UNAIDS: The First 10 Years

UNAIDS The First 10 Years256A number of developments, in particular the increased accessibility of antiretroviraltherapy, has raised a debate about the need to ‘normalize’ the way medical professionalsand health-care workers deal with people living with HIV, or those deemed to beat risk. If people are not offered testing (and many now promote routine offers oftesting), they will not receive life-saving treatment. As Cameron has argued 21 , the extraattention and ‘hullabaloo’ with which doctors approach the disease can reinforce theinternal stigma that prevents ‘AIDS-literate people’ from being tested.Both Paul Bekkers, the Dutch AIDS Ambassador, and Kazatchkine believe that AIDSshould be integrated into a health system offering a complete range of services. “It isnot acceptable that a patient should have access to antiretroviral drugs but not to anaspirin”, said Kazatchkine.However, Piot argues that it would be a gross mistake to match the reasonable need for“medical normalization” with a “normalization” or “medicalization” of the responseto AIDS, and thus abandon the need for an exceptional response in terms of specificleadership, financing and policies. A recent backlash has seen several journalists andpublic health specialists disputing that too much money is spent on AIDS comparedwith other diseases, and that AIDS has produced large vertical programmes, quiteseparate from the treatment of other diseases 22 .But, says Piot, because this exceptional epidemic calls for an exceptional response,“AIDS should be the top priority for policy-makers and budgets”. AIDS should beplaced in the broader context of development and security, and not in competitionwith other diseases. Without an exceptional response, if AIDS is treated as one of manydiseases, there will be insufficient protected funding for antiretroviral treatment, thusresulting immediately in millions of deaths and lack of support for harm-reductionprogrammes, general HIV prevention programmes, the Global Fund, PEPFAR andother AIDS funding mechanisms.Furthermore, as Paul De Lay, from the UNAIDS Secretariat Evaluation Department,argues 23 , HIV funding ‘should provide an opportunity and entry point forstrengthening health and social services systems if it is used appropriately. For example,large amounts have been spent on laboratory networks, universal precautions, bloodbank safety, and safe injections, as well as focusing on the wellbeing and training ofhealth workers, doctors and nurses and not only those working in AIDS’.21Cameron E (2005). Legal and Human Rights Responses to the HIV/AIDS Epidemic. University of Stellenbosch,Matieland, South Africa.22For example, see England R (2007). ‘Are we spending too much on HIV?’ British Medical Journal, 334:344;Garrett L (2007). ‘The challenge of global health’. Foreign Affairs, January/February.23Ibid.