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Cheap Drugs Are Only Part of Weapons Against AIDS

In Africa, access to the antiretroviral treatments won't make much difference unless there is good infrastructure, improved education and health care, as well as poverty reduction.


TUGELA FERRY, South Africa — The Church of Scotland Hospital is located in an arid backwater of KwaZulu-Natal province, but it can provide results of an HIV blood test in minutes. It has two operating rooms, X-ray facilities and a basic laboratory.

Nine experienced doctors treat about 500 patients each day. At 13 clinics in the surrounding Msinga district, nurses who are in telephone or radio contact with the hospital attend to drop-in patients.

Two mobile clinics also offer free treatment. In the absence of addresses, they use global positioning systems to determine the location of AIDS patients who are at home. Volunteers follow up with patients to ensure that no one is simply left to die.

One thing that is lacking, here and in most of Africa, is a supply of inexpensive antiretroviral drugs that could help prolong the lives of people who have AIDS. But given the size of the problem in sub-Saharan Africa, and the dire shortages of good roads, communications, medical facilities and trained doctors, the question is how much of a difference the drugs could make.

"If this area was flooded with cheaper drugs, we would be very happy because we would definitely use them," said Tony Moll, a senior doctor at the hospital. Fully 36% of the adults in KwaZulu-Natal province are infected. Moll estimated that, without proper treatment, 70,000 of Msinga district's 350,000 people will die within 10 years.

Announcements by several major pharmaceutical companies that they will slash the prices of anti-AIDS drugs have given some hope to KwaZulu-Natal. On Wednesday, a massive AIDS prevention and treatment plan spearheaded by U.N. agencies was unveiled, and on Thursday, U.N. Secretary-General Kofi Annan persuaded six companies to cut their prices further.

Annan, who called AIDS "the greatest public health challenge of our times," said he was also aiming for dramatic improvements in prevention, education and care.

KwaZulu-Natal has already put in place a structure to cope with the impact of the disease. Although it is far from perfect, doctors say it would help them distribute and monitor the use of antiretroviral medicines, were they to become widely available.

But the Msinga district is not typical--either of rural South Africa or the rest of the continent.

The annual health care budget of some African nations is less than $5 per person. Many hospitals lack equipment and medicine for even basic ailments. Doctors and nurses are in short supply. Poor roads and communications hamper access to medical facilities. And in much of Africa, the disease is treated as a badge of shame.

Intensive public awareness campaigns have helped Uganda cut its infection rate among adults from 14% to 8%. Senegal has kept it rate of adult infection close to 1%. But these countries are the exception.

Sub-Saharan Africa accounts for nearly 70% of the world's 36 million HIV and AIDS cases and 90% of all deaths because of the disease. About 4.7 million South Africans, or one in nine of the 45 million citizens, are living with the virus.

The acquired immune deficiency syndrome has orphaned millions of children, crippled the labor force and slashed life expectancy. A recent U.S. study projected that life expectancy in Botswana could fall to as low as 29 years.

In general, access to antiretroviral drugs has proved to prolong lives. But in Africa, the impact would be minimal, many researchers say. The standard triple therapy costs about $10,000 to $15,000 a year. Even reduced to 20% of the cost, the drugs would remain unaffordable.

Zweli Mkhize, minister of health for KwaZulu-Natal province, said South Africa would need more than 10 billion rand, or $1.24 billion, for the next 10 years to build an infrastructure that could cope with an infusion of antiretroviral drugs.

"On its own, the question of drugs will certainly go a long way," Mkhize said. "But that is not the complete picture."

A South African law allows the import of cheap, generic medications, but leading pharmaceutical companies have been seeking to strike down the legislation, which they say would violate patent rights. The court challenge is set to resume April 18.

South African President Thabo Mbeki has come under fire for questioning the cause of AIDS and for stalling on authorizing the use of anti-AIDS drugs in public clinics. He says he is not opposed to the use of antiretroviral drugs as long as there is an infrastructure to properly administer them.

Mbeki and other African leaders have also been criticized for wasting money on armaments. South Africa is embroiled in controversy over the 43 billion rand--$5.3 billion--it committed to buying new European-built planes and submarines.

Rampant Poverty on the Continent

Tens of millions of ordinary Africans survive on less than a dollar a day. Many are subsistence farmers. In South Africa's Eastern Cape province, almost half the 6.3 million people are unemployed.

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