Diary Prequel Package — page 7

foreign-born persons. We also believe the U.S. has a duty to ensure that those resources go to efforts that are medically and scientifically sound and will contribute to the development of a sustainable health infrastructure in the most affected countries so that they can meet their challenges themselves over time. Providing drugs at or below cost is only part of the solution. It is estimated that approximately 50 percent of HIV-infected people in the U.S. meet the HHS treatment guidelines for beginning antiretroviral therapy. What this percentage might be in developing nations is unclear. However, perhaps as important as providing antiretroviral drugs in some circumstances is treating opportunistic infections and providing nutrition and clean water. Yet even if enough drugs to treat every single infected person were sent, free of charge, to the African continent, an adequate surveillance infrastructure for testing for HIV infection and an adequate health care delivery system for administering the drugs do not exist in many countries. Furthermore, the capability of monitoring patients to insure they are taking these complex regimens of drugs properly and to determine the spectrum of toxicity and the effect of treatment on the spread of the disease There is no existing surveillance capability to ensure that patients follow extremely complicated drug regimens accurately, or to monitor what effect the treatment has on the spread of the disease is sorely lacking in many places. We should begin to help create the basic system to provide needed medications for opportunistic infections and symptomatic care, while also building the more complex systems needed to provide antiretrovirals and other medicines safely and effectively to avoid creating resistant strains, a lesson we have learned from efforts to control tuberculosis. At the same time, we must continue to focus our efforts on prevention ? a proven strategy that is cost-effective. Government accountability, individual behavior change and abstinence-based approaches (where they are culturally appropriate) must be part of prevention efforts. We have found that