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Now and then: lessons from the rollout of ART

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June 5 marks 40 years since the US Centers for Disease Control and Prevention first reported cases of the disease that would later become known as AIDS. The early years of the epidemic were defined by fear, illness, and certain death for those infected, with the first antiretroviral treatment (ART), azidothymidine (AZT), being approved by the US Food and Drug Administration in 1987. Yet the road to 26 million people receiving ART around the world in 2020 has been a long one. At the 13th International AIDS Conference in Durban, South Africa, in July 2000, Ugandan HIV/AIDS researcher and physician Peter Mugyenyi asked “Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.”

Initial concerns around the costs (up to $20 000 per patient per year) and complexity of delivering combination treatment regimens in resource-limited settings were overcome by the concerted efforts of…

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