Bitter Pills

The AIDS drug Ziagen has brought healthy windfalls to the University of Minnesota and GlaxoSmithKline. But it isn't doing anything at all for the millions who are dying of the disease in Africa.

In the first months of 1997, Sarah was preparing to start a new life. She'd recently secured a green card and was making the final arrangements to move from her native Nairobi to the United States. Her husband, who had immigrated eight months earlier, had found work in the Twin Cities. There was just one more detail to attend to: the blood screening required of prospective immigrants. It should have been a formality. Instead it seemed a death sentence.

"I was in shock," recalls the 29-year-old, who asked that her last name not be published. "I lost all of my hope. I cried all the time." Sarah had discovered that she, like millions of Kenyans, had contracted HIV. The news was especially devastating because she was two months pregnant at the time. Doctors in Kenya advised her to terminate the pregnancy at once: Because she had no access to the drugs that might prevent transmission of the virus to her unborn child, the baby would almost certainly arrive HIV-positive. Sarah refused. Getting an abortion would have meant she'd given up on herself.

Shortly after arriving in this country, Sarah visited an AIDS specialist at a Twin Cities hospital. Her viral load--a measure of the infection's advance--was around 4,000. That was within a safe range, her doctor told her, and she ought to wait before embarking on any treatment program. Sarah felt healthy. "When I came [to the U.S.] I was fine," she says. "I'd never been sick a day in my life."

Craig Lassig

As invariably happens, though, Sarah's viral load began to climb, and her doctor put her on a regimen of drugs to decrease the chance that her baby would contract HIV. The medicine was effective in combating the virus's spread, but the collateral damage was brutal: Sarah found her energy suddenly sapped, and the bitter, foul-smelling liquid drugs made her vomit.

As her due date neared, Sarah's doctor prescribed Ziagen, a drug developed at the University of Minnesota and one common component of the three-drug "cocktails" used in the aggressive early treatment of AIDS. The impact was miraculous: Her viral load plummeted to nearly undetectable levels, and the side effects virtually disappeared. The baby, delivered via cesarean section to further reduce the risk of transmitting the virus, arrived HIV-negative. Sarah named her daughter Faith.

Sarah is one of the lucky few.

Amanda Swarr has seen firsthand how drugs like Ziagen (pronounced zy-uh-jen) can rescue AIDS patients from near death. During a recent year spent studying in South Africa, the University of Minnesota women's studies graduate student and veteran AIDS activist also saw how few patients in Africa have access to those drugs. And the disparity makes her furious. "The difference between being HIV-positive in the U.S. and HIV-positive in Africa was really startling," says Swarr. "People were dying because they couldn't get access to drugs for prevention or treatment that people here can get with no problem."

Across Africa, AIDS claims 5,500 lives every day; another 11,000 people are infected daily. In Kenya alone, an estimated 1 million people--roughly one in every thirty citizens--have died of AIDS. In Zimbabwe life expectancy has already dipped below 40. In South Africa, epicenter of the epidemic, authorities believe that one in nine people is infected with the virus. In many parts of Africa, meanwhile, woefully inadequate healthcare, coupled with the stigma attached to the disease, confound any effective medical response. But according to Swarr, the most significant obstacle to treatment is the high cost of the drugs, called antiretrovirals, that are employed to slow the disease's progress. Even steeply discounted, a year's worth of the medicine that keeps Sarah healthy costs as much as $2,000 in Africa, while the average annual income often hovers below $350.

During her time overseas, Swarr became involved with the activist group Treatment Action Campaign, which was protesting a lawsuit 39 pharmaceutical companies had brought against the South African government in order to prevent the importation of generic AIDS drugs that cost as little as one-tenth as much as their name-brand equivalents. The point of contention was a South African law that allowed that nation to circumvent international intellectual-property regulations in times of national crisis. This past April, in the face of intense international criticism, the drug companies backed down.

At the same time, Swarr saw a way to draw attention to the issue in Minnesota. At Yale University, which had licensed its patent on the anti-AIDS drug d4T to Bristol-Myers Squibb, students, faculty, and the Nobel Prize-winning advocacy group Doctors Without Borders had successfully urged officials from the school and its corporate partner to loosen their patent claims in the developing world. Swarr hoped the University of Minnesota, which had licensed key patents on Ziagen to the London-based pharmaceutical giant GlaxoSmithKline in exchange for a projected $300 million in royalties, could be persuaded to do the same.

Emboldened by Yale's example, last spring Swarr organized a letter-writing campaign and student petition demanding that the university, in concert with Glaxo, sublicense its patent and pave the way for the manufacture of cheaper generic versions of Ziagen. In an April 19 statement, the school responded that it would welcome a price cut of Ziagen in sub-Saharan Africa "despite a potential reduction in its royalties."

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