In 1987, the U.S. Food and Drug Administration approved the first effective HIV/AIDS antiretroviral drug, zidovudine. As more drugs were developed, HIV/AIDS became a manageable chronic disease. Patients prescribed a mixture of drugs—known as antiretroviral therapy—can now live long, happy lives.

But in the early 1990s, the limited availability and astronomical costs of drugs made it difficult to treat people in poor countries such as Haiti, Rwanda, and Lesotho. Pressured by activists and the Clinton Foundation, generic drug manufacturers decreased the price of therapies from several thousand dollars a year to roughly $150 now.

However, this has not halted the disease. Since 1981, 78 million people have contracted HIV/AIDS, and more than 39 million have died from the disease.  About 35 million people are currently living with HIV/AIDS, with more than 70 percent of them living in sub-Saharan Africa.

The results of this imbalance are, and have been, catastrophic. An estimated 17 million children have lost one or both parents due to AIDS. In sub-Saharan Africa, HIV has been shown to significantly reduce economic growth, which contributes to further impoverishment and illness.

PIH’s Response

In 1998, Partners In Health launched its HIV Equity Initiative in rural Haiti. Skeptics thought that it and other attempts to treat poor people with AIDS were all but impossible—too expensive, too difficult. The head of the U.S. Agency for International Development went so far as to tell Congress that trying to treat poor Africans wasn’t practical; they couldn’t possibly stick to medication schedules because they “do not know what watches and clocks are. They do not use Western means for telling time.” This and other arguments were of course just thinly veiled racism.

Drawing on our experience treating tuberculosis patients, we removed as many barriers to treatment as possible, providing free food, transportation, lodging, and more. And we employed community health workers to administer therapies in patients’ homes.

The program was a success. The vast majority of patients stuck with treatment and ultimately resumed working or caring for their children. Hospital beds freed up. Morale increased throughout the region. And the world saw, as it had with tuberculosis, that complex diseases can be cured in poor communities. 

Today, we provide therapies as part of regular primary care to about 23,000 people in Haiti, Rwanda, Lesotho, and Malawi, using largely the same approach as we did back in rural Haiti.