BMJ  2003;326 (21 June), doi:10.1136/bmj.326.7403.0-d

Devising new strategies for AIDS in the developing world

This issue's Education and Debate section is dedicated to AIDS in the developing world. On p 1382 Brugha describes antiretroviral treatment in developing countries and states that only 5% of people who need antiretroviral treatment receive it. Antiretroviral drugs seem to be getting into informal private markets, and uncontrolled use of drugs could lead to rapid development of HIV resistance.

Comparing HIV transmission in five different countries, Pisani and colleagues (p 1384) found that patterns of transmission of HIV vary widely. They say that strategies to fight transmission should be based on an understanding of local issues.

Bhargava and Bigombe (p 1387) explore the economic factors related to the high mortality among parents in Africa and the problems faced by orphans. Subsidies for fostering, which could come from debt relief programmes, can have a beneficial impact on orphans' school attendance, training, and productivity.

The cost of treating one person with antiretroviral drugs for a year is equivalent to that of preventing almost 50 cases. Potts and Walsh (p 1389) state that the priority should be prevention, not antiretroviral treatment. They explain the current impact of the epidemic in India and strategies available to contain it.

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