The New World of AIDS: Despair in the Third World

Help Least Likely Where Most Needed; Africa Ravaged by Virus

By James Rupert
Washington Post Foreign Service
Thursday, September 4, 1997

ABIDJAN, Ivory Coast -- If Francis Koffi happened to live in America, he feels sure, he would be taking one of the new treatments for AIDS, hoping to get well. He would probably still have his job, wife and home.

But like most people here with the AIDS virus, the best Koffi can hope for is to hang on; to live a while longer despite his infection and the poverty and isolation it enforces. He wakes each day in a dingy cinder-block room in the muddy slum where a poor family provides him free shelter. He prays that no illness will enter through his tattered immune system, and that he can scavenge enough money for food.

At 41, Koffi is thin -- 104 pounds -- and burns a nervous energy as one of Ivory Coast's few activists with the virus. For months, he says, he's burned a lot of that energy with a question: "How can I get some of these medicines?"

When the world's giant pharmaceutical firms poured a crop of new AIDS-fighting drugs into the market, they sparked new hope for life and health among hundreds of thousands of people infected with the AIDS virus. In North America, Western Europe and a few other islands of affluence, people with the virus scramble to buy the new drugs for thousands of dollars per month, or get them through government programs or drug trials.

But about 93 percent of people infected with the human immunodeficiency virus (HIV) that causes AIDS live in Africa and other parts of the Third World, where news of the drugs is creating as much despair as hope. Even if they were available here -- and they are not -- a year of treatment would cost more than most Africans make in a decade, or even a lifetime.

"I am as desperate for treatment as anyone else," said Etienne Tape-Bi, another HIV-positive activist in Ivory Coast. "To know that the drugs now exist but that I can't have them because I don't have money, that can make me really feel sick."

The rich nations' excitement over AIDS treatments can engender bitterness among Africans. Jeanne Kouame, who heads an association of HIV-positive people called Illumination-Action, contemplated the American sense of hope glowing from an old Newsweek cover. Above a dramatic photo of new, anti-AIDS pills, a bold headline asked: "The End of AIDS?" In Africa, "we can't even ask this question," Kouame said. "For us, it is not the end of AIDS. We are still at the beginning."

For Africans, virtually all hope in the battle against AIDS is distant and abstract. With years of work, anonymous people of future generations might be spared the disease. "If you have AIDS today in Africa, it's still pretty much a death sentence," said Mark Aguirre, an American physician running Abidjan's only clinic for indigent AIDS patients.

It was in 1978, in the east African nation of Uganda, that a mystery first frightened doctors. Villagers in the forests west of Lake Victoria were wasting away and dying, their bodies' natural defenses against disease mysteriously destroyed. Researchers labeled the phenomenon "acquired immunodeficiency syndrome." Within a few years it had spread worldwide, mainly through sexual contact, to become known and feared by its acronym, AIDS.

Nearly 20 years later, Africa is by far the continent most ravaged. Of the 22.6 million people worldwide whom the United Nations estimates are infected, 14 million, or 62 percent, are Africans. The virus has reached 5.6 percent of all Africans, but only 0.3 percent of people in the wealthy regions: North America, Western Europe and Australia.

Among some populations of those wealthy regions, the percentage of people with AIDS effectively has leveled off, researchers say. That is partly because any epidemic eventually does so, according to local conditions, and partly because people have reacted defensively against the primary causes of HIV transmission in the West -- sexual contact between males and intravenous drug use -- by using condoms or avoiding sexual promiscuity, or using clean needles for drug injection.

The new treatments could provide a powerful new brake on the spread of HIV in the world's wealthy regions "simply because they will make people less infectious," according to Thomas Quinn, a Baltimore-based researcher with the National Institute for Allergy and Infectious Diseases. "But that won't happen in the Third World."

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