Sustained action for scaling up treatment for the HIV epidemic presumes solutions to numerous scientific and management challenges. At the same time, as wealthy, middle-income, and poor nations join together to tackle the overarching challenge of bringing the pandemic under control, it bears emphasizing that the global problem of HIV/AIDS will likely be present for decades despite research findings and optimized interventions. In a few years, when it may be hoped that the initial objectives of WHO’s 3-by-5 campaign and the U.S. Emergency Plan will have been met, we must not abandon the millions started on therapy or ignore the pleas of the tens of millions more who will soon need these medicines. Even short-term interruptions in support could be clinically disastrous and ethically unconscionable by allowing successfully suppressed HIV infections to emerge in drug-resistant forms. Thus, ART must not be seen simply as a short-term goal or the end point of a 5-year plan. The world is indeed at the beginning of a very long path forward that will require vigilant and sustained support.


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