Chicago Tribune - November 20, 2004
Laurie Goering, Tribune foreign correspondent

Now the 53-year-old, who lives in a displacement camp in war-torn northern Uganda, struggles each day to find the strength to hoe her meager vegetable plot and to care for seven children--four of her own and three left behind by a sister who also died of AIDS.

"I don't know who will take care of them if I die," she said quietly. The neighbors, who shun families touched by AIDS, "say it would be better if we all died fast," she said.

Uganda has waged one of Africa's most successful campaigns to stem the spread of HIV-AIDS, dropping its national prevalence rate from 18 percent in 1992 to about 6 percent today, largely as a result of a broad public education campaign.

But a long rebellion by the brutal Lord's Resistance Army in northern Uganda has pushed that region's HIV infection rate to double the national average. And a continuing lack of access to AIDS treatment drugs--a widespread problem in Africa--means women like Lodah may not be healthy enough, or live long enough, to raise families.

Lack of access to anti-retroviral drugs is the biggest problem facing AIDS treatment efforts on the continent, said Dr. Robert Colebunders, a Belgian researcher at Uganda's new international Infectious Disease Institute at Mulago Hospital in Kampala. The center will train doctors from across Africa to correctly administer AIDS medications, but most African governments--including Uganda's--have barely begun to make the drugs available.

That was one of the concerns at this week's meeting in Tanzania of donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The United States, the fund's largest donor, had proposed putting off the next round of grants to fight the diseases, arguing that international donors had not met their funding commitments.

But AIDS activists said a year's delay in getting funds out to new projects--particularly AIDS treatment programs--would mean many of their clients might be dead before help becomes available. The United States eventually relented after four African presidents, including Uganda's Yoweri Museveni, insisted the funding was key to supporting social and economic progress in Africa.

Colebunders said that even Uganda, with one of Africa's most acclaimed anti-AIDS programs, has yet to begin receiving AIDS drugs from the global fund. Of the 4,000 AIDS patients at the new institute's clinic, only 300 are receiving government-funded drugs. Nationwide, 20,000 Ugandans take anti-retroviral drugs, but 75 percent are patients able to pay the cost, rather than depending on government support, he said.

'Long way to go'

The government, with help from the global fund, hopes to begin funding anti-retroviral treatment for 60,000 Ugandans soon, but even that effort would reach only half of those who need the drugs.

"Uganda is a success story," Colebunders said, "but it still has a long way to go."

Much of Africa still has problems providing anti-retroviral medications. Botswana today is the only African nation that offers large-scale free access to anti-AIDS drugs. The government of South Africa, one of the continent's richest countries, had promised that 53,000 people would be receiving government-provided AIDS drugs by last March. Eight months after that deadline, only 15,000 of the country's 4 million HIV-positive citizens are getting government-funded treatment.

In part that is because South Africa's government has been hesitant to admit the size of the nation's problem and take action. But in many countries, including South Africa, the cost of providing AIDS drugs to millions of affected people also remains prohibitive.

The cheapest generic treatments now cost just $15 a month, down from hundreds of dollars a month a few years ago. But "the problem is keeping people on drugs for years," Colebunders said. Drug resistance, he said, was expected to be the main problem in Africa as countries began rolling out anti-retroviral treatment programs. But resistance has not been a problem, he said, largely because there aren't enough drugs being used for a problem to develop.

Access to medicine a problem

Lack of access to drugs is taking a huge social toll in Africa. Twenty-eight million Africans now are thought to carry the AIDS virus, which hits adults of working age hardest and leaves many unable to farm or hold jobs. But only 4 percent of those who need drug treatment are receiving it, according to the UN.

Two million people died of the disease in Africa last year. And 11 million African children younger than 15 have now lost one or both parents to AIDS, according to the United Nations.

In northern Uganda, thousands of girls kidnapped by the rebels and held as sex slaves are returning home HIV-positive as the conflict appears to wind down. In the region's squalid displacement camps, widows sell their bodies for money to feed their children, and government soldiers, charged with protecting the camps, rape some of their charges. That has pushed northern Uganda's AIDS rate to 12.5 percent, said Dr. Ogwang David Martin, the administrator of Lacor Hospital, just outside Gulu.

Lodah, worried about her children, travels each month to the hospital's AIDS clinic for a checkup and to see whether the drugs she needs are available yet. So far, the long wait on a wooden bench, beside dozens of other hopeful AIDS sufferers, has not paid off.

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