Ivory Coast’s HIV Patients Frustrated

When Desire Koua N’dah first heard that Ivory Coast would be included in a pilot program to make powerful new AIDS drugs available at subsidized prices, his hopes soared.

So, too, did those of thousands of other Ivorians like N’dah who are infected with HIV, the virus that causes AIDS.

But the U.N.-sponsored program has mostly spread frustration among patients and medical officials. Program officials say the poor and uneducated--the majority of Ivory Coast’s 1 million HIV-positive people--will be excluded because participants still face prohibitive costs for drugs.

“I don’t see how many people can have it unless it’s free. This is going to create problems, deep divisions,” said N’dah, president of the Friends Club, Ivory Coast’s largest support group for HIV-positive people.

Ivory Coast’s program decided to use a cocktail of AIDS drugs called protease inhibitors in combination with others such as AZT. When tried on patients in the United States, the combination halted the progress of the virus in some people and is credited with causing the first-ever drop in the number of full-blown AIDS cases last year.

The problem for Ivorians is the high cost of the treatment chosen--$15,000 a year for each patient. And the treatment is a lifetime thing.

Even if the participating drug companies subsidize up to 50% of the cost, prices for the medicines will still be far beyond the reach of most people in Ivory Coast, where the average per-capita income is about $500.

Christopher Assi of the Ivorian Health Ministry said the country was obligated to try the treatment after word of its success in the United States spread here.

“People turned on their TVs and realized that there was advanced treatment out there,” Assi said. “There is a moral obligation to give access to the treatment, if there is a means to do so.”

When Health Minister Maurice Kacou Guikahue announced the project in November, the plan was to start it in conjunction with the international AIDS conference that was held in Ivory Coast on Dec. 7-11. Vietnam, Uganda and Chile also are in the project, but Ivory Coast was to be the first to begin because of its superior medical and research facilities.

The program has yet to begin, however.

Major drug companies involved in the project--Glaxo Wellcome, Virco and Hoffman-LaRoche--have not said how much they will subsidize the drugs. They say that depends on how much medicine the government orders.

The government cannot say how much medication it needs until it figures out how to choose the 3,000 to 4,000 people who will take part.

That choice is in the hands of a committee of doctors, AIDS-support groups and nongovernmental organizations, which appears bogged down by determining clinical and medical criteria for selection, as well as the ethical dimensions.

“They said that people selected should contribute something towards the cost, but how can they if they don’t work?” asked N’dah from his club’s headquarters in the bustling Treichville neighborhood.

The cost factor seems certain to eliminate all but an elite few.

“If patients had to pay even 50,000 CFA ($100) a month, most of our patients could not,” said Dr. Marc Aguirre, an American physician who runs an Abidjan AIDS clinic chosen as one of the project centers.

Antiretroviral therapy, as the treatment is known, also is not suitable for everyone. Factors such as age, the disease’s advancement and access to a regular nutritious diet must be considered before patients begin taking the highly potent and toxic drugs.

Failure to adhere strictly to the demanding regimen of taking up to three dozen pills a day can lead a patient to develop resistance to the treatment and other AIDS drugs. Once started, the treatment can never be stopped.

U.N. officials say the pilot program will run two to three years and then be evaluated. If successful, the project would be extended and expanded to other countries.

Nicole Doumatey, an AIDS counselor, worries that many of the project’s participants may then be faced with the dilemma of how to continue to pay for the treatment.

“These are lifetime drugs,” she said. “What happens after three years?”

For the majority of AIDS sufferers here--so poor they can barely afford to buy aspirin--the requirements for participation may be unattainable, said Monique Rakotomalala, chairwoman of the U.N. project in Ivory Coast.

Still, she said, the challenges presented by the program will ultimately better prepare Ivory Coast and other developing countries to face the demands of caring for AIDS victims.

“I’m pretty sure that it will work, but we have to deal with all aspects of the project: research, poverty reduction, health care,” Rakotomalala said. “AIDS is a tiny part of a much bigger picture.”