War to fight AIDS is falling apart

On the grounds of Ugandas biggest AIDS clinic,Dinavance Kamukama sits under a tree and weeps. Her disease is quite advanced.

On the grounds of Ugandas biggest AIDS clinic,Dinavance Kamukama sits under a tree and weeps. Her disease is quite advanced. Her kidneys are failing and she is so weak she can barely walk. Leaving her young daughter with family,she rode a bus four hours to the hospital where her cousin Allen Bamurekye,born infected,both works and gets the drugs that keep her alive.

But there are no drugs for Kamukama. As is happening in other clinics in Kampala,all new patients go on a waiting list. A slot opens when a patient dies.

So many people are being supported by America, Kamukama,28,says mournfully. Can they not help me as well?

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The answer increasingly is no. Uganda is the first and most obvious example of how the war on global AIDS is falling apart.

The last decade has been what some doctors call a golden window for treatment. Drugs that once cost $12,000 a year fell to less than $100,and the world was willing to pay.

In Uganda,where fewer than 10,000 were on drugs a decade ago,nearly 200,000 now are,largely as a result of American generosity. But the golden window is closing.

In Kenya next door,grants to keep 200,000 on drugs will expire soon. An American-run programme in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots,according to a report by the medical charity Doctors Without Borders.

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The collapse was set off by the global recessions effect on donors,and by a growing sense that more lives would be saved by fighting other,cheaper diseases. Even as the number of people infected by AIDS grows by a million a year,money for treatment has stopped growing.

Science has produced no magic bullet no cure,no vaccine,no widely accepted female condom. Every proposal for controlling the epidemic with current tools is wildly impractical. Too few people,particularly in Africa,are using the ABC approach pioneered here in Uganda: abstain,be faithful,use condoms.

For every 100 people put on treatment,250 are newly infected,according to UNAIDS.