Care and support for people living with HIV/AIDS

National responses to the epidemic: factors that make a differenceAt the heart of debt reduction deals under HIPC lies the challenge of agreeing on significantgoals in poverty reduction and on measurable indicators of progress towardsthese goals. Lending countries will have greater incentives to reduce debt if there areclear and measurable ways of assessing the benefits. For example, a medium-termAIDS-related target might be to provide low-cost treatments to a specific percentageof the population suffering from the most common opportunistic infections.Measurable indicators for monitoring progress would likely include the availability ofspecific generic medicines in primary health care centres.During the first months of 2000, several countries in Africa have started to featureHIV/AIDS more prominently in their poverty-reduction strategies and in related HIPCdebt relief agreements. This is encouraging. But a concerted effort by a coalition ofinterested African government officials, civil society representatives, creditor governments,and United Nations and multilateral agencies will be required to ensure thatdebt relief is actually used to mobilize substantially increased funding for AIDS.ConclusionTwo decades of action against the epidemic have generated important insights intoan effective response. While international political, financial and technical supportare important, lowering incidence and mitigating the epidemic’s impacts must be anationally driven agenda. To be effective and credible, national responses require thepersistent engagement of the highest levels of government. Countries that haveadopted forward-looking strategies to fight the epidemic are reaping the rewards infalling incidence. Other countries are yet to see the fruits of their efforts, and in theabsence of rapid and visible results, sustaining a response becomes more difficult.However, evidence shows that the combination of approaches described in thischapter have brought about a lowering of incidence in some countries. At present,and until the arrival of a vaccine, these approaches are the strongest weapons in ourfight back against HIV/AIDS.115