HIV is the leading cause of premature death in Thailand. Since the first case of AIDS was reported in 1984 more than one million Thais have been infected. The social, human and economic costs of this burden are enormous. The Thai government has shown a strong commitment to providing care and support to persons living with HIV/AIDS by launching the National Access to Care Program (NAPHA) in 2003, which provides for publicly financed antiretroviral therapy (ART) to all HIV-infected people. This book documents through interviews how ART has radically changed the lives of those living with HIV. In the words of an HIV positive 29-year old man, ART is a "miracle." The book then develops an innovative analytical framework and uses it to show how the future sustainability and cost-effectiveness of this ambitious program depend critically on Thai government choices of AIDS treatment policy, HIV prevention policy and AIDS drug pricing. For the most likely assumptions, the book estimates that ART will save years of healthy life at a cost of between $700 and $2,400 per year. Successful AIDS treatment accumulates ever-increasing numbers of patients who need subsidized ART. Despite the magnitude of the resulting fiscal burden, the authors judge this expenditure to be a worthwhile public health investment for Thailand, However, they show that the future sustainability of the program will hinge critically on how well the government manages the quality of ART service delivery, on whether it is able to sustain its past successes in HIV prevention and on its negotiations with multinational pharmaceutical manufacturers on the prices of new AIDS drugs.

Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

This book collects studies performed mainly with the support of the Agence Nationale de Recherche contre le Sida (French French National Agency of Research against AIDS). The purpose is to analyse the conditions to improve access to drugs against AIDS in developing countries, to urge on international agencies determinedly support patients treatment. The first part deals with the market of antiretrovirals and patents : How the prices drop taked place in 1998-2002, what were the debates about Intellectual Property Rights and WTO, what happened in countries as Brazil and Thailand? The second part deals with the impact of AIDS epidemic in the developing world and the role of therapeutic strategies to lower this impact. The book backs up the argument that the impact has been undersestimated and theses strategies are feasible.

The global response to HIV/AIDS has been a major aspect of global health and development policy over the last three decades. The book illustrates the devastating health impacts of the epidemic, with life expectancy in some countries falling to the lowest levels observed anywhere, and the remarkable success of the global HIV/AIDS response in reversing such extreme outcomes. Concerns about the implications of HIV/AIDS for economic development have played a role in motivating the global HIV/AIDS response. However, evidence on the impacts of HIV/AIDS on economic growth or poverty is weak, and the magnitude and relevance of such economic effects appears trivial compared to the consequences for life and health. Because of the success in extending access to treatment globally, HIV/AIDS has effectively transitioned into a chronic disease. This means that HIV/AIDS absorbs not only a substantial chunk of current global and national financial resources, but that these spending needs are projected to persist over decades. The costs of the HIV/AIDS response thus resemble a long-term financial liability, shaped by past and current policies. Relatedly, the calculus of cost-effectiveness of HIV/AIDS interventions has changed. People who become infected with HIV can now expect to not die because of AIDS; at the same time, each HIV infection results in medical needs and expenditures extending over decades. The book presents a framework for integrating these financial consequences and the transmission dynamics of HIV in the analysis of cost-effectiveness of HIV/AIDS interventions and in the design of HIV/AIDS programs.

We began to research for this book in 2000, with the idea that we might contribute to the search for solutions to the global HIV/AIDS pandemic by c- bining perspectives from different disciplines. Much has happened in the interv- ing years. First, the severity of the HIV/AIDS pandemic in sub-Saharan Africa – and the threat it posed for many others regions of the world – led to a movement among several countries to correct the imbalance between producers and users of ph- maceutical products. This effort produced a clarification of the right of gove- ments to produce generic medicine under compulsory licenses and an amendment of the World Trade Organization’s TRIPS Agreement to allow exports of generic medicines from one WTO Member to another. In 2007, the amended rules were put into practice, with Canada authorizing the export of generic antiretroviral drugs to Rwanda. However, at the same time, global patent laws have been undermined due to regulatory capture, most notably in free trade agreements and through political pressure on countries like Thailand to not to exercise their right to issue compulsory licenses for pharmaceutical products. Second, the amount of money available for the treatment and prevention of HIV/AIDS has increased dramatically, with the establishment of the World Bank Multi-Country HIV/AIDS Program for Africa (MAP), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR), among other funding initiatives.

Five million people in poor countries are receiving AIDS treatment, but international AIDS policy is still in crisis. Donors are giving less than they had been, even though infections continue unabated, and the number of people dependent on treatment rises each year. This book proposes a feasible medium-term objective for AIDS policy: achieving an "AIDS transition," that is, keeping AIDS deaths down by sustaining treatment while pushing new infections even lower, so that the total number of people living with HIV/AIDS begins to decline. How? Through a new, incentive-driven strategy to improve HIV prevention and a sustained effort to get the most from AIDS treatment.