AIDS: from crisis management to sustained strategic response.

摘要

Seen from the perspective of a quarter century, it is apparent that some of the most insightful works on AIDS were written in the epidemic's earliest years. Among them is a commentary by the evolutionary biologist Stephen Jay Gould, published on the New York Times' op-ed page in April 1987. At a time when AIDS had probably killed less than half a million people and was still regarded as mainly a disease of marginalised minorities in the West, Gould warned that "the AIDS pandemic [is] an issue that may rank with nuclear weaponry as the greatest danger of our era... potentially, the greatest natural tragedy in human history."1How prescient Gould has proved to be. One set of statistics says it all: a disease that emerged as mysterious fatal illnesses in five American men in 1981 was by 2002 the world's leading cause of death among both women and men aged 15 to 59 years, causing one in every seven deaths in this age-group: around twice as many as caused by ischaemic heart disease or tuberculosis.Although AIDS is firstly a public-health crisis, it has become one of the make-or-break forces of this century, as measured by its actual impact and potential threat to the survival and wellbeing of people worldwide. Indeed, it is difficult to think of many other global problems that are in the same league as AIDS-arguably, only extreme poverty and deprivation as a whole; climate change; and the potential risks posed by nuclear war, chronic armed conflicts, or a sustained breakdown of international finance and trade.The global impact of AIDS has already been so devastating that the United Nations' Human Development Report 2005 concluded that "the HIV/AIDS pandemic has inflicted the single greatest reversal in human development."