Document Type

Article

Disciplines

International Law

Abstract

Twenty years into the HIV/AIDS epidemic, research has produced scientific advances in diagnosis, treatment and understanding of the basic pathophysiology of the disease. In the United States, Western Europe, and other developed countries these advances included development of complex combinations of new pharmaceutical therapies that can hold HIV at bay, reverse some of its damage to the immune system, and prevent progression of the disease to AIDS and death. The drugs do not cure HIV, however, and for now it appears that successful treatment means treatment for life, often at a cost of tens of thousands of dollars a year. Unfortunately, for most residents of non-western countries, these miraculous drugs are not available. For most of the world, the "official" message from public health experts, international organizations, and their own governments has been "prevention is the only cure," or, in the alternative, "until we develop a vaccine, prevention is all we have to offer." In fact, the received wisdom has been that it would be impossible to deliver combination therapy for HIV/AIDS to patients in the developing or undeveloped worlds and to ensure their safety through monitoring. Since the late 1990s, however, we have seen the beginnings of a paradigm shift in rhetoric, expectations, and even the experiences of people living with HIV in developing countries.

This paper examines some aspects of this paradigm shift, whereby we have gone from assuming that combination therapy for HIV could never be given in India or Africa, to asking "Why not? Why is it that millions of people who could benefit from something are being denied it?" First, the paper will review the current situation, the global disparities that frame this debate, and then it will look at potential barriers to and opportunities for improving HIV care. Next, it will consider, specifically, the role of international law and human rights in changing the landscape and the roles of state and non-state actors in making change possible.

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