Keeping the promise on AIDS
IT'S LONG been clear that political will and astute leadership play a central role in the global fight against the AIDS epidemic. The theme of this year's World AIDS Day, ''Keep the Promise," urges leaders in developing countries to work toward the HIV prevention and treatment goals of international agreements initiated by the United Nations and World Health Organization.
Many nations are meeting these goals and achieving even more. Their dedication demonstrates that the most effective policymaking to fight AIDS takes place not in New York or Geneva but on the front lines of the epidemic. The leaders of these countries are taking aggressive, visionary action to protect their citizens and mitigate the economic and social impact of this devastating global health crisis.
In 1996, spurred by activist lobbying, Brazilian legislators mandated free antiretroviral treatment for all HIV-positive citizens eligible for national insurance -- the first such legislation in the developing world. At the time, HIV prevalence in Brazil was among the highest in the Americas; one in three Latin Americans with HIV lived in Brazil. This historic decision represented a huge investment in public health for Brazil that the country would struggle to fund and maintain.
That investment soon paid off. Within two years, AIDS mortality in São Paulo State, which had the country's highest HIV prevalence, dropped an astonishing 32 percent. Today, more than 170,000 HIV-positive Brazilians receive antiretroviral therapy. The national AIDS mortality rate has been slashed in half, with AIDS-related hospitalizations in public health facilities down by 80 percent. Brazil's bold initiative proved to its neighbors and to skeptical public health experts worldwide that universal access to HIV treatment in developing countries is not only feasible but highly effective in saving lives. Brazil's example helped other Latin American nations establish their own treatment programs.
Brazil's comprehensive prevention, care, and treatment programs operate throughout the country. HIV prevention messages and activities are woven into everyday life, in the schools, streets, workplaces, and entertainment centers. As a result, national HIV prevalence dropped to 0.6 percent in 2000 and has remained low.
Botswana has played a similar role in Africa, pioneering widespread access to antiretroviral treatment for its citizens. Burdened with one of the most severe HIV epidemics in the world, nearly four of every 10 adult Botswanans are infected. In 2002, this mortal threat prompted President Festus Mogae and other national leaders to create Africa's first free AIDS treatment services, called the Masa (''New Dawn") Program. Now, some 42,000 Botswanans receive antiretroviral treatment, about 56 percent of the total who currently need it.
As the country improves public health infrastructure to handle more patients, health officials are actively promoting widespread HIV counseling and testing. Botswanans are learning their HIV status earlier, which allows them to get timely medical help and avoid infecting others.
Cambodia is among the poorest countries in the developing world, with the highest HIV prevalence in Asia yet too few resources to enact universal treatment. But this did not stop its leaders from acting early to slow HIV transmission by adopting the innovative prevention strategies that lowered transmission rates in neighboring Thailand.
Uganda has also provided legendary leadership in HIV prevention, with its focus on the ABC strategy: abstinence, be faithful, and consistent condom use. Identified in the 1980s as the epicenter of the epidemic, Uganda experienced an early and severe peak in HIV prevalence that caused horrific suffering throughout the country. Its leaders, most prominently President Yoweri Museveni, fought back by speaking frankly and directly to the Ugandan population. They urged citizens to protect themselves by taking charge of their sexual behavior. New data show that Ethiopia, Kenya, South Africa, and Zambia are achieving similar successes in prevention.
The US government provides significant funding and technical assistance to help dozens of countries provide its citizens with prevention, care, and treatment services -- and it does so most effectively by working hand in hand with political and public health leaders. Collaborating with governments throughout the developing world, the President's Emergency Plan for AIDS Relief is now helping to expand AIDS programs to even more nations, including some of the poorest of the poor. These partnerships -- fueled by true political will -- remain the backbone for action in the global campaign against AIDS.
Dr. Peter Lamptey, a native of Ghana, is president of the Institute for HIV/AIDS at the nongovernmental organization Family 
