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Uganda's AIDS problem

KAMPALA, Uganda (CNN) -- CNN's Charles Hodson interviewed Uganda's President Yoweri Museveni

Q: Mr. President, how would you explain to somebody who wasn't familiar with the problem of AIDS in your country how serious it is?

A: AIDS is serious but also not serious really. It is serious because it spreads through heterosexual sex amongst other things. In Uganda, promiscuity became a problem by the '50s '60s, '70s and therefore if the sickness was spreading through heterosexual contact and it had no treatment, it was obvious it meant disaster. That's why it was important to sound a very loud alarm.

Uganda's President Yoweri Museveni was one of the first African leaders to see the threat posed by AIDS  

The second aspect is that before it gets into the human body, the AIDS virus is not that aggressive. It doesn't infect that easily. You cannot get AIDS by shaking somebody's hand. Therefore, it is easy to stop. People only need to change their behaviour.

Q: You were one of the first African leaders, in fact of any leaders, to take this seriously. That was in 1986 and we're now in 2001. How has your attitude to the problem changed?

A: My attitude caused dramatic, positive changes in the struggle against AIDS. The prevalence, at the time, among adults was about 30 percent. Now it's about 8 percent. It has gone down, but we shouldn't relax.

Q: In the course of those 15 years, how have your attitude towards dealing with the problem changed? Is, for example, education important though it is perhaps not so important as access to drugs for your people?

A: Education is important all the time. That is the main way of stopping AIDS. As I said, people only need to behave correctly and AIDS will stop.

The only other danger I know is the blood supply, infections through the blood bank. And once you take care there, especially now with the new diagnostic means, you can clean up the blood bank. The other danger here was from customs like circumcision where they used the same knife. We had to stop that too.

Therefore education along those fault lines is important; sex, the blood bank, some customs must continue, should not relax. Nevertheless since a significant number of people have already been infected, you must also think about those who are already infected.

Q: How important is it that patients in Uganda have access to the latest HIV/AIDS drugs, the anti-retroviral drugs?

A: It is very important because it means the difference between life and death. We've got many cases where blood counts have come down. You know there are many cells in the body that fight the virus, a particular type called CD4 cells.

These are the ones that are targeted by the AIDS virus. Normally they come down from about 800 millimetres or something. They come down and in some cases they were down to about 50, instead of 800. However with the drugs they go up to 300, 400 and this is reflected in the ability to fight off infections.

Q: Are you satisfied with the extent to which patients in Uganda have access to those drugs?

A: No, I am not satisfied at all because of the cost of the drugs. It is only those who can afford them that have access to these drugs and then they recover.

Q: What are you going to do about that?

A: I have proposed to the Under Secretary for UNAIDS, Dr. Piott, that we negotiate with the drug companies and through international fund raising, we should pay the research and development costs of the companies. And then, add some profit so they can sell at lower prices.

Q: Doesn't that leave you in a position of being at the mercy of the pharmaceutical companies and of donor nations?

A: Why donor nations? We can raise the money ourselves. That is not the problem. We can make a contribution if it's an international effort. Uganda can raise $5 million. It is not that we don't have money at all.

Q: Why should people in Uganda pay for the R&D costs?

A: But ...why should they not? You see if they don't, you are really being naive, idealistic. These people are business people. They are in business because they make profits. First, they recover what they put into the development, and 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

Q: But they have already recovered the profits by selling the drugs in North America and Europe.

A: If they have recovered the European costs and they have already made a profit, then that is another matter. I was assuming that they hadn't and I was seeing a danger of discouraging them from further research by saying they should donate these drugs free at a loss to themselves. If they have already recovered their costs and their profits, I don't see anything wrong in Uganda putting in a little bit of money because, after all, the people who are sick are our people.

Q: What about the alternative approach, which would be to buy generics from Cipla or perhaps from Brazilian drug producers.

A: What are these generics?

Q: A generic drug is a drug that is a copy of ...

A: You mean you copy the inventor's formula? I think there is some danger in that one because the international community must really reward those who make the initial discoveries otherwise you discourage them. Unless of course the copying comes after the man has recovered his money and has made a profit.

Q: If you were one of the 1.5 million people in your country who was suffering from HIV/AIDS, it would be hard to understand why it's so important that drug companies which make in some cases several billion in profits, why they should recover the profits at your expense?

A: Why would it be difficult to explain? I am sick but I have a country and the country has some resources. These drug companies are not philanthropists. The only moral argument you are raising now is to say that they have already recovered their costs through selling to other countries. I was assuming that they had not recovered their costs but if they are simply making money, making super profits, then that is very bad. That's not acceptable. That's criminal actually.

Q: So, you are satisfied that the deal you have struck with the United Nations and in effect with the pharmaceutical industryÖ

A: I suggested it to them. I have not checked how far they've gone along that line.

Q: There are only other two nations in Africa that have taken a similar approach, Senegal and Rwanda. Are you satisfied this is the best way to get drugs to people who very badly need them?

A: Yes, yes, yes. Instead of quarrelling with the drug companies because if these people have found a formula which enables us to fight the virus rather than quarrelling and bringing in polemics, why not reach a compromise with them.

Q: You might get cheaper drugs for example if you bought its generics from a company like Cipla in India?

A: What impact would it have on future research? We are trying to end anarchy in the world. We are trying to say we will reward those who use initiative. Up to now the argument on patents has been that they don't accept our patent. For instance there are certain things that African people have the monopoly over which people come and rob and take away. We have been trying to stop robbery of intellectual or social knowledge, which I regard as intellectual property.

But now if you bring in another element and say that robbery is alright because that's what it seems to be. I think this would undermine a concerted effort to solve human problems. I don't think that's a good way of handling it. It would discourage initiative and effort.

Q: One of the difficulties with a lot of these drugs is that they are relatively complicated to take. Are you satisfied that your health services would make them available and make sure people take them correctly?

A: Oh, yes. That can be done because the health network is now going up to what we call a sub-county which is a fairly small area, about a four-mile radius. In some parts of the country there is a health unit in the sub-county with someone with a diploma there. Therefore it's possible. You can give instructions and the message will get passed down.

Q: In terms of benefiting from these drugs, from the approach that you are suggesting with the pharmaceutical companies, how many people do you think would be able to have access to those drugs and how quickly?

A: In Uganda we have about 1.5 million people with HIV virus so all of them should be able to get access to these drugs if the cost is low. They would have to pay the residual costs themselves because the government would not be able to pay it. The government could make a contribution to the international fund to bribe the drug companies and that would be the end of the government's contribution.

Special: AIDS -- 20 years of an epidemic


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