Rarely has an issue of The Lancet so well reflected the lack of respect shown by microorganisms to national and international frontiers. When economies are threatened, motivation to find solutions is increased, as was illustrated by the control of the epidemic of severe acute respiratory syndrome (SARS) in 2003 in China. But the scales of the HIV/AIDS and tuberculosis epidemics, particularly in Asia, warrant an aggressive and committed approach to strengthening health systems and to facilitating international collaboration in disease control.
Take Taiwan as an example. To find out about the impact of HIV/AIDS on Taiwan's people, turn to the Comment on page 623. Writing from Taiwan, Yi-Ming Arthur Chen and Steve Hsu-Sung Kuo state that the estimated number of people with HIV/AIDS in Taiwan is about 30 000 (one in 767 of the population), compared with 650 000 per 1·3 billion (one in 2000) in mainland China. The sharing of needles and of heroin diluents are important risk factors for HIV transmission in Taiwan, and HIV-1 subtype studies show similar patterns along known heroin-trafficking routes in southeastern China, offering potential for cross-border harm-reduction programmes. But you will find no explicit mention of collaboration with Taiwan, which lies 120 km off the mainland, in the Public Health paper on China's response to HIV/AIDS on page 679. Since 1971, when the People's Republic of China was admitted into the UN, Taiwan has been excluded from WHO, effectively restricting public-health collaboration.
With the rising incidence of HIV/AIDS in many Chinese provinces, mostly in intravenous drug users, opportunities for collaboration across all borders must be taken. Strategies that work, such as needle-exchange or methadone-maintenance programmes, need to be scaled-up, and consistently used along trafficking routes. Whether in Yunnan, Guangxi, or Taiwan, intravenous drug users face similar risks of contracting HIV, and need similar treatment and support. WHO's objective of “the attainment by all peoples of the highest possible level of health” needs to be translated into real collaboration and communication between WHO and the Taiwanese authorities for the sake of the Taiwanese people's health.