Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
Mail & Guardian Online - July 21, 2009
Mara Kardas-Nelson
Instead, they say, the HIV response has helped to strengthen healthcare systems across Africa, dubbing Aids funding and technology "transformative".
"HIV has challenged ... and transformed African health systems in very fundamental ways. Because HIV is a chronic disease, it transforms a system to one that is much more interested in long-term outcomes for people," says Wafaa El-Sadr, director of the International Centre for Aids Care and Treatment Programmes and a professor at Columbia University.
Michael Kazatchkine, executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, agrees: "Aids has shown that when the world decides to come together around a goal it is possible to achieve [extraordinary things]."
Over the past few months, there has been numerous accusations that domestic and donor funding is unfairly allocated to Aids programmes, leaving other health problems neglected.
This backlash to "Aids exceptionalism" has caused donors and programme implementers to question the effectiveness of HIV programmes and consider whether they are diverting funds and attention from other diseases, especially within resource-poor areas such as sub-Saharan Africa.
Conference delegates acknowledge that a large percentage of the world's health funding, especially within resource-poor countries, does go to HIV, but contend that this does not mean it diverts from other programmes.
"To my knowledge, no one has shown data that spending money on HIV means not spending money on health systems," says El-Sadr.
Instead, she argues, funding HIV programmes strengthens the fight against other concurrent health problems.
"People interested in HIV are interested in other health outcomes, they're interested in maternal health and child health because they're intrinsic in HIV outcomes," she says.
Alan Whiteside of the University of KwaZulu-Natal believes arguments against Aids funding fail to see the interconnectedness of all health outcomes, and is unhelpful in strengthening Africa's poor health indicators.
"Aids is absolutely exceptional and is an emergency, but it is disingenuous to divide the health sector. HIV and Aids has brought huge amounts of money to health and it works across entire health systems," he says.
Despite the successes in scaling up health systems, Jacqueline Batarigaya, senior policy adviser for the International Aids Society, cites the continuing "serious deficiencies in health systems" as instrumental in preventing future roll-out of antiretroviral therapy (ART) for seven million of Africa's HIV-infected people currently waiting for treatment.
Batarigaya says a severe shortage of healthcare workers across the continent is a major impediment to increasing the number of patients on treatment.
"There is currently a 3,4-million healthcare worker shortage in the world, and we're 1,7-million short in Africa alone. We can't treat seven million people without these workers," she says.
Whiteside blames the brain drain and the South African government's lack of commitment to training new health workers as responsible for the shortage and resulting treatment shortfall.
"I find it quite incredible that we haven't scaled up our training of healthcare workers in South Africa. It's just been business as usual," he says.
In order for the country to meet the targets outlined in the National Strategic Plan for HIV/Aids, which calls for 80% treatment coverage for those who need it by the year 2011, Whiteside says further healthcare innovation is needed.
El-Sadr reiterates: "We can't say that HIV is over. It's still an emergency."
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