ADDIS ABABA, ETHIOPIA -- Wibetu Zenabu, an emaciated 40-year-old
in the closing stages of AIDS, measures out her life in days -- days
spent mostly alone. In Ethiopia, where people with the disease often
are stigmatized, her neighbors shun her just as they shunned her
husband who died of AIDS-related tuberculosis two years ago.
"If you have the virus, most people treat you as if you're
already dead," Zenabu said, straining to talk over the rain's
clatter on her tin shack in one of the many slums in Addis Ababa,
Ethiopia's capital.
A year ago, there was a glimmer of hope for Zenabu as it was
announced the government had licensed two local drug makers to
produce low-cost, anti-retroviral drugs, known as ARVs. For Zenabu,
it meant she might live, at least long enough to raise her
13-year-old daughter and 10-year-old son.
But so far, not one ARV pill has rolled off the production line.
As the drug makers plead for start-up money from the government and
international donors, Zenabu's hope of staying alive is evaporating,
as is the hope of more than 2 million people in Ethiopia infected
with HIV.
The paucity of ARVs in Ethiopia -- and Africa, in general --
points to a breakdown in the global fight against AIDS, health
experts say. Despite the genocidal death toll of AIDS in Africa --
nearly 20 million AIDS deaths already and 6,500 new deaths every day
-- drugs that could slow its relentless spread across the continent
remain beyond the reach of poorer nations most affected by the
virus.
"The idea is to make AIDS drugs accessible to anyone who needs
treatment, even people who can't pay for them," said Bunmi Makinwa,
the United Nations AIDS coordinator for Ethiopia. "That's hard for
some countries like Ethiopia, which has so many problems, like
malaria and chronic food shortages, that AIDS doesn't get the
priority it needs."
In the Horn of Africa nation known more for its devastating
famines, the magnitude of the AIDS scourge is alarming, and growing.
Most rural areas of the country are posting steady increases in the
rate of new HIV infections. At a rural health clinic in Bahir Dar,
about 150 miles north of Addis Ababa, one out of every four pregnant
women tested positive for the virus.
Health experts fear the AIDS problem is deeper than the figures
indicate, as many Ethiopians choose to suffer the virus in
isolation, hidden from the suspicious glare of families and
neighbors.
"People who suspect they have the virus don't get tested because
they know not much can be done about it," said Paulos Kenea, a
program director in Addis Ababa for Ethiopia's Organization for
Social Services for AIDS, or OSSA.
"It goes back to the drugs. When people have access to ARVs they
think more positively about living with the virus. They will stop
thinking about it as a death sentence," Kenea said.
At least two African countries -- Ethiopia and South Africa,
which have among the largest AIDS caseloads in the world -- have
seized on a cheaper alternative to importing generic ARVs: they are
trying to make them. But pharmaceutical companies in both countries
confront bureaucratic and financial bottlenecks.
In South Africa, where 5 million people are infected with the
virus, health ministry officials recently stunned aid workers by
halting the roll-out of ARVs after concluding that the country's
fledgling pharmaceutical industry could not meet the sustained
demand. The government, in effect, reneged on a campaign pledge made
by newly re-elected President Thabo Mbeki, who thwarted criticism
for ignoring the AIDS threat by promising that at least 50,000
people would get ARVs within 12 months, rising to 2 million by 2009.
In Ethiopia, the two pharmaceutical companies licensed to produce
ARVs are trapped in a financial Catch-22: they need money to buy the
raw ingredients to make the first batch of ARVs, but Ethiopian banks
refuse to lend them money without a purchase order from the
government, the sole buyer and distributor of the drugs. Ethiopian
health ministry officials say they are unable to issue a purchase
order until the drugs are produced.
Even if drug makers can produce ARVs for $240 a year per patient,
providing regular ARVs to merely a fourth of Ethiopia's HIV-infected
population would dwarf the country's $120 million annual health
budget.
Western governments and many international aid groups have been
hesitant to support mass-produced ARVs in Africa, where extreme
poverty and armed conflict have made it difficult for many countries
to maintain the health infrastructure required to support lifelong
ARV treatments for such huge numbers of people.
"The fear is that without the infrastructure to make sure
patients stay on their ARV regimens, the virus can develop
drug-resistant strains," said Dr. Afework Kassa, head of the
Ethiopian health ministry's office for the prevention of AIDS and
sexually transmitted diseases.