AIDS exceptionalism is the idea that the disease requires a response above and beyond ‘normal’ health interventions. More recently, the term has come to refer to the disease-specific global response and the resources dedicated to addressing the epidemic. The authors of this study argue that AIDS exceptionalism began as a Western response to the originally terrifying and lethal nature of the virus. There has been a backlash against this exceptionalism, with critics claiming that HIV and AIDS receive a disproportionate amount of international aid and health funding. This paper situations this debate in historical perspective. By reviewing histories of the disease, policy developments and funding patterns, it charts how the meaning of AIDS exceptionalism has shifted over three decades. The authors argue that, while the connotation of the term has changed, the epidemic has maintained its course, and therefore some of the justifications for exceptionalism remain.
Equity and HIV/AIDS
In this study, researchers investigated gender differences in treatment outcome during first line antiretroviral treatment (ART) in a hospital setting in Tanzania, assessing clinical, social demographic, virological and immunological factors. They used structured questionnaires and reviewed patients’ files, including a total of 234 patients about to start ART, and followed up one year later. Seventy percent of participants were females. After one year of standard ART, a higher proportion of females survived although this was not significant. They showed a worse CD4 cell increase than men, even though they had a higher BMI. Although women were starting treatment at a less advanced disease stage, they had a lower socio-economical status. After one year, both men and women had similar clinical and immunological conditions. It is not clear why women lose their immunological advantage over men despite a better virological treatment response.
Evidence for the association between religiosity and HIV infections is limited. Sujda, the hyper-pigmented spot on the forehead due to repeated prostration during prayers and fasting to worship, involving abstaining from food, drink and sex during daytime in Ramadhan and other specified days, are measures of religiosity among Muslims In this study, researchers assessed the association between religiosity and HIV infections. They included 29 HIV positive cases and 116 HIV negative controls, from a total of 1,224 Muslims, 15-24 years. Respondents without Sujda had more HIV infections. Those with Sujda were more likely to abstain from sex and be faithful in marriage. Respondents without Sujda were more likely to have ever taken alcohol before sex and to have ever used narcotics.
In this article, the authors summarise the main points of the UNAIDS World AIDS Day Report 2012 (included in this newsletter), which evaluated global progress in reaching the goals of Zero New HIV Infections, Zero Discrimination and Zero AIDS-Related Deaths. While the report includes quantitative information on two of the “Getting to Zero” goals – zero new infections and AIDS-related deaths – there is very little information on the third - zero discrimination - the authors note. Challenges persist in treatment and prevention, and progress is further impacted on by politics, poor governance, prohibitive costs and failure to build on evidence in the multisector response. Despite the flagging global response, countries have managed to move ahead, albeit slowly, to treat HIV-affected people, prevent transmission from mother to child and promote safe sexual behaviour. With treatment now available for only US$100 annually in some countries, the authors argue it is time for another bold move such as 3 by 5, focused on direct support to countries and a more strategic and efficient allocation of global resources toward evidence-based strategies that have been shown to work.
In this new report, UNAIDS reports that there are 700,000 fewer new HIV infections globally in 2011 than in 2001, eight million people on life-saving antiretroviral (ARV) therapy (a 60% increase in the last two years), and a drop of more than half a million deaths from AIDS-related illnesses between 2005 and 2011 in people living with HIV. However, new HIV infections continue to outpace ARV treatment coverage. Sub-Saharan Africa has realised a 25% reduction in new infections, although the region still accounted for 72% of new HIV infections globally in 2011. Progress in treatment has been impressive, saving lives and transforming HIV into a chronic illness rather than a death sentence. In addition to their therapeutic effects, ARVs have been found to play a preventive role by significantly reducing the amount of virus in the blood and therefore reducing the risk of transmission to sexual partners. A major weakness in both prevention and treatment programmes in many countries is reported by UNAIDS to be their failure to decrease mother-to-child transmission of HIV, which is the most easily preventable form of transmission.
