[HIV management in Africa].
Africa is the continent hardest hit by the HIV pandemic with, according to the WHO for 2004, more than 25 million people infected. Although the mortality and socioeconomic consequences of HIV infection have been visible and predictable, only since 2000 has the catastrophic situation in Africa and other developing areas mobilized international political and medical attention, in view of the impressive results from antiretroviral treatments where they are accessible. The intolerable lack of access to medical care and effective treatments has engendered a fusion of energy and will - political and scientific, local and international - to make HIV treatment available in Africa. Access to treatment must be accompanied by creation of national public health programs and establishment of infrastructures and trained teams. Necessary steps including anticipation and prevention of pitfalls in the large-scale use of antiretrovirals, long-term planning, organization of supplies and distribution, ensuring the permanence of financial support, and making appropriate strategic choices. These steps are required to guarantee the future and to prevent an epidemic rebound due to drug-resistant HIV strains. The conditions of international economic and medical aid have been clarified and are now better adapted to real needs. Nonetheless large disparities still exist according to country and region. The initial results of cohorts of treated patients show results similar to those in the industrialized countries and provide encouragement about the future. Results in countries such as Uganda and Senegal show that local political involvement is primordial for long-term success. Access to antiretroviral drugs is an urgent and essential marker of comprehensive management, but the conditions of their use must be taken into account in assessing future projects if we want to change the course of HIV in Africa.
Tubiana
R
R
Unité de recherche clinique VIH, Hôpital Pitié-Salpêtrière, Paris. roland.tubiana@psl.ap-hop-paris.fr
D000349:Africa / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D004196:Disease Outbreaks / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D007391:International Cooperation; D011057:Politics; D011203:Poverty; D011247:Pregnancy
D044966:Anti-Retroviral Agents