Only a tiny minority of HIV-infected Africans can afford private AIDS treatment, and even fewer get it for free. But those numbers are jumping as the prices for trademarked retroviral drugs collapse. African governments are quick to point out that even if the drugs were free they would need to spend heavily to create the health-care infrastructure to treat the infected masses. But the new economic reality of AIDS treatment in Africa already is brightening what had been an unremittingly bleak picture.
Nonprofit groups are taking the lead. “We are having a very good experience with the new treatment,” says Sister Little Treasa, who administers anti-retrovirals to 13 HIV-infected orphans in Nairobi. For a year the Belgian wing of Medecins Sans Frontieres has run the only public clinics in South Africa dedicated to treating AIDS patients. Another pilot project is running in Cameroon. Next month these clinics will begin to offer free retroviral treatment for the first few hundred people.
In part, the projects aim to demonstrate that the public will accept such programs–despite the secrecy that still surrounds the illness in many countries. “We’re trying to move to a place where Africans can talk about AIDS as a chronic condition,” says MSF’s Toby Kasper. Price reductions promise to inspire other such efforts. “This is the first time I’m confident that we will be able to start [dispensing drugs] soon,” says Jean Luc Anglade, MSF’s mission director for Kenya. “The numbers will depend on how cheap the drugs will become.”
Some leading private firms already recognize that the new prices make treating HIV-positive employees affordable and cost effective. In South Africa, the mining giant Anglo-American last week announced a program to cover health-care costs, including retroviral treatment, for the infected among the 100,000 people who live near a company mine on the west coast. As with MSF’s efforts, part of the aim is to break a pattern of denial that has fed the pandemic. “Saying we will care for you if you are positive is a very good incentive to learn your status,” says Anglo vice-president Dr. Brian Brink.
Botswana’s Debswana, the country’s biggest diamond-mining firm, is to start subsidizing 90 percent of the cost of retroviral treatment for HIV-positive employees and their spouses. The firm took the step after absenteeism rose and a voluntary testing program revealed soaring infection rates; more than two thirds of current employee deaths are AIDS-related. Such programs can’t help the jobless, or those in more chaotic countries. But they are, at long last, a start.
