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March 30 2011
Sandra Macdonald
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Introduction

The suggestion oI direct correlations between climate change and the HIV/AIDS
pandemic may seem at Iirst perplexing, iI not improbable. While both concerns bring broad scale
crises threatening to change humanity in a spectrum oI populations, it is only in the last Iew
years that research is Iocusing a lens on identiIying the impact oI the changing environmental
conditions on the distribution and Irequency oI HIV inIection, and vice-versa. Much oI the
literature on climate change mentions HIV/Aids as a background or secondary Iactor in current
and expected mortality rates caused by climate change. For example, a 2003 report published by
the WHO indicates that inIectious diseases are on the rise in tandem with the current increase in
climate events and global warming, but stops well short oI suggesting and direct or indirect links
(Kovats, Ebi, & Menne, 2003). Furthermore, authoritative reports on HIV/Aids including the
2002 and 2003 UNAIDS studies, neglect to include any signiIicant research on climate and
correlations to transmission rates and dissemination patterns oI HIV (UNAIDS, 2002)
(UNAIDS/WHO, 2003). More recently, however, investigations into deIinitive links are being
undertaken by prominent scientists and sociologists. In a recent article published by Mongo Bay
news David Cooper, director oI the National Centre in HIV Epidemiology and Clinical Research
in Australia indicated that nutritional impacts caused by changing environmental conditions will
put the immunocompromized at a greater risk oI dying oI HIV (McLean, 2008). The same article
cites a leading proIessor oI health and human rights at the University oI New South Wales as
stating that a 'chain oI events caused by climate instability will result in vulnerability increases
to inIectious diseases such as HIV/AIDS. With pessimism in the Iorecast Ior a vaccine by
scientists predicting at least one or two decades Ior its development (McLean, 2008), it should be
paramount to develop a clear understanding oI how current and impending climate Ilux will alter
the disease transmission patterns in order to develop strong mitigation and coping strategies.
The spread oI HIV/AIDS and the impact oI climate change have many commonalities.
Populations with the least amount oI resources are aIIected the most, and there is a lack oI
political support and technical capabilities to contain either calamity. Additionally, just as
HIV/AIDS exacerbates poverty, gender vulnerability, exploitation oI children, and access to
health care, so too does climate change heightens these same social disparities. The background
Iactors and vulnerabilities that create the conditions Ior increasing HIV/AIDS risk are either
directly or indirectly inIluenced by changing climate conditions. Ecological changes in general
combined with social and political Iactors such as increasing population growth, mass migration
and mobility, growing urban centers and overcrowding, poor sanitation, poverty and hunger,
resource allocation, education and Iailure oI political eIIort can all be linked to the changing
environment, and lead to increasing inIection rates oI HIV/AIDS (Crewe, 2009). Additionally,
climate Iactors can aIIect human resilience and innate immunity to inIectious diseases, and
threaten the biological resources that could provide treatments and therapies in the Iuture
(Napier, et al., 2009). Using a medical ecology and biological approach, these Iactors can be
linked to climate change through cultural, physical, political and biological activities and
phenomenon, all leading to increased risk oI HIV/AIDS proliIeration.
IVJAIDS: A Social Pandemic

It is important to internalize that by and large the HIV/AIDS pandemic is rooted in social
processes. The Iirst reason Ior this is due to the physical transmission mechanisms Ior the
disease. Without strong evidence Ior vector-based transmission, HIV/AIDS is nearly exclusively
transmitted through sexual and drug-injection networks (Bluthenthal, Lorvick, Kral, Edlin, &
Khan, 1999), which in themselves are largely social phenomenon. Social norms which shape the
variables oI these networks, such as timing and number oI sexual partners, injection and drug use
patterns, community support, education and law enIorcement policies are all subject to disruption
by both long term and acute crises. Wars, revolutions, socioeconomic transitions, economic
collapses, and ecological disasters in recent years have lead to large-scale HIV outbreaks, mostly
due to rapid disruptions oI the social mechanisms that governed the aIIected populations. For
example, economic hardship aIter the disruption oIten leads some people to sell sex Ior goods or
money, putting individuals at high risk Ior inIection and transmitting inIections to large numbers
oI other people (Friedman, Rossi, & Flom, 2006). Additionally, social disruption and the
emergence oI disease as a result is oIten heightened by additional environmental stressors.
limate ange and te Food risis

