This report began with the story of Joseph Jeune, a 26-year-old peasant farmer in Haiti. It is a story of how hope can triumph over despair, and it also is an example of how people can fight back successfully against HIV/AIDS.
This is a crucial moment in the history of HIV/AIDS, and an unprecedented opportunity to alter its course. The most important message of this report is that, today, the international community has the chance to change the history of health for generations to come and to open the door to better health for all.
The World Health Report 2004 has chronicled the global spread of HIV/AIDS over the last quarter of a century. It has also traced the efforts of advocacy groups, civil society organizations, community health care workers, researchers and many others to control it and to combat its many side-effects, including stigma and discrimination. Despite those often heroic efforts, more than 20 million people have died from HIV/AIDS and an estimated 34–46 million others are now infected with the causative virus, for which there is as yet no vaccine and no cure.
But there is treatment. Joseph Jeune owes his life to it, as do many others. The pictures of Joseph before and after treatment illustrate what can be done. Antiretroviral therapy saved him from an early grave and enabled him to return to work in his fields and care for his family.
Effectively tackling HIV/AIDS is the world’s most urgent public health challenge. In advocating a comprehensive strategy which links prevention, treatment, care and support, this report makes a special case for treatment, which has been the most neglected element in most developing countries.
Treatment is the key to change. It is now possible to save the lives of millions of people who need that treatment but do not yet have access to it. Almost 6 million people now need antiretroviral drugs but only about 400 000 received them in 2003. This knowledge underpins the commitment of WHO and its partners to help provide 3 million people in developing countries with antiretroviral therapy by the end of 2005 – and not to stop there.
The treatment expansion initiative far outreaches the capacities of any single organization. It is one of the most ambitious public health projects in history, and is fraught with difficulties. But within the multiple partnerships of the international community, the knowledge that this can be done is leading to the recognition that it must be done.
The moral imperative needs no reinforcement, yet there are other excellent reasons to support the treatment initiative. As this report has shown, the long-term economic and social costs of HIV/AIDS in many countries have been seriously under- estimated, and some countries in sub-Saharan Africa may be brought to the brink of economic collapse. Treatment expansion is vital to protect their stability and security and to strengthen the foundations of their future development. Furthermore, and of inestimable importance, treatment can be the accelerator that drives efforts to strengthen health systems in all developing countries.
Building up health systems is essential, not just in the fight against HIV/AIDS but also in generally improving access to better health care for those most in need. This report has demonstrated how international organizations, national governments, the private sector and communities can combine their strengths to achieve this objective.
Advocacy by WHO and its partners for increased international investment in health is beginning to bear fruit. Countries should get the maximum public health benefit from new funds that are now becoming available. Although largely intended for HIV/AIDS, these resources can simultaneously strengthen some of the world’s most fragile health systems.
Beyond 2005 lies the challenge of extending treatment to many more millions of people, and of maintaining it for the rest of their lives, while simultaneously building and sustaining the health infrastructures to make that huge task possible. The success of this action cannot be guaranteed. But inaction will not be forgiven. It will be judged by those who suffer and die needlessly today, and by the historians of tomorrow. They will have a right to ask why, if we let the chance of changing history slip through our fingers, we did not act in time.