peripheries

The “normalisation” of AIDS

August 4th, 2008 | by roger |

Puzzling comment from Peter Piot, former head of UNAIDS, at the XVIIth International AIDS conference:

“We must categorically reject any attempt to so-called ‘normalise’ AIDS, or treat this epidemic as just one of many medical problems,” he said. “Now, more than ever, do we need an exceptional response… there’s not ‘too much money going to AIDS’ but too little.’”

Piot was reacting to a series of articles arguing that AIDS should not be considered an exceptional disease any more since antiretrovirals have turned HIV from a death sentence to a manageable disease and that funds should be redirected to fight less visible killer diseases.

More than 25 years into the fight against HIV and AIDS, Margaret Chan, director general of the UN’s World Health Organisation (WHO), observed that “AIDS is the most complex, the most challenging and probably the most demanding infectious disease humanity has ever had to face”.

But what about other exceptional diseases that have been around for much longer?

For instance Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the groups most affected. It is the fourth leading cause of death in children under five, responsible of the death of nearly three times more children than HIV. Like HIV, Malaria is a severe debilitating disease for which there is limited treatment available and no vaccines so far.

What about Tuberculosis? About one-third of the world’s population, or two billion people, carry the TB bacteria (although most never develop active disease). There were more than 9 million new cases of TB, and approximately 1.7 million deaths from the disease in 2006. Treatment does exist but is threatened by the emergence of drug-resistant TB.

Back to the point, what’s wrong with wanting to make HIV a disease that can be diagnosed and treated by your GP? What’s wrong with wanting to mainstream it within existing National Health infrastructures? How this de facto segregation will help fighting the disease at the national level when it is not a disease of the few but a disease of the many? Isn’t it a huge step backward for those who spent the last 25 years fighting HIV discrimination and stigma?

What makes HIV so special when compared to other killer diseases such as Malaria or even diarrhoeal diseases that kills 6 times more children than HIV and that could be prevented with little money? Is HIV really that different a disease or has our approach to it been and still is different from our approach to previous similar diseases (think Syphilis, or even TB in the West)? Is it that past and current strategies are failing to target those who are most in need? Listening to many of the activists who complain that they are ignored, one wonder if more money, if not properly allocated, will really make HIV less exceptional on the long haul.

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