HIV positive mothers need treatment for themselves and their children © United Nations' Integrated Regional Information Network

On average a patient with the HIV virus can live a normal life for 10-11 years without treatment. A cocktail of drugs known as antiretroviral therapy (ART) should commence when the immune system has weakened to a measurable threshold. The virus is not eliminated by ART but the risk of onset of Acquired Immune Deficiency Syndrome (marked by the establishment of one of a range of serious illnesses associated with immune deficiency) is reduced by about 80% giving the prospect of a reasonably normal lifespan. In about 10% of patients the treatment fails, and an alternative "2nd line" therapy is substituted.

Such is the position for people living with HIV in rich countries. In poor countries circumstances often conspire against the progress of modern medicine. The patient may be unaware that he or she is HIV positive, or there may be no available test for the ART threshold, or there may be no government funds to pay for the treatment. Other obstacles include the complexities of tuberculosis, often dormant in people living with HIV but liable to be activated by the virus. For those receiving ART drop-out rates of between 46% and 85% in Africa after just 2 years betray the shortage of skills for prescribing and monitoring antiretroviral treatment.

By the end of 2006, only 2 million people were receiving treatment in developing countries out of 7.1 million in need. Some estimates suggest that 14 million will be in need by 2010, the target date for universal treatment. Prospects are much dependent on the price of drugs which is a constant source of tension between the humanitarian concern to save lives and the profit motive of multinational pharmaceutical companies armed with 20 year patent protection. Although World Trade Organisation (WTO) rules permit the least developed countries (LDCs) to acquire or manufacture low cost generics until 2016, middle income countries such as India, Thailand and Brazil depend on less concrete concessions in WTO rules for health emergencies.

There are concerns that the current fashion for regional and bilateral Free Trade Agreements will close down these concessionary clauses, preventing the development of generics for prohibitively expensive 2nd line ART drugs. These painful lessons about equitable distribution of drugs may prove invaluable if the daunting problems associated with finding a vaccine for HIV are eventually overcome.

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