The War on HIV
One of the great global-health triumphs

Outside an HIV clinic in Nyagasambu, Rwanda


Patrick Brennan

This week, the world was rocked by the news that an infant born in Mississippi with HIV has apparently been cured: The child tested positive for the disease several times in the first month after her birth, while she was receiving aggressive antiretroviral (ARV) treatment, but now, at the age of 23 months, she shows no sign of HIV.

This development points to a hopeful way forward for infants who contract HIV during gestation or at birth, but almost all of them live not in Mississippi, but in places like Mali and Namibia. Yet thanks to the United States government and private benefactors, prompted by President George W. Bush, many of those children and their mothers do have access to some HIV/AIDS treatment programs.

Just a decade ago, before President Bush inaugurated the President’s Emergency Plan for AIDS Relief (PEPFAR), it was considered impractical and unaffordable to provide the world’s poor with HIV drugs. But because the U.S. has implemented PEPFAR so widely, driving down the cost of the drugs dramatically, whatever treatments come out of the Mississippi case should now be feasible in areas like southern Africa, where the HIV pandemic still rages.

Essentially, a pregnant woman who is diagnosed as being HIV-positive is treated with especially high doses of ARVs, weakening the presence of the virus in her system and making her less likely to transmit it to her child via bodily fluids. Because of this treatment, mother-to-child transmission (MTCT) is now very rare in wealthy nations — only 100 to 200 American children per year are born with the virus.

In the Mississippi case, because many risk factors were present, the doctor decided to begin treating the child with HIV drugs just 31 hours after birth. This appears to have to knocked out the virus for good (even though the mother took the baby out of the doctors’ care after about twelve months). It seems likely that this will become a plausible treatment in wealthy countries in the rare case when MTCT still occurs. The most obvious implication for the developed world, in fact, is that more accurate and quicker testing of babies born to HIV-positive mothers is needed, to detect whether the preventive measures have failed.

But such transmissions remain heartbreakingly common in the developing world — globally, hundreds of thousands of babies every year are born infected with HIV, and some who escape pre-natal transmission acquire the virus soon afterward via breast feeding by an infected mother. Many poor mothers still don’t know they are infected; even if they do, they don’t have regular access to ARVs during pregnancy, and don’t receive a regimen of drugs. Without that dosage of drugs around birth, the odds of passing on the virus are as high as one in two.

But many impoverished women in Africa and elsewhere do receive some pharmaceutical treatment, and these programs are expanding rapidly, thanks to Western generosity. If it weren’t for the programs already implemented and the progress made, the discovery in Mississippi would be as meaningless to the vast majority of AIDS victims as ARVs were before President Bush took action.

For years, the twin totems of sexual tolerance and cost effectiveness meant that the West’s approach to the HIV/AIDS pandemic was to hand out condoms, withhold judgment about risky behavior, and watch Africans die.

That began to change when PEPFAR began investing billions of dollars in treatment programs around the world, but concentrated in southern Africa. Actual treatment for HIV/AIDS had been considered completely unaffordable in the developing world. But the U.S. government went to the multinational pharmaceutical firms that Western liberals had been demonizing for years, and offered to begin buying billions of dollars’ worth of drugs, for millions of new patients, in exchange for dramatically lower drug prices in African markets and quicker availability of generics. Unsurprisingly, the corporations agreed. Simultaneously, the government of South Africa, which is home to about a quarter of the world’s HIV victims, finally admitted — under pressure from domestic activist groups — that AIDS drugs do in fact work. In doing so, the country’s largest party, the African National Congress, had to let go of an anti-colonialist strain of denialism about the causes and treatment of HIV, which the U.N. repeatedly offered president Thabo Mbeki platforms to espouse.