AIDS: A new pandemic leading to new medical and political practices

It seemed appropriate to assemble these texts now, at a time when the history of our AIDS missions is compelling us to formulate new goals. Until 1996, all we could do was to try to prevent and treat some of the opportunistic infections. Since then, the advent and large-scale distribution of antiretroviral drugs have turned the HIV field upside down, and the new drugs have brought new questions. At what stage of the infection should we start prescribing antiretroviral therapy? What should we do to ensure that every patient who needs treatment can get it, when millions still don't have access? How can we reduce the number of new cases? Can the epidemic be controlled in places where the HIV prevalence is very high?

The first text is taken from a book on medical innovation in the specific context of humanitarian situations. It looks at the different attitudes adopted by MSF over the years in response to human immunodeficiency virus (HIV) epidemics, starting in the early 1980s and stopping at the end of the first decade of the 2000s, when millions of patients worldwide began receiving antiretroviral therapy. The second text picks up the thread of that story, but this time at the field project level, in the Homa Bay district of Kenya.

The last two texts offer an anthropological perspective on two issues discussed among the Homa Bay project teams: how caregiver team analyses connect the local culture to the spread of the epidemic, and the conditions for patient access to HIV diagnosis and treatment.

To this selection we have added a DVD with five films showing the different steps taken to implement preventive and curative treatments in Malawi since the early 2000s. A sixth documentary looks at issues of antiretroviral access in low-income countries from a political and economic perspective.