HIV/AIDS and the rest of the global health agenda.

HIV/AIDS has reached the pinnacle of the global health agenda. More than 26 000 individuals attended the most recent international AIDS confere ence, one of the largest gatherings on international health in history. Annual funding to address HIV/AIDS in lowe and middleeincome countries has risen 28efold since 1996, reaching $8.3 billion in 2005.1 The emergence of HIV/AIDS as a global health priority is reason for celebration, because the tide may be turning against this humanitarian crisis, and because this prioritization may have galvanized commitment to addressing other health problems in the developing world. It is also reason for concern, bee cause the extensive focus on one disease may be crowding out resources and policyemaker attention for the many other causes of death and illness of the world’s poor people, a phenomenon that occurred in the past with powere ful causeespecific campaigns. While HIV/AIDS imposes a high burden, as of 2001 it was far from the dominant cause of illness and mortality in low and middleeincome countries, representing 5.3 % of deaths and 5.1 % of disabile ityeadjusted lifeeyears,2 figures that are unlikely to have changed significantly since then.1 Ideally, governments and other ace tors would provide sufficient resources to address all major health conditions effectively, including HIV/AIDS. The reality is different. Health budgets in most developing countries are small.3 Official aid for health as of 2003 4 was less than a third of the US$ 27 billion recommended by a WHO commise sion.5 Insufficient funding reflects ine adequate global political commitment to address health problems — particue larly those that affect poor people. This situation forces health initiatives into the unfortunate position of having to compete against one another for scarce resources. If one cause becomes domie nant, others may suffer. There is increasing evidence that HIV/AIDS may be having just such