By 1984, the HIV-AIDS epidemic had begun to devastate sub-Saharan Africa. Uganda was particularly affected early in the epidemic, and in October 1986 the country began a public education campaign that included promoting monogamous sexual behavior. ^[1] By 1990, an estimated 5.5 million Africans were living with HIV and 650,000 suffered from AIDS. ^[2] The first antiretroviral drug, AZT, had been available since 1987, but it was beyond the means of all but the wealthiest few in Africa. By 1993, the number of individuals infected reached 9 million adults and the number of AIDS cases rose to 1.7 million. In 2000, 70 percent of all HIV-positive people lived in sub-Saharan Africa, although it held only 10 percent of the global population. ^[3] Eighty percent, or some 1.1 million, of all HIV-positive children in the world lived in the region. ^[4]

Throughout the 1990s, experts noted that infection rates for pregnant women in particular were shooting up; the women, in turn, were passing it to their newborns. From 1992-96, the prevalence of HIV in pregnant women aged 20-24 in Lesotho, for instance, rose from 3.9 to 26 percent. ^[5] By 2001, 24.5 percent of pregnant South African women were HIV-positive. ^[6] AZT administered during pregnancy, labor and delivery reduced transmission to the baby by 67 percent, but it was a tremendous challenge to get AZT to patients in Africa. Fortunately, single doses of the drug nevirapine were found to cut mother-to-child transmission (MTCT) by nearly half, and African governments and international organizations launched a campaign to provide the drug to pregnant women.

Despite the progress on reducing MTCT, the high cost of AZT helped keep the rate of HIV-AIDS in sub-Saharan Africa high. Africans—led by the South African activist organization Treatment Action Campaign in collaboration with others from the global community—pressed for lower antiretroviral drug prices. In 2001, UN Secretary-General Kofi Annan issued a global call to action aimed at increasing access to HIV-AIDS care and treatment in low-income countries. Still, funding remained a major challenge. In January 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) was launched. It was a public-private organization that collected donations from governments and foundations (principally US and Western) for healthcare initiatives in developing countries. In July 2002, former US President Bill Clinton's newly formed Clinton HIV/AIDS Initiative began brokering deals with drug companies to cap antiretroviral drug prices.