Year 25+

A few developments in the past few years have come to light in the world of HIV/AIDS. One is that people on anti-retroviral therapy for a decade or so- which we're beginning to see now in the United States- develop chronic conditions like cardiovascular disease, kidney disease, diabetes and cancer at a premature age. This wave of chronic disease is just beginning to hit the developed world, and it will be a tremendous challenge to Africa and the rest of the developing world in the near future. The other development, which is an offshoot of the AIDS activist movement from the early days of the AIDS pandemic, is the shaping of AIDS policies and the creation of HIV care systems by people living with HIV. While those with HIV have always been the midwives of HIV care, the remarkably rapid expansion of HIV care in Africa over the past few years is a unique testament to this movement. Furthermore, when people are both patients and providers in a health care system, in their own communities, they are a powerful engine for transparent, accountable health care systems built from the ground-up. The future will tell whether the systems they've helped build can broaden to manage the new face of AIDS- which really means whether these systems can provide comprehensive care for all health, given the multiple dimensions of chronic HIV infection.