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Disaster management and the AIDS epidemic

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Despite efforts to tackle the HIV/AIDS epidemic the global prevalence of the disease is still increasing. Some 42 million people are infected with HIV and fewer than 5% have access to adequate treatment. The World Health Organisation has declared the epidemic a global health emergency. Now a call has been made for governments to step up the response by declaring states of emergency and instituting full disaster management.

The United Nations defines a disaster as “any serious disruption of the functioning of a society, causing widespread human, material or environmental losses which exceed the ability of a society to cope using only its own resources”. The HIV/AIDS epidemic satisfies this definition in some countries in sub-Saharan Africa. Over 23 million people worldwide have died of the disease, often young adults whose loss is felt most acutely by society. Such losses could threaten the fabric of societies and lead to their collapse.

The three main components of a formal disaster response are official recognition of the disaster, appropriate policy actions, and an appropriate management system. Each country must itself declare a state of emergency. By doing so they announce that the situation is critical and open the way for international humanitarian aid. They may better cope with legal, operational, and bureaucratic obstacles and use the Trade-Related Aspects of Intellectual Property Rights (TRIPS) provisions for public health emergencies. They would be able to apply for compulsory licences to manufacture and import, where appropriate, generic versions of antiretroviral drugs and other drugs needed to treat HIV and AIDS.

The recognition of disaster phases could make it easier to come to appropriate decisions. A three phase approach (phases I, II, and III; predisaster, early warning, and emergency/disaster; or green, yellow, and red phases) would enable focused decisions as the situation became more serious. Phases could be based on seroprevalence: <1%, phase I; between 1% and 10%, phase II; >10%, phase III. Bureaucratic indolence and ineptitude could be overcome more easily and, when appropriate, emergency powers could be phased out.

Disaster management might use an incident command system that encourages commitment to a common goal, clarity of purpose, responsibility, and authority, recognises competence and is intolerant of petty obstructions. Non-health sectors such as construction, military, education, and finance would be integrated into the common objective. Lessons learnt from the SARS outbreak could apply.

Declaring a state of emergency is a public admission that all is not well and could have adverse political consequences and affect trade. There may, however, be political capital in showing a strong commitment to tackling the epidemic and obtaining international help. Agencies empowered to cut through bureaucratic, political, and legal barriers could abuse such powers and national and international monitoring to ensure the preservation of human rights may be necessary.