.C. (1990). Global capitalism: the new Leviathan . Albany: State University of New York

Press.

WALLERSTEIN, I. (1974). The modern world system I: Capitalist agriculture and the origins of the European world-econom y

in the sixteenth century. New York: Academic Press.

WALLERSTEIN, I. (1980). The modern world system. II: Mercantilism and the consolidati on of the European world-economy,

1600± 1750 . New York: Academic Press.

Dow

nloa

ded

by [

Uni

vers

itaet

sbib

lioth

ek H

eide

lber

g] a

t 14:

30 1

5 N

ovem

ber

2014