Moving Mountains: The Race to Treat Global AIDS (review)

As an activist and journalist, Anne-christine d'Adesky has first-hand experience of the global struggle to fight HIV/AIDS. Her book serves as a useful introduction to the dramatic changes in international AIDS policy since 2000, when street protests erupted at the International AIDS Conference in Durban, South Africa, in favor of providing treatment. Previously, antiretroviral (ARV) therapy, which has transformed AIDS from a fatal illness to a serious, chronic, but manageable disease, was considered too costly to provide to patients in developing countries. In this well-researched book d'Adesky clearly explains how the global AIDS movement succeeded in making treatment an international priority, and describes the major obstacles to treatment.

Drugs are at the center of d'Adesky's story. On one side, the big pharmaceutical companies and their allies, namely the U.S. government under both the Clinton and Bush administrations, have acted to protect intellectual property rights, thus limiting competitors' ability to provide inexpensive, generic drugs; on the other side, activists and generic drug companies in Brazil, South Africa, and India have challenged international laws in order to produce drugs for their own populations. In November 2001 at the World Trade Organization conference in Doha, Qatar, Brazil brokered an agreement that allowed poor nations facing "national emergencies," such as HIV/AIDS, to import or make generic drugs. Falling prices have made large programs such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria possible—even if the 2001 agreement has serious flaws; it requires, for example, that each developing country build its own pharmaceutical manufacturing industry.

The book's greatest strength is its breadth of focus. D'Adesky spotlights nine different countries, a few of which receive little attention regarding AIDS, such as Mexico and Morocco. In Mexico, access to medications and health care depends on geography: services exist in urban centers, but not in rural areas. As one Mexican doctor said, the problem is only partially a lack of medication: without physicians and a health-care system, medicines alone will not be sufficient. In Morocco, the epidemic is still enviably small; the government has decided to offer treatment to all AIDS patients (1,152 cases in March 2003) to avert an epidemic, hoping that access to treatment will expand the use of HIV testing and counseling centers and thereby augment prevention. D'Adesky also describes Uganda's success in reducing HIV prevalence, Paul Farmer's efforts to provide treatment to the poorest of the poor in rural Haiti, and Brazil's leadership in providing ARV treatment to its citizens.

The final chapters—13, 14, and the conclusion—are the book's weakest. D'Adesky abandons her earlier complexity of analysis and describes the challenges ahead as a clash between rich and poor nations, with the greatest obstacle to success being President George Bush. A pity that she chose to oversimplify the problems she so richly detailed in earlier chapters: her call to action winds up sounding like partisan cant. Her prose becomes leaden in these chapters as well, as she stuffs each sentence with the name of every organization and activist that she knows.

In the United States, more than a thousand patients are on waiting lists to receive ARV therapy, which d'Adesky ignores. Millions of Americans have no health insurance; meanwhile, some Africans can afford to pay for their ARV treatment. The world is not so easily divided into rich and poor, nation by nation, nor is a new American president going to provide quick solutions to long-standing problems in international health. As d'Adesky herself has explained, the problem is not just about getting pills to people quickly: the problem is how to build sustainable health systems worldwide that can provide primary health care to treat a range of diseases—including, but not limited to, HIV/AIDS.