The Global Political Economy of Anti-Retroviral Treatment in the Developing World: Challenges to Overcoming the Price-Infrastructure Trap

In this paper I draw attention to how broad changes in the global political economy 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 “priceinfrastructure trap,” where high prices reduce the feasibility of scaling-up treatment programs, 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 designed to increase 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 priceinfrastructure trap.