Africa Needs More Than AIDS Drugs

Aid workers, pharmaceutical companies and donors have made drugs available to a small number of African AIDS patients, but as new programs take root, the lack of trained doctors and facilities are becoming the biggest barriers to care.

Many of the AIDS experts in Africa gathered to discuss their successes and failures at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, which wraps up Friday in Nairobi.

A few years ago, activists protested the high price of anti-retroviral drugs and demanded deep discounts from pharmaceutical companies, or access to generic equivalents in Africa. Both patented and generic drugs have become available in some countries at affordable prices, and aid agencies and pharmaceutical companies have set up trial programs to find the best way to treat the 30 million Africans with HIV.

The availability of drugs has dramatically increased the demand for treatment in countries that have experimental programs, but the main problem now is a shortage of clinics, trained doctors and pharmacists, doctors at the conference said.

In Tanzania, donors found the government was willing to begin treating AIDS patients, but the public health system in the impoverished country was a shambles. Hospitals served as warehouses for the sick and dying with few drugs or laboratory tests available. Most Tanzanian doctors, like the majority in Africa, know little about prescribing AIDS drugs, experts said.

The philanthropic arm of Chicago-based Abbott Laboratories, an AIDS drug manufacturer, has formed a partnership with the Tanzanian government to modernize the country's health system, which serves 37 million people. Tanzania Care has begun refurbishing hospitals, revising training programs for medical personnel and expanding the number of HIV testing centers, said Jeff Richardson, the program's executive director.

But while Abbott has a program to sell AIDS drugs to poor countries at prices below cost, Richardson said Tanzania doesn't have the facilities for large-scale distribution.

"Yes, we want to hurry up, but we don't want to do it in a way that will only last a year or two," he said. "The ultimate goal of the infrastructure improvements is not the infrastructure improvements, but to increase access to HIV care."

Medecins Sans Frontieres has taken a different approach in Kenya. Doctors have imported generic drugs from Brazil and have concentrated on streamlining anti-retroviral treatment to develop a methodology to treat as many patients as quickly as possible.

Dr. Saleban Oman, field coordinator for the program at the western town of Homa Bay, said that even with simplified techniques the largest barrier to treatment is the size of his clinic and staff, which can only handle 500 patients although thousands need help there. Nationwide, more than 200,000 Kenyans need the drugs, he said.

Oman said until more doctors and nurses are trained and paid to staff Kenya's health clinics, there will be a limit to the number of people receiving treatment.

The largest and oldest national anti-retroviral program in Africa is in Gabaronne, Botswana, and is a partnership between the national government and Merck and Co. Inc., based in Whitehouse Station, N.J.

The program covers every aspect of preventing and treating the HIV epidemic in Botswana, where 35 percent of the population of 1.6 million are infected with HIV, the virus that causes AIDS.

As the co-director for infectious diseases at the national hospital in Gabaronne, Dr. Tendane Gaolathe has more than 6,000 patients on anti-retroviral drugs. But only 21,000 of the 120,000 people who need the drugs in Botswana have prescriptions, she said.

Both Gaolathe and Oman said there is no shortage of drugs so far. They also said that after the clinics opened — and people learned that drugs were available — the number of patients asking for treatment skyrocketed.

"Availability of treatment has opened the door to more testing," Gaolathe said, acknowledging that demand for drugs will increase. She said another positive development is that the drugs have reduced the caseload of patients with full-blown AIDS taking up bed space and other hospital resources.

According to UNAIDS, about $10 billion a year is needed to fund prevention programs and provide drugs to just 10 percent of those infected. While donors have established a fun to fight disease in Africa, it doesn't have a fraction of the resources needed.

"Access is a pie, if you will, and one of the slices is pricing and drugs and the challenges of getting them there," Richardson said. "But there are others: infrastructure, training ... the success isn't that you get X number of pills there, but what happens once they are there."

By Chris Tomlinson