The 11 March 2003, the NAC carried unanimously the report entitle Rethinking the response to HIV/AIDS in the French overseas departments.

The evolution of the HIV/AIDS epidemic in the overseas departments remains a cause for concern and still does not seem to be under control. The incidence rate is seven times higher than in metropolitan France : 17 new AIDS cases per 100 000 population versus 2.5, between 2001 and 2002. Within the various departments, there still are huge disparities : over the same period, French Guiana totalled 43 cases per 100 000 population, as opposed to 3 in Reunion.

Although very far away, these territories are full French departments in which such a situation cannot be tolerated. The members of the Council -an independent advisory body designed to provide the public authorities with recommendations on the fight against HIV/AIDS -, decided to establish a state of the art inventory, complete with recommendations, on the epidemic in the overseas departments.

Since the Council’s 1996 report on the ‘French departments of America’, progress has been made as regards infrastructures, particularly hospital settings, but the implementation of antiretroviral therapies has modified the epidemic’s management. Problems now arise in access to care that did not exist a few years ago and many difficulties remain as regards patient care and follow up, prevention and confidentiality.

The situation is such that the Council is issuing recommendations to both national and local authorities, as well as to the local councillors and health care providers.

Specifically, the National AIDS Council:
- advocates strong commitment from the national authorities who must be backed by their health services and promote general health and sex education policies ;
- calls for the local assemblies to take their share of public health responsibilities ;
- recommends an increased effort in health care training and better coordination between private and hospital health care ;
- demands that access to care be guaranteed and social care ensured to any HIV-positive person, regardless of nationality ;
- suggests the implementation of effective cooperation with the local neighbouring countries in the fight against AIDS.

Closely linked with poverty and social exclusion, HIV/AIDS particularly affects French Guiana, which is France’s worst-hit department. Despite some individual commitment, the epidemic is not under control.

In this respect, HIV/AIDS reveals the structural deficiencies of the health system : the shortcomings of HIV/AIDS policy, observed during the Council’s visit to Guiana, highlight the shortfalls of French Guiana’s entire health system.

A more efficient combat is however possible : it requires thorough analysis of the mechanisms that have failed and a real administrative and political investment.

That is why the Council, whose concern it is to improve management of the HIV/AIDS epidemic, recommends the implementation of a general health and welfare programme in French Guiana, over and beyond AIDS-specific considerations. By so doing, the Council shows evidence of its will to contribute to the global improvement of the population’s living conditions.

The National AIDS Council is aware of the tremendous difficulties that the local authorities need to overcome. The Council’s position is based on a definitely positive ‘food-for-thought’ perspective designed to improve the existing programmes.