A few weeks ago, a former colleague of mine sent me a short article entitled "AIDS --A Challenge for all GTZ (German Technical Co-operation Agency) Projects". The article argues  that by its sheer dimension HIV/AIDS is a major social and economic catastrophe in many developing countries: AIDS predominantly kills the productive age group of the population and creates millions of orphans. AIDS-related morbidity and mortality will have a dramatic impact on public health as well as private lives, on nations, communities, families and individuals. The article mentions in a nutshell all that has been said by UNAIDS, the World Bank and other development agencies, heads of states or ministers. The only surprise of this article was the date of publishing: September 1992.
One could go back even farther. In 1987 and immediately afterward, the Global AIDS Strategy of WHO's now defunct Global Programme on AIDS already argued that an effective response to HIV/AIDS had to go far beyond the health sector: education, religion, culture, all facets of society will have to play a role in responses to the epidemic.
In 1996, the UN created UNAIDS to serve as its co-ordinating body to expand the response to the pandemic beyond WHO and the health sector. In 1999, the World Bank, the GTZ and SIDA (Swedish International Development Agency) issued new policy documents and in early 2000, the UN Security Council took up the issue of HIV/AIDS. At present, there seems to be no major international or regional meeting or conference that does not have AIDS on its agenda. It took more than a dozen years to translate so-called expert knowledge and insights into major policy formulation and large-scale action. During those years, the estimated number of persons infected with HIV rose from 5 to more than 50 million: an agonisingly long period during which 16 million people died of AIDS, and a tremendous burden for all of us.

AIDS now on top of everybody's agenda

It is difficult to pinpoint what triggered this old/new recognition that AIDS is not just the business of the health sector. Probably it was a combination of the sheer number of infected and dying persons, the catastrophic explosion of the epidemic in some parts of the world, the pressure from the groups of people living with HIV/AIDS (PLWHAs), the continuous advocacy by the experts and the AIDS community and the only relative successes of largely health sector-based National AIDS Control Programmes.
For whatever reasons, HIV/AIDS is now one of the top priorities of the development cooperation world, even ahead of climatic and environmental issues that have dominated the agenda for the last 20 years. Everybody talks about AIDS and everybody wants to do something.
This involvement is not completely new, however. In the past, non-health sectors have been active in the fight against AIDS to a varying degree. For example, several countries had  AIDS focal point persons in government ministries. In most cases, however, the early signs of multi-sectoral action were limited to low-profile scattered activities, lacking any systematic approach. Only recently have non-health sectors been really convinced of their responsibilities in the fight against HIV/AIDS. While earlier involvement of non-health sectors seemed to be  restricted to general AIDS awareness talks and condom distribution for the own staff, the focus has now shifted to impact mitigation, concentrating on studying what HIV/AIDS does to education, agriculture or the gross national product and how the devastating impacts can be mitigated. With the exception of the education field, where substantial efforts have been undertaken in the last few years to reach school-based audiences (pupils, teachers and parents), work in other development sectors is often still in experimental and exploration phases.
It would be wrong, however,  to now focus on impact mitigation alone. Non-health sectors should also strengthen their involvement in prevention, care and support. The key to effective action by all sectors is a proper analysis of each sector's role and comparative advantage in the fight against HIV/AIDS. Up to now, most sectors have lacked an in-depth analysis of these issues. Practical tools like the ones described in Rose Smart's Programme Feature on AIDS briefs and toolkits can help different players define the elements of an appropriate sectoral response to HIV/AIDS. Based on an analysis of the internal impact of AIDS on the organisation or sector and on its goals and activities, the various sectors can identify their role in prevention, care and support as well as impact mitigation.
However, the risk of institutionalising or mainstreaming HIV/AIDS into the work of ministries, NGOs and donor support is that it might mean a shift away from personal responsibilities towards institutional responsibilities. It is not only the impact of AIDS in the most dramatic sense (sickness and death) that necessitates a societal response, the dynamic of HIV transmission itself is society's business. The vast majority of HIV infections take place when people are sexually active. The way men, women and the young communicate sexually --with pleasure or with violence, responsibly or irresponsibly, legally or illegally, "normal" or "deviant"--  is socially constructed and no agency or sector, certainly not the medical sector, is in charge of people's sexual affairs. To be in control of their own affairs, people have to have options and choices in general life and in sexuality. Their choices must be based on information and knowledge, on access to condoms and services, on romance and pleasure.

"Let's talk about sex" was one of the catch phrases at the Durban AIDS Conference. For societies (communities, governments, development organisations) to become 'AIDS-competent', they must also be able to talk about poverty and development in general. However, they must first become 'sex-competent' in a much wider sense than the safer sex promoters advocate. "Talking about sex" includes talking about the multiple societal determinants and consequences of sex and sexuality. This should not be forgotten when we expand our HIV/AIDS concerns and activities to infrastructural, rural development and water projects.