I have been thinking a lot about a report I read recently indicating that there are today more than a quarter-billion regular Internet users. Indeed, the birth of the World Wide Web in 1991 ushered in a new era in the Information Age, providing people access to the structured delivery of issue-specific information at the stroke of a key or the click of a mouse button. In 1992, the World Wide Web comprised just 100 Web sites. Today, according to technology analysts, the Web is reported to grow by 300,000 more Web pages every seven days.

Yet, access to knowledge delivered via the Internet and other telecommunications media is denied so many. In turn, this denial threatens any progress we may make today on so many fronts, including medicine. With all due respect to our South African colleagues, what we are witnessing at the dawn of the 21st century is digital apartheid. I use the word "apartheid" purposefully because it immediately conjures up powerful images and powerful lessons. These are lessons, however, that we may fail to apply to other challenges to social and economic justice. The reality is that we will never begin to effectively address the challenges of endemic and epidemic diseases without understanding the intersecting challenges of poverty and lack of access to information.

Access to computers, the Internet and, as important, training to acquire the skills necessary to benefit from this information revolution, is dictating who can participate in the Information Age and who cannot. As with healthcare, the inequities in access to health information and support on the Internet has spawned a world of information "haves" and "have nots." In an attempt to end this cycle of digital apartheid, the International Association of Physicians in AIDS Care (IAPAC) launched I-Med Exchange (see February 2000 JIAPAC). Our goal with the I-Med Exchange is to ensure that physicians in the developing world benefit from instantaneous access to far off libraries, universities, and other troves of data via the World Wide Web. Physicians in the South should have an equal opportunity to reinvent their profession, to utilize telemedicine, and to access up-to-the-minute clinical information. In addition, our hope is that this new outlet will allow for personal and political expression by physician participants who utilize interactive, Internet-based fora to voice their opinions--both clinical and social--and listen to the views of others.

IAPAC members who frequent our Web site--www.iapac.org--will soon notice another information technology-related effort. In recognition of a growing need for comprehensive yet easily digestible medical and public health information, IAPAC plans a significant re-design and expansion of our Web site under the direction of its new managing editor, Douglas J. Ward, MD. An HIV/AIDS-treating physician who cares for more than 250 patients, Dr. Ward has made a commitment to ensure that IAPAC's Web site serves as a unique portal to cutting edge clinical management information, AIDS drug monographs, and incisive analyses of regional, national, and international conferences related to HIV disease and other coinfectious illnesses.

The site also will serve as an outlet for IAPAC members to become involved in advocacy efforts to better the lives of people globally who are living with HIV/AIDS and associated complications. In line with IAPAC's efforts to end digital apartheid, Dr. Ward and a select group of IAPAC members from the developed and developing worlds will spearhead a re-tooling of our Internet capabilities to take full advantage of a communications medium that has enveloped the physical world, altering traditional concepts of health, economics, politics, and social relations.

The Internet has the potential to revolutionize healthcare beyond the borders of industrialized nations, accelerating the dissemination of critical medical information and thereby enriching the lives of people around the world. Now is the time to take bold steps to broaden the circle of people whose lives have been positively affected by the information revolution. Recognizing a moral imperative to discover ways in which to overcome the seemingly insurmountable barriers, IAPAC is taking bold steps to address the information access crisis. To do otherwise would contribute to digital apartheid.

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ÆGIS is made possible through unrestricted grants from Roxane Laboratories, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeard in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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