Some Musings About Big Events and the Past and Future of Drug Use and of HIV and Other Epidemics.

The term "Big Events" began as a way to help understand how wars, transitions and other crises shape long-term HIV epidemiology in affected areas. It directs attention to the roles of ordinary people in shaping these outcomes. Big Events themselves can take years, as in long-term armed struggles like those in Colombia and also long-term political and economic changes like the turn over the last 15 years of many Latin American countries away from neoliberalism and towards attempts to build solidarity economies of some form. The effects of Big Events on HIV epidemics, at least, may run in phases: In the short term, by creating vulnerability to epidemic outbreaks among existing Key Populations like people who inject drugs (PWID) or men who have sex with men (MSM); then, in their non-PWID (or non-MSM) risk networks; and perhaps, several years later, among youth who became involved in high-risk sexual or drug use networks and behaviors due to the social impacts of the Big Event. Issues of time loom large in other articles in this Special Issue as well. Some articles and commentaries in this issue point to another important phenomenon that should be studied more: The positive contributions that people who use drugs and other members of the population make towards helping other people in their communities during and after Big Events. Finally, this Commentary calls for more thought and research about an impending very Big Event, global climate change, and how it may exacerbate HIV, hepatitis C and other epidemics among people who use drugs and other members of their networks and communities.