The Dimensions and “Exceptionalism” of the HIV Pandemic

Lyn's Comment: In a recent Special Report R.J. Vitillo writes of the ‘exceptional’ nature and requirements of the HIV epidemic, indirectly answering many of the arguments against focussed responses to HIV.

I include the first part of the article.

The full article, titled “Faith-based responses to the global HIV pandemic: exceptional engagement in a major public health emergency”  is available here http://www.springerlink.com/content/c32155081203887h/fulltext.pdf

Why should people of faith be so concerned about the global pandemic of HIV/AIDS? It certainly is true that no human situation can be considered “outside the realm” of faith-based communities and organisations as they share their teachings and put into action their determination to contribute to the common good. Compassionate, non-judgmental care for those living with and affected by HIV makes people of faith and others of good will all the more sensitive to other human tragedies. On the other hand, at this particular time in history, the situation of the HIV pandemic requires special attention by people of faith, since so many others in our world prefer to deny its impact or to “blame its victims”. 

In a speech given, in 2005, at the London School of Economics, Dr. Peter Piot, former Executive Director of Joint United Nations Programme on HIV/AIDS (UNAIDS), noted the “severity and longevity of … impact” of the HIV pandemic as well as the “special challenges it poses to public action”, including the following:

- “…in country after country, the tipping point is being reached … after which AIDS no longer remains concentrated in so-called ‘hot spots’ but becomes a generalised explosion across the entire population”;

- “By 2006, eleven sub-Saharan countries will have lost more than every 10th person in their labour force to AIDS – and, by 2010, five countries in this region will have lost more than every fifth person in their labour force [1]”. 

A cursory review of current epidemiological data [2] might lead one to an incorrect conclusion that the present state of the HIV pandemic does not demand the same level of urgency and concern as it has in the past. Indeed, estimates of the global number of persons living with HIV at the end of 2007 (33 million) represented a reduction of 16% when compared with those published by UNAIDS in 2006.

The most significant reason for this reduction was the intensive exercise to assess the HIV epidemic in India, which resulted in a major revision of that country’s estimates. Important revisions of estimates elsewhere, particularly in sub-Saharan Africa, also contributed to this decrease. Moreover, in both Kenya and Zimbabwe, there was increasing evidence of a reduction in new infections, which, in part, is due to a reduction in risky behaviours. 

Epidemiologists also report that the number of annual new HIV infections has decreased. Globally, HIV incidence peaked in the late 1990s, when some 3 million new infections occurred each year. In 2007, some 2.7 million new infections were estimated to have occurred. This reduction in HIV incidence is thought to reflect natural trends in the epidemic as well as the success of some prevention programmes that has led to behaviour change to avoid risk of HIV transmission and/or infection.

In 2007, the number of deaths due to AIDS-related illnesses was estimated to be 2 million. Decline in deaths due to AIDS during the past 2 years is partly attributable to scaling up of anti-retroviral treatment services. Thus, if we dare to label it as such, we have a bit of “good news” with regard to current global dimensions of the pandemic. However, before “striking up the band” too quickly, let us return to the micro level and survey the impact of HIV in terms of loss, suffering, and incapacitation of HIV-positive persons, and of their loved ones and fellow citizens in local communities, all as a result of this pandemic. Every day, more than 7,400 persons become infected with HIV and more than 5,700 persons die from AIDS-related illnesses. Such infections and deaths mainly are due to inadequate access to HIV prevention and anti-retroviral treatment, as well as to a failure to change behaviours that put oneself or others at risk of HIV infection.

The HIV pandemic remains the most serious of infectious disease challenges to public health.

Southern Africa continues to bear a disproportionate share of the global burden of HIV: 35% of HIV infections and 38% of AIDS deaths in 2007 occurred in that subregion.

Regrettably, sub-Saharan Africa is “home” to 67% of all people living with HIV. Most epidemics in sub-Saharan Africa appear to have stabilised, although often at very high levels, particularly in southern Africa.

For this region as a whole, women are disproportionately affected in comparison to men; this striking difference is especially true among young people.

These particularly disturbing trends and concerns were aptly summarised in statements made by world leaders during the 2008 High Level Session on AIDS, held at United Nations Headquarters in New York. Mr. Srgjan Kerim, President of the UN General Assembly, maintained, “The failure to make sufficient progress in our response to HIV/AIDS profoundly impacts all aspects of human development” [3]. During that same meeting, Dr. Peter Piot addressed the claims that the present and potential impact of HIV has been exaggerated.

In his view, pretending that AIDS “has been fixed”, that there was already enough money being devoted to the fight against it, or that it is not a heterosexual pandemic, is a recipe for condemning millions of people to death. 

He appealed to the international community to back up its commitments, first, by scaling up access to health and health care and, secondly, by devoting more resources to research and development of new lifesaving drugs and treatment methods.

The exceptional drivers and impact of the HIV pandemic require an exceptional response, in conformity to that described on World AIDS Day 2008 by Dr. Margaret Chan, Director-General of the World Health Organisation WHO: “AIDS is the most challenging and probably the most devastating infectious disease humanity has ever had to face. And humanity has faced this disease, in equally unprecedented ways. The international community has rallied at levels ranging from grass-roots movements to heads of state, from faith-based organisations and philanthropists to research institutions, academia, and industry [4]”.

In the above-cited statement, Dr. Chan acknowledged that faith-based organisations have made significant contributions to the global AIDS response. In the remainder of the article, this writer will examine those efforts in accord with the demanding but justifiable expectation placed on people of faith by Dr. Peter Piot: “I hope for a day when every church engages in open dialogue on issues of sexuality and gender difference. I hope for a day when every synagogue will mobilize as advocates for a global response to fight AIDS, when every temple will fully welcome people living with HIV, when every mosque is a place where young people will learn about the facts of HIV and AIDS. When that will have happened, I am convinced that nothing will stop our success in the fight against AIDS [5]”.