Reframing HIV and AIDS

doi:10.1136/bmj.327.7423.1101

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Lara Stabinski, medical student1,
Karen Pelley, master of science candidate22,
Shevin T Jacob, medical student (sjacob@post.harvard.edu)3,
Jason M Long, medical student4,
Jennifer Leaning, professor of international health2

¹State University of New York at Buffalo, 45 medical Education Building, Buffalo NY 14214-3013, USA
²Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA,
³Oregon Health and Science University, School of Medicine, 3181 SW Sam Jackson Park Road, L102 Portland, OR 97239, USA
⁴Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA

Correspondence to: S Jacob

Accepted 6 October 2003

Last month WHO declared the HIV/AIDS epidemic a global health emergency. Should governments go one step further and treat it as a disaster?

Over the past 20 years, the public health community has learnt a tremendous amount about the HIV/AIDS epidemic. Yet, despite widespread discussion about the epidemic and some measurable progress, the overall response has been insufficient: globally 42 million people are already infected with HIV, prevalence continues to rise, and less than 5% of those affected have access to lifesaving medicines.1 In the face of this growing crisis, the World Health Organization has made scaling up treatment a key priority of the new administration.2 We argue that not only is the HIV/AIDS epidemic an emergency, but its devastating effects on societies may qualify it as one of the most serious disasters to have affected humankind. As such, this crisis warrants a full disaster management response.

Why the HIV/AIDS epidemic should be formally treated as a disaster

According to the United Nations, a disaster is any “serious disruption of the functioning of a society, causing widespread human, material or environmental losses which exceed the ability of a society to cope using only its own resources.”3 In just over two decades, the epidemic has already killed over 23 million people.4 Although other diseases may have cumulatively resulted in more deaths, HIV and AIDS are unique because they attack young adults in their peak productive years. These are the people who are essential to a society's current stability, potential economic growth, and functioning in the next generation.5 Unless more effort is put into saving lives and remedying the loss of human resource capacities in vulnerable countries with high prevalence or increasing incidence rates, the devastating effects may exceed these societies' ability to cope and could lead to their eventual disintegration. This potential can already be seen in …