The AIDS epidemic. Past and future

As we near the end of the second decade of AIDS, this global epidemic is characterized by a widening gap between wealthier nations in North America and Europe and the poorer nations of the world. In developed countries the epidemic has stabilized and there are dramatic decreases in morbidity and mortality resulting from the use of intensive but expensive therapies. This contrasts with the experience of poorer nations, where the epidemic's spread is often unabated and has devastating effects on communities, families, and individuals. A decrease in transmission from mothers to their children is a possibility that still needs to be realized in developing countries, although the potential now exists. Adolescents and young adults are most at risk for contracting the infection, and, recognizing that an effective vaccine is unlikely to be a reality for many years, there is great need for culturally appropriate and innovative means of affecting behavior to decrease the risk of transmission. Although the extent of children's suffering through the loss of their parents has already been felt worldwide, the extreme magnitude of this is still to come, particularly in those countries and communities that have the least resources. The epidemic is a global problem, and addressing the disease and its consequences on children and youth worldwide requires an international response. The potential for complacency in developed countries needs to be replaced by a determination to bridge existing gaps. This requires the focus and support of governments, international agencies such as UNAIDS, nongovernmental organizations, corporations (particularly those that produce antiretroviral medications and artificial milk formulas), researchers from many disciplines, and other individuals.