African Journal of AIDS Research

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Why HIV/AIDS should be treated as exceptional: arguments from sub-Saharan Africa and Eastern Europe

Julia Smith, Khaled Ahmed, Alan Whiteside


The idea that HIV and AIDS gets too much attention and funding emerged in 2008 with a call to end ‘AIDS exceptionalism.’ This article outlines a short history  of AIDS exceptionalism — the idea that HIV and AIDS require a response above and beyond ‘normal’ health interventions and is privileged in terms of attention and resources when compared with other diseases — and the reasons for the  backlash to this idea. We argue that in some settings HIV and AIDS must be treated as exceptional. These are the hyperendemic countries of southern Africa, where HIV epidemics have shown substantial and lasting demographic and social impact, and parts of Eastern Europe where the epidemic is augmenting troubling demographic changes, such as declines in fertility rates and population growth,  and impacting society in nuanced ways. Also included are resource-poor settings,  mostly in Africa, where the combination of the high number of HIV infections and the cost of treatment have created issues concerning donor dependency and  sustainable responses. An HIV epidemic must be seen as a long-wave event, with complex challenges to both HIV prevention and treatment responses. The  article reviews the available data and literature to provide evidence for our arguments. We conclude that the perception that AIDS exceptionalism is outdated ignores the complexity of different HIV epidemics and obfuscates the challenges to effective responses.

Keywords: AIDS exceptionalism, demography, donor dependency, health interventions, health systems, hyperendemic disease, resource-poor settings

African Journal of AIDS Research 2011, 10(supplement): 345–356
AJOL African Journals Online