UNAIDS: The First 10 Years

The challengesThe challenges: the need for an exceptionalresponse to AIDS255It is only too clear that despite the significant increase in political engagement, the hugehike in funding for the AIDS response and the work of UNAIDS and so many others,the powerful human immunodeficiency virus is still spreading.Piot has argued strongly and forthrightly that AIDS is an exceptional threat to the world– and that it therefore demands an exceptional response.The impact of AIDS is exceptional because of its impact now and the future threatsit poses. It primarily kills adults in their prime, those who drive economic growthand provide care for the very young and the elderly. Too many countries, especiallyin sub-Saharan Africa, are being stripped of this generation; the labour force is beingsteadily wiped out, and in severely affected countries, the result could, over another twogenerations or so, be “the unravelling of economic and social development. … The keyfactor here would be the cumulative weakening from generation to generation of humanand social capital … Within the next five years, every sixth or seventh child in the worstaffectedsub-Saharan countries will be an orphan, largely because of AIDS. … Apartfrom chronic armed conflicts, such as in the Democratic Republic of Congo … there isarguably no other cause today of such utter economic and social regress” 18 .Piot has written 19 that the AIDS epidemic has ‘continually outstripped the worst-case globalscenarios . . . national HIV prevalence has risen far beyond what we thought possible … weare witnessing multiple waves of HIV spread even in countries where incidence has peaked’.The UNDP’s Human Development Report in 2005 concluded that ‘the HIV/AIDSpandemic has inflicted the single greatest reversal in human development’.However, unlike most health problems, and probably because it is transmitted largelythrough sex, AIDS affects all social classes. In that sense, it is not a classic ‘disease of poverty’.Another exceptional aspect of AIDS is its link to issues that are taboo in most, if not all,cultures – sex, homosexuality, sex work and injecting drug use. If HIV were transmittedin some other way, through some ‘innocuous means’, the world might well not beexperiencing today’s pandemic. But prejudice leading to stigma has silenced politiciansand other leaders for too long, and everywhere action has come too late.The result of such stigma and discrimination is that AIDS has always been treated differentlyfrom other diseases. Strong emphasis was placed on clinical confidentiality, informed consentfor HIV testing and surveillance systems that preserved people’s anonymity 20 .18Piot P (2005). Why AIDS is Exceptional. Address given at the London School of Economics, London, 8 February.19Piot P (2007). ‘AIDS: from crisis management to sustained strategic response’. The Lancet, 368.20De Cock K M, Johnson A M (1998). ‘From exceptionalism to normalisation: a reappraisal of attitudes andpractices around HIV testing’. British Medical Journal, 316.