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200920112013201520172019Figure 3:Effect of three scenarios on HIV infections in sub-Saharan Africa 2003–20Adapted from reference 18.Figure 2:Comparison of 2003 and 2005 data on coverage of antiretroviral therapy, mother-to-child prevention services, and antiretroviral prophylaxis to prevent vertical transmission among HIV-positive mothersAdapted from reference 4. Data are taken from references 6 and 17.
ViewpointVol 368 August 5, 2006 529adapt our programmes far more closely to the local social and cultural contexts. And in the long run, the money will not have the best effect unless we invest incapacity, chiefly in human resources for health but also in institutional capacity, such as for management and procurement. There is currently an estimated shortage of almost 4·3 million doctors, midwives, nurses, and support staffworldwide.19But we would be misleading the world if we claim that capacity building in the health sector will stop this epidemic. It is obviously essential for providing HIV treatment and scaling up access to HIV testing and counseling, but it will not solve the current deficit in HIV prevention. For a comprehensive AIDS response, there must also be strong capacity in education and other social sectors, as well as in terms of overall governance.20Not least,making the money work also means a commitment by all actors to a coherent response behind country-owned and country-led efforts. The roadmap is provided by the “Three Ones” principles (which call for the coordination of a national AIDS response around one agreed AIDS action framework, one inclusive national coordinating authority, and one monitoring and evaluation system), and the recommendations of the Global Task Team on Improving AIDS Coordination Among Multilateral Institutions and International Donors.4,21Money will not work effectively unless international development practice improves and we tackle the deadly gap between where the money is and where it is needed on the ground, among communities.Fourth, an exceptional response hinges on tackling the structural drivers of this epidemic, especially sex inequality, stigma and discrimination around homosexuality and sexuality in general, and poverty and deprivation in all their aspects. This challenge is perhaps the greatest of all those facing the AIDS response, given the pervasiveness of the barriers to providing life-protecting services to women, the socially marginalised, and the poor. No technological solution exists for overcoming them. To make headway, at a minimum we need to ensure that programmes for both HIV prevention and treatment reach the most vulnerable. If it does not, it is not only an injustice, but greatly reduces the effect of AIDS investments.22To combat stigma and discrimination, wide access to antiretroviral therapy and HIV testing and counselling will help, but is not sufficient, as shown in western countries with quasiuniversal access to antiretroviral therapy for a decade. And, as the report AIDS in Africa: three scenarios to 2025

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