In this Book

Lethal Decisions
summary
This first-person account by one of the pioneers of HIV/AIDS research chronicles the interaction among the pediatric HIV/AIDS community, regulatory bodies, governments, and activists over more than three decades. After the discovery of AIDS in a handful of infants in 1981, the next fifteen years showed remarkable scientific progress in prevention and treatment, although blood banks, drug companies, and bureaucrats were often slow to act. 1996 was a watershed year when scientific and clinical HIV experts called for treating all HIV-infected individuals with potent triple combinations of antiretroviral drugs that had been proven effective. Aggressive implementation of prevention and treatment in the United States led to marked declines in the number of HIV-related deaths, fewer new infections and hospital visits, and fewer than one hundred infants born infected each year.

Inexplicably, the World Health Organization recommended withholding treatment for the majority of HIV-infected individuals in poor countries, and clinical researchers embarked on studies to evaluate inferior treatment approaches even while the pandemic continued to claim the lives of millions of women and children. Why did it take an additional twenty years for international health organizations to recommend the treatment and prevention measures that had had such a profound impact on the pandemic in wealthy countries? The surprising answers are likely to be debated by medical historians and ethicists.

At last, in 2015, came a universal call for treating all HIV-infected individuals with triple-combination antiretroviral drugs. But this can only be accomplished if the mistakes of the past are rectified. The book ends with recommendations on how the pediatric HIV/AIDS epidemic can finally be brought to an end.

Table of Contents

  1. Cover
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  1. Half Title, Title Page, Copyright, Dedication
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  1. Contents
  2. pp. vii-viii
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  1. Foreword
  2. pp. ix-x
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  1. Acknowledgments
  2. pp. xi-xiv
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  1. I. The Beginning
  2. pp. 1-2
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  1. 1. Pediatric HIV/AIDS
  2. pp. 3-12
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  1. 2. AIDS and Blood
  2. pp. 13-16
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  1. 3. The Blood Banking Industry in Denial
  2. pp. 17-22
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  1. 4. A Personal Tragedy
  2. pp. 23-28
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  1. 5. Finding the Cause of AIDS
  2. pp. 29-33
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  1. 6. Saving Lives: Preventing HIV Infection of Infants
  2. pp. 34-39
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  1. 7. The Denialist Movement
  2. pp. 40-50
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  1. II. Pediatric AIDS Becomes a Reality
  2. pp. 51-52
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  1. 8. Born of Necessity: The Pediatric AIDS Foundation
  2. pp. 53-62
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  1. 9. A Priority at Last: Pediatric HIV/AIDS
  2. pp. 63-78
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  1. 10. A Living Legacy: Elizabeth Glaser Scientist Awards
  2. pp. 79-83
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  1. 11. The Ariel Project: The Best, the Brightest, and the Committed
  2. pp. 84-89
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  1. 12. Too Urgent to Wait: The American Foundation for AIDS Research
  2. pp. 90-98
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  1. 13. What about the Rest of the World?: The First Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants
  2. pp. 99-104
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  1. 14. Ensuring That Voices from Low-Income Countries Are Heard
  2. pp. 105-109
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  1. 15. A Call to Action: The Second Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants
  2. pp. 110-120
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  1. 16. Now Just Go and Do It: The Third Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants
  2. pp. 121-134
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  1. 17. From a Small Beginning to Major Prevention and Care Programs
  2. pp. 135-151
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  1. 18. Why Wait? Start Now
  2. pp. 152-159
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  1. 19. Going the Last Mile: The Obscure, the Neglected, and the Desperately Needy
  2. pp. 160-162
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  1. III. Unexpected Obstacles: Institutions, Therapeutic Denialism, and Treatment Guidelines
  2. pp. 163-164
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  1. 20. Pediatric AIDS and Drug Development
  2. pp. 165-175
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  1. 21. Acronyms and Legislative Redundancy
  2. pp. 176-180
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  1. 22. Facts Speak Louder Than Words: Examining Efforts That Failed
  2. pp. 181-190
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  1. 23. Guidelines Can Become Rules
  2. pp. 191-199
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  1. 24. Treatment Guidelines: Not without Risks
  2. pp. 200-208
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  1. IV. Stalled: Losing Sight of the Mission
  2. pp. 209-210
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  1. 25. Damn the Ethics, Full Speed Ahead
  2. pp. 211-219
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  1. 26. The Tyranny of Research
  2. pp. 220-232
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  1. 27. Misspent Dollars
  2. pp. 233-241
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  1. 28. For Better or for Worse?: The Pediatric AIDS Clinical Trial Group Expands
  2. pp. 242-245
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  1. 29. Turning the Corner
  2. pp. 246-252
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  1. V. Ending the Pediatric HIV/AIDS Epidemic
  2. pp. 253-254
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  1. 30. What Went Well
  2. pp. 255-264
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  1. 31. PEPFAR to the Rescue
  2. pp. 265-271
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  1. 32. Solutions
  2. pp. 272-292
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  1. Conclusion
  2. pp. 293-296
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  1. Timeline: Pediatric HIV/AIDS Milestones and Events
  2. pp. 297-310
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  1. Acronyms
  2. pp. 311-314
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  1. Notes
  2. pp. 315-338
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  1. References
  2. pp. 339-362
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  1. Index
  2. pp. 363-376
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