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LETTERS: Paul De Lay UNAIDS replies BMJ 2008; 336: 1206-a [Full text]

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Is HIV exceptional?

Josef Decosas   (30 May 2008)

Is HIV exceptional? 30 May 2008
Josef Decosas, Senior HIV Policy Adviser Plan International; Box 947 Kaneshie, Accra, Ghana Send response to journal: Re: Is HIV exceptional?	Roger England is known for his critical stance towards treating HIV as an exceptional issue. I was ready to dismiss his call to abolish UNAIDS as a quixotic charge at one more windmill. Reading the response by UNAIDS in the letter by Paul DeLay, however, makes me wonder about how solid this windmill really is. Almost 20 years ago, when Michael Merson was introduced as the new Director of Global Programme on AIDS (GPA) after changing his job from Director of the WHO Diarrhoeal Diseases Programme, I sat in the Canadian Delegation of the GPA Management Committee and told him to please remember that AIDS is not like Diarrhoeal Disease. A colleague, Tony Klouda, who attended the meeting on behalf of the International Planned Parenthood Federation (IPPF), later stopped me in the hallway and told me “You are wrong, Josef, AIDS is exactly like Diarrhoeal Disease”. I discounted the remark at the time, but it has since come to haunt me. Nobody denies that HIV is a big epidemic and in some parts of the world the biggest threat to health and survival. But numbers alone do not make an exceptional situation, especially when they are inflated by manipulating the denominator. What kind of statistic is “60 million infections and 25 million deaths since HIV was first discovered?” How would we judge the global situation of cholera or meningitis if we would report it using the same type of statistic? Certainly, HIV cuts across many social and economic issues, and HIV has many effects that are much more far reaching than simply the national health budget. But so do all other major public health issues. Certainly, the roll-out of HIV treatment has done much to improve health services in some parts of the world. But is that the most effective and cost-effective way to invest in health services? I am not as radical as England. I believe there are reasons to maintain the exceptionality of HIV, and there are reasons for UNAIDS to exist. But if UNAIDS cannot come up with any better arguments than those in the response by Paul DeLay, then I am starting to think that England was right after all. Competing interests: None declared