Reframing the HIV/AIDS debate in developing countries III: an effective, equitable response

Developing countries need to balance resources for treatment and prevention. In Southern Africa, only 100,000 out of 4.1 million people who need HIV/AIDS anti-retroviral therapy (ART) are able to access it. The drop in the price of ART has led to opportunities to increase the numbers receiving treatment, but problems remain. Increasing health service focus on HIV might poach staff and resource from other important programs like TB, malaria or child health. It depends on good organisation and laboratory support. It may medicalise the epidemic and distract attention from the need for education and prevention. There is now good evidence that preventive strategies, including STD treatment, improved practices of blood transfusion and needle use, use of drugs to prevent mother child transmission, voluntary counselling and testing, increased condom availability and behaviour change are very effective in reducing spread. It is obvious that both treatment and prevention strategies are necessary. International aid is still inadequate. The European Union spends 50 billion dollars on agricultural subsidies, but donates only 140 million dollars for HIV in Africa. As funding increases, it is vital that it is well used and reaches the people who need it most.