Étendre l'accès à la prévention et au traitement du VIH dans un contexte de rareté des ressources : défis et perspectives

Communicable diseases remain the major cause of morbidity and mortality in resource-poor settings. Through both biological and social mechanisms, poverty greatly increases the vulnerability of people to many infectious diseases. In turn, the major infectious scourges, such as HIV/AIDS, tuberculosis, and malaria, perpetuate poverty and are an important contributor to negative economic and social development. HIV/AIDS is a case in point, because it primarily affects people in the prime of their lives, leading to losses in productivity and social cohesion. Its effects are most dramatic in Sub-Saharan Africa, where the situation is often aggravated by the fact that so many countries are suffering from weak or dysfunctional governance. The latter has contributed to a steadily progressive erosion of the public health sector in those countries. HIV/AIDS also fuels a tuberculosis epidemic. On one hand, we are dealing with greatly increasing demands on the public health sector, especially in countries hardest hit by the HIV/AIDS epidemic; on the other hand, that health sector is losing already scarce workers to HIV/AIDS. Likewise, the capacity of the education sector is weakened because of increased mortality of HIV-infected teachers. In an era of globalization, the world cannot afford to ignore the health (and other) problems of developing countries. Humanitarian motives aside?which alone should be enough reason for action?the downward spiral of economic and social development in the poorest countries presents a recipe for global insecurity and instability. Despite the progress that has been made during the past few years in closing the ?funding gap,? implementation of effective interventions in countries has been lagging behind. There is great need for global leadership in the fight against HIV/AIDS and for a global action plan that takes a pragmatic approach, based upon the best of science and empirical evidence. The challenge is formidable, but the current momentum for the antiretroviral scale-up provides a unique opportunity to empower the poor and build sustainable health care systems in Africa and other resource-poor settings.