Abstract - The right of children in developing countries to be born and live HIV-free

Ten years ago, in international public health circles, it was common to suppose that people with HIV in developing countries had no right to life — although health experts avoided stating the point quite so bluntly. The problem was that survival for those in advanced stages of AIDS depended on their receiving triple therapy with antiretroviral medicines (ARVs) — a treatment judged too costly for poor people in low-income countries and too complex for them to manage. As a clinician, I remember clearly that, at the time, ARVs were in effect considered so mysterious and sophisticated that it was assumed one had to be an extraordinary specialist to prescribe the drugs and care for the patients taking them. To understand the multiple permutations and interactions of the different classes of ARVs, along with their possible side effects, seemed to constitute a distinct science reserved for initiates. The patients, too, were thought to need unusual discipline — and an arsenal of timers, watches, and other tools — to adhere to the complex ARV regimens, which required ingesting a battery of different pills at precisely regulated time intervals. For the therapy to succeed, patients had to be knowledgeable and determined enough to apply their wise doctors’ instructions unfailingly — a condition that many people imagined most poor Africans would be unable to fulfill.