422 CHAPTER ElEvEn ■ TransnaTional issues
have broader security consequences.”^15 Thus, in 2000, the UN Security Council identi-
fied HIV/AIDS as a threat to global security, the first time that a health issue has been
so recognized.
While many dif er ent actors have responded to the HIV/AIDS prob lem, individ-
ual states are key. Some states and leaders seized on the issue very rapidly, launching
major public- relations campaigns to inform their populations of risky practices lead-
ing to transmission of the virus, distributing condoms, and, eventually, facilitating the
distribution of life- extending drugs. Uganda, Botswana, and Brazil are examples of
states that took initiatives very early. Other states, like South Africa, India, and China,
were slow to acknowledge the prob lem. But states have now responded, constrained
by financial resources and technical expertise and sometimes social conventions. With-
out the willingness to act and respond openly, programs initiated by the international
community cannot penetrate national borders.
Intergovernmental organ izations took the leadership role at the early stages of the
HIV/AIDS epidemic, though that response was too slow and disor ga nized. Beginning
in 1986, WHO took steps to help states create national HIV/AIDS programs and made
recommendations for drug treatments, adding antiretroviral drugs to its essential drug
list in 2002. But WHO and other UN- related agencies strug gled to find an efective
institutional framework to address the vari ous issues. Dissatisfaction with UN leadership
led to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, an in de pen dent
institution that uses local expertise and local owner ship of issues to advance its cause.
Funding decisions are made by a board consisting of donors, recipients, NGOs, pri-
vate sector actors (including businesses and foundations), and representatives from
afected communities. The Global Fund continues to support and deliver antiretro-
viral drugs as well as help in the fight against tuberculosis and malaria.
Nothing was more critical to reducing the mortality rate of HIV/AIDS than the
development of antiretroviral drugs used to extend the lives of people living with the
disease. Multinational phar ma ceu ti cal companies became the saviors, albeit controver-
sial ones. These drugs became available in the developed countries in the mid-1990s,
but in the developing world, the cost of the drugs— between $10,000 and $15,000 per
person annually— made them essentially unafordable. But beginning in 1998, Brazil-
ian and Indian drug companies began manufacturing generics, reducing the cost of
the treatment to less than $500 per person annually. This activity was controversial
because the World Trade Or ga ni za tion’s intellectual- property protection rules pro-
hibit internationally traded generics that violate patent restrictions. Brazil took its
case to UN human rights bodies and to the international media, arguing that patients
have a human right to treatment. A compromise was reached on pricing, with the
phar ma ceu ti cal companies lowering prices for the developing world; in 2015, 15 mil-
lion people living with AIDS were accessing antiretroviral therapy, or 41 percent of all