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This chapter examines the impact of misguided development policy and inadequate epidemiology and health economics methodology on the choice of interventions for HIV and other health problems in poor countries. It discusses the influence of post-World War II development policy and its preoccupation with population control in promoting HIV/AIDS prevention plans that are narrowly focused on provision of condoms, behavior modification, and treating cofactor STDs. It criticizes the programs of UNAIDS, USAID and its private-sector partners, and other AIDS organizations.

This chapter reviews Indonesia's response to its HIV epidemic. Since 2000, Indonesia has had a concentrated epidemic, and the total number of people living with HIV are estimated at around 110,000 (range 53,000 to 180,000), about 10,000 of whom have progressed to AIDS, while over sixteen million people are at increased risk of getting HIV. The launch in May 2003 of the new National AIDS Strategy for an expanded response in line with the global AIDS strategy of UNAIDS was a significant step to ensure a broader multisectoral response. Central government ministries and local governments in partnership with NGOs have to translate the strategy into realistic action plans.

This chapter provides an overview on the data revealed by different agencies on the number of AIDS patients in South Africa over recent years. The international agency UNAIDS reported that in the year 2000 there were an estimated 36 million HIV-infected persons throughout the world and 25 million of them were on the African continent, the vast majority in sub-Saharan Africa. The Republic of South Africa had 4.5 million cases, for a total of 43 million persons. A Department of Health survey conducted the same year found a nationwide rate of seroprevalence among pregnant women of 24.5 percent. The figure was as high as 36.2 percent for the province of KwaZulu Natal, whose capital is Durban, and 29.4 percent for the province of Gauteng, which encompasses Johannesburg. WHO had reported that of the 5.6 million people infected with HIV in 1999, 3.8 million lived in sub-Saharan Africa, the hardest hit region. There were an estimated 2.2 million HIV/AIDS deaths in the region during 1999, being 85% of the global total.

The number of AIDS patients has been increasing in South Africa over the years. The Center for Actuarial Research of the University of Cape Town published a series of projections that were to become the main reference for the entire scientific community in the years following the first efforts to combat this rise. The Demographic and Health Survey of Kenya undertaken by the U.S. Centers for Disease Control had established the prevalence rate for the population of that country at 6.7 percent, considerably lower than the 9.4 percent that UNAIDS had officially validated. These results were also challenged because 14 percent of the women and 13 percent of the men had refused to be tested and may have done so precisely because they thought they were infected. Contemporary societies in South Africa are risk societies as they produce both the danger that threatens them and the awareness of a peril. The South African government ordered a study on mortality in the year 2002 from Statistics South Africa, the national demographic institution.

This chapter discusses the quest for an effective treatment for AIDS and efforts to provide universal access to treatment. In the early 1980s there were no effective treatments against viruses on the market, except acyclovir for herpes simplex and amantadine for influenza. The discovery of antiretroviral therapy in the 1990s changed the lives of millions of people living with HIV, as well as how the world perceived AIDS and the epidemic. HIV infection was no longer a death sentence, and there was hope that one day the epidemic could be stopped. Since then more than thirty antiretroviral drugs have been marketed. In 1999 and 2000 the first generic antiretrovirals arrived on the world market, mainly produced in India by companies such as Cipla and Ranbaxy. This move by the Indian generic industry fundamentally changed access to medicines in low-income countries, in particular sub-Saharan Africa, by introducing generic price competition of drugs still under patent. In 2000 major pharmaceutical laboratories also agreed to lower the price of antiretrovirals for low-income countries as part of the UNAIDS-WHO Accelerating Access Initiative.

This chapter examines prominent organizations drawn from various issue areas and time periods: the World Food Program (1930s to 1960s), the United Nations Development Program (1950s to 1960s), and the Joint United Nations Program on HIV/AIDS (1980s to 1990s). The comparative case studies support all three of the book’s predictions. International bureaucrats’ own insulation from states’ interference, as well as their alliances with personnel in fellow intergovernmental organizations (IGOs) or in non-governmental organizations, shape the extent to which they agenda-set in institutional design negotiations. This, in turn, affects the extent to which they can insulate new IGOs from state control. The book’s argument holds across diverse time periods, issue areas, and international bureaucracies. And international bureaucrats’ role and impact in the institutional design process is not only a widespread phenomenon—it is also a phenomenon that touches prominent institutions about which scholars and practitioners are most likely to care.

This chapter focuses on the emergence of the AIDS pandemic. It covers the emergence of symptoms associated with HIV, the discovery of the virus, and the understanding of its transmission. It emphasizes the importance of AIDS activists in acceleration of the development of drugs that changed the disease from a terminal to chronic disease. AIDS activists throughout the world then worked together to fight for equitable distribution of AIDS treatment. The movement drew an explicit connection between the AIDS pandemic and the right to health and succeeded in garnering novel funding for global health delivery. AIDS changed many things in global health, from patient-led activism to drug discovery to the long-term provision of care. In this book, the global health era is defined as the period after 2000, when AIDS activism helped shift the health paradigm in impoverished countries from prevention only to the delivery of health care.

The health impacts of HIV/AIDS, and concerns on the implications for economic development, resulted in an unprecedented global response, in terms of the resources committed to it, and the establishment of several dedicated international organizations (notably, UNAIDS and the Global Fund). The financial burden of HIV/AIDS follows a very regular pattern—80% of the variation in spending across countries can be explained by the ration of HIV prevalence to GDP per capita. This means than not only countries with very high HIV prevalence, but also certain low-income countries face a steep financing challenge. The chapter discusses the UNAIDS ‘investment framework’ and the drive towards ‘ending AIDS’, and closes with a discussion of the sustainability of the HIV/AIDS response, distinguishing epidemiological, financial, and political aspects.

This chapter centers on the role of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in promoting and protecting HIV-related human rights. It starts by recalling the rationale for creating UNAIDS and explains how its mandate and structure has enabled communities affected by HIV to remain engaged. This engagement has been critical in ensuring that human rights considerations remain at the forefront of the global AIDS response. The chapter also looks at the journey ahead, taking AIDS “out of isolation.” It argues that this process can benefit not only the AIDS response but also other health-related Sustainable Development Goal (SDG) targets, in particular universal health coverage (UHC). It concludes by recognizing the SDGs as a springboard for UNAIDS to scale up efforts to support the realization of human rights, which will ultimately determine whether we will be able to reach the end of the AIDS epidemic.