Over the last two years, ministries of health in sub-Saharan Africa and other countries with a high burden of HIV/AIDS have implemented strategies that concentrate resources on high prevalence areas and key populations.
Encouraged by their donor partners, such as PEPFAR, UNAIDS and The Global Fund, these strategies employ a biomedical approach that focuses on suppressing the viral load in the population in line with UNAIDS’ 90-90-90 objectives to reduce new infections and bring the HIV epidemic under control. If successful, this approach holds out the tantalizing prospect of ending the AIDS epidemic by 2030.
Often referred to in U.S. government circles as “the pivot,” this shift in strategy reflects constrained foreign assistance budgets as well as a number of successes in fighting AIDS over the last decade. We now have more robust surveillance methods that allow us to better target disease hotspots and key populations, countries have improved diagnostic and laboratory capacity that enable more rapid and sophisticated analyses, and new therapies allow people who are HIV positive to treat HIV/AIDS as a chronic condition instead of a death sentence. Call it the triumph of the medical epidemiologists.
There is an irrefutable logic to concentrating resources on the areas where a problem is worst. And this is especially the case when the problem is preventing the spread of an infectious disease. But does this logical approach inadvertently reinforce social and economic inequality by allocating scarce health resources to areas and communities that are already economically better off?
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