It’s only recently that treatment has been acknowledged as a legitimate priority. The argument about whether treatment was feasible in resource-poor settings raged for years, in research labs, in halls of legislature, and in hospitals. At the beginning of the pandemic, there was fierce disagreement on whether to focus on prevention, to avoid further spread of the virus, or to offer treatment to those already infected. Some funders wanted to devote a larger portion of money to research, in the hopes of finding a vaccine or a cure.
Many – including policymakers at World Health Organization and the United Nations – asserted that it was much more cost effective to focus on prevention, and if possible, to provide palliative care for those dying of AIDS. In 2001, the Bush administration’s highest-ranking foreign aid official, Andrew Natsios, said that most funding should go towards prevention, as treatment regimens were too complex for Africans who “have never seen a clock or a watch their entire lives.” The arguments against treatment seemed formidable. The cost of drugs alone seemed prohibitive. Typical costs in the US per patient per year were $15,000 in 1995, when the medicine first became available. Even with special agreements with pharmaceutical companies, the cost was far beyond the average per capita income of USD $425 in sub-Saharan Africa that year.
The question of denying treatment in impoverished nations based on cost-effectiveness enraged human rights activists, who pointed out that no-one suggested prevention as the only response to AIDS in wealthy countries.
Poor health infrastructure continues as another obstacle. Health systems in post-colonial countries may be weakened by generations of neglect, civil war, a lack of adequate governance, brain drain, and unsustainable external debt. Inadequate infrastructure and human resources for health makes procuring, delivering, distributing and monitoring the medicines difficult. Erratic drug distribution can foster drug-resistant strains of the virus – undermining the effectiveness of the few existing drugs in combating the epidemic.
Africa is particularly hard hit by this disparity in access to ARVs. The epidemic was long established on the continent before drug treatment was developed, and thousands were infected with HIV. However, throughout the last decade, evidence was mounting that treatment was essential to stemming the tide of the AIDS epidemic.
- The availability of treatment encourages testing and knowing one’s HIV status.
- Treatment is remarkably effective in halting the advancement of AIDS symptoms.
- Treatment of those who tested positive lowered their viral load, increasing a patient’s health and decreasing their risk of passing the virus on.
Many argued that equitable access to treatment was simply socially and morally just.
Once anti-retroviral treatment had been developed – and transformed HIV from an imminent death sentence to a severe, but manageable, illness – the question of who would receive treatment became a topic of fierce debate. Drugs that were commonly available to the sick in wealthy, industrialized nations by 1996 were simply unaffordable to governments in the rest of the world. Despite progress, they continue to be unavailable to many. Yet many believe that treating a privileged minority, while leaving others to die, is inexcusable.