The implications beyond public health if we don't manage the HIV epidemic

Public health is the study and practice of managing threats to the health of a community; paying special attention to the social context, and focusing on improving health through society-wide measures such as vaccination or changing behaviours. Public health has, to date, played a limited role in HIV/AIDS interventions. The human rights discourse quickly came to dominate HIV/AIDS and it tends to protect the rights of individual over the society. Cuba resolutely identified and isolated infected people and contact tracing was carried out in Scandinavia; these were exceptions in the response. This paper argues the HIV epidemic has far reaching implications for health and how it is delivered. Beyond this it may lead to an erosion of the principles of public health. Failure to put in place effective prevention will amplify the effects of the disease. Currently the epidemic is located in Southern and Eastern Africa and will have major impacts here and in Russia and Ukraine. HIV/AIDS has implications in terms of health care, health systems and funding. The current debate is around the 'exceptionalism' of AIDS; should it get special focus and more money than the other diseases? How will this play out in public health and beyond? The most obvious direct implications are increased TB rates. Of concern is how health is defined by both donors and recipients in resource poor countries. Indirect consequences include changing patient profiles, especially in resource rich countries and the reaction to this. The paper will illustrate the significant impact of HIV/AIDS in one country: Swaziland. Here it has resulted in a reversal of all development gains, even the population has decreased. In the hyper-epidemic countries HIV/AIDS has long-term effects outside health in general and these will be clearly visible. Beyond these countries the impact will depend on the scale and location of the disease and the environment in which it occurs. In some places the failure to manage HIV will have far reaching consequences for health and public health. Globally the debate on vertical versus horizontal programmes; human and societal rights; and the relative roles of prevention and treatment has been joined. This can only be helpful as we try to navigate our response to AIDS over the next decade, and think about the potential of new diseases.