Attacking AIDS


1. Africa's victory, Africa's sorrow

2. A tough challenge

3.Multiple proteins

4. Immune-system helper

5. Making sense of vaccines


These Senegalese youths are at risk of dying of AIDS.
© David Tenenbaum

    A great thing?
POSTED 10 MAY 2001 For advocates of equality and public health, it was a shining -- but vanishingly brief -- victory. Two boys play Frisbee in an African village.On April 19, 39 international drug companies decided to allow South Africa to import and sell generic versions of expensive AIDS drugs.

The price of drugs certainly could fall: GlaxoSmithKline wholesales a one-year dose of Combivir, a combination of AZT and 3TC, for $7,093 in the United States, and $730 in Africa. But Indian drug maker Cipla offers the generic equivalent for $275 (see "Lifting the Curtain..." in the bibliography).

The cut-rate drugs now available in Africa include the protease inhibitors that can delay death and reduce disability. (Cutting prices seems trendy: In early May, Novartis slashed the price of a treatment of Riamet, a malaria medicine, to $2, for sales to the World Health Organization.)

The pharmaceutical-company cave-in was good news in South Africa, where 4.7 million carry the AIDS virus. South Africa can now import generic equivalents without infringing patents.

But will the price cut help much? Probably not -- the lower prices remain way too high for most AIDS patients in Africa where 70 percent of the world's estimated 36 million infected people live.

map:'AIDS consume Africa'. Animation shows how the AIDS epidemic has spread from 1984 to 1999

data and still images from UNAIDS

Can't afford it
South Africans with HIV, the AIDS virus, were told not to expect help from their government. Shortly after the price cut, The New York Times reported that the ruling African National Congress "was not aggressively charting the way forward... the party was ticking off countless reasons why the country should think twice about providing lifesaving AIDS cocktails."

The reluctance extends to paying for AZT, which, by preventing a mother from infecting her child during birth, is about the cheapest anti-HIV measure.

Mark Heywood, a lawyer for AIDS activists, called the government decisions on AIDS drugs "a stab in the back" (see "Despite Legal Victory..." in the bibliography).

In neighboring Botswana, about 36 percent of adults carry HIV. In May, the government announced that, by September, it would pay for the three-drug AIDS that is saving lives and health among Western AIDS patients. Botswana's largest employer, the diamond-mining firm Debswana, is already paying 90 percent of the cost of AIDS treatment (see "Free Aids...." in the bibliography).

A grim reaper
It's hard to grasp the severity of the AIDS epidemic, which has killed least 15 million people in sub-Saharan Africa. More than 10 percent of people aged 15 to 49 are infected in 16 African countries, according to UNAIDS. The United Nations' anti-AIDS group used astonishingly apocalyptic terms in its fact sheet: "HIV will kill at least a third of the young men and women of countries where it has its firmest hold, and in some places up to two-thirds. Despite millennia of epidemics, war and famine, never before in history have death rates of this magnitude been seen among young adults of both sexes and from all walks of life. " (Emphasis added.)

A bloody code
The geometric mathematics of the AIDS epidemic continues in Africa where 4 million people were infected in 1999 alone.

Life expectancy at birth, which rose from 44 in 1950 to 59 in the 1990s, demonstrates the deadly impact of AIDS in sub-Saharan Africa. According to UNAIDS, the average child born in 2005 or 2010 will not reach age 45.

 Rates vary from 5 percent (in Cotonou, Benin) to almost 60 percent.
HIV infection rates vary widely among women, nearly 60 percent in the 20 to 24 age group in one South African city!
Courtesy: UNAIDS

In other words, AIDS will steal half-a-century's improvement in health (see "The Children..." in the bibliography).

Globally, the picture is marginally better -- but declining fast. AIDS has claimed about 21 million lives around the world, and nearly all of roughly 36 million people now infected will succumb to the disease within a decade or two.

The virus is galloping into other regions that likewise have neither mechanism nor money to cope with it. An estimated 4.7 million people in India carry the virus, and three countries -- Myanmar, Cambodia and Thailand -- have adult infection rates above 1 percent.

The prognosis is pretty gloomy, according to Emory University AIDS expert Carlos del Rio. "It's very discouraging, ... we're far from having signs of hope, there's so much to do and so little time to do it." Although "cutting the price [of drugs] is fantastic," he says drugs are "the least of the problem" in Africa. Any real improvement rests on fixing the "disaster" in Africa's public-health infrastructure.

Prevention can work
Still, there has been limited progress in a few African nations. Senegal, in West Africa, has avoided the worst of the epidemic, and the frightening rate of infection in Uganda has come under control. Experts credit a mobilized and realistic national government, combined with effective help from the private sector, for the rare signs of progress. "Especially in Uganda," says del Rio, the improvement is due to "government commitment ... societal commitment, some very good non-government organizations, a true commitment to improve thing at all levels."

Among girls, prevalence of HIV fell from 4.5 percent in 1989-90 to 1.5 percent in 1996-7. Among same-age boys, prevalence remained below 1 percent.
In Masaka, Uganda, aids-prevention efforts are paying off among girls, who tend to have sex with older men, who are more likely to carry HIV
Courtesy: UNAIDS

The international community is talking about the price of fighting AIDS -- and the costs of inaction. World Bank president James Wolfensohn recently estimated that $3 billion to $4 billion would be needed for treatment and prevention in Africa alone. European governments are pushing for a major, coordinated push to improve treatment, education and prevention, and to restore societies smashed by the epidemic.

Time Magazine has this excruciating photo gallery of AIDS in Africa.

Why such a delay for an AIDS vaccine?



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