The Global Reach of HIV/AIDS: Science, Politics, Economics, and Research

Abstract

HIV/AIDS affects people throughout the world - their health, their communities, and their countries' economic structures. It is truly a global epidemic, imposing a burden on all countries and regions, leaving none immune from its devastating impact. Of the forty-two million people infected with HIV/AIDS, almost ninety percent live in developing countries, which can least afford the sickness, death, and loss of productivity associated with the epidemic. Prevention of HIV/AIDS would benefit all regions and countries, irrespective of the prevalence or incidence of HIV/AIDS in the population, as all social and economic life in the early twenty-first century is interconnected. HIV/AIDS in one part of the world is bound to affect the health, economy, and security of countries everywhere. Given the level of need, there ought to be little disagreement that the more prosperous countries of North America and Europe should be devoting significant resources for education, prevention, and treatment in the poorer countries of Africa and Southeast Asia. International organizations such as UNAIDS, the WHO, and the World Bank have issued warnings and calls for action. Yet, political leaders in developed countries have not viewed it in their self-interest to provide the kind of resources needed. This lack of political will to cooperate may be caused, in part, by insular attitudes toward world health, economics, and politics and in part by the fact that resource-rich and resource-poor countries have markedly different priorities tailored to the different dynamics of the epidemic in their regions. Developing countries have been hurt not only by lack of political will, but by the interplay of drug companies, patents, and international law. Pharmaceutical companies have been unwilling to take steps to make drugs and potential vaccines available in resource-poor markets, instead electing to vigorously defend their proprietary interests in their drug patents. This strategy drives up the costs of most modern medications, leaving them out of reach for the poor. International law tends to support protection of these patents, but may provide some opportunity to circumvent property rules to protect the public's health. The research community has struggled with whether the ethical standards held in developed countries apply when engaging in research in less developed countries. Stakeholders are at odds and struggle to find the balance between ensuring strong ethical standards and expediting access to cost-effective treatments in poor countries. Although many of these trials would doubtless be regarded as unethical if conducted in the United States, given the social and economic context, it may have been unethical not to conduct the most rigorous and efficient international studies. The strategies needed to reduce significantly the burden of HIV/AIDS are well known and demonstrated to be effective. What is still needed are the economic resources and political will necessary to implement comprehensive programs for AIDS prevention and treatment in every region.