AIDS exceptionalism a defensible concept, says Stephen Lewis

Keith Alcorn
Published: 20 July 2009

The idea that AIDS is an exceptional disease requiring an exceptional response is a perfectly defensible concept, Stephen Lewis, the former UN Special Envoy on AIDS in Africa told the opening session of the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention last night in Cape Town.

He also accused critics of the levels of AIDS funding of acting from base motives of resentment and professional envy.

Lewis’s strong words are the first signs that leading figures in the AIDS field are preparing to make a much more aggressive defence of current levels of funding, following mounting criticisms that HIV is receiving a distorted share of global health resources, and that funding allocations are being driven by donor fashions rather than country needs.

Even within the HIV field there have been criticisms of the way in which HIV care and prevention have developed exceptional models of practice, such as the requirements for counselling prior to HIV testing, which critics say impedes diagnosis.

“I tramped the high-prevalence countries of Africa for more than five years; if I wasn’t viewing the most exceptional communicable disease assault of the twentieth century, then the word “exceptional” needs to be re-defined,” Lewis said in his address at the conference’s opening session.

"As a consequence of that exceptionality, and the tremendous campaigning of grass-roots advocates, AIDS received funding, a lot of funding … never enough to be sure, but enough to recognise the exceptionality.

"Then along come the detractors, driven by resentment, resentment at the success of the AIDS movement. These arithmetic arguments alleging that AIDS is getting too much money at the expense of other health imperatives … this is simply naked academic and bureaucratic envy. I know I’m not supposed to say that, but it’s got to be said.

“Why? Because the critics know that it’s not a matter of pitting one aspect of health against another. The critics know that it’s a matter of measuring the resource needs of global health against the crazy expenditures that the world makes on other things. But the seething resentment that pulsates beneath the surface creates this false argument.

"I urge the scientists and activists here assembled not to fight on the terrain of the poseurs. Your whole life is in the world of AIDS. You know the legitimate resource requirements. You just can’t permit an intellectual contrivance - an argument in favour of accepting the size of the pie and slicing it differently, rather than demanding a larger pie - you can’t allow that to be used to justify a terrible reversal in public policy. People infected with HIV or at risk of infection, are suddenly tossed onto the landscape of treatment ambiguity, and the gains we’ve made and the momentum we’ve achieved are put at risk.”