Although rising rates oI HIV/AIDS inIection in industrialized nations are being reported,
and there are grave concerns about possible explosions in rates oI transmission in the Asian
block countries, sub-Saharan AIrica, with less than 15 percent oI the world`s population, still
bears the brunt oI the overall inIections, with over 70 oI the worlds HIV/AIDS cases coming
Irom this area (Crewe, 2009). This area is one whose history is studded with strains on Iood
security, Irom outright Iood shortages in the 1970`s to lack oI access Ior the masses oI urban
poor due to pricing structures throughout the 1990`s and 2000`s (Maxwell, 1999). The near
absence oI social nets has shiIted the issues oI Iood security to the individual. The eIIect oI
environmental change on agriculture and Iood supplies is already becoming evident. Increasing
droughts has resulted in a drop in crop yield, increases in pests, and loss oI Iertile land (Cook,
1992). Climate change will continue to compound the existing Iood insecurity. The
simultaneous occurrence oI HIV/AIDS and Iood insecurity in AIrica is so proIound that some
researchers have nicknamed it the 'deadly duo (Gommes, de Guerny, Glantz, & Hsu, 2004). A
report by OXFAM investigated the Iactors leading to the current Iood crisis, and climatic Iactors
were at the IoreIront (Gommes, de Guerny, Glantz, & Hsu, 2004) . They stressed that the
improvement oI the Iood situation would not only quell the transmission, but also work to reduce
the HIV/AIDS pandemic overall. It is well established that under nutrition and inIection act
synergistically (Bluthenthal, Lorvick, Kral, Edlin, & Khan, 1999), and improvements in Iood
security will reduce the probability oI HIV inIection and slow the progression Irom HIV to
AIDS.
limate ange as a Driver for Mobility and Increased Population Density

The movement oI people and increases in population density may together present the
largest Iactor in determining vulnerability to HIV/AIDS (Gommes, de Guerny, Glantz, & Hsu,
2004). Mobility is generally a strategy Ior adaptation to environmental and political stressors, but
with globalization and mass population movements, the transmission oI diseases across both
geographical and cultural borders is a concern (McElroy & Townsend, 2009). Population growth
and clustering in urban areas interIaces with climate change in ways that ampliIy other
mechanism at work in the HIV/AIDS vulnerability Iramework, namely shelter, Iood, and water
scarcity (Napier, et al., 2009).
Large temporary populations Irequently occur and will continue to grow due to various
types oI climate-based disasters, including Ilooding, earthquakes, and extreme weather events.
So called 'environmental reIugees can also be displaced by drought or other Iactors such as
rising sea levels Iorcing them to abandon their living areas and land (Kovats, Ebi, & Menne,
2003). Over 25 million environmental reIugees have been created by climate and weather events,
and some predictions place over 100 million at risk Irom coastal Ilooding by 2100 (The
Intergovernmental Panel on Climate Change, 2007). Migrant and displaced populations are at a
higher risk oI contracting HIV/AIDS primarily due to their status and situations they must Iace,
including poverty, lack oI inIormation and health resources, discrimination and stigma.
Poverty and lack oI opportunity, particularly Ior women who make up the majority oI the
agricultural workIorce hardest hit in an environmental crisis, can lead to migration to urban
areas, where they are Iorced into dangerous work in the drug trade and prostitution (United
Nations Food Populations Fund, 2007). The possibilities oI entrepreneurial activities in the sex
or drug trades may be improved during climate-based disasters. This can arise due to the
combination oI an increase in potential workers due to economic desperation and migration plus
a weakening oI police controls over these activities due to institutional disruption, lack oI
resources or an increased willingness oI law authorities to look the other way (Friedman, Rossi,
& Flom, 2006).
When climate disasters cause a large scale movement oI people, they oIten weaken or
completely disintegrate the system oI social norms, support networks, and inIluence that Iorm a
basis oI regulation in communities (Kovats, Ebi, & Menne, 2003). People who have spent their
entire lives surrounded by close Iriends and relatives with established communication networks
Ior expressing their well being, and more importantly, expressing and accepting authoritative
opinions on how people should conduct their lives, can suddenly Iind themselves in temporary
living arrangements or urban centres where none oI this is available. This phenomenon can
increase the probability that some will undertake what was previously unacceptable behaviour,
such as drug use, violence, and risky sexual activity (Friedman, Rossi, & Flom, 2006), all
signiIicant risk Iactors Ior contracting HIV (Bluthenthal, Lorvick, Kral, Edlin, & Khan, 1999).
HIV/AIDS may itselI be a cause oI migration. People living with HIV are oIten driven to
leave their homes and Iamilies, both due to shame and stigma and the lack oI health resources
outside oI urban areas. Migrants living with HIV are subject to additional Iorms oI
discrimination due to Iactors such as ethic origin, religious belieIs, socio-economic status, and
migration and living status. This type oI migration stress illustrates the vicious cycle oI poverty
that is reinIorced by AIDS and climate change. 36 oI the world population lacks access to
health care, and Ior many oI the worlds working poor an HIV/AIDS diagnosis oIten leads to job
loss with no compensation or health care support (Unrepresented Nations and Peoples
Organization, 2006).
limate ange and Immunity Implications

