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Moïse Desvarieux, MD, PhD, Roland Landman, MD, Bernard Liautaud, MD, Pierre-Marie Girard, MD, PhD for the INTREPIDE Initiative In Global Health

Moïse Desvarieux is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roland Landman is with the Service de Maladies Infectieuses, Centre Hospitalier Universitaire, Bichat Claude Bernard, Université de Paris, Paris, France, and the Institut de Médecine et d’Épidémiologie Appliquée (IMEA), Paris. Bernard Liautaud is with the Hôspital de Jour en Maladies Infectieuses, Centre Hospitalier Universitaire de Fort-de-France, Fort-de-France, Martinique, and Groupe Haitien d’Études du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti. Pierre-Marie Girard is with the Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Saint-Antoine, Université de Paris, Paris, and the Institut de Médecine et d’Épidémiologie Appliquée, Paris.

Correspondence: Requests for reprints should be sent to Moïse Desvarieux, MD, PhD, Department of Epidemiology, Mailman School of Public Health, 722 W 168th St, New York, NY 10032 (e-mail: md108{at}columbia.edu).

The prospects for antiretroviral therapy in resource-poor settings have changed recently and considerably with the availability of generic drugs, the drastic price reduction of brand-name drugs, and the simplification of treatment. However, such cost reductions, although allowing the implementation of large-scale donor programs, have yet to render treatment accessible and possible in the general population.

Successfully providing HIV treatment in high-prevalence/high-caseload countries may require that we redefine the problem as a public health mass therapy program rather than a multiplication of clinical situations. The public health goal cannot simply be the reduction of morbidity and mortality for those treated but must be the reduction in morbidity and mortality for the many, that is, at a population level.

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