Brazil has managed to cut its AIDS mortality rate in half over the last 10 years, in part by ensuring that all those infected with HIV have access to free anti-retroviral medicines. The strategy was made possible by a controversial law that allows the government to produce generic copies of imported drugs in case of a national emergency. Today, the government produces eight of the 15 drugs in the cocktail and has negotiated discounts of up to 70 percent for the others by putting pressure on international drug companies. The innovative strategy has turned Brazil into a leading example in the fight against AIDS.

Other countries, including the Asian nations that collaborate with the UCLA/Fogarty program, have struggled. So-called highly active anti-retroviral therapy (HAART), while potentially lifesaving, requires a complicated medication-taking regimen and financial wherewithal, both of which continue to serve as significant barriers in much of the developing world. Even as the cost of HAART comes down and countries begin to produce the drugs themselves, the infrastructure for identifying people in need of treatment and effectively managing patients through the complex therapy is often severely lacking.

"Treatment is becoming increasingly available in these countries, but if you don’t know who is infected, you can’t provide it," says Detels. He notes that the majority of HIV-infected individuals in Asia are unaware that they’re infected, which makes them less likely to reduce their risky behavior. "Unfortunately, the stigma attached to being identified as HIV-positive — or merely getting tested — continues to be so terrible that a lot of people must decide whether doing so is worth the risk of losing their job and being alienated from their family and community," Detels explains. With that in mind, several UCLA/Fogarty trainees are undertaking projects to identify factors associated with stigmatization among health-care workers and villagers.

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