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In the fall of 2003, capitulating to both domestic and international pressure, a new plan was agreed upon that would ultimately provide treatment to AIDS patients, this was followed by inertia in implementing it. This chapter captures the response of those whose hospitals and clinics were chosen for the first phase of the roll-out, and who were finally given opportunity to provide life-saving medication to their patients. The chapter recounts the reaction of nurses and doctors who worked in settings that were not selected, whose patients would therefore continue to suffer and die. Finally, the doctors and nurses interviewed speak to the impact of AIDS on their own lives. They discuss their understanding of what it means to be a health care provider in a country whose very social fabric is threatened by an epidemic, and how their experiences with AIDS have shaped their own hopes for a post apartheid South Africa.

The introduction of HAART is one of the great success stories of modern medicine. In fact its application in the developed world has led to striking reductions in HIV-related morbidity and mortality. Consequently, prophylaxis and treatment of opportunistic infections associated with HIV infection are less of an issue in the HAART era than they were before. However, this is not true for developing countries, where the introduction of HAART is still limited to a minority of the population in need and which also have to deal with a dual epidemic of HIV and tuberculosis (TB). Thus, this chapter also discusses prophylaxis and treatment of opportunistic infections in resource-poor settings and specifically deals with HIV/TB dual infections.

For years, debates about the best way to combat the AIDS pandemic have pitted proponents of scaling up antiretroviral treatment for people suffering from AIDS against those advocating for more cost-effective prevention measures. In an important recent article, Dan Brock and Daniel Wikler argue that there is no sound moral basis to privilege the saving of identified lives through antiretroviral treatment, if preventive methods could save more (statistical) lives. This chapter takes issue with Brock and Wikler’s argument. In so doing, it develops a novel account of how the choice between “treatment” and “prevention” intersects the problem of identified versus statistical lives. The chapter concludes with a postscript on “treatment-as-prevention” (TasP), a new avenue of HIV/AIDS research that stresses the preventive benefits of early antiretroviral treatment. It argues that, despite its medical promise, TasP does not transcend the ethical dichotomy between treatment and prevention explored in this chapter.

This chapter describes the pandemic by region, highlighting the changing dynamics of HIV transmission and the diverse patterns of infection found worldwide. The epidemic remains extremely dynamic, growing and changing character as the virus exploits new opportunities for transmission. Virtually no country in the world remains unaffected. The epidemic is not homogeneous within regions; some countries are more affected than others. In reality, like the pandemic, the national picture is made up of a series of epidemics with their own characteristics and dynamics. The number of people living with HIV has been rising in every region, with the steepest recent increases occurring in East Asia, Eastern Europe, and Central Asia. In the coming years, as access to life-prolonging antiretroviral treatment increases, more people will be living with HIV. Providing treatment is both a humanitarian and a human rights issue.

Establishing the impact of the global response to HIV/AIDS is challenging because attribution is not straightforward, and many variables are observed only indirectly. HIV prevalence among young people has declined in almost all countries with significant HIV prevalence. Expanded treatment has reduced mortality among people living with HIV to about 2% in some countries with high HIV prevalence, and 4.6% across developing countries (instead of 8.8% without treatment). In some countries with high HIV prevalence, expanded treatment access has partially reversed the catastrophic health impacts of HIV/AIDS, with life expectancy plunging below 50 years. These gains have been achieved without causing obvious adverse impacts on summary non-HIV/AIDS indicators. The fact that HIV/AIDS has received a ‘disproportionate’ amount of funding relative to other health challenges has motivated charges that ‘HIV/AIDS has received too much money’, and the chapter closes by discussing the validity of this claim.

This chapter introduces the concept of ‘the post-ARV generation’ through a contextual analysis of the history of the HIV-AIDS pandemic in Africa – Uganda specifically – and how that shaped the childhood experiences of those born around the time that prevention of mother-to-child transmission (PMTCT) and antiretroviral treatment (ART) became available. The chapter also provides an account of the humanitarian and development aid responses to AIDS orphanhood, led primarily by NGOs and CBOs and then taken up by national governments and INGOs such as UNICEF and PEPFAR. The chapter considers how each of these developments have helped or hurt children orphaned by AIDS and the aim to create an ‘AIDS-free generation’.

This chapter examines the macroeconomic impact of AIDS in South Africa. It covers macroeconomic models of the impact of AIDS; the macroeconomic impact of antiretroviral treatment (ART); the political and economic consequences of the way in which HIV costs and savings are framed; and the impact of AIDS and ART on inequality.