The latest step in responding to that challenge has been the program known as the President's Emergency Plan for AIDS Relief
(PEPFAR), announced in President George W. Bush's 2003 State of the Union address and implemented, starting in June 2004—almost
25 years after AIDS was first diagnosed in Africa. Bush pledged $15 billion over five years to fight HIV/AIDS in 15 countries,
mostly African. Much of the money is intended for grants to NGOs that fight AIDS. The first wave of cash focused on infrastructure
initiatives, but as the program goes on, funds will increasingly go toward providing ARVs to AIDS patients.
A Ugandan man, whose sister and mother have died of AIDS
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Uganda, one of the PEPFAR targets, is a good place to start in looking at what works and doesn't work in bringing AIDS drugs
to the developing world. On the one hand, the country mobilized awareness and prevention efforts and political buy-in, resulting
in grants not just from PEPFAR, but from the Global Fund to Fight AIDS, Malaria, and Tuberculosis (Global Fund), and the World
Bank, as well as substantial investment from pharma companies. From 900 patients on ARVs in 2002, it now has an estimated
35,000 in treatment. "Implementation has been easier than we thought," says Amy Cunningham, HIV/AIDS advisor for USAID in
Uganda.
On the other hand, though 35,000 patients on ARVs is a triumphant success, in a country with estimates ranging as high as
one million HIV-infected patients and an 18-year-old war that threatens to make that number skyrocket, it is also a drop in
the bucket. Uganda needs to have 60,000 patients on therapy by the end of next year, and more the year after that, if it is
to have a sustainable defense against the epidemic. And getting drugs from the United States and England and Germany to Uganda
is only the first step in the process. It's also a matter of getting the products from Kampala to Kabalagala and beyond, to
the dying villages within the four kingdoms of Uganda.
Sowedi Muyingo,
medical access
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"Now the problem is not that we have the products available," says Helmut Leuchten, Boehringer Ingelheim's head of marketing
for virology products. "Now we have to see how we can deliver the products, all of them, to the point where we need them.
Outside PEPFAR
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For pharmaceutical companies, which have staked both dollars and reputation to clean up the world's biggest health disaster,
the next few years will be crucial. Can Africa scale up its infrastructure to actually get drugs to the patients who need
them? (That question becomes particularly important now that PEPFAR's $7 billion drug procurement and distribution program
is on hold.) Can local caregivers achieve adequate compliance with drug regimens, not just to benefit patients but to help
control resistance? As use of ARVs increases, will donated and preferentially priced products leak back into the US and European
markets? And most important, how can the lessons of Africa be brought to bear as the AIDS pandemic moves to India, China,
and beyond?
In the streets of Kabalagala, the orphans treat Pastor Paddy like an uncle or one of their lost parents. Perhaps in a few
years he can preach a new sermon—not about faith and the botched test results, but perhaps this time a gospel story. Maybe
he can tell them about Lazarus, who was dead and came back to life—and tell them that finally it's not a hope but a reality.
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