Building African AIDS Care from the Ground Up

The epicenter of AIDS activity in the early 1980s was San Francisco General Hospital, where Merle Sande, MD, was chief of medicine. The mystifying disease appeared at higher rates there than any place else in the United States, and Sande and his staff helped pioneer its clinical treatment. Within the next decade, physicians in the United States learned how to treat HIV infection and AIDS as pharmaceutical companies launched drugs that controlled the infection without curing it. Triple combination antiretroviral therapy, introduced in 1996, led to a 70% decrease in deaths from HIV/AIDS. But at the same time as these successes in the United States, AIDS was ravaging many other countries, particularly in Africa.

Almost 25 years later, Sande, now professor of medicine at the University of Utah, is again working at the epicenter of AIDS activity. Along with Ugandan and North American colleagues, he is running an HIV/AIDS clinic at Mulago Hospital in Kampala, Uganda, and teaching local physicians advanced techniques to manage the disease. Uganda was hit early and hard by HIV/AIDS. At one time, the virus infected as many as 1 in 3 people in some regions, and more than 100 000 Ugandans died of AIDS every year throughout the 1990s. Furthermore, Uganda sits squarely in sub-Saharan Africa, the region of the world most affected by HIV/AIDS.

Even though HIV/AIDS is much better understood now, Sande's work in Kampala is in many ways even more challenging than his earlier work in San Francisco: The national health care system of Uganda is rudimentary by comparison, especially outside of the urban centers, and only 1% of the people with HIV can afford to pay for antiretroviral therapy, which costs about $1 a day. But Sande, who has worked in Kampala on and off since the late 1980s, is already …