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Each year, millions of people in low- and middle-income (LMI) countries die from preventable and treatable diseases. AIDS provides one of the starkest examples: it killed more than three million people in 2004 and has become the world's leading cause of death for adults aged fifteen to fifty-nine. These deaths continue despite the fact that we have known for years that antiretroviral combination therapy (ARVs) can substantially improve the lives of those living with HIV/AIDS, and even reverse the tide of death associated with the disease. But the drugs that we take for granted in the United States have long been out of reach for most of those living with HIV/AIDS around the world. One crucial reason has been their cost. In 2000, the average worldwide price for patented ARVs was more than $10,000 per patient per year. Today, the same medicine is sold in generic form for as little as $168 per year. This drastic reduction in price has enabled governments and international agencies to initiate programs designed to bring these medicines to millions of HIV-positive individuals around the world who otherwise lack access to them. These programs still have a long way to go before they meet existing need, but they would not have begun at all if prices had not come down so dramatically. These recent price reductions have also generated a storm of controversy regarding the contribution that patents and other exclusive rights make to the inequities in global availability of life-saving medicines. The problem that patents can pose for access to medicines and medical technologies is complex and cannot be understood without a nuanced assessment of the political economy in which the key players operate.

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