San Francisco Chronicle - Sunday, December 7, 2003
Sabin Russell, Chronicle Medical Writer

AIDS was about to take her, as it had her police officer husband and their 7-year-old son. In the tribal culture where polygamy is the norm, AIDS had also killed her husband's two other wives, and the children of his second wife. "I was almost gone," Achieng said.

But at noon on Friday, Achieng stood serenely in her mud-brick hut here, a rural outpost east of Uganda's capital city, Kampala, and graciously invited America's leading AIDS researcher into her home.

"You are most welcome. Come in!" she beckoned to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. On Sept. 1, Achieng became one of the first Ugandan women to receive free AIDS drugs under a new program that could serve as a model for much of this continent. Within weeks, she felt her energy returning. She has added 18 pounds to her still-thin frame.

Success stories like Achieng's are of particular interest to the 80 delegates who flew to Africa this week with Health and Human Services Secretary Tommy Thompson for a close up look at the devastation wrought by AIDS. To them, Achieng represents what could be accomplished by President Bush's proposed $15 billion, five-year program of emergency AIDS relief.

The delegates were divided into small groups Friday and sent to homes in Tororo, each to visit at least two clients who were receiving AIDS drugs from a program known as TASO, or The AIDS Support Organization. Among the group of visitors who filed into Achieng's home with Fauci was Chris Viehbacher, president of the American unit of GlaxoSmithKline, the largest maker of AIDS drugs in the world. Gary Cohen, president of syringe-makers BD Systems, a unit of Becton-Dickenson, came calling on Achieng, as did Dr. Thomas Ansfield, a Wisconsin cardiologist who is an adviser to the National Institutes of Health.

The delegates rode in a car following Irene Athieno, a 25-year-old women who has been trained as an accountant. She rode a motor scooter supplied by TASO, 3 miles up direct roads and paths, to bring Achieng a week's supply of life-saving antiviral medicines. She delivers drugs now to 34 different clients each week, sparing them the time, expense and precious energy that would otherwise be required to walk miles to the clinic in Tororo.

In Uganda, 85 percent of the nation's 26 million inhabitants live in rural areas such as Tororo, which is a three hour drive east of the capital city, Kampala.

TASO believes that programs like this Home Based AIDS Care Project, led by former UC San Francisco AIDS specialist Dr. Peter Solberg, are the most effective weapons against the epidemic in rural parts of Africa, where there are serious concerns whether the "infrastructure" of roads, water supplies, medical centers and the people to staff them are sufficient to handle a massive program of AIDS drug distribution.

Reducing costs

Solberg said that the cost of providing the three AIDS drug combination through the Tororo program is $729 a year, which could be reduced to $300 a year, or less, using the new three-drugs-in-one-pill endorsed this week by the World Health Organization.

If patients develop resistance or have side effect problems with the first line of AIDS therapies, a different set of drugs can be prescribed, costing about twice as much as the first round. But even the cheapest formulations pose an economic dilemma for Uganda, where the per capita income is only $300 a year.

For GlaxoSmithKline president Viehbacher, the experience of the visit to two homes of recovering AIDS patients was "mind blowing." As a top drug company executive, he had been on these kinds of home visits before in South Africa, near the border with Mozambique.

"There, you see people on their deathbeds," he said. "But Achieng was saying she was feeling better after only two- to three-months. There are definitely possibilities here.''

Fauci called the visit to Achieng's home, and then a subsequent stop to another 43-year-old mother with HIV, the most moving experience of the entire trip, and one of the most impressive demonstrations of program potential that he had seen. "These people are heroes," he said. A longtime leader in the fight against AIDS, Fauci said he was struck by how the experiences of the two women he visited encompassed so much of the story of African AIDS.

Battling fear

Achieng had related how few of her friends ever dared get the AIDS tests. There was even a rumor that TASO, which offered the tests, was really trying to kill them. When her husband died of AIDS in May, her brother-in-law tried to seize her property, but succeeded only in taking the possessions in her home, not the land and the building itself.

She spoke of her surviving five children, and how they feared what would happen if she died. "Mom, if you die, who will help us?" they asked her. "Uncle's wives will abuse us. They will say we have AIDS," In fact, all her surviving children are HIV-negative.

Ironically, Achieng said that neighbors who once taunted her now notice her improved health. "Most people want to go to the testing clinic after seeing me up, after this long illness," she said.

At Mary Ochoko's family compound of 10 round, grass-roofed huts, the 43-year-old mother sat deferentially on a woven mat, as is required of women hostesses in their home. Mary's own count of infection-fighting white blood cells had slipped to 228, she said, but since starting the pills, she feels she will soon have the energy to dig for manioc in the fields and brush surrounding her family compound.

Fauci noted that Andrew Natsios, the head of the Agency for International Development, created headlines two years ago when he said that AIDS drugs would not work in Africa because Africans did not know how to tell time. "Not only did Mary know what time it was, she even knows what her CD-4 count is!" he said.

The entire brain trust of the Bush administration's health department had fanned out in small groups to these Tororo homes, and they returned from the hour-long visits excited and emotionally touched. "If you help a person who is on death's doorstep to live, that person will never forget you," Thompson said after the visits.
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