By far the greatest burden of disease from HIV infection is in developing countries, where health services are generally ill equipped to cope. The authors consider how effective HIV services can be delivered in such countries

HIV infection poses tremendous challenges to healthcare systems globally. Over 90% of the estimated 40 million people living with HIV infection in 20011live in resource poor settings and do not share the improved prognosis now achieved in developed countries.2The World Health Organization estimates that in 2002, of the 6 million people in developing countries in need ofantiretroviral therapy, only 4% are getting such treatment, half of whom live in Brazil.2 In 2001 about 900 000 people were infected with HIV in the United States, and over 500 000 (over55%) were receiving antiretroviral therapy.1 In sub-Saharan Africa, however, of the more than 28 million people with HIV infection in 2001, fewer than 30 000 (just over 0.1%) were receiving antiretroviral therapy.1 In 2001, there were about 15 000 deaths from AIDS in the United States (roughly 1.7% annual mortality)and an estimated 2.2 million deaths from AIDS in sub-Saharan Africa(over 7.9% annual mortality).1 In this article we explorethe question of how effective HIV services can be delivered in resource poor countries.