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
HIV testing of African immigrants in Belgium showed that HIV existed among Africans by 1983. However, the epidemic was recognized much later in most parts of sub-Saharan Africa due to stigma and perceived fear of possible negative consequences to the countries’ economies. This delay had devastating mortality, morbidity, and social consequences. In countries where earlier recognition occurred, political leadership was vital in mounting a response. The response involved establishment of AIDS control programs and research on the HIV epidemiology and candidate preventive interventions. Over time, the number of effective interventions has grown. Triple antiretroviral therapy (ART) has led to a rapid decline in HIV-related morbidity and mortality in addition to prevention of onward HIV transmission. Other effective interventions include safe male circumcision, and pre- and post-exposure prophylaxis. However, since none of these is sufficient by itself, the authors argue for a combination package of these interventions in the public health response.
Mozambique had 1.3 million people estimated to be living with HIV by end 2003. The epidemic poses significant development challenges to this low-income country. The Government of Mozambique formed a National AIDS Council (NAC) in 2000, and is currently operating its National Strategic Plan to Combat HIV/AIDS for 2005-2009.
Recent assessment reports suggest that climate change patterns are threatening social and ecological vulnerability and resilience, with the strong potential of negatively affecting human health. Persons living with HIV/AIDS (PLWHA) have weakened physiological responses and are immunologically vulnerable to pathogens and stressors in their environment, putting them at a health disadvantage in climate-based rising temperatures, water scarcity, air pollution, potential water- and vector-borne disease outbreaks, and habitat redistributions. These climatic aberrations may lead to increased surface drying and decreased availability of arable land, threatening food/nutrition security and sanitary water practices. Coupled with HIV/AIDS, climate change threatens ecological biodiversity via a larger-scale socio-economic recourse to natural resources. Corresponding human and environmental activity shape conditions conducive to exacerbating high rates of HIV/AIDS. In South Africa, this epidemic is forming a ‘syndemic’ with tuberculosis (TB), which has come to include multidrug-resistant TB (MDR-TB) and extremely drug-resistant TB (XDR-TB) strains. Be-cause of high convergence rates, one epidemic cannot be addressed without understanding the other. Concurrent climate change mitigation and adaptation strategies are becoming increasingly important to curb changes that negatively affect the biospheres on which civilisation is ultimately dependent – from an agricultural, a developmental, and especially a health standpoint. Mitigation strategies such as reducing carbon emissions are essential, but may be only partially effective in slowing the rate of surface warming. However, global climate assessments assert that these are not sufficient to halt climate change patterns. Regionally specific climate research, socioecologically sustainable industrialisation paths for developing countries, and adoption of health system strengthening strategies are therefore vital.
This paper considers how the design of agricultural policies and programmes might be modified to better achieve policy objectives in the context of severe HIV epidemics and underscores the central role of agricultural policy in mitigating the spread and impacts of the epidemic. It is argued that - even though the absolute number of working age adults in the hardest-hit countries is projected to remain roughly the same over the next two decades - the cost of labour in agriculture may rise in some areas as increasing scarcity of capital (notably, animal draft power for land preparation and weeding) will increase the demand for labour in agricultural production or shift agricultural systems to less labour- and capital-intensive crops.
This briefing explores the logic of International Monetary Fund (IMF) loan conditions to developing countries and why the IMF insists that keeping inflation low is more important than increasing public spending to fight HIV/AIDS in Africa, Asia, Latin America, and Eastern Europe. In 2003, funding levels for HIV/AIDS prevention and treatment are estimated to have reached almost $5 billion; meanwhile financing needs will rise to $12 billion in 2005 and $20 billion by 2007. But if these large increases in foreign aid become available, will lowincome countries be able to accept them? Despite the fact that the global community stands ready to significantly scale-up levels of foreign aid to help poorer countries finance greater public spending to fight HIV/AIDS, many countries may be deterred from doing so due to either direct or indirect pressure from the IMF.
In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge.
Sub-Saharan Africa disproportionately represents the largest incidence of both HIV/AIDS and internal conflicts. The impact of conflict on HIV incidence is largely unknown. Current epidemiological evidence paradoxically suggests that in most populations affected by conflict, HIV prevalence is lower than surrounding communities. Together, these dimensions of conflict create a complex and challenging situation for prevention of HIV/AIDS and delivery of care to conflict-affected populations. The authors examine the complexity of monitoring HIV/AIDS in conflict settings, and argue that increased efforts are needed to protect vulnerable populations and design health-delivery systems that are sustainable in settings of conflict.
Whilst the HIV/AIDS epidemic is affecting people all over the world, it affects young and middle-aged adults most seriously. This is the most economically active age group, meaning the disease has a dramatic impact on agricultural production, rural livelihoods and food security in many countries. Labour-saving crops and improved agricultural techniques will be a valuable support measure for such communities to increase agricultural output and food production.
The HIV/AIDS epidemic has a dramatic impact on agricultural production, rural livelihoods and food security in many countries. Labour-saving crops and improved agricultural techniques will be a valuable support measure for communities to increase agricultural output and food production.