In poor African countries, patients with HIV often cannot afford their medicines, even when they are heavily discounted in cost. Africa is home to 26.5 million of the 37 million people in the world living with HIV. Scientists fear the result may be new superstrains of HIV that are resistant to the drugs.

This same process has happened with tuberculosis. We now have drugs that cure TB, but if a patient does not take the full course of the drugs, he can become reinfected with a super form of the disease that is drug-resistant. This new TB superbug can then be passed on to others.

In the Ivory Coast, even though recent deals with major pharmaceutical companies have slashed the prices of HIV drugs, Edmond Adjobi still can?t always afford to buy them. ?When I don?t have the means to take my medicine, I am very afraid that one day something awful will happen to me,? he says. HIV medications there can cost between $85 and $110 per month, even with price breaks.

Auguste Blibolo, a medical researcher at Abidjan?s Institute for Development Research in the Ivory Coast, followed the treatment of 11 HIV patients in 1998 and 1999. None of them managed to stick to the regime, involving about a dozen pills daily, without missing at least a few days of treatment, and 9 repeatedly went without pills for more than a week at a time.

The government subsidizes the medicine for some of the poorest patients, who pay only $14 per month, but even with drugs that low cost, only about 1,000 of the 1 million people infected with HIV in the Ivory Coast now receive treatment.

If patients don?t take their medicines, studies have shown that the virus can mutate inside them into a more virulent strain that can be passed on to others. Even when drugs are taken correctly, the virus can sometimes mutate into a superbug. In the past 2 years in the U.S., there has been a dramatic increase in the prevalence of resistant forms of HIV.

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