Applying the principles of AIDS 'exceptionality' to global health: challenges for global health governance

In this paper, we argue that a key feature of the “exceptionality” of the global AIDS response—its reliance on open-ended international solidarity to complement domestic efforts—can only be preserved if it is extended to broader health issues of the poorest countries of the world. This reliance on open-ended international solidarity hinges on three related principles: a new approach to sustainability, a flexible application of fiscal space constraints, and an international financing mechanism that provides long term reliable assistance. We will briefly explain these principles, focusing particularly on fiscal space constraints because the importance of that element is often overlooked or underestimated. Then we will explain why health systems and broader health issues in low-income countries need the same three principles (or similar solutions), to sustain early successes of the global AIDS response and to expand these successes. Finally, we will examine the challenges the wider application of the principles of AIDS exceptionality creates for global health governance