Cheap AIDS Drugs Bring Uganda Hope

A new factory by Indian drugmaker Cipla is boosting the local supply of free anti-retroviral treatments for those suffering from HIV

Patients at AIDS clinic in Kasasa, Uganda DAVID ROCKS

by David Rocks

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Once a month, Jane Nandawula walks seven miles from her home to an AIDS clinic in Kasasa, a ramshackle collection of storefronts and huts clinging to a roadside in southwestern Uganda. There, in a tidy concrete building set back from the highway, she meets friends, gets tips on hygiene, learns about a healthy diet, and picks up her monthly dose of anti-retroviral (ARV) drugs , which help keep her HIV in check. "I was getting sick over and over—fever, coughing, colds," says the mother of five. "But since I've started coming here and getting treatment, I feel much better."

The price she pays for her treatment: Nothing. She's one of the lucky ones, though. More than 2.4 million Ugandans are HIV-positive, and virtually every family in Uganda has lost someone to the AIDS virus. While more than 250,000 Ugandans are taking ARVs, at least 100,000 more need the drugs and aren't getting them. And only a fraction of Ugandans with HIV get free drugs or have access to the kind of care that Nandawula does.

The drugs, at least, may soon be much more readily available. In late August, a new $32 million pharmaceutical factory owned by India's Cipla and a local group called Quality Chemicals (Cipla's local distributor) is expected to start commercial production of ARVs and a treatment for malaria, another big killer throughout sub-Saharan Africa (BusinessWeek, 1/2/08). The factory will have a capacity of 6 million tablets daily when operating full-tilt, or enough to treat some 3 million patients (BusinessWeek, 5/15/08). "The factory will go a long way toward making the drugs available to everyone who needs them," says Fred Nalugoda, a director at Rakai Health Sciences Program, which operates 17 clinics in southwestern Uganda.

Emerging Countries Exempt From Generics Rules

The plant is a sign of changing global trade regulations. A World Trade Organization agreement called TRIPS (Trade-Related Aspects of Intellectual Property Rights) has beefed up enforcement of patents on drugs (BusinessWeek, 4/18/08). That means companies in India and China can no longer churn out generics, inexpensive copies of proprietary medications that are widely used in the developing world. Until 2016, however, countries deemed to be "least developed"—whose ranks include Uganda—were granted an exemption. "This plant exists largely thanks to TRIPS," says Frederick Mutebi Kitaka, finance director of Quality Chemicals.

Cipla, a big producer of such generic drugs, needed a new factory site in a least developed country so it could keep selling its wares. After meeting with Ugandan President Yoweri Museveni and other local officials, Cipla decided on a site in Kampala due to the East African nation's high prevalence of HIV and malaria and its business-friendly environment.

The plant sits among fields of bananas and corn alongside one of the potholed roads that lead out of Kampala. It is a near-clone of a Cipla facility in India, and uses the latest production and packaging equipment from the U.S., Germany, Italy, and elsewhere. The meter-thick walls and insulated windows help keep out the heat and dust, and workers must pass through three air-locks before arriving in the rooms where the compounds are actually produced. "This plant follows the most advanced manufacturing practices," says finance chief Kitaka. "Still, the cost of production in Uganda is much lower" than in Europe, the U.S., or even India. With lower production costs and an exemption from patent regulations, the new plant can sell its drugs for as little as 5% the cost of imports, Kitaka says.