The first step backwards is of course that counterfeit drugs usually don’t work very well. But people who take them presume, at least until they get hopelessly sick, that they are working. They believe their viral loads are falling, and they believe that they are getting less infectious. We already know that people get sloppier about using condoms it they think they are not infectious (or, if they are uninfected, that any HIV-infected partners will be on meds and not infectious). So it’s not encouraging to think that those may be the very people whose viral load is bouncing skywards because they are on ineffective medication. Oh, and that resistance is almost inevitably going to rise because people will be on and off “real” medication depending on the supply.

The second step backwards is that this kind of thing gives the self-appointed guardians of Big Pharma’s bottom line a new cudgel with which to bash generics and compulsory licensing. And sure enough, there they are today, wielding the cudgel on the op-ed pages of The New York Times. (Note the source of Roger Bate’s funding…) Conflating generics with counterfeit drugs is like conflating sex work with trafficking. One provides services people want at a price they agree to pay, the other is illegal and dangerous. But waging war on the first is almost certainly going to make it harder to wipe out the second.