New England Journal of Medicine
June 6, 2013  Vol. 368 No. 23
http://www.nejm.org/toc/nejm/medical-journal

How AIDS Invented Global Health
A.M. Brandt
Excerpt [Free Full Text]
Over the past half-century, historians have used episodes of epidemic disease to investigate scientific, social, and cultural change. Underlying this approach is the recognition that disease, and especially responses to epidemics, offers fundamental insights into scientific and medical practices, as well as social and cultural values. As historian Charles Rosenberg wrote, “disease necessarily reflects and lays bare every aspect of the culture in which it occurs.”1

Many historians would consider it premature to write the history of the HIV epidemic. After all, more than 34 million people are currently infected with HIV. Even today, with long-standing public health campaigns and highly active antiretroviral therapy (HAART), HIV remains a major contributor to the burden of disease in many countries. As Piot and Quinn indicate in this issue of the Journal (pages 2210–2218), combating the epidemic remains a test of our expanding    knowledge and vigilance.

Nonetheless, the progress made in addressing this pandemic and its effects on science, medicine, and public health have been far-reaching (see timeline). The changes wrought by HIV have not only affected the course of the epidemic: they have had powerful effects on research and science, clinical practices, and broader policy. AIDS has reshaped conventional wisdoms in public health, research practice, cultural attitudes, and social behaviors. Most notably, the AIDS epidemic has provided the foundation for a revolution that upended traditional approaches to “international health,” replacing them with innovative global approaches to disease. Indeed, the HIV epidemic and the responses it generated have been crucial forces in “inventing” the new “global health.”…

Review Article
Global Health
Response to the AIDS Pandemic — A Global Health Model
Peter Piot, M.D., Ph.D., and Thomas C. Quinn, M.D.
N Engl J Med 2013; 368:2210-2218June 6, 2013DOI: 10.1056/NEJMra1201533
http://www.nejm.org/doi/full/10.1056/NEJMra1201533

Excerpt [Free full text]
…International Response to AIDS — A Global Health Model

It was not until the third decade of the epidemic that the world’s public health officials, community leaders, and politicians united to combat AIDS. In 2001, the United Nations General Assembly endorsed a historic Declaration of Commitment on HIV/AIDS, a commitment that was renewed in 2011.7 These actions resulted in the formation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which was established to finance anti-AIDS activities in developing countries. In 2003, President George W. Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR), which allocated billions of dollars to the countries hardest hit by AIDS.

This unprecedented global response to the AIDS pandemic can serve as a model for the response to other global health threats. For example, the global AIDS response incorporated a multisectoral approach that involved public health officials, clinicians, politicians, and leaders in civil society, business and labor, the armed forces, and the law, working in concert and with financial resources in excess of $15 billion per year8 to reduce the incidence of HIV infection and associated mortality.    The response to the pandemic required a coordinated global effort, which has been led by the Joint United Nations Program on HIV/AIDS (UNAIDS) since 1996. This transformational response helped redefine what is meant by health diplomacy and led to a new culture of accountability in international development. Tiered pricing of medicines became commonplace, and renewed optimism provided a boost for research on other neglected global health issues. This response to the AIDS pandemic highlighted the shortage of health care workers, inadequate availability of essential medications, and weaknesses in primary health care and public health systems. The stigma of HIV infection and inequities in the care of those infected focused attention on social and medical equity and human rights…