Social Iactors aIIecting the prevalence and distribution oI HIV/AIDS will be increasingly
joined by biological and physiological Iactors inIluenced by climate change. In addition to under
nutrition, other important causes oI immune suppression such as environmental pollutants and
ozone depletion may directly suppress immune responses, and render individuals more
susceptible to acquiring pathogens such as HIV (Kovats, Ebi, & Menne, 2003). Immunity to
inIectious diseases is mediated by a biological response which is compromised by ultraviolet
light exposure. Exposure to excess summer sun due to inIrastructure loss by climate disaster,
increase oI UV-B radiation due to atmospheric changes or both will decrease immunity cell
concentrations, and leave individuals more susceptible to inIection (Cook, 1992).
Immunosupression Irom exposure to other climate change exacerbated pathogens also plays a
role in increasing the threat oI HIV/AIDS. Climate changes have been shown to increase the
prevalence oI certain disease vectors such as mosquitoes responsible Ior yellow Iever, dengue
and malaria (Cook, 1992). Additionally, overcrowding, under nutrition, lack oI access to health
care, urbanization and disturbed social conditions, all precipitated by climate change, can lead to
increases in immune compromising conditions such as tuberculosis, leprosy, measles, parasites
and the plague (Cook, 1992),.
Human health is dependent upon the biodiversity oI the earth. The largest direct cause oI
lost oI biodiversity is the conversion oI land Ior agricultural use, and the subsequent destruction
oI habitat. This practice is one oI the leading anthropological causes oI the current global
warming trends, which in turn leads to Iurther habitat destruction through weather related
disasters, drought, erosion and other longer term changes. There needs to be an appreciation oI
the impact oI not only destroying the organisms themselves, but also the intricate network oI
interactions between species which can hold valuable clues to the discoveries oI new
pharmaceutical and traditional treatments (Daily & Ehrlich, 1996). The delicate network oI
interactions between the species is paramount Ior the discovery oI unique treatments and cures oI
disease. In Iact, 118 out oI 150 top prescription drugs are based on chemical compounds
harvested Irom other organisms (Farhsworth, 1988). Because oI this, climate change poses a
threat to the prognosis oI long term treatment options and a cure Ior HIV/AIDS.
allenges in Resource Allocation

In an interesting social and political tug oI war, climate change, even with its signiIicant impact
on HIV/AIDS, may be directing media attention and government support away Irom issues in human
health. Indeed, the attention that climate change has received in the media and in scientiIic study has been
relatively narrow. For example, investigations into the impact oI increasing levels oI atmospheric carbon
dioxide have been undertaken largely without consideration oI the direct and indirect impacts that this has
on human health (Ziska, Gebhard, Frenz, & Faulkner, 2003). This phenomenon is causing a shiIt in
resource allocation that threatens the advancements that have been made in Iighting the disease. Bjorn
Lomborg oI the Copenhagen Consensus Center provides an illustration oI the struggle between the issues
through a story Irom Tanzania. He claims that 10,000 tourists are drawn to Mount Kilimanjaro in
Tanzania, driven in no small part by the Iear that the mountain's magniIicent ice will soon melt (Lomborg,
2009). Some experts reIute the claims that the receding glaciers are indeed due to global warming,
however climate activists have managed to promote local tourism and have brought the world's attention
to the mountain's glaciers. What has been neglected is bringing attention to the actual people oI Tanzania,
and their battle with HIV/AIDS. Mr. Lomborg suggests that the resources used to promote tourism and
bring attention to the melting ice could better be used to provide public education about HIV in order to
reduce the stigma Ior those aIIlicted, and slow the transmission rates in the country.
In the same theme oI resource allocation, climate change and its related consequences threaten to
tax resource systems to maximum levels, depleting resource pools previously dedicated to the Iight
against HIV/AIDS. Progress on HIV/AIDS prevention, treatment, and care is plateauing as major Iinding
sources begin to ration resources, their coIIers running low (Stockman, 2010). II existing health needs are
excluded Irom climate change adaptation strategies then it is likely that climate change will act as a
competitor, detracting attention and Iunding away Irom current needs and investing in strategies that may
not deliver any signiIicant health improvement (Hall, 2009). At a time when it seems as though
medication costs, education trends, and viable long term treatments seem to be nearing the tipping point
Iunding is being capped or diverted away Irom the cause (Stockman, 2010). By understanding the
interrelations between climate change and HIV/AIDS a concerted eIIort and resource pooling may be a
viable strategy Ior mitigating the eIIects oI both concerns.
onclusions

By taking a step back and investigating HIV/AIDS within a broader Iramework, it becomes
evident that although there are speciIicities with respect to management oI the disease, interactions
between the environment, social structures, migration and other inIectious diseases exist, and are growing
rapidly in importance. It is imperative to complement existing eIIorts and to advocate looking beyond the
Ilat Iace oI AIDS and stop dealing with it in isolation. IdentiIying and recognizing climate and
environmental Iactors as warning signs Ior the dissemination and growth oI the disease is imperative in
creating development strategies that can pre-empt or mitigate the root causes oI HIV/AIDS. Continued
discussion needs to be initiated among Iunders, media, biological and social researchers to encourage the
continuation oI concerted eIIorts in dealing with the eIIects oI both climate change and HIV/AIDS.

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