Earliest and hardest hit so far were the countries of East and southern Africa. Some countries, such as Uganda and Senegal, have undertaken energetic efforts to prevent the spread of HIV and deal with the impact of AIDS. In these countries high-level political support and initiative proved crucial for an effective, comprehensive and nationwide response. Similarly, Thailand responded timely to an emerging epidemic, before HIV had already widely spread. Other countries however, such as South Africa, are still struggling with their response. Lack of political will has caused an unnecessary delay in the response, while hard-learned lessons from neighbouring countries were available.

In many countries we see that the initial response concentrates on, and remains limited to specific vulnerable groups, especially in urban areas. Even 20 years into the epidemic, in many rural areas of sub-Saharan Africa, the fight against AIDS yet needs to start.

Towards comprehensive, multisectoral responses

Over the years, priorities have shifted. Initially, in the absence of any effective drugs to control HIV, prevention and home-based care were the main strategies to deal with AIDS. As the numbers of people living with HIV/AIDS (PLWHA) grew, issues of care and treatment became more important, and the concept of the continuum of prevention and care became generally accepted. The development of effective antiretroviral treatment and the lack of access in poor countries highlighted the influence of economic and political powers, and some important victories for increased access to these drugs were won by activists around the world, such as in Brazil, Thailand and South Africa.

In later stages, HIV/AIDS ceased to be regarded as an exclusive health problem. Only two years ago, HIV/AIDS was finally recognised at high political levels as a major, worldwide problem threatening economic development, social stability and security, and neutralising the development gains that had been achieved at great cost over many decades. The International AIDS Conference in Durban, 2000, the UN General Assembly Special Session on HIV/AIDS in 2001, and various other regional and world summits finally placed HIV/AIDS high on the agenda. Comprehensive, multi-sectoral approaches, mainstreaming, scaling up etc. have become buzzwords, but will decisive action follow? In the mean time, other problems continue to compete for the world's attention – and funds.

Taking stock of progress

Today, we are more than 20 years into the AIDS pandemic: many people have suffered and died, but many good lessons were learned as well, and societies and communities are slowly learning to be ‘AIDS competent'. Although socio-economic, cultural and political contexts differ greatly across the world, lessons from one country can be adapted to the context of another. Perhaps there are no "best" practices, but there are definitely "good" practices. However, these good practices and lessons learned are not automatically shared and taken into account. Last year, we had a special issue on countries with low HIV prevalence: it showed that silence, denial and stigma related to HIV/AIDS still rule many countries of the world, and that lessons learned at a very high cost in Africa are not always taken into account elsewhere in Asia, Latin America or Eastern Europe, where new HIV epidemics are rapidly emerging.

This issue of the S/HE wants to address the many ways in which HIV/AIDS affects different groups, societies and settings worldwide – such as orphans and vulnerable children in Africa; injecting drug users in Asia; men who have sex with men in Latin America – as well as how the local and national responses vary accordingly – truly multisectoral collaboration; harm-reduction programmes; greater involvement of PLWHA, to name just a few. It may take the world decades to eradicate HIV – if at all possible – but let us hope at least that 20 years from now, we will have been able to apply what we know works best.