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High Costs of HIV Medication Cause ‘Terrible Dilemma’ in Mozambique

November 23, 2010 at 12:00 AM EST
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In Mozambique, where 1 in 8 adults is living with HIV, the number of patients on antiretroviral drugs has expanded thanks to international AIDS funding, but a debate is emerging over whether foreign donors can continue to fund an ever-expanding pool of patients. Ray Suarez continues his series from the southern African nation.
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JIM LEHRER: Next tonight: another front in the war on AIDS.

In the second of three stories, Ray Suarez and our Global Health Unit report on how policy decisions made in Washington affect people in the Southern African nation of Mozambique.

RAY SUAREZ: Twenty-two million people live in Mozambique on Africa’s Indian Ocean coast. One out of eight adults is HIV-positive. The first case of HIV was reported here 24 years ago. Since then, the number of new people infected each year has grown.

HIV infection and its progression into AIDS was once considered a death sentence, but drug treatment in Mozambique and across heavily infected sub-Saharan Africa has changed that. Most of Mozambique’s HIV- infected population is on lifesaving antiretroviral drugs called ARVs, people like 40-year-old Leonor Gipumbo Cumbane.

When Cumbane’s husband, working much of the year in South Africa, contracted HIV, he never told her. It’s a sad and typical story in Mozambique and across sub-Saharan Africa. When she asked him why he was sick, he lied. When he died, she learned he was HIV-positive and urged to get tested.

LEONOR GIPUMBO CUMBANE, HIV-Positive (through translator): They told me I was HIV-positive, and I didn’t cry, because I know it’s not the end of your life.

RAY SUAREZ: That was seven years ago. Cumbane has taken daily ARVs since. She has a job. She’s raised three children and now has a grandchild.

LEONOR GIPUMBO CUMBANE: I’m living with HIV for years. But I’m still OK. I can still work. I can still feed my family.

RAY SUAREZ: ARVs have been an overwhelming success, keeping millions alive. But now a new debate has emerged: What’s the price of that success? Can international donors like the United States be expected to keep up funding drugs for future generations?

Since 2004, the United States has donated $835 million to HIV/AIDS programs in Mozambique. Renaud Leray coordinates HIV programs for Doctors Without Borders in Southern Africa.

Is there a moral or ethical obligation to keep someone on ARVs however long they remain alive once you begin them? Is that an implied contract, that you will always provide it for them?

RENAUD LERAY, Doctors Without Borders: Of course. I think it’s a responsibility, as a medical body, when we have started treatments for person who need it for life, no, then we need to continue to support.

RAY SUAREZ: In places like Mozambique, the number of people on ARV treatment is growing faster than the supply of drugs. Some patients are caught in the middle.

Several times, Leonor has arrived at the clinic to find no drugs were available.

LEONOR GIPUMBO CUMBANE (through translator): It’s a problem when I don’t take the medication. My limbs are very weak. I can’t walk. In the morning when I wake up, I have a fever. I can’t stand up. I can barely work when I don’t have my medication.

RAY SUAREZ: The story is the same at Primero de Maio (ph) clinic in Mozambique’s capital, Maputo. On this day, the clinic’s pharmacist, Roseler Ventura, has run out of ARVs specifically used to treat HIV-infected children.

ROSELER VENTURA, Doctors Without Borders: Sometimes, we see tears on the face of the mother, because we tell them here at the pharmacy that we don’t have that medicine now, you understand? And so it’s very difficult to deal with that.

RAY SUAREZ: Adult supplies are also running low. And monthly packets need to be broken up and shared between patients.

ROSELER VENTURA: We must divide the medicine, because we can’t stop the treatment after we initiate. So, sometimes, we divide a package for four, five patients.

RAY SUAREZ: Problems with the supply of antiretroviral drugs is not just a medical problem. It’s mathematics. When you cut down the supply from a month’s worth of drugs to a week’s worth of drugs, people have to come to the hospital four times as often, take off work, forego income, and then fall off their regime.

Every year, the U.S. government has given more and more to Mozambique for AIDS programs. This summer, the Obama administration pledged $1 billion for the next five years. But the amount slotted for ARVs will stay the same. AIDS advocates point to the long lines for lifesaving AIDS drugs and say the administration’s pledges do little to meet the increasing needs for treatment in Mozambique and across Africa.

