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[Evaluation of France's contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria: Ten years later].

For 30 years, France has been very committed politically in the international combat against AIDS. The discovery of the AIDS virus at the Pasteur Institute in 1983, the AIDS summit meeting convened by Simone Veil in 1994, the excellence of research by French institutions on its virologic and other aspects as well as the socioeconomic and anthropological issues, and the strong commitment to international technical cooperation against this disease - all these have made (and continue to make) France a major political, technical, and financial participant in this battle against the combined pandemic of AIDS and tuberculosis. More than 10 years after the creation of the Global Fund, 5 years after the first evaluation of this Fund, and 2 years before the schedule for meeting the Millennium Development Goals, an assessment commissioned in 2013 from a French consulting firm of the French contributions is timely. The study was expected. Its results are disappointing. Why? Because the team chosen to conduct the assessment has a limited knowledge of the history of the interventions already funded by France and of the results of earlier assessments. The point was not to repeat the same observations but to move forward to see where they lead. In addition, the current and coming challenges are not considered. The countries to which France is providing cooperation are on the continent that after 30 years remains the most heavily affected by the pandemic. Several transitions are occurring there simultaneously: epidemiologic, demographic and urban. These metamorphoses influencing social values quite substantially, as well as risk factors for transmission of the AIDS virus; at the same time, they facilitate overcrowding and the propagation of tuberculosis. Nor do the authors consider the resistance of these infectious agents to the most commonly used drugs. The effects of the propagation of AIDS, of the expansion of armed conflicts in French-speaking Africa and of the sexual violence alongside them are not mentioned, while France is intervening militarily in Mali! I use the observations of this assessment to discuss all these questions.