PHA-Exch> Peter Piot to Leave UN AIDS Agency After 13 Years (3)

[Claudio Schuftan]

  From: "Andreas Wulf" wulf at medico.de

 I think UNAIDS was quite offensive in challenging the "cost effectiveness"
approach of AIDS treatment" - with all the problematic aspects of
distortions of resources moved away from health systems to  treatment
programs, but definitely this was a major "paradigmatic shift", away from
the conventional wisdom of the 90ths that "Treatment is not possible in
Africa" - and that no one would have thought that AIDS patients could
receive more than palliative treatment and care and some prevention of
opportunistic infections.

I wonder if we shouldn't go beyond bashing UNAIDS for what seem to me not
just a neoliberal approach of a behavioral concept of  prevention (and the
same must be said by the simplistic language of most prevention slogans of
non communicable diseases of the "eat well, dont smoke, do physical
activity" type). What is indeed a conflict between the "exceptionalist"
concept of HIV/AIDS is something different from the "classical diseases of
poverty" and the necessary perseverance of the underlying dynamics of
structural social determinants of health.

In my understanding, the aversion of UNAIDS against the "poverty discourse"
in 2000 is not to to be explained without the infamous and indeed criminal
refusal of the "aids-dissidents" to acknowledge the infectious character of
the disease; their political allies were too embarrassed and reluctant to
discuss issues of (homo)sexuality, sexual violence, gender power and drug
use in their own societies. So poverty was an easy escape discourse, most
notably in the South African showcase in 2000, with all the focus on the
International AIDS conference there and the (in)famous speech of Mbeki in
September in front of the parliament, dismissing HIV as the cause of AIDS.

The inherent value of the "exceptionalist" approach of AIDS has been to
challenge the "rules of the game" in dealing with diseases in poor countries
- to mobilize unprecedented resources for it as well as the involvement of
the concerned people, turning them from victims/patients to activists. This
should be valued and the AIDS movement needs to be a strategic ally of PHM,
not an enemy.
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