Emerging future issues in HIV/AIDS social research

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IntroductionPeter Piot (Executive Director of UNAIDS) challenged Bangkok International AIDS Conference attendees to think ahead 10 years or more so we will be prepared to meet the challenges that will face us [1]. Over this next decade, many formidable challenges are likely to stem from the interactions of social, ecological, political, and economic change; existing social structures; the changing HIV epidemic, and changes produced by emerging biomedicine and viral evolution. Although some challenges will be unpredictable, we should plan ahead for those we are able to anticipate. This paper identifies important social research issues regarding the changing global epidemic so funding agencies, journal editors, social science communities, individual researchers and students, non-governmental organizations, community-based organizations, and the general public can debate them and, hopefully, act on them.Social change is likely to create complex problems for our response to HIV. Weiss and McMichael [2] demonstrate the acceleration of socially-driven epidemic outbreaks of infectious diseases in recent years. As Rischard has argued [3,4], there is a high probability of massive political, ecological and social changes over the next few years. These threaten large-scale disruption of existing social and risk networks, sexual (and injection) mixing patterns, and sexual and injection behaviors that can impede or facilitate HIV transmission – and thus might generate HIV outbreaks parallel to those that followed the disruption of the USSR or that seem to be resulting from the increasing ‘globalization’ of India and China [5]. Global warming could produce large-scale population movements with similar results.Our reflections here on social change and other possible transformations have not produced a comprehensive or complete list of social research priorities. We have emphasized ‘macro’ and middle-level processes focusing on social, economic, political and cultural factors that affect HIV spread and/or that influence responses to the threat of HIV (rather than on small group or individual level processes that focus on the psychological and interpersonal) because we think these have received relatively less attention than is needed. We recognize that other researchers might produce different lists. We also recognize that it is important to foreground the probability that socio-epidemiologic contexts are likely to continue to have great cross-national variation and that ‘big events’ such as wars and transitions, perhaps in interaction with religious revival movements, can rapidly move countries into crisis conditions that pose the threat of explosive HIV outbreaks. Such changes can occur in countries that currently appear politically and economically stable. (It is useful to remember that few analysts in the early 1980s foresaw either the fall of the USSR or the collapse of apartheid in South Africa). The HIV/AIDS epidemic is itself a ‘big event’ in localities with high prevalence.While acknowledging the above, we propose six major emerging social research issues or themes. These themes, organized in terms of selected social and epidemiologic processes and situations (although noting that research on each of these topics will have at least some relevance everywhere), concern the following items.Wars, transitions, ecological or economic disruptions.Large-scale HIV epidemics, their related illness and death, and their attendant social instability and social disruption.Government policies that ignore or defy available evidence.Stable societies without generalized epidemics, which face distinctive challenges.Emerging biomedicine and its attendant opportunities and (perhaps unintended) social consequences.Possible failure of previously effective therapies due to viral evolution or disruptions in patterns of social organization.Each of these six themes provokes a number of research questions.

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