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Despite the huge death toll from AIDS in Africa, about 20 million dead already and rising by 6,500 deaths every day, drugs that could slow the spread of the virus across the continent remain beyond reach in the poorer, most-affected nations.
For more than year, Ethiopia has been trying to produce its own antiretroviral drugs for its two million people infected with the virus. But so far, not one pill has rolled off the production line.
Wibetu Zenabu, 40, an emaciated mother in the closing stages of AIDS, measures out her life in days -- days spent mostly alone in her corrugated-tin leanto. In this deeply religious nation, where people infected with HIV often are stigmatized, her neighbors shun her just as they shunned her husband who died of AIDS two years ago.
Normally, she said, in Ethiopia, when you prepare coffee you share with your neighbors. Since they know, everyone knows from my neighbors that I'm living with the virus, nobody wants to come to take a cup of coffee with me in my home, she says.
Of the two million people infected with HIV in Ethiopia, only about 5,000 can afford drug treatments, mostly paid for with money sent back from relatives living in the United States and Europe.
Because so few people have access to treatment, Wibetu Zenabu says, people with the virus usually are treated as though they are already dead.
But last year, she had a glimmer of hope as newspaper headlines in Addis Ababa announced the government had licensed two local drug manufacturers to mass produce low-cost, antiretroviral drugs, known as ARVs. For Ms. Zenabu, it meant she might live, at least long enough to raise her 13-year-old daughter and 10-year-old son.
But that hope of prolonging her life, and the lives of tens of thousands of Ethiopians with full-blown AIDS, is evaporating. Drugmakers licensed to produce the ARVs have hit a barrier -- they can't find the funding necessary to buy the raw ingredients for the drugs.
Even if locally manufactured drugs are estimated to cost $240 a year per person, a quarter of the price of imported generic ARVs, but still more than most Ethiopians can afford, Ethiopia's meager $120 million health budget is hardly enough to sustain lifelong ARV treatment for even a fifth of its HIV-infected population. That's why Ethiopia is asking for foreign aid in its fight against the virus.
So far, Western governments and many international donors have been hesitant to support mass produced ARVs in Ethiopia, and Africa, in general, where extreme poverty and armed conflict have undermined the health infrastructure necessary to administer and monitor ARV treatments. Their fear is that, without the infrastructure in place, such as clinics, health workers, and uninterrupted supplies of ARVs, the virus could develop drug-resistant strains.
Some critics say that pharmaceutical giants that hold the ARV patents are pressuring African governments to use donor funds to import brand name ARVs, ostensibly to ensure the quality of the drugs, but also to bolster the price of ARVs on the world market.
Sudhir Sathe is pharmacist and manager at Bethlehem Pharmaceuticals, one of the factories licensed to make ARVs. He says he's frustrated by the international community's lack of support for Africa's effort to produce the drugs.
"The African countries and the companies here have never had a chance to get into this category of drugs and demonstrate that, yes, we are also capable," Mr. Sathe said. "It's a notion which, I think, is borne out of their reluctance to come close to Africa. They're sitting in faraway places and making judgments, which is not right."
He says that with just $8 million, he can start making ARVs for up to 150,000 AIDS patients. But as yet, no one has come up with the money.
Meanwhile, the United Nations says HIV-infected Ethiopians continue to die of AIDS at a rate of 600 a day. Aid workers say the deaths are creating a population of more than a million orphaned children, igniting a crisis for the generation to come.