Twentyfive years twentyfive million deaths

"Twenty-five years, twenty-five million deaths." It is by this brutal shortcut that experts summarize the pandemic that hit the world since the first descriptions of the syndrome of acquired immune deficiency (AIDS) in June 1981. Sunday opens in Toronto the 16th World Conference that will bring together more than 20,000 experts of this disease. Expected speakers include Bill Clinton, Melinda and Bill Gates and actor Richard Gere. The organizers pursue three main objectives: a new inventory of the resources needed to combat the scourge, gather the latest epidemiological and therapeutic advances and make the point on the access to treatment in developing countries.

These topics are a constant source of controversy between the countries of the North, where the means and researchers, and the countries of the South, where most of the patients live. The epidemic currently affects some 38 million people worldwide, including approximately 25 million in sub-Saharan Africa. In the Southern Cone of the continent, the prevalence of infection approaching 40 in some isolated regions and on the point to be removed from the map. In developed countries, AIDS is now treated as a chronic disease and about 80 of patients are supported by health systems. The generalization of multi allowed otherwise cure, at least to the disease "under control". But access to care remains the exception in Africa, China and India.

Large disparities

Currently, 1.3 million patients receive drugs in poor countries, or about 20 of those who need it. But very large disparities remain. While the Brazil generalized access to treatments, South Africa, 5.5 million people infected with HIV continues to conduct an incoherent strategy. The India, which has nearly 6 million people living with HIV, prefer to export its generic medicines instead of caring for his own sick. China remains a terra incognita for Western epidemiologists. As was the case with SARS or avian influenza, the empire of the Middle applies to the AIDS policy of radio silence.

In 2005, the financing mobilized by the international institutions have reached $ 8.3 billion. This amount is consistent with the forecast (between 7 and 10 billion dollars), but less than the requirements displayed by the UNAIDS: 12 billion (15 billion dollars for 2006). Four institutions share this effort: the global fund for the fight against AIDS, malaria and tuberculosis, the World Bank, US President (Pepfar) program and the United Nations. These institutional actors are added the charitable foundations and corporations, which play a role in more and more important. In many countries, private companies have implemented policies of care for their employees to compensate for the lack of public health systems.

Using diluted

In Africa, the battle against AIDS doubles as a real struggle for political influence among major countries. First donors, the United States clearly play the card of bilateralism. Funding Pepfar (15 billion over 5 years) are devoted in almost all ($14 billion) identified programs of abiding by the flag. The France made the opposite choice (see table). The bulk of its aid is diluted in the global fund and therefore virtually invisible at the local level. This hexagonal preference for multilateral action concerned the many French CIEL physicians who are still living in Africa. Every day, they find the rise of health diplomacy United States, including in francophone countries. This is the case in Côte d'Ivoire where Pepfar funding are present in very remote areas of the country as the village of Blahou, close to the port of San Pedro. "The American program requires concrete results and that is what we want." "However, the global fund behaves as a simple agency means", said Raphael Agneroh, Coordinator of the programme to combat HIV/AIDS in Abidjan.

French AIDS experts have continued to mock on the Pepfar program ("President's Emergency Plan for AIDS Relief"), launched in January 2003 by George Bush. Two main criticisms are addressed: its moral aspects (in particular its calls for abstinence and marital fidelity) and its support disguised producing industry of antiretroviral drugs. The Bush plan covers 15 countries (including 12 in Africa) along four axes: treatments (55), prevention (20), palliative care (15) and support for orphans and vulnerable children (10). The whole is placed under the supervision of the Congress who votes every year budgets. It is built according to the logic of "reporting" dear to the Anglo-Saxons. The effectiveness of each action is regularly measured by control procedures. It is no doubt that is the main difference with the global fund, inspiration and European culture. The first seeks to achieve results in a

emergency and with

limited infrastructure. The second officials fear above all to be taxed by the former colonies of neo-imperialism.