[1986-2006: 20 years of failed international policy to control AIDS in Africa].
Agencies of the United Nations and other international organizations involved in fighting AIDS in Africa have been wrong for 20 years. Despite this failure that was publicly avowed for the first time by a high UNAIDS official in Brazzaville in March 2006, the international community continues to propose a strategy based exclusively on organizational and financial solutions for a highly complex human tragedy that requires a much more comprehensive, coordinated public health approach. Organization of the fight against AIDS has taken many forms over the period between 1986 and 2006. The WHO Global Programme against AIDS program initiated only five years after the beginning of the epidemic in the United States was followed ten years later by the joint United Nations program named UNAIDS. The period between 2000 and 2006 saw a growing number of worldwide initiatives outside the framework of the United Nations. With programs based on cooperation of bilateral agencies, the European Commission, and the World Bank with expert technical agencies and civilian representatives, the whole international community felt that they were "in the driver's seat ". However analysis of the strategy deployed against AIDS during this period shows a shift from "total emphasis on prevention" (1986-1996) to "total emphasis on ARV treatment" (1996-2006). This shift occurred with no assessment of the benefits of the previous strategy for the main users, i.e., the populations of Africa and health care officials. Financial pledges have considerably increased in the context of global public partnerships such as the Global Fund against HIV/AIDS, TB and Malaria, with no change in the overall strategic vision to control the pandemic. There has been a total lack of planning and leadership in controlling the pandemic. Even though we failed to treat 3 million people before the end of 2005 within the framework of the "3x5" initiative despite the availability of ARV in Africa since 1998, WHO called for "universal access" in Toronto in 2006. But how can we achieve this? The time has come to assess the results of the last 20 years, to share the lessons drawn from this experience, and to develop effective research to control a scourge that annually produces 5 million HIV-positive persons including mainly women and children in Africa. We must implement measures to reach Objective 8 of the Millenary Declaration on which relies the achievement of the other objectives.
Kerouedan
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Expert indépendant en santé internationale, Enseignante à Sciences Po. d.kerouedan@skynet.be
D000349:Africa / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007391:International Cooperation; D009937:Organizational Objectives; D014480:United Nations
D044966:Anti-Retroviral Agents