Governments as facilitators or obstacles in the HIV epidemic

The current trajectory of the HIV/AIDS epidemic is unlikely to change quickly. Five million people will become infected each year despite decades of research that has discovered every preventable means of HIV transmission—via sex, intravenous drug use, blood transfusion, breast feeding, and perinatal transmission.1 We could try to blame science for having failed to perform research that affects international public health. But the transition from successful clinical research to implementation of public health rests in the hands of governments. Faced with a crisis of enormous proportions, how do we motivate governments to mount a vigorous public health response? Initially, in the early 1980s, the US government was slow to act, but with constant prodding by activists over $9.7bn is now spent annually for research, education, prevention, and treatment. New HIV infections in the United States have fallen from a peak of about 150 000/year in the 1980s to 40 000/year currently.2 Here …