Paul Zeitz is the director of the Global AIDS Alliance.

PAUL ZEITZ, director, Global AIDS Alliance: The metaphor I like to use is that it was like we were an airplane on the ascent, and the momentum that had been created was like on the upswing. So, the Obama administration policies, unfortunately, are being viewed as having chopped the wing off the airplane. And the airplane is now spiraling down.

And when you hear the stories of people being turned away, when they had been receiving care, the alarm bells are being rung.

PRINCETON LYMAN, Former U.S. State Department Official: We’re caught in this terrible dilemma.

RAY SUAREZ: Princeton Lyman is a former U.S. ambassador to both South Africa and Nigeria.

PRINCETON LYMAN: The United States has directly provided half the people on treatment with treatment. Now, if we sustain that, it would take a steadily larger share, not only of our international health budget, but of our foreign aid budget. And, yet, when you try to slow it down or to say, well, we’re going to go — only go so far, you’re accused of condemning people to death.

RAY SUAREZ: U.S. Global AIDS Coordinator Dr. Eric Goosby recognizes that the need is great.

DR. ERIC GOOSBY, U.S. Global AIDS Coordinator: The United States has been, I think, vigorous in mounting a response. We are not backing off of this effort. We have given, in both last year and this year’s budget, increasing amounts.

One country’s ability to respond to this extraordinary epidemic is not going to be successful without others. The partner countries in which we work have got to step up to the plate.

RAY SUAREZ: But the worldwide recession has squeezed funding for HIV/AIDS programs. International government donations are down, placing the replenishment of the drug supplies and expansion in jeopardy.

At the same time, the Obama administration has plans to move away from targeting money for specific diseases, like HIV/AIDS, and has moved toward a more holistic approach, like funding health care facilities, as they’re doing in the rural hospital in Xai-Xai, Mozambique.

Mozambique’s former health minister, Paulo Ivo Garrido, helped guide the U.S. HIV/AIDS strategy.

PAULO IVO GARRIDO, former health minister, Mozambique: If you give me a lot of drugs, but I don’t have a good logistical system, part of the drugs will be spoiled, because I’m not able to do the transportation of the medicines from the city capital to the most remote area in my country. This is a problem in Africa. We have weak health systems.

RAY SUAREZ: And the U.S. says more money needs to go directly to prevention.

Here in Gaza Province, where one in four adults has HIV, school-age children gather daily to create plays about how to avoid the disease. Mozambique has a long history of using theater to send public health messages.

It’s a program the American ambassador, Leslie Rowe, sees as key.

LESLIE ROWE, U.S. Ambassador to Mozambique: The area that we’re really trying to put a lot of resources into is prevention, because, quite frankly, there are not enough resources in the world to be able to deal with the problem of HIV and AIDS, if people continue to be infected in large numbers.

RAY SUAREZ: But Mozambique is desperately poor. Half the population lives on less than $2 a day. People without work, without enough to eat often ignore prevention messages.

So, the United States is also stressing economic development as an AIDS prevention strategy. One striking example of how a small investment can go a long way in a very poor country is the Foundation for Community Development in the small town of Massingir. Three thousand families who have lost loved ones to AIDS or are infected themselves now create wealth for themselves and the entire region. Families design and create garments for sale around the world.

Dulcia Mudhlovo, is the project manager.

DULCIA MUDHLOVO, Foundation for Community Development: With that kind of money, we’re able to buy all the salary, to pay the salaries. We are able to buy the local grown material. So, basically, it covers everything and guarantees the production, you know, throughout the year.

RAY SUAREZ: The Global Fund, a primary source for AIDS treatment, has missed its fund-raising targets for the next few years. So, the debate continues on how to best treat the already infected and bring life-sustaining medicine to new patients.

JUDY WOODRUFF: The worldwide incidence of HIV infection has fallen by 19 percent over 10 years, according to a new U.N. report.

There was also news today of a major breakthrough in preventing the disease. A global study of high-risk gay men found that daily doses of the drug Truvada cut their chance of infection by as much as 70 percent. Later this week, Spencer Michels will profile the company that manufactures the new drug.