Free AIDS Drugs in Africa Offer Dose of Life

February 8, 2003
Free AIDS Drugs in Africa Offer Dose of Life
By RACHEL L. SWARNS

KHAYELITSHA, South Africa, Feb. 4 - Every Monday morning, patients 
infected with the AIDS virus come to the red-brick clinic in this 
impoverished community of dilapidated shacks.

In the waiting room, babies wail, nurses hustle and some young women 
fidget on wooden benches as their earrings dangle and their chipped pink 
toenails gleam. The clinic looks like one of the hundreds of medical 
centers overwhelmed by South Africa's AIDS epidemic. Yet there is little 
talk of depression or dying here.

In this clinic, patients are getting stronger, not weaker, and they 
chatter about gaining weight, returning to school and searching for 
jobs. They are taking part in an ambitious program that offers the poor 
what was once unthinkable: free AIDS medicine and a chance to live.

Akhona Jazi, who once relied on a wheelchair, now walks on her own. 
Doris Matanda, who weighed 86 pounds, has gained 37 pounds in three 
months. Pumza Charlie no longer worries about dying from tuberculosis 
before her 30th birthday. These days, she dreams of finding a job and 
buying her own house.

"I thought I was going to die, but now I'm fresher than ever," said Ms. 
Charlie, 28, who shares a two-room house with her mother. "People here 
are dying of AIDS every weekend, every weekend. But I'm gaining weight. 
I've got no problems. So far, so good."

This clinic offers a rare glimmer of hope in South Africa, which has 
more people infected with H.I.V. than any other country.

The vast majority of AIDS patients die here because they cannot afford 
the lifesaving medicines common in the West. But over the last two 
years, the number of private initiatives offering free or low-cost AIDS 
drugs has slowly but steadily increased.

In this gritty township near Cape Town, the relief agency Doctors 
Without Borders provides free triple-therapy treatment to about 330 
people and reports remarkable results. Doctors treat even the sickest of 
the sick, patients who can barely walk or swallow. After six months of 
treatment, most people show dramatic improvements, gaining as much as 20 
pounds and the strength to fight off killer diseases.

Doctors Without Borders, which runs the largest free program, started 
treating the poor here in 2001. In August, Anglo American and De Beers, 
the mining giants, announced that they would provide AIDS drugs to their 
employees, joining companies like DaimlerChrysler, which already offered 
such treatment.

Meanwhile, the number of patients receiving AIDS drugs through their 
health insurers has doubled in the last two years as drug prices have 
begun to fall.

Only about 25,000 of the 4.7 million people infected with H.I.V. in 
South Africa are believed to have access to lifesaving medicines, and 
most of those are covered by health plans.

But when President Bush announced in his State of the Union address on 
Jan. 28 that the United States would finance AIDS treatment for two 
million more people, most of them Africans, he gave an unexpected lift 
to a continent where 2.5 million people died from the disease last year.

News of the American initiative inevitably focused attention on the 
groups in South Africa that have started providing free AIDS drugs, 
frustrated by the national government's reluctance to provide the 
medicines in public hospitals and clinics.

President Thabo Mbeki has expressed concern about the safety of AIDS 
drugs commonly prescribed in the United States and Europe. Senior 
members of his political party have called the medicines "poison" and 
accused drug companies of trying to use Africans as guinea pigs. Other 
officials insist that providing AIDS drugs in the public sector is too 
costly.

But critics note that the prices of brand-name AIDS drugs have fallen 
sharply in the face of stiff competition from makers of inexpensive 
generic equivalents. The pressure on the government to soften its 
position is rising as doctors, ministers, trade unions and prominent 
officials, including Nelson Mandela, the country's revered first black 
president, demand distribution of the drugs.

Skeptics, including some national government officials, argue that the 
strict triple-therapy regimen, so successful in the West, is too 
complicated and costly for Africans. Patients must take several pills a 
day at specific times, which can be difficult in rural communities. 
Failure to adhere to the regimen, which must be taken for life, may 
produce strains of the virus resistant to medication.

The challenges facing new patients are evident even in successful 
programs like the one here.

In its first year, Doctors Without Borders found that three-quarters of 
its patients suffered mild reactions to the drugs, including nausea, 
rashes and low white blood cell counts during the first three months of 
treatment.

Interviews suggest that some patients struggle to maintain the regimen 
in the early days.
Of 159 participants, three dropped out of the program during the first 
year. Thirteen people, very sick at the onset of treatment, died that 
year from illnesses including chronic diarrhea and Kaposi's sarcoma.

The condition of the vast majority, however, improved greatly. The mild 
reactions to the drugs, which never resulted in hospitalization, 
diminished sharply after three months. And adherence to the regimen has 
been excellent, doctors say.

Within three months, the virus was undetectable in 90 percent of 
patients. They also got sick much less often. Patients on the drugs, 
known as antiretrovirals, suffered an average of one illness a year 
instead of four.

The struggle to recruit doctors and nurses remains an enormous problem. 
Right now, the clinic has three full-time doctors, down from six last 
year. But provincial officials, who have their own health budget, have 
been eager to help.

Doctors Without Borders pays for the generic AIDS medicines from Brazil 
- which cost about $1 per patient per day - and the provincial 
government covers the costs of other drugs, laboratory tests, and 50 
percent of staffing costs and allows the group use of three clinics here.

"We're very pleased with the results," Dr. Fareed Abdullah, the deputy 
general in the Western Cape Province's health department, said of the 
program. "We're confident that it will be regarded as a best-practice 
model for all of South Africa."

But the demand for AIDS drugs far exceeds supply. The United Nations 
estimates that four million Africans need AIDS drugs right now. The Bush 
administration initiative would halve that figure, but nearly two 
million people would probably die for lack of medicine.

Dr. Eric Goemaere, who runs the Doctors Without Borders project here, 
estimates that about 1,000 people still need treatment in Khayelitsha.

The lucky few visit the nurses and doctors regularly to collect their 
pills and get checkups. They must also attend monthly support group 
meetings.

At one such meeting of 14 people this week, a man in a plaid shirt 
confessed that he had forgotten to take his tablets. Another man said he 
had learned to take his tuberculosis medicine and AIDS medicine at 
different times to avoid nausea. An older woman in a silky white shirt 
admitted that she had not told her children the true purpose of her new 
pills.

"I tell them it's treatment for high blood pressure," she said, and the 
group laughed.

Some talked about the guilt they felt at having access to lifesaving 
drugs. Others said they were still nervous about the drugs, fearing they 
might be poisonous.

Most fears evaporate after the patients see the startling improvements. 
Many people say they feel ready to disclose their disease to friends and 
relatives.

Nobantu Kwinana, for instance, invited two foreign visitors to see her 
four-room house and her precious tablets. She started taking them six 
months ago - one in the morning and four at night - and keeps them on 
her night table in a bedroom wallpapered with supermarket fliers.

"At first, I was just hoping to die," said Ms. Kwinana, 54, describing 
her reaction to her first AIDS test two years ago. "I thought: `What are 
my children going to say? What are my sisters going to say?' Now, I'm 
not scared. I know that I have H.I.V. and I know how to save myself. I 
have these pills. They are good for my life."