Why did AIDS get such a global profile?

Last week, I was invited to speak at Chatham House, the London foreign affairs thinktank, looking at the way in which HIV became a global health concern, with attention from the UN, the G8 and donors that has outstripped so many other development topics.

From 2002-2006 I was head of ActionAid’s HIV Policy & Campaign team in London and worked on advocacy against the global HIV epidemic. During that period, HIV acquiried a very high profile in international development issues.

The other speaker was Simon Rushton of University of Aberystwyth who has looked into the argument that the reason was that it became a global security concern.

His article, with Colin McInnes, thinks that this has been overstated.

I gave some personal thoughts about why the advocay was (relatively) so successful. Of course the magnitiude of the epidemic and statistics such as 5%, 10% or 20% of adults in a country infected were very powerful.

There was a very justified fear that HIV rates this high could undermine whole societies and that this was, as we used to say, the “single biggest threat to development”.

However, I argued that it was the 1980s domestic fear of HIV in Europe and North America, the moral panics than ensured, which prepared the ground for the late 1990s international response.

Crucially, the 1980s debates ended up asserting a rights-based approach to HIV, against the homophobia and prejudice which fear of HIV had unleashed.

The same advocates who asserted that everyone had an equal right to treatment, prevention and freedom from discimination took the same approach later to the global epidemic.

This led to commitments such as universal access to HIV treatments, something very differnt to the usual pragmatic development targets.

I also acknowleged that I would no longer call HIV the “single biggest threat” and that many other health issues, particularly basic maternal and child health services, have been neglected and now need attention, without taking funding away from HIV.

This is a very contentious debate but I think that those of us now advocating for health systems to provide basic healthcare free at the point of use need to remember the lessons for the approach that won gains on HIV.

The record of the discussion is being published here. This was also in my mind the following week when I joined my colleague Zahid Memon at a consultation on the rights-based approach to child health.

Incidentally, we have recently published a new policy briefing about the links between HIV and child survival and the importance of working through the health system.