Compartmentalizing HIV intervention programs has, from the beginning, reduced its potential for success. The only effective and sustainable way to reverse the course of the HIV/AIDS pandemic and its companion epidemics is to de-exceptionalize it. Stand-alone HIV prevention and care clinics should not exist. HIV and tuberculosis ought not to be treated as stigmatized outlier syndromes. Syphilis, gonorrhea, hepatitis C, pediatric dysentery—all must come under one tent. And in building that tent the world needs to recall that nearly 75 percent of global wealth is now in the hands of just nine nations, according to 2003 World Bank data. Combined, the poor countries of the world, representing the majority of the population, possess less than one percent of global wealth. By necessity, building a health tent must mean attracting funds from the wealthiest nine states to the needs of the poor, on a massive and sustained level. Given the scale of the challenge, coupled with the constant emergence of new disease threats and potential for manmade scourges, the key for policymakers is to build alliances, work with and strengthen existing multilateral agencies, and avoid bilateral approaches that can undermine and alienate members of the international community.

Local support for these programs is also imperative. This support is two-pronged: community acceptance for the programs being administered is necessary for their success, as are human resource support systems to make the programs sustainable after the international community departs. Integrating services and de-exceptionalizing HIV will go a long way to minimize the stigmatization of this disease and increase community “buy in.” To begin to repair the human capital issues, the obvious yet daunting answer is to lessen the developed world’s demand for foreign health care workers while creating incentives for developing countries’ health workers to stay home. These changes will not occur overnight, but even a gradual shift away from the current trends can make a substantial difference in program effectiveness and begin to reinforce the local confidence level that has been eroded by years of failed promises.

Strengthening multilateral institutions, building local capacity, and improving communication and coordination between agencies will not be an easy task. Humanitarian and development agencies are not known for their ability to play well with others, and many world leaders continue to deny the global catastrophe that is waiting for them if they continue to neglect the need for focused and realistic infectious disease interventions. In contrast to their relatively low ranking on foreign policy priority lists, these issues represent an immediate threat to the security and stability of both the developed and the developing world and can no longer be overlooked.