Reviews

AIDS in the digital age

Is the internet relevant to addressing HIV/AIDS in India or Africa?

To combat the AIDS pandemic it is necessary to deliver timely, credible, and multisectoral information about HIV. It has to reach not just clinicians and scientists, but a huge array of others, such as behavioural specialists, policymakers, donors, activists, and industry leaders.

It must also, of course, be accessible to affected individuals and communities, many of whom live in the world's poorest, least wired countries. The G8 Digital Opportunity Task Force estimates that low income countries account for about 60% of the global population, but only 5% of the world's internet users.

In addition to poverty, constraints to using the internet include high local and international telephone connection charges, the import duties on equipment, limited bandwidth, telecoms policy, import duties on equipment, high tech brain drain, lack of email privacy, monitored or censored internet access, and the huge barriers to accessing information because of differences in language, literacy, or culture.

Amazingly, despite these enormous obstacles, many of those working in the HIV sector in poor countries are accessing the internet. Yes, the number of internet users in Africa, estimated at about 4 million, is small. But low cost, email only services are attracting many African subscribers. Many use Yahoo or Hotmail accounts and often access them at the increasing numbers of cybercafes or public kiosks.

In Asia, a high speed, broadband service is being piloted in China, India, Indonesia, and Thailand.

Electronic discussion forums and HIV websites have allowed the North and South to share knowledge. Even more importantly, they have allowed those in the South to share their experiences with each other. Many national associations of people with AIDS and community based organisations in Africa and India have at least one member with an email account. Many are using email networkinga cheap, fast, effective way to disseminate information that they have created themselves.

The internet has brought people together, even from remote regions, to a "virtual conference table" and a "virtual consultative process." Some of the most marginalised communities of the world are actively involved in dialogue and in policymaking on HIV.

What about online content? There are an enormous number of websites dedicated to HIV/AIDS (the box left highlights only a fraction of them). There are also numerous databases of research, and some, such as PubMed, can be accessed without charge or registration.

Unfortunately, for nearly all articles only the abstract is availableyou need to pay to see the full article. Although full-text access is increasingly available through institutional subscriptions to researchers in rich countries, the cost of a single subscription to a major journal often exceeds the average per capita income of many poorer countries.

This month, though, more than 100 of the world's least developed countries are projected to get access to over 1000 of the top biomedical journals (BMJ 2001;323:65). This deal could transform the working environment of HIV professionals in these countries.

In many ways, the battle for access to high quality online HIV information in poor countries echoes the battle against the HIV epidemic itself. In both, countries face challenges related to socioeconomic resources, good governance, and the participation of civil society and marginalised communities. We do not doubt that the internet, email, CD ROMs, DVDs, and wireless technologies will continue to increase the number of people involved in HIV/AIDS policy dialogue, promote partnerships and networking, improve access to and quality of information, and increase accountability and transparency in decisionmaking.

Lisa Garbus, Laurence Peiperl, editors, 

HIV InSite (hivinsite.ucsf.edu), San Francisco

Manju Chatani, program manager. 

Health & Development Networks (www.hdnet.org), Accra, Ghana