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Still Losing the AIDS Fight

But none of this will work without widespread testing -- highly confidential but highly encouraged (which can now be done with simple, cheap 15-minute tests). I have been criticized in the past by some in the international health community for advocating testing, on the grounds that it would violate people's privacy. This is, of course, not my intent: Confidentiality must be respected.

And attention must be paid when Dr. Fauci speaks. Along with former president Bill Clinton, he is one of the few who have publicly advocated vastly increased testing as part of a strategy to stop the spread of HIV. (Even in the United States, according to the Centers for Disease Control and Prevention, at least one in four Americans with HIV do not know they are infected.) In no other medical epidemic in modern history has detection been such a low priority. But because HIV is sexually transmitted, it still carries stigmas in much of the world, including, until fairly recently, the United States. Those with AIDS lose jobs, are thrown out of their families, are denied medical help and are left to die alone. These appalling but widespread reactions lie behind long-standing international guidelines that testing should be completely voluntary.

Here is my challenge to the international health community: This year, tell the truth on World AIDS Day. Admit that we are still losing. Advocate strategies that emphasize prevention and detection, based on the successful "opt-out" testing systems being tried in Botswana, Lesotho and Malawi. If current policies are not changed, we will face uncontrollable growth in the costs of treatment of the victims of a disease that should be, as Bill Clinton has said, completely preventable.

Richard Holbrooke is the chairman of the Asia Society, and president of the Global Business Coalition on HIV/AIDS, Tuberculosis, and Malaria.