All-Out Effort Fails to Halt AIDS Spread in Africa

Two years into the five-year African Comprehensive HIV/AIDS Partnership, Botswana is learning what big money, free drugs and strong leadership can and cannot do to halt the epidemic. "We're making astounding progress, and it's astoundingly inadequate," said Ernest Darkoh, a physician and former management consultant for McKinsey & Co. who runs Botswana's antiretroviral program.

The reality is that the nation spends its weekends at funerals. More than one-third of Botswana's adults are HIV-positive. Life expectancy has plunged from over 65 to under 40. More than 65,000 children have lost their parents to AIDS, and that number is projected to double or triple by 2010. If the United States had Botswana's rate of AIDS deaths, it would lose 15,000 citizens per day.

The Bill & Melinda Gates Foundation and the drug conglomerate Merck & Co. have both pledged $50 million in assistance over five years. Merck is also offering an unlimited supply of antiretroviral medicines, which are available only to about one-tenth of 1 percent of infected people elsewhere in Africa. The Harvard AIDS Institute has developed a training program for the nation's health care workers and has launched a new research laboratory in the capital, Gaborone. Botswana's president, Festus Mogae, has provided aggressive leadership, warning his people in fiery speeches that they are "threatened with annihilation," chairing his country's AIDS council, and badgering health officials with questions about condom distribution in prisons and construction timetables for clinics.

Since January, more than 3,000 patients have enrolled in Botswana's antiretroviral program -- known as Masa, or New Dawn. So far, only 3 percent have dropped out, even though the drugs can cause side effects such as nausea, headaches and dizziness. About 5 percent have died, which might sound high, except that Darkoh said these patients were so sick at the outset that their expected death rate without antiretroviral treatment would have been 30-40 percent.

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