2000 – HIV becomes political

Returning to the timeline traced by the International AIDS Conferences, the 2000 meeting was held in Durban, South Africa. This was the first time that a resource-limited country had played host. It was at this conference that science was met head on by politics. The focus on HIV treatments that had dominated the previous two meetings was displaced by a new emphasis on a profound global disparity with respect to attention, resources and research for HIV. More than 90% of people living with HIV resided in poor settings, yet access to HIV treatments in those regions was available to only a handful of elites. As such, activists argued that it was unjust for attention at a global meeting to centre on the science behind treatment without simultaneously addressing the vast political chasm of concern between rich and poor countries.

At that point, the cost of treatment was so prohibitively high that it precluded serious contemplation of universal coverage in poor countries. However, 2001 saw a dramatic drop in the price of treatment due in large part to the competitive market created by low-cost generic versions of the HIV drugs by Indian pharmaceutical companies that were not limited by World Trade Organization patent regulations.

In 2002, the XIV International AIDS Conference in Barcelona, Spain, witnessed a shift that reflected newfound commitment to redressing the disparity in access between rich and poor countries with respect to HIV treatment, as well as other aspects of HIV prevention, care and support.

The World Health Organization announced its bold "3 by 5" campaign, which promised to have three million people on HIV treatment by 2005. Two years later, the theme of the 2004 conference, held in Bangkok, Thailand, was Access For All. The question of whether or not universal access was possible had shifted to how best to achieve this goal. Although unforgivably late and tragically slow, the move to deliver HIV treatment to all in need was in motion.

With the arrival of treatment in poor countries, so the issue of rehabilitation in the context of HIV surfaced in these parts of the world. Some issues have mirrored concerns raised in environments like Canada, such as the challenge of living with an unpredictable and episodic illness when one's financial safety net is tied to health and employment status [15]. However, new issues have emerged in research, such as paediatric rehabilitation interventions: the number of children living with HIV in high-prevalence countries is significantly higher than in wealthy countries. It is also important to note that issues of disability and rehabilitation are not limited to people on treatment.

Although the advent of treatment has prompted action in this field, there are concerns and opportunities for intervention for people who either cannot access or tolerate the drug regimens.

Thus, the field of disability and rehabilitation in the context of HIV has gone global, and one may expect that interest in these issues will expand as treatment becomes more of a reality in poor countries.