Global Policy Forum

For Sister Tibebe Maco there is little reason to note, let alone celebrate, the first distribution of drugs to treat victims of the AIDS pandemic in Ethiopia. Neither do the hundreds of patients living with the virus that she currently looks after pay much attention. "They are not for us," is their oft-repeated mantra.

Anti-retroviral drugs - which the federal government started distributing last week - are too late for many infected with the virus and too expensive for most of them. "These people are the real victims," says Sister Tibebe, speaking of the 420 people with HIV/AIDS who her charity, HIWOT, is helping. "They will die simply because they are poor."

ONLY FOR THE RICH
Under the initial government distribution, 2,000 paying patients - the government estimates some two million people are living with the virus - will receive the treatment. According to health experts, at least 200,000 people could qualify for medical treatment - which effectively is being handled on a first come first served basis.

Argehgne and Bayush, two of Sister Tibebe's patients, married three years ago. Last year they discovered they were HIV-positive. Argehgne acknowledges he infected his wife, saying he probably contracted the virus before they were married. The couple, with their two-year-old son, scraped by on US $1 a day which Argehgne earned labouring in one of the many construction sites in the sprawling capital, Addis Ababa. But since the virus has taken a hold, more often than not the 30-year-old is unable to work. It means they generally will beg for food or be helped out by Sister Tibebe. "We do not have enough money for food to eat for a day, let alone to buy drugs," says Baynush. "Food is our priority, the drugs are not for people like us."

POVERTY THE REAL KILLER
Their plight is a tragic reminder of the real killer in Ethiopia - poverty. The government is aware of the need to distribute drugs, but cannot afford it. With its limited funds, the entire health budget is just US $120 million a year. Only those who can pay will get the chance to buy the drugs. "We are trying to expand gradually for the paying patient," Mengisteab Waregay, the deputy head of the country's Drug Administration and Control Authority told IRIN.

"The government cannot afford to make the drugs available for everybody particularly at a time when there are 14 million people starving. We are trying our best to make the drugs available for free for patients," he adds.

Although the cost of the drugs has dropped dramatically in recent years - in Ethiopia the monthly cost is around US $40 per person - they are still out of the reach of most. The government is looking at two ways of ensuring greater supply and reducing the cost - by financial support from the Global Fund and through generic drugs. Ethiopia is one of two countries on the continent - the other is South Africa - to receive technical support to start producing anti-retroviral drugs.

MOVES IN THE RIGHT DIRECTION
The World Health Organisation (WHO) also adds that the country could soon move towards free distribution of anti-retroviral drugs with support from the Global Fund. Dr Endalamaw Aberra, WHO national programme officer for HIV/AIDS, says US $28 million has been earmarked for combating the virus for the first year.

Initially Ethiopia had not applied for funding from the fund for anti-retrovirals, believing they were simply too expensive. "Initially the thinking was it was too expensive for the government to distribute it for free but now things are changing," Dr Endalamaw said. "Now the price has come down."

Dr Endalamaw says that current thinking in treatment is also directed towards improving access to drugs through better health centers and doctors who can administer them. "Access and equity are always relative so the global thinking is that we have to improve access - perfect equity is not achievable," he stated. He said only half the population have access to health facilities - a physical barrier to receiving treatment and one reason why the first round distribution was limited to just 2,000 people.

"It is a complicated equation but one we have to address," he adds. Dr Endalamaw also acknowledges the current distribution round is just a drop in the ocean, but says that health practitioners will gain invaluable experience. "The big question is how do we make sure that people take the drugs properly," he added. "Hopefully in a few months time we will start giving anti-retrovirals for free."

BLACK MARKET FEAR
The distribution also aims to stamp out a black market in the drugs. One senior health official told IRIN they are selling for around US $150 a month in Addis Ababa. "We know there are people who get treatment in private clinics," the official said. "It is black market and one way of fighting that is making sure the drugs are available."

"The medical danger of course is that if the drugs are poor quality then you could bread resistance in the country which would be extremely alarming," the official added.

But while the government and international organisations look to finance anti-retrovirals in Ethiopia, Sister Tibebe warns of the enormous cost of failing to provide them. With the country already witnessing an explosion in AIDS orphans - there are some one million in the country at present - she predicts that number will sky rocket. "The current approach is short-sighted," she says from her small office in the heart of the capital. "If my patients die, who is going to look after their children, who will pay for that? Better that we pay now, rather than pick up a much larger bill in a few years' time."

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