Uganda's deal with the drug firms
KAMPALA, Uganda (CNN) -- About one and a half million people in Uganda have HIV or AIDS.
That's actually a lot less than projections of just a few years ago as Uganda has cut the rate of new HIV/AIDS cases by two thirds in the past 10 years through an aggressive education campaign.
However, HIV/AIDS still ravages the area around Kwanda, one of the first places to be struck by the virus.
The local carpenter has stopped making furniture altogether. He is too busy building 35 coffins a week.
About 10 percent of Ugandans have HIV/AIDS. Nearly one million Ugandans have already died from the disease, but while images of the sick and dying in Africa abound, there are a lucky few who have had access to life-extending anti-retroviral drugs or ARVs.
Reverend Gideon Byamugisha of the Church of Uganda told CNN that he nearly died in 1998.
"I shouldn't be speaking to you. I should be dead. Because my doctors had written me off until some good samaritan came to my rescue and began sending this medicine," he said.
However, the vast majority of infected Ugandans cannot afford the combination of drugs that could save their lives, even after the government and the big drug companies struck a deal in December via the United Nations, making ARVs 90 per cent cheaper than in Western countries.
The average price for a combination of ARVs is now $700-$1,300 a year.
The average Ugandan makes less than $2 a day.
South Africa and Kenya have fought the drug firms to bring down the cost, but Uganda decided instead, like a handful of other countries in sub-Saharan Africa, to sign a deal with the international pharmaceutical companies, through the United Nations, to buy cheaper drugs.
Uganda's President Yoweri Museveni told CNN that the drug companies were "business people."
"They are in business because they make some profit. First, they recover what they put in the development then they make a profit. How can you reasonably argue with them to produce these drugs at a loss to themselves? This is not common sense," he said.
Drive to lower prices
But many doctors and non-governmental organisations (NGOs) want drug companies to cut prices further.
Doctor Peter Mugyenyi, director at the Joint Clinical Research Centre in Kampala, said: "A huge number of people continue to die while treatment is available, is cheap to produce and yet certain groups of people are hanging onto this treatment because they must exact their pound of flesh while people are dying."
Doctor Mugyenyi runs a clinic that sells ARVs to some 3,000 patients.
Last year, Cipla, an Indian-based drug manufacturer, started to sell cheaper versions of Western AIDS drugs. These generic versions of the drugs have upset Western pharmaceutical companies who accuse Cipla of violating drug patents.
But Uganda's doctors have no problem importing the generics to bring costs down further.
"In response to the cheaper versions of these drugs, we have had a huge rise in the number of patients. We have had to hire new staff to cope with the increased number of patients who have come simply because for the first time in their lives they are able to afford these life-saving treatments," said Doctor Mugyenyi.
It was pressure from international bodies like the UN and the presence of generics that led the drug companies to cut their prices in parts of Africa.
Pharmaceutical giant GlaxoSmithKline says the company now sells its drugs at cost price in Uganda.
"A substantial amount of money is required to tackle HIV/AIDS and as an industry we have done our bit: lowering the price of products and making sure the medical community is educated on HIV/AIDS products. Yes, obviously there is a need for more funding, but the industry, or Glaxosmithkline, has done its bit," said the firm's representative in Uganda.
With prices unlikely to fall much further, the international community is looking for ways to pay for ARVs in sub-Saharan Africa. There is widespread agreement here that Africa can contribute a tiny portion to a larger fund.
"We can make a contribution if it's an international effortÖUganda can raise $5 million and put it in that bag. It is not that we don't have money at all," said President Museveni.
NGOs and Western governments are also under pressure to increase their contributions to a U.N.-sponsored war chest to fight AIDS, malaria and TB.
Campaigners say the West needs to raise $10-20 billion a year to start treating millions of Africans.
"With a great deal of hard work, with a tremendous amount of goodwill, with strong donor support, with strong support from the pharmaceutical companies, we may be able to get to around a million people in treatment within two or three years in Africa. That could rise to three to five million people by the fifth year," Jeffrey Sachs, director of international development at Harvard University told CNN.
Individual companies in Uganda and indeed across Africa could become big beneficiaries of this push. Lower drug prices will save their health plans millions and millions of dollars and enable them to offer these life-extending drugs to their employees.
One such company is Kakira, a sugar firm in eastern Uganda. With more than 6,000 employees and some 25,000 dependents, Kakira is one of Uganda's biggest employers.
It estimates that 10 percent of its employees are probably HIV positive. The company cannot afford to cover employees with AIDS.
What money it does spend goes on preaching prevention in the villages where the employees live.
The company would like to provide ARVs.
"They are very, very expensive in the marketplace. If the initiatives bring the price downÖthen we certainly will look at it," said Kakira's Richard Orr.
But until companies, governments and the drug firms find a way of making the drugs more affordable, HIV sufferers like mother-of-four Fausta Katabaira will continue to plan for her death.
"Seeing death coming to you and you have nothing to do. It's very unfair. We are human beings, when there are drugs and you cannot get to them," said Katabaira.
While the education campaign continues to spread the message of prevention, places like the Mildmay AIDS Clinic outside Kampala provide comfort to sufferers such as day care for infected children.
Staff at the clinic wait for donations to move their patients, one at a time, onto ARVs.
In-depth: AIDS -- 20 years of an epidemic
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