In August, South Africa's government announced it would finally begin offering antiretroviral (ARV) drugs to its citizens with AIDS, but some experts warn that drug-resistant strains of HIV may proliferate if the program is not managed properly. Dr. Robert Gallo, the co-discoverer of HIV, said: "The attitude seems to be that resistance is understandable and a part of life." Unfettered access to AIDS drugs could lead to "multiple drug- resistant mutants of HIV which become epidemic and cause new kinds of epidemics in the future," said Gallo, who supports South Africa's program.

In parts of the world where ARV drugs have been used most, such as the United States and Europe, 10-15 percent of all new HIV infections show at least some drug-resistant mutations. And conditions are ripe for the development of HIV mutations in developing nations because of the chaotic drug delivery process.

"In every African city, these medications are available to the open market," said Dr. Paul Farmer, professor of social medicine at Harvard University. "What's going on now is called 'therapeutic anarchy.'" Many stop taking drugs when their funds run out and continue when they have saved enough to buy more, a "recipe for disaster." Farmer said those who focus on the threat of resistance share some of the blame for that chaos. "In repeating the drug resistance mantra, they have slowed down the aggressive interventions that might deliver these drugs regularly to those who need them most, not merely those who can pay for them." With generic medications available in parts of the continent and donations from drug companies, ARV drugs now cost only $1 a day in Africa. But HIV is quick to mutate, and once it does, it must be attacked with ever more expensive drugs. In the United States, each resistance test costs $350 to $500, a fortune in South Africa, where per capita government health expenditure is $108 per year. However, when only 50,000 people in sub-Saharan Africa with AIDS receive ARV drugs, resistance is not yet a major issue.

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