Abstract：
As HIV unfolded in the 1980s, HIV and AIDS were heard and seen through the lives of those whom it touched directly. Personal histories were foregrounded, centred by the inevitable mortality attached to HIV infection, the courage of circumstance in the face of illness, and the activism necessary to make a difference. In the later part of the decade, the impacts of HIV were most apparent in East Africa, where community responses and political leadership coalesced to reduce new HIV infections. The 1990s marked a turn towards centralised policy, funding, and the reification of biomedically oriented approaches and systems that are intrinsically top-down. This biomedical turn centred on foregrounding the widespread availability of low-cost antiretroviral therapy and was articulated in the 90-90-90 and subsequent targets. Biomedicalisation reinforces individualised approaches to health primarily focused on biomedical technologies and health service provision that do not rely on community or social organisation formats. Emphasis on HIV treatment, along with the promise of reduced HIV transmission through viral load suppression, contributed to limiting socio-behavioural approaches to HIV prevention. While the importance of community-led response was highlighted in the 2016 United Nations Political Declaration on Ending AIDS, community-led response has devolved towards concepts such as community-led monitoring and community-led response that frame responses in direct relation to the dominant biomedical paradigm. There are lessons in the history of the AIDS response that demonstrate that communities formulate responses to AIDS differently when there have been opportunities for community members to determine the pathways for action to address HIV independently. Older research studies offer retrospective insights into moments in the history of HIV when communities were foregrounded and highlighted the need to reconsider the current trajectory of the HIV response. Not only for history\'s sake but to acknowledge that community leadership remains overwhelmed by elites. While lofty targets and goals drive the contemporary HIV response, the way forward is mired by uncertainty. HIV prevention efforts remain uneven, and millions of people living with HIV depend on access to treatment for decades to come in the context of budgetary uncertainties. Changing the course of AIDS will not be achieved if we fail to ensure that communities occupy a genuine and unambiguous place in shaping HIV response.
摘要：
随着艾滋病毒在1980年代的发展，艾滋病毒和艾滋病通过它直接接触的人的生活被听到和看到。个人历史是有先见之明的，以艾滋病毒感染不可避免的死亡率为中心，面对疾病的勇气，以及有所作为所必需的激进主义。在十年的后期，艾滋病毒的影响在东非最为明显，社区反应和政治领导联合起来减少新的艾滋病毒感染。1990年代标志着向中央集权政策的转变，资金,以及本质上自上而下的面向生物医学的方法和系统的具体化。这种生物医学转向以低成本抗逆转录病毒疗法的广泛可用性为前景，并在90-90-90和随后的目标中得到了阐述。生物医学化加强了个性化的健康方法，主要集中在不依赖社区或社会组织形式的生物医学技术和卫生服务提供上。强调艾滋病毒治疗，伴随着通过抑制病毒载量减少艾滋病毒传播的承诺，限制了预防艾滋病毒的社会行为方法。虽然2016年《联合国终结艾滋病政治宣言》强调了社区主导应对措施的重要性，社区主导的反应已转向诸如社区主导的监测和社区主导的反应等概念，这些概念将反应与占主导地位的生物医学范式直接相关。艾滋病应对历史上的经验教训表明，当社区成员有机会确定独立应对艾滋病毒的行动途径时，社区对艾滋病的应对方式有所不同。较早的研究提供了对艾滋病毒历史时刻的回顾性见解，当时社区被预先确立，并强调需要重新考虑艾滋病毒反应的当前轨迹。不仅是为了历史，也是为了承认社区领导仍然被精英压倒。虽然崇高的目标和目标推动了当代艾滋病毒的应对，前进的道路充满了不确定性。艾滋病毒预防工作仍然不均衡，在预算不确定的背景下，数百万艾滋病毒感染者在未来几十年依赖治疗。如果我们不能确保社区在制定艾滋病毒对策中占据真正和明确的地位，就不会改变艾滋病的进程。
