In the early years of the AIDS epidemic, medical treatments could do little except relieve unpleasant symptoms.

As researchers understood more about HIV—how it infects, how it multiplies—they began to find drugs that slow the infection, and even to understand how to cus­tom-build drugs to attack HIV.

We now know that certain drugs reduce the numbers of HIV the way antibiotics reduce other microbes that cause infections. We know that when the numbers of HIV go down, the immune system comes back. We know that certain vaccines and antibiotics will delay or even prevent the medical complications that accompany AIDS. These drugs and vaccines are part of traditional medicine.

The medical care of people with HIV infection can be divided into traditional medicine and alternative medicine. Traditional medicine is traditional to us in the West—in the United States and the Western world—and is based on specific scientific standards. Alternative medi­cine has diverse forms: some borrow heavily from Eastern (Chinese, Japanese, or Indian) philosophy; some use methods based on the mind­body interaction; and some are based on nonapproved drugs or diets or other treatments that, measured by the yardstick of the science of med­icine, have no established merit.

Most people with HIV infection receive traditional medical care. As many as a third of the people with HIV infection in some large urban areas receive some form of alternative treatment as well. Both traditional and alternative medicine make the same claims: the treatments kill HIV or prevent HIV from reproducing, or strengthen the immune system, or relieve symptoms. People with HIV infection hearing these conflicting claims are understandably confused. The confusion was great in the first ten years after 1986 when AZT was introduced, because it was never clear whether AZT did much to combat the infection. In retrospect, this skepticism may have been justified. The drugs that were related to AZT (ddI, d4T, 3TC, and ddC) seemed to improve people’s health when used in combination, but the advantage wasn’t great. In 1996, however, the benefit claimed for new protease inhibitors was powerful, convincing, and indisputable. Some people continued using alternative medications, some used a combination of alternative and traditional medicine, and many were simply confused. In the late 1990s, in studies of health, in clinical trials, and in the personal experiences reported in clinics, the ben­efit of HAART became obvious.

The purpose of this chapter is to discuss the drugs of traditional medicine and their side effects, and—another source of concern for peo­ple with HIV infection—how to pay for them. It also explains how drugs are tested to find out whether they are useful and how best to use them.