Whiteside, who is Director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal, has spent more than twenty years researching the economic and development impact of AIDS.
His presentation to Alliance staff was a response to suggestions, put forward in the press a few months ago, that AIDS should no longer be treated as an exceptional issue, and that organisations such as UNAIDS should be abolished.
Whiteside argued against these “dangerous” ideas, while acknowledging that changes are needed in the global response to HIV.
He contended that AIDS has an exceptional impact on a number of countries in Southern and Eastern Africa. Some 57% of all new HIV infections occur in these regions.
Elsewhere AIDS deserves exceptional treatment with regard to certain populations – for example in Russia and Eastern Europe, where it is contributing to population declines by killing young adults – at least until adequate services become available.
The professor cited the example of Swaziland, where he spent his childhood. Nearly half of adults in this small kingdom are infected with HIV, and the resulting death toll is shrinking the population.
In Swaziland, 23.3% of children are orphans and another 11.7% are vulnerable to HIV. Life expectancy is only 33 years. AIDS is “going to cut away at the heart of the nation”, said Whiteside. It is creating a “chronically depressed society” in which people do not invest in the future.
Such an exceptional disaster demands an exceptional response, he argued.
Whiteside went on to discuss the future of global action on AIDS. Efforts to expand access to antiretroviral treatment have been highly successful, but are they sustainable? Has the number of people receiving therapy reached a limit, beyond which health systems will suffer from overburdening?
And, given the need to keep people on treatment for as long as they live, can we be sure of sufficient funding over the longer term? Have we reached the peak of global interest and financing? We must engage with these difficult questions, said Whiteside.
Prevention, meanwhile, has become the “orphan” of the global response to HIV. By prioritising treatment ahead of prevention we are “mopping the floor while the tap is running”. We must do more, and must build our responses on a better understanding of gender issues, male-female dynamics and sexual networks.
The professor urged the Alliance to take a lead in HIV prevention and international advocacy, and to continue working with key populations that are all too often marginalised in the global response.