This cross-sectional study was carried during 2009 to assess water, sanitation status and hygiene practices and associated factors among People Living with HIV and AIDS (PLWHAs) in home-based care services in Gondar City, Ethiopia. Researchers collected data from 294 PLWHAs in the form of in-depth interviews (72.8% females and 27.2% males). They found that 42.9% of the households had “unimproved” water status, 67% had “unimproved” sanitation status, and 51.7% had poor hygienic practice. Diarrhoea with associated with water status, while educational status and latrine availability were associated with sanitation status. Lack of hand washing devices and the unaffordable cost of soap reduced hygienic practices. In conclusion, the authors found a high burden of water, sanitation and hygiene problems in home-based care services for PLWHAs. They recommend hygiene education and additional support for the provision of water, sanitation and hygiene services.
The Southern and Eastern Africa Youth Conference on HIV and AIDS and Reproductive Health Rights for Sustainable Development (SEYCOHAIDS 2012) was held in Malawi, 6-8 November 2012, and delegates produced this statement at the end of the conference. During the conference, delegates were able to share best practices and lessons in HIV and adolescent Sexual Reproductive Health (SRH) interventions in the region. Although regional governments have ratified the African Youth Charter; the signatories to this statement recommend that it is domesticated and used to inform the Youth policies and development programmes in the respective countries. Funding alone cannot deal with the issues of child marriages, as well as HIV and SRH support. The community systems require strengthening in order to support effective HIV and SRH programmes and interventions for adolescents at the community level to achieve universal access to health and the Millennium Development Goals by 2015. The statement points to best practices and models of HIV and SRH capacity building in the region that can be replicated and scaled up, including improved family planning programmes targeted at the youth, to prevent unplanned pregnancies and unsafe abortions.
The South African Government has taken a major step towards improving HIV treatment compliance and cost with the announcement that the new antiretroviral (ARV) tender will include a triple fixed dose combination (FDC) tablet, which combines three pills into one. FDCs have shown to have major benefits for ART patients in terms of easier compliance and fewer side effects, with the added benefit for hospitals of reduced logistics and less storage space needed. The cost of the FDC is only R89.37, making it arguably the world’s lowest priced FDC. From April 2013 all pregnant women will be given the fixed dose combination during pregnancy and breast feeding and thereafter if their CD4 count is less than 350. According to Health Minister Aaron Motsoaledi, the fixed dose combination is more effective than dual therapy and has fewer side effects for the pregnant mother, in addition to its convenient dosage regimen. He confirmed that the most of the patients currently on the three ARV drugs would switch to the FDC from April 2013. Government will continue to stock the current ARVs for those unable to switch. Activists, who have been campaigning for FDCs for a number of years, welcomed the decision.
Much of the progress in recent years in the fight against HIV may be attributed to increased use of antiretrovirals (ARVs), argues the World Health Organisation (WHO) in this short article to commemorate World AIDS Day on 1 December 2012. The latest global statistics suggest that, provided countries are able to sustain current efforts, the goal of getting 15 million HIV-infected people worldwide on ARVs will be reached by 2015. Currently eight million people in low- and middle-income countries are accessing the treatment they need, up from only 0.4 million in 2003. However, vulnerable and marginalised groups are still not able to access HIV prevention and treatment services, including adolescent girls, sex workers, men who have sex with men, drug users and migrants. And children are lagging badly behind: only 28% of children who need ARVs can obtain them. Some countries are considering initiating treatment at an even earlier stage in the course of HIV, as well as offering all HIV-positive pregnant women ARV therapy for life. WHO is currently reviewing new scientific research and country experiences in order to publish updated and consolidated guidance on the use of ARVs in mid-2013.
In light of the emerging debate on what a post-2015 development agenda and accountability framework should look like, the authors of this paper call on policy makers and other stakeholders to look at the AIDS response for lessons in global health responses, where the most marginalised are at the centre of the debate, human rights are protected under the rule of law, strong accountability is in place for results for people, and community and participatory processes are the norm. These hard-won principles of the AIDS response should be incorporated into the post-2015 global health agenda, while at the same time acknowledging that a rapidly changing world, including a shifting geopolitical and economic landscape, requires policy responses that are context sensitive. Three years ago, UNAIDS articulated what was then considered to be an ambitious vision: zero new HIV infections and zero-AIDS related deaths by 2015, underpinned by zero discrimination. The authors argue that the post-2015 development agenda calls for the reconceptualision of this vision as a set of concrete goals. They discuss the Shared Responsibility-Global Solidarity agenda, as pioneered by the African Union in its recent Roadmap on AIDS, Tuberculosis, and Malaria, to illustrate ways in which global health can be re-thought to tackle twenty-first century challenges.