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In 1996, Brazil became the first developing country to adopt an official policy granting free access to antiretroviral drugs through its broad-reaching but ailing public health care system (SUS). In the wake of the country's highly publicized antiretroviral drug rollout, public health and care have become increasingly pharmaceuticalized and privatized, and the rights-based demand for drug access has migrated from AIDS to other diseases and patient groups. A growing number of citizens are acting within the state to guarantee their right to health, understood as access to medicines of all kinds, whether or not they are available in official drug formularies. This chapter examines the political subjects that emerge from this complex law–state–market ecology and shows how in this new chapter in the history of the right to health, the judiciary has become a crucial arbiter and purveyor of care and technology access.

This chapter critiques South African President Thabo Mvuyelwa Mbeki's skepticism of HIV science and his move to halt the distribution antiretroviral drugs in South Africa. When Mbeki became the president, almost one in five South African adults was already infected with HIV. Rather than immediately developing AIDS policy based on scientific consensus, Mbeki took seriously the claim that HIV science was fundamentally flawed and corrupted by the pharmaceutical industry. He convened the Presidential AIDS Advisory Panel with half the seats allocated to HIV critics, and half to HIV scientists and clinicians. The conflict between the opposing parties delayed the distribution of antiretroviral drugs. The chapter argues that Mbeki's skepticism mirrors three key characteristics of AIDS denialism: extreme cynicism toward the science of HIV pathogenesis; ignorance of advances in antiretroviral treatment; and the active promotion of alternative, unproven therapies in its place.

This chapter reviews Costa Rica's response to its HIV epidemic. The country's most important achievement in dealing with the epidemic thus far has been ensuring access to affordable antiretroviral drugs for all patients who need them. It must be remembered that Costa Rica is a developing country with limited resources to spend on services, and yet it prioritized and managed this problem as though it were part of the wealthier, industrialized world and did so without any foreign financial support. What made this possible was the country's focus on developing social services for its populatin and the size of the epidemic: by the time HIV patients started receiving HAART in November 1997, there were no more than 400 patients requiring it. As soon as they appeared, antiretrovirals were purchased as generics, with optimal results in terms of CD4, viral load and health recovery.

This chapter examines how the World Health Organization (WHO), under the leadership of Director-General Gro Harlem Brundtland, was able to overcome the most pressing financial difficulties and regain some of its authority over global health programs by strategically adapting to the principles of neoliberalism. It considers the WHO's efforts to accommodate the interests of the private sector and reinvent the organization as a business-friendly venue, in part by avoiding antagonizing an industry even when important health issues were at stake. It also discusses the WHO's strategic resistance in two instances: a global campaign against the tobacco industry as part of its antismoking mission, and the WHO's opposition to the pharmaceutical sector in the dispute over intellectual property protection and access to antiretroviral drugs.

This introductory chapter focuses on the different conspiracy theories about acquired immune deficiency syndrome (AIDS). Most people do not believe conspiracy theories about AIDS. But suspicions that the human immunodeficiency virus (HIV) may have been created in a laboratory, and that the pharmaceutical industry invented AIDS as a means of selling toxic drugs, persist until today. There are two theories about the origin of HIV. First, HIV is a manmade bioweapon; and second, HIV is harmless and antiretroviral drugs themselves cause AIDS. Although very different, both theories make a “conspiratorial move” against HIV science by implying that scientists have either been duped by, or are part of, conspiracy to inflict harm. This book explores the factors prolonging the erroneous belief that the American government manufactured the HIV to be used as a biological weapon, as well as the belief that antiretroviral drugs caused AIDS.