Challenges to treatment: the price-infrastructure trap and access to HIV|AIDS drugs

The paper draws attention to broad issues in international political economy that affect responses to the HIV|AIDS epidemic in the developing world. I argue that stable access to affordable medicines is essential for developing countries to tackle HIV|AIDS epidemics. Developing countries must overcome the 'price-infrastructure trap', where high prices reduce the feasibility of scaling-up treatment programmes, reduced feasibility of treatment decreases the incentives to invest in public health infrastructure, and poor public health infrastructure makes even limited treatment programs less effective than they could otherwise be. I examine four mechanisms for increasing developing countries' access to affordable drugs. I consider the political economy obstacles to scaling up treatment based on each of these mechanisms, with particular attention paid to the impediments posed by the new global regime on intellectual property rights. I show how each mechanism remains inadequate for realizing the central objective, that of achieving sufficient stability of supply so to stimulate domestic mobilization of resources and thereby escape from the price-infrastructure trap. Copyright © 2004 John Wiley & Sons, Ltd.