1,650,000

How killing a global program to fight HIV/AIDS kills

In 2004 the stalls off a main road in Malawi’s capital had turned to coffin making. Rough wooden caskets lined “Coffin Row” in Lilongwe and sold for a premium as death became a growth industry and carpenters worked round the clock to meet demand.

At that time the African nation’s life expectancy was in freefall in the midst of Africa’s HIV/AIDS epidemic—dropping from 43 years in 1996 to 39 years by 2000. About 30 percent of pregnant women in some districts were testing positive for HIV, and about 70,000 Malawians a year were dying of AIDS-related illnesses.

The trend was similar in other parts of Africa. When I visited hospitals in Kenya or Sudan in those years, the hallways overflowed with AIDS victims, some sleeping on the floor, some two and three to a bed.

Yet by 2007, Lilongwe’s Coffin Row had become Furniture Row, the casket displays replaced by chairs and bed frames. What changed in three years? HIV prevalence in Malawi fell with the arrival of affordable antiretroviral medicines…