If by locating “HIV/AIDS in the lap of the impoverished” you mean “blaming the impoverished for HIV/AIDS”, then nothing is further from my view. HIV/AIDS is an illness caused by a virus, not by the poor.

Perhaps your question was directed more at wanting me to explain why I think there is a link between poverty and HIV/AIDS. An argument for this link is made very forcefully by Paul Farmer in “Pathologies of Power” “Aids and Accusation” and “Infections and Inequalities”. If you are interested in these questions, I suggest you consult these works directly. For the sake of responding to your question though Nirut, I give this potted summary.

Farmer is an anthropologist and a medical doctor. He informs us that since 1995 it has been evident that antiretroviral “drug cocktails” can dramatically cut mortality and virtually wipe out mother-to-child transmission. Populations on ARV also experience LOWER INFECTION RATES. But these drugs are costly: around $1500 a year for each patient when Farmer was writing. They also require infrastructure (refrigeration, electricity). The development industry saw ARVs as wasteful, as not “sustainable”, and not “cost-effective”. Farmer asks why is it “sustainable” for the sick in the US and Europe to use these drugs, but not “sustainable” for poor people in the Third World to use them? Farmer reports on a program he ran distributing ARV in Haiti. It was a success. More people came to be tested because it was no longer seen as a death sentence or a stigma to have HIV/AIDS. He argues that, around the world, models that ignore treatment are destined to fail. Yet, prevention-only models are repeatedly the only assistance on offer to the Third World.

Farmer argues that poverty is a major risk factor for HIV/AIDS. If you are poor, you are more likely to be infected, less likely to receive care, more likely to die of a preventable complication. These risks are multiplied if you are poor and also a woman. HIV/AIDS is an epidemic of poverty.

Farmer argues that the severity of the epidemic in the Third World is attributable directly to a miserly distribution of resources. ARVs can reduce transmission rates and provide hope to the ill. He anticipates the response of development workers – that ARV drugs are too expensive. Farmer acknowledges that the medications are too expensive – but asks what that means: that the medicines should not be given to the poor? Or that the price should come down? The basic question is: is health a commodity? Or is it a right? Farmer argues that it is a right.

I would be interested for you to elucidate your ideas on the “overwhelming poverty of most HIV/AIDS sufferers” as the ineffectual programming you mention doesn’t strike me as a redirection of resources away from poverty alleviation if you understand where it is coming from and how it is funded. The lunacy of the programmes and the absence of anti-retrovirals are to me unrelated issues and while I would agree that the experience of HIV/AIDS in terms of life and death and suffering can be mediated economically do you mean to say that most people with HIV/AIDS are poor. To locate HIV/AIDS squarely in the lap of the impoverished surely plays into the systemic traps you are critiquing here.

By “blame-based development’ I am referring to that strain of policy that blames the poor for their own poverty. Often, it is ‘cultural’ traits that are blamed. Minorities are as a rule associated with ‘cultural’ distinctiveness. When these minorities encounter problems such as poverty or epidemics, blame-based development projects start with the assumption that this cultural distinctiveness must be the cause of their problems. This is a false assumption because it elides the degree to which epidemics, poverty, and other ills are generated through wider structures, such as regulations, distributional mechanisms, and systematic exclusions.

A good example of a blame-based development project is the style of HIV/AIDS interventions that distribute condoms and moral preaching but not anti-retroviral drugs. This blames people’s sexual behaviour without addressing the key structural issues, which are the lack of access to health care, and the overwhelming poverty of most HIV/AIDS sufferers.

As a student of peace and conflict, I am interested in this idea of blame-based development in Laos. And I feel that you are right to refer to the denial of health care as structural violence against the poor, an insidious form of violence in addition to the more overt forms that the Lao saying implies (that is, state power).

I also think that your observation that “[i]t is possible that resource distribution, not resettlement, is the real issue of concern” strikes at the heart of this matter and other issues that effect poor populations in the developing world.